“改善心血管健康状况：一项崇高的使命”
弗雷德·哈桑
先灵葆雅公司主席与首席执行官
在第三届美国心血管高峰会议上的演讲
伊利诺斯州芝加哥市
2006年11月10日

      非常感谢你们的参与，我们深感荣幸，尤其是对我来说更是如此。你们中有些人可能知道，我是特地参加这次会议。去年和前年，我都参加了高峰会议。

      在这里的所有人都心怀一个重要的使命。心血管疾病是全世界范围内一个巨大、而严重的威胁。它不仅损害人们的生命，也损害人们的生活质量。

      我们所有人都拥有一个崇高的使命，我们汇集在这个统一的目标之下，致力于挽救患者的生命，改善现在以及未来患者的生活质量。

      今天下午，我将和你们探讨一下四个方面的问题，我认为这些问题对于我们每个人来说都非常重要。首先，是对心血管健康的历史进展进行简单评述，这些进步具有重大意义。其次，我将谈论一下我们面临的严峻挑战。第三，让我们分享一下我们存在的重大机遇。第四也是最后一点，我希望向明年一月份就职的国会立法者们提出一些建议。

      首先是关于心血管健康领域所取得的重大进展。刚刚过去的这个夏天，我在《纽约时报》读到了Gina Kolata撰写的一篇重要文章。我个人认为，Gina是我所认识的卫生领域最好的记者之一 。她的这篇报道是关于对美国内战时期士兵的健康记录所作的研究，报道将内战时期士兵的健康状况与今天美国人的健康状况进行了对比。

      其结果令人惊讶。研究显示：在内战时期，大部分士兵年龄都很小，在20多岁就患有疾病。在这之后，他们的健康状况继续恶化。那些在40多岁依然生存的人大都身患慢性疾病。例如，根据内战退伍军人健康记录，心脏病的发病率比今天要提前10到20年。在年满60岁的男性人群中，差不多有80%身患心脏疾病。

      今天，在年满60岁的男性人群中，患有心脏疾病的男性比例不到50% 。而这，只是说明心血管健康状况取得惊人进展众多例证中的一个数据。但是，虽然我们取得重大的进步，我们依然面临着严峻的挑战。

      在取得重大进步的同时，在心血管方面的很多挑战也在加剧。比如：在今天，每四个美国人之中，就有一个人患有代谢综合征，而且这一比例还在上升。在美国，肥胖症患者的急剧增长已经造成严重的卫生问题。为此，疾病控制中心(CDC) 实施了CDC行为风险因素监测系统 ，该系统对肥胖症的发病情况以及其他风险因素进行跟踪。

      回首1991年， 根据CDC的数据，美国每个州的肥胖症发病率都在20%以下。但到了2005年，情况发生了严重恶化。2005年，同样还是CDC的评估，结果发现除了四个州以外，其他所有州的肥胖症发病率都达到或者超过20%，有17个州的发病率甚至达到或者超过了25% 。与此同时，肥胖症正在蔓延到欧洲、亚洲、远东以及拉丁美洲等世界各地。许多统计数字令人忧心忡忡。例如，对治疗方案的严重依赖。根据一项研究，每八名出院的心脏病患者中 ，就有一名患者在仅停止服用救命性处方药一个月后就复发心脏病。而在第二年，停止服用三种可靠药物(阿司匹林、阻滞剂与降LDL药物)的患者的死亡率大约是继续治疗的患者的三倍。
另外，在患者交流与教育方面，我们也存在很多挑战。即使是在美国这样的发达国家，也依然存在很大的提升空间。

      但在我们面临的所有挑战中，也许最大的挑战就在于：医疗卫生服务系统只关心短期的费用压缩，而忽视长期的卫生服务质量。你们当中的很多人都应该很了解这一问题，因为很多国家在政府管理卫生服务、确定卫生优先问题以及制定卫生预算时都存在这一问题。

      在美国，这是管理式医疗目前面临的挑战。美国的管理式医疗确实应关注缩减费用，但也必须关注改善医疗的质量。

      良好的管理式医疗方案真正专注于患者的长期卫生福利；良好的管理式医疗使患者获得教育、预防性医疗以及质量与选择的机会；良好的管理式医疗与医生进行友好合作，而不是对抗；良好的管理式医疗认为医生作为与患者之间的“专业中间人”，发挥着独特的、特殊的作用。

