The Federal Drive with Terry Gerton provides expert insights on current events in the federal community. Read more interviews to keep up with daily news and analysis that affect the federal workforce. Reach out to Terry and the Federal Drive producers with feedback and story ideas at [email protected].
Terry Gerton You have had a remarkable career in medicine and public health. I want to begin by asking you how you chose to do that in the public sector. Why did you choose public medicine?
Dr. David Goff Well, Terry, I’d had a really fulfilling career in academia, had been in an academic position of one sort or another for several decades, when the opportunity came to take a look at a position at the National Heart, Lung and Blood Institute. At that time, I had, as I said, been doing academic work for a couple of decades, a combination of some patient care teaching, research and academic leadership. And at the time when the call came to see if I was interested in this position, I was serving as dean of the Colorado School of Public Health. And that was a really remarkable opportunity as well to really try to nurture the next generation of public health professionals and researchers through that great school. But the opportunity to come to the National Heart, Lung and Blood Institute is really a one-of-a-kind opportunity. The NIH is a leading supporter of research and research training in the world. And to have the opportunity to contribute to that mission in a leadership role was just something beyond my expectations when I grew up in a small town in eastern North Carolina. The opportunity to serve really the population, the country, and if it’s not too bold, the world, since we are the largest funder of cardiovascular science in the world, was something too good to pass up.
Terry Gerton Well, since you’ve been at the National Heart, Lung and Blood Institute, you’ve really set the nation’s cardiovascular research agenda. How are we doing on cardiovascular health?
Dr. David Goff Well, first I’d say that the way I’ve gone about this is to listen, to try to be a good listener, because it’s not really kind of my agenda, but it’s the agenda of the cardiovascular research community. And it’s informed by our needs. What are the big challenges that we face with cardiovascular health? And we’ve come a long way. I was born in 1960, and in the 60s, heart attacks were claiming Americans in their prime. We had the death rate from heart disease was roughly five times what it is today. We’ve had about an 80% reduction in age-adjusted death rates for cardiovascular disease since about the middle of the 1960s. And that’s tremendous progress. But we’ve had backsliding in really the past decade, decade and a half, after really four or five decades of remarkable progress. And that backsliding, most people have come around to thinking, has to do primarily with obesity and diabetes. I think everyone’s aware that we’re going through what’s called an obesity epidemic in the United States. And it’s not just the United States, it’s really a global problem. It’s just that we are leading the way, in some ways, with obesity in the U.S. And with that obesity comes along high blood pressure, more of a likelihood of diabetes, and alterations in our lipids, cholesterol and triglyceride, the fats in our blood that contribute to atherosclerosis, the process of disease in the arteries that leads to a heart attack or a stroke. So while we’ve had great progress since the mid 60s, a lot of that due to fewer people smoking, a lot of that due to decades of progress on lowering cholesterol and blood pressure, a lot of that due to better treatments, whether it’s statins to reduce cholesterol or blood pressure lowering medications or treatments of heart attacks in the hospital. We’ve had a lot of success, but we’re now having backsliding, and there’s a lot of work to be done.
Terry Gerton I’m speaking with Dr. David Goff. He’s the deputy director for precision medicine and data science at the National Heart, Lung and Blood Institute. Well, let’s follow up with some of that extra work. You’ve launched some pretty impressive research agendas there at NHLBI. Tell me first about the Enrich program.
Dr. David Goff Well, thank you for asking about Enrich. It’s a project that I’m really, really excited about. It’s a program in which we’re testing the ability of home visitation to improve the cardiovascular health of pregnant women and their offspring, their babies. One of the big problems we have in the U.S. is that far too many women are unhealthy before they become pregnant. These are young women — same thing’s true for young men — but young women are too often unhealthy before they get pregnant, very often overweight or obese with the blood pressure and diabetes risk that goes along with that. And then pregnancy is a stress test on the health of the of the woman. And a woman who goes into pregnancy unhealthy has a greater likelihood, of course, of a bad outcome for herself and a bad outcome for her baby. And we’ve also learned that the health of a baby at birth is really strongly related to the health of that individual across the lifespan. So a child born under less than ideal circumstances when it comes to their mother’s cardiovascular health is already on a trajectory to poor cardiovascular health at birth. So what we’re trying to do is test whether having home visitors like community health workers go into the household and intervene on cardiovascular health behaviors, improving diet, improving activity, working on weight reduction, working on improving sleep, working on improving blood pressure, cholesterol, and glucose levels. If we can be effective in improving the health of the mother, we believe it’ll also have benefits on the baby. And so we’re going to be measuring measures of health in the mother and the baby during follow-up. Very excited about this project. And it’s a partnership with several other institutes within the National Institutes of Health, as well as with the Health Resources and Services Administration and the Administration for Children and Families.
Terry Gerton That sounds so promising. And speaking of partnerships, you’ve also got a public private partnership, Heartshare and Precision Medicine. Tell us about how that one’s working.
Dr. David Goff Yes, Heartshare is another program I’m really excited about, and part of that is because of the partnership you mentioned. It’s a public-private partnership in which we’re working with four or five pharmaceutical companies, device companies in the imaging space, as well as nonprofits like the American Heart Association to address a real major unmet need in cardiovascular medicine around heart failure. Heart failure is a major problem in the U.S., it’s a leading cause of hospitalization in the Medicare population. So once you get focused on people 65 and older, the most common reason for being in the hospital is heart failure. Now, chronic heart failure has two main forms. One form, the heart’s a pump, one form of the heart failure is when the heart doesn’t squeeze very well. The other part is when the heart doesn’t relax very well. We have some pretty good treatments for the form of heart failure where the heart doesn’t squeeze very well, although it’s still a bad problem to have. But we have almost no treatments for the kind of heart failure where the heart doesn’t relax very well. If it doesn’t relax well, it can’t fill with blood, and if it can’t fill with blood, it can’t pump blood out. And so that’s what this program is really focused on, understanding why the heart doesn’t relax well in some people. What’s the basic problem at the molecular level, so that we can try to identify drug targets, targets for drug development? So very excited about that. We have multiple pharmaceutical companies working with it because they have the same, they see the same problem. They really don’t know how to develop effective therapies for this form of heart failure. We’ve tried all the medicines that work for the other form. They don’t work for the form of heart failure that is related to the heart not relaxing well. So it’s our hope and our expectation that within the next couple of years we’ll have much more insight into why the heart doesn’t relax well at the molecular level, and we’ll have some targets for drug development.
Terry Gerton Well, those both sound so, so promising and have the potential to impact so many people. What might you be doing next?
Dr. David Goff Back in December I took on a new role at the institute. So previously, I was directing the cardiovascular sciences division. In December, I moved into a new role that you announced. I’m deputy director of precision medicine and data science. And in that role, I have responsibility for overseeing our precision medicine and data science programs across heart, lung, blood and sleep disorders. And so it’s a more broad area of responsibility. We’re developing a cloud-based data science ecosystem to enable us to ingest data from the studies we support, provide those data to the biomedical research community so that others can analyze it and generate additional knowledge from those data that the original scientists may not have been thinking about. We’re supporting development of artificial intelligence methods to try to, again, extract more information from the data that our studies have been generating over the past decades. We think this is a a way of really increasing the return investment in the taxpayers’ investment in our research projects. We have all this data, and once the scientists answer the primary questions that they had when they collected the data, oftentimes the data aren’t used for other purposes. And we’re going to try to address that through our data science program to get the data, curate it, harmonize it, share it and make it available for people who have new ideas they want to bring to the data.
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