Why was this seventh annual “Israel Medical Conference ” organized by
the Hadassah Medical Organization at Jerusalem’s International Convention Center
different from all the others? This time, an unaccustomed blanket of doom and
gloom hung from the rafters of the cavernous Teddy Hall, where HMO ran the free
event to promote itself among the general public and showcase its most recent
Numerous familiar faces from Hadassah management were missing
this year, having been dismissed under the new management of 74- year-old
multi-millionaire businessman and insurance executive Avigdor Kaplan. He
preceded his debut at the conference with an interview in a local paper in which
he disclosed that HMO has a operating deficit of NIS 300 million and an
accummlated, long-term debt (including pension payouts) of NIS 1.3 billion. The
shortfall is partially due to declining financial support for ongoing operations
from the Hadassah Women’s Zionist Organization of American and the high level of
discounts and payment capping enjoyed by the four health funds for services
their members receive at the two Hadassah University Medical
Political figures including Jerusalem Mayor Nir Barkat bemoaned
the budgetary deficit hole into which the HMO has fallen and called on the
government to provide significant financial help to one of the capital’s most
important employers, healers and biotech innovators – an unlikely prospect, at
least without strings attached.
At the previous convention, organizers
bubbled over HWZOA’s 100th anniversary and its opening of the magnificent and
luxurious $360 million hospitalization tower opened in Ein Kerem. But this time,
Israel Medical Association chairman Dr. Leonid Eidelman confessed: “We are
worried that Hadassah might be dragged down and become a center of moderate or
even lower quality because of its financial problems. Hadassah has existed for
100 years, and it has raised many generations of doctors, department chairmen
and unit heads around the country. The future of the hospitals very much worries
me. We need a strong HMO, and everyone must do everything he can to prevent the
collapse of this place.”
Clalit Health Services director-general Eli
Defes said, “It would be terrible for Jerusalem and Jerusalemites if something
prevents HMO from functioning properly. If the health funds are overwhelmed by
deficits, Hadassah will be weak, and if Hadassah is weak, it will be bad for the
health funds in the long term.”
And Kaplan, who was appointed HMO
director-general a few months ago by the American, women-controlled board after
chairing Clal Insurance Enterprises Holdings and previously running the Clalit
Health Services health fund, also sounded glum. The hospitals have deficits, and
so do the four public health funds, he said. The Health Ministry is the
regulator of the health system, Kaplan said, but it has a conflict of interest
because it also owns state hospitals and provides services.
been proposed but not implemented.
The HMO director-general went on to
explain that government and Clalit hospitals get state funds as a matter of
routine, but voluntary hospitals in Jerusalem such as Hadassah’s and Shaare
Zedek Medical Center provide service without getting help to cover employees’
pensions and growing insurance costs, while at the same time having to forfeit
some of their income by giving discounts to health funds, adding that a cap is
placed by the Treasury on the purchase of health services.
longer can we erode the public hospital system, with too few beds and the
growing gap between investment in hospitals and the rise in community clinic
facilities? The population continues to grow, while the value of the basket of
health services provided to the public continues to be eroded,” Kaplan
The national health budget declines, and the privatization of the
health system proceeds; patients make more out-of-pocket payments for the health
services they need.
“It’s a very dangerous process, as equity for all
parts of the population dissolves,” he said.
“My goodness! Avigdor,” said
Channel 2 TV journalist Rina Matzliah, who was the paid emcee. “That was quite
depressing!” BUT KAPLAN still voiced optimism.
The HWZOA has donated
through its supports NIS 2.2 billion in the past seven years for the
hospitalization tower and other infrastructure, he said. And getting more
personal, he added that more than 20 years ago, his daughter-in-law contracted
“Her doctors predicted that she had three months go live.
“I did everything to help her. I was told that we should take her to an expert
in Seattle for a bone-marrow transplant, but it was hugely expensive.
doctors there advised that she could go through the same procedure at Hadassah
in Jerusalem, that their doctors know how to do it just as well. We brought her
to Hadassah for the transplant, and she was saved. She married and gave birth to
three children – my grandchildren.
That’s Hadassah! Devoted care!”
Brig-Gen. Prof. Yitzhak Kreiss, the head of the Israel Defense Forces Medical
Corps, was very optimistic when he reported that there has been a reduction of
50 percent in deaths from battlefield injuries.
“Even though there are
more wounds, we have learned how to stop hemorrhaging and give better protective
equipment to soldiers,” he said. The head of the medical corps has appeared
regularly at the Hadassah event because its Tzameret military track at the
Hebrew University- Hadassah Medical School is preparing doctors for service in
“There have been many advances in military medicine research
around the world, as we are small compared to the international effort, but we
are nevertheless at the forefront.
We are the first army in the world to
used dried plasma [reconstituted on the battlefield]; we used it in last year’s
Operation Pillar of Defense in Gaza, and it saved lives.
