Peter McCullough was born in Buffalo, New York, on 29 December 1962. When a teenager, his family moved to Texas (Wichita Falls and later to Grapevine). He graduated from Baylor University in May 1984 and from the University of Texas Southwestern Medical School in June 1988. His residency in internal medicine was at the University of Washington School of Medicine in Seattle, Washington. Upon completion of his 3 years training in June 1991, he moved to Grayling, Michigan, and served as an internal medicine attending at Mercy Hospital for 2 years. From there he enrolled in the University of Michigan School of Public Health and received a Master in Public Health in August 1994. From July 1994 until June 1997, he was a fellow in cardiovascular diseases at the William Beaumont Hospital in Royal Oak, Michigan. He then joined the Henry Ford Heart and Vascular Institute in Detroit where he remained until August 2000, when he moved to Kansas City, Missouri, to be Section Chief of Cardiology of the University of Missouri – Kansas City School of Medicine, Truman Medical Center. In October 2002, he returned to the Detroit area and to William Beaumont Hospital as a Consultant Cardiologist and Division Chief of Nutrition and Preventive Medicine–where he remained until August 2010, when he became the Chief Academic and Scientific officer of the St. John Providence Health System, also in Detroit. In February 2014, Dr. McCullough joined Baylor Scott & White Health as Vice Chief of Internal Medicine at BUMC, Chief of Cardiovascular Research of the Baylor Heart and Vascular Institute, and Program Director of the cardiovascular disease fellowship program at BUMC.
Dr. McCullough’s career has been adventurous and incredibly productive. He is an internationally recognized authority on the effect of chronic kidney disease on cardiovascular disease. He has >1,000 publications to his credit, and received several honors, mainly for his outstanding contributions to the understanding of the cardiorenal syndrome. Currently, he is chair of the National Kidney Foundation’s Kidney Early Evaluation Program (KEEP), the nation’s largest community screening effort for chronic kidney diseases. Peter is also co-editor of Reviews in Cardiovascular Medicine . He is one of medicine’s best speakers and his presentation topics have varied widely. He is a wonderful teacher and mentor, a marathoner of extraordinary proportions, the proud father of 2 teenagers, and a great guy. During the several months he has been at BUMC he has shown his star brightly. He has had a terrific impact on the cardiovascular training program at the Baylor Heart and Vascular Institute and on its staff. We are most fortunate to have attracted him to Baylor Scott & White Health.
William Clifford Roberts, MD (hereafter ROBERTS): Dr. McCullough, I appreciate your willingness to come to my house for this interview. Could we start by my asking you to describe your early life, some of your early memories, your parents, siblings, and your growing up period?
Peter Andrew McCullough, MD, MPH (hereafter M c CULLOUGH): Dr. Roberts it is a privilege to be here. I was born in Buffalo, New York. My parents are Thomas Leslie McCullough and Mary Ruth McCullough. I have 2 siblings, Thomas McCullough, Jr, my older brother and my younger brother, Matthew McCullough.
ROBERTS: What was your mother’s maiden name?
MCCULLOUGH: Zimmerman. My mother was adopted so we don’t know anything about her biological family. Both of my father’s grandparents came from Northern Ireland. My early life was a happy one. We lived in a small house in Tonawanda, New York, which is just outside of Buffalo. My dad worked in a Western Electric factory as a supervisor. My mother stayed at home and raised the boys. I went to elementary school, junior high and one year of high school in Buffalo, New York. In 1975-1976, there was an economic recession in the industrial north including Buffalo, Pittsburgh, and Cleveland, and the factory that my dad worked at was shut down. After several unsuccessful attempts at getting another job that was sustainable, we sold the home and moved to Wichita Falls, Texas, in 1976. My father worked at Sprague Electric on the third shift and worked as a factory line supervisor. We lived in Wichita Falls where I went to S.H. Rider High School as a sophomore. We stayed there for a year. My father then obtained work in facilities management at Abbott Diagnostics in Irving, Texas. Our family then moved again to Grapevine where finished my junior and senior high school years.
