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St. George’s, Grenada – Many Americans may know about the Caribbean island of Grenada only if they remember the 1983 US military operation, when American armed forces expelled a Cuban communist force and secured the safety of several hundred American medical students.
That successful mission was, indeed, a great moment for the Reagan administration, and the people of Grenada remember it well. Right in the middle of the medical-school campus, there’s a memorial to the 19 Americans who gave their lives in Operation Urgent Fury.
In fact, the 30th anniversary of Urgent Fury is coming up this October 23, and the islanders are planning a commemoration.
Yet Grenada is much more than the site of a Cold War incident; Grenada is an English-speaking, independent island nation of some 108,000. Indeed, this visitor can attest that many Grenadines are Fox Fans.
Grenada has all that one would expect from a tropical vacation destination; the waters are bright blue, the beaches are pristine, the cliffs are spectacularly steep, and the hilly land is a lush and verdant green. And yet perhaps the most unique feature of the island is the medical school, which has grown from a few hundred students thirty years ago to some 4,000 students today, from 140 countries.
Indeed, under the leadership of its founder, Chancellor Charles Modica, St. George’s University has expanded to include four different schools--medicine, veterinary medicine, arts and sciences, and a graduate student program; the sprawling $250 million campus is the largest employer on the island. While some foreign medical schools have gotten a bad rap for their academics, St. George’s proudly points out that its students actually outscored US and Canadian students in the 2011 US Medical Licensing Exam.
In fact, in 2011 and 2012, St. George’s University placed more doctors into first-year US residency positions than any other medical school in the world; some 11,000 St. George’s-trained doctors are currently practicing in the US. At a time when doctor shortages are looming in the US, this is, for sure, good news.
Yet St. George’s is also a resource to the world. Since Grenada is closer to South America than North America, and relatively closer to Africa, St. George’s has made the most of its global-south-oriented location; the school has a major academic partnership, for example, with the African nation of Botswana.
Moreover, many of St. George’s faculty and alumni are involved in medical missions. One alumni medical missionary is Dr. Chauncey Crandall, a cardiologist in affluent Palm Beach, FL--and yet through the Chadwick Foundation, created in honor of his late son, Dr. Crandall serves the medical and spiritual needs of the poorest of the poor in Haiti, Africa, and Latin America.
Meanwhile, St. George’s itself has carved out a niche in the study of tropical diseases. In Grenada and much of the Caribbean, a significant percentage of the population is infected with Human T-Lymphotropic Virus type I. In most people, HTLV-1 is asymptomatic, the virus just going along for the ride. But in some cases, HTLV-1 nestles in the spinal cord and causes progressive loss of motor control in the legs, affecting other bodily functions as well. HTLV-1 is also extensive, we might note, in parts of North and South America, as well as Africa, the Middle East, the Philippines, and even Japan.
HTLV-1 is, in fact, a kind of virological cousin to the dreaded HIV/AIDS, and so as part of its ongoing research efforts, St. George’s invited Dr. Robert Gallo, the co-discoverer of the HIV/AIDS virus back in the 80s--and before that, the HTLV family of viruses in the 70s--to speak at the school on February 12.
Gallo addressed some 1,000 students and members of the St. George’s community, surveying recent epidemiological history. He recalled that the 20th century witnessed three great epidemics, all due to viruses, or more precisely, RNA viruses.
The first great epidemic was the Spanish Flu of 1918-1920, which killed at least 50 million people around the world. As with all epidemics, it burned itself out, but not before killing five times as many people as died in World War One.
The second epidemic was polio, which afflicted millions in the 40s and 50s. Happily, thanks to the Salk Vaccine, introduced in 1955, polio has been all but eliminated in the US, and mostly snuffed out around the world.
The third epidemic was HIV, the Human Immunodeficiency Virus, which, when it developed into AIDS, has killed some 30 million. Yet thanks to the vision of Gallo and others, treatments for HIV/AIDS have been created that saved many millions of lives--although, even so, in 2011, the disease killed 20,000 Americans and another 1.7 million around the world.
Thus the clear lesson: It’s infinitely better to thwart an epidemic, as in the case of polio and HIV, than simply to let it run its course.
In an interview after his speech, Gallo marveled at the intensity and diversity of the students, as they thronged around him afterward, politely pressing him with their detailed follow-up questions; many of the students, of course, come from countries devastated by AIDS. Gallo summed up his experience in these crisp words: “The campus here is beautiful, the people are kind, and the students are on fire.”
Gallo himself has had an interesting life story. As a child growing up in Connecticut, he watched his sister die of leukemia, and that tragic witness inspired him to go to medical school, then to work at the National Cancer Institute in the 1960s. There he helped pioneer a scientific paradigm shift--the realization that many kinds of cancer are caused by viruses.
Moreover, Gallo points to evidence that many other illnesses--from arthritis to autism to bi-polarity to diabetes--could have a viral component. That is, viral infection at an early age could have a slow, persistent, and cumulative effect on the body. And virus nexus could be the story, too, of many different kinds of auto-immune diseases, from gluten intolerance to lupus to muscular sclerosis. As a result of this understanding, in 1996, Gallo created the Institute for Human Virology, a part of the University of Maryland, to further life-improving, and life-saving, research.
