Where Are We Going?

On June 5, 1981, the Centers for Disease Control and Prevention (CDC) issued a brief report describing the occurrence of a rarely seen pneumonia in five young gay men living in Los Angeles. “It was the week of our graduation that the first report of AIDS came out,” said Michael St. Louis, HMS ’81. Within days, the CDC established its first task force on the mystery disease. A few years later, St. Louis moved to Atlanta to join the CDC effort, then to Africa in the late 1980s to assess the worldwide impact of HIV/AIDS, and finally back to Atlanta, where he established the CDC’s global AIDS program. In 2004, he worked with the Bush administration to set up the President’s emergency plan for AIDS relief.

Photo by Graham Ramsay “We need to ask what it is that creates a higher performing health care system and go there,” said Elliot Fisher, HMS ‘81.

It turns out, HIV/AIDS has not been his only brush with disaster. In 2005, St. Louis, chief science officer in the coordinating office for global health at the CDC, was dispatched to New Orleans during Hurricane Katrina. He is currently working with the Department of Health and Human Services to plan for a potential avian flu pandemic. Most attendees of the afternoon session of the HMS Class of 1981 Symposium, held on June 8, had a front-row seat for these and other critical events of the past 25 years—the health care crisis, the stem cell revolution, and most personal, turning 50.

Getting Nowhere Fast
According to St. Louis, the AIDS epidemic was a slow disaster. HIV was around decades before it was found in the five California men and might have been contained had early efforts been made to detect, isolate, and control it. “Failures of policy regarding testing and prevention did not allow us to contain what was a low-grade emerging disease,” St. Louis said. Hurricane Katrina happened literally overnight, but it, too, was a disaster put in place over many years, he said. People and property were put in harm’s way, protected by flawed levees, insurance policies, and governmental organizations. Determined to avoid these mistakes, the government is undertaking massive preparations for a potential avian flu epidemic, an effort that may be out of proportion to the threat. “We have had something of a ‘plandemic,’ an uncontrolled outbreak of planning, ” he said.

The health care system might benefit from such a scourge. The current system not only lacks a plan, it appears to contradict the rules of logic. “What we are learning is that spending more gets you worse quality,” said Elliot Fisher, professor of medicine and community and family medicine at Dartmouth Medical School. He and his colleagues found that mortality rates are 2 to 5 percent higher, and physician and patient satisfaction lower, in areas of the country that consistently receive more Medicare dollars. Fisher attributed this “paradox of plenty” to more spending on expensive, often unnecessary, and even harmful, high-tech tests and procedures and less on the kind of face-to-face family-centered doctoring found in areas receiving less Medicare assistance.

Health Care Compass
Robert Sackstein works in one of the most high-tech fields of all, regenerative medicine. He told the audience how he and his colleagues are developing ways to deliver adult stem cells to tissues and have identified a protein, hematopoietic cell E-/L- selectin ligand (HCELL), that helps put the brakes on cells as they exit the high-velocity environment of the bloodstream. “The goal for us is to figure out how to regenerate tissue,” said Sackstein, HMS associate professor of dermatology at Brigham and Women’s Hospital. “That is the Holy Grail.” It is a quest he expected members of the audience to appreciate since many people over 50 suffer from some form of bone loss.

Michael Payne enumerated the vicissitudes of being 50. “Number one, you’re going to die. Number two, not much time left. Number three, how do you really want to spend the time you have left? Number four, what is important in your life, in life generally? Finally, and most important, quo vadis—which way do we go not just for ourselves, but for those who come after us?” asked Payne, HMS instructor in medicine at Cambridge Health Alliance. “The health care system is a mess, yet we have the capacity for it to be the best. We assume we are going to improve our ability to treat and care. I am not so sure.”

—Misia Landau

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