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 Bruce
Brundage, MD, has seen it all, from the first anecdotal
cases when no treatment for pulmonary hyper-tension was
available, to the land-mark National Institutes of Health
(NIH) registry, to the large scale clinical trials of
today involving hundreds of patients. For anyone seeking
to chart progress in the field, his career serves as a
bridge, spanning milestones in the treatment of the disease.
He has been associated with virtually every key development
in the progress toward a cure, beginning in the 1970s
when he served as the director of the cardiac catheterization
laboratory at the University of California, San Francisco.
It was during his study of those early cases, when he
inserted catheters into the pulmonary artery to measure
the effects of various vasodilating drugs, that he began
focusing on pulmonary hypertension. During the last 25
years, research has been his passion—leading him to serve
on the steering committee of the national registry and
to play a key role in the growth of the 5,000-member Pulmonary
Hypertension Association (PHA), of which he is now president.
“It was in the late 1970s that I discov-ered the NIH was
starting its patient registry in pulmonary hypertension
so I applied to have our center enrolled as part of the
registry,” he said. “Soon afterward, I was invited to
be on the steering committee for the patient registry
at a time when we began collecting data in an organized
manner.” Joining the faculty at the University of Illinois
at Chicago, Dr Brundage teamed with Stuart Rich, MD, and
Paul Levy, PhD, two leading investigators, as they explored
the effects of high-dose calcium channel blockers in treating
pulmonary hypertension. “This was the first breakthrough
in the treatment because we found there was a percentage
of patients who were helped.”
Dr Brundage’s team at UCLA had enrolled more than 300
patients with pulmonary hypertension, one of the largest
groups in the country at one center. In 1990 Dr Brundage
was named chief of the Department of Cardiology at Harbor-UCLA
Medical Center and became involved in the early studies
of intravenous prostacyclin therapy. Enrolling 300 patients
to receive what was a new infusion therapy at the time,
he was a coauthor of a major paper published in the Journal
of the American College of Cardiology demonstrating the
long-term survival benefits of prostacyclin. At that point
Dr Brundage’s team at UCLA had enrolled more than 300
patients with pulmonary hypertension, one of the largest
groups in the country at one center.
Following his departure from UCLA in 1998, Dr Brundage
accepted the medical director’s post at the Heart Institute
of the Cascades in Bend, Oregon. At that point he began
focusing more attention on the development and financial
resources of PHA. He had already become chairman of the
association’s Scientific Advisory Board in 1996, a position
he held until 2001. The Advisory Board has been renamed
the Scientific Leader-ship Council. This year he agreed
to become president of PHA and also serves as a member
of the Board of Trustees. As a key figure in PHA’s growth,
Dr Brundage has seen the association’s annual budget grow
from about $100,000 to $1.8 million in only five years.
Gifts from foundations, corporations, and individuals
have spurred the group’s efforts in research and have
helped it award grants to young investigators seeking
new therapies for PH as they pursue a career in this field.
“I think PHA will encourage the formation of another
patient registry. Many things have changed since the for-mation
of the first NIH registry. We might be able to col-lect
data that will help us determine which patients are candidates
for lung transplantation. We may also investi-gate the
appropriate use of warfarin. The current recommendation
is that all patients with pulmonary hyperten-sion receive
warfarin, but this practice has never been adequately
evaluated in a randomized study. So we need to determine
in a randomized, placebo-controlled study whether warfarin
makes any difference in the long-term outcome of patients
with pulmonary hypertension. It has been presumed that
there is a thrombotic aspect of the disease but the long-term
beneficial effect of anticoagula-tion has never been proven.
“This new registry will have thousands of patients in
it throughout the country. Since we have representatives
on the Scientific Leadership Council from Canada, Ireland,
Germany, and Italy, it could be an international registry,”
he added. “As president of PHA, my main focus will be
to raise revenues in support of all of these projects.
I am strongly committed to research to find a cure and
raising millions of dollars in this effort. This is the
best way to get to the cure. Pulmonary hypertension is
multifactorial. The more we study this disease the more
clear it becomes that it is a polyglot with many causes.
Fortunately, many differ-ent kinds of therapies are being
developed.”
In recognition of his achievements, PHA has given Dr
Brundage its Physician of the Year Award. Widely respected
in the medical community for his commitment to finding
a cure for pulmonary hypertension, Dr Brundage has also
earned the respect of colleagues and patients alike for
his compassionate attitude and the quality of patient
care he provides. PH
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