Meet the ESC Gold Medallists: Professor Milton Packer
31 Aug 2024
ESC Gold Medallist For 50 years, Professor Milton Packer (Baylor University Medical Center - Dallas, USA) has challenged the understanding and management of heart failure (HF), being the first to propose the neurohormonal hypothesis, and has established the foundation of many of the currently accepted principles and treatments for this disease.
What inspired you to specialise in cardiology research?
When I began my training, HF treatment had remained stagnant for decades and the outlook for patients was poor, so it was the right time to think differently. In the 1970s, two major technologies were introduced that revolutionised cardiology: non-invasive echocardiographic imaging and cardiac catheterisation, particularly the use of bedside haemodynamic monitoring. Combining these techniques, the cardiologist was able to directly measure the structure and function of the heart in real time, making them ideal for investigating HF. Motivated by the availability of these new tools and, in all honesty, by the confidence of youth, I took up the challenge of trying to change the status quo in order to provide better management for HF patients.
What are your main career achievements to date?
I think that if you ask most people about my achievements, they will probably point to my involvement in major large-scale trials of angiotensin converting-enzyme inhibitors, beta-blockers and angiotensin receptor-neprilysin inhibition, which changed the course of HF treatment. In addition, as a member and Chair of the US FDA Advisory Committee for Cardiac and Renal Drug Products, I helped to develop the efficacy and safety evaluation criteria that are used today for new cardiovascular drugs. While I am extremely proud of what has been achieved throughout my career so far, I think that my main contribution to cardiology has been to improve the community’s understanding of the mechanisms of HF and to relate these coherently to the action of HF drugs. Cardiologists treating patients don't remember individual trials – the names, the results or the people who led them. What they do remember is the story about how the heart works. But of course, my real legacy is the hundreds and hundreds of young investigators I have encouraged and mentored.
What are you working on at the moment?
I still have a lot of work to do! My plan, drawing on a lifetime of experience in the field, will see me continuing to work in clinical trials but at the same time really focusing on building an even deeper knowledge of the mechanisms of HF through collaboration with basic science laboratories. This leads into an area I regard as crucial to furthering progress in HF management – the teaching of cardiologists about mechanisms at the molecular and cellular level. There are so many fascinating fundamental discoveries and the clinical world needs ‘bench-to-bedside’ translators to help it understand their meaning. I hope this will help to achieve what I set out to do decades ago, that is, to make lives better for our patients with HF, by doing things differently.
“You cannot make meaningful progress in medicine if you keep doing things the same way. Challenge it, change it!”
