Peter Kowey was born in Norristown, Pennsylvania, January 4, 1950, and that is where he grew up. He graduated from Bishop Kendrick High School in June 1967 as Salutatorian and received a Presidential Scholarship to St. Joseph’s College in Philadelphia where he graduated in May 1971, Cum Laude with a BS in Biology and was a member of the Alpha Sigma Nu honors program. From there he went to the University of Pennsylvania in Philadelphia for medical school graduating in 1975. His internship in internal medicine was at the Milton S. Hershey Medical Center, Philadelphia, in Hershey, Pennsylvania, and his fellowship in cardiology was at the Harvard University School of Public Health and Peter Bent Brigham Hospital in Boston, finishing in June 1981. His major mentor was Dr. Bernard Lown. After completing his cardiology fellowship, he returned to Philadelphia, joining the Medical College of Pennsylvania as director of the coronary care unit and of the cardiac arrhythmia service. He rose to full Professor of Medicine and Pharmacology by 1990. He became chief of the division of cardiovascular diseases of the Mainline Health System, Bryn Mawr, Lankenau and Paoli Memorial Hospitals in 1999 and has remained in that position to the present. He also occupies the William Wykoff Smith Chair in Cardiovascular Research. From 1990 until the present he is also Professor of Medicine and of Clinical Pharmacology at Jefferson Medical College of The Thomas Jefferson University in Philadelphia. He was Clinical Professor of Medicine at MCP/Hahnemann/Drexel University College of Medicine from 1992 – 2003. He also serves as president of The Heart Center of Lankenau, Bryn Mawr, and Paoli Memorial Hospitals.

Throughout this 30-year period since finishing his training Dr. Kowey has been a prominent researcher primarily in the area of cardiac arrhythmias and conduction disturbances and these investigations have led to over 300 publications, mainly in peer-reviewed medical journals. He has been the recipient of numerous grants through the years in support of his research. He has been an ad hoc consultant to numerous pharmacologic and device companies. Through the years he has received numerous awards for his research and leadership accomplishments. He has edited or authored 11 books including 2 novels, one entitled Lethal Rhythm and the other, Deadly Rhythm . Dr Kowey has been on numerous advisory boards particularly with the Federal Drug Administration and also numerous monitoring boards of major multi-center studies. Dr. Kowey is the happy husband of Dorothy Freal Kowey and they have 3 very successful daughters. Dr. Kowey is also a wonderful human being who possesses a great sense of humor, a wonderful storytelling ability, and is a star speaker at most of the meetings where he presents. It was a real pleasure getting to know Dr. Kowey and I hope the readers feel the same way.

WILLIAM CLIFFORD ROBERTS, MD (hereafter ROBERTS ): Dr. Kowey, I really appreciate the opportunity to talk with you. Peter is here in Dallas and in my office and this is 19 November 2013. Dr. Kowey is in Dallas for the Annual Scientific Sessions of the American Heart Association and we were fortunate to get him to come to Baylor University Medical Center to give Grand Rounds earlier this morning and he graciously agreed to allow this conversation in my office thereafter. He is also giving a 12 noon presentation to the Baylor cardiology group. Peter, may we start by my asking you to talk about your early life, where and when you were born, your parents, and your siblings so we all can get a feel of your early life.

PETER RUSSELL KOWEY, MD (hereafter KOWEY ): First of all thank you for the opportunity to sit and chat with you. I have enormous respect for the work you have done with the AJC over the last many years. I think these interviews are important to provide a perspective about people who have been laboring in this field. Our fellows and young faculty know very little about the people who have gone before them.

I was born January 4, 1950, in Norristown, Pennsylvania, a small town about 20 miles west of Philadelphia. My father was Lebanese. My paternal grandparents had emigrated from Beirut, Lebanon. My mother was Italian and her parents had emigrated from Naples, Italy. Both of my parents were extraordinarily hard-working people. They both dropped out of high school – my mother in the tenth grade and my father in the ninth. My mother’s mother had died and she had to take over the role of mother for her younger siblings. My paternal grandfather sold fruit and vegetables off the back of a pick-up truck in the Philadelphia suburbs, and he needed my father to drive the truck for him. That’s how my father became a truck driver, which was his occupation for the next 45 years.

ROBERTS : What was your father’s name?

KOWEY: Peter Sarkis Kowey. Sarkis is a common name in Lebanon. Sarkis was a fourth century saint who is revered in Lebanon.

ROBERTS : When was he born?

KOWEY: He was born in 1921.

ROBERTS : Is he still alive?

KOWEY: He died in 1995 from diabetes.

ROBERTS : Did he have it when he was young or older?

KOWEY: When he was older. He was obese and didn’t take good care of himself. He developed pretty severe macro-vascular disease.

ROBERTS : What was your mother’s name?

KOWEY: My mother’s name is Edith Adeline Sagrantz. All four of my grandparents came through Ellis Island and their names were severely altered. Kowey is actually “Khoui”, and Sagrantz is “Sicoronza.” My grandfather had a particularly bad experience when he arrived and they asked his name. Boutros is a name that goes back several generations in my family. So he memorized the English translation and said “Peter.” But Lebanese people have a hard time with the “p” sound so it came out “Beter.” The clerk recorded his last name as “Beter.” My grandfather then said Joseph, thinking they next wanted his middle name, but that was recorded as his first name. So, he became Joseph Beter. When my father was born, he had to be named Peter in the tradition of the family, so for several years my father was known in his hometown as Peter Beter. Fortunately for me, he changed his name back to something like the Lebanese when he was married, and he became Peter Sarkis Kowey. I was given the middle name of Russell because I had two uncles by that name.

ROBERTS : When was your mother born?

KOWEY: 1920.

ROBERTS : Is she still alive?

KOWEY: No, she died in 2004 from progressive supranuclear palsy.

ROBERTS : So neither your mother nor your father finished high school? Do you have siblings?

KOWEY: I have one younger brother, Richard Brian Kowey. He was born in 1958.

ROBERTS : What does he do?

KOWEY: He is an executive vice president for a gas company. A very successful businessman and a real good guy.

ROBERTS : Does he still live in the Philadelphia area?

KOWEY: He lives about 20 miles north of Philadelphia.

ROBERTS : Does he have children?

KOWEY: He has 2 daughters, Erin and Emily.

ROBERTS : What was home like as you were growing up?

KOWEY: I think it was terrific. We lived in a blue-collar neighborhood, in a very modest house. My parents didn’t have much money, but they were warm, engaging people. They were also very bright and they had a strong opinion about the value of education. They were completely and utterly convinced that my brother and I had to get as good an education as possible. They spent a lot of time helping with homework and encouraging us to do well in school.

ROBERTS : Both your father and your mother or mainly your mother?

KOWEY: My father was on the road a lot, being a truck driver.

ROBERTS : Eighteen-wheeler?

KOWEY: Yes. The funny thing is I was a truck driver. When I was in college he got me a job driving a truck during the summer.

ROBERTS : It’s hard to get drivers I understand.

KOWEY: Back then there wasn’t driver training like there is now. But I loved it. It was great getting out on the road on your own, especially in nice weather. I made a lot of money too, as a card-carrying Teamster.

ROBERTS : So your parents were born here?

KOWEY: Yes. They both were born in or near Philadelphia.

ROBERTS : Did you know your grandfather?

KOWEY: I knew my paternal grandfather and grandmother. But both of my mother’s parents died before I was old enough to know them.

ROBERTS : Your father’s father was born in Lebanon. What was his name?

KOWEY: He was Boutrus Khoui and as I said, he became Joseph Beter, born in the 1890s and he passed away in 1970.

ROBERTS : And your paternal grandmother?

KOWEY: Katherine Farhatley Khoui, and she also was born in the 1890s. She passed away in 1986.

