"Into a Limbo large and broad, since called the paradise of fools, to few unknown"
In Paradise Lost, John Milton reminds us that the early Christians identified Limbo as a temporal, physical border place for souls to linger between Heaven and Hell, instead of its contemporary understanding of a metaphorical state of uncertainty. Today, the healthcare community appears to be lingering in the latter.

Since Congress has adjourned for the remainder of the summer without having passed healthcare reform--much to President Obama's dismay--many questions remain. Leaving the entire month of August to ponder issues, such as: Will the government include a public insurance option? Will small businesses be required to provide insurance, and will that equate to more layoffs? How will the U.S. cover those additional costs, and will it mean widespread tax increases? Will comparative-effectiveness research be packaged into the reform bill, and would that equate to a government mandate of certain practices? What will happen to the current sustainable growth rate policy?

Although many of these questions permeate our minds and consume the 24-hour news cycle, most clinicians and professional medical associations--like the ACC--agree that changes must occur to cut costs and provide more coverage.

When a bill passes, the new policies will undoubtedly mean broad changes across the entire healthcare community. Meanwhile in the cardiovascular realm, major trials have been published and new treatments have received regulatory approval over the past year. Yet, it remains to be seen if these new data and therapies will  have an effect in clinical practice.

With the official availability of prasugrel, branded as Effient, about 45 percent of interventionalists said they would use the anticoagulant less than 25 percent of the time for acute-MI patients, according to a Cardiovascular Research Technologies (CRT) poll. Due to the highly publicized bleeding risks in TRITON-TIMI, many clinicians may wait to see how the drug performs in real-life practice, which may mean slow adoption rates

Almost a year has passed since HORIZONS AMI was presented at last year's TCT, and Medicines Company has just started to see the benefits of the trial's positive results using Angiomax (bivalirudin) in STEMI patients, compared with the long-standing gold-standard, heparin. This week, the company reported a second quarter jump in Angiomax profits of 17 percent in the U.S., and 96 percent internationally.

What the effect will be of the FDA's approval of a new statin on the U.S. market--Kowa's Livalo (pitavastatin)--or the longer-term effects of BARI 2D or SYNTAX remains to be seen, as we remain in this constant state of Limbo. Despite Milton's harsh words for those in this state, hopefully, our very souls are not wrapped up in these processes, and some healthy foolishness can ensue in the waning days of summer.

On these topics, or any others, please feel free to contact me.

Justine Cadet