Medicine with an eye on the future

Tel Aviv Sourasky Medical Center is blooming with renewed energy.

THE SOURASKY Medical Center in Tel Aviv 370 (photo credit: Wikipedia)
THE SOURASKY Medical Center in Tel Aviv 370
(photo credit: Wikipedia)
Still commonly referred to by Tel Aviv residents, patients, visitors and even staff as Ichilov Hospital – as it was named in 1961 – Tel Aviv Sourasky Medical Center is one of the largest acute-care general hospitals in the country, with a total 1,500 beds.
The hospital was originally named after the Moshe Ichilov, the then-deputy mayor of Tel Aviv who held the health portfolio. The original building, designed by architect Arieh Sharon, has since been bolstered by additional structures for the Lis Maternity and Women’s Hospital, the Dana- Dwek Childeren’s Hospital and the Ida Sourasky Rehabilitation Center, competing by sheer size with Tel Hashomer’s Sheba Medical Center and the Rabin Medical Center’s two campuses in Petah Tikva. Sourasky also serves as an instructional and research center affiliated with Tel Aviv University’s Sackler Medical School and Sheinborn Nursing school. Sourasky’s facilities now cover a total of 250,000 square meters.
The main building was expanded with donations from Ted Arison and his daughter Shari Arison. Seven years ago, a 700-to-1,000- bed bombproof emergency facility was built at the cost of $110 million, $45 million of it donated by the late Israeli shipping magnate and philanthropist Sammy Ofer. It has been called “the most luxurious building in public medicine.” The architect was Arad Sharon, grandson of Arieh Sharon who designed the original facility.
Covering a catchment area with a million residents, Sourasky treats some 400,000 unique patients annually, with a total of 1.8 million patient visits. Some 36,000 operations are performed; 220,000 emergency room visits are made and 12,000 babies are born at Sourasky each year.
PRO F. RONNI GAM ZU became Sourasky’s director-general in 2015, taking over from Prof. Gabi Barbash who served in that role for 22 years. Previously, Gamzu was director-general of the Health Ministry under then-health minister Yael German and then- (and current) Deputy Health Minister Ya’acov Litzman. Even while serving as director-general, he spent one day a week operating on women at Lis so as not to lose his touch at treating patients.
When he left the ministry, Gamzu was a member of the German Committee for Strengthening the Public Health System, which worked intensively for about a year. Gamzu had prepared a strategic plan for the ministry and the health system for the coming years and put stress on strengthening the public health system while aiming to fight the growing trend of private medicine and private health insurance.
Gamzu ran Ichilov Hospital before moving to the ministry for four years of service. He was named to the Sourasky post following the decision of the public tenders committee headed by Tel Aviv Mayor Ron Huldai, as the medical is a government/municipal hospital.
Gamzu, who says Sourasky is “the best medical center in the country in terms of innovation and clinical and basic research,” apparently has more academic degrees than any of his Israeli peers in medical administration. The son of a silversmith father and a mother who worked in health promotion, Gamzu began studying medicine at Ben-Gurion University and after two years moved to Tel Aviv University’s Sackler Medical Faculty because he wanted to do research that he couldn’t do in Beersheba.
Gamzu became an academic laboratory technician for the Health Ministry and was a researcher and lab technician at the maternity hospital’s Institute for Fertility Research.
After earning his MD, he specialized as an obstetrician, gynecologist and surgeon at Lis Hospital and continued at Sackler for a doctoral degree. A master’s degree in healthcare administration from the Recanati Graduate School of Business Administration was the next in his collection, followed by master’s degree in business administration from the same school. In 2008, at Ichilov, feeling the need to learn more, especially to “understand how to run things,” he completed a bachelor’s degree in law at TAU as well.
In addition to all this, Gamzu participated a decade ago in the European Health Leadership Program in France and a research fellowship at the Radboud Medical Center in Nijmegen, Holland. In 2003, he became a senior lecturer at Sackler; six years ago he was named an associate professor there; four years ago an associate professor at TAU ’s School of Public Health and three years ago a professor at TAU ’s School of Management. Gamzu also found the time to publish 65 medical journal articles in his fields and actively participated in or presented at 35 medical conferences.
On the eve of Passover, Gamzu, with his staff, celebrated the move of a ninth internal medicine department to the Ofer building. The Ofer building also includes an innovative research floor where Gamzu predicts researchers will discover new drugs and other medical technologies, developments that will further enhance Israel’s advanced medical work. Sourasky recently inaugurated a first-of-its-kind information center and queue-shortening shortening service.
Sourasky, he told The Jerusalem Post in an interview, “is among the largest medical centers in the world, innovative and dynamic, and it provides the highest quality and best treatment experience in the world. Our medical, administrative and logistical staff are sought worldwide. It is for every Israeli, of every nationality and religion, of every origin, of every color, for the poor and the rich,” he said.
MEDICINE, BOTH in Israel and abroad, is undergoing a digital revolution, said Gamzu.
“This makes it possible to deal with a lot more data and suit medical processes to the patient. The amount of medical data is tremendous. When we decide, for example, what group of drugs to give to diabetics, there is a difference between what benefits an overweight patient and what helps a slim one. Lung cancer in a non-smoker is different from that in a smoker. At present, we see only the tip of the iceberg. We still use too little information. There is a lot more, but most is not analyzed. The medical teams have to make decisions, but they can’t digest all the data rapidly.”
