MedEvidence! Truth Behind the Data

From Clinic To Boardroom, Medicine is About Patients

• Dr. Michael Koren, Dr. Evan Loh • Episode 353

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Dr. Evan Loh joins Dr. Michael Koren to discuss Dr. Loh's journey through the medical profession. Dr. Loh moved from doing lab work in medical school to patient care in the academic sphere and into the pharmaceutical world of research. Dr. Loh and Dr. Koren discuss the core differences between bedside physican work and research, including in time spent with patients, physician incentives, and the treatment that results. Through it all the doctors find a simple axiom: all medicine is about patients at the end of the day.

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Music: Storyblocks - Corporate Inspired

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Announcement:

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Michael Koren, MD:

Hello, I'm Dr. Michael Koren, the executive editor of MedEvidence! And one of the really fun parts of my job is I get to catch up with old friends and talk about their lives. And gives me an opportunity to talk a little bit about my life, but more interestingly, the guests' lives and how we have interfaced over time. And I had that great opportunity today to interview my friend and colleague, Dr. Evan Loh. And Evan and I caught up at a recent Harvard Medical School reunion. And when I was learning about what he was doing with his career, I was really frankly blown away. And I said, Evan, you got to come to Med-Evidence and tell us about your journey from uh when I know you knew you back as a medical student to becoming an academic cardiologist to now running a drug company. So, Evan, welcome to MedEvidence! and uh share with us um this incredible journey.

Evan Loh, MH:

Yeah. Hey Michael, this is such a treat for me to be here with you. I'm delighted uh that we've had each other in our lives over these many, many years. It's hard, hard to even imagine the uh the actual number of years uh since we actually were in medical school together.

Michael Koren, MD:

That's a classified secret, my friend.

Evan Loh, MH:

It is a classified; I was not gonna reveal that. So uh a little bit of background on me for for the audience. Um I am the uh firstborn uh son of Chinese immigrants uh who came here uh to the United States in uh 1955, uh, neither of them speaking uh English, having to relearn English and relearn their medicine. My father was a physician and my mom was a nurse, and trying to figure out how to make a world for themselves here in the United States. They didn't have family to go back to at that time. There was a lot, a lot going on back there in Asia uh at the time. And um, you know, as being the firstborn uh son in a traditional Chinese household that we tried to make, um, there was a big emphasis on trying to figure out you know what was going to be the uh career path uh for uh for for this child. And um I um did a lot of things. I enjoyed every kind of sport uh possible. I was the shortstop of my little league baseball team, and uh I also played the violin and I was quite good at it.

Michael Koren, MD:

You were incredible, by the way, and um just an aside uh for for the audience, um we had a big show when we were second-year medical students, and Evan actually opened the show playing the violin from Fiddler on the Roof that we turned into uh a bit of a comedy sketch and was was more than just good. He uh maybe not quite a virtuoso, but pretty darn close.

Evan Loh, MH:

Well, you're awfully kind, Michael. I it was it was something that I enjoyed then and continue to play today in terms of enjoying it, chamber music and what have you. Uh, but the um uh my mother quickly said, You can't have a career as a musician.

Michael Koren, MD:

Really?

Evan Loh, MH:

That was not okay.

Michael Koren, MD:

Okay.

Evan Loh, MH:

So uh, and you know, the small world that I lived in, you know, we I grew up in New Haven, and um, all of the men and women that we had in our Chinese student circles, uh, they were all either MDs or PhDs. So there was a little bit of predestination in the sense that my world was very narrow, Michael. Uh so I think that uh on some level, medicine was preordained or some pathway within the medical research field uh from that perspective. So um as I uh finished college and applied to medical school, decided that was the path that I ultimately uh wanted to take, um, I think that the pathway deviated a little bit from what my parents knew, because my parents really, when they came here, needed to basically get certified to practice medicine. And that was really their goal to have a career, to have a job, and to be able to put a roof over our heads and uh support our education. But where I deviated a little bit was the fact that I really, by being at Harvard and searching out opportunities to actually open my mind up, got um involved with uh ongoing medical research. And so I did a senior thesis. I did it at the Dana Farber Cancer Institute. Uh, we worked on uh fundamental pathways of uh metabolism in oncologic cells, and we had the chance to uh get those data published, but I got exposed to the fact that there's a real opportunity to put translational data that you generate in cell systems, even in mice systems or other animal systems, and apply them to ask the question are they relevant for human disease and asking that particular question? And so that was the background upon which I went into medical school. And um, you know, when Michael and I first met there, I don't know whether you remember this, Michael, but we had a um research mentor program for all first year HMS students. And I think you mentioned maybe Harvey Feinberg was someone that was close to you, but Tom Smith, who was the chief of cardiology at the Brigham. Oh, wow, okay. Was my first year mentor. Very cool. And uh so he brought me down into the basement of the Brigham, it's the new Brigham, showed me his, you know, his uh uh dig antibody machine that he had, the only person in the world that could actually get dig antibodies and uh monitor dig levels in the world.