      成为一名医生，是一项特殊的使命。作为医疗从业者，你们所有人都遵从这一使命，原因就是你们清楚自己作为战胜病患的真正勇士的作用。这就是希波克拉底誓言的真谛。作为一名医生，要求你们为了患者的利益有权自由做出医疗判断；作为一名医生，还要求你们为了患者的利益，花费足够的时间与患者呆在一起。

      因此，在心血管以及所有卫生服务领域，我们面临的最大挑战就是如何推进和改善良好的管理式医疗，同时降低与减少低质量的管理式医疗。这是我们面临的严峻挑战之一。

      现在，我们谈论一下我们存在的机遇。今天以及未来的世界在心血管治疗领域能够取得积极的变革，我对此充满乐观。

      这些历史性的变革可能通过三个关键方式实现：第一是通过改善预防；第二是通过改善干预；第三是通过促进创新。

      首先是改善预防。在心血管健康方面的重要改善，可以通过我们所了解的所有因素得以实现。这些因素包括饮食、运动、避免吸烟、戒烟、简易的预防性治疗，如服用阿司匹林降低心脏病风险。

      在预防心血管疾病方面有两个关键因素：一个是患者的健康素养，另一个就是建立在健康素养基础上的疾病预防行为。对于促进健康素养与疾病预防，有很多潜在的驱动者，如学校、健康专家、雇主、政府机构以及其它。

      在美国，促进健康素养与疾病预防行为的一个重要驱动者可能、并且应该是管理式医疗机构。在美国以外，也有同行，他们可能是政府计划，也有可能是其他健康管理计划。

      现在再回到“良好”管理式医疗的概念上来。良好管理式医疗计划将更多地关注健康素养与疾病预防行为。他们对患者更加友好、更倾向于从长期的角度缩减医疗服务的费用。

      因此，美国的管理式医疗以及其他卫生管理者、如其他国家的预防疾病基金，应鼓励和促进健康素养与疾病预防行为并为其提供支持。

      如何做到这一点? 我认为我们可以通过积极实施卫生标准得分表的作法，来在整个医疗服务领域取得重大的进步。

      不久前，在我们行业的国际性协会国际制药企业协会联合会或称IFPMA的年度会议上，我提出了这一设想。在这次会议上，我被选举为主席。

      正如我在会议上所说，在今天，消费者们在考虑是否购买时，可以轻而易举地比较各种汽车的基准汽油效率以及冰箱的每年运行费用，但他们却不能轻易地比较卫生服务的质量，这一点确实是匪夷所思。

      我们可以通过公布在重要卫生指标上的简易、透明、可比的得分，采取措施打破这一壁垒。在这种情况下，独立的被保险人与其他人，如支付其卫生服务费用的雇主，可以看到管理式医疗机构在长期良好健康关键指标方面的得分。这样，被保险人可以选择能为他们提供最佳价值的方案，能在长远良好健康的关键指标方面提供高效得分的方案。

      在开始时，我建议卫生管理者们应在关系健康素养和预防的少数几项关键指标上计分。这些指标与卫生管理人覆盖的患者比例有关，在以下三个方面实现医疗许可目标：
1. 减少肥胖症;
2. 避免吸烟、戒烟或者减少吸烟;
以及     
3. 增加运动。

      通过这种计分表措施，我认为我们不仅可以看到健康素养与疾病预防的重大提升，而且可以降低费用。这与所有社会面临的卫生服务上涨的趋势形成鲜明对比。

      现在，让我们谈论一下改善干预的问题。这里只是一组统计数据，旨在说明我们通过改善干预可以达到什么目标：在可能受益于胆固醇管理的9000多万美国人中，只有一半得到诊断；而在诊断人群中，只有一半得到治疗；在治疗人群中，又有一半没有达到治疗效果。换句话说，在美国治疗候选人群中，只有大约12% 的人得到有效的治疗，而且这一比例还在下降之中。

      这只是在心血管治疗方面采取适当干预的重要性的一个例子。实际上，还有许多诊断不足与治疗不足的例子。

      在心血管健康领域，我只提议两个改善干预的指标。他们都是基于实现医疗许可目标的管理式医疗计划所覆盖的患者比例：第一是控制高血压的指标，第二是控制高LDL胆固醇。

      通过在这两个重要的心血管指标上实施透明的得分表，加上患者对长期健康重要性的素养，我相信我们能够在心血管健康方面取得重大的改进。

      顺便提一下，除了我今天提出的心血管领域，我们也应在其他指标上对卫生提供者进行计分。其他得分表应包括以下指标：接种与免疫；控制血糖水平以及控制哮喘。他们都是改善干预的重要因素。

