Mount Sinai Leaders Discuss the Future of Medicine at the 2016 Aspen Ideas Festival
The future of medicine and health care delivery, the promise of cancer breakthroughs, and ethical issues regarding increasing organ donation by living donors were among the topics explored by leaders from the Mount Sinai Health System during the 2016 Aspen Ideas Festival held in Aspen, Colorado. Presented by the Aspen Institute and The Atlantic, the festival is unique in its dedication to the global exchange of ideas.
“What excites me the most about medicine in the short term is that we have learned about immunology and immunotherapy and how it is affecting cancer treatments. The breakthroughs have been remarkable,” said Kenneth L. Davis, MD, President and CEO of the Mount Sinai Health System. “We have seen amazing therapies, vaccines, and experimental therapies work to put people—who were once considered hopeless cases—into remission.”
In a panel discussion on “Cancer Breakthroughs: The Promise of New Treatments,” Steven Burakoff, MD, Director of The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai, said, “Though President Nixon’s ‘War on Cancer’ was waged 45 years ago, we have begun to make progress in the last five to eight years. Through basic science research, we have learned to manipulate the immune system and use genome sequencing of cancer cells, which have allowed us to identify mutations in the DNA that we can target with drugs that in some cases can control the growth of cancer.”
Describing breakthroughs in personalized cancer treatment and patient success stories were experts from The Tisch Cancer Institute: Joshua Brody, MD, Director of the Lymphoma Immunotherapy Program; Matthew Galsky, MD, Director of Genitourinary Medical Oncology; and Ross L. Cagan, PhD, Director of the Center for Personalized Cancer Therapeutics.
As for other long-term goals in medicine, Dr. Davis said that he “looked forward to breakthroughs in neuroscience where drugs could be developed that could make a difference for patients.” He said, “With the help of imaging and genetic studies, we are now on the right track for developing drugs to treat Alzheimer’s disease. We now know that the changes that happen in the brain occur as early as 25 years preceding symptoms. That means that there is a marker that will allow us to begin therapies decades before one is symptomatic and that drugs can be targeted to slow the progression.”
During a “Deep Dive on Drug Prices” discussion, Dr. Davis said, “The question we have to consider is: What is the fair return of investment of developing a drug? What troubles me most about the high cost of new drugs to treat Hepatitis C, for example, is that instead of pricing them as a fair return on investment, the drug companies are pricing in terms of how much money they are going to save the health system down the line because we don’t have costs related to the patient.” He noted: “What happened to the social contract between drug companies, taxpayers, and the consumers whereby drugs would be priced so that people could afford them? The polio vaccine was very inexpensive. Imagine if we had priced the polio vaccine in terms of the savings in health care costs that would result? Many would not have been able to afford it.”
In a discussion on “Organ Donation: How do we Share a Precious Resource?”, Sander S. Florman, MD, Director of the Recanati/Miller Transplantation Institute at The Mount Sinai Hospital, said that even if we make great strides to increase the numbers of donors, deceased organ donations are not enough to close the gap and provide enough organs to everyone who needs them. “We need to really focus our efforts on increasing the number of living organ donations. In order to do that, we should consider removing the disincentives to living organ donation.”
Dr. Florman explained, “Current federal laws allow for reimbursement to donors for travel- related expenses and for lost wages: we should fund these for everyone who wants to be a donor. We should make it easy for everyone to donate. They literally give a piece of themselves to save another person’s life. And if removing disincentives isn’t enough, then we should consider appropriate incentives to increase the number of living donors.”
In another panel on the ethics of editing the genetic code, Eric Schadt, PhD, Director of the Icahn Institute for Genomics and Multiscale Biology at the Icahn School of Medicine, said that gene-editing technologies such as CRISPR will have a dramatic impact on how we treat or even prevent disease in the future. “By using CRISPR, it will be possible to cure or prevent diseases by repairing the genetic mutation at the earliest stage of development. However, there are many ethical and safety implications that come with the power of this technology, so we need to have a conversation on how to control and guide the technology to ensure it is not abused.”
At the Aspen Institute Ideas Incubator, Prabhjot Singh, MD, PhD, Chairman of the Department of Health System Design & Global Health at the Mount Sinai Health System, launched ATLAS, which uses satellite data, bottom-up annotations, and machine-learning methods to deliver insights to frontline workers at the point of care. “We know that blind spots in the health of communities inevitably become hotspots of infectious or chronic conditions,” he said. “We need a new generation of scalable, socially engaging technologies that enable community insiders to use and share insights with health systems.”
For the duration of the Festival, Mount Sinai Heart experts offered complimentary blood pressure and cholesterol screenings to more than 570 participants. Individuals were also encouraged to download the “Circle of Health” app, which focuses on modifiable risk factors of cardiovascular disease that can account for 90 percent of heart attacks and strokes (BE-WAT: Blood pressure, Exercise, Weight loss, Alimentation, and Tobacco). The app was developed by Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.
A team of dermatologists from the Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai also provided 745 skin cancer screenings, identifying 6 possible melanomas, the most deadly type of cancer, and 40 potential non-melanoma skin cancers (basal cell and squamous cell carcinomas).
Two years ago, Melanie Sacks from Stanford, California, was screened by a Mount Sinai dermatologist at the 2014 Aspen Ideas Festival. The dermatologist noticed a lentigo, a small pigmented spot on the skin with a clearly defined edge surrounded by normal-appearing skin, on her face and recommended that she see her local specialist for follow-up. “I thought it was a birth mark,” said Ms. Sacks. “It didn’t stick up, and it didn’t look like any of the scary pictures of melanoma.”
This year, Ms. Sacks reported that after a biopsy, her doctor told her she had a lentigo meligna, a melanoma that was present in the top layer of the skin. She was able to have it removed. “It was really a scary experience that has changed how I wear sunscreen,” said Ms. Sacks. “So, I am grateful to Mount Sinai for finding something that could have been potentially really devastating to me.”
After four years of similar screenings at the Aspen Ideas Festival, Mount Sinai dermatologists have performed a total of 2,591 screenings, identifying 36 possible cases of melanomas. Screenings also detected a total of 196 potential non-melanoma skin cancers (131 basal cell and 65 squamous cell abnormalities).
About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.
The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is in the "Honor Roll" of best hospitals in America, ranked No. 15 nationally in the 2016-2017 "Best Hospitals" issue of U.S. News & World Report. The Mount Sinai Hospital is also ranked as one of the nation's top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai's Kravis Children's Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals."