SPOTLIGHT by TMC News: Brett P. Giroir, M.D.

Brett Giroir

Brett P. Giroir, M.D., executive vice president and CEO of Texas A&M Health Science Center.

Originally published by Texas Medical Center News online, April 2014

Brett P. Giroir, M.D., Texas A&M Health Science Center Executive Vice President and Chief Executive Officer, sat down with Texas Medical Center Chief Strategy and Operating Officer and Executive Vice President William F. McKeon to talk about his Cajun roots, his work with DARPA, and his love for the “can-do” Aggie attitude.

Can you tell us about your formative years?

Dr. Giroir: I grew up in a small town outside of New Orleans, where my family has been for centuries–hence my strong Cajun roots. My parents were hard working, self-made people. My father worked in the oil fields and was a part-time police officer. He dropped out of school when he was in the sixth grade and got a GED through the military. My mom was a full-time police officer and was the only person in my family to finish high school. They always instilled in me the value of education and wanted me potentially to be the first person in the family to get an advanced education.

My whole life has been a function of experiences in my childhood; they seemed like coincidences and chance events, but in retrospect I believe they happened for a reason–and that is part of the driving force that makes me passionate about contributing. Growing up, I had significant hearing problems and hearing loss, and there was no ENT physician in my small hometown; we had to drive 30 miles to the city to see a specialist. It just so happened that clinic was near the Jesuit High School, one of the best high schools in the region. It looked like an interesting place to be, so I set my goal, which was astronomical at that time, to be admitted in the Jesuit High School. Luckily, I got in, and that was the academic launching point for me.

The Jesuits were very rigorous about education, had very high standards, and really challenged me. I was in the Marine Corps JROTC there, and learned many valuable lessons about leadership from the instructors. I also joined the debate team, and won the national championship my senior year. This experience took me to many universities around the country that I would have never known about. I was always interested in science, but I didn’t know how it would ultimately fit.

When I was at the Harvard debate tournament in my junior year, the Harvard debate coach asked me about coming there and joining their team. He asked me to fill out an application, so I did. I got invited for an interview and the next thing you know, I was admitted to Harvard. I was the first person in my family to go to college. Needless to say, I have had a blessed life.

How did you initially become interested in science? You have an undergraduate degree in biology. Did that start with your Jesuit education or at Harvard?

Dr. Giroir: In the Jesuit educational system, you receive a very broad liberal education. I became interested in science, and infectious diseases, during high school. I was intrigued by a very simple question, but one that is fundamental and still drives research: Why do you get “sick” when you are infected? It seems that’s a simple question, but it’s a very profound one, and ultimately led to the Nobel Prize for the person I trained under, Bruce Beutler. Bruce discovered that it’s not the infection that kills you, it’s your body’s response. And the molecular and biochemical pathways that orchestrate that response hold promise for diseases as diverse as tuberculosis and cancer.

One of the people that I met through high school debate ended up being my best friend and attended Harvard with me. He was former valedictorian at the Bronx High School of Science, and we were both interested in research. One day we literally snuck in the back door at Children’s Hospital Boston Research Building, went up the freight elevator to the immunology floor, and knocked on the first office that we could find. The professor in that office gave us an opportunity. We tried the front door many times and they said we really weren’t qualified as undergraduates to do anything. He and I started doing research together and published several papers together as undergraduates, which really solidified my interest in science and ultimately led to my decision to major in biology.

What led you to UT Southwestern?

Dr. Giroir: We were sending monoclonal antibodies from my lab at Harvard to Southwestern, so I was familiar with it, and knew it was an up-and-coming institution. At the time, my girlfriend’s father–now my father-in-law–was faculty at the VA Hospital at Southwestern as well.

I came home the summer before my senior year to apply to medical schools and sent in applications to Southwestern and about 20 other schools. Literally a few weeks before I was going back to Boston, I got a call from Dr. Bryan Williams, who was the associate dean of student affairs at Southwestern. It was one of those life-defining moments–one that ultimately brought me to Texas.

For me, having a physician call your home was unheard of. He said he had received my application and wondered if it would be difficult for me to travel from Boston to come to Dallas to interview, and I said that indeed it would be. In fact, I probably wouldn’t be able to afford it. So he told me not to worry about the interview schedule, if it would be easier to just come over from Louisiana before the school year. I thought that was the most amazing thing. When I arrived in Dallas, it just screamed “Texas” to me. Immediately, people looked at me as a colleague and not just a student, or someone who was taking their time. I saw enthusiasm. I saw opportunity. I saw openness and a collegiality that I didn’t see in Boston or Baltimore or anywhere else. And I knew that was the place for me.

