Today my intellectual fantasies of seeing some of the best most interesting people in my field was fulfilled. Although I was excited to see Helene D. Gayle, MD, MPH, (President and CEO of CARE USA), I have to say I wasn't all that impressed. Not the best public speaker and she didn't say anything new.
However, Jim Yong Kim, MD, PhD (Harvard, WHO, Partners in Health) was a charismatic, innovative and inspiring lecturer. I am not surprised that in 2003, he received a MacArthur Foundation "genius" grant, and in 2005, he was recognized as one of America's Best Leaders and in 2006, he was listed as one of the top 100 most influential people by Time Magazine http://www.time.com/time/magazine/article/0,9171,1187277,00.html.
He started his lecture by discussing HIV and MDR-Tb and the newer XDR-Tb which is even more drug resistant. This XDR-Tb is very dangerous. In a sample of people near Lesotho 41% had MDR-Tb and 10% of those people had the XDR. 100% of the X'ers were HIV positive and the average time from diagnosis to death for this study was 16 days. Almost all the people had the exact same strain meaning it is passing from individual to individual He gave the normal stats and photos and talked about some of the successes of DOTS-Plus. He showed the famous photo of recovering HIV/TB patients.
He reinforced that a focus on Basic science research (4-5 new drugs are needed for TB), Clinical Research (we need to know what works), and Technology (what is the best way to get this out and coordinate it) needs to be strong. However, will it help to add these new innovations on top of a heap of old, ineffective/semi-effective programs already in place?
The innovative part of his lecture was a proposal of a new discipline that will seal the gap in Public Health. This is DELIVERY SCIENCE. It looks specifically and how things are implemented and imposes a business modelling system into health.
He suggests compiling information using the case study approach to look at successes and failures. He recommends lessening the focus on outcomes and refocusing on how we get the outcomes to learn from practice. He made a very good case for this and after a few years with WHO's failed 3 by 5 goal (3 Million people by 2005-Universal access to anti-retroviral therapy for all living with HIV/AIDS), he knows his fair share of bureaucracy and the dangers and complacency it imposes in the eyes of many visionaries.
My only hesitation on his plan however, is when we are at critical epidemic rate of increasing co-morbidity from HIV/Tb, for example, where are we going to get the TIME and Funding for us to compile this information and then test and test and try and try? I understand a need to identify an effective way to have people globally access primary health care, but do we have time for trial and error? Error in some countries is genius in others.
Using financial resources and business models for health care product dissemination is frankly amazing. As he said, if every person in the developing countries can get a coke in their hand, then why can't we use that same marketing model to apply to health. Getting this information from the coke PR firm and blending and molding it to many of the challenges faced by global health workers may present itself to be a bigger challenge than some of the global health challenges we face today
At any rate, it was an amazingly thought provoking lecture and I will post a link as soon as its available.
If the efficiency of marketing and globalization could be used to better the health of the world, hell, even i will drink a coke and cheer to that.
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