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What do Jewish doctors discuss when in another country? Doctoring. Two hundred Diaspora physicians from Russia in the East to the US in the West convened recently at Jerusalem's Inbal Hotel with dozens of Israeli colleagues for discussions on "Advanced Technologies in Medicine" that veered into a variety of other subjects, including "Medicine and the Holocaust."
The event was the 18th World Fellowship International Conference, organized by the Israel Medical Association and the "Fellowship" - an organization of Jewish physicians from around the world established over 50 years ago to promote solidarity with Israel and raise money for Israeli fellowships abroad and exchange programs with Israel. The Absorption Ministry took advantage of the occasion by setting up a stand encouraging doctors to come on aliya and offering research grants and subsidies for those who do.
Despite the country's high ratio of doctors to patients and the IMA's 22,000 members, a shortage of physicians here is predicted over the next decade as many retire. And there are already serious shortages of certain types of specialists, including anesthesiologists, general surgeons, pathologists, geriatricians and internal medicine experts, as well as others in the periphery.
"Our main goal is to enhance mutual exchange among physicians for long-term bonds," said Dr. Itzhak Siev-Ner, the Fellowship's chairman.
At the opening session, Vice Premier Shimon Peres advised his audience to enjoy their visit and not to read many newspapers. "They have their role to inform you, but don't let them blind you," the indefatigable Peres said. While newspaper readers will easily conclude that the Middle East is "sick," there are bright spots, such as the fact that a growing number of Israeli Arabs are studying in institutions of higher learning, and some are physicians. In fact, Jewish and Arab doctors and nurses work harmoniously in hospitals and clinics around the country, Peres added. At the two Hadassah University Medical Centers in Jerusalem, about 10% of doctors are Arabs, while at the Emek Medical Center in Afula, they constitute 30%, Peres said.
"More education means more progress and a better future for all." Peres suggested the opening in the Galilee of a fifth medical school (opposed by the existing four, that prefer instead to expand) and staffed by the "best brains" to promote development in the area. He also invited the Diaspora physicians to participate in Israeli medicine by promoting cooperation projects, including those using telemedicine, and joint research.
THERE WILL be "revolutionary changes" in medicine during the next two decades, predicted Prof. Rafael Beyar, a senior interventional cardiologist and director-general of Rambam Medical Center in Haifa. Just as biomedical technology like ultrasound, CT and MRI scanners reshaped medical practice in the 20th century, embryonic stem cell and gene therapy, nanotechnology, implants, biomaterials, robot-assisted surgery and advanced pharmaceuticals will do so in the 21st.
Prof. Mordechai Shani, head of Gertner Institute for Epidemiology and Health Policy Research and a former Health Ministry and Sheba Medical Center director-general, noted that most health-care expenditure is focused on treating chronic diseases. But they can be prevented as well.
"Emerging sciences are revolutionizing the ability to predict an event and head off damage. The new approach will be prospective health care, in which patients will be evaluated for baseline risk for various diseases, and their doctors will develop specific clinical solutions. There will be personal health plans, with biomarkers and biological factors tracked over time. At birth, a baby's genotype will be registered to predict a higher risk for disease, such as Type 1 diabetes, leading to interventions that can postpone or even prevent it. Gene expression tests will predict the progression of cancer, suggested Shani, eliminate the need for some biopsies, or even predict whether a transplant organ will be rejected by the body.
PROF. MOSHE SHOHAM of the Technion Institute's mechanical engineering department's robotics lab described a miniature, semi-active surgery robot located on the spine that moves on the patient. Five years ago, when his lab found a niche for medical robots, his team designed one called SpineAssist that enables a surgeon to perform a spinal operation more accurately by determining the exact angle for insertion of implants. A few hundred remotely manipulated surgical robots are available around the world, and are used for heart and prostate surgery. In the past, he said, surgeons opened up patients to see the inside of the body. In the future, "we will let the robot see, then plan an operation and carry it out. There are even some voice-controlled robots that allow surgeons to tell the camera where to move so their hands can be free.
THE LINK between the sense of smell, autoimmune diseases and mental illness was revealed by Prof. Yehuda Shonfeld, editor of two Israeli medical journals and head of an internal medicine department at Sheba Medical Center at Tel Hashomer.