ROBERTS : As you were growing up, your father may or may not have been at the dining room table each night?

KOWEY: He frequently was on the road.

ROBERTS : It was often early on just you and your mother? Your brother came along 8 years later. What did you talk about?

KOWEY: I remember it being pleasant. There was a lot of discussion about what I was doing at school. There was a high priority to get my schoolwork done, not that I couldn’t go out and play after school. But I remember that homework always got the priority. We were one of the first families on the block to get a television set. My mother and I would watch some television before I went to bed. I remember watching the little black-and-white screen. My mom was a very warm person, great cook, and very nurturing. We had a good relationship.

ROBERTS : Home life was pleasant?

KOWEY: I don’t remember it being onerous or burdensome in any way. She had a really good knack for getting me to do what I was supposed to do without slamming her fist on the table. I was spanked but rarely.

ROBERTS : You and your father got along also?

KOWEY: Yes we did. He was a bit more distant, due to his work but we had a good relationship. Sports were one of the ways we communicated because he was a big Philadelphia sports fan and made me into one as well. A lot of our conversations over the years had to do with how the Eagles or Phillies were doing.

ROBERTS : Did you go to those sporting events with him?

KOWEY : Yes. Some of my most vivid memories from childhood are going to Connie Mack stadium to see the Phillies or Franklin Field to see the Eagles.

ROBERTS : Did you go on vacations?

KOWEY: Yes. My dad got 2 weeks’ vacation every year and during one of those weeks, we went to Wildwood, New Jersey. That was our big vacation.

ROBERTS : What did you do there?

KOWEY: We stayed at a boardinghouse, went to the beach every day, and the boardwalk at night for the amusement rides. Pretty standard Jersey shore stuff but we enjoyed it immensely. My mother’s sister and her husband would bring their two girls, and we had a blast.

ROBERTS : When you were growing up, you, did you go on big vacations across country? Or did you stay close to home?

KOWEY: The only time we left Philadelphia was to visit an aunt in Florida every few years. We took this big pilgrimage by car to see her in Orlando. Never flew anywhere. First airplane ride was during my medical residency.

ROBERTS : You didn’t have a lot of money but you had enough for you to think your childhood was pleasant?

KOWEY: Yes. Recently, my hospital asked me to visit my old stomping ground in Norristown. We get patients from that area and they thought it would be good PR to have me out in my old community to talk about my childhood in a commercial. So I went with a film crew to my old house. I hadn’t been there in a long time and was amazed at how tiny it was. In my mind, we had a large backyard, but it was really not much bigger than your conference room. I remember spending hours throwing baseballs up against the garage wall, and shooting hoops on a basket my father nailed up on the wall of our house. I had enormous fun in that backyard and in the stone covered, narrow back alley behind our house, but in reality, it was a very modest place.

ROBERTS : In grammar school, did you enjoy going to school?

KOWEY: I did. I went to a Catholic grade school for 8 years, which was within walking distance of our house, about half a mile. The first few years, my mother would walk me to school, but then I would walk myself. I had nuns for teachers. I have very vivid memories of their discipline techniques. For example, there were 106 children in my first grade class with one nun, who was somewhere between 80 and 100 years old. She kept that class perfect. Nobody talked because if you did, you were immediately struck. Not hard, but firmly. And the other thing I remember is the way we sat in that classroom; there were 10 rows of 10 seats, and then there were 6 people who didn’t get a full desk. The way you were seated was by your grades. So the top kids in the class got to sit in the first rows and the kids with the lowest grades were in the last rows. It was that way through grade school; every class had the same arrangement. Never any question about who was doing the best. It was cruel, but it did provide strong motivation to work hard. We graduated about 70 of those 100 kids and I keep up with a small number of my classmates.

ROBERTS : Do you remember the names of all your grammar school teachers?

KOWEY: They were all Sister something. Sister Mary Thomas, Sister Anna Theresa. I remember most of them quite well.

ROBERTS : Did any of them have an extraordinary effect on you?

KOWEY: I took piano lessons when I was in grade school. The sisters who taught me music had the biggest impact because I spent a lot of time with them. But I would say they were all extraordinary. These were women who had given up their lives essentially to teach us. They weren’t all highly skilled, but they were totally dedicated and gave their time unselfishly.

ROBERTS : And you felt it?

KOWEY: Yes.

ROBERTS : Did you have a piano at home?

KOWEY: Yes. After I took lessons for a couple of years I was bugging my parents about getting a piano. It was a big deal because it cost a lot of money. The piano that we were looking at cost about $800, which back then was 4 weeks of my fathers’ salary or more. It was a tough decision for them. But they finally bought it and delivery day was one of the best days of my life. I practiced on that piano for hours.

ROBERTS : You really enjoyed music. Were you a natural at it? Were you good at it?

KOWEY: Not really. I realized after 8 years of taking piano lessons that I didn’t have much musical talent. I learned because I worked at it. I played the trumpet and French horn in high school, and the organ in church, but I never excelled. But the experience has given me a great appreciation of excellent music.

ROBERTS : Do you sing?

KOWEY: I took vocal lessons. Whenever I sing in the shower, my wife will tell me that whatever my parents spent on vocal lessons was a waste. I’m afraid she is correct, as she usually is.

ROBERTS : Where did you get your great storytelling ability from? Was your mother a good storyteller?

KOWEY : She was excellent. She loved to tell stories about growing up and her family experiences. I have a very large extended family. My mother had 13 siblings, my father had 7, and each of the siblings had lots of children, so I had an enormous number of cousins. I still can’t keep track of all of them. When we had large family gatherings, all the cousins would sit around and ask my mother to tell stories about her years in Bridgeport, the tiny town where she grew up, just over the bridge from Norristown. She told great stories, down to the little details. I admired her for that. I think that was probably the seed.

ROBERTS : What would be a story she would tell?

KOWEY: She told many stories about her father. He was kind of a nasty person who disciplined them harshly, like locking them out of the house if they didn’t get home on time, even in bad weather. But he was also an interesting character. He sold ice cream off the back of a truck for a living. We have a picture of him with the truck. What I found out recently from one of my older cousins was that my grandfather made an enormous amount of money and no one could figure out how. Turns out he was probably a bootlegger. The ice cream was a front. He would be selling ice cream to kids on one side of the truck and on the other side he would be selling hooch to adults.

ROBERTS : How old was your mother when she found out how he made his money?

KOWEY: She never found out. It was my cousin who discovered the story, long after my mother passed away.

ROBERTS : What about your father, was he a good storyteller?

KOWEY: No, he was pretty quiet and kept his emotions to himself. He was a worker. My work ethic comes from him. At any given time, my father would have 3 or 4 jobs. He fixed television sets back when TVs had tubes and were easy to repair. He used to service and grease cars and trucks on the side. He would fix appliances. Then he bought some old houses, fixed them up, and rented them out. He liked to be busy.

ROBERTS : He was an entrepreneur.

KOWEY: He was the breadwinner and took it very seriously. I remember a conversation I had with him. We were talking about families. He said, “I don’t like to hear crap about ‘loving your family.’ You love your family by supporting them. Your job when you get married and have kids is to go out and make money for them and to get them a good education. That’s showing your love.” That conversation had a major impact on me. I have spent my career making sure that whatever I do, there are funds for the mortgage, food on the table and money for tuition payments.

ROBERTS : That’s good. Were your mother and father a close couple?

KOWEY: They were very close. They were each other’s best friends and they had a great relationship. A lot of it came from adversity. My father’s parents did not want my father to marry my mother. She was Italian, and they wanted him to marry an Arab, like them. A lot of his siblings didn’t really care for my mother either. My parents were insistent, got married and loved each other to the day they died.