Michael Koren, MD:

Right. And um And for everybody, digoxin is a drug that we we've used in cardiology for hundreds of years, literally. For decades, yeah. And and uh it was changing when we were in in school, but prior to that, people would never know if if you were toxic from dig or actually benefiting from it. That's right. And this will get into our evidence-based medicine discussion, but we didn't even know the evidence for digoxin until relatively recently. But sorry for-

Evan Loh, MH:

Yeah, that's right. That's right. And it's been controversial, actually, interestingly.

Michael Koren, MD:

Yeah, sorry to interrupt it. Uh yeah, a little aside.

Evan Loh, MH:

Then um it turns out that uh HMS had a program in the in the summertime. I don't know if you remember this. You could apply as a student to actually do a medical research project, and they would pay you. Guess how much they paid, paid me? $1,500 for 12 weeks of work. Nice. And it turns out that I uh did a research project in uh one of Tom Smith's cardiology labs. And um, it was um with Jim Marsh, and um, we did work on understanding uh calcium channel uh receptor physiology. And so that was my start of my exposure to cardiology and uh learning about that, and it's kind of stuck with me, Michael. And so that's ultimately why I I ended up uh you know going into cardiology from that standpoint. So um you and I graduated. I went got my house staff training at the Brigham Internal Medicine, did my cardiology there, and got a transplant fellowship as certification there uh at the Brigham, spent a few years there, and ultimately went to the University of Pennsylvania, where they asked me to run their cardiac transplantation program, which I did for about seven years or so. And uh we were able to grow that program to I think the fifth largest volume heart transplantation program in the country.

Michael Koren, MD:

Wow.

Evan Loh, MH:

And um had a lot of fun doing that, built a giant program, uh, a lot of fun. And um, you know, it was at a point where academic medicine, this was back in 2000 or so, this is when academic medicine, you know, had begun to have its struggles with understanding, you know, how to actually run medical centers. Uh, they were trying to consolidate primary care practices, et cetera. And I think the margins in those businesses were hard. And uh they really, you know, even though I had a translational program where I was the clinical director and I had to liaise with people that had labs, um, you know, that was not the commodity that they valued, Michael. They really valued my RVUs, they wanted me to be busier, and uh, that's what they valued at that time.

Michael Koren, MD:

Yeah, it was a very for the audience, RVUs are relative value units, and that doctors get paid in a lot of settings based on how many visits they do or how many procedures they do based on this RVU matrix.

Evan Loh, MH:

But good, yeah. And and so, you know, even though we had fellows and lots of research going, uh, I'd published, you know, a hundred plus papers, written a book, et cetera. That was not really what they valued, which was disappointing to me. And I wanted to actually ask myself, where else could I go to actually think about being in that translational space where I could apply interesting basic science knowledge, translate it into animal models, and ultimately think about how it could continue to be a positive outcome for improving and advancing uh clinical care. Because I'd done some of that work, you know, when I was a cardiologist. You read some of my papers in terms of being the first person to publish the effects of the beneficial effects of warfarin in patients with heart failure, secondary to myocardial infarction, and other things along those lines. So it turned out that I made a big transition. I put a I left academic medicine and I joined a uh large uh pharmaceutical company called Wyeth, been stayed there for about nine years, developed a bunch of different uh medicines, and then uh we were acquired by Pfizer. And um, after being there for a couple of years, I really wanted to get out and go on go on my own and wanted to get back to drug drug development. And um ultimately um landed here at my company called Paratech. This is uh back about oh, 13 years ago, and we've been able to get the company public uh after being private, and then now we're private again, but raised a ton of capital, probably about a billion and a half dollars worth of capital in about 12 years to get to the point where we actually have two approved products in our portfolio, and we are commercially uh out in the marketplace with our two drugs. One is an broad spectrum next generation uh tetracycline, and then the other product is a new med device combination with a uh next generation flonase for people with chronic sinusitis with and without nasal polyps. And so um we're moving along and we're having a good time, but it's you know one of those places where um, you know, as I hearken back to something that I learned when I transitioned into uh pharma, you know, we had um, you know, I was a I was a thought leader, Michael, had published a lot of papers, and you know, there's academicians who think they're really important. And um, I get into the pharmaceutical world, and uh my head of clinical research and development at Wyatt sat me down and said, Look, I just want to let you know, and this is what I've seen before in the past, he said, you know, when academics come into pharmaceutical land, they think they're really important. But at the end of the day, no one really cares. All they care about is that you're focused on doing great drug development and helping them be successful. And that was really a sobering moment for me. You know, it was kind of humbling in some sense because I didn't really understand how drug development has to work, which is in a team setting. You know, one of the things that I like to say in my company is that no one in my company has a monopoly on intelligence. And you need to bring ideas from everybody in order to have successful drug development because people come from different places, they have different different levels of experience.

