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William O'Neill, M.D., Recounts 50 Years of Cardiovascular Advances in Lemberg Lecture

3/5/2010

When William W. O'Neill, M.D., executive dean for clinical affairs, was an intern and resident in the late 1970s, doctors could offer little more than hope to patients who suffered severe heart attacks.

"All we did for patients with acute myocardial infarction is give them nitroglycerin, give them morphine and put them to bed," O'Neill recalled Wednesday as he delivered the 18th annual Miriam Lemberg Visiting Professorship in Cardiovascular Disease lecture. "That's all that we had and we hoped they would survive."

Twenty-five years later, thanks to tremendous strides in the treatment of cardiovascular disease, the life expectancy of patients who have suffered heart attacks has been extended by 10 years, a dramatic improvement that, as O'Neill noted, did not happen by magic, or by decree. It happened by hard work, and through the passion and perseverance of cardiologists who dared to push their field into new, often unpopular directions with therapies once considered "heretical."

"American cardiologists have led the charge in the treatment of cardiovascular disease," he said. "We can't be embarrassed about that. We have to brag about that. It truly is one of the major advances of modern medicine in the last 50 years."

An international leader in interventional cardiology, O'Neill - and the University of Miami - played a pivotal role in that history, which he condensed into a 35-minute talk titled "Myocardial Preservation after AMI: Will Novel Therapies Change Future Treatment Paradigms?"

In the late 1980s, as most of the cardiology world pushed to abandon angioplasty for more convenient clot-busting drugs for the treatment of acute myocardial infarction, O'Neill organized and carried out the seminal trial comparing the two. Published in The New England Journal of Medicine in 1993, the study definitively showed that angioplasty was superior to thrombolytic therapy, with decreased mortality, reinfarction rates and incidences of ischemia and stroke.

"He showed once and for all that using a catheter within the appropriate period of time led to a better outcome than the use of drugs that can dissolve the blood clot," Miller School Dean Pascal J. Goldschmidt, M.D., said in introducing O'Neill. "That discovery was so important that it has now changed the way we treat patients."

But a half century before that trial, O'Neill noted, the Miller School's Dr. Robert Boucek, with the assistance of Dr. Leonard Sommer and others, planted the seeds of change by performing the first thrombolytic therapy during a heart attack in the cardiac catheterization lab at Jackson Memorial Hospital.

"Miami is really the birthplace of mechanical reperfusion therapy for acute myocardial infarction," O'Neill said. "It all started here in Miami by Miller School medical faculty."

It was not, however, easy. Boucek abandoned his work when the American cardiology community rose up and condemned it as a radical and unnecessary emergency procedure. At that time, O'Neill noted, they didn't even agree that clots were causing acute infarction and, for the next 17 years, research on thrombolytic therapy went to Europe.

Then in 1980, as a cardiology fellow at the University of Michigan, O'Neill would meet the patient who would redirect his own life's work - a 39-year-old man who had suffered an acute heart attack. As O'Neill watched a drip of clot-busting drugs restore the man's blood flow, he said, he "could see right away that this was going to revolutionize the way we treat patients with acute infarction."

Thirteen years later, O'Neill went against the prevailing tide and established the supremacy of angioplasty with his seminal clinical trial, learning a lesson he imparted to the fellows and young investigators sitting in his Lemberg audience.

"The beauty and magic of science is that, in science, truth will always win," he said. "If you do an experiment properly and you get an accurate outcome, that experiment will be replicated time and time again."

The Lemberg lecture, too, has deep ties to the history of cardiovascular therapies, and to the Miller School. A former professor of clinical cardiology who began working at Jackson Memorial in 1952, Louis Lemberg, M.D., helped develop the implantable demand pacemaker in 1964.

How his wife's name became synonymous with one of the Miller School's most successful annual lectures is, appropriately, a matter of the heart. As Joshua Hare, M.D., director of the Interdisciplinary Stem Cell Institute, recounted Wednesday, 21 years ago Dr. Lemberg's wife Miriam asked former Dean Bernard Fogel, M.D., to help her endow a chair in her husband's name. Within a year, they raised $1.5 million for the Lemberg chair that Hare said he is now privileged to hold.

Shortly afterward, Dr. Lemberg sought Dean Fogel's help in honoring his wife with a lecture series in her name. Now married 39 years, the Lembergs were in the audience Wednesday, and were all smiles when they gave Dr. O'Neill a plaque honoring his accomplishments.