My father didn’t get drafted because he had asthma. He couldn’t get into the service but he worked in a shipyard as his service requirement. He did not make much money back then. They lived in a tiny apartment and had no frills. I think that experience brought them closer together.

ROBERTS : When they were both at home, which doesn’t sound as if it happened a lot, what was it like?

KOWEY: It was terrific. Because since my father wasn’t home much, when he was home it was a celebration. One of his favorite things would be to bring something home from wherever he had been to cook. Like when he went to Maryland, he would bring back crabs. He might arrive home in the middle of the night because his run ended late. He would wake us all up, have the pot on the stove with the water boiling, and we would throw the crabs in and have a feast at 3:00 am in the morning. It was an event. When he left we were sad, and when he came home we were elated. I remember well the ebb and flow of our emotions.

ROBERTS : You entered the ninth grade, what did you do after the first 8 years in school?

KOWEY: I went to the local Catholic high school, Bishop Kenrick . Again, nuns and priest dominated as the teachers, but it was a pretty ordinary high school existence. I played intramural team sports but not too many because I was in the band. I was also on the debate team and a few other clubs.

ROBERTS : Were there any teachers in high school who had a particular influence on you?

KOWEY: Mr. Murray, an English teacher, was the director of the debate team. He taught me a tremendous amount about presenting in public. It has helped me in my career to speak comfortably in front of people. I’m not intimidated, and I think it was due at least partially to my experience on that debate team.

ROBERTS : What did he do? What did he teach you?

KOWEY: He taught English, but what he taught me was how to stand up in front of a group of people and present an argument that is cogent. Not to just fire facts at people but to build a story so people buy into your point of view. It was a debate society so you wanted people to be convinced. It worked. We had a great debate team and were the champions of the Catholic league several times. But a lot of it was because Mr. Murray was good at making us understand how to present arguments. It was a very good education. A number of my teammates became successful lawyers. Not a big surprise.

ROBERTS : You would have been a great lawyer.

KOWEY: My wife says that. She is a lawyer and she says that we goofed. She would have been a much better doctor because she is more compassionate. I like to argue and should have been the lawyer in the family.

ROBERTS : How did Mr. Murray learn so much about teaching how to debate?

KOWEY: He had been with the school for several years and director of the debate society for so long that he had learned a good deal. He was one of those naturally smart guys. I remember he was a chain smoker. Those were the days when you could smoke right in front of everybody. He died of lung cancer several years after I graduated. Too bad, he was a great guy.

ROBERTS : Did you work during high school?

KOWEY: I worked part-time for Mack Truck selling truck parts. I worked in the parts department one afternoon during the week, Saturday morning, and during the summer.

ROBERTS : You always had some spending money in your pocket.

KOWEY: Had to because it wasn’t coming from anywhere else. My parents weren’t stingy but just didn’t have much to give.

ROBERTS : Did you enjoy your work?

KOWEY: I really think that my ability to connect with patients is because I spent a lot time with people at different socio-economic levels through my life. I dealt with truck drivers and laborers a lot. When I see such people as patients, I don’t feel like I’m talking down to them. I understand where they’re coming from. That’s why I encourage kids to work during their schooling. It’s not just for the money. You get exposed to other ideas and people and it’s a valuable life experience.

One bad outcome from that experience is that I acquired a foul mouth. I was hanging around people who spoke that way and it stuck. I don’t curse too often now, but when I’m on the golf course and hit a bad shot, it can get pretty nasty.

ROBERTS : Did learning come easy for you in school or did you have to work at it?

KOWEY: I think it came pretty easy. I worked hard but I don’t remember having to struggle to learn things.

ROBERTS : Were there books around your house? Did your mother encourage you read?

KOWEY: Another big purchase that we made and that was a big decision for my parents was the World Book Encyclopedia. I was dying for those books. They finally bought a set and spent a lot of time reading them.

ROBERTS : You probably read them all, didn’t you? How old were you then?

KOWEY: I would have been probably around fifth or sixth grade.

ROBERTS : Learning appealed to you?

KOWEY: Yes.

ROBERTS : When you were talking about college, were you one of the first ones in your extended family to go to college?

KOWEY: The very first.

ROBERTS : Who gave you information on colleges?

KOWEY: I have a great story about that. It was October of my senior year and I got a letter from St. Joseph’s University. I knew St. Joe’s was a great place, and that they had a good basketball team. I knew where the school was, but had never been there. The letter said, “Congratulations. You have been awarded a Presidential Scholarship to St. Joseph.” Back then, the principals of Diocesan high schools in Philadelphia were allowed to allocate scholarships to the major Catholic colleges in Philadelphia. My principal learned that I was interested in St. Joe’s, and, without telling me about it, gave one to me. I hadn’t even applied to the place. My father came home that evening and I showed him the letter. He said that’s fantastic and that is where you’re going. I said I hadn’t even seen the place. He said to get in the car and he drove me 20 miles into Philadelphia, circled around the campus 2 or 3 times and said, there now, you’ve seen it. And that’s where you’re going. I reminded him that I hadn’t even applied. So he finds the admissions office, which is closed, and starts knocking on the door until an elderly priest came to the door. My father asked for an application and told me to fill it out in the car. He took it back to the Jesuit, got back in the car and said, “Congratulations – you’ve found your college.” And that was my college interview and selection experience.

ROBERTS : That was early on in the year?

KOWEY: This was in October of my senior year of high school.

ROBERTS : So your high school principal knew you were bright. You were the only one recommended for St. Joe’s. And it was a full scholarship?

KOWEY: I think it was a half scholarship. It was a substantial amount of money and my father was crazy for it.

ROBERTS : You attended St. Joe’s for college? It was 20 miles away from home? Did you live on campus? Did you have your own car?

KOWEY: I commuted for the first 2 years. I have to laugh because my father who fixed cars made sure he got me a car to drive to Philly, but it was really a clunker. It was an old Oldsmobile Cutlass and I used to literally pray it wouldn’t break down while I was driving to St. Joe’s, especially on exam days. I was never really sure I would make it. When it did stop working, my father and I would patch it up and get me back on the road.

ROBERTS : How long did it take to drive to college?

KOWEY: About an hour with traffic.

ROBERTS : An hour each way?

KOWEY: Yes.

ROBERTS : How did medicine come into the equation?

KOWEY: For as long back as I can remember, I told people I wanted to be a doctor. I’ve tried to understand where that came from. We had a family doctor who I just idolized, named James Barthold . He was a primary care doctor with an office but he had no nurse, no appointments and no fancy equipment. He wore a suit and used a beautiful fountain pen. His office was nicely furnished, but the most important thing was two English Spaniels that were in his waiting room. I loved those dogs. I would ask to go to the doctor so I could see them. I think I got so enamored with Dr. Barthold – I thought he was so cool – that I began to tell people I was going to be a doctor. There was no other place it could have come from. Nobody in the family or nobody we knew or none of our friends – nothing else that I can trace it to.

ROBERTS : Did you have many illnesses growing up?

KOWEY: Nothing serious. Measles, mumps, that kind of stuff but I was a healthy kid.

ROBERTS : But you liked him too, he was a good guy.

KOWEY: He didn’t talk to me a lot but I just admired him. He was so confident and reassuring when my parents would go into his office. They always came out feeling as if something good had happened after he took care of them or me or my brother.

ROBERTS : What was your implication when you say “he always wore a suit and had a nice pen” that he used? What did that do to you?

KOWEY: I just admired the whole show. I thought he had put it all together and had figured out how to be a good doctor and how to portray himself as a professional and as a highly principled person who was really concerned about his patients.

Years later, when I was in college, I had a summer job as an orderly in our local hospital. I had to shave and prep the male patients before their surgeries. One day I got a list of the patients I had to shave and one of them was Dr. Barthold who was having a gallbladder operation. I almost lost it I was so nervous. I went to his room and he remembered me. It was crazy. We had a conversation catching up on my family and his. I got to tell him I was going to medical school and how he had influenced me. I never saw him after that. He died a few years later. I was grateful for the closure.

