December 3, 2025 • 21 mins
Dr. Sara Collins joins Dr. Michael Koren to talk about her journey as a research cardiologist. They discuss Dr. Collins's path through preparatory school, college, med school, and the post-school experience as a cardiologist. They also discuss her role starting a clinical research site in Washington, D.C., and her efforts to leverage the research apparatus to provide equitable care to otherwise disadvantaged and underserved communities. Dr. Collins talks about how there is a racial disconnect in care in spite of the typically good insurance coverage in the D.C. area.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Announcer (00:00):
Welcome to MedEvidence, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts, hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Hello, I'm Dr.
Michael Koren, the executiveeditor of MedEvidence.
And I'm going to be talking toa true kindred spirit of mine,
Dr.
(00:20):
Sara Collins.
Sara, welcome to MedEvidence!And you and I have gotten to
know each other a little bitover the last few years because
we're both working with anational group called Flourish
Research.
And as I've gotten to know youand actually study your resume,
we actually have other things incommon, including how we got
interested in research in thefirst place.
So I want to share ourcollective journey, mostly
(00:42):
focused on yours, with ouraudience and then jump into some
of the issues about what it'slike being a female in
cardiology, which has been sortof a male-dominated
subspecialty, and also the greatwork you're doing to try to
reach out to underservedcommunities.
So again, Sara, welcome to MedEvidence and share some tidbits
about yourself.
Tell us tell us your story inthree minutes.
Dr. Sara Collins (01:04):
Oh well, first of all, thanks for having me.
I'm super honored to be here.
I've admired your work, yourwork in a lot of capacities, but
podcasts are new to me.
And I think I wholeheartedlyagree with the idea of having a
casual conversation betweencolleagues to talk about the
important stuff without all thefluff.
So gosh, so much to say.
(01:24):
How did I how did we get here?
Dr. Michael Koren (01:26):
Where did you grow up?
Start just with the basics.
Dr. Sara Collins (01:29):
Okay, cool.
That's easy.
I grew up in San Francisco,California, right in the city.
So I get to claim the city.
And I immediately love stillvery close to my family.
I love them.
I don't want to act like Iescaped, but immediately after
after college, I mean after highschool, I went to school on the
East Coast for college, and Ihave never left.
I live in DC now.
Dr. Michael Koren (01:48):
You went to a very fancy college, I see.
Dr. Sara Collins (01:51):
I did.
I went to a fancy high school,so that it was sort of an easy
trajectory to college.
Dr. Michael Koren (01:56):
Okay.
Brown University.
Yep.
I went to Brown.
Dr. Michael (01:59):
Ivy League school.
Dr. Sara Collins (02:00):
I loved Providence.
It was a small, sleepy townthen, not at all what it is now.
And had a great time there.
And it was pre-med there.
And then I kind of followed inmy grandparents' footsteps.
My grandparents met at MeharryMedical College.
Really?
In a dental school.
Dr. Michael Koren (02:16):
Wow.
That's cool.
And it was actually the onlyplace I applied to for med
school.
So I ended up applying.
And while I was applying, I didtwo years of research at what's
now Med Star WashingtonHospital Center under the
tutelage of Ron Waksman, who wewho we've mentioned.
And that sort of began myresearch career.
(02:37):
I was doing a stentangioplasty model in pigs,
carotid cutdowns in pigs, whichwas was pretty cool at the time.
And just sort of in the cathlab all day for two years and
learned a lot aboutinterventional cardiology,
learned a lot about generalcardiology, and I sort of got a
(03:00):
whiff of what a certain type ofresearch looked like.
And and Ron gave me a lot ofautonomy, which was which was
really beautiful.
And I that's when I reallycaught the cardiology bug, and
in particular, theinterventional cardiology bug.
Yeah.
Well, that's fabulous.
So just a few things on that.
One for those of for those ofthe uh the folks that are
(03:21):
listening to us that don't knowRon Waksman, he's truly one of
the rock stars of cardiology andwell known as a great
interventional cardiologist andalso a great teacher.
So you you got the benefit ofthat interaction.
And I I've certainly enjoyed myinteractions with him in the
past.
But tell me, like, why did youchoose cardiology?
That's not what women typicallydo.
So give me a little insightinto that.
Dr. Sara Collins (03:43):
Well, I I'll be truthful here.
After college, I really wantedto spend a little time getting
to know myself and you knowmaking sure that medicine was
the direction I wanted to head.
That was sort of the trajectorythat was laid out based on, you
know, other family members andfolks around me that I really, I
really respected, but I wasn'tquite sure.
(04:04):
So I I thought, you know, agood chunk of time working in
some sort of clinical settingwould help.
And the two biggestopportunities were in breast
cancer and research andinterventional cardiology.
And I poked around a bit andfolks said the interventional
cardiologists were were justtough as nails.
And that's and that's what Iwanted to do.
(04:25):
I just wanted to kind of runwith the cowboys.
That's kind of my personality.
So it was a naive decision atthe time.
But, you know, as I mentioned,I got this sort of glimpse into
interventional as a field, whichwas, and I, and I love the
procedural aspect of it.