      现在，我们谈论一下我刚才提到的改善心血管健康的第三个问题：创新。在我们面前，我们可以在很多领域看到重大的创新机遇：新诊断方法；新器械、新医疗制度以及新药物。

      具体到我们公司，同样存在很多机遇。例如，我们的实验室正在研究一种治疗血栓的重要新型药物。如你们所知，目前的治疗方案是结合使用阿司匹林与波立维（Plavix），但效果并不理想。你们可能听说过我们激动人心的凝血酶受体阻抗剂复合药品。虽然我们需要进一步的科学证明，但我们希望在2010年或者2012年，将能够向你们提供药品，用来治疗患者。

      其他制药与生物科技领域的公司也都在各自领域具有激动人心的进展，其中包括目标为个体患者并适合个体患者的新型治疗领域。

      但是，在继续推进我所称之为生物制药业的创新引擎方面，我们依然面临严峻的挑战：生物制药，顾名思义，是生物与制药两个领域的不断融合。

      让我们看一下今天所面临的产品流挑战。显而易见，在过去几十年里作用强劲的创新引擎，现在很少能够跟上产品通用化的发展。在行业内，四处可见大型的项目失败，而且常常是发生在晚期阶段。这些失败开发的费用可能高达数亿美元。即使是成功的复合药品，临床试验的费用也高不可攀。这使得资助其他新项目越来越困难，当然也增加了治疗的费用。

      我们必须寻找使生物制药创新更加有效的方法。在重要的进展方面，我们需要与监管者与学术界保持密切合作。例如，我们迫切需要看到监管科学方面的进展，以与医疗科学方面的进展保持一致。如更新临床试验设计、更有效地实施临床试验以及后续有效地审查数据包。为了促进这些进步的发生，生物标记与适应性临床设计是能够促进这些进步发生的、在监管科学方面所需要的重要环节。

      我们必须破解创新生产力的密码。生物制药科学的整个行业必须对此不懈努力，其原因就是生物制药对于患者福利具有重大的前景，不仅仅是在心血管一个领域，更是遍及卫生服务的整个领域。

      举例说明，由于80岁以上人口的不断增长，患阿尔茨海默病的人数将上升到每两个人中就有一个！二分之一！作为一个富于同情心的社会，我们不希望居住在充满护理院的城市。而且从经济的角度上，我们根本就负担不起!

      对于良好答复的最佳希望，就在于生物制药创新。目前在生物制药领域进行的研究并不会阻止阿尔茨海默病的减少或者最终治愈，但我们必须建立使创新得以出现的环境。

      现在到了今天下午的最后一个问题，就是对美国国会参众两院新当选的政治领袖们的希望．

      下面是我对新当选的立法者的倡议：首先，向你们的当选表示祝贺！今天，你们已经开始计划你们的议程。在你们开始工作时，请认清你们的最大挑战与最大责任之一就在于卫生服务领域。作为一个国家、一个社会，我们寄希望于你们的长远眼光，我们的子孙后代也寄希望于你们的长远眼光。

      请记住，在美国，生物制药研究不仅仅对人们的健康至关重要。对于经济的成功同样至关重要。其他国家意识到生物制药创新的高科技动力。其他国家、如日本，已经开始实施长远计划，以提高生物制药行业的竞争力。中国、印度等国家也不甘落后。

      我们已经在汽车工业和电脑行业输给了亚洲。但美国在生物制药科学领域依然具有绝对的优势。其他的国家对此非常羡慕。我对于华盛顿新当选的立法者们的要求是：千万不要让这一优势丧失殆尽。

      为保持生物制药方面的优势，我希望向华盛顿新当选的立法者们提一条优先考虑的意见。希望你们授予 FDA所需要的资源以及开展工作所需要的独立性，使FDA能够应对其他的监管者，如欧洲的EMEA。考虑一下我们如何提升FDA程序的创新、速度与效率。最重要的是，希望美国的立法者小心谨慎，确保FDA 的非政治性。如果将FDA政治化，损害的不仅仅是它的权威性，还有它的科学性。如果我们这样做的话，我们将损害我们整个国家的宝贵的创新动力。