ROBERTS : What did you do in college, other than travel back and forth from home? Were you involved in any activities?

KOWEY: I was a biology major and a member of the biology club, and the pre-med honor fraternity. Most of my activities were science related. I played a lot of tennis and worked out with the team. I also played golf.

ROBERTS : Your father liked golf?

KOWEY: Yes he did. He was a terrible golfer, but he loved the game. It gave him a chance to hang out with his friends.

ROBERTS : Did you take up tennis before college?

KOWEY: Yes. Played some in high school and then in college. I wasn’t good enough to actually be on the competition squad.

ROBERTS : You look like you were a good athlete. Did you run fast?

KOWEY: I liked playing any sport. I was a good shortstop in Little League. I didn’t hit well but had a good glove and arm.

ROBERTS : Have you kept exercising through the years? Still play tennis and golf?

KOWEY: Yes.

ROBERTS : What’s your handicap?

KOWE Y: 11 or 12. It depends on the time of year.

ROBERTS : How tall are you?

KOWEY: 5′8″.

ROBERTS : What’s your weight?

KOWEY: 170.

ROBERTS : College was quite an experience for you. That was the first time you were really out of the home.

KOWEY: The last 2 years I got into an apartment, which I shared with 3 other pre-med guys. We lived off campus. This did not make my father happy. He thought I was wasting money because I could still have lived at home.

ROBERTS : Were you paying for it?

KOWEY: Most of it. They were helping out a bit.

ROBERTS : You did work all through college?

KOWEY: I did.

ROBERTS : With the auto parts job initially?

KOWEY: Yes, mostly delivering truck parts. Then I had all different types of jobs – soda canning factory, boxing soda cans for delivery. I worked in a steel mill one summer because that paid very well. The goal was to make as much money as possible during the summer. I had jobs pretty much through college.

ROBERTS : When did you realize you were smart?

KOWEY : Probably sometime in college. It dawned on me after my second or third year that I was going to be okay.

ROBERTS : How did you do in college? Were you graded conservatively? What year did you enter college?

KOWEY: 1967. I had a pretty rugged freshman year and didn’t do as well as I thought I would. Inorganic chemistry was tough and I had a calculus course that I just didn’t nail. My GPA after my first year was about 3.0, which wasn’t going to cut it for medical school. I don’t know what happened to make me switch gears but I didn’t get another B. I pretty much aced the next 3 years.

ROBERTS : What did you do different?

KOWEY: I remember studying a bit harder, being able to game the system a little bit better. Not just putting the time in but knowing how to maneuver things and study efficiently. I wasn’t just picking gut courses because I took all the usual pre-med stuff but I got on a roll.

ROBERTS : Where there any teachers/professors in particular that had a prominent influence on you?

KOWEY: The guy who ran the biology department was Louie Marks and he was a real character and looked a lot like Groucho Marx. He was a feisty guy. He really ran a tight ship. His goal was to get as many of the premed biology majors into medical school as he reasonably could. He did an amazing job. Katie Nash taught us comparative anatomy and was a wonderful person too. She was a former Ms. Maryland. She taught us when she was in the fifties, but she was still gorgeous. We all loved her even though she was a tough grader and her course very demanding.

ROBERTS : How good a college/university is St. Joe’s?

KOWEY: It’s an excellent Jesuit educational experience. It’s not a large place but the Jesuits have a great tradition of emphasizing reading, writing, and thinking. The basics. So when you graduate, you have the tools to achieve. I am on the board of The College of Arts and Sciences now at St. Joe’s and spend a lot of time there, including doing a little teaching and mentoring pre-med students.

ROBERTS : What is the student body when you were there?

KOWEY: There were about 400 people in our graduating class.

ROBERTS : The entire school was how many?

KOWEY: Two thousand. Up to about 4,000 these days, but still a pretty small school.

ROBERTS : When you graduated, do you know what your ranking was in your class?

KOWEY: Pretty sure I was in the top 25.

ROBERTS : If it hadn’t have been for your freshman year you would have really been up there. How did you go about getting into medical school? Who was your advisor then?

KOWEY: Dr. Marks was our principal advisor. We all applied to the same places in Philly– Penn, Jefferson, Hahneman, Temple, and Penn State. Everyone applied to all those schools.

ROBERTS : You got into Penn? Were there many that got into Penn?

KOWEY: 35 people from St. Joe’s applied to medical schools my year. There was a lot of interest because it was an automatic deferment, which meant no Viet Nam for those of us with low draft numbers. One guy got into Hopkins and Harvard, five of us got into Penn, and everyone else got into other schools in Philly. It was an amazing year, very smart class.

ROBERTS : How did Penn hit you?

KOWEY: I was in an accelerated curriculum in which we did basic sciences in one year before starting our clinical rotations in our second year.

ROBERTS : You got put into the accelerated group from college?

KOWEY: The whole class was in the accelerated program. The goal was to get us all in the clinic early, and have a lot of time to go back to do electives in either the basic sciences or in the clinic.

ROBERTS : How many were in your class at Penn?

KOWEY: About 150.

ROBERTS : So what happened? Was medical school what you thought it was going to be like? Was there any major surprises? Did you find it a major step up from college?

KOWEY: It was a major step-up from college, and it was a difficult for me. I remember the first several months of medical school being very intimidating. I was anxious about fitting in at such a sophisticated and advanced institution. But after a few months, I began to realize that I was fine academically. I had been well prepared and totally competitive with the students in my class. By the second semester of the first year, I was feeling better about being there. I also had a very positive experience at the Radcliffe Infirmary in Oxford between my second and third years of medical school. I did well on that demanding clinical rotation with Professor Paul Beeson as my attending, and I became much more confident about my clinical abilities.

ROBERTS : You started medical school in 1971? Who paid for your medical school?

KOWEY: My father wanted me to go to Penn State –Hershey because the tuition was a fraction of Penn’s tuition. He couldn’t understand why I chose Penn. Penn State was $700 a year and Penn was $3,000. He said he would pay what Hershey charged and I would have to make up the difference, which meant grants, loans, and working.

ROBERTS : Did you get some scholarships?

KOWEY: Probably got half in scholarship and the rest was grants and loans.

ROBERTS : In medical school you lived near the campus?

KOWEY: I got an apartment near the art museum in Philadelphia because my two roommates were going to Temple Medical School. They were friends from college. We decided to get someplace in-between our two schools.

ROBERTS : Who had extraordinary impact on you in medical school?

KOWEY: There were a number of psychiatrists who had an impact on me in medical school. They were not psychoanalysts but neurobiologists who were interested in neurochemistry and membrane physiology. I did some research and got interested in the chemical basis of psychiatric disease. Believe it or not I planned to do a psychiatry residency at Penn. I had to do a year of medicine first. I picked Hershey since it was close. It was a new medical school and an interesting hospital.

I arrived at Hershey and was assigned in my second month to the coronary care unit with an every other-night rotation. My two attending physicians were Barbara Roberts and Robert DeJoseph, just out of their training and very enthusiastic. I spent three months with them attending and was completely and utterly seduced into cardiology, especially arrhythmia management. I went to the Chairman of Medicine, Graham Jeffries, and asked him if I could stay and do three years of medicine so I could apply for cardiology fellowships. He said fine.

ROBERTS : Hershey Pennsylvania at that time was a brand new medical school.

KOWEY: Yes.

ROBERTS : That was really the first time you had been away from home?

KOWEY: Yes, first time out of Philly.

ROBERTS : How did that hit you?

KOWEY: Hershey was a small town. There wasn’t much to do so the residents bonded. It was one of the most collegial experiences of my medical career. I still keep in touch with many of them. We hung out together and became involved with each others’ families. I enjoyed it.

