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Stephen MacMahon | |
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| Born | Stephen William MacMahon Scotland |
Stephen William MacMahon is a British-Australian academic medical researcher, healthcare entrepreneur and founder of The George Institute for Global Health. [1] He holds professorial academic appointments in medicine at UNSW Sydney [2] and Imperial College London. [3]
MacMahon was born in Scotland and emigrated with his family to New Zealand where he completed his school education. At age 16, he won a scholarship to study at the University of Canterbury Christchurch, from which he graduated in 1979. [4] He went on to study in Australia at the UNSW Sydney School of Medicine, graduating in 1985. Subsequently, in 1996, UNSW Sydney awarded him the university's highest research degree (Doctor of Science in Medicine). [5]
In 1985, the Australian Heart Foundation awarded MacMahon a 2-year post-graduate scholarship to undertake research at the US National Heart, Lung and Blood Institute [6] and complete requirements for admission as a Fellow of the American College of Cardiology. [7] In 1987, he was awarded a 2-year Research Fellowship by Green Templeton College [8] at the University of Oxford. There, he worked in the Clinical Trials Services Unit of the Nuffield Department of Medicine with Professor Sir Richard Peto.
In 1989, he moved back to New Zealand to a National Heart Foundation-funded academic position at the University of Auckland. He established a Clinical Trials Research Unit in the University Department of Medicine [9] at Auckland City Hospital and was appointed Senior Lecturer and then Associate Professor of Medicine and Clinical Pharmacology. He remained in these roles until 1999, when he moved to Sydney to take up an appointment as Medical Foundation Professor of Cardiovascular Medicine at the University of Sydney. [10] There, in partnership with Professor Robyn Norton AO, he established The George Institute for Global Health [11] (then known as the Sydney Institute for International Health [12] ). In 2017, The George Institute moved its Australian university affiliation from the University of Sydney to UNSW Sydney. [13]
Throughout his career, most of MacMahon's research has focussed on the causes and treatment of cardiometabolic diseases. [14] Much of that work has concerned the effects of blood pressure and blood pressure lowering on the risks of stroke and coronary heart disease. In his early work with Peto at Oxford, he showed that the associations of blood pressure levels with stroke and coronary heart disease incidence were continuous down to very low levels within those usually considered "normal". [15] On that basis, he postulated that blood pressure lowering may prevent stroke and coronary heart disease even among those without hypertension.
To test this, he designed and led two large-scale clinical trials assessing the effects of blood pressure-lowering treatment on major cardiovascular disease outcomes in individuals at high risk, irrespective of the initial level of blood pressure. The PROGRESS trial [16] focused on the effects of treatment in patients who had suffered already stroke, and the ADVANCE trial [17] focussed on the effects of treatment in patients with diabetes. Both these trials showed that blood pressure-lowering treatment reduced the risks of serious cardiovascular disease outcomes in hypertensive and non-hypertensive patients. The ADVANCE trial also showed that intensive reduction in blood glucose in high-risk patients with diabetes reduced the risk of death, as well the risk of major vascular complications associated with diabetes. [18] The results of these trials have had an impact on many clinical guidelines for the treatment of diabetes, stroke and hypertension worldwide.
Some of MacMahon's more recent work has focused on multimorbidity (the coexistence of multiple chronic or acute conditions). He chaired the committee of the UK Faculty of Medical Sciences that produced the first report on research needs in this area. [19] That report has proven pivotal in generating major investment in research on the causes and treatment of multimorbidity. [20]
MacMahon's work at Oxford, Auckland and Sydney involved collaboration with clinical and epidemiological researchers across Asia and this experience led him to suspect that most of the global cardiovascular disease burden was being experienced by people living in low- and middle-income countries, not high-income countries, as was widely believed. This was subsequently proven correct by the Global Burden of Disease Project. [21] His collaborations with researchers across the Asia Pacific region also led him to suspect that treatment for cardiovascular diseases was likely to be inadequate in many low- and middle-income countries. In parallel, his colleague, Robyn Norton, observed that the burden of injuries – particular that resulting from motor vehicle crashes – was also growing rapidly in many of the same countries, and, once again, it appeared that treatment for trauma was inadequate.
They recognised that the research base upon which to develop regionally relevant strategies for prevention and treatment of many of the most serious non-infectious conditions was extremely weak. And it was for this reason that in 1999 they established The George Institute for Global Health (formerly the Sydney Institute for International Health). [22] From an initial staff of three, the Institute grew to a staff of more than 1,000 worldwide over the subsequent two decades, during which more than $1.5 billion in research funding was secured. By 2022, the Institute had major research centres in India, China, the UK and Australia, and research collaborations across Africa, Asia, Latin America, North America and Europe.
