10 QUESTIONS WITH IBD DOCTOR PETER HIGGINS
Ride4IBD recently spoke with Dr. Peter Higgins, or better know on Twitter as @IBDdoctor . Doctor Higgins is an avid Zwifter, cycling fan, and in his words a “Physician scientist studying inflammatory bowel disease, working toward reproducible medical research”.
Doctor Peter is a highly respected Physician and Researcher, with credentials ranging from : Professor, Division of Gastroenterology, Director, IBD Program, Chair, GI & Hepatology Research Advisory Committee, Director, Michigan Clinical Trial Support Unit (M-CTSU), and Chair, AGA IMIBD Section.
Here are our 10 Questions with Doctor Peter:
1. Peter, tell us who you are and what you do?
I am the Director of the IBD Program at the University of Michigan. I do research, teaching, and clinical care of IBD patients. My research includes working to understand the mechanisms of inflammation and scarring in IBD, development of new therapies and new ways to measure bowel damage, and clinical trials of new therapies in IBD. I teach fellows how to take care of IBD patients, and how to do reliable and reproducible research.
2. What compelled you to focus on researching IBD?
I knew that I wanted to do medical research, so I pursued an MD/PhD combined program leading to both degrees, and a master's degree in clinical research. IBD was a compelling area for several reasons.
When I started as an intern, infliximab was approved as the first biologic for IBD, which meant that we likely had enough understanding of the disease to start making real breakthroughs (which has turned out to be true over the last 23 years).
The patients are often young, and effective treatment means a big gain in quality of life for many years - a lot of impact
The patients, as a general rule, really want to get better, and are willing to do what it takes (participate in research, try a new drug) to make that happen. That is not always the case in other diseases.
3. Peter you are an active Zwifter, what got you into cycling and why do you love it?
I grew up biking just to get around our small town, and cycle-commuted though graduate school. Then residency happened, and I did not ride for a while. I got back into it when I joined a neighbor with a regular weekend ride group, and upgraded my ride (Specialized Roubaix) when I joined the faculty. We mainly are in it for the outdoors (Border 2 Border off-road trail in Ann Arbor), the camaraderie (there is a required mid-ride stop for donuts and coffee), and the exercise. I usually try to work up to one century ride per summer.
Zwift became a part of my riding after a shoulder injury in the fall of 2019, and became a huge part of my cycling after March of 2020.
The gamification and badges are motivating, and it is a lot of fun to see steady progress.
Peter Higgins on Zwift
4. In the realm of IBD Research, what has changed the most from when you began your work until today?
We have found that:
IBD is a lot more heterogeneous that we thought in the 90s. More than 150 genes involved. So there are a LOT of different flavors of IBD. Unlikely that a single medication will work for all people with IBD.
We are getting a much better handle on bits and pieces of the mechanisms of IBD. As we identify new molecules and pathways (IL-23, JAK, S1P), which have lead to many new treatment options.
We are just starting to take a page from the Oncology approach, and starting to explore combination therapy in earnest.
We are slowly getting a better understanding of the role of the gut microbiome (bacteria, fungi, viruses) in IBD. It is important (many of the genes are focused on reacting to bacteria), but we are still working out the details.
We are just starting to understand intestinal scarring (fibrosis) that causes intestinal blockages, and developing targets for new medications to slow or reverse scarring.
5. What latest research brings you the most excitement and or hope when it comes to IBD?
The number of late-stage new therapies in clinical trials.
New anti-fibrotic therapies that could reduce intestinal obstruction and surgeries in Crohn's.
New rapid induction protocols with tofacitinib for severe UC that could reduce colectomies.
Lots of work on the microbiome and stem cells - which may be new avenues for effective therapies.
6. Why do you Ride4ibd?
Because I know how far we have to go to bring new understanding to IBD, and new therapies to improve patient outcomes. And, I know how much rigorous research costs, both in money and person-time.
* Doctor Peter recently rode the Crohns and Colitis Zwift charity event, raising over $2,000 himself.
7. What is the biggest misconception related to IBD?
That people with IBD can't live full lives, including career aspirations and having families.
8. Do you have a favorite cyclist and race to watch?
2 favorites.
While he seems like a Paul Buynan-esque legend, Marshall "Major" Taylor was real. A sentimental favorite.
Also, one of my IBD lab technicians, Laura Johnson, (I believe still) holds the women's 35-39yo 24 hour US record (set in 2005) with 416.5 miles in 24 hours, which I still find ridiculous.
A good city criterium is always fun to watch, though awfully dicey in the turns.
9. Why is it important for IBD to have outlets like cycling to build community and awareness?
It is especially important to get outside, bond as a community, while encouraging each other, and cycling is an accessible way to demonstrate the benefits of exercise for both physical and mental health.
10. What is your advice to newly diagnosed IBD patients?
1. Take a deep breath, your life is not over.
2. This is a chronic disease, and you will need to work on long-term management. Remission is an important goal, and it is the first step toward leading a full life.
3. There is a lot to learn, and it will take time. Lean on trusted sources like the CDC and the CCF (and IBD School videos - https://www.youtube.com/playlist?list=PL818426534AC030E0 ), rather than paid ads on the internet.
4. Keep asking questions - the research in the field changes all the time
5. You will often have to weigh short-term (rare) risks against long-term benefits. It really helps to bet on the long-term.
6. Prepare for doctor visits. Write down a list of questions, and get answers.