ROBERTS : When you were in medical school, did you have a hard time as you rotated through specialties deciding what you wanted to do?

KOWEY: Yes I did. I liked everything I saw. But I the assignments that interested me the most by far were the psychiatric rotations. I was terribly interested in behavioral medicine as it related to physiology. I became convinced that psychiatric diseases are biochemically mediated. It was just a question of figuring out how.

ROBERTS : Maybe that brought you more into drugs that you have subsequently been on?

KOWEY: I perceived that the heart was going to be easier to study than the brain. That we were going to learn a whole lot more about the biochemistry of the heart and how drugs affect the heart than we would about the brain. The heart is a lot more accessible to study and much less complex than the brain. It was the same idea; I just switched organs.

ROBERTS : Was there any other experiences in medical school that had a lasting impact on you?

KOWEY: I discovered in medical school that I liked procedures, I like to use my hands. I discovered that cardiac procedures were fun. It was a different way of interacting with the patient. The other thing I developed was a deep appreciation of literature and how it influences our field.

ROBERTS : You knew before medical school was over that you didn’t want to go into private practice?

KOWEY: I think that was pretty clear to me even before medical school.

ROBERTS : You said you got involved in research in medical school with neuropsychiatrists but you didn’t publish any manuscripts. When was your first publication?

KOWEY: In my cardiology fellowship.

ROBERTS : How did you get your cardiology fellowship?

KOWEY: Barbara Roberts had trained at the Brigham. She and I had several conversations about where to look for fellowships. I was pretty sure that I wanted to do electrophysiology at that point. I was interested in cardiac rhythm problems after my coronary care unit rotation. But this was happening just as electrophysiology was getting started. Hein Wellens had just published his experience with programmed stimulation of the heart, so the discipline was in its infancy. There were only a few places in the country where you could go and have any expectation of getting training in electrophysiology – Penn, Duke, Stanford, Indianapolis, and the Brigham. I applied to those programs. I didn’t get into Duke or Stanford. I interviewed with Doug Zipes at Indianapolis and didn’t get accepted. I enjoy giving him a hard time about that.

I was getting very nervous after multiple denials but finally got that positive phone call from Bernard Lown and Tom Graboys at the Peter Bent Brigham. I guess it was February of my second year of residency.

ROBERTS : This was what year?

KOWEY: February 1977.

ROBERTS : You started in July 1977?

KOWEY: I started in July 1978. Back then you applied for fellowship during the second year of your residency.

ROBERTS : At that time, Braunwald went to the Brigham in 1972. What kind of program did Bernie Lown have at the Brigham in 1978?

KOWEY: There were several services at the Brigham. Richard Gorlin and Ed Sonenblick had departed for New York. Lew Dexter was still there, but Gene Braunwald had really established himself at the Brigham before I got there. Lown had labs and offices in the Harvard School of Public Health but he had a large clinical service at the Brigham. So there was the Braunwald fellowship and the Lown fellowship. Many Braunwald fellows spent some time on the Lown service and the Lown fellows rotated on the Brigham clinical services. Most of my catheterization and echocardiography training was on the Brigham services. My research and arrhythmia training was with Lown. In many ways, I got the best of both worlds.

ROBERTS : Tell me about Bernie Lown. I went on a trip with him when he was head of a delegation to study sudden death in Moscow about 1972. He was an absolute charmer. How did that work out for you?

KOWEY: If you asked me to pick the person who had the greatest impact on my professional life, it would have to be Dr. Lown. He is one of the most fascinating people I’ve ever met. He was brilliant but personable, conversant – able to talk to almost anybody – patients or presidents. But the thing that made the biggest impression on me was his clinical skills. He is simply a master clinician. He is an amazing doctor. The most striking thing about him is his intuition at the bedside. He was able to arrive at the truth, even with what all of us thought was pretty superficial evidence. An astounding talent.

ROBERTS : He had trained with Sam Levine?

KOWEY: Yes.

ROBERTS : Did you have any contact with Sam Levine?

KOWEY: Sam passed away before I got to Boston. But we spent a lot of time talking about him. Lown was Sam Levine’s fellow and partner for decades. They were more father-son than colleagues. I have a copy of one of Dr. Levine’s original textbooks. It is page after page of commentary about patients. There are no tables, no figures, just information about patients he had seen. He had a photographic memory of all of the patients he had ever cared for. He taught Lown to be a master cardiologist.

ROBERTS : How much time did you spend with Bernie Lown? Did you make rounds with him? He had a substantial private practice, right?

KOWEY: Yes he did. We had two rotations with Dr. Lown. The first was on the clinical service at the Brigham. For 3 months we rounded with Dr. Lown daily. The other rotation was in his private office. We were assigned to the office rotation for 3 months. It was pretty intense.

ROBERTS : What do you mean by intense?

KOWEY: He is very demanding. If he asked a question, you had better know the answer because he does not suffer fools. Dr. Lown would also make the fellows write his notes. My first reaction to that idea was decidedly negative. But I was surprised to discover that it was fine and completely within the spirit of our relationship because we were literally at his knee. He was teaching me even as he was dictating his note. It was an extraordinary experience. I’ve never seen anything like it in medicine. It was an apprenticeship in every sense of the term.

ROBERTS : Who were you fellow colleague fellows when you were there with Lown?

KOWEY: Rodney Falk, Jeff Matos, and Betty Corrigan were the other three in my year. Peter Friedman, Elliot Antman and Bill Colucci were Braunwald fellows at the same time.

ROBERTS : Was it a 3-year program at that time?

KOWEY: It was a 2-year but most of us ended up spending more time there.

ROBERTS : How did you get into electrophysiology?

KOWEY: I was captivated by the whole idea that you could observe arrhythmias on the body surface. I fell in love with electrocardiography. I thought it was the coolest thing I’d ever seen. That you could record somebody’s heart rhythm on the body surface, analyze it, and diagnose arrhythmias was fantastic. Then you had the opportunity to put catheters inside the heart and record arrhythmias and learn even more. You could even stimulate the heart to arrhythmia, administer drugs, and observe the effects of the drugs on electrical properties. It put everything together – anatomy, physiology, pharmacology, pathology. I fell in love.

ROBERTS : How did you start doing EP procedures?

KOWEY: It was during my first year of fellowship with Dr. Lown. Phil Podrid, who became one of my best friends, had just finished his own fellowship and was doing catheter procedures at the Brigham. They took place in the Levine Cardiac Unit in a small procedure room. We carried a homemade stimulator from the dog lab. We used a single right ventricular catheter, induced ventricular arrhythmias, placed the patient on an antiarrhythmic drug, and determined its effectiveness in suppressing inducability.

ROBERTS : Did Bernie Lown do any of those procedures himself?

KOWEY: No, he never did the invasive procedures himself.

ROBERTS : But he knew what was going on in there?

KOWEY: He would come in and observe and tell us what he thought. .

ROBERTS : When did you leave Boston? You were there 3 years?

KOWEY: I left at the end of 1981.

ROBERTS : And you came back to Philly?

KOWEY: I did. It was a tough decision. I had a couple of offers to stay in Boston. I considered an advanced fellowship at MGH. But my parents were still in Philly. My whole family was in Philly. I thought it was important to go back. I went to the Medical College of Pennsylvania, which was a medical school in Philadelphia. It doesn’t exist anymore. It got absorbed into Hahnemann. They wanted me to start a program in electrophysiology. It was an opportunity to build something from scratch.

ROBERTS : How long were you there? That’s a big private hospital.

KOWEY: Yes it was. It was a private medical school hospital. I was there 9 years.

ROBERTS : But you had a lot of patients there.

