Richard Wahl

Q&A with SNMMI president-elect Richard Wahl

June 11, 2021
by Sean Ruck, Contributing Editor
This year’s SNMMI Annual Meeting kicks off on June 11 and runs through June 15. Like last year’s meeting, it will be a virtual event to reduce risks surrounding COVID and to enable attendees to participate without physically pulling them away from their hospitals, as some places are still contending with higher than usual patient loads.

While the year may again be unusual, our interview and annual update from SNMMI leadership should provide a point of familiarity. This year, HealthCare Business News spoke with SNMMI president-elect Dr. Richard Wahl, M.D., FACR, FACNP. Dr. Wahl is the Elizabeth E. Mallinckrodt Professor and chairman of the department of radiology, director of Mallinckrodt Institute of Radiology, and professor of radiology and radiation oncology at Washington University in St. Louis School of Medicine.

HCB News: Who or what inspired you to follow a career in healthcare?
Richard Wahl: I was always interested in science and math as a kid. I had some aptitude in those areas. My father had a series of strokes when I was early in high school. I got interested in medicine during my father’s illness and decided I wanted to go to medical school.

HCB News: How long have you been a doctor?
RW: I guess the answer is, “a long time.” I graduated from medical school in 1978.

HCB News: You hold around 20 patents — is there anything among those patents readers would be familiar with?
RW: Several of the patents are related to radioimmunotherapy for lymphoma. Those patents led to the commercial drugs Bexxar and Zevalin. There were several patents on dosimetry as well. They allow for patient-specific imaging and then calculate a radiation dose for a specific patient. Another one was a radionuclide-guided biopsy. A series of patents related to intraoperative detectors that could find radioactive tumors with a probe system. Another one, which ended up being FDA approved in a couple of devices, was a radionuclide-guided biopsy which was deployed for molecular breast imaging. One other is a software to measure tumor metabolic activity — how much tumor there is — and then measure it in a systemic way.

HCB News: Is there any particular moment in your career that stands out above the rest?
RW: There are two. One was: I was an early user of FDG in patients with cancer. I remember one of our very early patients had a “whole-body PET scan” — this was in 1988 or ’89 — and in the scan we could see the primary tumor, lymph node metastases in the axilla and bone metastases in the spine. So, in a single scan, we were able to see primary, local, regional and systemic metastatic disease with the radiotracer within images better than anything I had ever seen up to that date.

The other moment was with the radiolabeled antibodies. This was a case where a patient was treated with anI-131 anti-CD20 antibody for a large tumor of the abdomen. Looking at the CT scan 12 weeks later and seeing the tumor had shrunk by over 50% with this radiolabeled antibody was quite exciting.

So, it’s one discovery on the diagnostic side and one on the therapy side, and I remember both very clearly as things that could make a real difference to patients.

HCB News: How long have you been a member of SNMMI?
RW: I think it was roughly 1983 when I joined, and I’ve been to every meeting since, and virtually last year and this year.

HCB News: What drew you to nuclear medicine?
RW: I went to medical school at Washington School of Medicine. Mallinckrodt Institute of Radiology was a big department with a major presence in terms of the medical student education curriculum. I was familiar with radiology; I thought it was interesting based on my rotations through different fields. My challenge was that I liked pretty much everything I rotated through as a medical student, and I was reluctant to specialize in one organ system.

My first rotation in radiology was within nuclear medicine. I thought it was really interesting to deal with the entire body. And I was a chemistry major and very interested in physiology. So those fields grew together — chemistry, biology, medicine of the entire body — so that breadth of interest was very interesting to me.

HCB News: What do you most appreciate about being a member of SNMMI?
RW: I wouldn’t say it’s any one thing, but SNMMI has been one of the major scientific and clinical organizations of my career. It allows for growth and recognition of people from entry-level residents and faculty up to senior-level leadership. It’s a society that maintains a scientific and educational focus.