ROBERTS: How did you do in high school with all the moving around?
MCCULLOUGH: My brothers and I did fairly well adjusting. I went to 3 high schools in 3 years so that really broke up any opportunities for friendships but I stayed active. I played club soccer in the Buffalo area, soccer for Rider High School, and then club soccer in Grapevine. I also ran track in Buffalo. Sports helped. My brothers and I were naturally academically focused. We didn’t need or get too much pushing from our parents.
ROBERTS: When were your brothers born?
MCCULLOUGH: Thomas was born on February 23, 1960, and Matthew, February 26, 1966.
ROBERTS: What do your brothers do now?
MCCULLOUGH: Thomas is a senior vice president at Xanitos, which is a hospital consulting company, and Matthew a senior vice president at Fidelity Investments.
ROBERTS: How many students were in your graduating high school class?
MCCULLOUGH: About 200.
ROBERTS: How did you stand among those 200?
MCCULLOUGH: I was third.
ROBERTS: Did your brothers do similarly in their graduating classes?
MCCULLOUGH: My older brother ranked second and my younger brother was in the top 25%.
ROBERTS: Did either of your parents go to college?
MCCULLOUGH: Yes. My father graduated from the University of Buffalo with a degree in geology. It was always unclear what he would do with that degree and he ended up taking a job in the factory following in his father’s footsteps. My paternal grandfather, who I never knew, died of rheumatic heart disease at age 52 when I was a toddler. He had mitral stenosis and had an attempted open commissurotomy but afterwards died of heart failure. The Irish diaspora during the great potato famine of 1850 brought many Irish to the USA. It’s been said that 25% of people in the USA have Irish blood in them. New York City and Boston are heavily Irish. My maternal great-grandmother died in the tenements in New York of Bright’s disease (post-streptococcal glomerulonephritis). The streptococcus wasn’t too kind to the crowded Irish after they arrived on the boats and were processed through Ellis Island and settled in to “Hell’s Kitchen”—as evidenced by two affected generations of my family.
ROBERTS: Where is the Hell’s Kitchen area?
MCCULLOUGH: It’s about 44 th or 45 th Street in Manhattan. It’s a nice area now. Hell’s Kitchen was an incredible melting pot from Western European countries. My mother was adopted by childless parents and went to college at Bowling Green University in western Ohio, and graduated with a degree in English. Only about 20 of my graduating high school class went to college. I knew through high school that I wanted to go into medicine.
ROBERTS: Were there any other medical people in your extended family?
MCCULLOUGH: One physician married into our family, and that was when I was in grade school. Al Santos, MD, is now a retired cardiologist. He is Brazilian and married my paternal aunt. He spent most of his career in a community/academic role in Rochester, New York. He was the chief of cardiology at St. Mary’s Hospital until it closed and then at Highland Hospital. He helped Dr. Brad Berk unite the community hospitals with the University of Rochester — Strong Memorial Hospital.
ROBERTS: Did you spend much time with him?
MCCULLOUGH: I did. Al was a positive role model. He took me to the hospital several times on rounds in which he taught students and residents.
ROBERTS: How far is Rochester from Buffalo?
MCCULLOUGH: About an hour.
ROBERTS: In high school, did you and your brothers have part-time or summer jobs?
MCCULLOUGH: We worked incessantly. In Buffalo the very first thing my brother and I did at the age of 10 and 12 years old was become paperboys. At that time, paperboys were the ones who delivered newspapers. We worked for The Courier Express . We delivered papers during grade school and would get up early, organize the papers, put them in the bag and walk our paper route to deliver the newspapers. We did this for years. On the weekends we would strap on the coin holder to our belts and go around and collect the money. Typical payment was in dimes and quarters. When we moved to Wichita Falls, my older brother got a job at the Wichita Falls Country Club picking up golf balls and I got a job for the Wichita Falls Newspaper delivering newspapers. The distances were greater in Texas and I could no longer walk and used a bicycle with a giant basket on both sides of my back wheels. In Texas the papers did not have to be taken up to the front door but thrown up. I became adept at riding without hands on the handlebars and throwing the papers. When moving to Grapevine, at ages 15 and 16, my brothers and I bought cars and auto insurance with the money we had saved from our paper routes. I worked in the laundry room and kitchen at a nursing home and then got a job at DFW airport where I worked in the candy/newspaper stores. Then I worked in the warehouse that supplied the stores and pack all the delivery boxes and deliver them to the stores. In high school I spent hours working.
