Max Laurans: An Entrepreneurial Life in Medicine
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Howie and Harlan are joined by Max Laurans, a Yale neurosurgeon and hospital administrator, and a founder of the healthcare staffing company Nomad Health. Harlan discusses the problem of doctors giving too much weight to suggestions from AI; Howie celebrates a milestone in the campaign to eliminate trachoma, a common cause of preventable blindness in the developing world.
Links:
Automation Bias
“Some doctors are using public AI chatbots like ChatGPT in clinical decisions. Is it safe?”
“Automation Bias and Assistive AI: Risk of Harm From AI-Driven Clinical Decision Support”
“Combining Human Expertise with Artificial Intelligence: Experimental Evidence from Radiology”
Max Laurans
Maxwell Laurans, MD, MBA, FAANS
Nomad Health: Travel Nurse and Travel Allied Health Jobs
2003 residency placements for Yale medical students
“Yale New Haven Hospital breaks ground on $838 million, 505,000 square foot Neurosciences Center”
“Hospitals across the U.S. face IV fluid shortage after Hurricane Helene”
Trachoma
“Elimination of trachoma as a public health problem in India”
The Carter Center: Waging Peace. Fighting Disease. Building Hope
Learn more about the MBA for Executives program at Yale SOM.
Transcript
Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.
Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University. We’re trying to get closer to the truth about health and healthcare. Our guest today is Dr. Max Laurans. But first, we like to check in on current hot topics in health and healthcare. So what are you bringing us today, Harlan?
Harlan Krumholz: Yeah, I’m bringing you a little more A.I., Howie. Have you had enough A.I. yet?
Howard Forman: There is never enough of A.I.
Harlan Krumholz: There never is enough A.I.
Howard Forman: Not from you, particularly. I love hearing your takes.
Harlan Krumholz: This is quickly becoming a tool in the hands of docs, and how it’s being used and whether it’s safe continues to be debated. Hospitals are trying to figure out what they can institute, what they should integrate, or healthcare systems. But docs are also using this stuff on their own outside of the healthcare system. And there was a recent survey that came out. It was a small survey selected sample, but it said that maybe three quarters of doctors are using these sort of A.I. tools in their decision making. And many of them are using them to check for drug interactions, half are using for diagnosis support, 40% for treatment planning. Like I said, it’s a small survey, but even if this is directionally correct, it confirms my own observation that the people are just making use of tools like ChatGPT on their own to try to help them do a better job. And I think why this shows the appeal of these tools, they’re very user-friendly and they can simplify complex tasks. It introduces some concerns and in particular because of something called automation bias. Do you know about automation bias, Howie?
Howard Forman: I wouldn’t be able to define it, Harlan, but I’d love to have you define it for me.
Harlan Krumholz: Well, I’m glad to, because I think it’s something that most people aren’t aware of, but it’s very important, especially for you as a radiologist, which it refers to the tendency of users to over-rely on automated systems even when those systems may be wrong. And so what that means is that we often talk about having a physician in the loop with the A.I. The A.I. is producing some information, but we feel better if there’s a human who’s looking at the information and making decisions based on it. But it turns out cognitively we’re sort of inclined to accept a diagnosis or recommendation from A.I. without thoroughly cross-checking it against our own judgment. And there was a study published in JAMA recently in December, and our own Rohan Khera wrote an editorial on this that was really pointing out this problem, how A.I. support can affect clinical decision-making even when the A.I. models may be biased or producing incorrect predictions.
And so what was really interesting about this paper was, we often talk about if the A.I. produces something, we know it’s a black box, but if there’s some level of what we call interpretability, if the output explains to us how the A.I. got there, then we can evaluate better whether or not it worked. But in this study, even when the A.I. include explanations or visual aids to justify its recommendations, if that was wrong, doctors tended to default to what the A.I. said. They trusted the A.I. more than they trusted their own judgment. And then this is going to create this significant risk if doctors place too much trust in A.I., and those systems aren’t built so that they are almost always right, it can lead to errors and poor patient outcomes.
