Talk:Milton Packer

Bosentan trial

On page 8, the CV says:

Principal Investigator and Chairman, Steering Committee, Effect of Bosentan on Clinical Status in Heart Failure (REACH-1), 1997-2003

Of this trial PMID 11532543 says "bosentan was the first endothelin antagonist that was developed for clinical use. REACH-1 (Randomized Evaluation to Assess the effects of Ro 47-0203 [bosentan] in patients with Chronic Heart failure) was the first larger (pilot) study that was designed to study the efficacy and safety of an endothelin antagonist in patients with CHF, and also to examine whether the higher dose of this drug (500 mg twice daily) was well tolerated [12]."

Ref #12 is Packer M, Swedberg K, McMurray JJV et al., for the REACH-1 Investigators. Multicentre, double-blind, placebo-controlled study of long-term endothelin blockade with bosentan in chronic failure: results of the Reach Trial (abstract). Eur Heart J 1999;20(Abstr suppl):95.

PMID 11532543 goes on to talk about that trial, its termination for safety reasons, and the questions that raised, and bemoans the lack of published data.

Unclear what is wrong with this? So great that the results finally published! Jytdog (talk) 16:31, 6 August 2017 (UTC)

Dear jytdog

Thank you so much for helping with this. This is a new experience for me, so I appreciate any guidance that you can provide. I want to understand what I can do to help.

Regarding bosentan, there is confusion because there were two trials. The first was a small pilot trial, known as REACH-1. It was presented in 1999 and published as a full paper in 2005; it had promising results. A much larger trial with bosentan was then launched; this was called ENABLE. It was not terminated early. However, the results of the ENABLE trial were disappointing; these results were presented in 2002, and these were published as a full paper in 2017. So I think that the next to last paragraph should refer to ENABLE (not REACH1), and it should not say that the trial was terminated early. Both ENABLE and PROFILE trials were published as full papers in 2017.

There is an explanation for the delay of publication of the trials. Both projects were closed immediately by the sponsors after the trials were completed, and we had great challenges getting access to the databases. Only after many years, were we able to get full access and find a sympathetic editor. The full story of the delay is described in a commentary (JACC Heart Fail. 2017 Jun;5(6):408-410).

I hope this is helpful. — Preceding unsigned comment added by Xostugo (talk • contribs) 17:50, 6 August 2017 (UTC)

Quick note about using talk pages - we "thread" comments by indenting. The Wikipedia software recognizes a colon in front of a comment as a sign it should make an indent when it displays the text. So you are replying an original post (as you did above) you put one colon, and it indents once. I am replying to you, so i put two colons and you will two indents as you read this. When you reply, you will put three colons, etc. When that gets silly we "outdent" by putting {{od}} in front of the comment. Will reply on the substance in the second... The other key thing on talk pages is signing -- you do that by typing exactly four tildas at the end of your comment, and the software turns that into a link to your userpage and the date. That is how we know who said what, and to whom! Complicated and clunky, but that is the software we have to work on. Jytdog (talk) 18:35, 6 August 2017 (UTC)

Thanks for your reply! I hear you on the ENABLE thing, but this is weird the strange world of Wikipedia arises. Everything in WP must be based on what sources actually say. PMID 11532543 doesn't discuss the ENABLE trial -- it discusses REACH1. As a Wikipedia editor, I have no right to talk about the data from ENABLE not being published, as there the source I am using doesn't discuss that (it was ongoing at the time that reference was written). I know that probably seems insane to you but this limitation is one of things that makes Wikipedia possible -- editors here cannot do their own research. We summarize what reliable sources say. I added something earlier today that the two new papers explain why the research wasn't published. Is that OK with you? Jytdog (talk) 18:39, 6 August 2017 (UTC)

I am beginning to understand. At the age of 66, this is a very unfamiliar world to me. (But I think I got the number of colons right!) You can certainly leave the text the way it is. I think I need to think about all of this for a bit. Until a few weeks ago, I never had a Wikipedia page and was surprised when someone created one on me. Most of the summaries of my career achievements have not appeared on the internet, so I am still getting used to the idea. The only one that I know about is when I was designated a "Pioneer in Cardiovascular Medicine" by the European Heart Journal. Here is the reference: https://academic.oup.com/eurheartj/article/37/21/1633/2887778/CardioPulse-Articles. If you were to look it up, you will see that the post has two parts; the first part is a memorium I wrote for a dear friend, and the second part is a description of my career and contributions. (You need to scroll down to the second part to see it.) This career summary (which I did not write!) highlights my major contribution, which was the development of the "neurohormonal hypothesis of heart failure". If there is anything in the "Pioneer" summary that you think is worth moving to the Wikipedia page, please do so. I will leave that up to you. Thank you! Xostugo (talk) 22:50, 6 August 2017 (UTC)

Thanks for the reference. The interview when you took the job at UTSW was super helpful. as well. Wikipedia is not like the rest of the internet. It is it own strange corner, with all these "policies and guidelines". Jytdog (talk) 02:39, 7 August 2017 (UTC)

This page is about me. I am Milton Packer. The content has not been updated in 8 years. Please help!

Please help. I am 75 years old and am not very tech-savvy. Please help me get through this. My motivation is to make sure that the page is written clearly and is up to date. The last update was 8 years ago. I identified several sources, and I can provide others.

