Tim Russert’s death from a heart attack at age 58 is a potent reminder of our vulnerability to the ravages of cardiovascular disease even in the face of major advances in understanding its causes and how to prevent its consequences.

Tim Russert, 58, died from a sudden heart attack. (AP Photo/NBC, Virginia Sherwood)

Some 300,000 Americans die of sudden cardiac arrest outside the hospital each year, according to the American Heart Association. Russert was one of those who at least was aware that he was at risk.

Russert’s doctor Michael Newman said the tough-questioning but congenial host of NBC’s “Meet the Press” had been under treatment for asymptomatic coronary disease, but that it was under control with medication. He was carrying excess weight, Newman observed, but he got regular exercise and he performed well on an exercise stress test in April.

None of that prevented a cholesterol-laden plaque from rupturing while he was doing voiceovers Friday morning for this Sunday’s edition of Meet the Press. The resulting clot, an autopsy indicated, apparently caused his heart to go into ventricular fibrillation which led to cardiac arrest. The autopsy also showed he had an enlarged heart–a manifestation of coronary disease.

This report from the New York Times indicates efforts to revive him through CPR were almost immediate, followed by unsuccessful attempts at defibrillation when an ambulance arrived. It isn’t clear from information available to the Health Blog what medications Russert was taking or just how soon after his collapse defibrillation — his only real chance of survival — was tried.

Sidney Smith, a cardiologist at University of North Carolina Charlotte and past president of the American Heart Association, tells the Health Blog that Russert’s death underscores a major shortcoming in cardiac prevention: protecting people at immediate risk of a heart attack. Tools such as the Framingham Risk Score help doctors predict a patient’s risk of an event over 10 years. But, Smith asks, “who are those patients where something is just waiting to happen within the next few days or weeks?”

Prediman K. Shah, director of cardiology at Cedars-Sinai Heart Institute, Los Angeles, says it was a classic episode, the way 80% of cases of sudden cardiac arrest occur. He wasn’t impressed with the report of Russert’s recent successful treadmill test. Even if a test is normal, “You can still have plaque and be at risk,” he tells us. It wasn’t clear whether Russert had been taking a cholesterol-lowering statin, but even if his LDL, or bad cholesterol, was under control, that wouldn’t assure protection against a heart attack.

“Statins do stabilize plaque (and thus reduce chances of rupture), but they haven’t eliminated every heart attack or sudden death,” Shah says. “We have to look for other means.”

Both Smith and Shah have seen plenty of Russert-like cases in their careers as cardiologists, but that hardly jaded their views of the import of the newsman’s death.

“My wife and I, every Sunday morning, it was our routine.,” Shah says. “He was tough and very fair. He treated his subjects with respect but at the same time he didn�t let them get away with anything. I�m personally very saddened.”

Ron Davis, president of the American Medical Association, assumed a dual role as doctor and patient in a moving speech before his colleagues over the weekend.

Ron Davis, AMA president, fights on against pancreatic cancer and tobacco. (AP Photo/Russel A. Daniels)

Davis, 51, was diagnosed with pancreatic cancer in February. Bald and thinner from treatment, he urged his fellow physicians to “never take away someone’s hope,” according to the Chicago Tribune’s report from the AMA’s annual meeting of its House of Delegates. “As a physician, I know the survival statistics for someone with stage 4 pancreatic cancer,” Davis said. “But if the five-year survival is five percent, that is not zero.”

He encouraged doctors to be leaders in pushing for healthy lifestyles, coverage for the uninsured and the reduction of medical errors. A staunch foe of smoking, Davis urged the AMA to keep fighting for federal excise taxes on tobacco.

Davis, whose one-year term as AMA president ends Tuesday, also hit some hot-button topics for doctors, including the perennial battle over Medicare cuts in payments for physicians.

For inspiration in the Medicare mess, he suggested his colleagues remember “Daniel Tammet, an autistic savant with Asperger syndrome who set the European record for reciting Pi,” according to an AMA account of the speech. “If a person with autism can recite Pi to more than 22,000 digits, we ought to be able to � figure out how to get off the [Medicare] hamster wheel.”

Direct-to-consumer genetic tests, the flavor of the month in high-tech health, are getting some scrutiny from California regulators.

The state sent cease and desist letters to 13 genetic testing companies last week, ordering them to stop providing the tests to California residents until they prove they aren’t breaking state law, reports the San Jose Mercury News.

In particular, the companies must prove that a doctor orders the tests, and that the labs where the tests are done are licensed by the state.

Officials didn’t say which companies have been contacted, but a shop called Navigenics confirmed that it received one of the letters. Navigenics’s CEO told Forbes that the company uses a licensed lab, works with a doctor in the testing process, and is continuing to process orders from California residents.

The tests offered by Navigenics and others aren’t the kind of targeted genetic tests long offered by doctors to search for a specific marker. Instead, the tests look at a broad range of indicators and purport to tell patients their overall risks for common diseases.

Companies have been springing up to sell this sort of thing to consumers, but many experts say our understanding of genetics and disease is still too primitive to make sense of the results.