The question’s going to be, how can we use the A.I. for what it can do to help us improve? But also, if we’re going to put a human in the loop, a human in the middle of the A.I. output and the clinical decision, how can we make sure that doctors are using best practices to fully evaluate what they’re being recommended, but through these decision support systems? So in sum, the promises I mentioned, I’m totally pro-A.I. I think it’s going to transform medicine. I think it has so much potential to make us better. But as we’re seeing more and more docs using it, we have to help them combat the tendency just to default to what the A.I. is telling them rather than use their own critical thinking to ensure that, yeah, that decision support is helping me, but I’m still always going to think through for myself whether that makes sense and it’s the right thing to do. Finding that balance is going to be an important challenge to us as we enter into this A.I. age.
Howard Forman: One quick point and then a question to follow. There are a couple of studies that have implied that radiologists perform worse when they’re working with A.I. and that the A.I. alone at times can be better than the radiologist or the radiologist can be better without the A.I. I’m not certain I believe that, but there are these two studies and so there’s a group that started off at Yale and now is working in Stanford on just that question. So there is a lot of questions that need to be answered there.
But I want a quick question for you. When I go into A.I., and particularly you and I talked about this, openevidence.com, which is a large language model that is intended for physicians or healthcare providers. If I were to enter into that, “I would like to know a differential diagnosis for a 59-year-old man with atrial fibrillation who works only as a clinical radiologist and now presents with headaches for three days” or something like that, it will immediately feed me back sort of a message saying, “Do not input real clinical information as it may violate privacy issues.” And I’m just wondering like, is that a real concern? As much as I may give a very detailed history, how does it reveal anything about a specific person when it’s a machine that’s basically rolling around with this information?
Harlan Krumholz: Well, I think the problem is that it’s not HIPAA-compliant, so you’re providing information to an environment that can’t protect that information, even as you may believe that it’s impossible to identify the person. Now, increasingly, products are being developed that are in a HIPAA-compliant space and will ensure that the information you’re providing isn’t going to be used to go somewhere else, for example, for continued training of the model but can be only used for evaluation. It again points to the idea that we’re still at the very beginning here. I believe it will transform medicine, but we need to figure out how to optimize this, optimize for security, optimize for accuracy, optimize for where does it fit in to the clinical environment where it can help us do a better job, perform better, get better patient outcomes, and minimize the possibility of unintended adverse consequences. In the case you’ve talked about, by the way, I’ve done this in clinic when I’m working with medical students. We’ll generate a differential, and sometimes we’ll say like, “I wonder what ChatGPT will say,” but we provide a very light, you know, “There was a rash, there was this, there was that. What might these three signs be?” And so it’s not about putting in detailed information about the patient, but it’s saying if someone presents with an ocular problem and arthritis and something else, what might that indicate?
But I am always very cognizant of the fact that this has to be at a very high level, do these three symptoms together mean something as opposed to a detailed history about an individual in a non-HIPAA-compliant space. That would be violating. We’d be breaching confidentiality, even though we may be hard to imagine how would anyone figure out who this is? That’s just not allowed. And we’re going to need more and more guidance about what we can do and what we can’t do. But I’ll give you another example, Howie. You can take a picture of a rash with a wide variety of programs. Google, for example, can give you back a differential. Is that violating confidentiality?
Howard Forman: Yeah. Or an X-ray. Great. Yep. I agree.
Harlan Krumholz: And I think a lot of people would say, “You should only be doing that in a place where it’s highly secure environment.”
Howard Forman: Yeah. I’m grateful you’re pursuing this because people need to be looking out.
Harlan Krumholz: This will be more and more stuff coming out, but hey, let’s get to our interview with Max. This should be terrific.
Howard Forman: Dr. Maxwell Laurans is an assistant professor of neurosurgery at Yale Medicine and serves as the senior vice president of neurosciences, orthopedics, and surgical services at Yale New Haven Hospital. Clinically, his surgical skills are put to best effect on tumors of the spine as well as minimally invasive spinal procedures. Aside from his medical duties, Dr. Laurans is involved with the Yale New Haven Health Innovation Executive Committee and the Yale Center for Biomedical Innovation and Technology. He co-founded Nomad Health in 2015 to connect traveling nurses to job opportunities across the United States. He remains on their board to this day, actively involved. Dr. Laurans completed his undergraduate degree in economics at Yale, graduated from the Yale School of Medicine, including pursuing a coveted Howard Hughes Fellowship and completed his residency at Yale New Haven Health. During that time he also obtained an MBA from Harvard Business School.