You have dedicated a great deal of your career to infectious disease. What provoked your initial interest in infectious disease?

Dr. Giroir: I really became much more interested in infectious disease as a pediatric resident and then an ICU fellow working in Bruce Beutler’s lab. Bruce won the Nobel Prize for discovering the fundamental building blocks of the innate immune system. It was something that was theorized about for decades, but Bruce–with genius and hard work–really cracked the code. I was excited to be training under him, and at the same time there was an unprecedented outbreak of a disease called meningococcemia, commonly known as college meningitis in North Texas.

Meningococcemia has two peaks: one in early childhood and the other in the adolescence. It is caused by bacteria that rapidly multiply and shed a powerful toxin known as “endotoxin.” Endotoxin is the match that lights the innate immune system, and that massive activation rips the body to shreds.

While a place like Children’s Hospital of Dallas might see a couple of patients a year with this disease, we were seeing as many as 50 patients a year, many who were well in the morning and by the evening could be dead. If they lived, within days, they developed gangrenous limbs causing extremity amputations. It was the ultimate challenge for our team, and I worked with some of the most dedicated people imaginable on this very emotional and scientifically challenging project. We had a critical care team and did translational science, bringing some of the discoveries we were making in the laboratory directly into the clinic as novel treatments. We actually performed trials which, at that time, were the largest ever be done in a critical care pediatric population.

The fight against this disease really defined many years of my early, and I think most passionate part of my career, fighting this disease on all fronts. It was, across the board, a multinational, multi-continental effort, but the severest outbreaks were in North Texas and Oregon.

In North Texas, we were able to drop the mortality of the disease from about thirty percent to five percent, which was due to a combination of innovative new therapies combined with enhanced transport and initial resuscitation. We hosted courses in every small town in East Texas and North Texas, educating school nurses and family physicians. We really considered the victims of this disease to be part of our own families, and even attended the funerals of those we could not save. It was a very dramatic and emotional period for all of us, teaching us all incredible lessons to build on for the rest of our careers.

What was it that led to the opportunity to serve at the Defense Advanced Research Projects Agency (DARPA)?

Dr. Giroir: Some of our work on meningococcemia was featured on PBS Nova, so the work we were doing was pretty highly publicized. I received a call from someone who worked with DARPA who said that the US Government was highly concerned about something he termed “asymmetric warfare,” which was completely outside of my realm of knowledge. I didn’t know anything about the military, although I had always appreciated it and respected those who served. They asked if I would come assist on this elite academic advisory committee of about 16 people to help DARPA build programs. I agreed, of course. If I could contribute, I would.

So in 1998, our academic assessment group started working on problems of biosecurity, and specifically decontamination. Our study found that chlorine dioxide offered the best means to decontaminate large-scale facilities after a biological attack. And of course, DARPA utilized chlorine dioxide to decontaminate the U.S. government buildings after the anthrax attack of 2001–so this was a very real thing. By 2003, I was running a children’s hospital and ICU, but also spending 60 or 70 days a year working on this defense advisory group. I was literally on submarines under the Atlantic, on aircraft carriers, on tankers refueling B52s, and then spending a week on the ground with Marines during full fire exercises in the California desert. So it was really like a duel life, and I became very passionate about our military and the sacrifices they make every day.

I was offered a truly unique opportunity in 2003 when I was asked to go to DARPA as Deputy Director, then Director, of the Science Office, which is one of the five offices of DARPA and the most innovative. It was the first time that a physician was offered a leadership role in DARPA’s 50-year history. The position provided me with an unequalled opportunity to do all of the “typical DARPA things” in physics, engineering, and materials–but now also to make advances in combat casualty care and defenses against biological, chemical, nuclear radiological warfare–to protect the country in a very serious way. But we all knew the only difference between most biological agents and natural agents is how they are employed. Anything we did for the warfighter, especially in biodefense, would yield huge benefits for civilian global health.

Tell us about your life as an Aggie.

Dr. Giroir: One of the best things about DARPA is that you can’t become a bureaucrat. You can only be there four or five years, particularly if you are in a leadership role, and then you have to return from where you came, or often find an entirely new position. That keeps the agency fresh. There is no fear of losing your career at DARPA, because as they say, you don’t have one to begin with. So you can be bold, you can press the frontiers, and then you leave. You make an impact and then you go away. And that’s exactly what happened.