DNA image via Wikimedia Commons

A pharmacy opening in Virginia this summer won’t sell condoms, birth control pills or emergency contraception, the Washington Post reports. The shop will be a so-called “pro-life pharmacy.”

Several states (including Washington and Illinois) have been wrestling with the question of whether individual pharmacists can refuse to fill a prescription for emergency contraception. But this is the first we’ve heard of whole pharmacies that don’t carry particular products for ethical or religious reasons.

The Post doesn’t put a number on how many such shops are operating around the country (other than “small but growing”), but the reporter mentions calling eight such stores. Two quotes from the story lay out the opinions on the pharmacies:

“In general, I think product differentiation expressive of differing values is a very good thing for a free, pluralistic society,” Loren E. Lomasky, a bioethicist at the University of Virginia in Charlottesville, told the WaPo. “If we can have 20 different brands of toothpaste, why not a few different conceptions of how pharmacies ought to operate?”

R. Alta Charo, a University of Wisconsin lawyer and bioethicist told the paper: “We may find ourselves with whole regions of the country where virtually every pharmacy follows these limiting, discriminatory policies and women are unable to access legal, physician-prescribed medications. We’re talking about creating a separate universe of pharmacies that puts women at a disadvantage.”

Health Blog Question of the Day: Should pharmacies be required to sell birth control?

Photo: iStockphoto

Illinois docs have been calling for more regulation of the retail clinics springing up in drug stores and big-box retailers around the state. But a proposed state law pushed by the Illinois State Medical Society “could excessively restrict retail clinics to the detriment of Illinois consumers,” the Federal Trade Commission said.

The bill would require special permits, curb advertising and mandate more physician involvement, the Chicago Tribune reports. But, the FTC said, because the rules would apply only to retail clinics, they “could put retail clinics at a competitive disadvantage without offering countervailing consumer benefits.”

The letter came in response to a legislator who had asked for the agency’s take on the bill. “I think that this would diminish any momentum that this bill might have had,” one state rep told the Trib.

The clinics are typically staffed by nurse practitioners who treat walk-in patients with simple ailments. Some have recently gone out of business, but many more are opening, sometimes to the consternation of doctors and local officials.

The FTC has already weighed in on retail clinic regulations in Massachusetts; there, the state followed the agency’s advice and rejected proposals to regulate advertising of the clinics. And just last week, Boston’s mayor worried that Walgreen’s plans to open retail clinics in the city could disrupt Boston’s network of public primary care clinics.

Prescribing drugs by computer rather than in sloppy handwriting on a prescription pad seems so eminently sensible that you’d think the online approach option would take off like Amazon or Google.

Electronic prescribing reduces the risk of simple errors, and improves safety by helping doctors track all the drugs a patient is taking. But the vast majority of docs still use the prescription pad rather than the computer.

There are some forces pushing doctors to digitize their scripts, reports Dow Jones Newswires columnist Victoria Knight . In some parts of the country, the insurance company WellPoint pays docs extra if they use e-prescribing. Some in Congress are pushing for Medicare to do the same thing (and, eventually, to start docking docs who refuse to switch).

At the same time, though, countervailing forces are keeping docs stuck in the pad-and-pen era. The DEA prohibits many drugs (including pain medicine and ADHD drugs) from being prescribed electronically. And many docs may be wary of making the leap into a new technology — particularly those in solo or small group practices, who don’t have as much tech support as those in larger groups.

One small-group doc Knight spoke with said the technical hurdles weren’t too bad — but he did have to work extra hours initially to get up to speed. With doctors’ time already stretched, that barrier alone could be enough to keep many writing paper prescriptions.

Photo: iStockphoto

Industry watchers are predicting good things for J&J’s experimental psoriasis drug ustekinumab. (Sorry about the hard-to-say generic name; we haven’t yet heard what the brand name is.) The drug will be vetted tomorrow by a panel of FDA advisers, and the briefing documents for the meeting were published online late last week.

Studies show the drug works and looks safe, the FDA documents suggest. But the agency wants the panel to weigh in on whether there’s a need for more data to see if the drug raises risk of cancer in the long-term.

The drug targets the immune system in order to reduce inflammation. Anti-TNF drugs, another class of medicines used sometimes for psoriasis, also target the immune system. They already carry a warning about a potential cancer risk. Although the human studies of ustekinumab submitted to the FDA don’t show heightened risk of cancer in humans, there was an association in animal studies.

“Although the occurrence of malignancies were comparable to placebo in clinical trials for ustekinumab, the risk of malignancies with immunosuppressive therapy is theoretically possible,” J&J spokesman Michael Parks wrote in an e-mail to the Health Blog. “Though not observed in our relatively large clinical trial safety database, we plan to monitor such risks through a comprehensive Risk Manangement Plan that will be presented to the Committee on Tuesday.”

Wall Street analysts don’t seem to think that the potential risk will be a big problem. Merrill Lynch analyst Michael Jüngling puts an approval date in September or October. Bruce Nudell at UBS also thinks approval is likely, though he and others suggest the FDA may require J&J to conduct a “robust” (read: expensive) post-approval study.

The drug’s label may also reflect the potential cancer risk, Nudell says, and the agency may require it to be injected by a medical professional, rather than by the patient.