From ACC to CRF: An Interview with Jack Lewin

Shelley Wood

October 21, 2013

NEW YORK, NY — Dr Jack Lewin was the frank and charismatic CEO of the American College of Cardiology (ACC) from 2006 until April 2012, when his resignation from the organization caught many by surprise. Last week, the Cardiovascular Research Foundation (CRF), the nonprofit organization best known for its clinical trials and popular Transcatheter Therapeutics (TCT) meetings, announced that Lewin was its new CEO. heartwire caught up with Lewin to hear his hopes and plans in this new role, what he's been up to for the past 18 months, and why he left the ACC when he did.

heartwire: What have you been up to since we last spoke?

Dr Jack Lewin

I've been working in health innovation and as a health policy consultant for the last year and a half . . . working closely with Congress and the administration on some issues, payment reform, and helping doctors and hospitals figure out how to cope with change and working on new models of care. It really has been fun. But the one drawback is that I've always been working on four or five very interesting and exciting projects and didn't feel like I could focus on one thing and really make a difference over time. So I've had a terrific experience getting back into the healthcare environment unencumbered by the organizational issues that one has to represent.

heartwire: How did this new opportunity come about with the CRF?

I've had ongoing interactions with the CRF over time and often talk to Drs [Gregg] Stone and [Martin] Leon about various health policy issues, so I've retained some friendly contact with some of the folks there. The search committee contacted me about two months ago and asked me if I might have some interest [in the CEO position]. I've always known the organization from my years at ACC and respect a lot the work they do in education but also the clinical-trials work they do. After meeting the president of the board and key staff people, I felt I could help them make a difference going to the next plateau in the organization. I talked to my boss at home and said, Would you be willing to move to Manhattan? And I was surprised when she said yes.

heartwire: What do you think you can do with CRF? What are the opportunities?

CRF represents me a number of things to me. First of all, they love science and cardiovascular science in particular, so this gives me a chance to get back into the world of science and some of the academic aspects of what CRF does. CRF is an academic science organization but it's also an incubator of ideas and innovation. It's also a very nimble organization. Unlike professional associations, big state agencies, or government entities, which move slowly and have to go through very cumbersome governance processes—that's just the nature of the beast—CRF has a board that's composed of stellar physicians and business leaders: about 12 people. It's manageable in size.

heartwire: When do you officially start as CEO?

I've started, officially, but because some of my consulting contracts are outstanding and I don't want anyone to hire a hit man to come after me if I just walked away, I'm finishing up the work that I'm doing in various projects that are very dear to me. I'll be phasing in the CRF job, becoming full-time Jan 1, 2014 and half time between now and then.

heartwire: What's your vision for where you might take CRF?

CRF has a basic-science laboratory called Skirball, and I think there's some real opportunity for that center to grow. Their clinical-trials arm, the CTC, has about 40 trials a year that they oversee and manage, and I think there's a real opportunity to expand that area and go beyond just interventional cardiology to perhaps look at the intersection of interventional cardiology with pharmacology or cardiology with oncology. And then the TCT arm is also an interesting one because in addition to the big meetings in the US, TCT also has partnerships with a lot of other entities [overseas]. There's a lot that could happen there in terms of not only clinical-trial collaboration but also in trying to accelerate the translation of new science to actual clinical practice, which as you know always lags behind. Finally, I think this is the beginning of the era of big data and analytics across all industries, but healthcare is only slowly arriving at that. I think what CRF can do is begin to work with the payers with huge patient databases and preidentified populations to use big data and analytics to try and answer some of the outstanding questions in cardiovascular care that are not likely to receive funding for randomized controlled trials.

heartwire: At one point in your Life and Times interview for theheart.org with Dr Rob Califf you said you worried about a new kind of public skepticism of the medical profession. People have watched CRF and the TCT meetings grow each year and pointed to the vast funding they acquire to do the research they do and the prominence of industry at the TCT meeting. Are you concerned that the skepticism you mentioned in that interview might have adverse effects on the organization that you're now heading up?