A couple of my highlights: I was fortunate to receive a few awards from the society. Being selected to deliver the highlights of the Annual Meetings was a nice honor, and I received the De Hevesy Award for contributions to nuclear medicine, and the Saul Hertz Award for radiopharmaceutical therapy. I was very fortunate to receive a couple of awards, and they were noteworthy to me because those were areas I’ve worked in for a long time. Working with the society, helping play a role in getting FDG-PET approved for cancer imaging, was also very important. To see the things I’ve worked on over decades get Medicare reimbursed was exceptional.

HCB News: What will your initiatives be as president?
RW: Some of the things we’ve been working on I want to continue to work on. The overarching issue, broadly, is making sure patients have access to innovative radiopharmaceutical diagnoses and radiopharmaceutical therapies. That access means you have those radiopharmaceuticals properly reimbursed, that there’s a workforce that can deliver these agents, that there are sufficient cameras and instrumentation for this, that the payments for the procedures are appropriate, and that historically underserved populations have access.

Within that, some of the emerging areas: I think we’ll see new diagnostic agents approved for prostate cancer and therapies. It will be very important to help roll those out and make them available. We’ve also had some major focus on the use of radiopharmaceutical dosimetry, to administer a precision dose to a specific patient. Another focus will be the responsible use of artificial intelligence in nuclear medicine. We have an AI taskforce, and they’re working on specific opportunities in nuclear medicine for AI. There’s no shortage of opportunities.

HCB News: What are the biggest challenges facing members today?
RW: Having sufficient reimbursement for some of our innovative radiopharmaceuticals and procedures is critically important. If it costs a hospital more to buy a radiopharmaceutical than you’re paid for it, it’s not a sustainable model. Regrettably, that’s the model we’re living with right now, with what they call a loss of “pass-through reimbursement” on innovative nuclear medicine diagnostic agents. So I’d say if you get the finances to work, then access would be there for patients. If there’s a realistic reimbursement for what we do, that would ensure the providers and technical staff are available and investments in nuclear medicine are made by hospitals. That is the challenge — if you don’t get paid, it’s hard to offer technology.

HCB News: Is there any other country you might point to as far as doing things better, doing things right with covering reimbursements?
RW: Every country has its own peculiarities, but unfortunately, the availability of certain radiopharmaceuticals in the U.S. has lagged behind others. I’d say Australia has done fairly well in terms of making some of the radiopharmaceuticals available. There’s probably better availability in some parts of Europe, but the rules differ by country. I don’t think anyone has anything like the U.S. does, where after two or three years, a diagnostic radiopharmaceutical that’s, let’s say, hypothetically, $3,000, has reimbursement drop by 70 or 80%. That’s unique to us and I think completely fixable.

Having enough positions and training slots is an issue as well. There are more medical students graduating than there are matching spots.

Obviously, all the interesting things happening in nuclear medicine that will improve patient care — all those things were possible because there was continued investment in research and increased investment in innovation.

HCB News: How has the pandemic impacted nuclear medicine?
RW: I think most places, certainly ours, during the first peak of the pandemic a little over a year ago, had declines of 60% to maybe 80% of their nuclear medicine volume. That impacted the economics, but it also impacted our training, because you need cases to train people. Since then, our institution has come back to where we were, or even increased for a bit because there was some pent-up demand. Certainly, I’d say the pandemic spurred us to do more teleradiology, telenuclear medicine, and I think some of those changes are here to stay. From a patient consult standpoint, I think we’re doing more virtual visits as opposed to in-person. Again, I think those are lasting changes.

In some niche areas like lung imaging, there was some concern, if you’re dealing with patients and you don’t know if they have COVID, that led to some specific recommendations regarding those procedures.

HCB News: What are you most looking forward to at this year’s meeting?
RW: I think there’s going to be a lot of optimism. There’s quite a bit of excitement about the progress being made in this field. I’m looking forward to a lot of the scientific sessions presenting the data as our diagnostic and therapeutic procedures mature. The reality is, many of the medical schools doing research were really slowed down over the past year. We couldn’t put people on clinical trials for probably six months, maybe longer, so it’ll be interesting to see how the science looks and if there was any visible impact on science.