So that's kind of how thathappened.
Dr. Michael Koren (04:44):
Interesting.
So you you did your training inDC.
And then did you go intopractice from there or what what
happened after you finishedyour training?
Dr. Sara Collins (04:52):
I did.
So um I was lucky and luckyenough to have my my general and
interventional training all atGeorgetown slash MedStar
Washington Hospital Center.
And there was a research trackthat allowed me to truncate that
training.
Uh, and so I was able to kindof you know do a lot in a short
amount of time and immediatelywent into private practice.
(05:12):
And I've always practiced insmall boutique practice
settings.
That's always been, in myopinion, the best way for me to
be able to access my patients atthe pace and with the closeness
that I really enjoy.
Dr. Michael Koren (05:27):
Fabulous.
So let me dig into this alittle bit more.
How did you go from youfinishing up your training to
ending up working in a researchfacility?
What tell us about that journeya little bit?
Dr. Sara Collins (05:40):
So, in so in training, there was a research
track for fellows.
And then once I got out oftraining, I was in one small
boutique practice.
And when I left that practiceand moved to a larger practice,
I I realized we had access to ahuge patient database and
patients who would reallybenefit from some of the
(06:01):
technologies that were beingstudied in different more
academic centers.
So I was in that capacity, Isort of just, you know, rubbed
two nickels together and broughton some colleagues to do a
couple of trials in the in theinterventional space and the
device space.
And so that was kind of thetransition before Flourish.
Dr. Michael Koren (06:24):
Interesting.
So you basically became anentrepreneur.
You you put on both yourbusiness hat and your clinical
hat and said, here's anopportunity.
This is something that I lovedoing, and and and just went for
it.
Sounds like and I'm sure youlearned a lot along the way in
terms of the infrastructureneeded to run research in the
modern era.
Dr. Sara Collins (06:45):
Absolutely.
Not nearly as much as I'velearned in the in the last two
years, but uh, but yes, it was ait was a it was a peek into
this large machine in a muchdifferent setting because
clinical research is is a is abeast.
Dr. Michael Koren (06:58):
Absolutely.
Dr. Sara Collins (06:59):
In the best way, but it's completely
different.
Dr. Michael Koren (07:02):
Understood.
So tell us a little bit aboutthe work you're doing reaching
out to an underservedpopulation.
So tell people you're sort ofin a suburb, exurb of DC, and
had you end up there and and youguys are doing some fabulous
work reaching out to patientpopulations that may not always
get the word about research.
So let's talk a little bitabout that.
Dr. Sara Collins (07:22):
Absolutely.
So, you know, the the reasonwhy I'm I'm practicing, I like I
said, I live in DC, but DC isis is a huge metropolitan region
with a lot of different typesof pockets of demography.
Uh and I I work in a smallprivate practice with Dr.
Barbara Hutchinson.
She and it's her practice, andshe does a wonderful job of sort
(07:44):
of nestling herself inside ofthese really important, I mean,
these communities that couldreally benefit from all types of
of you know good empatheticclinical care and also research.
And what's special about I Ibelieve the way that we have
been able to juxtapose the typeof care that we are giving in
(08:05):
the clinical setting with theresearch is that you know, our
patients are not always are notalways underserved in the
socioeconomic sense.
You know, our patientpopulation is very well insured.
I mean, honestly, that wouldhas changed drastically since
the federal shutdown, since somany people are are losing their
(08:26):
are losing their employment.
But typically they're not theour patient population is not
necessarily underserved in thein the access to research sense.
However, they are underservedin the type of care they're
getting, which is a truedisparity.
So, you know, if if I I canjust take a self-identified
(08:48):
African American population, forexample, we serve a large
African American population.
What is so striking to me isdespite high education levels,
good health literacy, there'sstill a disparity.
And that's really baked intothe system in a lot of ways.
(09:10):
It's baked into in the systemin that African Americans can be
hesitant to seek care in thesame way because of a mistrust
that is quite frankly warranted.
And they're not offered thecare in the same way.
So what we try to do in ourpractice, which is next door to
(09:31):
our our clinical research sitethat Flourish built, is provide
that access in a place of trust.
So when the message isdelivered from your trusted
caregivers, because we we trulydo care deeply about the
patients that we serve, and weallow the opportunity for
(09:54):
important conversations, youknow.
Let's talk about the historicalmistrust, let's talk about the
mistrust that's warrantedbecause you just discharged from
the hospital a week ago and youwere discriminated against in
the ER there.
It's it it's happening in realtime, it's not always historic.
So you know, I I I firmlybelieve that the therapies that
(10:14):
we are developing in theresearch setting are incredible
and cutting edge andlife-changing, paradigm
shifting.
So my passion, and the reasonwhy I'm doing this is to make
sure that everyone has equalaccess to those therapies in the
trial phase.
Dr. Michael Koren (10:36):
Fascinating.
So just just for my knowledge,what percentage of your
population is black in in yourclinical practice?
Dr. Sara Collins (10:43):
In the clinical practice, it's about
it's about 50%.
Dr. Michael Koren (10:46):
Okay.
And yeah, there's a lot ofareas in DC that have majority
black populations, as of courseyou know.
So tell me how you present thevalue proposition of research to
patients, particularly thosewho may have trust issues based
on historical misdeeds.
Dr. Sara Collins (11:05):
It's a complex conversation, and sometimes
it's it's two or threeconversations.
Um sometimes I I begin theconversation by explaining why
I'm involved in clinicalresearch, which is the science,
which is the purity of that sortof scientific pursuit.
But it's also to provide accessto these novel therapies that
(11:32):
you would get if you went to anacademic center.
If you go to Hopkins, you'regetting offered a trial.
Also in in cardiology, wehaven't quite figured out how to
package these conversations thesame way they have in the
cancer space.
No one blinks, you know, blinksan eye when they have a new
cancer diagnosis and anoncologist offers them a trial.
(11:53):
It's just not even aconsideration.
However, you know,cardiovascular disease is far
more deadly than than cancer toa certain extent.
And we don't have thoseconversations.
So the first thing is I sort ofexplain why I'm in it, and I'm
in it for that reason.
I want my patients to haveaccess to the latest and
(12:15):
greatest.
And then I talk to them aboutwhat it means to be in a
clinical trial.
You know, it's it's not so bad.
You know, it's it's actuallykind of great.
Dr. Michael Koren (12:22):
It's fun, people actually like it.
Dr. Sara Collins (12:24):
People really, people really like it.
Yeah.
You know, forget thecompensation, which is in and of
itself uh uh, you know, gettingcare that's that cutting edge
and and and high level with allthose touch points with that's
outside of the insurance systemis pretty great.
Dr. Michael Koren (12:41):
Yeah.
Dr. Sara Collins (12:41):
But a lot of people really start to nerd out
about the about the science.
Dr. Michael Koren (12:46):
Yeah.
Dr. Sara Collins (12:47):
They really enjoy that.
Like I said, our patients arevery well educated, so they ask
a lot of really great questions.
Dr. Michael Koren (12:52):
I love that.
Yeah.
And so I I think it starts by,you know, to just just a long
that was a long answer, but it'sit begins I begin with just uh
saying why I'm in it,
yeah
and then finding out, you know,how how I think any particular
trial could be helpful.
Well, your enthusiasm is infectious.
I I want to join your trialjust by talking to you.
(13:13):
So that's that's fabulous.
But that gets to one of thevalue points, which is that
people want to feel connected.
And in the clinical trialworld, because it's an intense
experience, they get thatfeeling of connection with you
and your staff.
And quite frankly, I stillpractice cardiology.
We're so pressed for time inthe clinical setting, in the
insurance-driven setting, thatit's really sometimes hard to
(13:37):
not just go down an algorithmand not connect with the
patients.
So you have you clearly have askill to connect with patients,
and I would think that's a bigdriver for your patient
population to do more researchand have a really intense
experience.
Dr. Sara Collins (13:50):
I hope so.
And then we've got anincredible staff, which really
just extends the message thatDr.
Hutchinson and I sort ofinitiate in the in the set in
the in the office.
Our our staff, we really haveat this point solved for
culture.
We have everyone in our on ourstaff is is brilliant and and
(14:11):
absolutely experienced, but theyget the why.
And so they extend thatconversation to our
participants, which is reallypretty incredible to watch.
Dr. Michael Koren (14:20):
I love that.
I love that.
So, what what are the futureplans for your site?
What what do you see in thenext five years?
Dr. Sara Collins (14:28):
Oh, sky's the limit.
So, you know, at this point,because we were a de novo site,
you know, built from scratch andFlourish's first de novo site,
there was a lot to learn.
We continue to learn, and youknow, I even as an investigator,
there's a ton for me to learn,obviously.
(14:49):
When I attended yourinvestigator training last year,
I was, you know, all ears.
So many cool conversations andthe case studies just blew my
mind.
Environments like that arereally important for all of us
to participate it in.
So I hope that Flourishcontinues to offer that to folks
who are interested.
But we want to really continueto hone in on putting out a good
(15:14):
quality data product.
That's just incrediblyimportant, making sure that
we're crossing all of our T'sand dotting all of our I's, but
also expanding our therapeuticareas outside of you know
cardiovascular outcomes trialsand cardiometabolic and
lipoprotein(a) to I'm hoping wecould expand to sleep medicine.
(15:38):
Dr.
Hutchinson is board certifiedin sleep.
She's my co-medical director.
And clinical practice, she'sboard certified in sleep
medicine and a brilliantpractitioner and principal
investigator.
So I'm, and we have we have twosleep labs next door.
So I'm I'm hoping very muchthat we can expand into sleep.
And other therapeutic areas Ithink are are incredibly
(15:59):
interesting, or all thingsaround, you know, memory and and
Alzheimer's as well.
So I like to start with thosetwo and then see how that how
that goes.
Dr. Michael Koren (16:08):
That sounds uh very ambitious and very
exciting.