All of medicine has come through a lot of changes with [higher scrutiny of] what we'd call conflicts or relationships with industry and with government. What I've heard from people repeatedly at CRF was the desire to focus on the best professionalism to actually manage those relationships with industry but not walk away from them because of the need to really promote innovation. To partner, but partner in new ways that meet the expectations of today, which is transparency and the highest level of ethics and always putting patients and science first.

heartwire: One of the things you brought in at ACC, or that I assume you were closely involved in, was the Choosing Wisely initiative. ACC was one of the first organizations out of the gates with their five "don'ts." How do you view that initiative and how might it influence what you do at CRF?

I think there's going to be a lot of work in the future, something that hasn't been done much in terms of clinical trials and clinical research, which is not to dilute the focus on science and objectivity in clinical progress but rather to consider the economics of what we're doing. Because the difficulty is with all the glamour and spectacular scientific progress in healthcare—a 30% reduction in CVD mortality in the last decade—all that's great, but we live in an unsustainable world in terms of how to finance healthcare. Congress has spent 16 days in paralysis to some extent over the fears about that. I think the research world, and this is globally, needs to be thinking about the incremental improvements in science and ask, but how much does it cost? And when we're doing something that we hoped was going to be incredibly successful that then longer-term research showed does not pan out in terms of reducing morbidity or mortality or complications, we need to be ready to change our behavior and move onto something else.

heartwire: Do you think that sometimes the excitement over innovations outstrips the ability to pay for them?

New technology can kind of dazzle. It's exciting, but we do need to apply scrutiny these days to make sure that innovation is also providing better outcomes at lower costs. And that's a new thing for doctors. There's a desire at CRF to begin to look at that.

heartwire: Many have been curious about why you left the ACC. Many thought it was quite abrupt.

I'd been around the cycle six times and I felt like it just came upon me—it was time to get back out there. There are other issues in terms of differences of opinion and that sort of thing that come up in an organization and I just thought it was time. I came back from the big annual meeting, and the new president was coming in, and there were some new directions coming that were being proposed and I thought, you know, do I want to stick around for 10 years, for eight years? No. Now is the time to go.

heartwire: Was that Choosing Wisely initiative, announced just five days before news of your resignation, a part of the decision? The timing was conspicuous.

The one thing that I would say about that is—not about Choosing Wisely, because I think the leaders at the ACC are stellar people—but I was getting ready to say let's take the data from registries and go public with public reporting. Let's just put the data out there, because doctors are competitive beings. Choosing Wisely sort of just scratches the surface of what the opportunities are. It's a great start, it's a great effort, and all I can say is exciting things about it and I can only say good things about what the ACC has done, which is incredibly heroic in terms of the willingness to invest in registries and provide outcomes data back to hospitals and cardiologists all across this country. It has really made a difference in how people practice. But I think the bold step that we're going to have to take next, as a profession in the next phase, is to go all the way and have public reporting of this data.

heartwire: So people can see what procedures are being done and who's doing what?

So people, patients, have the opportunity to make choices, to go to places where the outcomes are better, where complications are fewer, and where newer and better services are available and that sort of thing.

heartwire: Are professional organizations resistant to that, do you think?

I think that it's not so much professional organizations as it is the nature of human beings, of doctors in general. We find all that threatening and we say, for some good reasons, that the data are always bad and it's never perfect and we can't trust it. It's all understandable. But the reality is, if we start to do this and become more transparent both about the costs of care and the quality of care, and we have people measuring that quality who are competent to do it—and that's got to be the profession itself—then I think we're going to give consumers a lot better opportunities to select where they get their care and from whom they get their care, based on something other than subjective recommendations.

heartwire: So you're bringing this to CRF? Transparency, patient access . . . ?

Of course, CRF is not so much an advocacy organization, it's a research and education organization. But I still think CRF is really looking to try to be part of the best, with the recognition that everything in healthcare is changing and they want to change with it and be a part of the future, not part of the past.

This interview has been edited and condensed.

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