And so first, I just want to welcome you to the podcast. You are like truly a Renaissance person. I mean, you have accomplished so many things, and I’ve been privileged to at least watch from afar at each of these steps to see what you’re doing. And for our listeners, you are a true active clinician. You are a senior member of the leadership of the hospital and put to good use your understanding of technology and management. And at the same time, you are also an entrepreneur and innovator. And I want to just start off, you were at Yale College. You graduated Yale College the same year I started teaching at Yale College, so I never had the chance to teach you in the economics department, but what were you thinking when you were in Yale College? Did you ever imagine this particular path to follow?
Max Laurans: Well, Howie, first of all, let me just say thank you for having me. This is a real privilege to be here speaking with you and to have a chance to discuss this a little bit. When I was in undergrad, I knew that I wanted to go into medicine. I knew I really enjoyed healthcare. I’d always been fascinated by science and fascinated by biology, and so medical school was a pretty natural next step for me. But I was simultaneously always interested in economics. No one in my family is in medicine except for me. I’m the one that gets the phone calls in the middle of the night about the rash that someone’s child has that I can’t answer. Anyone who’s had that experience knows...
Howard Forman: Oh, well.
Max Laurans: ...yeah, you quickly say, “Call a doctor.” So I grew up around a dinner table where we discussed more politics and business, but I found myself going down the path of science and biology.
Howard Forman: And let me just one quick follow-up question. You come from this incredible class at Yale Medical School, and so you roomed with our Surgeon General when he was not our Surgeon General back when I first met him and you first met him. How exciting is it to look at your classmates and be able to bask in the glow of all of their successes?
Max Laurans: Certainly it’s surreal to know that Vivek Murthy was my roommate. He is a remarkable person. Always knew he was a remarkable person, would do amazing things. Certainly didn’t anticipate that he would become Surgeon General, but I have colleagues around the country from my medical school class who I’m still in touch with and I’m so impressed by who have taken a variety of career paths, some strictly clinical, some a combination of clinical and health policy and others moving the needle in healthcare in really important ways. So it was a privilege to go to school with them and it’s an honor to say “I knew them when.” I was listening to The Daily this morning, which is all about a statement which Vivek made, I think just yesterday, warning us about how we’re parenting and how that’s a potential healthcare crisis looming. And it’s great whenever I hear his name in the news.
Howard Forman: We covered that on the podcast a week before The Daily, I’ll just point out.
Harlan Krumholz: We beat The Daily.
Max Laurans: Because you’re forward-thinking. You beat The Daily. That’s great.
Harlan Krumholz: Howie, what do you think? I mean, Max has got one of the best radio voices I’ve heard in a long time. Don’t you think? I mean—
Howard Forman: Well, I have the best radio face, so I think I—
Max Laurans: I thought that’s what Harlan was going to say. It’s a really—
Harlan Krumholz: And Howie’s getting himself in trouble by calling out a single Yale Medical School class as being extraordinary when, Howie, every single Yale Medical School class is.
Howard Forman: They are. They are.
Max Laurans: Yeah.
Howard Forman: I will say that because we’ve had four guests from that one class, I’m drawn to thinking that class was special. But I’m sure over the years, we’ll find more and more.
Max Laurans: We always knew that class was the best class.
Harlan Krumholz: Okay, okay. I wonder if you could tell us what is senior vice president of Neurosciences, Orthopedics and Surgical Services? And is this usually held by someone who is a hundred percent devoted to this or is it usually with someone who’s got other responsibilities?
Max Laurans: Yeah, it’s typically held by a hospital administrator, someone who has an MBA, but typically not medical training. Maybe had some degree of clinical background, but often someone who’s been—
Harlan Krumholz: And that’s their full-time job.
Max Laurans: And that’s their full-time job. That’s correct. Yeah.
Harlan Krumholz: And so what is it? What’s your—
Howard Forman: What do you manage?
Harlan Krumholz: Yeah. What do you do?
