ESC’s Congress is just one meeting of the many international meetings the ACC leadership team and I attend each year that foster relationships with other international societies, although it is certainly the largest. In the five brief days we'll be in Barcelona, we’ve met with 14 international cardiovascular societies, along with Huon Gray, Chair of our new International Council, and that's not counting the informal conversations we've had along the way. This is a reflection of how strongly the ACC feels about working with international societies.

As mentioned at the start of the Congress, cardiovascular disease is not just a problem in the U.S. – it’s a problem across the world. And if all the countries across the world work together to find what works best for treatment CVD, then patients everywhere benefit.

One area in which this is particularly evident is comparative effectiveness research. Comparative effectiveness research has the potential to do so much: from informing the practice of medicine to improving care. Not only do we need to work together with international societies to collect comparative effectiveness data to improve care, we also need to work with other societies to disseminate these best practices. It’s not good enough that the information stay within the U.S. or the originating country; the information needs to be spread as far and wide as possible. By keeping the lines of conversation open at meetings like ESC’s, hopefully we’ll be able to increase our collaborations to benefit patients around the world.

*** Image from Flickr (katmere). ***

Tony DeMaria, M.A.C.C., our JACC editor in chief, recently used his May 19 Editor’s Page to discuss the alarming frequency with which initial clinical trials for novel devices and therapies are being performed outside of the U.S. According to Dr. DeMaria, the situation "clearly raise[s] a question as to whether we in America are exploiting the rest of the world to prematurely test potentially hazardous therapies, or conversely, whether our regulatory and financial environment is stifling access to important new innovations for patients and investigators."

The piece has generated a high volume of responses. “It seems to have struck a chord,” Dr. DeMaria says. One reader notes, “Over the past two decades I have seen an unfortunate gap develop between U.S. and overseas investigations, making us in effect second-tier investigators within the international community. Devices we have invented end up being evaluated, approved and used in general practice well ahead of us ... Percutaneous valves are one the latest example of this dangerous trend/gap!”

I applaud his message. We need to turn this around. Read Dr. DeMaria’s Editor’s Page here. But having just returned from India this week, and after visiting a most amazing 1000 bed CV hospital in Bangalore that produces outcomes comparable to the US (be ready to be stunned) for about 10 % of the cost, I think we need to be aware of the astounding and frankly positive growth of research outside the US that is developing exponentially. One thing the emerging world has going for them is that in environments with no insurance or health care coverage, experimental and novel therapies can be tested in willing patients far more prevalently that in the US or Europe. This will result in a great deal more relevant manuscripts, and in application of new therapies in early stages of illness, that will be considered here only as “compassionate use” therapy in late stages of disease, and only after traditional therapy fails. They will be able to see if new therapy works when started before the patient is near terminal. We won’t. And, as health reform in the US ratchets down the screws on PHARMA, they will go abroad to innovate, taking jobs with them. I’m just trying to cheer everybody up here…

The Hellenic CV Society (Greece), after hosting President Doug Weaver recently, decided to join Malaysia in forming the early adopters forming international "chapters" of the ACC, and participating in ACC international quality activities. This is a big leap forward for our international collaboration activities. The goal here is to enhance the strength of the local national society, and to collaborate on improving CV health worldwide together. What a fun and needed process.

Canada’s medical schools this week endorsed a report from the Association of American Medical Colleges calling for medical schools and teaching hospitals to prohibit industry gifts and services and to curtail the involvement of industry in educational activities.

The head of the Association of Faculties of Medicine of Canada says endorsing the report, "Industry Funding of Medical Education," ensures that industry support of education does not lead to real or perceived conflicts of interest.

We walk a fine line with our partners in industry. The ACC, of course, has strict policies in place to ensure industry never influences our educational content, and we’re incredibly transparent about our funding. On the other hand, without industry support, we — and other CME providers — could not offer the quality education our members trust.

The ACC’s delegation to the Cardiological Society of India’s meeting earlier this month made big news in India — see the story at right, including a photo of Jagat Narula, M.D., F.A.C.C., Pratap Reddy, M.D., F.A.C.C., and me. Reddy owns many CV hospitals in India. Although the media there aren’t the best fact-checkers (I’m Dr. Levin, chief cardiologist from the American Heart Association in one article), they did a great job disseminating our basic message, which was that, while the recent terrorist killings of 170 people in Mumbai were truly tragic (and which have had non-stop 24-hour media coverage there for weeks), multiples of that number of Indians die needlessly each hour of every day of preventable CV disease. CV disease is already the number one killer in India, but it is increasing alarmingly with recent dietary and lifestyle changes.  India must do more to decrease their risk factors for CV disease.

The CSI (Indian Society of Cardiology) is very interested in working more with us in these regards in helping them develop PR capacities to better reach out to the public on prevention issues, and to include more on prevention in our joint education efforts.