Shonfeld said that some cases of depression are connected with autoimmune system failure connected to the limbic system in the brain that senses odors. Systemic lupus erythematosus (SLE), an autoimmune disease more common in young women, affects a wide variety of body systems and sometimes involves depression and even psychotic attacks. When antibodies in the blood of an SLE victim were injected into healthy mice, it caused them to be depressed.
How does one determine whether a mouse is depressed? When normal mice are put into a container of water, they swim and struggle to find a dry spot. But if they are depressed, they give up easily. When the mice with induced depression were given injections of Prozac, they began to swim just like normal ones, Shonfeld said. They also found that if their sense of smell is deactivated, mice go into depression, but this disappears when they are treated with Prozac. Thus there is a clear connection between depression and the sense of smell, but it still can't be said for sure whether depression causes harm to the sense of smell or vice versa. Studies on depressed women showed that they lose the sense of smell, and that aromatherapy with citrus or lavender can help them get out of their emotional lows. In certain conditions of stress, large amounts of cortisol are released by the body; this hormone can cause the breakdown of parts of the limbic system in the brain, causing depression. It's also an early system of Alzheimer's disease, he said.
Prof. Michael Baum, a leading expert at University College London on breast cancer resulting from genetic mutations, discussed the mutations on the BRCA1 and BRCA2 genes that affect between one in 300 and one in 800 women. In Iceland, it is found in one in 170 women, but among Israeli Jews, the prevalence is one in 40. Of three "Jewish" mutations, one (on the BRCA1 gene) occurs in 1% of both Ashkenazi and Iraqi Jews and is probably between 2,000 and 3,000 years old, dating back to Mesopotamia soon after the destruction of the First Temple and carried north by Jews who contributed to the establishment of Ashkenazi Jewry.
The second, said Baum, is estimated to be about 700 years old and located on the BRCA2 gene. It is found in 1.4% of Ashkenazi Jews and must have arisen from Jews who settled in Eastern Europe. The third is on the BRCA1 gene and occurs in 0.1% of the Jewish population. It is sometimes called the "pogrom" mutation, as it resulted from pregnancies following rape in the ghettos of the Pale of Settlement between the 13th and 19th centuries. A unique Anglo-Israel collaboration, which has combined historical and molecular findings and translated them into a plan of action for developing specific treatments for breast cancer arising from a defect in DNA repair has been launched, Baum said.
Doctors from the Royal Children's Hospital in Melbourne discussed a subject that probably could be presented only at a conference for Jewish physicians - the use of stereolithography to enable doctors of the Priestly Tribe to study ear surgery while avoiding contact with corpses. Kohanim are not permitted to become ritually defiled by contact with a corpse (except for those of close relatives). Many rabbis have therefore argued that it is forbidden for a kohen to study medicine, or at least a medical specialty that requires contact with dead bodies. But stereolithography uses CT scans to create 3-D prototypes of a patient. While it is not often used in ear surgery, the Australian doctors said, it can be very useful for virtual training of kohanim in this surgery, as it allows accurate ear models, so trainees can examine and drill resin material on prototypes as if they were working on cadaver ear bones.
RESEARCH INTO the influences of the Holocaust on the health of survivors took up a significant part of the lectures. Dr. Elitzur Hazani of the Western Galilee Government Hospital in Nahariya reported that hypertension, high blood cholesterol, lung diseases, Type 2 diabetes and psychiatric disorders were much more common in women who suffered from starvation when pregnant. Some of the damage may have resulted from refeeding after their liberation, he said. The second generation also were at higher risk for these disorders. Starvation, disability and stress - especially during early adolescence - have been found to endanger the future health of victims even after they return to a normal way of life, concluded Hazani.
Female Holocaust survivors are at higher risk than their counterparts when it comes to developing osteoporosis (bone thinning), said Dr. E.L. Marcus and Prof. Jacob Menczel of Herzog Memorial Hospital in Jerusalem. They examined 73 women over 60 and a control group of 60 European-born women who immigrated to Israel or other non-European countries before 1939. Survivors who had been younger than 16 in 1945 were much more likely to have osteoporosis than those who were not in the Holocaust, they found.
Elderly survivors are also 3.5 times more likely to commit suicide than those who had not been through the Holocaust, said Prof. Yoram Barak of the Abarbanel Mental Health Center in Bat Yam. Preventive strategies, he argued, are needed to reduce the risk of suicide among people who have gone through such traumas. Most survivors still define their experiences during World War II as the most difficult in their lives and suffer from depression, reliving of trauma, a terrible feeling of loss and mental distress.
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