Meanwhile, in the US, the once-robust system of medical research and development, which made it possible to develop the polio vaccine and effective treatments for HIV-AIDS, seems to be breaking down. And that breakdown, we must observe, not only puts America at risk, but also the world.
A case in point is the current fiasco of the latest flu vaccine. As the Associated Press observed
on February 21, “It turns out this year's flu shot is doing a startlingly dismal job of protecting older people, the most vulnerable age group.” According to the Centers for Disease Control, the vaccine is proving only nine percent effective in those 65 and older.
Indeed, the overall “pipeline” of new medicines and new medical devices is drying up. A look at page eight of a US Food and Drug Administration document reveals the fall-off in new medicines approved by the FDA, and the same sort of fall-off is seen in new medical devices as well.
We might pause here to note that the problem is far larger than just an overly restrictive FDA. For decades, the life-sciences industry has been besieged by an innovation-killing alliance of regulators, trial lawyers, and price-controllers, and the problem portends to get only worse--that is, if the Independent Payment Advisory Board (IPAB), a part of the 2010 Affordable Care Act, puts further downward pressure on medical investment and entrepreneurship.
The idea of restraining health care cost-inflation is meritorious, to be sure, but the issue is the means, the “how.” Health care history tells us that simple rote price controls can squelch innovation--and yet such controls don’t stop people from getting sick. And if people get sick, that’s expensive, no matter what the regulations might say.
Today, for example, Alzheimer’s Disease (AD) is a $200 billion-a-year hit on the US economy, and rising fast--and there is no effective treatment whatsoever. In other words, all that AD expenditure goes to what can be deemed as “futile care.” Such care might be a humanitarian necessity, of course, but it’s not going to make people better.
Indeed, in the absence of an AD cure, such expenditures will go on forever. And yet at the same time, price controls on the chronic care of AD victims will be unpopular and thus perhaps impossible to impose.
So what’s left, then, for the Independent Payment Advisory Board to cut? Perversely, the real impact of IPAB will be to stymie AD research, because research is speculative and future-oriented, and thus it lacks a strong here-and-now constituency, such as nursing homes full of patients, all of whom will vote in the next election.
So it’s easy to see IPAB squeezing down on future pharmaceutical revenues, while not touching nursing-home expenses. Such a compromise adaptation might be politically necessary, but from the point of view of America’s long-term health strategy, it would be catastrophic. The long term goal should be to cure AD, and that takes research, not more bedpan-changers.
An even more acute instance is antibiotics, which have also been squeezed by the same forces of regulation, litigation, and price-restriction. If we don’t have new antibiotics, we will indeed spend less on antibiotics--but then we will spend more on the illnesses that antibiotics no longer cure.
As USA Today reported in November, “Deadly CRE [Carbapenem-Resistant Enterobacteriaceae] bacteria are showing up in hospitals and other health care facilities across the country and there is virtually nothing to stop these ‘superbugs’ at this point.” And CBS News adds that superbugs--the best known of which is MRSA--are implicated in many of the 99,000 deaths, and 1.7 million infections, that occur in hospitals every year.
The problem is that medical sciences’s evolution has not kept up keep up with bacterial evolution. Indeed, as page two of this chart shows, the number of new antibiotics coming on to the market has collapsed, even as the “superbug” plague has worsened. Again, while it costs money to create new antibiotics, it costs more money to treat illness. And it costs even more when productive lives are lost.
So what can be done? How can we restart our medical pipeline of effective treatments and cures? In Washington, it’s possible to see a new bipartisan consensus emerging on behalf of more medical research, based on the reality that it’s the only smart and sustainable way to drive down future medical costs. After all, a cure is cheaper than care.
Just on February 19, Rep. Michele Bachmann (R-Minn.) published an op-ed in The Minneapolis Star-Tribune in which she declared:
"I’m proud to be known as one of the leading penny-pinchers in Congress, but investing in medical research to find cures, or even postponing the onset of diseases, will provide dramatic savings in the long term — not to mention incredible quality-of-life benefits."
Here in America, we can hope that such wisdom gets policymakers thinking about saving money by saving lives. It’s smart, it’s humane--and it’s also the best way actually to save money on serious illness.
Yet in the meantime, here in St. George’s, the founding chancellor of this expanding school, Charles Modica, has some further big ideas.
Modica figures that since he managed to start up a medical school out of nothing, creating medical-education benefits for the world, then maybe he could manage the same for medical research and development. That is, extend the entrepreneurial vision of St. George’s and Grenada to the actual creation of better treatments and cures--to take yet another step in the worldwide advancement of medicine. Moreover, as he puts, it Grenada could be a medical “free trade zone,” sort of like a Hong Kong for health care.
That is, if the US is throttling its cure pipeline, then maybe Grenada could start another cure pipeline, on its own sovereign territory, where it could set its own rules. “Grenada is a small island, 21 miles long, 7 miles wide--and so we’re nimble.”
Modica has no intention of cutting corners; his plan is to make his medical R&D effort totally transparent to local and international observers. Indeed, the more ethically transparent his effort is, the better, because he needs international investment, as well as talent. Both big money, and big brains, are called for.
Yet if Modica can succeed in this new effort, the whole world will be a winner, as well as the people of Grenada. And who knows: Maybe the US will be reminded that it, too, has the capacity to prosper by making cures. If that happens, then the whole world will be able to look forward to healthier, and wealthier, 21st century.