ACC had a significantly successful participation in the Cardiovascular Society of India (CSI) annual meeting in Chennai (formerly Madras) this week. This was our first major delegation foray into India. This was an excellent opportunity to strengthen our relationship with our Indian colleagues, and particularly the increasing numbers of FACCs there. There were many positive CSI side meetings about future educational partnerships. Our willingness to participate, despite the horrific attacks in Mumbai last week, was greatly appreciated by CSI. And, the courage of the ACC group was remarkable, in particular after we learned while there the hotel our delegation was in was reportedly a target of a second team of assailants, according to intercepted satellite intelligence messages. Indian authorities redoubled security measures at the hotel and the conference. But despite all that, every one of the ACC lectures were delivered as promised—no one ditched. My thanks to Dr. Jagat Narula and the other staff and volunteer members of our group for their perseverance in the face of terrorism and their outstanding commitment to quality science and cardiovascular care. Suffice it to say, we are all glad to be safely home.

The ACC this month participated in the Iranian Heart Association’s annual meeting. This was not a decision we took lightly. We were not official co-sponsors, but we sent an able delegation to participate in the scientific program. The Executive Committee debated the issue at length and ultimately agreed that the dissemination of quality cardiovascular science must take precedence over politics. After all, we reach out to Israel as well.

Our CV colleagues in Iran were most grateful. Samuel Wann, M.D., F.A.C.C., and other ACC members participated in the meeting of their own accord. While not an officially sponsored event. Dr. Wann reports that ACC's participation was an outstanding success. “I found the scientific quality of the meeting to be very high,” Dr. Wann says. “I think everyone involved enjoyed interacting with our counterparts from Iran and cardiologists from other countries including India, Pakistan, Taiwan, Saudi Arabia, Turkey and others. I recognize that this was a bold move not favored by all and want to thank the College for taking a chance. I am proud to be a member of ACC.” In the words of ACC President Doug Weaver, “Cardiovascular medicine and science transcend political, social, religious and racial boundaries.” This meeting demonstrated our unqualified commitment to quality cardiovascular care — everywhere in the world.

Of course, this may take a bit of courage at times, too. Visitors in Mumbai could attest to that last week. Ironically, ACC has a delegation going to India this week to produce educational exchanges, led by JACC Imaging editor Jagat Narula.

We have now reached China on our cardiovascular tour through Asia. ACC President Doug Weaver and I, along with our ACC delegation, are attending the Great Wall International Congress of Cardiology. This is our 3^rd year in this joint sponsorship of a major meeting -- this year with over 2500 cardiologists from China and Asia attending. It has been a great and eye-opening trip. The science exchange is very valuable for BOTH sides. Dr. Weaver and I had an incredible visit to Fu Wai hospital, China’s largest CV center. Just in the one year since former President Jim Dove and I were there, the changes are impressive. Fu Wai is a D2B partner and they feel they are well within the 90 minute reperfusion goal -- and they’d be interested in using the NCDR to be consistent with ACC in data exchanges. Their outcomes in PCI, CABG, CHD, and transplants closely parallel ours, but CV disease is rapidly growing in China, partly because of worsening Western habits of diet and exercise, but also because so many people (mostly men) still smoke here. The Great Wall Conference is probably the biggest anti-smoking venue that occurs in this country -- given the government conflict with significant ownership of tobacco income -- and this is a really bold aspect for the Chinese contingent of our joint meeting.

For anybody who hasn’t been to Beijing recently, it is almost shocking to see the near absence of bicycles and scooters, replaced by modern, up-scale and luxury vehicles and super-modern transit and infrastructure. I don’t think there is a U.S. city as modern, clean and affluent in general as this place. There is no ‘bad section.’ Most Americans don’t know this. The rural areas may be far behind -- but watch how fast they start to catch up too. The energy, passion to achieve, and work ethic is what our country was like until recently. By comparison, we seem to have developed a society that feels ‘entitled’ in many ways in the U.S. (in my opinion), versus the ‘fire in the belly’ passion and personal responsibility ethic to succeed that one can’t help feeling here. But, people are very, very nice. They seem to like us and the U.S.

Personally, I have complete faith in our country to continue to lead and succeed in the changing world, but success in the future will not be handed to us on a platter of entitlement. I’m not talking about lower income people here, I’m talking about us ALL! We need to keep our antennae up to deal with the competition we face in the future. I think we’re up to it -- but not in the way old Europe and America feel entitled to more time off, more benefits, higher pay without higher performance, etc. If America doesn’t start replacing our aging infrastructure, for example -- and be willing to pay for it -- we will become obsolete over the next decade in this new world. But, we won’t let that happen. Right?

Hello from Vietnam! ACC President Doug Weaver and I are here with an impressive ACC delegation to the ASEAN Congress of Cardiology.

What a phenomenal opportunity for the ACC to reach out to our colleagues across Asia. There is great interest here in collaborating on joint educational efforts. Two-thirds of males smoke here. And public school is only funded by the government through about 6th grade -- but they will expand funding through high school in about 5 years. Traffic (mostly motorbikes) is indescribably complicated.

But it’s very entrepreneurial for a socialist country. Health care is mostly cash on the line beyond basic public health services. But the progress toward a sophisticated society is moving along swiftly. It is a very safe and low-crime environment. Wonderfully warm people. ASEAN nations truly want to collaborate more with ACC, and have asked that we consider helping them with medical society-building efforts and leadership training. They're also interested in more scientific collaboration with JACC (ACC's journal) as well.

From here, we’re off to Beijing for our third annual Great Wall International Congress of Cardiology collaboration, which expects 6,000 attendees. Check back for more!