KOWEY: It was cool because they allowed me to build an electrophysiology practice from scratch. Over those 9 years that’s exactly what I did. The only other established program in Philadelphia at that time was Penn.

ROBERTS : But you started moving around in Philadelphia so after those first 9 years where did you go?

KOWEY: I moved once to Lankenau in 1990. That was it. I’ve been there ever since.

ROBERTS : But you’ve had appointments at Hahnemann?

KOWEY: Correct. MCP was absorbed into Hahnemann-Drexel so that was where the Hahnemann appointment came from.

ROBERTS : But physically you didn’t move?

KOWEY: No. I never spent any time at Hahnemann or any other school.

ROBERTS : When you went to Lankenau where did that name come from?

KOWEY: John D. Lankenau was a German entrepreneur and in 1860 he opened a hospital for German-Americans in Philadelphia called “The German Hospital.” In 1861, it was commandeered by the Union for wounded soldiers. It reverted back to the German Hospital after the war but shortly thereafter was named The Lankenau Hospital after its founder. In 1955, it was moved to where it is now, the former grounds of the Overbrook Country Club. It is situated one block west of the Philadelphia city line.

ROBERTS : What was the advantage/disadvantage to that?

KOWEY: No wage tax. That’s a big advantage in hiring nurses, and staff who work at the hospital. It’s a perfect location at the top of the Main Line. We are right next to several nice residential areas so we have a wonderfully diverse demographic.

ROBERTS : How big of a hospital is it?

KOWEY: About 380 beds.

ROBERTS : When you were there in 1990, why did you go there?

KOWEY: Leonard Dreifus was the chief of cardiology and he was retiring. So Len actually called me and asked me if I would be interested in looking at the job. Initially, I wasn’t interested because it wasn’t a university hospital. But it was a large teaching hospital and it had its own fellowship. Len had built a beautiful basic electrophysiology laboratory. I had a basic lab that I knew I could transfer there. Most importantly, they didn’t have much clinical electrophysiology. It was an opportunity for me to bring my clinical practice there, to continue my research and help with the fellowship program. It had all the components I was looking for. Plus I didn’t have to move from Philly, which made my family happy.

ROBERTS : Where do you live?

KOWEY: I live in Bryn Mawr, which is ten minutes west of Lankenau.

ROBERTS : When did you start dating and how did you meet your wife?

KOWEY: I’m in my second marriage. My first wife and I met in college when I did that operating room orderly job. She was an operating room student nurse. We met, got married and had one beautiful daughter.

ROBERTS : You were married in medical school?

KOWEY: Yes, after the second year. We divorced after about 7 years of marriage. It was a relatively amicable divorce. We both realized that we wanted to go in different directions. She lives in North Carolina now and is still an OR nurse. We are friends and keep in touch. I met my present wife when I was at the Medical College of Pennsylvania. She was the head nurse of the coronary care unit. That was in 1982.

ROBERTS : You weren’t single very long in between those marriages?

KOWEY: No, I divorced in 1981 and remarried in 1986.

ROBERTS : What is your wife’s name?

KOWEY: Dorothy Freal Kowey.

ROBERTS : Now, she is a lawyer now?

KOWEY: Yes. She got tired of being a CCU nurse administrator. She went to law school but didn’t like the law so much. Now she is a potter and very good at it.

ROBERTS : At home? Or does she have a studio?

KOWEY: We have a studio in our house. She also does stuff at our local arts center. She was a Fine Art major at Penn and then realized she couldn’t make a living doing that so that’s why she went to nursing school. Now she’s back to art. She’s a pretty extraordinary person for whom I have great respect.

ROBERTS : You have a daughter by your first marriage and another daughter by Dorothy and Dorothy has a daughter from a previous relationship?

KOWEY: Yes. Our youngest is an adopted daughter. So I have a biological daughter and Dorothy has a biological daughter and together we have an adopted daughter. It’s truly a “modern family” unit.

ROBERTS : How did you do that?

KOWEY: When my daughter went to college, we were still relatively young and we didn’t want an empty nest. We had some difficulties getting pregnant so we decided to adopt. Dorothy was in legal practice at the time. Her secretary came in one day crying because her son’s girlfriend was pregnant and they weren’t able to keep the baby. She asked if we might want to adopt the baby. We jumped at it, and that’s how we adopted our daughter, Olivia.

ROBERTS : Your children’s names are what?

KOWEY: The oldest is Susan Kealy, born 1969; the middle one is Jaime Shean, 1977, and the last is Olivia Kowey, 1990. Olivia is in Law School. Susan and Jaime are practicing attorneys.

ROBERTS : So when you all get together, what’s it like?

KOWEY: I tell lawyer jokes. I always try to find one that stick pins in them but they don’t care. They just ignore their silly father. Susan is a Trust and Estate Lawyer in Boston, and Jaime is in California and does credit law. My son-in-law in Boston is on the law faculty at Boston University and my middle daughter’s husband is an intellectual property and patent attorney. And we are blessed with six beautiful grandchildren.

ROBERTS : Peter, what is your day like right now? What time do you get up in the morning?

KOWEY: I’m up at 4:30 in the morning. I make sure our dogs do their business and are settled. We have three Portuguese Water Dogs who like to crawl back into bed with my wife after I get up. Then I exercise on an elliptical trainer and rowing machine for about 30 to 45 minutes. I then shower and dress and I am at my desk before 6:00 am. Between 6:00 and 8:00 I try to do something creative. If possible, I try to get some work done on one of my novels. Once I get to 8:00, things get pretty hectic. The components of my days are similar but one day is never completely like the last. Two days a week I see patients. I have a lot of administrative meetings since I run the Division. I have a fair number of research meetings with my staff about various projects. I do a fair amount of consulting so teleconferences are dispersed through the day. I have a teaching responsibility for the fellowship and residency at Lankenau but I also have a faculty appointment at Jefferson so some of my teaching time is at Jefferson downtown. Every day is a menagerie of things that are all set up for me ahead of time by my amazing secretaries. Donna and Roe have been with me for decades and have kept me on a very even keel.

ROBERTS : When do you leave the hospital at night?

KOWEY: I rarely leave later than 6:00. Since I don’t see my wife in the morning, I feel strongly about getting home and spending time with my family. I don’t do dinner meetings or symposia very often. I try really hard to preserve some quality time with my wife—and my dogs, of course.

ROBERTS : Do you do work at night?

KOWEY: No. I did when I was younger but now that my day starts so early, I am pretty used up after dinner. So we just relax, I have a Scotch, and we put our feet up and watch something on TV. I can afford to do that because I work very efficiently during the day. I work at my desk while I have a small lunch. No time is wasted.

ROBERTS : How many staff do you have in cardiology at Lankenau?

KOWEY: I’m the head of cardiology for Main Line Health which has 4 hospitals in the system. There are about 100 cardiologists within the system. I’m administratively responsible for those cardiologists.

ROBERTS : Do you make those appointments or do you just approve them?

KOWEY: We have a fulltime faculty at Lankenau that I have more control over. The other hospitals are mostly private practice and they hire as they wish. All staff privileges and faculty appointments come through me.

ROBERTS : How many cardiologists are at Lankenau?

KOWEY: There are about 30.

ROBERTS : How many fellows do you have?

KOWEY: Sixteen. (Three-year fellowship and 4 per year). We usually have 2 interventional fellows and 2 electrophysiology fellows.

ROBERTS : How many administrative, laboratory and other staff do you have?

KOWEY: I’d have to sit down and count. Just say a whole lot.

ROBERTS : Do you know most of them?

KOWEY: I know almost everybody because I’ve been there so long. In fact I still have people that I brought with me from MCP. My personal secretary, Donna, has been with me for 32 years. Most of my staff is very senior, and very good.