Max Laurans: Yeah. So I’m responsible for all of the surgeries that happen at Yale New Haven Hospital. So we do about 50,000 surgeries a year. It’s a budget of a little over $300 million. If you look at all the top—
Harlan Krumholz: So just to be clear, all the OR nurses, all the technicians, everything that goes on in the OR, the scheduling, all that rolls up to you?
Max Laurans: That’s correct. It’s about—
Harlan Krumholz: You delegate, obviously, but this is all rolling up to you, the responsibility for the performance, the financial, everything that goes on in surgical services?
Max Laurans: Yeah. It’s about 2,200 people, about $300 million. If you looked at the top-line revenue of all the surgery that comes in, it’s just under a billion dollars. So I manage that part of the operation in addition to the service lines for neurosciences and orthopedics. And so that’s our strategic planning in those areas. Yale New Haven, you’re probably aware, we’re putting up a couple of new towers, the Adams Neurosciences Towers on the Saint Raphael Campus. That’s an $850 million project and expansion in neurosciences, so—
Harlan Krumholz: So your neurosciences goes surgery but also neurology. I mean you’re not just—
Max Laurans: Also neurology.
Harlan Krumholz: How do you remain so calm?
Max Laurans: Well, I haven’t ever found that getting agitated has helped me at all. So I think remaining calm is job number one. I mean, the other thing, just this week, we’ve really been faced with a new challenge, which is reminiscent of the PPE shortage that we had during COVID, and that’s the—
Howard Forman: Yeah.
Max Laurans: ... IV fluid shortage caused by the—
Harlan Krumholz: I was amazed by that.
Max Laurans: So 60% of the entire country’s IV fluids is produced in a plant just outside of Asheville, North Carolina, and was damaged terribly in the hurricane a couple of weeks ago. And so Baxter, unfortunately, has had to put us on allocation and we’re now working through all the challenges related to that shortage. And as you can imagine, IV fluids are critical. And to his credit, Tom Balcezak, our chief clinical officer, cools the other side of the pillow and is leading the teams through what’s going to be required for us to conserve where we can—again, reducing waste and extending our runway and finding alternative solutions that we can continue to provide—
Harlan Krumholz: How long will that likely last?
Max Laurans: We’re not getting any specific timelines just yet. It sounds like the plant may be down for as much as six months, but we’re still waiting to get more information from Baxter. It is one of those truly evolving situations.
Harlan Krumholz: So today we’re operating with maybe 40% of the supply that we usually have? Is this going to—
Max Laurans: Yeah. Well, we have inventory on hand, so we have several weeks of inventory available. There are some institutions across the country that have announced that they’re postponing elective surgeries, as an example. Some large places, actually. Fortunately, we’re not in that circumstance. Our supply chain partners—we have a center that we manage our inventory out of, and we’re able to identify that we’ve got a few weeks, and then we’re creating strategies as a bridge to when other alternatives might be available. And obviously there’s collaboration with the FDA and other partners who might be able to produce and ship product to us.
Harlan Krumholz: But is it a chance for innovation too? Perhaps sometimes we overuse fluids and we’ve got to be able to be very thoughtful now about our use.
Max Laurans: Absolutely. And we’ve seen this. Ever since the pandemic, we have seen supply chain disruptions, and it really has shed light on number one, how fragile our supply chain is in some areas. And we’ve seen disruptions in other products and had to do similar things, Harlan. There was a blood culture bottle shortage, of all things, and we really discovered that we were over-culturing quite a bit and that we could be much more thoughtful in how we used blood culture bottles. And so yes, in this space, absolutely, clinical innovation and also innovation in terms of how we can supply that product in and of itself.
Harlan Krumholz: You know, Max, I have marveled at the way in which you’re able to balance so many things. Can you give us some hints? Like how do you organize your life so that, I mean, being a neurosurgeon, it would be enough, but being, leading these services and being in the hospital leadership and health system leadership is extraordinary. And then to really be a mentor and a catalyst for innovation within the system, to be working in so many different ways at the cutting edge of what’s next in healthcare, and then I know you’ve got a personal life. How do you make it work? Help some of the rest of us who are trying to keep up figure out like what are the tricks.
