Elizabeth Nabel

Betsy Nabel is an American cardiologist and the current President of Harvard-affiliated Brigham and Women's Health Care, Professor of Medicine at Harvard Medical School, and Chief Health and Medical Adviser to the National Football League.

Nabel was the 10th Director of the National Heart, Lung, and Blood Institute (NHLBI) at the US National Institutes of Health (NIH). Prior to joining the NHLBI, Nabel was Chief of the Division of Cardiology, director of the Cardiovascular Research Center, and Professor of Internal Medicine and Physiology at the University of Michigan. Nabel brings a unique perspective to health care based on her experience as a physician, research scientist, academic medicine leader, and wellness advocate.

Family and education

Nabel was raised in St. Paul, Minnesota. Her father was a research scientist at 3M who loved science and loved to talk about it. Nabel became interested in the field of biomedicine during a physiological psychology class at St. Olaf College, when she conducted a study in rats to see how various stimuli affected their behavior. She graduated summa cum laude from St. Olaf in 1974, and received her M.D. degree from Weill Cornell Medical College in 1981.^[1]

Nabel and her husband Gary, who is the chief scientific officer for Sanofi, have three children, all of whom are pursuing careers in medicine.

Early medical career

Nabel completed an internship and residency in internal medicine followed by a clinical and research fellowship in cardiovascular medicine at Brigham and Women’s Hospital—an institution she would return to lead 23 years later in her journey "from resident to president."

As a cardiology fellow, Nabel became interested in vascular biology, in particular atherosclerosis and restenosis, due to her care of cardiac patients coupled with her strong interest in interventional cardiology. She began clinical studies of endothelial and vascular smooth muscle function in the cardiac catheterization lab, and carried those observations over to her basic laboratory work.

University of Michigan

Career trajectory

Nabel conducts early gene therapy trials at the University of Michigan

In 1987, Nabel joined the faculty at the University of Michigan as an Assistant Professor of Medicine and rose through the ranks, becoming Director of the Cardiovascular Research Center in 1992, Professor of Medicine and Physiology in 1994, and Chief of the Division of Cardiology in 1997.

Research focus

During this time, Nabel became known for her research in the fields of vascular biology and molecular cardiology, and for her gene transfer studies of the cardiovascular system. She set up a basic science lab to investigate the molecular basis of vascular disease, hoping that a better understanding of the underlying biology would lead to more effective treatments. She developed gene transfer techniques to investigate the pathophysiology of vascular cell growth and designed models of biologics combined with devices to treat vascular disease.

National Heart, Lung, and Blood Institute

Career trajectory

Nabel in her lab at the NHLBI

Nabel joined the National Heart, Lung, and Blood Institute (NHLBI) in 1999 as the Institute’s Scientific Director of Clinical Research. Among her many accomplishments as Scientific Director, she initiated a cardiothoracic surgery branch, a state of the art training and research program in cardiovascular surgery. She also began a program to investigate genetic variation among patients with vascular diseases.

In 2005, Nabel succeeded Claude Lenfant, MD, as Director of the NHLBI. In this position, Nabel oversaw an extensive range of national research, training and education programs to promote the prevention and treatment of heart, lung, and blood diseases.

New scientific programs

Nabel leveraged the $3 billion research portfolio to establish pioneering scientific programs to pursue the promise of genomics and stem cells, stem and progenitor cell biology, and translational research. These programs realized many of the plans laid out by Nabel in the NHLBI’s strategic plan, released in 2007, which featured a crosscutting rather than disease-specific approach.

The Heart Truth

At the NHLBI, one of Nabel's signature advocacy efforts was The Heart Truth campaign, which raises heart health awareness in women through innovative partnerships with more than 150 organizations, including more than 50 companies. (See Career Achievements: Women’s Health.)

Collaborating Centers of Excellence

During her tenure, Nabel established the NHLBI network of 11 Collaborating Centers of Excellence in low- and middle-income countries, with the goal of building sustainable programs to combat chronic cardiovascular and lung diseases. Each center includes a research institution in a developing country paired with at least one partner academic institution in a developed country. These Centers of Excellence create an infrastructure for research and training, enhancing capacity for population-based and clinical research to monitor, prevent and control chronic diseases.

Brigham and Women's Hospital

Overview

In 2010, Nabel became President of Harvard-affiliated Brigham and Women's Health Care, which comprises Brigham and Women's Hospital and Brigham and Women's Faulkner Hospital. She is the first female president of a Harvard-affiliated hospital.