ROBERTS: You never required a lot of sleep?
MCCULLOUGH: No. I have always gotten 6 to 8 hours of sleep each night.
ROBERTS: You mentioned soccer and track in high school. Did you start running for exercise while you were in high school or did all that come later?
MCCULLOUGH: All that came later.
ROBERTS: How did you decide on Baylor University for college? How did you pay for college?
MCCULLOUGH: I finished high school at age 17. Baylor University offered a terrific financial aid package which covered for all my expenses through a combination of grants and scholarships.
ROBERTS: You had a car to drive back and forth to Waco?
MCCULLOUGH: Yes. I had a Dodge Charger, which lasted all through college.
ROBERTS: Were there any teachers who had a particular influence on you?
MCCULLOUGH: Yes. In elementary school the gym teacher, Bruce Radka , taught us a sense of fairness, especially with the more aggressive games.
ROBERTS: What was the atmosphere in your home. Did all of you eat dinner together at night? What was a typical conversation at dinner?
MCCULLOUGH: My father was reliably home by 5:00 pm at night. We always had dinner together. The conversations were largely lead by my father and were largely directed at my mother. The general environment encouraged the kids to be silent—seen but not heard.
ROBERTS: Did they ask you much about your activities at school and how they were going?
MCCULLOUGH: No.
ROBERTS: They just took it for granted that all 3 of you were going to do pretty well.
MCCULLOUGH: There just wasn’t much of a discussion about expectations. There was an unspoken emphasis on proper behavior.
ROBERTS: What did your parents talk about ?
MCCULLOUGH: My father was always chronically frustrated with his career and with what he had done professionally. My sense was that given his intelligence he could have done a lot more. Conversations were largely based on his frustrations with his supervisors, his job, and financial pressures.
ROBERTS: Was the atmosphere of your home pleasant? Did your father and mother fuss at the kids very often?
MCCULLOUGH: I would characterize it as a fair amount of tension. It encouraged us to get out of the house.
ROBERTS: Were there books around the house? What did your father and mother do at night?
MCCULLOUGH: They watched television.
ROBERTS: They didn’t spend a lot of time expanding their intellectual powers?
MCCULLOUGH: No, my dad had some interesting hobbies that didn’t really spill over to the kids. He was a talented chess player. He played chess by mail, where they would mail post cards across the world. He had a US ranking in chess. He played chess tournaments on the weekends. He also painted with some oils but mainly water colors. He would go through spurts painting many canvases in short amounts of time. He displayed his art in local art shows.
ROBERTS: Do you play chess? Or paint or draw?
MCCULLOUGH: No.
ROBERTS: Did you play any musical instrument in school?
MCCULLOUGH: I learned to play guitar. Today I can play an A, C and G and that’s about it.
ROBERTS: Did you like your time at Baylor University?
MCCULLOUGH: I loved Baylor. I made the soccer team in college. I came off the bench and played relatively infrequently. I traveled all around the Southwest Conference schools so I have good memories of play against schools like SMU and Rice. Soccer was considered an NCAA sport in the Southwest Conference but it didn’t have any type of stature in the University.
ROBERTS: Were you a walk-on?
