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Young researcher wows cardiologists

High school senior presents cardiac care disparities study

By Katrina Woznicki
MedPage Today Staff Writer

Scott Casale presents his study, a project he did "for fun," at the Heart Association's annual meeting.



Science and Technology
Applied Sciences

LANCASTER, Pennsylvania (MedPage Today) -- Scott Casale couldn't have been more pleased when the American Heart Association accepted his research study for presentation at the group's big annual meeting a month ago, a gathering of the world's most prominent cardiologists.

But the heart association needed his title for the program. Was Casale a Ph.D. or an M.D.?

Casale doesn't have a Ph.D., or an M.D., or any other kind of title after his name. He hasn't been to college yet.

He's just a high school senior who decided to conduct a study about racial disparities in cardiac care.

"They e-mailed and asked what my title was," Casale said. "I said I don't have a title. I'm an 18-year-old high school student and they e-mailed back and said, 'Wow.' "

Actually, Casale, a student in Lancaster, Pennsylvania, about 85 miles west of Philadelphia, turned 18 on November 2, just two weeks before he and his father flew to Dallas, Texas, for the meeting. He managed to squeeze in an 18th birthday celebration between rehearsals of his presentation at the family dining room table.

Born to medicine

A roomful of middle-age cardiologists may have been surprised to see a teenager speaking from the podium about how African-Americans and low-income people receive angioplasty treatment less often than whites. But those close to Casale know well that this straight-A student with an unquenchable curiosity about the world is a remarkable achiever. The eldest of three children and the son of a cardiologist father and gastroenterologist mother, Casale appears to have been born to medicine.

His interest in health care disparities grew after he participated in a project with his grandparents that involved sending boxes of donated goods to struggling families in Nicaragua.

"This project gave me an understanding of the extreme poverty that exists in developing nations," he said.

That got him thinking about poverty in his own country, which led to a cultural eye-opener for the budding scientist.

"I was surprised that health care disparities exist in the United States," Casale said.

Genesis of project

He began to do some digging. Casale, who played on his school's basketball, tennis and golf teams, decided to forgo basketball last winter, focus on his studies, and pursue an independent research project for fun. He turned to his dad, the cardiologist, and friends and acquaintances for help.

First, he called the Pennsylvania Health Care Cost Containment Council, an independent state agency that tracks hospital and ambulatory care, to get the data. He explained his project and asked the council to fax some statistics to his father's office.

Then his father, Dr. Paul Casale, who is in private practice, introduced his son to his own medical school mentor, Dr. Richard Devereux, a professor of medicine at Weill Cornell Medical College in New York and director of the echocardiography laboratory. Devereux, listed as a co-author on the study, helped guide the younger Casale through the reams of data coming through the fax machine. The two e-mailed regularly discussing the research. Devereux advised Casale to keep an open mind.

"He said not to stick straight to your hypothesis, but to be willing to factor in the different angles," Casale said. Devereux also encouraged Casale to submit his findings to the AHA for possible presentation.

Watches angioplasty

Meanwhile, Paul Casale arranged for his son to observe him performing an angioplasty procedure on a patient. Scott Casale got into hospital scrubs and stood near his father in the catheterization lab while his dad talked him through the procedure.

"I was amazed how this small little wire with a stent can do such a marvel as opening up a heart artery," he said.

He also turned to the parent of a classmate for assistance. Carol J. Fuster, a sociologist and professor of nearby Franklin and Marshall College, helped Casale understand the sociological aspects of his study. She is also listed as a co-author.

Casale submitted his abstract last May. Three months later, the AHA invited him to present his report.

Negotiating news conference

Casale and his father flew to the meeting in Dallas. The AHA knew a good story when it saw it and arranged a news conference for the 18-year-old the day before his study, which helped prepare him for what it would be like to give his presentation.

"I was expecting a press conference like what President Bush does, with reporters in your face and cameras going off, but it wasn't like that at all," he said. Instead, he talked for five minutes about his upcoming presentation.

On game day, both father and son were nervous. The normally calm-as-a-cucumber cardiologist admitted he was anxious. "But when he started talking," Paul Casale said, "he really did seem poised and then I relaxed. And I was nervous for him about the questions he might get, because he's not as familiar with medical terminology, but I thought he really did a good job."

Casale described his son as a natural scientist who "has the joy of discovery."

Scott Casale said he plans to take his abstract and turn it into a full paper, which he intends to submit to a medical journal, although he's not sure which one. The abstract was published in a recent issue of Circulation, an AHA journal.

Shoots for chemistry

Meanwhile, high school graduation approaches, and Casale, one of 46 students in his class, is busy preparing college applications. Casale said he intends to major in chemistry, thinking that would be a good scientific base on which to build a possible medical career, although he isn't sure about medicine just yet.

"I'm going to wait until college to make a decision about going to medical school," he said.

And what does Casale do in his free time, when he does have free time? He hasn't had time for a girlfriend lately because "my research takes up so much time." The young scientist does, however, possess a strong artistic streak and likes to unwind by playing the piano at home.

"I love Debussy and Beethoven," he said, with Debussy's "Claire de Lune," his favorite.

But although Casale is willing to take his research to the stage, don't expect him to appear in Carnegie Hall any time soon.

"It's just a release," he said of his piano playing. "And it's a good skill to have as an adult. Girls like it."

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