Nabel led development of a comprehensive strategic plan that defines a new model of medicine characterized by seven strategic commitments focused on innovation in care redesign toward population health management; on research and discovery through multiple life sciences collaborations; and on personalized therapies and precision medicine. Initiatives include a new translational research and clinical facility, and a $1 billion campaign to advance innovation, patient care and community health.

Innovation

Under Nabel’s leadership, Brigham and Women’s Hospital has established a range of forward-thinking initiatives to accelerate patient-centered innovation. These include the Brigham Innovation Hub, which turns breakthrough concepts, inventions, and research by Brigham clinicians and scientists into products and services; the Translational Accelerator, which speeds the process of translating scientific discoveries into therapies; and the Ann Romney Center for Neurologic Diseases, which is leading a global collaboration in medical research to accelerate treatment, prevention and cures for five of the world’s most complex neurologic diseases, including multiple sclerosis (MS), Alzheimer’s disease, Lou Gehrig's disease (ALS), Parkinson’s disease and brain tumors.

To continue advancing research despite nationwide reductions in federal funding, Dr. Nabel has forged new partnerships with industry and external investors to provide funding opportunities through innovative revenue streams and strategic partnerships, including launching a first in class venture capital fund based in an academic medical setting and open to individual investors.

Care delivery

Nabel has been at the forefront of reimagining how care is delivered to patients, and created a number of new initiatives at BWH to advance this work. The Integrated Care Management Program assigns a nurse care coordinator to high-risk patients. The care coordinator identifies health risks, answers questions, and connects patients with additional support. The Care Redesign Start-up and Incubator Program encourages teams of frontline clinicians to submit proposals to improve the quality of care and reduce health care costs, and then provides them with resources and support to implement their ideas. The new Vidscrips program allows BWHC care providers to record videos and “prescribe” them to patients, while a Virtual Visits program enables patients to remotely see and talk with their clinician.

Quality and safety

Quality and patient safety are among Nabel’s top priorities at BWH, and she is committed to transparency. She has supported several efforts to break down the barriers in talking about errors and ensure staff feel comfortable coming forward to talk about errors so that everyone can learn from them. Two important initiatives in this area are a monthly Safety Matters internal publication, which discloses an error made at BWH and the steps taken to prevent it from happening again for the purposes of educating staff throughout the organization. BWH also launched an institution-wide Just Culture initiative to create a safe, respectful environment for employees disclosing adverse events, without fearing punishment or retaliation.

Education

As health care evolves, Nabel has been a leader in establishing educational initiatives to meet emerging needs. As team-based care becomes more prevalent, BWH’s medical education programs provide opportunities for future providers to train in this new environment. The BWH Medical Student Nurse Mentor program pairs BWH nurses with third-year students at Harvard Medical School in order to foster communication and connection between disciplines. Global education initiatives include partnering in the creation of Haiti’s national teaching hospital, the Hôpital Universitaire de Mirebalais; establishing a Global Health Equity Residency in General Surgery at BWH; and working with the Ministry of Health in Rwanda to increase the country’s clinical and academic training capacity through the Human Resources for Health program.

Community engagement

Nabel has a deep commitment to strengthening community health, both locally and globally. The BWH Center for Community Health and Health Equity has 18 programs that benefit Boston-area residents across the lifespan. This work impacts more than 5,000 individuals and families annually, through initiatives ranging from youth programs to domestic violence intervention, health promotion, and engaging young parents. Nabel advocates for the role that the Brigham can play in many parts of the world to help to reduce disparities in disease burden and to improve health outcomes through research, patient care and teaching.

National Football League

In 2015, Nabel was appointed Chief Health and Medical Advisor to the National Football League, a role that builds on her lifelong commitment to improving health through science. Nabel provides strategic input to the NFL’s medical, health and scientific efforts; participates as an ex-officio member on each of the NFL’s medical advisory committees; and identifies areas for the NFL to enhance player safety, care and treatment.^[2] In May 2016, a Congressional report detailed how multiple doctors tied to the NFL, including Nabel, lobbied the NIH not to fund a study whose lead investigator had been critical of the NFL in the past.^[3]

Career achievements

Biomedical research

Nabel has made many contributions to basic and clinical research on the pathogenesis and treatment of cardiovascular diseases. She has long championed the concept “from bench to bedside,” which is reflected in her work that intertwines basic research and translation to clinical medicine.