ROBERTS : Going through your CV I’ve never seen a list of consulting as long as yours. My own view is that physicians and pharmaceutical companies need to work together more rather than less. Your list impresses me rather than an opposite view of it. How did you get involved with evaluating so many drugs?

KOWEY: First of all, I completely agree with what you just said. The only way to advance therapeutics is with industry support. Nearly every important therapeutic intervention in medicine has come with industry support. Even ideas that start in academic laboratories eventually need industry backing. Development is just too expensive. If industry is going to do a good job, they need help. That’s a very important part of what I do.

ROBERTS : When was your first appointment to the FDA?

KOWEY: 1984. I was just a pup. Two years out of training. When I was a fellow I had worked with Public Citizen, a healthcare advocacy group in Washington run by Sid Wolfe. We published an article about unnecessary pacemakers and it got noticed. I actually ended up testifying about overutilization of pacemakers at a Senate Subcommittee meeting. Sid nominated me to be on the Cardiorenal Advisory Committee as the consumer nominated representative. I honestly had no idea what I was doing. I got to the first meeting and was so naïve. I opened my mouth and said something incredibly stupid. Ray Lipicky ran that division back then and he just let me have it. Remember, this was a public hearing of a new drug application and he basically destroyed me—and I deserved it. I quickly realized that this was a very important assignment and that I had to be better prepared. I started to really get into it. We would get these huge boxes of information to be reviewed prior to the meetings and the data were very interesting, as were my colleagues. Bert Pitt, Ray Woosley, Craig Brater, Milton Packer, Lloyd Fisher, Jeremy Ruskin, Craig Pratt were all members of that committee. They were great. We would have meetings 4 to 6 times a year. They asked me to come back for a second term and I continued on for 10 years. I was also on the FDA CV device committee for 4 years. Then I rotated off and as soon as I did, I started getting calls from drug and device companies asking if I would consult for their company. That’s what started it. I agreed. I knew the ropes and could help them with their development programs. We got a lot of clinical trials started that way and a lot of drugs approved.

ROBERTS : How much do you travel?

KOWEY: I have made a real conscious effort to stay out of airports. I do a fair amount of traveling in the northeast corridor but I don’t like being away for long periods. The nice thing about living in Philly, not that it was planned, is that we are close to Boston, Washington, New Jersey, Delaware, and New York, where almost all pharmaceutical companies have offices. So it’s usual for me to get where I need to be by car, or train.

ROBERTS : You see patients 2 days a week? Is that a morning or afternoon?

KOWEY: It’s usually all day.

ROBERTS : You still have quite a big practice?

KOWEY: Yes I do.

ROBERTS : Do you do EP procedures anymore yourself?

KOWEY: No, I gave that up several years ago.

ROBERTS : Was that hard to give up?

KOWEY: I thought it was going to be hard. I was sad initially but it freed me up and I was so happy about getting out from underneath what was a crushing schedule. I realized I was hurrying through procedures trying to beat the clock to get to a meeting. My partners love it because I feed them a lot of cases and they enjoy procedures.

ROBERTS : Are you on salary?

KOWEY: Yes. Straight salary.

ROBERTS : No matter how many patients you see?

KOWEY: I am paid for patient care as well as the administrative stuff. I convinced our Administration that a straight salary was best for me, that I didn’t need any incentives. I wasn’t going to stop seeing patients or sit on my hands.

ROBERTS : That’s nice. You’ve done a lot of investigative work through the years, what contribution that you’ve made are you most proud of?

KOWEY: One of my first projects when I started at MCP was the implantable defibrillator. I got to know Mirowski very well and he agreed to let us implant the original device. Toby Engel and I actually put in the third device in the world in 1982. Sinai in Baltimore was first, Stanford second and then us. We stayed on the vanguard and produced several important papers about that new technology. We were really in on the ground floor.

I’ve also had a hand in the development of several drugs that are being used in cardiovascular medicine. I helped in various stages in the development of those drugs. For example, IV amiodarone was one of our most important projects. The oral formulation was approved in the 1980’s but we had to spend several additional years on the development of the intravenous formulation. Mel Scheinman and I directed the clinical trial work that eventually got the drug through the FDA regulatory process. There are a lot of other examples of antiarrhythmic drugs, drugs for other cardiac indications, and most recently the novel oral anticoagulants. I am very proud of helping to get those drugs out to patients who need them.

ROBERTS: You and Ray Woosley. Anyone else?

KOWEY : Jim Reiffel, Jerry Naccarelli, Craig Pratt and a few others have worked hard in this space. It is challenging to say the least.

ROBERTS : Have you been offered head of any pharmaceutical company just out of curiosity?

KOWEY: No one has ever offered one to me formally. I’ve had people assess my level of interest, but I’ve had none.

ROBERTS : No interest?

KOWEY: No. I like what I’m doing. I never wanted to ascend the academic ladder, and I never wanted to go into industry. I’ve always wanted to see patients and be a cardiologist. The best thing about what I’ve been able to do is preserve my practice for 30 years and at the same time do lots of other interesting things. There is no other job that would have allowed me to do that.

ROBERTS : Is cardiology at Lankenau a separate department or are you in the Department of Medicine?

KOWEY: We are in the Department of Medicine.

ROBERTS : As a division of cardiology?

KOWEY: That’s correct.

ROBERTS : Do you have much contact with whoever is chairman?

KOWEY: Yes. The guy who has been chairman for the past 20 years just stepped down and was replaced with another Infectious Disease physician. I have had good relationships with both of them. They have been very nice about leaving me alone because it works. We went from an averaged sized good cardiovascular program when I started to an immense program. We have tripled our revenue generation. We just built a $500 million Heart Pavilion on our campus. It’s been a successful cardiovascular program because I’ve had a clear vision of what I wanted to do. A lot of my success was predicated on the idea that I wasn’t leaving, I wasn’t looking to become a dean or a president of a pharmaceutical company.

ROBERTS : Do you take vacations?

KOWEY: I take time away for different reasons. In the summertime we take a couple of weeks off to go to our lake house in the Poconos, my favorite spot in the world. I get a lot of my writing done up there. But other than that it’s more in the flow of where meetings are being held. My wife will come along and we will spend an extra day or two at a nice place. We go out of our way to travel to see our grandchildren. We have three in California and three in Boston. They are the love of our lives. I am a sucker for lecture invitations in either place.

ROBERTS : How did you get into the novel writing?

KOWEY: The Jesuits in college encouraged us to use our right brain. They thought it was good for bio majors to take courses in other areas and I loved creative writing. I never pursued it. I knew that I could write well but I never had the motivation until I was in a court room defending a cardiologist in a malpractice case in 2004. A young woman who had long QT syndrome and had not been properly diagnosed died suddenly. The family sued everyone who had ever seen her including the cardiologist. The patient’s husband was a multimillionaire. He was on the stand testifying how much he missed his wife and didn’t know how he was going to live without her or who was going to take care of their children. None of it was true but nobody could tell the jury because it was prejudicial. I was furious because I knew the facts. To vent my spleen, I decided to write a story about the case. I had a yellow pad and pencil and I started scribbling. Once I started writing I just couldn’t stop. I was like a maniac. I wrote the first draft in a few months but it was terrible. I still have that draft and can’t believe I wrote something so stupid and prejudicial. The characters and scenes were poorly drawn. So I took some courses and started working on cleaning it up and it got better, with help from some friends. I finally managed to find a publisher. Lethal Rhythm was a success. There was a lot of excitement about it and the publisher agreed to a second book, Deadly Rhythm. My third book will be titled Empty Net and should be out next year. It’s been so much fun. I’ve had an opportunity to meet some interesting people including a few who might be able to help to make the books into a TV series or movie. I’ve met people all over the country – publishers, literary types I never would have known. I’ve learned a tremendous amount.

ROBERTS : When do you write?

