Mount Sinai Leaders Discuss Improving the Drug Ecosystem, the Revolution in Cancer Immunology and the Pediatrician of the Future at the 2019 Aspen Ideas Health and Aspen Ideas Festival
Mount Sinai dermatologists and clinicians provided more than 1,000 onsite complimentary skin cancer and heart screenings
Improving the drug ecosystem and challenging the status quo in drug discovery, the promise of new cancer treatments, and helping pediatricians and parents learn how best to help children thrive were among the topics presented at Aspen Ideas Health and the Aspen Ideas Festival from June 20-29, 2019, in Aspen, Colorado. Presented by the Aspen Institute and The Atlantic, the festival is a unique forum for the exchange of ideas.
With prescription drugs costing Americans an estimated $460 billion a year, finding a viable long-term solution to curb the price of once-affordable medications is a top priority, according to Kenneth L. Davis, MD, President and Chief Executive Officer of Mount Sinai Health System. “We want to ensure that patent laws favor innovative drugs, not just brand-name drugs that have added patents to extend the terms of market exclusivity even if there’s no additional patient benefit,” said Dr. Davis.
As a scientist whose research led to the U.S. Food and Drug Administration (FDA)’s approval for the first four out of five drugs to treat Alzheimer’s disease thirty years ago, Dr. Davis said more needs to be done to incentivize companies to take the risk to develop breakthrough treatments. “Despite 35 failed drugs in Alzheimer’s disease, we have to keep trying. The new direction is to give drugs to people well before they develop symptoms of Alzheimer’s so we can see if we can stop the progression—to see how many people convert to Alzheimer’s disease and how many don’t—but this will be very expensive and we need to provide incentives.”
Dr. Davis also said that drug companies should develop drugs for chronic diseases, not necessarily those that will make the most money for the pharmaceutical industry. “We need to find new drugs to treat pain that are not addictive, and we need to treat insulin resistance in type 2 diabetes so that we can reverse the effects of downstream consequences in diabetes,” said Dr. Davis. “To me there is an implicit social contract between pharmaceutical companies and the American people to keep the prices of drugs down—especially since the science comes from the National Institutes of Health, which is supported from taxpayer dollars.”
Dennis S. Charney, MD, the Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai, co-invented a patented method for treating patients with treatment-resistant depression, Spravato (esketamine) nasal spray, which was approved by the FDA in early 2019. “The question is how to make a transformative discovery and in the case of this discovery, it was a small group of researchers who met every week to share ideas,” said Dr. Charney. “We also created a collaborative relationship with a pharmaceutical company to bring forth a treatment for a devastating disorder that has a profound impact on people’s lives.” Dr. Charney also encouraged more novel and transformative research to be funded by the National Institutes of Health.
In a panel titled “Immune Power: New Directions in Cancer Treatment,” Mount Sinai cancer experts discussed the revolution in using immunotherapy to fight cancer. “What we have learned is to harness the immune system, our own immune system which was developed to fight viruses and bacteria to keep us free of infections, and now have it directed at tumors,” said Steven J. Burakoff, MD, the Lillian and Henry M. Stratton Professor of Cancer Medicine who served as Director of The Tisch Cancer Institute at the Icahn School of Medicine from 2007 to 2017. “This has resulted in the ability to develop drugs that unblock the immune system so it could be effective against the cancer with far fewer long-term toxic or side effects than chemotherapy.
“Checkpoint inhibitors are the drug that has been instrumental in blocking the checkpoint that stops the immune system from working—so the immune system is activated to fight the cancer,” said Fred Hirsch, MD, Executive Director of the Center for Thoracic Oncology in The Tisch Cancer Institute at Mount Sinai. “In fact, 25 to 30 percent of patients with lung cancer benefit from this drug, as well as 35 percent of patients with metastatic melanoma. Both cancers were lethal five years ago."
Miriam Merad, MD, PhD, Mount Sinai Professor in Cancer Immunology and the Director of the Mount Sinai Human Immune Monitoring Center (HIMC), said there are still more targets to find drugs for. “Our goal at Mount Sinai is to identify othercheckpoints and find new drugs that are already approved for other indications that we can give patients, or develop new drugs that will unblock the checkpoint, in order to reactivate the immune system in cancer patients.”
Experts also discussed the challenges of cancers, like pancreatic and brain cancers, that have learned to put up a barrier or “scaffolding” to prevent the body’s immune cells from getting close to the cancer. “We are all working to find drugs that will be able to find a drug to break down that wall so the body could fight the cancer,” added Dr. Merad.
The Mount Sinai experts urged cancer patients to get a full genomic panel review of their cancer. “Twenty-five years ago, you would go to an oncologist that treats many cancers, but now everything is very specific,” said Dr. Burakoff. “It is very important to go to a tertiary care center where the subspecialty expert will look at the tumor, look at the type of mutations you have and that will help identify or define some of the treatments that will bring forward.”
In a panel titled “Reinventing the Pediatrician’s Visit,” Carrie Quinn, MD, a pediatrician and Executive Director of the Mount Sinai Parenting Center, noted, “As a pediatrician, you are confident in diagnosing diseases such as meningitis and pneumonia, but you are less equipped to focus on language delays, development concerns, and mental health issues. So there is a big gap in what you are trained to do, and what you do in practice. That gap is the main reason we established the Mount Sinai Parenting Center: realizing pediatricians were not armed with the specific knowledge that was needed.”
Working in collaboration with the Bezos Family Foundation, Dr. Quinn has been pulling the science of early childhood development together to find out what key developmental concepts could be shared with pediatricians as well as parents. “We formulated six development keystones, including attachment, self-regulation, and problem-solving, as well as developmental areas of literacy, and created environmental messaging to help parents in the hospital setting know what to do to help their child succeed.”
Mount Sinai Kravis Children’s Hospital has also created a pediatric residency training program to give clinicians the tools they need to promote language development and improve behaviors in children. “As pediatricians, we need to give parents the skills they need for responsive parenting, which is essential to a child’s ability to thrive in emotional relationships and achieve school success,” said Dr. Quinn. “We are also taking these initiatives and scaling so we can get it to health care settings all around the country.”
In addition to serving as panelists, Mount Sinai clinicians were on hand to provide complimentary skin and heart screenings for Aspen Ideas Festival participants. A team of dermatologists from the Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai provided nearly 600 skin cancer screenings, identifying four possible melanomas, the most deadly type of cancer, and 40 potential non-melanoma skin cancers (basal cell and squamous cell carcinomas). Mount Sinai Heart experts offered complimentary blood pressure and cholesterol screenings to more than 500 participants.
Maley Thompson from Seattle gets a yearly skin screening in Aspen with Mount Sinai dermatologists. Last year, a Mount Sinai doctor identified an irregular mole on her neck. "I was shocked when they found something because I always took for granted that I was going to be fine," said Ms. Thompson. "I am fairly young, my skin feels fine, and I live in Seattle where it is always cloudy."
Mount Sinai dermatologists urged Ms. Thompson to see her local doctor, who performed a biopsy that determined she had a precancerous growth. She underwent surgery last summer and is now fine. "I am so grateful for the Mount Sinai doctors as I would never have gone back to see my dermatologist for another year," said Ms. Thompson. "Now I know I am at a higher risk of skin cancer because of my fair skin and because I grew up in Aspen where there is high altitude. Thank goodness for the screenings in Aspen."
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.