And I'll just comment on one ofthe things that you said, which
I think is super important, isthat there is a specific skill
set related to being a clinicalinvestigator that's not really
well understood by the generalpublic and even by physicians.
Yeah, people think, well,you're a doctor, you should know
(16:28):
research, but that's not thecase.
And even during our training,we don't get full exposure to
all the nuances in in clinicalinvestigation, especially when
you're involved in these largemulti-centered trials.
And there's always tensionswhen we have to figure out
what's best for the patientwhile still collecting accurate
data while also managing a staffbecause none of us can do it
(16:50):
ourselves.
So a lot of things come up, andyou you mention our teaching
program, which is what we callresearch grand rounds, and
MedEvidence sponsors that.
And we invite everybody that'slistening to us to take a
listen.
You don't have to be aflourished person.
This is open to all members ofthe medical community.
We get CME credits for it, andwe talk about these cases.
(17:12):
Every single day, a case comesup that requires thinking
through this.
And so I'll give you a recentexample and I won't give you the
answer, but I had a patientcome in for an Lp(a) trial that
you mentioned.
Lp(a), for those of you thatare not familiar with that, is
what we call the really, really,really, really bad cholesterol.
(17:32):
And it's a form of LDLcholesterol that tends to have
even more negative prognosticelements than just LDL itself.
And it's hard for our bodies toget rid of, and it's also
genetically mediated, so you getfamily concerns that are
involved.
But I had a fellow physiciancall me, said, Oh, I hear you're
doing Lp(a) study, and I know Ihave a very bad family history
(17:55):
related to Lp(a).
In fact, I have a CAC scorethat's in the worst 5%.
CAC score is a coronary arterycalcium score, and it's a good
indicator that somebody is gonnahave trouble with
atherosclerotic complications.
He was around 50 years old, andhe told me, Yeah, I had a heart
attack, and you know, I'd liketo be in your study.
So I said, Well, you sound likesomebody that would be really,
(18:17):
really good.
Obviously, we have a screeningprocess, but why don't you come
in and we're gonna figure outwhether or not you're the right
patient for this, and it soundslike you would be, but this is a
placebo-controlled study, so Ijust want to make sure I
understand that you're notguaranteed to get the product,
but we will certainly learn alot about your condition during
the course of this, and maybeyou'll get it.
And he was fine with that.
So he comes in again.
This is a physician, and hementioned to me he had a heart
(18:40):
attack, but when my staff wastrying to find out what the
heart attack when the heartattack actually occurred, it
turned out that he considered anepisode of very severe chest
pain that he self-treated aheart attack.
So that's a dilemma.
Here's a physician who made thedecision that he was having a
(19:03):
severe anginal attack, treatedit with what he had available in
terms of aspirin and nitrates,and never went into the
hospital.
So, is that a heart attack fromthe standpoint of clinical
research?
So I won't give you the answer,but these are the kind of
dilemmas that we have to faceevery day.
At the end of the day, we haveto adjudicate these patient
(19:24):
stories into things that areelements of the protocol.
And to me, I find thisfascinating.
These are the tensions aboutdoing research.
And in this particular case,there was a lot of implications
in terms of randomization andstratification, which we won't
go into for this particulartalk, but you and I know that
these are important elements ofaccurate data analysis.
(19:44):
And again, this is coming froma physician who now is a patient
that wants to get into a study.
So some fascinating things thatwe deal with on a day-to-day
basis.
Dr. Sara Collins (19:54):
Yeah, it's an it's it's tricky.
Those conversations are arereally incredible to witness,
the conversations aroundquestions like that, because you
know, what your trainingprovides is not only your
expertise, but the expertise andexpertise of your staff, but
this wide, quite variable rangeof opinions.
(20:14):
Because if there's one thingphysicians know how to do, it's
be opinionated.
Well, we don't always know weknow what's right, we we know
what's right clinically most ofthe time, but that is not always
the research answer.
Um so that's that is the nuancethat's really teased out in
these conversations.
Dr. Michael Koren (20:31):
Well, that's the interesting thing about
research.
You have to balance doingthings right with doing the
right thing.
And they sometimes are not inthe same Venn diagram.
And so it can be very, verytricky how to deal with it.
But that's part of the skillset of a good clinician
investigator.
And we cover all these type ofthings and go into the
regulations and going to thehistory, going to the pragmatic
(20:54):
elements, and going to the factthat the safety and the welfare
of the patient supersedes all ofthe other goals of research.
And that's part of our ethics,and and we need to sometimes
remind our business colleaguesabout this.
So it's uh it's a neat thingthat that we do, and thank you
for doing it.
It's it's super important.
And our on behalf of yourpatients and our community, you
(21:17):
do a fabulous job, and we trulyappreciate it.
Oh, thank you.
Any last words before we signoff?
This has been a fabulousconversation, and we'll
definitely have you back formore focused discussion on one
of the many things that wetalked about, including maybe
Lp(a), and and look forward toyou being involved in our
research grand rounds.
Dr. Sara Collins (21:35):
Yeah, I thank you.
Just thank you for having meand thank you for doing this.