MacMahon and Norton stood down from their roles as Principal Directors of The George Institute in December 2022 and remain as Founding Directors. [23]
Increasing the contribution of the private sector to improving the health of people in low- and middle-income counties has been one of MacMahon's long-term goals. This has involved both advocacy and direct leverage of private sector resources.
In 2019, he founded George Medicines Pty Ltd, [24] raising $53 million in private equity capital [25] to develop two new low-cost drug treatments for hypertension and diabetes. Each of these treatments comprise combinations of ultra-low-doses of drugs with complementary mechanisms, designed to maximize benefits and minimize side effects. MacMahon oversaw the design, development and conduct of the preclinical research programs that generated the evidence on which patents for both treatments are based. [26] He was also centrally involved in the design and conduct of the clinical research programs [27] required for regulatory approval. George Medicines' business model is based on profitability in established markets and affordability in emerging markets
Additionally, he founded George Clinical, [28] a commercial health research organization with operations across the world, including many countries in Asia. The company was established to provide research services to the pharmaceutical industry, leveraging the experience of George Institute researchers in order to generate financial resources for reinvestment in the Institute's programs of research, advocacy and training. In 2023, George Clinical was acquired by private equity company, Hillhouse, [29] creating a large endowment for The George Institute to pursue its work with low and middle-income countries worldwide.
MacMahon has received numerous honors and awards for his work. These include election as a fellow of the Australian Academy of Science (FAA), [30] the UK Academy of Medical Sciences (FMedSci), [31] and the Australian Academy of Health & Medical Science (FAHMS), [32] in addition to the American College of Cardiology (FACC). In 2015, he was listed by Thomsons Reuters as one of "The World's Most Influential Scientific Minds" [33] He was made an Officer of the Order of Australia (AO) in the 2017 Queen's Birthday Honours List [34] for distinguished services to medical research. For his research programs on the prevention and treatment of cardiometabolic diseases, he has twice been the recipient of an Excellence Award from the National Health and Medical Research Council of Australia. For his role in the establishment of George Clinical and George Medicines he was named EY Social Entrepreneur of the Year in 2013. [35]
Cardiology is the study of the heart. Cardiology is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists, a sub-specialty of internal medicine. Pediatric cardiologists are pediatricians who specialize in cardiology. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of general surgery.
Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia. Hypertension is a major cause of premature death worldwide.
Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.
Indapamide is a thiazide-like diuretic drug used in the treatment of hypertension, as well as decompensated heart failure. Combination preparations with perindopril are available. The thiazide-like diuretics reduce risk of major cardiovascular events and heart failure in hypertensive patients compared with hydrochlorothiazide with a comparable incidence of adverse events. Both thiazide diuretics and thiazide-like diuretics are effective in reducing risk of stroke. Both drug classes appear to have comparable rates of adverse effects as other antihypertensives such as angiotensin II receptor blockers and dihydropyridine calcium channel blockers and lesser prevalence of side-effects when compared to ACE-inhibitors and non-dihydropyridine calcium channel blockers.
Essential hypertension is a form of hypertension without an identifiable physiologic cause. It is the most common type affecting 85% of those with high blood pressure. The remaining 15% is accounted for by various causes of secondary hypertension. Essential hypertension tends to be familial and is likely to be the consequence of an interaction between environmental and genetic factors. Hypertension can increase the risk of cerebral, cardiac, and renal events.
The George Institute for Global Health, is an independent medical research institute headquartered in Australia with offices in China, India and the United Kingdom. The George Institute conducts research on non-communicable disease, including heart and kidney disease, stroke, diabetes, and injury. The institute is known for conducting large-scale clinical studies. Between 1999 and 2017, the George has consumed over A$750 million in research grant and fundraising.
The Kolling Institute is located in the grounds of the Royal North Shore Hospital in St Leonards, Sydney Australia. The institute, founded in 1920, is the oldest medical research institute in New South Wales.
Perindopril is a medication used to treat high blood pressure, heart failure, or stable coronary artery disease. As a long-acting ACE inhibitor, it works by relaxing blood vessels and decreasing blood volume. As a prodrug, perindopril is hydrolyzed in the liver to its active metabolite, perindoprilat. It was patented in 1980 and approved for medical use in 1988.
