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Nissen still focuses most of his time on IVUS trials
Nissen is accessible to the media because he strongly values an informed public and he wants to set the record straight on scientific issues.
Every time he investigates a drug and unveils a heart-related problem, Steven Nissen, MD, makes health news headlines.
Most recently, after The New England Journal of Medicine published the results of his meta-analysis demonstrating a 43% increased risk for nonfatal MI among patients who took rosiglitazone (Avandia, Glaxo SmithKline), bloggers accused him of trying to posture himself to run the FDA. Media reports threw around the word “whistleblower.”
He will tell you that, yes, his drug safety activism is probably a parallel to his civil rights activism during the Vietnam War. But while he does not pay attention to the publicity attached to such a crusade, he said people should realize that his concerns about drug safety do not define him.
“The fact is that I have been very much involved in the national debate on issues of drug safety,” said Nissen, chair of the department of cardiovascular medicine, Cleveland Clinic. “But in point of fact, that’s not really what I do. Clinical trials, particularly randomized trials using IVUS, represent the core of my activities.”
With respect to his high-profile drug safety activities, “it’s not about me, it’s always about the work and the science,” said Nissen, also a member of the Noninvasive Imaging section of the Cardiology Today Editorial Board. “I happen to have stumbled into some findings that were particularly interesting and that, of course, gets much more press.”
IVUS pioneering work
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Nissen, who was included on Time magazine’s list of the 100 most influential people “who shape the world,” is a pioneer in the field of intravascular ultrasound (IVUS), which he helped develop in the mid-1980s. He said IVUS grew out of a concern that angiography did not tell the whole story and that in order to track regression and progression of disease, one needed to look at the atheroma within the vessel wall.
“IVUS made the most sense for doing that, and our laboratory played a pivotal role in developing it,” Nissen said.
He said his new research – to be presented at the American College of Cardiology’s annual meeting in spring 2008 – involves a comparison of pioglitazone (Actos, Takeda) and glimepiride, and a large rimonabant (Acomplia, Sanofi-Aventis) study.
“IVUS is a fantastic research tool,” Nissen said. “However, it has not evolved as a mainstream technique in clinical practice as some people had hoped.”
When he is not researching the latest capabilities of IVUS, Nissen devotes time to the ACC. He is the immediate past president of the ACC and continues on as an executive committee member working on a number of projects. He also previously sat on the FDA Cardiorenal Drug Advisory Committee, serving his last year as chairman.
Among Nissen’s achievements: In 2004 he received the Award for Outstanding Research in Cardiovascular Research from the Gill Heart Institute at the University of Kentucky.
Nissen has also spent more time on Capitol Hill in the last year, working on FDA reform and health policy issues, something he says is a big change for him.
As for rumors that he is working toward the top spot at the FDA, he ignores them but he does not completely rule anything out, either.
“Who knows what the future holds?” he said. “One always has an open mind, but in general I do not have political aspirations. I may be more effective on the outside than on the inside.”
Informed patients better
There’s another reason why Nissen makes health news headlines: He talks to at least one media outlet every day.
“My willingness to be accessible really stems from a strong belief system of empowering patients,” he said. “I spend some portion of every day talking to media.”
Nissen said that he not only addresses drug safety issues or IVUS with the media, but reporters will also turn to him for background information. Sometimes, these chats with media have helped squelch undeserved hype about a procedure or drug.
“I have always believed that the public has a right to know about medicine, and medical science, and I’ve strongly valued having an informed public,” Nissen said. “I make a point to be readily accessible and available to the media.”
He is also careful to avoid conflict of interest in order to maintain a level of objectivity, something the media values. Reporters want to quote someone with no financial gain.
"Educated patients do better, but I think you have to work at it,” he said.
Destined for medicine
As editor of the University of Michigan daily college newspaper. Nissen developed his sense for the importance of informing people, Nissen said.
But journalism was not the career path he chose; the 59-year-old Toledo, Ohio, native was destined for medicine as the son of an obstetrician/gynecologist (who at mid-career entered general practice). Nissen recalls sitting with his father and learning the names of all the bones in the body.
“I was exposed to medicine at a young age,” Nissen said. “I was certainly destined and developed my own passion for it.”
Anthony N. DeMaria, MD, director of the University of California San Diego Sulpizio Family Cardiovascular Center, was one of Nissen’s greatest influences outside the home in his decision to choose a career in medicine and, more specifically, cardiology.
“He stimulated my interest,” he said. “He was really a mentor and played a very important role in [my career].”
Although a Toledo native, Nissen was raised in California. After medical school in Michigan, Nissen went on to a fellowship at University of Kentucky Chandler Medical Center in Lexington. He did his residency and internship at University of California Davis Medical Center in Sacramento.
In addition to his work, his contributions to the ACC and his availability to the media, Nissen has appeared in television specials that educate the public about heart disease. Earlier this year he appeared in PBS’ “The Hidden Epidemic: Heart Disease in America.”
When he has free time, Nissen likes to go bicycle riding with his wife, professional photographer Linda Butler, who has published four books of her art-photography. He enjoys helping her with her career, he said.
“She allowed me to keep my own name when we got married,” he joked.
He is well-known in his own right, but did he ever expect the attention he gets?
“Really, I did not,” he said. “What I’ve always done is about doing what I do. … I’m not really by nature combative, but there are controversial issues in medicine that must be discussed. I’m open about these problems, and I say what I really think rather than take positions that are politically correct.” — Judith Rusk