These conversations are arereally cool to be a part of.
Dr. Michael Koren (21:42):
Uh Sarah, thank you very much, and and
thank you for being part of theMed Evidence! family.
Dr. Sara Collins (21:46):
Thank you, Dr.
Koren.
Welcome to MedEvidence, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts, hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Hello, I'm Dr.
Michael Koren, the executiveeditor of MedEvidence.
And I'm going to be talking toa true kindred spirit of mine,
Dr.
(00:20):
Sara Collins.
Sara, welcome to MedEvidence!And you and I have gotten to
know each other a little bitover the last few years because
we're both working with anational group called Flourish
Research.
And as I've gotten to know youand actually study your resume,
we actually have other things incommon, including how we got
interested in research in thefirst place.
So I want to share ourcollective journey, mostly
(00:42):
focused on yours, with ouraudience and then jump into some
of the issues about what it'slike being a female in
cardiology, which has been sortof a male-dominated
subspecialty, and also the greatwork you're doing to try to
reach out to underservedcommunities.
So again, Sara, welcome to MedEvidence and share some tidbits
about yourself.
Tell us tell us your story inthree minutes.
Dr. Sara Collins (01:04):
Oh well, first of all, thanks for having me.
I'm super honored to be here.
I've admired your work, yourwork in a lot of capacities, but
podcasts are new to me.
And I think I wholeheartedlyagree with the idea of having a
casual conversation betweencolleagues to talk about the
important stuff without all thefluff.
So gosh, so much to say.
(01:24):
How did I how did we get here?
Dr. Michael Koren (01:26):
Where did you grow up?
Start just with the basics.
Dr. Sara Collins (01:29):
Okay, cool.
That's easy.
I grew up in San Francisco,California, right in the city.
So I get to claim the city.
And I immediately love stillvery close to my family.
I love them.
I don't want to act like Iescaped, but immediately after
after college, I mean after highschool, I went to school on the
East Coast for college, and Ihave never left.
I live in DC now.
Dr. Michael Koren (01:48):
You went to a very fancy college, I see.
Dr. Sara Collins (01:51):
I did.
I went to a fancy high school,so that it was sort of an easy
trajectory to college.
Dr. Michael Koren (01:56):
Okay.
Brown University.
Yep.
I went to Brown.
Dr. Michael (01:59):
Ivy League school.
Dr. Sara Collins (02:00):
I loved Providence.
It was a small, sleepy townthen, not at all what it is now.
And had a great time there.
And it was pre-med there.
And then I kind of followed inmy grandparents' footsteps.
My grandparents met at MeharryMedical College.
Really?
In a dental school.
Dr. Michael Koren (02:16):
Wow.
That's cool.
And it was actually the onlyplace I applied to for med
school.
So I ended up applying.
And while I was applying, I didtwo years of research at what's
now Med Star WashingtonHospital Center under the
tutelage of Ron Waksman, who wewho we've mentioned.
And that sort of began myresearch career.
(02:37):
I was doing a stentangioplasty model in pigs,
carotid cutdowns in pigs, whichwas was pretty cool at the time.
And just sort of in the cathlab all day for two years and
learned a lot aboutinterventional cardiology,
learned a lot about generalcardiology, and I sort of got a
(03:00):
whiff of what a certain type ofresearch looked like.
And and Ron gave me a lot ofautonomy, which was which was
really beautiful.
And I that's when I reallycaught the cardiology bug, and
in particular, theinterventional cardiology bug.
Yeah.
Well, that's fabulous.
So just a few things on that.
One for those of for those ofthe uh the folks that are
(03:21):
listening to us that don't knowRon Waksman, he's truly one of
the rock stars of cardiology andwell known as a great
interventional cardiologist andalso a great teacher.
So you you got the benefit ofthat interaction.
And I I've certainly enjoyed myinteractions with him in the
past.
But tell me, like, why did youchoose cardiology?
That's not what women typicallydo.
So give me a little insightinto that.
Dr. Sara Collins (03:43):
Well, I I'll be truthful here.
After college, I really wantedto spend a little time getting
to know myself and you knowmaking sure that medicine was
the direction I wanted to head.
That was sort of the trajectorythat was laid out based on, you
know, other family members andfolks around me that I really, I
really respected, but I wasn'tquite sure.
(04:04):
So I I thought, you know, agood chunk of time working in
some sort of clinical settingwould help.
And the two biggestopportunities were in breast
cancer and research andinterventional cardiology.
And I poked around a bit andfolks said the interventional
cardiologists were were justtough as nails.
And that's and that's what Iwanted to do.
(04:25):
I just wanted to kind of runwith the cowboys.
That's kind of my personality.
So it was a naive decision atthe time.
But, you know, as I mentioned,I got this sort of glimpse into
interventional as a field, whichwas, and I, and I love the
procedural aspect of it.
So that's kind of how thathappened.
Dr. Michael Koren (04:44):
Interesting.
So you you did your training inDC.
And then did you go intopractice from there or what what
happened after you finishedyour training?
Dr. Sara Collins (04:52):
I did.