MCCULLOUGH: Yes. Those were fond memories my freshman year but also we had daily practices, and all the weekend road trips really curtailed study time. I was not very successful my first semester so it became clear to me that something had to go. I couldn’t balance both athletics and academics to the degree that was really needed to be successful. About half of the undergraduates that enrolled were pre-medical, but the 1200 fell to about 200 who actually applied to medical school. The final group that applied to medical school was virtually 100% accepted. I was accepted at UT San Antonio and planned on going there. Then I got a call from Brian Williams, dean of UT Southwestern, indicating there was a spot for me in July. Naturally, I was thrilled and accepted. I think I was the last one of 201 students accepted to UT Southwestern.
ROBERTS: How did you come out at Baylor University?
MCCULLOUGH: My rank was 29 of 131 among the pre-meds. I got my degree in biology and psychology. I was 127 of 1152 among the total graduating class.
ROBERTS: You entered Southwestern Medical School in 1984?
MCCULLOUGH: Yes.
ROBERTS: Were there any surprises after entering medical school?
MCCULLOUGH: No. I felt very well prepared. I have to give credit to the professors and to the whole program at Baylor University. There were some wonderful professors at Southwestern: Dr. Maximillian Buja in pathology; Al Gilman , pharmacology, who later won the Nobel Prize, and Vinay Kumar , an editor of our pathology textbook. UT Southwestern had an absolutely superb faculty during my first two years. It was a very competitive atmosphere. The professors fostered that competitiveness. Donald Seldin , chief of internal medicine, was very influential. He held teaching conferences on the wards during my third and fourth years. The students were very intimidated by his teaching style. He pimped for information. Jim Willerson , chief of cardiology, with a very soft voice, was very persuasive in encouraging us to know all the information about our patients. The emphasis at Southwestern Medical School was putting in as much time as possible. The care of patients at Parkland Hospital at that time was almost exclusively provided by students, interns, and residents from Southwestern. The attendings taught on the medicine wards. The emergency department care of patients was exclusively by residents. Parkland emergency room was organized into “pits”: medicine, surgery, psychology, and Ob-Gyn. A student could be called down to any one of these “pits” to assist. This time was before there was computerized medical information. Our daily routine was to get to the floors early, draw blood samples on patients, and get them to the labs. Around 10:00 or 11:00am, we would go get the lab results and put them in the patient’s chart.
ROBERTS: Were there any professors who had a particular influence on you?
MCCULLOUGH: I was influenced by Pat Claggett , a vascular surgeon at the Veteran’s Administration Hospital in Dallas. He was a terrific teacher. Dr. Claggett would explain to the patients, usually sitting on the side of the beds in their hospital gowns, where the blockages were. He would start drawing a giant aorta and the common iliac arteries on the bed sheet where the blockage was. Then, the other veteran bed mates would come over and be amazed at the drawings and start giving their opinions. Pat went on Christian mission trips for as long as a year deep in the jungles of Africa. When returned, he would give a slide show of astonishing illnesses he had seen. He would describe how they worked there with minimal equipment, medicines and used rudimentary lighting during operations. His talks were mesmerizing.
I was lucky enough to be a student at Baylor University Medical Center in Dallas, one of the last to get the 2-month BUMC medicine rotation. Students at Southwestern spent 2 months at Parkland and then 2 months at either the VA Hospital or BUMC. When I was at BUMC, Bob Hootkins , now a nephrologists in Austin, was my senior resident. He was a terrific senior resident. I also had exposure to John Fordtran , the co-editor of Slesinger and Fordtran , the major textbook in gastroenterology. I have terrific memories of BUMC. Even as a student at Southwestern I was interested in learning in community hospitals and learning from the physicians who maybe were more engaged in patient care than in research. There was a young pulmonologist at St. Paul who was a terrific teacher, Randy Rosenblatt, so I signed up to do pulmonary medicine under him, and it was terrific. My experience under all three – Parkland, VA Hospital and BUMC – was exceptional. I met my future wife during medical school. She was going to the School of Nursing at Texas Women’s University. We lived in the same dormitory in Dallas. She finished nursing school before I finished medical school and returned home to Toronto, Ontario, to live with her parents while I finished medical school. On my elective I went to Toronto to the Hospital for Sick Children, to be on the orthopedic service with Robert Salter . He is known for the Salter-Harris fracture classification for hip fractures. When I arrived, they asked me what I wanted to do. I said I wanted to operate. They told me they didn’t have students operating but that I could observe. I told them down at Parkland as students we scrubbed in and operated. I convinced them to let me be a part of the operating team. So, I scrubbed in on an enormous number of cases as a student, largely holding the retractor, getting to do at least do some part of the case. I also met Tony Bobechko who invented the “Bobechko hook” which could be attached to rods and these rods would go along the spine to correct for severe kyphoscoliosis. The Hospital for Sick Children orthopedic service was incredible.
