Tag Archives: Clinical Outcomes

Population (Heart) Health

I had a great time at the national meeting of the American College of Cardiology (ACC) this past weekend.  I hadn’t been to “the meetings” in a few years, in part because my professional focus is no longer primarily clinical and well, I never really liked going even when it was. I generally believed (and still do) that I get more valuable information about new developments in cardiology by reading journals than by shlepping around some gargantuan convention center and listening to a few talks while dodging the barrage of drug and device manufacturers. Now that the results of “late breaking” clinical trials are instantly available (complete with slides and expert analysis) within hours of their presentation, I find the whole convention thing even less compelling.

So (with a nod toward the upcoming Passover holiday) why was this meeting different from all other meetings?

First, I had the pleasure of hearing my brother, David Nash, founding Dean of the Jefferson College of Population Health, deliver the Simon Dack lecture. As I said to him when he first told me he was invited (and wanted to know if it was a big deal), this is a big deal. It is the opening keynote for the conference, and is intended to set a tone or theme for the meeting, which draws almost 20,000 people from around the world. Here is a picture of him being introduced by the President of the ACC:

Nash_ACC

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The New Paradigm

A recent FDA advisory panel recommended the approval of 2 new agents in a novel class of cholesterol lowering drugs known as PCSK-9 inhibitors. What makes this remarkable is that these drugs illustrate all the promise and pitfalls of modern pharmaceutical development.

First, a little science. The target of the new drugs – a protein named proprotein convertase subtilisin/kexin type 9 (PCSK-9) – was discovered in 2001. Two years later, investigators reported that “gain-of-function” mutations in the gene that codes for PCSK-9 were associated with familial hypercholesterolemia and high rates of atherosclerotic vascular disease. Mutations of the gene that led to reductions in the function of PCSK-9 were associated with low LDL-cholesterol levels, and a lower incidence of vascular disease. That made the compelling case that PCSK-9 had a counter-regulatory function in LDL-cholesterol metabolism, so that interfering with its function would lead to lower cholesterol levels.

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So What Else is New?

Steven Brill made a name for himself with an article in Time magazine back in 2013 entitled “Bitter Pill,” in which he harshly criticized how health care providers (especially hospitals) inflate the costs of their services. The piece created a lot of buzz, and some backlash from hospital groups and others. Now it seems that Mr. Brill has had a bit of a “sick-bed conversion.”

He has a new piece in the January 19th issue of Time called “What I learned from my $190,000 open-heart surgery: the surprising solution for fixing our health care system.” Since Time won’t let you read the article without subscribing or paying, I will save you the trouble. It seems that what he learned is that health care providers – the same ones he vilified in 2013 – were pretty great when they were taking care of his heart in 2015. In fact, he now believes that the way to “fix” healthcare is to “let the foxes run the henhouse” by allowing large integrated health systems become insurance companies and compete on price and “brand” and regulate their profits to assure that they are acting in the public interest. Yeah, well, no kidding.

Continue reading So What Else is New?