      最后，我希望我们的新立法者在考虑众多重要的卫生问题时，心中要牢记一个指导原则：做对患者来说正确的事。如果我们做对于患者长远来说正确的事，我们就会看到很多、很多困难的政策问题以正确的方式得以解决。

      女士们、先生们，非常感谢你们的倾听，谢谢你们在推进心血管科学与心血管护理方面的领导。正是对你们工作重要意义的理解，使得世界各地围绕同一目标团结一致 ：共同改善今天以及将来人类的健康状况。

      在推进患者治疗方面，我们面临着重大的机遇。同时，我们也肩负着重大的义务。希望我们在这一项伟大使命之下，不断加强彼此之间的协调与合作。

“Improving Cardiovascular Care: A Noble Mission”
Fred Hassan
Chairman and Chief Executive Officer
Schering-Plough Corporation
Remarks at the 3rd Annual Cardiovascular Summit
Chicago, Illinois
Nov. 10, 2006

Thank you for joining us. We are honored. I am, especially. As some of you know, I have made a special point of coming to this meeting. I was at our summit last year and the year before.

Let me begin my saying we feel a sense of humility here today. I feel it. The cardiovascular knowledge in this room is remarkable. We value your engagement with us. Your advice and counsel are very important to us at Schering-Plough. We are listening. We are learning. And very important, we are acting on what we hear to do more for your patients.

All of us here share in an important mission. Cardiovascular disease is an enormous threat, an insidious threat around the world. It destroys lives. It destroys quality of life.

We all have a noble mission. We are joined in a mission to save lives and to improve lives for patients today and for patients of the future.

This afternoon, I would like to talk with you about four things that I believe are important to all of us. First, I'd like to make a few comments on the historic advances in cardiovascular health. The advances are quite remarkable. Second, let me address what I see as some of the biggest challenges ahead. Third, let me share with you my perspective on the big opportunities that also lie ahead. Fourth and finally, I'd like to conclude with some remarks directed to the incoming class of Congressional legislators in the U.S., who will take office in January.

First, some reflections on what has been achieved in cardiovascular health. This past summer, I read an important article in The New York Times by Gina Kolata. Gina is one of the better writers I know of on health issues. Her story reported on research done on health records of Union Army soldiers. It compared the health of those Civil War soldiers with the health of Americans today.

What was found was fascinating. The research showed that in the Civil War era, most soldiers were small and sickly by their 20s. Things got rapidly worse. Those that were still alive in their 40s were often chronically ill. For example, according to the Civil War veteran health records, heart disease hit 10 to 20 years earlier than today. Nearly 80% of that male population suffered from heart disease by age 60.

Today, less than 50% of males suffer from heart disease by age 60. This is just one statistic among many that is proof of remarkable progress. So a lot has been achieved. But as we know, the challenges we continue to face are enormous.

Despite the progress, many challenges in cardiovascular care are growing. Just one example: metabolic syndrome today affects one in four Americans, and it is growing. The dramatic increase in obesity in the U.S. is a serious health challenge. The Centers for Disease Control (CDC) operates what is termed the CDC Behavioral Risk Factor Surveillance System. It tracks the prevalence of obesity, among other risk factors.

Back in 1991, every state in the Union showed obesity prevalence rates of below 20%, according to this CDC measure. By 2005, the situation had changed starkly for the worse. In 2005, the same CDC assessment found that all but four states had obesity prevalence rates of 20% or more, and 17 states had prevalence rates of 25% or more. Obesity is spreading around the world to Europe; to Asia and the Far East; and to Latin America. We see a lot of other worrying statistics. For example, on adherence to treatment plans. According to one study, it took only one month after leaving the hospital for one out of eight heart attack patients to stop taking the lifesaving drugs prescribed for them. The patients who stopped taking three proven drugs (aspirin, beta-blockers and LDL-lowering treatments) were three times more likely to die during the next year than the patients who stayed on their medications.

We also have challenges when it comes to patient communications and education. There is a lot of room for improvement even in a sophisticated country like the U.S.

But of all the challenges we face, perhaps the biggest one is this: The tendency for health delivery systems to focus on short-term cost containment vs. quality of health delivery for the long term. This is familiar to many of you from other countries as taking the form of government control of health care, health priorities and health budgets.

In the U.S., this is now the challenge facing managed care. Managed care in the U.S. must certainly focus on containing cost, but it must also focus on improving quality of care.