Early in her career, she made seminal discoveries regarding genetic therapies for cardiovascular disease, having developed methods for the introduction and expression of recombinant genes into blood vessels. These basic studies were instrumental in designing device therapies, in combination with genes or drugs, to treat the vascular disease restenosis.

Nabel’s research focused on the molecular genetics of vascular diseases. She conducted clinical studies to understand the contribution of genetic factors to proliferative and inflammatory diseases in blood vessels, including common diseases like atherosclerosis and the rare, premature aging in Hutchinson Gilford progeria syndrome.^[4]

Nabel delineated the mechanisms by which cell cycle and growth factor proteins regulate the proliferation of vascular cells in blood vessels, a process important for the development of atherosclerosis and restenosis. Her vascular biology laboratory characterized the role of cell cycle inhibitors on vascular proliferation and inflammation, and this research has opened up new avenues for therapeutic targets in the vasculature.^[5] Nabel contributed to both policy and basic research on embryonic stem cells.^[6]

Her work has produced 17 patents and more than 250 scientific publications.

Women's health

Nabel is an advocate for women’s health. As Director of the NHLBI, she was instrumental in the launch of the Heart Truth and forged rare partnerships between government and private industry. The result was a campaign that changed the way women around the country thought about heart disease and empowered them to take charge of their health. Nabel knew that leveraging the marketing power of Diet Coke and the fashion industry would spread this important message in an untraditional, but highly-effective, way. In the decade following the campaign’s launch, heart disease awareness among women rose from 34 percent to nearly 70 percent.

In 2014, Nabel and Paula Johnson, MD, Executive Director for the Connors Center for Women at BWH, convened a national policy summit in Boston with Senator Elizabeth Warren, FDA Commissioner Margaret Hamburg, CBS’ Lesley Stahl, Boston Mayor Martin Walsh, Bank of America’s Anne Finucane, and other senior political and industry leaders to call upon the federal government to make gender-based science an imperative. The Summit was a catalyst for progress, leading to unprecedented policy changes at the NIH that require researchers to expand inclusion of female cells and lab animals in NIH-funded medical research, as well as a new funding policy that requires scientists to consider the role of sex as a biological variable in both animal and human studies—a major movement forward in requiring health equity in all phases of biomedical research.

Global health

Nabel visits Rwanda

Throughout her career, Nabel has been a champion for global health. During her fourth year of medical school, Nabel spent part of the year with the Flying Doctors in Kenya, travelling with a surgeon, anesthesiologist and pilot to provide much-needed services to patients in rural areas.

At the NHLBI, Nabel established 11 Collaborating Centers of Excellence in developing countries to combat cardiovascular and lung diseases, creating an infrastructure for research and training activities. At BWH, Nabel partnered in creating Haiti’s new national teaching hospital, and is advancing training for clinicians in under-resourced countries. She traveled to Rwanda and post-earthquake Haiti to explore how BWH could provide assistance and support. BWH has a close partnership with Partners In Health, and Nabel is an active member of the organization’s Board of Trustees.

Nabel is a founding and convening member of the Global Alliance for Genomics and Health, leading the creation of a common global framework of harmonized approaches to enable the responsible, voluntary, and secure sharing of genomic and clinical data. She is also a founder of the Global Alliance for Chronic Diseases, which coordinates and develops innovative research collaborations between low- and middle-income and high-income countries in the fight against chronic diseases.

Thought leadership

Future of academic medicine

Nabel is a firm believer that academic medical centers are the cornerstone of evidence-based advances in health. Foreseeing that academic medicine was headed for turbulent times due to health care reform and the state of the economy, she decided to return to academia in 2010. She accepted the position as President of BWHC, intent on creating a new model of academic medicine that peer institutions across the nation could emulate while continuing to support their research and teaching missions – and in the case of the Brigham, its deep commitment to health equity and community engagement.

Nabel engaged the entire BWHC community, from physicians to front-line staff, in redesigning care delivery to improve patient access and quality of care. She championed the evolution of BWH’s medical education programs to ensure future health care providers are prepared to face challenges that have not previously existed. To facilitate breakthroughs, Dr. Nabel created an infrastructure of opportunities—from research days to hackathons and shark tanks—to support researchers tackling today’s toughest medical challenges.

