Editor’s note: Larry was too depressed to write the 2015 yearly review. Veteran healthcare journalist and eternal optimist Candide Corn volunteered 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 for cardiology! The year brought us an unending parade of cures, breakthroughs, landmark trials, and paradigm shifts, as well as the slightly less exciting but even more numerous significant advances, major improvements, and incremental improvements.
The End of Cardiology?
Can there be any doubt that as a result of all the recent breakthroughs and cures the incidence of cardiovascular disease is going to plummet faster than Ben Carson’s poll numbers? Experts are increasingly confident that cardiovascular disease will be wiped out in the next generation. Senior cardiologists are advising doctors in training to avoid cardiology for more promising fields. The one slightly bad part is that hospitals are now on a desperate hunt to find the next big profit center, but you shouldn’t worry too much about this. Industry observers are supremely confident the hospitals will find new revenue streams.
Can there be any doubt that the new PCSK9 inhibitors will play a central role in this great victory over one of the greatest scourges of mankind? I don’t normally give out stock tips but in this case I’d advise you to load up on Amgen and Sanofi stocks. Invest the kids’ college funds. These stocks have nowhere to go but up.
Also approved this year was Entresto. All you need to know about this drug is contained in the name of the trial that showed its worth: PARADIGM-HF. That’s right, this trial not only changed the paradigm of heart failure treatment but it told you it was going to do that before it even started. That’s how confident the sponsor, Novartis, and its investigators were about this trial. Even my gloomy colleague, Larry Husten, has been raving like a maniac for almost two years about how great this drug was.
The great thing about 2015 is that it not only gave us these amazing breakthroughs but it brought them to us faster than ever. In particular, the NIH deserves enormous credit for beating all speed records for the delivery of positive results from the SPRINT trial. They told us the results of the “landmark” trial were “practice changing” well before we lost precious time actually examining the data. This new emphasis on speed represents a welcome development which will surely serve as the model for many trials in the future.
Amarin & Orexigen Save The First Amendment!
But maybe the NIH didn’t go quite far enough. After all, the NIH waited until the SPRINT trial was actually stopped before announcing the results. But think about it: doesn’t that just waste a lot of time? Why not release important life-saving information even before the trials are over? What could possibly go wrong? In this respect two companies deserve special praise for their unremitting and unprecedented efforts to deliver important new information to the world.
Amarin’s victory over the FDA: For years now the FDA has been torturing Amarin and harming the health of the public by insisting that the company wait until their big clinical trial was actually over before promoting widespread use of their fish oil pill Vascepa. So Amarin went out and hired itself a top shelf constitutional lawyer who convinced a US judge that the first-amendment rights of the Amarin sales team were more important than the FDA’s efforts to protect the American public. Could this be the beginning of the end of the FDA’s stranglehold on medical progress?
It would be hard to top Amarin for sheer guts but 2015 was a special year and one company really deserves prominent attention. Orexigen released the results of an interim analysis of its large, FDA-mandated cardiovascular outcomes trial testing its diet drug. This raises an important question: can it ever be too soon to release and act upon good news?
Both Amarin and Orexigen deserve special praise for their innovative and brilliant efforts to speed up and bypass the cumbersome and increasingly infuriating clinical trial system and regulatory process which prevent people from getting all the life-saving breakthrough drugs they don’t yet know they need to take.
We Solved The Conflict of Interest Problem!
To be honest, although I am an inveterate optimist I was actually starting to become disturbed about this whole conflict of interest (COI) problem. I’d read all these articles that were starting to worry me. But then the New England Journal of Medicine completely put my mind to rest. In a masterful 3-part series NEJM proved conclusively that COI isn’t a problem. It turns out that concern about COI is far worse than COI itself and that it is the efforts to suppress COI that threaten medical progress and practice everywhere. Most of my doctor friends, as they discussed it over their free lunches, were happy as well to have their concerns allayed by this NEJM masterpiece.
I confess I was also concerned after reading Larry’s story which reported that cardiologists received more than $300 million from industry over 16 months. I know that seems like a lot, but after reading the NEJM articles it’s clear that the real problem would be worrying about all that money. I’m reminded of the subtitle of the Stanley Kubrick movie: Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb.
I propose that we celebrate rather than castigate physicians working intimately with industry. And let’s start at the top, and wish a happy new year and give special praise to all those physicians pulling double duty as academic leaders and directors of corporate boards. Well done and bombs away!
The Future Belongs To Precision Medicine!
Precision Paper of the Year: Can there be any doubt that the future belongs to precision medicine? Everyone from President Obama on down keeps telling us so. My choice for paper of the year goes to Victor Dzau and colleagues. (Dzau, a cardiologist, is the president of the Institute of Medicine. Before that, while running the Duke Health system, he generously helped bring science to Big Soda by serving on the board of directors of Pepsi.) Using a “health simulation model” Dzau and co-authors conclusively prove that precision medicine will save the US many billions of healthcare dollars over the next 50 years. They calculate, for instance, that precision medicine, just by reducing heart disease by 50%, “would generate a staggering $607 billion in improved health over 50 years.” My only concern is that the authors may actually have underestimated the benefits of precision medicine, since it is clear from its advocates that we are on the verge of a new healthcare utopia.
Precision Man of the Year: Finally, let’s not forget the contribution to medicine this year from billionaire celebrity Mark Cuban. Proving once again that the rich really are different from you and me, Cuban started a revolution in medicine in 3 twitter posts. He recommended that everyone who can afford it have their “blood tested for everything available, do it quarterly so you have a baseline of your own personal health.” What could possibly go wrong?