The better managed care plans are genuinely focused on long-term health benefits for the patients. Better managed care gives patients access to education, to preventive care and to quality and choice. Better managed care works with physicians, not against them. Better managed care recognizes the unique and special role of the physician as the "learned intermediary" with the patient.

Being a physician is a special calling. As medical practitioners, all of you entered this calling because you saw your role as a true champion for the patient. That is what the Hippocratic oath is all about. Your role as a physician requires the freedom to exercise medical judgment for the good of the patient. Your role also requires adequate time with the patient for the good of the patient.

So one of our biggest challenges in this field of cardiovascular care and across all of health care is how to advance and encourage better managed care while discouraging and reducing low-quality managed care. Those are some of the big challenges we have in front of us.

Now, let me talk about our opportunities, because I am overall very optimistic that we can achieve positive transformations in cardiovascular care around the world today and for future generations.

Those transformational changes can be accomplished in three critical ways: First, through enhanced prevention; second, through improved intervention; and third, through advancing innovation.
Let me begin with enhanced prevention. Important improvements in cardiovascular health are achievable through disease prevention in all the factors that we know about such as diet, exercise, avoidance of smoking, smoking cessation and simple prophylactic treatments; for example, aspirin to help lessen heart attack risk.

There are two critical factors in prevention of cardiovascular disease: first, patient health literacy and second, disease prevention behavior based especially on health literacy. There are many potential drivers of health literacy and disease prevention: schools, health professionals, employers, government agencies and many others.

In the U.S., one of the important drivers of health literacy and prevention behavior can, and should be, managed care organizations. There are counterparts outside the U.S., whether government programs or other health management programs.

I come back to that concept of "better" managed care. The better managed care plans will put a huge focus on health literacy and disease prevention behavior. They are the most patient-friendly, cost-containing dimension of health care for the long term.

So managed care in the U.S. and other health managers, such as sick funds in other countries, should be encouraged and provided with incentives to build health literacy and disease prevention behavior.

How do we do that? I believe we can achieve great progress across the health care spectrum by aggressively implementing the practice of health metrics scorecards.

I presented this approach recently at the annual meeting of the international association of our industry, the International Federation of Pharmaceutical Manufacturers Associations, or IFPMA, on the occasion of my election as its president.

As I said at that meeting, it is peculiar that consumers today can easily compare the benchmarked fuel efficiencies of automobiles that they are considering for purchase and the annual running costs of refrigerators, yet they cannot easily compare the quality of health delivery.

We can take a major step in breaking down this barrier by publishing simple, transparent, comparable scorecards on important health metrics. In this way, individual enrollees and others, such as employers who pay for their care, can see for themselves how the managed care organization is performing on the key metrics of good health for the long term. This is so enrollees will go to the plans that give the best value, the plans that deliver high performance on the key metrics for long-term good health.

To start with, I suggest that health managers should be scored on just a few critical metrics that are "markers" for health literacy and prevention. These metrics would be related to the percentage of patients covered by a health manager that reach medically endorsed goals on three counts:

     1. Reduction in obesity;
     2. Smoking avoidance and smoking cessation or reduction;
     and
     3. Increasing exercise.

With this kind of scorecard approach, I believe we would begin to see not only a significant acceleration in health literacy and disease prevention, but also a cost-reduction trend vs. the escalating health-care cost facing all societies.

Now, let me turn to a few comments on enhancing intervention. Here is just one set of statistics that show us how much we can achieve through enhanced intervention: Of the more than 90 million people in the U.S. who could benefit from cholesterol management, only half are diagnosed. Of those people, only half are being treated. And of those being treated, about half are not at goal. In other words, only around 12% of people in the U.S. who are candidates for treatment are getting effective treatment. The goals are getting even lower.

This is only one example of the importance of appropriate interventions in cardiovascular care. There are many, many other examples of underdiagnosis and undertreatment.

In the area of cardiovascular health, I would propose just two metrics to improve intervention. Again, they are based on the percentage of patients enrolled in a managed care plan that are getting to medically endorsed goals: first, metrics on control of high-blood pressure, and second, control of high LDL cholesterol.

With transparent scorecards on these two cardiovascular metrics combined with patient literacy on the importance of these metrics to long-term health, I believe we would accomplish a major upgrade in cardiovascular health.

By the way, beyond the cardiovascular arena that I am addressing with you today, we should also score health providers on other metrics. Other scorecards should include metrics on vaccinations and immunizations; controlling blood sugar levels; and on controlling asthma. Those are some proposals for enhancing intervention.

