By Gay Lyons

Dr. Malcolm Foster, Director of Cardiovascular Research at Tennova Healthcare, came to Knoxville to work at Baptist Hospital, which had “the biggest heart program in the city.”

“I was given one nurse for a year,” he said. “We now have five full time nurse research coordinators, and we’ve done over 100 clinical trials.”

“In medicine, when we take care of patients, especially in cardiology, we are very much evidence based,” he explained. “It’s based on clinical trials. We ask ‘what are the standards of care?’ and ‘what are the optimal practices?’”

“We have excellent health care in Knoxville,” he continued. “Everyone strives to follow guidelines and do evidence-based medicine. In cardiology, we’re particularly focused on that. For example, in trying to figure out the best treatment for heart attacks, we did trials involving over 40,000 patients.”

“We’re participating in clinical trials that will change guidelines going forward,” he said. “I get to provide treatment that is ‘next step.’ We look at new drugs and new devices that we compare to older drugs and devices. Clinical trials go one step beyond that: You don’t know whether it’s going to be better; we think it will, but you don’t know until you do the trial.”

Foster is especially proud of a ‘first in human’ study for hypertension involving an implant in the carotid artery.

“Most ‘first in human’ studies are performed outside the U.S.,” he explained. “To be selected and to do this study in the U.S. is very special.”

Medicine was a logical career path for Foster. “I had good role models,” he said. “My grandfather was a doctor; my dad and my uncles became doctors. My mom was a nurse who became a professor of nursing. As a kid we talked a lot of medicine at the kitchen table. My sister is a Ph.D. psychologist. My brother, who is in the music business in New Orleans, is married to a veterinarian. We joke that everyone’s Dr. Foster except my brother.”

Following undergraduate work at Duke University, medical school at Wake Forest and internship and residency in Baltimore, Foster began specialized training in cardiology starting with a cardiology fellowship at Vanderbilt.

“As a medical student, I loved every rotation,” he said, “but I loved cardiology best, in particular treating heart attacks. They come in, and they’re having a life-threatening heart attack. You open up a blocked artery, and you literally restore life right before your eyes. It’s extraordinary. Foster describes himself as an interventionist but also says he emphasizes prevention every day.

“I’m trying to put myself out of a job,” he said. “It’s impossible, but I’m trying. Over half of all adults will have some form of cardiovascular disease. It’s the number one health consideration. If you put all the cancers together, it’s still a fraction of that number.”

“We’re in an area considered part of ‘the stroke belt,’” he continued. “We’ve made progress in treating patients; your chance of dying is much lower than in the past. But on the prevention side, we’re not making much progress. In fact, we’re getting worse. We have major challenges: unhealthy foods, fast foods, processed foods, foods that are cheap, highly available and over consumed. People are eating junk, and they don’t realize it. There are people who have never eaten healthy. Eating habits have gotten so far away from healthy eating. People have forgotten what healthy portions are. Super sizing is a real killer.”

“We’ve made progress with smoking,” he said, “but vaping is a set back. The FDA is looking at that. Maybe it ought to be regulated like cigarettes.” “There’s no silver bullet, but there are lots of copper bullets,” he concluded.

Foster and wife Beth, a Public Relations professor at the University of Tennessee, have been married since 2015. The family includes five children: Miranda, age 25, and 21 year old twins Mac and Natalie and Beth’s sons, Spence and Rollin Avery, ages 10 and 7. Medicine and family are priorities for Foster, but he also enjoys being part of a four-person group of investors who own Nama, Cru and Shuck.

“It’s been fun,” he said. “You get to go experience your investment. I’m like a ‘secret shopper.’”