So um I was lucky and luckyenough to have my my general and
interventional training all atGeorgetown slash MedStar
Washington Hospital Center.
And there was a research trackthat allowed me to truncate that
training.
Uh, and so I was able to kindof you know do a lot in a short
amount of time and immediatelywent into private practice.
(05:12):
And I've always practiced insmall boutique practice
settings.
That's always been, in myopinion, the best way for me to
be able to access my patients atthe pace and with the closeness
that I really enjoy.
Dr. Michael Koren (05:27):
Fabulous.
So let me dig into this alittle bit more.
How did you go from youfinishing up your training to
ending up working in a researchfacility?
What tell us about that journeya little bit?
Dr. Sara Collins (05:40):
So, in so in training, there was a research
track for fellows.
And then once I got out oftraining, I was in one small
boutique practice.
And when I left that practiceand moved to a larger practice,
I I realized we had access to ahuge patient database and
patients who would reallybenefit from some of the
(06:01):
technologies that were beingstudied in different more
academic centers.
So I was in that capacity, Isort of just, you know, rubbed
two nickels together and broughton some colleagues to do a
couple of trials in the in theinterventional space and the
device space.
And so that was kind of thetransition before Flourish.
Dr. Michael Koren (06:24):
Interesting.
So you basically became anentrepreneur.
You you put on both yourbusiness hat and your clinical
hat and said, here's anopportunity.
This is something that I lovedoing, and and and just went for
it.
Sounds like and I'm sure youlearned a lot along the way in
terms of the infrastructureneeded to run research in the
modern era.
Dr. Sara Collins (06:45):
Absolutely.
Not nearly as much as I'velearned in the in the last two
years, but uh, but yes, it was ait was a it was a peek into
this large machine in a muchdifferent setting because
clinical research is is a is abeast.
Dr. Michael Koren (06:58):
Absolutely.
Dr. Sara Collins (06:59):
In the best way, but it's completely
different.
Dr. Michael Koren (07:02):
Understood.
So tell us a little bit aboutthe work you're doing reaching
out to an underservedpopulation.
So tell people you're sort ofin a suburb, exurb of DC, and
had you end up there and and youguys are doing some fabulous
work reaching out to patientpopulations that may not always
get the word about research.
So let's talk a little bitabout that.
Dr. Sara Collins (07:22):
Absolutely.
So, you know, the the reasonwhy I'm I'm practicing, I like I
said, I live in DC, but DC isis is a huge metropolitan region
with a lot of different typesof pockets of demography.
Uh and I I work in a smallprivate practice with Dr.
Barbara Hutchinson.
She and it's her practice, andshe does a wonderful job of sort
(07:44):
of nestling herself inside ofthese really important, I mean,
these communities that couldreally benefit from all types of
of you know good empatheticclinical care and also research.
And what's special about I Ibelieve the way that we have
been able to juxtapose the typeof care that we are giving in
(08:05):
the clinical setting with theresearch is that you know, our
patients are not always are notalways underserved in the
socioeconomic sense.
You know, our patientpopulation is very well insured.
I mean, honestly, that wouldhas changed drastically since
the federal shutdown, since somany people are are losing their
(08:26):
are losing their employment.
But typically they're not theour patient population is not
necessarily underserved in thein the access to research sense.
However, they are underservedin the type of care they're
getting, which is a truedisparity.
So, you know, if if I I canjust take a self-identified
(08:48):
African American population, forexample, we serve a large
African American population.
What is so striking to me isdespite high education levels,
good health literacy, there'sstill a disparity.
And that's really baked intothe system in a lot of ways.
(09:10):
It's baked into in the systemin that African Americans can be
hesitant to seek care in thesame way because of a mistrust
that is quite frankly warranted.
And they're not offered thecare in the same way.
So what we try to do in ourpractice, which is next door to
(09:31):
our our clinical research sitethat Flourish built, is provide
that access in a place of trust.
So when the message isdelivered from your trusted
caregivers, because we we trulydo care deeply about the
patients that we serve, and weallow the opportunity for
(09:54):
important conversations, youknow.
Let's talk about the historicalmistrust, let's talk about the
mistrust that's warrantedbecause you just discharged from
the hospital a week ago and youwere discriminated against in
the ER there.
It's it it's happening in realtime, it's not always historic.
So you know, I I I firmlybelieve that the therapies that
(10:14):
we are developing in theresearch setting are incredible
and cutting edge andlife-changing, paradigm
shifting.
So my passion, and the reasonwhy I'm doing this is to make
sure that everyone has equalaccess to those therapies in the
trial phase.
Dr. Michael Koren (10:36):
Fascinating.
So just just for my knowledge,what percentage of your
population is black in in yourclinical practice?
Dr. Sara Collins (10:43):
In the clinical practice, it's about
it's about 50%.
Dr. Michael Koren (10:46):
Okay.
And yeah, there's a lot ofareas in DC that have majority
black populations, as of courseyou know.
So tell me how you present thevalue proposition of research to
patients, particularly thosewho may have trust issues based
on historical misdeeds.