The Dietary Approaches to Stop Hypertension or the DASH diet is a diet to control hypertension promoted by the U.S.-based National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH), an agency of the United States Department of Health and Human Services. The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods. It includes meat, fish, poultry, nuts, and beans, and is limited in sugar-sweetened foods and beverages, red meat, and added fats. In addition to its effect on blood pressure, it is designed to be a well-balanced approach to eating for the general public. DASH is recommended by the United States Department of Agriculture (USDA) as a healthy eating plan. The DASH diet is one of three healthy diets recommended in the 2015–20 U.S. Dietary Guidelines, which also include the Mediterranean diet and a vegetarian diet. The American Heart Association (AHA) considers the DASH diet "specific and well-documented across age, sex and ethnically diverse groups."
Professor Murray David Esler, is a clinical cardiologist and medical scientist, based at the Baker Heart and Diabetes Institute and the Alfred Hospital in Melbourne, where he is the Associate Director of the Heart Centre. He is a Professor of Medicine at Melbourne's Monash University. As Associate Director of the Baker, Professor Esler leads the Institute’s research into the relationship between the brain and heart health. He studied medicine at the University of Melbourne and received a PhD from the Australian National University. His chief research interests are the causes and treatment of high blood pressure and heart failure, the effects of stress on the cardiovascular system, and monoamine transmitters of the human brain.
The Baker Heart and Diabetes Institute, commonly known as the Baker Institute, is an Australian independent medical research institute headquartered in Melbourne, Victoria. Established in 1926, the institute is one of Australia's oldest medical research organisations with a historical focus on cardiovascular disease. In 2008, it became the country's first medical research institute to target diabetes, heart disease, obesity and their complications at the basic, clinical and population health levels.
The Rogosin Institute is an independent, not-for-profit treatment and research center with facilities throughout New York City that treat patients with kidney disease, including dialysis and kidney transplantation; lipid disorders; and hypertension. It is affiliated with NewYork-Presbyterian Hospital, Weill Cornell Medical College and is a leader in research programs for cancer and diabetes.
Hypertension is managed using lifestyle modification and antihypertensive medications. Hypertension is usually treated to achieve a blood pressure of below 140/90 mmHg to 160/100 mmHg. According to one 2003 review, reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21% and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease.
Cardiovascular disease, including heart disease, is a major cause of death in Australia. Heart disease is an overall term used for any type of Cardiovascular disease that affects the heart reducing blood supply to the heart. It is also often referred as Cardiac disease and Coronary heart disease. It is generally a lifelong condition where damage to the artery and blood vessel cannot be cured.
Vlado Perkovic is an Australian renal physician and researcher who is the Provost at the University of New South Wales, Sydney, having previously been Dean of Medicine & Health at that University between 2019 and 2023.
The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial, also known as ALLHAT, was a randomized, double-blind, active-controlled study comparing at the same time, four different classes of antihypertensive drugs with the rate of coronary heart disease (CHD) events in ‘high-risk’ people with hypertension. Participants were initially randomised to chlorthalidone (diuretic) versus doxazosin, lisinopril (ACE-inhibitor), and amlodipine.
John Philip Chalmers is an Australian medical researcher, best known for his work in the field of cardiovascular physiology, specifically for his research into hypertension.
Aletta E. "Alta" Schutte is a South African hypertension and heart disease expert based in Sydney, Australia. She is a SHARP Professor and Principal Theme Lead of Cardiac, Vascular and Metabolic Medicine at the University of New South Wales in Sydney, with a joint appointment as Professorial Fellow at the George Institute for Global Health. Until 2019 she was the Director of the Hypertension in Africa Research Team (HART), South African Research Chair (SARChI) and Director of the Medical Research Council Extramural Unit for Hypertension and Cardiovascular Disease at the North-West University in South Africa. She has fulfilled several leadership roles, including the President of the Southern African Hypertension Society, and President of the International Society of Hypertension, Secretary of the Australian Cardiovascular Alliance, and is the co-chair of the National Hypertension Taskforce of Australia.
Jason C. Kovacic is an Australian-born cardiologist and physician-scientist; the Robert Graham Chair and Professor of Medicine, University of New South Wales; Executive Director of the Victor Chang Cardiac Research Institute in Sydney, Australia; and Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai, New York.
Barry Robert Davis is an American statistician and public health doctor specializing in the design, conduct, and analysis of clinical trials. He is Professor Emeritus of Biostatistics and Data Science at the University of Texas School of Public Health, where he served as Director of its Coordinating Center for Clinical Trials. He served as President of the Society for Clinical Trials in 2000 and as Chair of the Biometrics Section of the American Statistical Association in 2003.
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