Max Laurans: So when I was in residency, I got this crazy idea that I wanted to get my MBA. And you may know neurosurgery residency is a long training period. It’s a seven-year training period. But there are two years in our program at Yale, which are dedicated to research, but they’re not protected time. You still have about 35 hours a week of clinical responsibilities.
Harlan Krumholz: Wait, wait, wait a minute. You’ve got time that’s supposed to be allocated towards research. This is the time when you can breathe and actually do something else, but you’ve got 35 hours a week that’s committed to continued clinical training?
Max Laurans: Just about, roughly. Keep in mind, a typical neurosurgery resident, even today with current work hours restrictions, is working about 80 hours a week. That is a standard workweek for a neurosurgery resident. I mean, it’s a grueling schedule, there’s no question, and it’s not like it goes for a month or two. It goes for seven years straight. And at that time, I think we were taking a week or two of vacation each year, but that was the expectation. And I got this crazy idea in my head that I wanted to get an MBA during my research years. And that was, at the time in neurosurgery, a pretty outrageous thing to ask for.
And so I went to Dennis Spencer, been a mentor of mine and was chair of the department, and I told him I had this crazy idea and he asked me, “Why do you want to do this?” And I told him that I thought that the future leaders of healthcare should be physicians and educated as physicians but also had to speak the language of business and management and medicine and not in a superficial way. And much like you learn a language in medical school but can’t practice, but you need that language, I felt as though I needed the language that one gets in business school. And I think he appreciated some of those challenges and really had some foresight into what was coming down the pike in healthcare in the coming decades. And so he agreed to let me go. But I spent those two years fulfilling my 35-hour week clinical commitment and running back and forth to Harvard from Yale and doing their full-time MBA. So it’s always been a little bit in my DNA to do multiple things, and I actually thought it made me a more valuable physician to have that background, and I was able to bring much deeper clinical expertise into the world of business and management so I could contribute in class. Even at that time, I felt I could contribute in ways that added a different perspective than what my other colleagues might share.
And as of today, I guess it’s not nearly as intense as it was. I mean, those were lots of sleepless nights working 36 hours at a pop on a regular basis. I don’t do that, anything like that anymore. But it’s a matter of figuring out how do I live that 80:20 rule as completely as possible? How can I be as value-add in whatever area I’m in and drawn the breadth of my experience to do so?
Howard Forman: I want to follow up. The Nomad Health business is a fascinating one, particularly as we come out of the pandemic and our hospital systems everywhere have leaned so heavily on short-term nursing assignments, and not just nursing but all types of professionals. Nomad Health is a company that has existed now for nine years, maybe longer, and that basically was a dominant player and is a dominant player in that space trying to disrupt the previous existing part-time nursing traveling services and make it more market-friendly. Can you explain to our listeners what the original idea was and how it’s evolved over time?
Max Laurans: Yeah. So this is an idea I was kicking around even in business school in I guess 2007 and then evolved a little bit over time. So the whole idea is that the temporary clinician staffing space is pretty antiquated in how it functions. You can think of it, the parallels that you can think about are like the old travel industry where you used to call up a travel agent and they would make arrangements for you and they’d take a cut of the airplane ticket or whatnot. There’s a lot of sort of manual process, paper and pen management in the travel clinician staffing industry. And so the concept was, can we build automated processes to facilitate what are pretty complex transactions, decrease the cost of hiring those clinicians for hospitals and healthcare institutions, increase the rate of pay for the traveling nurse or the traveling clinician? And so you’re shrinking the overall margin but creating much more scale in the process. But that was the whole concept. And then all the challenges that a company goes through when there’s a lot of external shocks and COVID was about the biggest external shock and every industry was affected, but obviously healthcare dramatically so, and so we saw huge acceleration, need for rapid expansion and then a settling of that market and a contraction in that market. So very challenging for that company to manage through those rapid expansions and changes.
But fundamentally, I think it adds a lot of value to healthcare. And if I had to characterize what do I want my career to be in sort of broad strokes and broad terms, I really want to find ways where we’re maximizing value, being explicit about defining it as the relationship between quality and cost and where we can reduce waste and cost to the system, I think we can add a lot of value. I’ve joked with people that of all the things that I’ve done, the patients I’ve operated on, the teams that I lead here at Yale New Haven Health, probably the most value that I’ve added is this little idea that I had in Nomad Health because we were able to squeeze an awful lot of waste, that money that really was going nowhere by automating these processes and creating a more efficient way to match temporary clinicians with institutions.