Now, let me turn to the third dimension of improving cardiovascular care that I mentioned: Innovation. We can see ahead of us enormous opportunities for innovation in many dimensions: new diagnostics; new devices; new delivery systems; and of course, new medicines.

In my own company's work, we see enormous potential ahead. For example, we are working on an important new treatment coming out of our own labs for thrombosis. As you know, current therapy is a combination of aspirin and Plavix. It is not ideal. You may have heard about our very exciting thrombin receptor antagonist compound. We need to see where the science takes us, but we are hoping that this can be in your hands to treat your patients sometime in 2010 or 2011.

Other companies in the pharmaceutical and biotech arena have exciting advances in their pipelines as well, including the exciting new realm of therapies that are targeted and tailored to the individual patient.

However, we face some very big challenges in continuing to power the innovation engine of what I like to call the biopharma industries: Biopharma, because these two worlds of biotech and pharma increasingly converge.

Let me single out today the challenge of product flow. It is clear that the innovation engine that worked so powerfully for several decades is now barely keeping up with products going generic. All across our industry, we see important projects failing, very often at a late stage. The costs of these failures can run to the hundreds of millions of dollars. Even for successful compounds, the cost of clinical trials is going through the roof. This makes it tougher and tougher to fund other new projects, and of course, it increases the cost of treatment.

We have to find ways to make biopharmaceutical innovation more efficient. We need to keep working with regulators and academia on important improvements. For example, we urgently need to see advances in regulatory science that keep pace with the advances in medical science, such as modernizing clinical trial designs, more efficient execution of trials and more efficient subsequent reviews of data packages. Biomarkers and adaptive clinical designs are important examples of the kinds of needed advances in regulatory science that can help make these improvements happen.

We must crack the code on innovation productivity. The entire world of biomedical science must work hard on this because biopharmaceuticals hold such enormous promise for patient benefit not just in cardiovascular care, but across the spectrum of care.

As one example, a steadily rising proportion of our population will be over the age of 80 at which the odds of contracting Alzheimer's disease rise to one in two! One in two! As compassionate societies, we do not want to see this population consigned to cities of nursing homes, and from an economic perspective, we cannot afford it!

Our best hope for a better answer lies with biopharmaceutical innovation. The research under way today in biopharma does hold out hope for remission, or eventually, even cure, of Alzheimer's. But we must build an environment that keeps that innovation happening.

That leads me to my final comment this afternoon. It is a message to our newly elected political leaders here in the U.S. House of Representatives and Senate.

I say to our newly elected law makers: Congratulations on your election. Today, you are already beginning to plan your agendas. As you begin your work, please know that one of your biggest challenges, and biggest responsibilities, is health care. As a nation, and as a society, we are counting on you to play for the long term. Our children and their children are counting on you.

Remember, biomedical research in the U.S. is not only vitally important to the health of our citizens, it is vital to the success of our economy. Other countries understand the high technology power of biomedical innovation. Other countries, such as Japan, are already implementing long-range plans to improve their competitiveness in biomedical research. Countries such as China and India are not far behind.

We are already losing our auto industry and our computer industry to Asia. But America is still pre-eminent in biomedical science. Other countries envy us. My urgent message to the newly elected lawmakers in Washington is this: Don't let this one get away from us.

To sustain our biomedical strength, let me propose one specific priority to the newly elected lawmakers in Washington. I urge you to give the FDA the resources it needs and the independence it needs to do its job well. Benchmark the FDA against other regulators, such as Europe's EMEA, and see where we can improve the innovation, speed and efficiency of the FDA process. And above all, I call on our U.S. lawmakers to be vigilant in keeping the FDA nonpolitical. If we politicize the FDA, we will be damaging not only its authority, but also its science. And if we do that to the FDA, we will be damaging a precious innovation engine of our country.

Finally, I urge our new class of lawmakers to keep just one guiding principle in mind as they address these many important health issues: Do what is right for the patient. If we do what is right for the patient long term, we will see that many, many tough policy questions will be answered in the right way.

Ladies and gentlemen, thank you for your attention. And thank you for your leadership in advancing cardiovascular science and cardiovascular care. Our societies around the world are united in their understanding of the importance of your work: to improve the health of people today and generations to come.

Together, we have great opportunities to keep advancing care for the patients. Together, we have great obligations to keep advancing care. We look forward to working with you and collaborating with you on this great mission that we share.
Thank you.