Michael Koren, MD:

Right.

Evan Loh, MH:

And, you know, when I and another theme that I had that I learned that I still think about today is that the head of our commercial business also said, you know, you you guys here can really spend a lot of time thinking about transformational changes, making the company more efficient, thinking about doing it with less heads, blah, blah, blah, blah, blah. But you know what? There are no great, there are no great pharmaceutical companies on this planet. There are only companies that have great products. Focus on the great products. And that was really a theme that I continue to believe in today that's really, really important. And what are those great products, Michael? You know, I know that you're you're in this field, you've been in your in this field for decades, leading uh clinical trial development, clinical trial protocol development, living in the regulatory world. At the end of the day, it's it's a mix, right? One is that it has to make a difference in a patient's life in a way that's really objective, demonstrable, measurable, that a regulator can see, say yes to. But at the end of the day, it's got to be something that a doctor is going to care about. And then finally, I think the other piece that I think pharmaceutical companies can sometimes lose their way, and it speaks to the value of I think being a physician in this particular field, is just always respecting and honoring a prima facie commitment to patient safety. Always because you're asking them to take a potential drug or an antibody or a vaccine that could ultimately hurt them. And you and I know that the last thing that we want to ever have at the patient's bedside is that we do something or make a recommendation that the outcome is less than less than perfect. And I know nature, nature and medicine are humbling every day. We do our best based upon the information we have, but we don't want to actively participate with a company or a product that ultimately has a higher risk of actually hurting someone than making them better.

Michael Koren, MD:

Yeah, you you said so many incredible things in in that little discussion and a lot of stuff to unpack. So I'm gonna uh in no particular order. Uh one of the things that you said that resonated with me was this trade-off between the clinical care and the RVU environment where you're being valued based on what you do for one patient at a time, which is important, versus research, which impacts thousands of people at a time. And it reminds me of a discussion I had with my cardiology fellowship mentor, Dick Devereux. I don't know if you ever worked with Dick, but he was he was my mentor at Cornell during cardiology fellowship. And he he kind of drove that idea into my head in a big way. He said, You're you know, clinical care is important, but let's face it, you're affecting one person at a time. Whereas in the research world, you're literally affecting thousands or millions of people based on the work you're doing. And that that always really resonated with me. And I think you had that that DNA as well. Uh and and and interestingly, you kind of made the path to industry in part to pursue that DNA, if you will.

Evan Loh, MH:

Yeah, I think that's right. I think you you hit it right on the head. People have asked me, you know, you had such a great career uh in academia and in cardiology, why'd you leave? I said, well, in some regards, it was it was unbelievable in terms of my experience, just like yours, when you were actively and you may still be seeing patients, I think one day a week, uh, to make that difference one patient at a time. I think though, where the where the rubber met the road for me is that I was getting pulled so heavily into the clinical arena that I couldn't actually have the time to think about fundamental research questions that would advance the field and make patients' lives better. And I hoped when I moved into the pharma world that number one, the science was good, and number two, that they that they were asking good fundamental questions that could advance the care of patients. And I think that's part of the I think that's part of the subtlety, Michael, that folks don't really appreciate that the science in the pharmaceutical research world and the biotech world is top shelf.

Michael Koren, MD:

Yeah, oh no doubt.

Evan Loh, MH:

Uh it's really top shelf with top shelf scientists, top shelf researchers. I mean, you can't really go into clinical trials and give patients these medicines unless you've really understood the products. And and I've learned so much that I'd never learned in medical school, which is pharmacokinetics, pharmacodynamics, drug metabolism, conversions. I had to go back to my Krebs cycles, I had to go back to my, you know, all yeah, all of it's relevant.