Harlan Krumholz: One thing I wanted to ask you, Max, because you’ve had this experience, I mean this gives you such great credibility when you’re talking with innovators. I mean, you’ve actually walked the walk, you’ve understood the challenges, and yet—here’s the “yet”—a lot of times at the institution level or at the area of hackathons, we try to inspire people to think about solutions, but there’s a big journey ahead. When you’re advising people who have got ideas and want to try this out, what are you telling them that balances both your encouragement about following your dreams and your hopes, but the realistic truth about what it’s like to actually get funded, to be able to get this thing off the ground, to be responsible for its success? I mean, how do you balance that kind of advice when you’re talking to folks who come to you?
Max Laurans: Number one, you have to find something that you’re passionate about, and you have to find something that’ll keep you getting up in the morning. One of the best pieces of advice I ever received was from my father, and he said, “No matter what you’re doing, find something that you’re really excited about because you’ve got to do it for an awfully long time, so you might as well find something that gets you up in the morning because you’re going to work hard no matter what you do.” So I do think you do have to find something you’re passionate about, and not just because you think it can become successful, but because you think it adds value in a meaningful way.
And the other piece of advice that was really important for me, because I was not looking to leave clinical practice and I was not looking to leave my operational role at Yale New Haven Health, you got to build a great team. You have to find people who are going to partner with you and who will see and share your vision because much of that hard, grueling work that you just described, I have to credit the Nomad team with putting together. It does certainly require fortitude. There’s a lot of bumps in the road that you certainly feel, but you have to be willing to share it. I think a lot of innovators get very concerned early on that they’re going to give something up or someone will steal their idea or they’ll run away with it, and they won’t have that credit. So they hold it so tight, or they have the tiny little circle that they share the idea with. And that ends up really limiting how it can grow. And it’s really important, there’s the old venture capital adage that it’s much better to own a small part of a big thing than all of a nothing. If you find ways to continue to add value to the idea, you stay a part of it. And so that’s how I stayed close to and was able to be a part of Nomad’s growth over time. Yeah.
Harlan Krumholz: That’s terrific.
Howard Forman: It has been true pleasure and honor to have you on this, and I learned so much about what you’re doing now. Even though I seemingly was following your career for these two decades, I had no idea just how much you do and really, we both appreciate what you do for the patients, for the hospital, for our medical students, our residents, and for the greater community around you.
Harlan Krumholz: Yeah. And I can say it’s just so great to have you as a colleague. Every time we’re on calls together or doing anything together, just my respect for you grows and grows. It’s incredible, so thank you so much, Max.
Max Laurans: Well, it’s a shared sentiment. I appreciate both of you deeply, and this little mutual admiration society can continue as much as we have time for, I’m sure. But it is such an honor to be here, to be able to talk about my career as well as the important impact that I think that our teams can have in providing care for our community. As I said, my whole mission is thinking about how we can create value in healthcare and for our patients, and that’s been my privilege and honor.
Howard Forman: Thank you.
Harlan Krumholz: Terrific. Thank you so much. Howie, as expected, terrific interview with Max. I so enjoyed hearing him.
Howard Forman: He’s amazing.
Harlan Krumholz: This guy’s a neurosurgeon and he’s running surgical services, and he’s one of the chief innovators in the institution. It’s incredible. But let’s get to one of my favorite parts of the podcast always: your section. What’s on your mind today?
Howard Forman: Yeah. So this is an odd one for me. Trachoma is a disease I am certain I learned about in medical school and probably forgot sometime after I took part three of my boards in 1990. And why? Because it just doesn’t occur in the United States, or at least rarely enough that I would never see it as a student, an intern, and it’s not a disease that radiologists pay much attention to, but it remains a common cause of blindness in the world. It’s the number one cause and an infectious cause of blindness in the world. And as you see, there’s some good news to report here. So briefly, Chlamydia trachomatis affects about 80 million people throughout the world, primarily causing disease in poorer areas with poor sanitation. Often children, and there are reports, by the way, that as many as 60% to 90% of children in some areas are actively infected at a given point in time, but predominantly children at first.
