Speakers address health care issues and aging successfully during Brown commencement weekend

Dr. David Carlisle is seen before he spoke about the history of health care to an audience on May 28 at Brown University. / COURTESY NANCY KIRSCH
Dr. David Carlisle is seen before he spoke about the history of health care to an audience on May 28 at Brown University. / COURTESY NANCY KIRSCH

PROVIDENCE – By highlighting the world’s medical progress throughout several centuries, Dr. David Carlisle, the Charles R. Drew University of Medicine and Science’s president, CEO and a professor of medicine, in Los Angeles, noted how far we have to go.

Thanks to Obamacare, which he named “Healthcare 4.0,” Carlisle said that fewer patients across America fail the “wallet biopsy” – the first procedure patients undergo in hospital emergency rooms to assess whether they have health insurance. Carlisle, a 1981 graduate of The Warren Alpert Medical School of Brown University, gave The Charles O. Cooke Lecture, “Healthcare 5.0: A History of the Future of Healthcare,” on May 28 at a Brown medical reunion weekend presentation.

“One of the tragedies of health care in the United States [is that] not all Americans had equal access to the best of health care… We were the last hold-out for universal health care, even after South Africa.” After chasing universal health care for more than a century, Obamacare levels the playing field and gets us beyond barriers of access, he said. “[It] stands to [reduce] the issues around a ‘wallet biopsy.’” Californians with individual health insurance spent almost $2,500 less on health care – a 33 percent reduction on out-of-pocket expenditures – between 2013 and 2014, given Obamacare, which also improves patient outcomes, said Carlisle.

Things were far worse in earlier eras: In 2000 B.C., death could occur with a simple scratch or a broken leg, which, said Carlisle, would make you “a tiger’s dinner.” The writings of Hippocrates, Galen and others, “Healthcare 1.0,” during the transition from the B.C. to A.D. era, laid the groundwork and foundation for many current medical practices.

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Nineteenth century “Healthcare 2.0” witnessed the “tremendous advance” of basic surgery, albeit without much anesthesia beyond “drinking a lot of whiskey [and] biting down on a bullet,” said Carlisle. With surgical amputations, many wounded Civil War soldiers survived.

During “Healthcare 3.0” or “the dawn of science,” people didn’t comprehend how the Black Plague and cholera were transmitted, said Carlisle, who noted that developing synthetic antibiotics and storing blood plasma both benefited Allied, but not Axis, soldiers during World War II.

A century later, Carlisle said, “We cut our teeth on the AIDS epidemic; [it was] the real scourge of our medical care.” AIDS patients in the 1980s who were admitted to a hospital “were rarely discharged; now, they are rarely seen in hospitals,” he said. “They are dying of other maladies, not HIV/AIDS. [That’s the] result of the era of science and health care.” Cardiac transplants were the ultimate surgical advances late in the 20th century.

Today, health care is at a crossroads, and the future augurs well for “Healthcare 5.0,” the transformation of medicine, with the promise of genetic therapies, precision and personalized medicine, immunotherapy, biologics, antibody treatments and gene editing, he said.
As a nation, we’ll need to wrestle with these therapies’ costs, said Carlisle, as Great Britain has done; they constitute a major national challenge in the 21st century.

“I envy young doctors [who] don’t have to worry about patients failing the ‘wallet biopsy,’ as I did,” said Carlisle. “[They have the] possibility of even curing [diseases] that we considered incurable.”

Can we age successfully?

Later that day, Dr. William J. Hall, a longtime faculty member at the University of Rochester (N.Y.) School of Medicine, gave the Frank and Joan Rothman Lecture at Brown University, “Successful Aging: New Horizons,” to an age-diverse audience.

Acknowledging his own mid-70s age, Hall encouraged audience members to reflect: “Where are you graduating from … or to? What’s the next step in your life?” Those questions are significant; according to Hall, people spend more time planning their summer vacations than planning for retirement. He wants to help people add years to their life and life to their years. “This is not a contest to see who can live the longest, but how many of us can live the best lives we can,” said Hall, a geriatrician who serves on the Medicare Payment Advisory Commission, an independent group advising Congress on issues affecting Medicare, and and served as former president of the American College of Physicians.

What should an aging society look like? With a period of remarkable longevity in developed countries’ populations, we have the opportunity to make plans that no previous generations could envision, he said. In 1965, when President Lyndon Baines Johnson signed the bill establishing Medicare, men’s life expectancy was only 66, Hall said. Harry and Bess Truman were Medicare’s first two recipients, said Hall, although Harry Truman, not convinced of its appeal, balked at paying the supplemental Medicare costs (Part B, parts of Parts C and D) – $2 a month!

Having changed every paradigm and every generation, baby boomers, said Hall, “have a very good prospect of living into their 90s. They could also be a tremendous burden on society. We’ll have serious negotiations on sharing resources: Do we address the Flint water [crisis] or care for ‘geezers’? The more productive we are and bring value to society, the better.” With unprecedented growth in the cohorts of individuals over age 85 and age 95, extending one’s lifetime is a solvable challenge, while developing a productive lifespan remains a challenge and an exciting opportunity, said Hall, acknowledging that excellent medical care is not enough.

Aging adults typically ask their physicians about their chronic illnesses, cognitive changes (memory loss and Alzheimer’s disease); frailty, accompanied by weakness, falls and loss of muscle mass; and loneliness, given reduced social opportunities and the deaths of loved ones. “Generally, the last question they ask is the most important,” Hall advised the physicians in the audience.

Distinguishing normal memory loss from Alzheimer’s, Hall dispelled the myth that all memories fade with age: Procedural memories – how to ride a bike – and powerful experiential memories –the assassination of John F. Kennedy or 9/11 – survive. Sixty percent of individuals over age 60 report memory problems with name recall, for example; 100 percent of those over age 70 do, he reported.

“Take your brain seriously; don’t expose it to toxic substances and be resolute about exercising it,” he advised. Engaging in atypical and mentally challenging activities allows the brain’s hippocampus, the site of new memories, to actually become bigger. While we lose physical muscle mass as we age, we can ameliorate that loss with regular exercise – Hall recommends 150 minutes a week of vigorous walking to his patients. Resistant exercise – climbing stairs or vacuuming – is also important, as is eating a common-sense diet, added Hall.

Recommending HEALTHbeat as a free source of authoritative health information from Harvard, Hall briefly mentioned the merits of socialization, brain exercises like Sudoku and crossword puzzles and lifting weights, which stimulates new bone formation.

Remember, he said, “Ask the last question on your list; it’s uncanny how often the last question will totally change the [doctor-patient] relationship.”

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