ROBERTS: When did you decide that internal medicine was the area for you?
MCCULLOUGH: I nearly went into surgery. I really liked surgery and I was good at it. I think it was the sheer depth of internal medicine made me realize in my fourth year — infectious diseases to cardiovascular – that I loved medicine. I also knew what I didn’t want to do — psychiatry, obstetrics and gynecology, and pediatrics.
ROBERTS: When did you get married?
MCCULLOUGH: I met my wife, Maha Buyuk , in 1984. She is from Jerusalem and is a Palestinian Christian. We got married in 1988, the year I graduated from medical school.
ROBERTS: Where did you intern?
MCCULLOUGH: Although I applied at Parkland Hospital, I wanted to leave Dallas and I applied to Harvard, Johns Hopkins, Yale, Penn and then University of Washington (Seattle). I interviewed at all of them and liked them all. Seattle was the only one in which I took my fiancé with me. The day was bright, sunny, and cool. We saw Mt. Rainier. We decided that Seattle was the best combination. The other unique quality is its basically one residency program for the entire city. The University of Washington residents in medicine and surgery covered the 5 hospitals — University Hospital, the VA Hospital (which was the VA hospital for Washington, Alaska, Montana and Idaho), Harbor View Hospital (the county hospital), Providence Hospital, and the Swedish Hospital. The training experience in Seattle was absolutely spectacular. Robert Petersdorf the chief of medicine had just retired the year I started my residency. We had a terrific faculty at all 5 hospitals. We also had the excitement in Seattle of being where the Nobel Prize was awarded to one of our faculty – E. Donal Thomas – who won for bone marrow transplantation. One of the other hospitals we covered was the Fred Hutchinson Cancer Research Center. During my time there the nuclear disaster at Chernobyl, Russia, occurred and they flew some of these poor fellows who had been exposed to radiation to our cancer center. At this stage I was influenced by Michael Copass , neurologist, and the emergency room director, J. Ward Kennedy and W. Douglas Weaver , both future presidents of the ACC. They devised the “Medic One Unit”. This was the premier paramedic response program in the U.S. Seattle is an interesting town because it’s very hilly, compact and surrounded by water and has bridges. They devised a response program where the nearest fire house would send a fire truck and then follow with a paramedic unit. They made Seattle the best place to have a cardiac arrest because the response was so fast and organized. They were the leaders in early defibrillation. The big firehouse, where the paramedics were stationed was next to Harbor View Hospital where Michael Copass was the director its emergency room. The paramedics enormously respected Dr. Copass. The rotation both feared and loved by all the residents was his Harbor View emergency room rotation. Michael Copass was a military man and wore a brush cut and wore the old style glasses with a white sleeved button-down shirt, blue tie and khaki pants every day. He wore a belt loaded down with 6 beepers, because he kept communications on all the emergency transfer traffic in the entire Pacific Northwest. We had Airlift Northwest coming from Alaska and Idaho. The Harborview emergency room was run by second-year residents so the highest ranking person in medicine was called the “Medic-One doc” and the highest ranking surgeon was “Trauma One doc”. We would see all patients in ER with no attending and a beeper would go off with message “Medic-One doc go to the phone room” so we would have to leave what we were doing and go into a closed room with a battery of phones, pick up the call regarding the emergency. I distinctly remember several cases where the patient had a ruptured abdominal aneurysm. Part of the work there was to get the patient transferred to the correct hospital and get the hospital alerted. On one case I incorrectly approved a suspected triple AAA patient being taken to the Ballard Community Hospital and immediately the red phone (who was Michael Copass) called and questioned my decision and corrected my mistakes. There were many Harborview emergency room stories. One concerned mass cyanide