Author + information
- Spencer B. King III, MD, MACC, Editor-in-Chief, JACC: Cardiovascular Interventions∗ ()
- ↵∗Address correspondence to:
Dr. Spencer B. King III, Saint Joseph’s Heart and Vascular Institute, 5665 Peachtree Dunwoody Road NE, Atlanta, Georgia 30342.
China is ancient, and yet it is brand new. My first visit to China was with Willis Hurst and 2 others from Emory University in 1987. We spent more than 2 weeks visiting medical schools and hospitals in 4 cities. Just recently, I went to China as a guest of our publisher, Elsevier, to visit cardiologists who are interested in publishing their work. I visited 6 hospitals in 3 cities. Although I have been to China many times over the past 27 years, I could not escape the contrast between my first visit and this one: from Mao jackets to Paris fashions, and from bicycles and rickshaws to Mercedes and Maserati and buildings soaring to the sky. The medical facilities have also transformed. Cardiac catheterization laboratories in 1987 were few, and equipment was barely functional, whereas today the latest imaging systems are installed and the scale is massive. There are about 16 catheterization laboratories in the Fu Wai Hospital, but next year there will be 25.
The purpose of my visit was to talk about getting published, but as I advised them, publishing papers in highly-rated journals is over 90% dependent on the project and <10% dependent on preparation of the manuscript. A few years ago, the research projects in China were rudimentary. Some massive trials were accomplished with the involvement of major research organizations, such as Oxford in the United Kingdom, but the local research expertise is rapidly expanding. I saw research activity from translational animal experiments to large randomized clinical trials, and I spent a good bit of time with investigators who showed me their projects. In the clinical research area, the tendency to submit review papers with or without various meta-analyses is beginning to give way to the submission of original research. During my visit, one of the highly respected senior colleagues from China advised his fellows to “forget about meta-analyses and do your own research.” I perceived that there are a number of unique opportunities for clinical research in China. For one, the patient population is never small. The early reluctance to randomization that I had previously heard about no longer seems to be present. Enrollment in large randomized trials in multiple hospitals across the country seems to move very fast. Subjects of great interest, such as anticoagulation schemes for primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, have enrolled thousands in patients in months. We discussed the fact that much of the financial support for clinical research around the world will continue to come from industry sponsors. There is the opportunity to participate in such studies while leveraging the large patient volume to investigate more targeted questions by including pre-specified substudies in the protocols. The opportunity for investigator-initiated studies, I suspect, will also increase as the government realizes the opportunity from funding clinical research organizations. There is still a long way to go in developing and funding clinical research coordinators, core laboratories, and other expertise. Although the tendency to imitate technology that was developed elsewhere is widely known, there are opportunities to address specific questions with these technologies. A paper in this issue of JACC: Cardiovascular Interventions reports the comparison of a bioabsorbable polymer-coated stent with a biostable one largely controlling for the same drug (sirolimus) and the stent platform (1). That study was presented at Transcatheter Cardiovascular Therapeutics and was simultaneously published ahead of print in this journal. There also appears to be a great opportunity for outcomes research. Registries are critical for this type of work, and, although there are hospitals with well-developed registries, there is a need for broad collaboration in creating regional and national registries. Much of the work that has gone into developing the American College of Cardiology’s National Cardiovascular Data Registries is applicable and adaptable to China. The potential for cardiovascular research in China is vast, and I, for one, welcome the development of that capability. It is hoped that progress in China will be a stimulus to those countries with well-established research capabilities to invest adequately in biomedical research. The recent revelation that the Ebola outbreak requires not only a major public health effort, but also a major push for new drugs and vaccine research, has pointed the spotlight on shrinking research funding for the National Institutes of Health–sponsored laboratories. We should not have to wait for dramatic events such as the threat of Ebola to fund scientists and clinical researchers who are committed to our greatest health threat—cardiovascular disease.
In the area of device development, it is no secret that imitation has dominated. Now, it is estimated that 80% of the drug-eluting stents sold in China are those locally produced. The same will be true for heart valves and other devices. Patent protection is not a priority in China, and it is not clear how the legal questions surrounding development of like devices would impede the availability of these products outside China. One would hope, however, that some of the energies that have gone into imitating existing devices will be applied to innovating unique solutions. In such a “young country” with very different rules, it is not surprising that there is incentive to reproduce what has been done elsewhere. That is not all bad, as the methods of scientific investigation are universal. What I am seeing now in clinical research and device development is a transition from imitation to innovation. It is the innovation that will be publishable in leading medical journals.
- American College of Cardiology Foundation