Dr. Sara Collins (11:05):
It's a complex conversation, and sometimes
it's it's two or threeconversations.
Um sometimes I I begin theconversation by explaining why
I'm involved in clinicalresearch, which is the science,
which is the purity of that sortof scientific pursuit.
But it's also to provide accessto these novel therapies that
(11:32):
you would get if you went to anacademic center.
If you go to Hopkins, you'regetting offered a trial.
Also in in cardiology, wehaven't quite figured out how to
package these conversations thesame way they have in the
cancer space.
No one blinks, you know, blinksan eye when they have a new
cancer diagnosis and anoncologist offers them a trial.
(11:53):
It's just not even aconsideration.
However, you know,cardiovascular disease is far
more deadly than than cancer toa certain extent.
And we don't have thoseconversations.
So the first thing is I sort ofexplain why I'm in it, and I'm
in it for that reason.
I want my patients to haveaccess to the latest and
(12:15):
greatest.
And then I talk to them aboutwhat it means to be in a
clinical trial.
You know, it's it's not so bad.
You know, it's it's actuallykind of great.
Dr. Michael Koren (12:22):
It's fun, people actually like it.
Dr. Sara Collins (12:24):
People really, people really like it.
Yeah.
You know, forget thecompensation, which is in and of
itself uh uh, you know, gettingcare that's that cutting edge
and and and high level with allthose touch points with that's
outside of the insurance systemis pretty great.
Dr. Michael Koren (12:41):
Yeah.
Dr. Sara Collins (12:41):
But a lot of people really start to nerd out
about the about the science.
Dr. Michael Koren (12:46):
Yeah.
Dr. Sara Collins (12:47):
They really enjoy that.
Like I said, our patients arevery well educated, so they ask
a lot of really great questions.
Dr. Michael Koren (12:52):
I love that.
Yeah.
And so I I think it starts by,you know, to just just a long
that was a long answer, but it'sit begins I begin with just uh
saying why I'm in it,
yeah
and then finding out, you know,how how I think any particular
trial could be helpful.
Well, your enthusiasm is infectious.
I I want to join your trialjust by talking to you.
(13:13):
So that's that's fabulous.
But that gets to one of thevalue points, which is that
people want to feel connected.
And in the clinical trialworld, because it's an intense
experience, they get thatfeeling of connection with you
and your staff.
And quite frankly, I stillpractice cardiology.
We're so pressed for time inthe clinical setting, in the
insurance-driven setting, thatit's really sometimes hard to
(13:37):
not just go down an algorithmand not connect with the
patients.
So you have you clearly have askill to connect with patients,
and I would think that's a bigdriver for your patient
population to do more researchand have a really intense
experience.
Dr. Sara Collins (13:50):
I hope so.
And then we've got anincredible staff, which really
just extends the message thatDr.
Hutchinson and I sort ofinitiate in the in the set in
the in the office.
Our our staff, we really haveat this point solved for
culture.
We have everyone in our on ourstaff is is brilliant and and
(14:11):
absolutely experienced, but theyget the why.
And so they extend thatconversation to our
participants, which is reallypretty incredible to watch.
Dr. Michael Koren (14:20):
I love that.
I love that.
So, what what are the futureplans for your site?
What what do you see in thenext five years?
Dr. Sara Collins (14:28):
Oh, sky's the limit.
So, you know, at this point,because we were a de novo site,
you know, built from scratch andFlourish's first de novo site,
there was a lot to learn.
We continue to learn, and youknow, I even as an investigator,
there's a ton for me to learn,obviously.
(14:49):
When I attended yourinvestigator training last year,
I was, you know, all ears.
So many cool conversations andthe case studies just blew my
mind.
Environments like that arereally important for all of us
to participate it in.
So I hope that Flourishcontinues to offer that to folks
who are interested.
But we want to really continueto hone in on putting out a good
(15:14):
quality data product.
That's just incrediblyimportant, making sure that
we're crossing all of our T'sand dotting all of our I's, but
also expanding our therapeuticareas outside of you know
cardiovascular outcomes trialsand cardiometabolic and
lipoprotein(a) to I'm hoping wecould expand to sleep medicine.
(15:38):
Dr.
Hutchinson is board certifiedin sleep.
She's my co-medical director.
And clinical practice, she'sboard certified in sleep
medicine and a brilliantpractitioner and principal
investigator.
So I'm, and we have we have twosleep labs next door.
So I'm I'm hoping very muchthat we can expand into sleep.
And other therapeutic areas Ithink are are incredibly
(15:59):
interesting, or all thingsaround, you know, memory and and
Alzheimer's as well.
So I like to start with thosetwo and then see how that how
that goes.
Dr. Michael Koren (16:08):
That sounds uh very ambitious and very
exciting.
And I'll just comment on one ofthe things that you said, which
I think is super important, isthat there is a specific skill
set related to being a clinicalinvestigator that's not really
well understood by the generalpublic and even by physicians.
Yeah, people think, well,you're a doctor, you should know
(16:28):
research, but that's not thecase.