Michael Koren, MD:

No, no doubt. And absolutely. And and and uh And it's fun to use that stuff. Yeah, it it's fun to say, oh, I I did study this when I was a first-year medical student, and now I see the relevance after all these years. Yeah. So that is fun. So I want to also focus on something else you said that I think is really compelling, which is the role of the physician in drug development and how there's a centricity around the patient and safety when we do what we do, that's probably fundamentally different than non-physician researchers. So maybe you can comment a little bit more on that.

Evan Loh, MH:

Yeah, you know, if you think about, you know, if you think about the predominant percentage of people that are in pharmaceutical drug development, I would say 98% of them are actually non-physicians. And if you look at the leadership of these organizations, because they have to survive, right? And they have to be, you know, profitable, most of the senior leaders are actually commercial commercially driven or from the finance world. And so they've never been at the bedside. And I do think that there's also some bias that clinicians in the pharmaceutical drug world, drug development world, are really only good for safety to evaluate patient safety, which is great. They understand that there's no one else can that can actually do that because then they've not been at the bedside. But I think where that that assumption goes awry, Michael, you know, and you and I were talking about this earlier, is that I don't think that anyone else has really been at the bedside to understand how a clinician thinks, how they might use a new medicine, what their determinants of what a good outcome would be for a patient with disease X or Y. And I think that's where I think physicians that have the ability to navigate through the complexities of the science, the translation, the clinical development data, as well as on the commercial side and marketing side, to be able to blend those together, I think physicians have an incredibly important role because we're the only ones that have ever been at the bedside. And I think that one of the one of the pieces of feedback that I re that I get very consistently, that I'm very pleased about in my current company, by being a physician who's the CEO. I talk about patients every time I talk publicly with my company. Patients are always front and center. Patient safety always is number one, Michael. I know you believe in that in terms of everything that we do, but the products that we ultimately have. I asked all of my employees at the end of the day, if it's your mother, father, brother, sister, grandmother, grandfather, would this actually be a product that you would feel comfortable giving to your mother, father, brother, sister, grandmother, grandfather?

Michael Koren, MD:

I love that.

Evan Loh, MH:

So it is about patient safety. And so by doing that, you know, everyone in the company comes up to me and they say, Wow, it's so great to have a physician leading this company because I understand who we are fighting for. We are fighting for our patients. And that's really the theme that I like to carry through in my current leadership role. And I don't think it's any different, Michael, than why I went to medical school, which is kind of odd because you know, I'm not actually at the bedside, but I patients are front and center because they have to be. Otherwise, otherwise, the mission is actually off point.

Michael Koren, MD:

Yeah, well said. So that that gets me to sort of uh the last point I wanted to drill down with you on, which is this concept of what is evidence-based medicine and particularly how patients could fit into that. And as you know, we've had this discussion previously, but kind of my career path has been around not only looking at the outcomes of the studies that we do, but also thinking about what that experience was for all these patients, and why that's such a fulfilling experience and a valuable experience for patients. And of course, I've I've built an organization around that to give patients the opportunity to have those experiences. But I think there's a lot of misconceptions about what evidence-based medicine is, first of all, and then secondly, why it's so attractive for for patients, for people to get involved in this process. So maybe share some of your thoughts on that.

Evan Loh, MH:

Yeah, look, I think that they're, you know, there, if you look at the history of clinical research, right, you can go back to the Tuskegee experiments and other things that you know have given it a bad name. And I think that things have really come a long way. You know, if you look at the Declaration of Helsinki and uh the International Committee on Harmonization of Clinical Trial Development or ICH, they are fundamental oversight bodies that we ascribe to, we commit to, and that we live by to ensure that patients, when they're asked to participate, there's no coercion, that they're actually in a place where the experience is actually should be in some ways no different than getting routine clinical care. And that in fact we try to minimize the amount of abuse of in terms of uh blood draws or other procedures or other you know x-rays or other things.

Michael Koren, MD:

Data collection. We won't we won't call it abuse, we'll call it data collection.