Intellectual humility

Based on her experiences as a physician and researcher, Nabel encourages future health care providers to understand the importance of challenging the known and putting “knowledge” to the test. She hadn’t heard the role of humility in medicine being shared in the medical community, and her talk at TEDMED 2014 served as a platform for raising awareness.

In her talk, Nabel outlined how an oft-shunned word--ignorance—carries great importance as a driver of scientific inquiry, and thus, the molder of new knowledge. Yet when myths—such as heart disease as a man’s disease—are widely believed to be facts, ignorance can kill. Nabel’s goal is to help the next generation of care providers embrace the idea of humility, and in the process open the door for a wide range of new discoveries that will ultimately save lives.

Honors

Awards

Nabel has been named one of the nation’s top leaders in medicine by Modern Healthcare^[7] and Becker’s Hospital Review,^[8] and one of Boston’s 50 most powerful people by Boston Magazine.^[9] Her honors include the Distinguished Bostonian Award from the Greater Boston Chamber of Commerce,^[10] the Kober Medal from the Association of American Physicians,^[11] the Champion in Health Care award from the Boston Business Journal,^[12] the Willem Einthoven Award from Leiden University in the Netherlands, the Amgen-Scientific Achievement Award, two Distinguished Achievement Awards and the Eugene Braunwald Academic Mentorship Award from the American Heart Association, and six honorary doctorates.

Elected memberships

Nabel’s colleagues have elected her to the American Academy of the Arts and Sciences, the National Academy of Medicine, the Association of American Physicians and the American Society for Clinical Investigation. She is a Fellow of the American Association for the Advancement of Science.

Editorial positions

Nabel is currently on the TEDMED Editorial Advisory Board, and previously served on the editorial boards for the New England Journal of Medicine and Science Translational Medicine as well as editor-in-chief of Scientific American Medicine.

Olympic torchbearer

For the Vancouver 2010 Olympic Games, Nabel served as one of 20 U.S. torchbearers with Olympics sponsor Coca-Cola, which is also a sponsor of The Heart Truth campaign. Her nomination recognized the National Heart, Lung and Blood Institute (which she directed at the time) and The Heart Truth campaign for their dedication to promoting healthy lifestyles, empowering civic engagement, raising awareness of women's heart disease, and equipping women with tools and information to lead heart-healthy lifestyles.

Selected publications

• Nabel EG. The Women’s Health Initiative – a victory for women and their health. JAMA 2013; 310: 1349-50.
• Nabel EG, Ferris TG, Slavin P. Balancing AMCs’ Missions and Health Care Costs – Mission Impossible? N Engl J Med 2013; 369:994-6.
• Nabel EG, Braunwald E. A tale of coronary artery disease and myocardial infarction. N Engl J Med 2012; 366:54-63.
• Guttmacher AE, Nabel EG, Collins FS. Why data-sharing policies matter. Proc Natl Acad Sci 2009; 106:16894.
• Nabel EG. Linking biomedical research to health care. J Clin Invest 2009;119:2858.
• Daar AS, Nabel EG, Pramming SK, Anderson W, Beaudet A, Liu D, Katoch VM, Borysiewicz LK, Glass RI, Bell J. The global alliance for chronic diseases. Science 2009;324:1642.
• Nabel EG, Stevens S, Smith R. Combating chronic disease in developing countries. Lancet 2009;373:2004-2006.
• Nabel EG. Genomic medicine: cardiovascular disease. N Engl J Med 2003;349:60-72.
• Boehm M and Nabel EG. ACE-2: a new regulator of the heart. N Engl J Med 2002; 347:1795-1797.
• Duckers HJ, Boehm M, True A, Yet S-F, San H, Park JL, Webb RC, Lee M-E, Nabel GJ, Nabel EG. Heme oxygenase-1 protects against vascular constriction and proliferation. Nature Medicine 2001;7:693-698.
• Nabel EG. Gene therapy for cardiovascular diseases. Circulation 1995;91:541-548.
• Ohno T, Gordon D, San H, Pompili VJ, Imperiale MJ, Nabel GJ, Nabel EG. Gene therapy for vascular smooth muscle cell proliferation after arterial injury. Science 1994;265:781-784.
• Nabel EG, Yang Z-Y, Plautz G, Forough R, Zhan X, Haudenschild CC, Maciag T, Nabel GJ. Recombinant fibroblast growth factor-1 promotes intimal hyperplasia and angiogenesis in arteries in vivo. Nature 1993;362:844-846.

References