Light shines through the gloom

An audience of 1,400 people, packed Jerusalem’s International Convention Center at the Hadassah Medical Organization’s annual conference.

Hadassah annual conference 2013 370 (photo credit: Avi Hayoun)
Hadassah annual conference 2013 370
(photo credit: Avi Hayoun)
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 research.
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 Centers.
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.
Reforms have 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.
“How much 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 said.
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 acute leukemia.
“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.
The 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 the IDF.
“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 country.”
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 pronounced.
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.
The first 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 eye.
“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 disease.
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 Israel.”
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.
“Lambs were unable to get through a maze and join the flock, causing them to bleat from distress.
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 1950.”
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 diseases.”
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 emergency room.
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 deconditioning).
“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.
The 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 research.