KOWEY: Early morning generally, but I try to carve out a few hours to write whenever I can.

ROBERTS : If you get up at 4:30am, what time do you go to bed?

KOWEY: No later than 10:30p

ROBERTS : So 6 hours is normal for you and you feel good on that amount?

KOWEY: Yes. I take a 20 minute nap every day in my office. It’s essential. I never go out to lunch. I sit at my desk, have a small lunch, and then stretch out on the floor with a pillow. I wake up spontaneously and feel terrific.

ROBERTS : So you and Tommy Edison….

KOWEY: He almost never slept at night. He would work 4 hours and nap for a short time and then start working again. I just take one nap. If I don’t get that nap when I’m at work, I’m dead. My afternoon is ruined. The phone gets turned off and my secretary knows what is going on. I recommend naps to my patients, especially my elderly patients. There is a good reason for siestas.

ROBERTS : You were born in 1950. You are stepping down from your cardiology chiefship when?

KOWEY: In about 1½ years.

ROBERTS : You are 63 now?

KOWEY: I’ll be 65 when I step down.

ROBERTS : But you don’t have to step down? That is a voluntary move on your part?

KOWEY: I’ve been chief for 25 years and I think it’s time for someone else to take over. I think if I went longer I would just get stale and I think it’s time for somebody with new ideas to take over the reins. I’m going to stick around. I’m not leaving but I’ll be part time. I’ll support my successor because I want him/her to be successful. I think there comes a time in everyone’s life when it’s time to step aside.

ROBERTS : What do you want to do after your retirement?

KOWEY: Whatever I want to do. That’s the goal: to wake up and plan the day with my wife. I want to write more, continue to do consults, and research. I’ll still see patients, just not as many. I want to get out from under the administrative meetings and be more independent.

ROBERTS : Do you do much malpractice testifying? I’m sure you are called all the time.

KOWEY: I get lots of phone calls. I take cases selectively. I have a low threshold for taking a look but I’m rarely in the courtroom. I only take cases about which I feel strongly. Fortunately, if I write a strong opinion, the cases generally don’t go to court. But I will go if I have to.

ROBERTS : D oug Zipes does a good bit of cases, doesn’t he?

KOWEY: Yes. There are a few excellent people who do it selectively, like Doug, Eric Prystowsky, and Bob Myerburg. I feel obligated to do it because I think there are clearly cases wherein physicians have been taken advantage or where they haven’t really done anything wrong and deserve to be defended.

ROBERTS : What do you think Obamacare is going to do to your activities?

KOWEY: I’m so far along in my career that I don’t think it’s going to have a major impact on me personally. There is potential for Obamacare to turn cardiology on its head. The end game of Obamacare is a capitated environment. There will be a fixed allotment per year per life and the ACO will be allowed to spend the money any way it chooses. But when the money runs out that will be it. If that happens, fee-for-service cardiology will vanish and we will no longer value people who do lots of procedures the way we do today. It will turn the world upside down. I think that is a good thing because we are doing way too many procedures and we over utilize technology and underutilize people’s brains. It’s going to be painful transition but I think that’s where we need to head.

ROBERTS : What do you think about all the expensive procedures that physicians and surgeons do? What’s going to happen to them?

KOWEY: I think as a society we are going to have some tough decisions as to how we allocate them. We’re not going to be able to do as many and there will have to be some mechanism put into place to select patients who are most likely to benefit because we just can’t go on the way we are. We just don’t have enough money. Technologic advances continue, in the drug and the device side of cardiology without much regard for the cost issues. We are creating an amazing tension between what we can do and what we might be allowed to do. I can’t bring any new technology or treatment into our hospital anymore without first being able to sit down and explain to an administrator what it’s going to cost, what it’s going to replace, and how much money it’s going to generate. This includes new drugs, devices, and diagnostic procedures. They all have to be justified economically. In the old days if you wanted something new, you went out, bought it, and that was it. We’re going to see progressively more scrutiny.

ROBERTS : There are a lot of hospitals in Philadelphia, medical schools and some of those are going to close in relatively near future.

KOWEY: I wouldn’t say near future but I think there’s certainly going to have to be an adjustment. As we get into less bed utilization and less technology, there are a number of hospitals that are going to have difficulties. Hard to say at this point when that will happen and which ones will be the losers, but I think that there is going to have to be some consolidation. You are right about Philadelphia being a very tough environment, especially in cardiology. We have way too many cardiologists. We have more Electrophysiologists in the Philadelphia metropolitan region than the United Kingdom.

ROBERTS : How do you keep track of that?

KOWEY: It isn’t easy. We used to train our competition. Fortunately, more of our trainees are heading out to practice in other parts of the country.

ROBERTS : You put that in the contracts?

KOWEY: No, that wouldn’t be fair to them. We did try to put a hold on our electrophysiology fellowship for a couple of years and not train people, and we were told that we would lose our accreditation.

ROBERTS : What about 4 cardiology fellows per year, that’s a lot.

KOWEY: We are not the largest program in Philadelphia. I think we are sized well. You need to have a critical number of trainees to maintain the quality of the program.

ROBERTS : What’s your view on the new statin guidelines?

KOWEY: It amazes me as a trialist that people can come out with a whole new paradigm without any new data. There were no new data that generated this guideline reformation. Guidelines are like that—based on a lot of opinions. As far as I’m concerned it’s a tempest in a teapot. I think doctors will continue to measure lipids and disperse medicine based on an objective laboratory measurement not based on a risk score. I hope the new guidelines don’t choke off lines of research. There are several new drugs coming along that will help us treat patients at risk. Guidelines don’t necessarily do us a whole lot of good. They are not the standard of care but they are interpreted as such, and help lawyers when they sue doctors. Doctors aren’t fully aware of what’s in the guidelines. There are at least six or seven AF guidelines that are all different from each other. So which one are you supposed to pay attention to? I think we are going overboard with them. I’m still going to measure cholesterols and LDLs and give statins if they are elevated.

ROBERTS : What do you do for fun?

KOWEY: My wife says I have ADHD but I do a lot of different things. I play golf and tennis, and ski – downhill and cross-country. We like to sail and bike too. We have three Portuguese waterdogs that need a lot of exercise. We are total dog nuts. I like taking walks through the woods with the dogs. My daughters have kept me interested in a lot of things. Our youngest daughter is attending law school in Philadelphia now and finds great restaurants and shops for us to go to. We love to spend time with the grandchildren. They range in age from14 down to 6, and are continuously amusing. We have a very busy life but a happy one.

ROBERTS : Is your daughter in Philadelphia?

KOWEY: No she is in California.

ROBERTS : And your second daughter?

KOWEY: Dorothy’s daughter is in Boston.

ROBERTS : How far is your lake house from your home?

KOWEY: One hour and 40 minutes, 92.6 miles. It’s a terrific place on Lake Naomi. It’s a developed community with a lot of amenities and our house is set back off the lake in the woods. It’s heaven.

ROBERTS : Are you religious?

KOWEY: I was raised a Catholic. I was an altar boy and did all the Catholic stuff growing up. But somewhere along the way I lost the Catholic thing. I still believe there is a lot of what the Catholics teach that’s important but we don’t go to church. The ritual does nothing for me.

ROBERTS : Peter is there anything you’d like to talk about that we haven’t touched on?

KOWEY: No, I think you did an amazing job of covering things. I’m at an interesting point in my life. We spend so much time at the beginning of our careers organizing what we are going to do. We thought it was complicated and it was, but we had a single goal: medicine. This part of our lives is even more complex because we have so many wonderful choices. What are you going to do when you are not the chief, or running a department? We have to make good choices. I’m looking forward to this time of my life and excited about organizing things, for me, for my patients and, most importantly, for my family.

ROBERTS : I think this has been terrific. Thank you.