poisoning on the docks. Some big canister of cyanide that was used for industrial reasons had broken and many men had been exposed. I was in a panic from all ready dealing with a busy night in the ER and while the paramedic was talking to me the red phone rang at around 3:00 am. I knew it was Copass and he started barking out instructions on what to do. Instead of making me feel intimidated he enabled me by telling me what I needed to do: call police to help gather all cyanide treatment kits across the city; organize the hallways at Harborview to triage all the patients; call the surgery residents and get blood gases on every single patient; figure out quickly who needs to be intubated or who just needs oxygen and who needs the cyanide reversal injections kits. He helped me organize the whole thing and we ended up treating 25 people with only 3 needing intubation. Cyanide is toxic so we had to take all clothing away, put it in bags to dispose, and all the workers wore the paper gowns.
ROBERTS: What was your standing in your medical school class when finishing?
MCCULLOUGH: I finished number 1 in the clinical years and twelfth of 199 during the entire 4 years.
ROBERTS: When did you decide you wanted to be a cardiologist?
MCCULLOUGH: When I finished in Seattle, I was completely lost. When I finished the medicine residency I didn’t know what to do. I was offered the chief residency position at Harborview but my wife didn’t want to stay another year in Seattle. She felt we were too far away from family. I signed up with World Health. I applied to a few towns that were advertising for physicians. I ended up in Grayling, Michigan, with a population of about 2,000 people. The service area was approximately 4,000 people. The unique thing about Michigan is that it is surrounded by water. We were about an hour away from Traverse City, Michigan. The closest specialist we had was about 2 hours from Petoskey, Michigan. A fellow from Duke University, Chuck Williamson and I agreed to come to Grayling and be the internal medicine physicians. There was a handful of family physicians, 2 surgeons, and one ob-gyn specialist. We had a very busy office and were responsible for about 80% of patients in the 100-bed hospital. We took turns covering the emergency room. They gave us a house, they gave my wife a job at the hospital, and I signed up for a 3-year tour of duty. In return, I got all my Texas-guaranteed student loans paid off. I got a signing bonus and at the time received a pretty handsome salary. Thus, fairly soon after residency I was financially stabilized.
ROBERTS: How did you enjoy that experience?
MCCULLOUGH: Those were the hardest working years of my life! I got to the office as soon as humanly possible in the morning and did not stop until 10:00 or 11:00 at night. So many patients to see: no students, no residents, no helpers, just a massive amount of work — all the history & physicals, spinal taps, intubations, Swan-Ganz catheterizations, stress tests, gastroenterology procedures, and bone marrow biopsies. I was the first person up in northern Michigan to give streptokinase for acute myocardial infarction. I was the first one to diagnose a case of HIV and report it to the Michigan Department of Community Health. It was a terrific experience. I really enjoyed working with Chuck Williamson. He was the only African-American person in the town. After 2 years, Chuck decided to go back to Duke for a residency program in orthopedic surgery. I decided during the experience that at least half of internal medicine was cardiovascular disease. The other thing I realized was that I craved any type of academic interaction. If a doctor came to town to give a lecture I really broke my back to get there to maintain some connection to academic medicine. The other thing I learned was that there were too many terms that I had no understanding about – relative risk, hazard ratio, odds ratio, and regression analysis. So I negotiated to leave Grayling and go to Ann Arbor, Michigan, for my third year and attend the University School of Public Health. Then work on a public health degree in epidemiology and statistics. I did emergency room coverage and to make an income to keep supporting my family. Then I made my application to cardiology fellowship.