1 CHANGE #1 Replace the following text: "Milton Packer (b. ca 1951) is an American cardiologist who is known for his clinical research concerning heart failure."

Replace it with the following text Source: https://hfsa.org/milton-packer-md Source: https://pubmed.ncbi.nlm.nih.gov/1351488/ Source: https://www.acc.org/latest-in-cardiology/articles/2026/03/01/01/cover-story-the-adipokine-hypothesis Source: https://academic.oup.com/eurheartj/article/46/4/337/7915815

"Milton Packer, MD (born 1951) is an American cardiologist who has made important contributions to the field of heart failure, both in understanding its mechanisms and defining its rational management. Over more than 40 years, his work established the cornerstone of the current modern treatments for heart failure, including ACE inhibitors, beta-blockers, angiotensin neprilysin inhibitors and SGLT2 inhibitors. He also raised concerns about the safety of positive inotropic agents, calcium channel blockers and antiarrhythmic drugs in patients with left ventricular systolic dysfunction.

"He proposed the neurohormonal hypothesis of heart failure with reduced ejection fraction in 1992 and the adipokine hypothesis of heart failure with preserved ejection fraction in 2025. He has been the overall Principal Investigator for 20 large-scale international trials of novel interventions in heart failure. He was a Founding Member and served as President of the Heart Failure Society of America (2000-2002), and he has served on numerous guidelines and standards committees for the American Heart Association and American College of Cardiology. Since 1986, he has been a primary consultant to the FDA on matters related to the design of clinical trials and the interpretation of clinical trial evidence. He is currently Distinguished Scholar in Cardiovascular Science at Baylor University Medical Center at Dallas and Visiting Professor at Imperial College in London."

2 CHANGE #2 Replace the following text "In 1992 he published a paper on a neurohormonal hypothesis to explain heart failure that synthesized ideas that were percolating at the time; the paper made him known as the father of that idea.[1][6]"

Replace it with the following text: "In 1992, Packer published a formal proposal for the neurohormonal hypothesis of heart failure, which argued that neurohormonal activation was deleterious to heart failure progression. This hypothesis became a foundational concept in contemporary cardiology and heart failure management, and he is considered the "father of the neurohormonal hypothesis of heart failure"."

Source: Original sources: [1] [6] Also Source: https://hfsa.org/milton-packer-md Source: Gold standard: Milton Packer honoured for pioneering work European Heart Journal, Volume 46, Issue 4, 21 January 2025, Pages 337–338, https://doi.org/10.1093/eurheartj/ehae723 Published: 03 December 2024 Source: https://academic.oup.com/eurheartj/article/46/4/337/7915815

3 CHANGE #3 Please add the following text:

"Dr. Packer was the recipient of the Jesse H. Neal Award for Best Commentary/Blog in 2018 for his column "Revolution and Revelation" on MedPage Today, an award that is considered the Pulitzer Prize for specialized and business journalism."

Source: Milton Packer receives Jesse H. Neal award European Heart Journal, Volume 39, Issue 23, 14 June 2018, Page 2127, https://doi.org/10.1093/eurheartj/ehy262

4 CHANGE #4 Please add the following text:

Dr. Packer received the Lewis Katz Lifetime Achievement Award from Columbia University College of Physicians and Surgeons (2010) and the Eugene Braunwald Lifetime Achievement award from the Heart Failure Association of the European Society of Cardiology (2021). He has also been honored with the Silver Medal (2023) and Gold Medal (2024) from the European Society of Cardiology."

Sources: 1 Source: Gold standard: Milton Packer honoured for pioneering work European Heart Journal, Volume 46, Issue 4, 21 January 2025, Pages 337–338, https://doi.org/10.1093/eurheartj/ehae723 Published: 03 December 2024 Source: https://esc365.escardio.org/person/24777 Source: https://www.escardio.org/news/news-room/congress-news/2024-gold-medallists-packer/ Source: Gold standard: Milton Packer honoured for pioneering work European Heart Journal, Volume 46, Issue 4, 21 January 2025, Pages 337–338, https://doi.org/10.1093/eurheartj/ehae723 Published: 03 December 2024

5 CHANGE #5 Please add the following text:

"Dr. Packer was the Principal Investigator for the EMPEROR-Reduced trial (2021), which demonstrated the efficacy of empagliflozin in patients with heart failure with reduced ejection fraction and for the SUMMIT trial (2024), which showed the efficacy of tirzepatide in patients with heart failure with preserved ejection fraction."

Sources https://www.nejm.org/doi/full/10.1056/NEJMoa2022190 https://www.nejm.org/doi/abs/10.1056/NEJMoa2410027 ~2026-36328-95 (talk) 18:32, 23 June 2026 (UTC)

6 CHANGE #6 Please add the following text:

"In 2024, Dr. Packer published a formal proposal for the adipokine hypothesis of heart failure with preserved ejection fraction, which posited that an imbalance in the secretion of signaling molecules from dysfunctional adipose tissue drives the disease. The hypothesis represents the complement to his neurohormonal hypothesis for heart failure and a reduced ejection fraction, which had been published 33 years earlier. Source: https://www.acc.org/latest-in-cardiology/articles/2026/03/01/01/cover-story-the-adipokine-hypothesis Source: J Am Coll Cardiol. 2025 Oct, 86 (16) 1269-1373. doi: 10.1016/j.jacc.2025.06.055.