It was my time to step down and I was offered some incredible opportunities in Washington, but I really felt I wanted to get back to Texas and take what I had learned in D.C. and bring that knowledge back to benefit Texas. Texans are always self-reliant and we do things on our own, but I really learned that there was a great deal of money and resources flowing to the east and west coasts that were not coming to Texas, despite that fact that our scientific and technical communities were most deserving. I thought I could play a positive role in helping the Texas community understand the way the research world works in D.C., with lessons that you could only learn from inside. Also, I really developed a passion for cracking the engineering side of vaccine manufacturing. Despite all of the things we have at the Texas Medical Center with regard to basic and translational research, and the best clinical facilities, Texas does not really have a pharmaceutical industry to speak of. I thought we could assist that as well.

I had just started looking to return to Texas when I met Chancellor Mike McKinney and Dr. Terry Fossum. As they say, I very quickly drank the maroon Kool-Aid. One of the things that attracted me to Texas A&M, from a science aspect, is it has one of the most outstanding engineering programs in the country. And perhaps more importantly, there is the “can-do” Aggie attitude. Aggies are very humble, but also very self-assured that if they put their minds to it, great things will happen. I am not a former student, but my wife and I have certainly become Aggies. So it has been a great five-and-a-half years, and that decision to become an Aggie ultimately led to the National Center for Therapeutic Manufacturing and the $3 billion federal contract for the Center for Innovation in Advanced Development and Manufacturing–through which we will supply influenza vaccines for 50 million Americans in the next pandemic.

Can you share your vision for Texas A&M and its role in the Texas Medical Center?

Dr. Giroir: One of the reasons I was excited to become CEO of the health science center was the range of opportunities here. We are a very diverse health science center, in terms of our five colleges, with medicine, pharmacy, nursing, dental and public health and four large basic science departments, as well as the Institute of Biosciences and Technology in Houston.

And of course, as a physician scientist, with the privilege of being able to go from the lab to the clinic, I understand that there is no more important piece of medical real estate and intellectual capital in the world than the Texas Medical Center. It is the place where discovery begins, where translation happens, and home to some of the most passionate people I’ve ever met. You can look around you any day and see that’s true.

Take for example, MD Anderson, where the scientists ride the same elevators as the patients, to make sure that everyone knows who they work for. Every day they are driven by that passion to “make cancer history.” You look at Dr. Willerson and his passion for ending heart disease. The Texas Medical Center is the place, and has the leadership, to define the future of modern scientifically-based medicine and health care delivery.

And I think our Texas A&M team fits in the medical center very well. Cheryl Walker, Director of the Institute of Biosciences and Technology, is bringing together multiple institutions to understand the epigenetic impact of our environment on diseases as diverse as cancer and obesity. To me, the TMC is an irreplaceable, unique international resource that we not only want to be a part of, but also desire to dramatically increase our investments in infrastructure, faculty, staff and students.

You are taking part in the Texas Medical Center’s strategic planning process. Can you share your thoughts on the new direction of the Texas Medical Center?

Dr. Giroir: One of the most important aspects of the Texas Medical Center is the fact that individual faculty and students work across institutional boundaries–there are tremendous collaborative efforts at the grassroots level. I’m relatively new to the TMC, but my impression is that despite these collaborations, there had not been a focused effort to bring institutions at the macro level together, under the leadership of the TMC, to achieve things collectively that could not be done individually. And that’s what this strategic planning process is all about; it will have global impact, and quickly.

The results of the strategic planning process will solidify TMC’s place as the international leader in modern medicine. An exciting part of that is a focus on innovation and commercialization, with the real promise of building a biotech community that not only leverages the incredible science and humanitarian resources at the TMC, but also the business climate of the state of Texas. In my opinion, you cannot divorce all of our successes from the success of Texas, as a state, in creating a business climate and a community where everyone wants to be, and outsiders want to invest.

I think the Texas Medical Center is entering a new era as the premier entity defining the national biomedical agenda–at least for the next decade. To me, it’s an incredibly exciting time and I feel honored and privileged that the Texas Medical Center has invited Texas A&M to be a full part of its future.

What gives you the greatest sense of pride?

Dr. Giroir: I’m most proud of the fact that I still get cards from patients and their families whom I took care of ten or fifteen years ago. I always say, twenty-first century medicine is a team sport. The word “I” should never be used. Our team made tremendous impacts on those families, and a lot of them still contact us today. There is no greater satisfaction than making a difference in their lives. That is the continuous motivating force–for me, and the team around me. I see that here every day at Texas A&M. We want to impact patients’ lives, from bringing clean water and health education to South Texas, to high-tech regenerative medicine in the Texas Medical Center. We have an incredible team here at Texas A&M, and I love the Aggie attitude of selfless service and patriotism. I love the self-deprecating humor–yes, the “Aggie jokes.” But make no mistake, the people here are hungry to make a difference. They are really driven in a positive way. They want to change the world. They want to be on teams that change the world. And I think given the opportunities that the Texas Medical Center has provided, together we will do just that.

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