Pediatrics Leader Weighs In on State of Children's Health

Clifford Bogue, MD, knew from a young age that he loved solving mysteries and working with children.

As a boy, he devoured all the “Sherlock Holmes” books by Arthur Conan Doyle and spent many summers at a sleepaway camp in the mountains of North Carolina, where he worked as a camp counselor and program director. Then, an opportunity as a senior in high school in his hometown of Tampa, Fla., offered a chance to shadow a pediatrician for a week—a pivotal experience that melded his interests into a potential career path.

“I was fascinated by the experience and seeing the impact that doctor had on the children he worked with,” says Dr. Bogue, chair of the Department of Pediatrics at Yale Medicine and chief of pediatrics at Yale New Haven Health System. The experience also showed him that medicine is often about finding pieces of a puzzle and putting them together to answer questions.

“Children often can’t tell you what is wrong with them. They only know what they are experiencing, and you must use a lot of different cues and clues to figure out what is going on. To me, that’s a fun and exciting challenge,” he says.

Since then, Dr. Bogue has become a national leader in his field, specializing in pediatric critical care, leading a research lab that investigated the genetic underpinnings of childhood illnesses, and advocating to prevent firearm violence against children.

Below, Dr. Bogue talks about his work and offers advice for parents navigating the health care system.

I liked the intensity and rapidity of it. You can make a big difference in a short amount of time. I also loved the variety. It's not limited to a certain organ system—we don’t focus on just the kidneys or the lungs, for example. Instead, you need to know a lot about many organs and diseases, while also remaining focused on the sickest of patients and pulling them through.

Children are incredibly resilient. They can withstand more damage to their bodies than adults and still come out strong. Children are also often incredibly hopeful, even when the situation is difficult.

People have often asked me, ‘How can you work in pediatric critical care? It must be so difficult.’ But most of the time, it’s a positive and rewarding field because children bounce back from things that adults never would.

During my residency, my interest was piqued by a physician who ran a basic research lab dedicated to studying lung injury. He became a role model after I saw how he combined his clinical and research work. It appealed to me to be able to do both. I became interested in lung injury and in trying to understand how high concentrations of oxygen injure the lungs.

From there, I realized that if we wanted to understand how to repair lungs, we should understand how they were formed. That’s how I got into studying the embryonic development of the lungs, liver, and cardiovascular system. I started out studying a group of genes called homeobox genes, which are master regulators of other genes, and looking at them in the early mouse lung to see what role they play and how they are regulated. Through that research, we were able to identify a novel gene expressed in the lung in the early embryo, which helped shed light on a lot of embryo development work.

So, I really spent my research career just following that path: What are these genes doing? What are they regulating? What are the pathways? The goal was to understand both the basis of certain diseases, as well as some of the pathways that cause them, with the hope of helping patients with those diseases.

The lab was an opportunity to be creative and to experiment. I liked that you could try things and if they didn’t work, it was just time lost but no harm was done.

In the Pediatric Intensive Care Unit, on the other hand, you only do what works. It’s not the place where someone says, ‘Hey, I have an idea!’ Although clinical work was not very creative, children got better quickly, and I would have that immediate sense of gratification. Whereas in the lab, it might take months to see something take shape.

Over time, I became interested in leading groups of physicians and building programs both within my own section and then, eventually, in the department.

As I was contemplating becoming chair of the Department of Pediatrics in 2017, I was thinking that, if I have X number of years left in my career, how will I make the biggest impact on children? At that point, I thought that having the opportunity to lead a department and be a leader in the hospital, where I could affect the careers of many trainees, and the lives of patients, and families, I would have more impact than if I kept on my original path of focusing on my research.

And I believe I was right. Being chair has allowed me to have a broader voice and influence in supporting education, research, and clinical services.

I’m president of the American Pediatric Society, the oldest and one of the most prestigious pediatric groups in the country, with more than 1,800 members who are academic and research leaders in pediatrics.

Each year, the society decides on an issue to highlight. This year, it’s firearm violence in children. We are trying to bring attention to what is now, unfortunately, the leading cause of death in children.

I’ve gone to Capitol Hill to advocate for funding for more pediatric medical research and other topics that are important to children’s health. Funding research is important because if we can find cures for children, they have many more years to live than if you focus research on someone my age. With a child, it’s a huge multiplier in terms of benefits.

One of the things I’ve tried to support here at Yale is training our physicians to be advocates for children, whether it’s firearm injuries, immigrant health, or other issues.

Some of the newer possibilities and newer drugs being discovered through basic science are exciting. The promise of gene therapy, including gene replacement and correction, will be hugely impactful.

Sickle cell is a good example. Using gene correction and providing treatment early in life through a bone marrow transplant can make a huge difference in quality of life and lifespan. We have already seen this in cystic fibrosis from studying its basic biology. People with cystic fibrosis are now routinely living into their 40s and 50s when most of them used to die by age 18. With type 1 diabetes, we have immunotherapies that are showing great promise.

At the same time, workforce issues can potentially threaten our progress. Fewer students are going into pediatric subspecialty fields. Many groups, including the National Academy of Medicine, are working to understand this trend and make recommendations on how to deal with it.

I have two grown children—a daughter and a son. Parenthood has given me much more empathy and understanding of what parents go through. We didn’t have children when I was a resident or a fellow. We had our first when I was an early attending physician, and before that, I often found it hard to understand why people do what they do or how they could let their children do certain things. After becoming a father, I realized how hard it is and what a struggle it can be.

On the other hand, having grandchildren is pure fun. My grandchildren are in North Carolina, which at least is an easy flight from New Haven.

Be persistent. Navigating the health care system can be difficult, but be a strong advocate for your child. If you feel like people aren’t hearing you, keep at it.

Something I’ve learned as a pediatrician is to listen to the parent. They might not know the proper terminology for a particular body part or how to say, for example, ‘My child is having bronchospasms and needs an inhaler.’ But they know when their child isn’t acting right and something is wrong. I tell young physicians to pay attention to that.

I’ve always enjoyed the spontaneity, joy, and enthusiasm children bring to everything and the fact that you can be goofy around them. We have a teddy bear clinic at the Bridgeport Hospital campus, where kids can bring their teddy bears in for a check-up. This is a fun way to expose kids to nurses and doctors and get them comfortable in a medical setting.