Evan Loh, MH:

Yeah, I think abuse is not the right word for it, but um, thank you for that. But I think it's really the amount of data collection. Right. And I think that there's also a moral contract that you develop with these patients or even known volunteers who participate in pharmacokinetic studies to ask them to actually participate, is that I think that they're what what what I think you've experienced as well as I've experienced is that there is a deep-seated level of altruism that humans actually have. Yeah, that they say, you know what, it may not be good for me, but if this is data that you say could lead to this improvement or this new medicine helping this cohort of individuals down the road, I'm all in. Yeah, I'm all in to help you. Yeah. And and I just continue to just tip my hat to to all of those patients who say yes. And when they say yes, I also say to my folks that are working on my side, remember what they've said yes to. And we have an absolute obligation to transparency, to treat them well, to let them be able to say that I'm done. I don't want to participate anymore, to give them complete freedom to, you know, determine their pathway, and at the end of the day, interact with their physicians in a way that at the right time they can also share the outcomes of the trial with them so that they know what they participated in. So I think that there's a there's a full circle here, Michael, as you said, in terms of their participation to generate these data.

Michael Koren, MD:

Yeah-

Evan Loh, MH:

But in the absence of these data, we don't get life-saving cancer drugs, we don't get life-saving cardiovascular drugs, we don't get life-saving drugs that, you know, change the natural history of people with rheumatoid arthritis. You remember the days when we were at the Brigham where these elderly patients would come in in wheelchairs with deformed joints, their hands, their legs, they couldn't walk. You know, today medical students don't see that type of rheumatoid arthritis.

Michael Koren, MD:

Yeah, so interesting.

Evan Loh, MH:

Right? And it's because of the proteins that we've developed, the Enbrels and the Humiras and things like that, the disease has completely changed. I mean, uh and I just am so excited to be part of this uh industry. I mean, think about the natural history of cystic fibrosis, right? Uh they used to all uh perish, you know, in their late teens. Today, uh the natural history of patients with cystic fibrosis, because of the interventions and the places that uh these these new drugs have gone. 64 years, Michael. Is the life expectancy of a patient with cystic fibrosis.

Michael Koren, MD:

Amazing.

Evan Loh, MH:

Five more decades of life. I mean, that's amazing, right?

Michael Koren, MD:

It's it's it's absolutely fabulous. It's absolutely fabulous. And so you know, uh, we used to um compare notes all the time at at the different cardiology meetings when you were uh uh running the heart failure program at Penn. I remember we we had some discussions, and obviously you were doing you were getting people in clinical trials that were really, really sick. And um, you know, in though in that case, a lot of the people are really doing it to see if they can improve their survival. But there's so many other elements of participation that people love. Uh and my favorite statistic to quote is when you ask an average American or average European who's never been exposed to clinical research whether or not they're interested in being involved in a clinical trial, only 40% say yes. But if you ask somebody that's completed a research study, if you would do a second study, 97 to 99% of people say yes. And the reason that there's that high conversion rate to being true believers and fans in the process is because they get so many things. They get the socialization, the intense interaction with the staff and the physicians, which as you alluded to, is not really part of clinical medicine nowadays. Everything has become sort of cookbook and and just processing. And the the human touch has been unfortunately extracted a lot from from clinical medicine, but you still get that in research, ironically, when you think about it. And uh, of course, there's a lot of information that's shared with the patients. Uh people get imaging tests that they might not get, people get uh treatments that they may or may not get, although we are always very clear that sometimes we don't know what you're on, and sometimes it can be a placebo. But and and there's also stipends. People in many cases get paid for their time in travel. That is helpful for a lot of people. It could be the difference uh between uh not a great Christmas and having more money for gifts for for the family. So you know these are practical things that really impacted a lot of our patients. But you brought up the thing that I think is the most compelling, which is at the end of the day, we get these results that change the world. And people love that. Uh and and it it could change the world for that generic person out there, or it can change the world for a family member because it's a genetic disease that we're learning about. And and so to me, this is what floats my boat. This is what gets me excited. And um, you know, this is the experiential part of evidence-based medicine. And then there's one other part that I don't think people understand that well, and I'd love to hear your comments on that, which is, and we kind of alluded to it in some of our stories, but you know, 50 years ago, the way physicians worked was kind of, okay, well, my friend, the oncologist, tried this and maybe we'll try it, uh, versus what we do now, which is when we actually use a medicine that's been approved, we know a lot about it. And we talked about digoxin, which is probably the oldest cardiac drug. Uh uh aspirin may have been the oldest cardiac drug we didn't even know it was a cardiac drug for many years.

Evan Loh, MH:

No, that's right.

Michael Koren, MD:

But digoxin has been something that's been uh used by physicians for over 200 years, and it was only in the last 20 years or so where we actually had a study to show that it kind of worked, but maybe not as much as we thought. So this whole concept of just assuming that the physician has all this information versus actually having the information is a fundamental transformative medicine uh transformative part of evidence-based medicine. But your your reaction to that.