And even during our training,we don't get full exposure to
all the nuances in in clinicalinvestigation, especially when
you're involved in these largemulti-centered trials.
And there's always tensionswhen we have to figure out
what's best for the patientwhile still collecting accurate
data while also managing a staffbecause none of us can do it
(16:50):
ourselves.
So a lot of things come up, andyou you mention our teaching
program, which is what we callresearch grand rounds, and
MedEvidence sponsors that.
And we invite everybody that'slistening to us to take a
listen.
You don't have to be aflourished person.
This is open to all members ofthe medical community.
We get CME credits for it, andwe talk about these cases.
(17:12):
Every single day, a case comesup that requires thinking
through this.
And so I'll give you a recentexample and I won't give you the
answer, but I had a patientcome in for an Lp(a) trial that
you mentioned.
Lp(a), for those of you thatare not familiar with that, is
what we call the really, really,really, really bad cholesterol.
(17:32):
And it's a form of LDLcholesterol that tends to have
even more negative prognosticelements than just LDL itself.
And it's hard for our bodies toget rid of, and it's also
genetically mediated, so you getfamily concerns that are
involved.
But I had a fellow physiciancall me, said, Oh, I hear you're
doing Lp(a) study, and I know Ihave a very bad family history
(17:55):
related to Lp(a).
In fact, I have a CAC scorethat's in the worst 5%.
CAC score is a coronary arterycalcium score, and it's a good
indicator that somebody is gonnahave trouble with
atherosclerotic complications.
He was around 50 years old, andhe told me, Yeah, I had a heart
attack, and you know, I'd liketo be in your study.
So I said, Well, you sound likesomebody that would be really,
(18:17):
really good.
Obviously, we have a screeningprocess, but why don't you come
in and we're gonna figure outwhether or not you're the right
patient for this, and it soundslike you would be, but this is a
placebo-controlled study, so Ijust want to make sure I
understand that you're notguaranteed to get the product,
but we will certainly learn alot about your condition during
the course of this, and maybeyou'll get it.
And he was fine with that.
So he comes in again.
This is a physician, and hementioned to me he had a heart
(18:40):
attack, but when my staff wastrying to find out what the
heart attack when the heartattack actually occurred, it
turned out that he considered anepisode of very severe chest
pain that he self-treated aheart attack.
So that's a dilemma.
Here's a physician who made thedecision that he was having a
(19:03):
severe anginal attack, treatedit with what he had available in
terms of aspirin and nitrates,and never went into the
hospital.
So, is that a heart attack fromthe standpoint of clinical
research?
So I won't give you the answer,but these are the kind of
dilemmas that we have to faceevery day.
At the end of the day, we haveto adjudicate these patient
(19:24):
stories into things that areelements of the protocol.
And to me, I find thisfascinating.
These are the tensions aboutdoing research.
And in this particular case,there was a lot of implications
in terms of randomization andstratification, which we won't
go into for this particulartalk, but you and I know that
these are important elements ofaccurate data analysis.
(19:44):
And again, this is coming froma physician who now is a patient
that wants to get into a study.
So some fascinating things thatwe deal with on a day-to-day
basis.
Dr. Sara Collins (19:54):
Yeah, it's an it's it's tricky.
Those conversations are arereally incredible to witness,
the conversations aroundquestions like that, because you
know, what your trainingprovides is not only your
expertise, but the expertise andexpertise of your staff, but
this wide, quite variable rangeof opinions.
(20:14):
Because if there's one thingphysicians know how to do, it's
be opinionated.
Well, we don't always know weknow what's right, we we know
what's right clinically most ofthe time, but that is not always
the research answer.
Um so that's that is the nuancethat's really teased out in
these conversations.
Dr. Michael Koren (20:31):
Well, that's the interesting thing about
research.
You have to balance doingthings right with doing the
right thing.
And they sometimes are not inthe same Venn diagram.
And so it can be very, verytricky how to deal with it.
But that's part of the skillset of a good clinician
investigator.
And we cover all these type ofthings and go into the
regulations and going to thehistory, going to the pragmatic
(20:54):
elements, and going to the factthat the safety and the welfare
of the patient supersedes all ofthe other goals of research.
And that's part of our ethics,and and we need to sometimes
remind our business colleaguesabout this.
So it's uh it's a neat thingthat that we do, and thank you
for doing it.
It's it's super important.
And our on behalf of yourpatients and our community, you
(21:17):
do a fabulous job, and we trulyappreciate it.
Oh, thank you.
Any last words before we signoff?
This has been a fabulousconversation, and we'll
definitely have you back formore focused discussion on one
of the many things that wetalked about, including maybe
Lp(a), and and look forward toyou being involved in our
research grand rounds.
Dr. Sara Collins (21:35):
Yeah, I thank you.
Just thank you for having meand thank you for doing this.
These conversations are arereally cool to be a part of.
Dr. Michael Koren (21:42):
Uh Sarah, thank you very much, and and
thank you for being part of theMed Evidence! family.
Dr. Sara Collins (21:46):
Thank you, Dr.
Koren.
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