Jeffrey Wang tells Spinal News International about growing up in a small town, the profound influence his father had on his philosophy and how basic science can help unravel some of the mysterious secrets of the spine.
How did you become interested in medicine? Why orthopaedic surgery?
No one in my family before me was ever in the medical field. I was born in a small town, in Mitchell, South Dakota, but moved to Fairmont, West Virginia at age four. Growing up, it seemed that the doctors were the ones who had the gratitude of the community. In such a tiny town, there were really no executives, people in corporations, or really anyone who wore a suit to work. We had coal miners, farmers, and people working in shops. Seeing how appreciative the people in the community were to the few doctors in town made that career seem the one which could impact the most lives and make the biggest positive difference. As a child, it seemed, the people I dealt with were the most impacted by the orthopaedic surgeon in our town. I still remember teachers, camp counsellors, and others, telling me how they had been in an accident and broken several bones and how the orthopaedic surgeon allowed them to walk again. That made such an impression on me that I decided quite early to be a doctor and to choose orthopaedic surgery.
Who were the people who inspired you in your career, and what advice of theirs do you remember today?
My father has inspired me the most in my life. He has one of those sad but inspiring stories that are probably quite common to people in his generation. He grew up on a small farm outside a small town in the middle of mainland China. He knew early on, that if he did not leave his town or change his situation, during that period of time in China, he would never have the chance to do anything else but work on a farm. At age 13, he and his father packed all the produce they could carry on their backs, and the two of them walked several days to the nearest town. They sold all the produce and his father handed him all the money. My father took it and went to the nearest city to go to school. He never saw his parents again. He struggled to put himself through school, and left communist China to get his PhD in political science at the University of Pennsylvania. Living in the United States, he did not have the opportunity to contact any of his relatives, because of the Communist Government, until he was in his fifties, and by then, his parents and most of his brothers had passed away. He told me stories of how he survived the war, struggled to find food to eat, and struggled to get his education. These had such an impression on me that I try to take nothing for granted. Whenever there is an important issue or emergency at the hospital, I think of how tough it was for him, and it really puts things into perspective. One of the most memorable pieces of advice he gave me was that you cannot control what other people do and what they think, you can only control what you do. So even if others are treating you unfairly, treat them fairly and do what is right. That way, you can always live with what you do and you can sleep at night. He was a teacher, and although an immigrant where English was not his first language, he found a way to connect to people.
What is your personal philosophy/approach to care of the spine?
I find the spine one of the most amazing parts of the human body in its form and function. We are only at the tip of the iceberg in understanding what causes spinal pathology, and how to treat it effectively. My philosophy in treating my patients is to inform them as much as possible, and let them make the decisions when it comes to the treatment options. It takes extra time to explain the options to the patients, but more importantly, why we think they are having their specific problem. They come to me for recommendations on treatment, but instead, they get an education on their disorder, where they are making the treatment decisions. Perhaps more importantly, they gain an understanding that we do not have all the answers, we cannot guarantee results, but we make the best decisions possible with the information available to us. That is how I approach patients with spinal disorders.
Could you identify some exciting developments in treating the spine today?
I think the most exciting developments in spine lie in the biological basis of spinal disorders and the potential to treat these disorders on a molecular science level, rather than with surgery in the future. We have made significant advances in the basic science arena over the past 10 years and this is a rapidly advancing area for the spine. I think this research may yield more effective therapies in the future, but the process itself excites me. It may take years to actually develop an FDA-approved biological treatment or growth factor. But the process of the research allows us to better understand the pathogenesis of the spinal problem on a basic level. Unlike the new spinal devices that are coming out each year, we cannot measure the success of our basic science research by the numbers of novel treatments that we are developing each year. Instead, we need to measure it in terms of how the research we do collectively, advances our insights into basic fundamental problems that lead to spinal disorders. We need to support basic science research in hopes of future biological treatments. Along the way of developing these therapies, we will gain a greater understanding of the secrets of the spine, and perhaps that is the greatest value of the research. I do, however, think that we will have growth factors or transformed stem cells in the future that will play a role in the regeneration of the spine and hopefully the spinal cord.
Could you describe some memorable cases you have treated, and the outcomes?
One of the most memorable cases was a famous author who had metastatic cancer that unfortunately was eroding into her spine and causing spinal cord compression. We resected the tumour from her spine and decompressed her spinal cord. This was an enormous procedure for her, given her age and medical condition at the time. She had been fighting cancer for years, and had experienced four completely different types of tumours through her life. The most memorable thing about her was her spirit and will to live. She expressed herself best through her poetry, and as she fought her cancer, her writings gave such a vivid portrayal of her thoughts. She did well from her spine, but unfortunately, about two years after her spine surgery, the widespread cancer was taking its toll. Towards the end, she wrote her last book, which she and her family published before she passed away. In the book, I saw how she felt towards her cancer, her acceptance of her oncoming death, and her personal thoughts about me as her spine surgeon. It made me understand her experience completely, and I will never forget her. My message to all my colleagues who are treating patients with spinal disorders, is that we play such an important role in our patients’ lives, we cannot take this for granted. We have to be honest and put their interests and well-being as the top priority.