Evan Loh, MH:

I I think it's spot on. It's it it is, I think when you look at evidence-based medicine, Michael, I think you can you can take it to one extreme, which is that if you don't have the evidence, you can't use it. However, I think that there is a gradient of of data that actually you can couple together with your bedside experiences to ultimately have you decide what's what's best at the end of the day. I think that you know, where things have gone a little sideways recently is uh not really understanding or appreciating how hard it is to generate those studies. And when you look at the analytics that go along with it, how important they are to, I think being able to answer a fundamental clinical question. And number two, I think how does it ultimately get applied in the clinical care? Because as you know, sometimes these clinical trials are designed in ways where you have to try to get as pure a population as possible to be able to have that intervention be the one thing that you could actually determine was making the difference, as opposed to putting it in the context of a clinical care algorithm where you actually may have other drugs in the mix at the time. But the regulators and also clinicians want to see the effect of that one drug as opposed to that in combination. Those those data come later, uh, but it's one of those things where I think it really is very helpful. And I think when you go back to our training and you think about some of the some of the trials that we looked at, right? Such as the natural history of untreated aortic stenosis, you know, from Eugene Braunwald, or you know, the uh outcome of low-gradient aortic stenosis and LB dysfunction, right? That Blase Carabello study was done in like 20 patients. I mean, that's what we based our practice on, was just what was published, right? I mean, it was the best we had at that time. But now you're you're talking about trials that have tens of thousands of patients of data, like you said. We really do know that these drugs, number one, are fundamentally safe, or they have, you know, a risk of diarrhea or nausea or or what have you. But at the end of the day, we can actually be able to actually, in a very, very accurate way, tell the clinician exactly what they could potentially expect on a population basis for the effect size.

Michael Koren, MD:

Absolutely. Absolutely. And you you brought up something that's interesting. Is again, it's the balance between some of the clinical aspects and the scientific aspects. And all the things that we do in evidence-based medicine is built on these protocols, but it doesn't take away our commitment to the patients and doing the right thing for the patient. I'll give you a recent example of that. So, as you know, I've done a lot of work in the lipid world, and we've done a lot of uh early phase clinical trials here in Jacksonville, and we had a patient last year who was in for a very early phase lipid study, which involved confinement for seven days here in our offices. And um, very nice guy. Um, probably not somebody that was interacting with the standard medical profession as much as he should, had multiple cardiovascular risk factors, but actually no known actual heart disease. And he's in a lipid study, and he, you know, starts to get a little angina when he's here with us. Okay. And um, because of the fact that we're, you know, even though we have a protocol that doesn't really evaluate angina, of course, for the safety of the patient, we do what's necessary. And then we find he has a little troponin bump, which means that he had some damage to his heart muscle. And uh so uh literally we got him from our confinement area to the cath lab, which is of course not part of the protocol at all, but this is what we need to do for the patient. And he had a very serious obstruction of his coronary artery that we fixed. And um uh and so he comes back uh after that, and you know, I didn't know how he was gonna react to the whole thing. You know, would he blame the study for this whole thing? And Evan, he was so thankful. He literally thanked me for saving his life because you know he said, you know, I I understand that if it wasn't for this study, I would not have had that experience. And even though I did end up having a small heart attack, it turns out you would have never known this problem and you literally saved my life. And so it's an example of in the uh in the process of creating evidence-based medicine for a new lipid drug, we actually had a huge impact on somebody's life. And and and again, this is to me why it's so important what we do. And and and you've touched this space in so many places during your career from being a medical student and drawing blood on people to uh to running a heart failure clinic and now actually running a drug company that finds the funds and finds the logistics to actually run these studies across the world. So again, congratulations and thanks for everything that you do.

Evan Loh, MH:

Look, Michael, thanks, thanks for that. I I love that story. And you know, at the end of the day, and I know you care deeply about eviden evidence-based medicines, but you know, what I like to say, you know, is that at the end of the day, data's forgotten, but stories are remembered. And what are we in the business of? We're in the business of generating great patient stories. And that through line has not changed a whit from our time in medical school to today. And I'm just honored and privileged to have been part of this industry and making a difference in patients' lives each and every day.

Michael Koren, MD:

Well, that was a brilliant way to end our discussion, and I want to thank you for being part of MedEvidence! and thank you for spending some time with us. And um, this has been a true pleasure for me. Thank you, Evan.

Evan Loh, MH:

Tons of fun, Michael. Thank you so much.

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Dr. Michael Koren

Host