Alan Packard

Q&A with SNMMI incoming president Alan Packard

June 16, 2020
by Sean Ruck, Contributing Editor
In light of COVID-19, the annual SNMMI meeting will be held virtually this year. The event will be free for all SNMMI members and discount registration will be available to nonmembers. HealthCare Business News spoke to Alan Packard, senior research associate in the Division of Nuclear Medicine and Molecular Imaging at Boston Children’s Hospital, about his career and also what initiatives the molecular imaging community is currently looking at. Packard is also associate professor of Radiology at Harvard Medical School as well as the incoming president of SNMMI.

HCB News: What inspired you to follow a career in healthcare?
Alan Packard: Like many scientists in the field, it was a circuitous route. I’m a chemist by training, with a bachelor’s in chemistry and a Ph.D. in inorganic chemistry. When I was looking for a post-doctoral fellowship, I had the opportunity to work with professor Ed Deutsch at the University of Cincinnati, who at the time was one of the few people in the world doing synthetic technetium chemistry.

At that time, I didn’t know much about technetium. As you may know, it’s sort of a hole in the middle of the periodic table that has no stable isotopes. Not much was known about its synthetic chemistry. So I saw it as a great opportunity to explore.

From there, I became intrigued with the idea of doing technetium chemistry and the opportunity to work on something that had a direct practical impact. After I finished my post-doc, I had the opportunity to work with Jim Richards doing technetium chemistry at Brookhaven National Laboratory. He led the team that invented the molybdenum-technetium generator that’s used all the time in nuclear medicine clinics. After two years at Brookhaven, I was offered a position at Children’s Hospital leading a team developing a new type of radionuclide generator, which evolved into my current research on radiometal-labeled proteins and 18F chemistry.

HCB News: How long have you been a member of SNMMI and why did you join?
AP: I’ve been a member since 1986. I joined because the mid-80s were a great time for technetium chemistry. A lot of new agents were coming out. That’s when the first technetium-based heart agent came out, followed by new agents for imaging cerebral perfusion and several other things. I’d been active in the field for a bit before that, but the excitement about these new radiopharmaceuticals motivated me to join the Society.

HCB News: Why did you make the commitment to what’s led to your becoming the 2020-21 president?
AP: I think my path was similar to that of most people who become engaged in leadership in the society. I got involved in the Radiopharmaceutical Sciences Council. I was originally on the Program Committee and helping to organize CE sessions for the annual meeting. Then I was asked to run for the board of directors of the Radiopharmaceuticals Sciences Council and then, subsequently, for RPSC president. About that same time, I was asked to serve on the Scientific Program Committee for the Society as the associate chair for categorical seminars, and then asked to serve as the general program chair, which carries with it a position on the board of directors. I saw this as an opportunity to address several challenges that are facing the Society, so I decided to run, and was fortunate enough to be elected.

HCB News: Something that struck me as unique for the Society is the mix of Ph.D. and M.D. professionals on the executive committee. Can you talk about that a little?
AP: It sort of follows your earlier question. That’s one of the reasons I became involved. The Society welcomes scientists, and not all medical societies are so engaged with basic scientists. SNMMI has a long history of being engaged with the science and scientists who drive our field. And what drives our field are new innovations in radiopharmaceuticals. The physicians who are the ultimate beneficiaries of this, who use those radiopharmaceuticals in clinical applications, recognize the contributions of the scientists who develop them. Technologists are also strongly represented. We have about 15,000 members, and about two-thirds are technologists. Of the remaining 5,000, about two-thirds are physicians and one-third basic scientists — chemists, physicists, and radiopharmacists. Together, we make a great team.

HCB News: What are the key initiatives you’re focusing on as president?
AP: The thing I wanted to focus on when I ran was enhancing the value of membership and helping people realize what the Society can do for them. The big things, of course, are the annual meeting and CE for physicians, physicists, and radiopharmacists. I also want to increase the visibility and value of the Journal of Nuclear Medicine. It’s the premiere journal in nuclear medicine and we want to keep it there. Johannes Czernin, the editor-in-chief, has done a terrific job with the journal.

Another problem that the Society is helping with is reimbursement. We’ve dealt with some of those issues already. For example, there was a problem last year with inadequate reimbursement for myocardial perfusion imaging studies, which the society worked with CMS to address. We’re working now with CMS to allow reimbursement for infection and inflammation imaging with FDG.

There’s also a long-term problem with the availability of molybdenum-99. We haven’t had a domestic supply since the 1980s, when the last U.S. reactor shutdown. The problem was exacerbated when the Canadian Chalk River reactors shut down a few years ago. The manufacturers have done a great job of assembling a coalition of five or six international reactor operators that produce the molybdenum-99 and the processors that separate the molybdenum from the targets after it comes out of the reactors. This was a greater challenge following 9/11 since a lot of these reactors use highly enriched uranium. There was a mandate from the National Nuclear Security Agency to eliminate the use of highly enriched uranium both as a reactor fuel and as a target material. Also, Congress passed AMIPA (American Medical Isotopes Production Act) a few years ago, which provided funding to create domestic supplies of molybdenum-99. One of these projects, Northstar, is already online. Another, SHINE, should be coming online in the next year or so, and there are three or four other companies a little further down the pipeline.

HCB News: We’ve covered the molybdenum-99 shortages extensively over the years, but it sounds like even in the face of the COVID-19 pandemic, the supply is currently steady?
AP: The supply is steady. The accessibility is the problem. Most of the molybdenum-99 is shipped to the U.S. on commercial airliners and a lot of those flights have been cancelled. The biggest challenge seems to be getting it from South Africa to Europe, because there are very few flights coming out of South Africa at the moment.

HCB News: How does our nuclear medicine program compare to that of Europe?
AP: The environment is very different. In the U.S. in general, nuclear medicine is now part of the radiology departments, whereas in Europe, it’s a freestanding specialty. That may lead to different perceptions by the referring physicians, in terms of the partnerships that are developed and in terms of how new tracers are developed. There are some differences, but I think overall we’re pretty similar. There’s a greater difference in the regulatory environment, in terms of both approval and reimbursement, which leads to faster adoption of new tracers in Europe than in the U.S.

HCB News: Hospitals have delayed elective procedures in the face of the epidemic, but are you aware if it’s impacted nuclear medicine-based procedures at all?
AP: There has been a significant slowdown because, as with most other medical procedures, the hospitals are restricting access to procedures that aren’t either urgent or emergent. So the volume of procedures is down significantly in nuclear medicine and in radiology more generally.

HCB News: Other than the pandemic hurting everyone, continued shortages of Mo-99 and reimbursement issues, are there any other big challenges facing members today?
AP: I’d call it more an opportunity — the growth of theranostics. Nuclear medicine has done theranostics since the 40s with I-131 for thyroid cancer. But the development of new agents over the past five years or so and the recent approval of several has provided a great opportunity. The challenge is to make sure that these new agents are broadly adopted. They’re very effective, but their visibility is perhaps not as high as it should be. This is one area where the Society can help a great deal, in terms of educating referring physicians and oncologists, but also educating patients about the availability and effectiveness of these new drugs.