What is the most interesting paper you have come across recently?
I am very happy to see some very well-conducted prospective studies looking at the effectiveness of surgery. Some of the recent SPORT study data and some other studies are showing the benefits of surgery. When properly indicated and after failing an appropriate period of conservative treatments, surgery can help. These are the types of studies that need to be conducted. Not all will show that all surgeries are effective, and some may show that we should not be doing certain procedures. But the fact that we are doing better research studies and trying to demonstrate efficacy to justify any of our non-surgical or surgical treatments is something that is sorely needed.
Which technique or technology had a profound influence on your career?
I would say that the procedure of cervical laminaplasty has been an interesting part of my career. It is not a profound or remarkably significant part of my career, but just an interesting part. When I had finished my spine training in residency and my spine surgery fellowship with the late Henry Bohlman, MD, I had done exactly zero laminaplasty surgeries. These were not popular in the mid 1990s, and I had never even seen one performed. The literature at the time did not show favourable results with this procedure, and there were very few studies published from the United States. Our colleagues in Japan had been doing these for years and really invented and perfected this technique.
I was lucky enough to be awarded a traveling fellowship from the North American Spine Society, that allowed me to spend one month in Japan, traveling to several academic spine centres. During my time in Japan, I gained expertise in this procedure and understood the indications and contraindications. When I returned to the United States, I incorporated this into my practice, and many of my colleagues also adopted this procedure. I saw the use of cervical laminaplasty grow to the point where even my fellowship director began to perform them. I felt that I and many of my close colleagues played some part of popularising this procedure.
What do you hope to achieve as the chairman of Global Spine Congress this year?
There are a number of very good spine meetings that occur throughout the world, and many of them are successful by focusing on one part of the spine or focusing on one particular pathology. The Global Spine Congress is unique in that it represents a truly academic meeting that is global in its attendance. At the last meeting, standing in the opening reception and closing your eyes, you would not be able to guess the country or region you were standing in. Our goal is to continue to be appealing to our global audience and continue to attract the highest quality research and knowledge updates from the best of all countries. I have travelled to different countries and attended meetings where there is such amazing research being conducted, but the researchers do not have a platform on which to present their data due to language issues or logistic issues with other meetings. The Global Congress is the venue where this research can be presented if it meets the high quality standards.
What are your interests outside of medicine?
I have many interests outside of medicine which allow me to be a devoted and compassionate physician when treating my patients, but then be a ‘normal’ person when I leave the hospital. Sports activities and fitness are a true passion for me. I still play full-court competitive basketball at least twice a week. The competitiveness helps keep me mentally challenged, and certainly trying to avoid injuries and recover physically from each game is becoming an increasingly more difficult physical challenge.
None of the friends that I play with regularly are physicians or have any link to the hospital. Most are actually writers, producers, or actors, and I find what they do so far from what I do as a surgeon, and it is fascinating. I also try to exercise everyday and I think this is an important part of life. My family takes top priority outside of medicine and I try to spend time with them really connecting with them. Music is also a passion of mine. I was in a rock band during my college and medical school years. I hear about people retiring and then not having anything to do. When I finally retire, I believe that this will not be a problem for me.
Professor, Department of Orthopaedic Surgery, Neurosurgery, University of California Los Angeles, David Geffen School of Medicine
- BS in Biological Sciences with Departmental Honors Stanford University, California (1983−87)
- MD, Medical School, Cum Laude, University of Pittsburgh School of Medicine, Pittsburg PA (1987−91)
- Residency in Orthopaedic Surgery, University of California, Los Angeles, Dept of Orthopaedic Surgery, Los Angeles, CA (1991−96)
- Fellowship in Spine Surgery with Henry H. Bohlman, MD Case Western Reserve University Dept of Orthopedic Surgery, Cleveland, Ohio (1996−97)
Selected academic appointments
- Professor of Orthopaedic Surgery (2008−present)
- Professor of Neurosurgery (2008−present)
- Associate professor of Orthopaedic Surgery (2003−present)
- Associate professor of Neurosurgery (2003−present)
- Assistant professor of Orthopaedic Surgery (1997−present)
- Assistant professor of Neurosurgery (2002−present)
- Executive director, UCLA Comprehensive Spine Center (2003–2007)
- American Academy of Orthopaedic Surgeons
- Cervical Spine Research Society
- North American Spine Society
- Scoliosis Research Society
- Spine Arthroplasty Society
- Western Orthopedic Association
- California Orthopedic Association
- Alpha Omega Alpha Honor Society
- Western Orthopaedic Association
- Interurban Orthopaedic Society