And the infection itself is not seemingly devastating. It can mimic just benign viral conjunctivitis, which anybody listening to our show has seen either in their own family members or someone near to them. But in its untreated form, particularly with repetitive infections, it causes distortions to the lids and eyelashes that ultimately scar the cornea, leaving the individual with blindness. It’s a 100% preventable form of blindness, and yet 1.2 million people are completely blind, and another 1.2 million have reduced vision just from this disease. And once they’re blind, they’re blind. You can’t reverse that. You can’t treat it with antibiotics or surgery at that point.
So there’s a very organized and relatively simple public health approach to this disease that’s not particularly costly. So for the tens of thousands of people that already have damaged eyelids but not blindness yet, there’s surgery. Then there’s antibiotics to treat the active disease, and Pfizer is known to donate azithromycin for this purpose. There’s facial cleanliness and personal hygiene, and then there’s environmental changes such as sanitation. And this is described by the World Health Organization as SAFE—surgery, antibiotics, facial cleanliness, environmental changes, S-A-F-E. Now put aside, Africa remains the continent that is most affected at the current time. And the World Health Organization has set 2030 as the date for global elimination. And despite the setback introduced by COVID, more progress is being made.
So why do I bring this up this week? Because this week, India was certified by the World Health Organization as having eliminated trachoma as a public health problem. We often focus on diseases of the rich, developed world on this podcast. We forget often that there are so many people that suffer from blindness, elephantiasis or die from malaria, all conditions that can be eradicated if we just have the will to do it. And India working with the global community, and again, credit to Pfizer for contributing, has done just that. There’s a lot of bad news in the world presently and on the horizon. We’re going to continue to try to cover a lot of that and elevate that, but every so often, I feel incredibly inspired by my global health colleagues. We’re making a difference every day, working with people, with governments, with clergy, with other community leaders to materially improve the lives of so many.
Harlan Krumholz: Yeah, I love this topic. I’m so glad you brought it up. And what a great opportunity to celebrate Jimmy Carter because—
Howard Forman: Exactly. Very much so.
Harlan Krumholz: Jimmy Carter—
Howard Forman: I should have mentioned that.
Harlan Krumholz: Yeah. He’s been closely associated with efforts to combat trachoma and particularly through—
Howard Forman: And he just had his hundredth birthday—
Harlan Krumholz: Hundredth birthday.
Howard Forman: And his center is dedicated.
Harlan Krumholz: So this just shows you, in a post-presidential impact on the world, through the Carter Center, which was founded in ’82. They really have focused on this area. His commitment’s been instrumental, I think, in reducing—
Howard Forman: 100%.
Harlan Krumholz: ...prevalence in all these various countries and—
Howard Forman: And we also talked about the Guinea worm a few months ago, also the Carter Center. So it really is like, I will say that as a medical student, when I would hear about the Gates Foundation and Clinton Foundation and the Carter Foundation, I always wonder like, how much good are they doing? But I’m learning lately that their impact is far, far greater than I ever would have imagined.
Harlan Krumholz: Yeah, that’s great topic. Thanks so much. It’s good to end on a positive note like that. You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.
Howard Forman: So how did we do? To give us your feedback or to keep the conversation going, email us at health.veritas@yale.edu or follow us on any social media, and we will look at your replies.
Harlan Krumholz: And in addition to social media, we want to hear your direct feedback or questions or experiences on these topics. You can contact us, you can make comments on the various different platforms for podcasts. We always read these reviews and it helps us get better.
Howard Forman: Yeah, really, we appreciate it. If you have questions about the MBA for Executives program at the Yale School of Management, reach out via email for more information or check out our website at som.yale.edu/emba.
Harlan Krumholz: Health & Veritas is produced with the Yale School of Management and the Yale School of Public Health. Thanks to our researchers, Ines Gilles and Sophia Stumpf, and to our producer, Miranda Shafer. They are just incredible. We’re so grateful.
Howard Forman: We are grateful.
Harlan Krumholz: Talk to you soon, Howie.
Howard Forman: Thanks very much, Harlan. Talk to you soon.