It’s likely that
other armies have already adopted it,” Kreiss said.
“What we learned will
contribute to pre-hospital, emergency and surgical care in the
MEDICAL CARE for the elderly filled many of the clinical
sessions of the conference and was called “Medicine of the Future,” because the
growth of pensioners needing the health system will be so
Prof. Eyal Banin, a leading ophthalmology researcher at
Hadassah- Ein Kerem, told the crown of 1,400 about his translational research
(moving from the lab bench to the patient’s bedside) on the hereditary eye
disease named retinitis pigmentosa (RP). While its prevalence around the world
averages one case per 3,500 residents, in Israel it is more common because of
consanguinity (inbreeding of first cousins).
By age 50, half of those
with RP are near-blind. The retina – the lightsensitive tissue lining the back
of the eye – becomes damaged gradually, thus affecting sight. In the disease,
the ability of the retina to respond to light is affected.
symptom, which usually appears between the ages of 10 and 30, is most commonly
having difficulty seeing in poor light, for example outdoors at dusk or in a
dimly lit room. A second symptom is reduction of the visual field, in which
sight is lost from the sides, or from above and below. This is often referred to
as tunnel vision. All RP conditions are progressive, but the speed at which
deterioration takes place varies from one person to another.
There is no
cure, said Banin, or even a way to prevent the decline in vision from
progressing. But coordinated research in many medical centers around the world –
including Hadassah – offer hope. He and his team are developing a safe system
for introducing corrective genetic material to the appropriate cells of an
“We usually take the virus that causes flu as a vector and replace a
healthy gene for a sick gene, which in this case is called RPE65. The cell then
starts to produce the protein that was missing and whose absence caused the
Working on lab animals, we inject the viral vector into the eye,
and they can see much better than before,” said Banin. “At Hadassah, we have
started to map genes causing eye disease.
Light rays can be used to scan
the eyes so we know where, in which photoreceptors, the gene should be injected
under the retina. We’re now in phase 1 trials with the first three patients, and
it went well. The patients’ sensitivity to light is up to 100 times more. I
believe it was the first clinical gene therapy treatment in
Banin also showed a video film of lambs born with archromatopsy
– colorblindness – in Micronesia, that affects not only sheep but also humans.
The hereditary disease involves a mutation of the CNGA3 gene.
unable to get through a maze and join the flock, causing them to bleat from
When a healthy gene was inserted into the eye, the sheep easily
coped with the maze and rejoined the flock.”
Banin’s team is also working
on human embryonic stem cells to produce retinas in rats; in humans, this could
cure regenerative eye disease.
“We just have to make sure that these
don’t cause tumors to develop.
We hope to start clinical trials at the
end of 2014. It will take years, but these developments should become available
in the foreseeable future.
Cell therapy will be big revolution, like the
introduction of antibiotics.”
DR. EPHRAT Gil, an internal medicine
specialist at Haifa’s Bnai Zion Medical Center (which partnered with HMO on the
conference), noted that “old people are the future. People over 60 will
constitute 21 percent of Israel’s population in 2050 compared to 8% in
The elderly, she said, consume 3.4 times more health services as
younger people. “The elderly are different than young adults; they suffer from a
decline in body reserves.
Their heartbeats are different and cognitive
function declines. They usually have a combination of chronic
Gil gave as an example an 85- year-old widower who lived at
home. Suffering from hypertension, an enlarged prostate, glaucoma and hearing
problems, he was hospitalized with a high fever and taken to a hospital
A pneumonia infection caused his urination to stop,
requiring the insertion of a catheter. He tried to pull it out, leading nurses
to tie down his hands. He spent five days in the internal medicine department,
and when the infection was cured, his sons decided he could no longer live
alone. Delirium set in and his functioning declined (called
“He recovered from the pneumonia, but he paid a price in
the public hospital system. Preserving his bodily reserves does not get high
priority. There is plenty of technology, but dealing with function is not good
enough. Complications of hospitalization must be prevented. This patient should
have been taken out of bed, activated, with drugs he no longer needed cancelled,
his pain treated and his sleep patterns improved.
Manpower,” said Gil,
“is expensive, so maybe volunteers are needed for this.”
THIS SESSION was
followed by a series of oncology and gene experts discussing the case of actress
Angelina Jolie, who underwent prophylactic mastectomy to avoid contracting the
breast cancer that killed her mother at a relatively young age.
discussion was highly scientific, like a hospital clinical conference, way above
the heads of the laymen who packed the hall. If HMO wants the audience at its
free gathering to really understand the hospital’s developments, it might be
better off holding separate lectures for doctors and other medical professionals
and for the general public, who are otherwise more likely to remember the
standup comedienne’s jokes, the free food and seeing VIPs than the details of
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