Editor’s note: Once again Larry was too depressed to write the 2016 yearly review. (Actually, he’s hiding under his bed.) Veteran healthcare journalist and eternal optimist Candide Corn has again kindly agreed to take over the task this year. Candide’s motto is “all is for the best in the best of all possible worlds.”
What a great year! In fact, I’m pretty sure it was the greatest year ever, but I have this absolutely amazing feeling that 2017 is going to be even better, so I’m saving “greatest” for next year. Of course, there are a lot of nonmedical reasons why 2016 was so great, but healthcare and cardiology were swept along in the huuuuge current of amazing great changes that swept the nation. So here we are, poised for our ascent to maximum biglyness.
The 21st Century Cures Act: Could there be any better symbol of our time? Last year we were still working with a hopelessly outdated concept of “cure.” Now we have an actual “Act” that is worthy of our century. Don’t pay attention to Larry’s moaning and groaning that it should really be called The GiveAway Act. Instead, focus on the fact that we’re finally going to stop wasting money on boring stuff like public health measures, or making sure that drugs are both safe and effective. Instead we’re going to make it rain for glamorous things like precision medicine and cancer moonshots. Now that’s what I call progress. And we didn’t even need a new president to achieve it.
Just in case this isn’t enough, Google, the American Heart Association, and AstraZeneca are going to cure heart disease, and it’s only going to cost them $75 million.
Don’t listen to all the Debbie Downers who say that millions of people won’t have medical care after ObamaCare is repealed. Haven’t they been listening? We’re going to have great plans, amazing plans. You won’t believe how great those plans are going to be. And, just in case they’re not all quite so great, it actually won’t matter. As I mentioned above, we’re going to have cures! If something goes wrong in just a few short years you’ll be able to go to the inevitable stem cell clinics in the mall. And we won’t have to worry about the FDA or others holding these miracles back. No more will we have to wait for government FDA hacks to tediously comb through patient-level data. Now drug companies will be able to use their own data to show how great their drugs are. Everyone knows the really smart people work for industry, so this can only be an improvement.
But why waste time and money on cures? Instead, let’s prevent disease from happening in the first place. There were too many major advances in prevention in 2016 to cover here, so let me just mention two:
First, back in 2015 the SPRINT trial showed that aggressive lowering of blood pressure was life-saving. The only problem was that no one knew how to apply the results in the real world. In 2016 we got the answer to this question. It doesn’t matter, the SPRINT investigators told us, how you measure blood pressure, or if the method used in the trial bears any relationship to the way BP is measured in the real world. In fact, the SPRINT investigators don’t even know how they measured BP in their own trial. So, the message is clear: just go ahead and lower BP in just about everyone. What could go wrong?
Statins for primary prevention: here too the debate is over. Rory Collins and friends published a 30-page paper in the Lancet with more than 300 references, proving beyond a doubt that statins save lives in everyone. Collins and Lancet editor Richard Horton call for medical editors and the media to sharply curtail and manage “with exquisite care” dissemination of research that might influence people against statins. I am sure Collins and Horton are thrilled by more recent press coverage of statins. Instead of criticizing articles that highlight the dangers of statins, they must surely be pleased by a new set of headlines, including this from the Daily Mail: Could statins be the miracle cure for Alzheimer’s? Now that’s what I call progress!
Here’s something else everyone now agrees with: sharing data is great! From the editor of the New England Journal of Medicine— who once had grave concerns about data parasites– straight through to a who’s who of cardiology clinical trialists, there is now nearly universal support for data sharing. But whenever you have a big change like this it’s always important to safeguard the interests of the most vulnerable among us. In this case we’re talking about the poor underappreciated clinical trialists. To protect them the data will be shared only after they get a fair shot at publishing their findings. Their latest proposal is a 5 year wait, but I think they’re being far too generous. Let’s give them 10 years! After all, what could be more important than their careers?
Special Year-End Appreciation For Interventional Cardiology
Alas, there will always be some who get heart disease. These unfortunate people can take comfort in the extraordinary advances over the last year in interventional cardiology, and they should know that interventional cardiologists are, literally, putting on boxing gloves to fight for them against heart disease. Since some people are starting to wonder whether this sort of thing might inadvertently reinforce the impression that interventional cardiology is a boys club, leaders of the field, it is rumored, are now recommending that consciousness raising sessions be held immediately after all boxing matches.
The great thing about interventional cardiologists is that they always known with perfect certainty how great they are. Bernhard Meier, who was there when Andreas Gruentzig first inflated a balloon inside a coronary artery, stands as a perfect model for younger interventional cardiologists to emulate.“Generating and publishing evidence is a tedious job,” he wrote. “Waiting for the results of randomized trials may preclude patients from an apparently good thing while the trials are ongoing.” In Meier’s world, everyone can have a drug-eluting stent or a PFO closure.
Another pioneer of interventional cardiology is Julio Palmaz, who co-invented the first successful coronary stent. One bit of bad news is that his latest company went bankrupt. The good news is that Palmaz is still fabulously wealthy and even while his company was going bankrupt it was able to invest nearly half a million dollars in a venture capital fund co-founded by yet another interventional cardiology pioneer, Martin Leon, founder of the Cardiovascular Research Foundation (CRF) and TCT, the premiere interventional cardiology meeting in the world.
And then there’s the the Absorb bioresorbable stent, which the FDA approved this year. It disappears after a few years– if you don’t get a heart attack before that happens.
Safeguarding Journalism
In a time when journalism is under attack, I’d like to express my gratitude to the American Heart Association for its efforts to protect healthcare journalists. At the organization’s annual meeting in New Orleans the AHA took exceptional efforts to protect journalists covering the meeting, making sure they weren’t able to commit potentially fatal self harm by putting real butter on their bagel or adding whole milk or half-and-half to their coffee. Larry called this “Buttergate.” I call it the culmination of decades of enlightened dietary guidance.
thanks for sharing very useful article……