Artificial intelligence (AI) will help cope with this problem.
“When one undergoes blood or other tests, there are 20 or 30 results that show up inside limits or above or below them. But if some results are a bit to the right or the left within acceptable limits, the combination can mean a hidden condition. The doctor,” asserted Gamzu, “can’t know on his own what this means. You need systems for machine learning and many more parameters to point to insights that are deep inside the data. We at Sourasky are developing algorithms that can root out this information.”
In an intensive care unit, each patient undergoes continuous monitoring. The doctor sees each person two or four times per shift, but he can’t perform analysis of the data to determine who will develop sepsis [a dangerous complication of infection in which chemicals released into the blood stimulate inflammatory responses in the whole body that could lead to multiple organ failure].” Sourasky’s Dr. Ahufa Meilick, an AI expert, and Dr. Alexis Mittelpunkt, a pediatrician and data analyst, have developed a model for the neonatal intensive care unit to determine the onset of sepsis 10 hours before it presents itself, Gamzu disclosed.
While Sourasky has opened an R&D company named Aviv Med Tech to promote medical innovations, “our aim is to innovate for patients, not for selling technology,” said the Sourasky director-general.
As for oncology, cancer specialists at the medical center are examining the genetic load of patients to determine the treatment that will be most effective in fighting the disease. Cell therapies are being developed to fight lymphoma and leukemia. The patient’s T cells are removed and genetically engineered to return to the patient and fight the tumor.
Adult stem cells are the focus of research for amytrophic lateral sclerosis (Lou Gehrig’s disease), with Sourasky scientists working with the Brainstorm company. Others are developing Giogen models for treating an Ashkenazi mutation for Parkinson’s disease that they hope will help the neurons in the brain produce dopamine more efficiently.
While most physicians spend their time treating patients, there are special Sourasky programs to set aside time for research by those interested in pursuing it.
“We have 40 or 50 physician/ scientists who get scholarships. In addition, we have clinicians who get ‘protected time’ for doing research with around 60 people with doctorates.”
Gamzu urged the Health, Finance and Economics Ministry to do much more to encourage medical research.
“The hospitals can advance a lot more in these fields and they must. Many countries, including China, are investing a lot now in medical research.”
THE SOURASKY director looks ahead at the next two decades and is extremely concerned that Israel’s medical system is not prepared to cope with increasing longevity and aging of the population. Along with this, combinations of chronic diseases will challenge healthcare.
“We have a good health system, but our abilities to cope are with a young country. When the elderly comprise 15% of the population, we will feel the difference with longer queues for service. There are not enough physicians and nurses, and the infrastructure is inadequate. The speed of educating them is not fast enough. If the queues are too long, private medicine will benefit,” said Gamzu, who as Health Ministry director-general was a strong proponent of public medicine.
Health expenditures in Israel now comprise 7.5% of the gross domestic product, with 4.5% public and 3% in private healthcare (compared to almost 18% in the US). Gamzu argues that our government should raise health expenditures in the next decade to 8.5% of the GDP, which means an increase of NIS 10b. He hopes that the vast majority of the increase will be invested in public, rather than private medicine aimed at the well-off.
“Israel has to have more equality. The socioeconomic periphery does not get optimum healthcare,” he added.
While the health minister doesn’t necessarily have to be a medical professional like in the US, the ministry should at least be led by a politician who has much knowledge of medicine and healthcare. Gamzu discloses that he, himself, aims one day to become health minister.
Asked to name, off the cuff, outstanding directors-general who have turned around other general medical centers in the country, Gamzu names Prof. Rafael Beyar of Haifa’s Rambam Medical Center, Dr. Orna Blondheim of Emek Medical Center in Afula, Dr. Chezy Levy of Ashkelon’s Barzilai Medical Center and Prof. Jonathan Halevy of Jerusalem’s Shaare Zedek Medical Center.
Although women will soon constitute 60% of physicians in Israel, Gamzu does not think that this gender shift will require the training of extra doctors beyond what would be if men were the majority. Women won’t work any less than men, as this is the Y generation in which men want to take off and be with their families as much as women, he said.
The main limitation is not the lack of medical schools – he has nothing against the planned opening in two years of another medical faculty, at Ariel University in Samaria – but the lack of hospital departments with qualified teachers among their staff.
“This is the bottleneck. How many medical students can you get around a bed in a pediatrics ward and be taught by professors there? Israel needs 1,500 medical graduates per year, but we are producing only 750,” noted Gamzu. This clinical teaching problem, he added, does not exist in the US, where there are plenty of professors and hospital beds for teaching. Here there are too few beds.
But he sees improvements. The rate of nosocomial (in-house) hospital infections is decline because of more awareness of ways to prevent them.
“There is a big decrease in bacteremias [bacteria in the blood], even in the premature baby units where it used to be high,” he said. As for telemedicine replacing doctors, Gamzu dismisses the idea that smartphone- applications monitoring and consultation from a distance will replace doctors touching and talking directly to their patients. The doctor/patient relationship, he concluded, is more important now than ever.