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Health is more than just the absence of illness


Rallying support for the eradication of multidrug-resistant TB
Howard Hiatt Physician
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I might say that I became aware of how much difficulty they were having in getting drugs one day, when I was stopped in the corridor at the Brigham Hospital by my friend the president of the hospital who said to me, 'Your friends are in trouble with me'. I knew of whom he spoke. I didn't know quite what the trouble was, but Paul and Jim are people who can sweet-talk almost anybody out of almost anything, and their trips to Peru to take care of these patients were invariably preceded by trips to the pharmacy at the Brigham where they 'borrowed' in quotation marks the drugs that were necessary for that next week's activity.

They, the... the, they had a, and have now, a large number of people who help support them, but at that time a marvellous man in Boston, a man named Tom White had met Jim... had met Paul, had learned what Paul was doing and became his benefactor. Initially gave him enough money to build a clinic in Haiti, subsequently enough money to build a hospital in Haiti, ultimately enough money to do two things. First, to make possible virtually all of the other activities at that time that Paul was involved in and, secondly, for... to virtually bankrupt himself. Tom likes to say, I've never seen a shroud with pockets, and he has now, over the years, given literally tens of millions of dollars to the work that these two men and their colleagues have done.

It turned out that when I heard that there was, from my friend, the president of the hospital, that Paul and Jim were in arrears in an amount of something in excess of $90,000, I called Tom White and within a matter of a few hours a cheque for that amount was on the desk of the president.

Paul and Jim brought another problem to me - that problem they didn't bring to me that was brought by others - but Paul and Jim reported that they were having difficulties with the World Health Organisation, and by chance, the person in charge of the tuberculosis program at WHO had been a student at the Harvard School of Public Health. I called him and told him I was calling to ask a favor. Anything you wish, Dean, he replied. That was a broad response but one that I was prepared to exploit. I said, 'I'd love for you to join me at a meeting that I'm going to hold in Boston with the movers and shakers in the field of tuberculosis to see the results of Paul and Jim in the barrios of Lima'. Hesitation.  'But... yes, Dean, of course'. Well, an additional favour I'd ask... nervous pause. 'What is, what is that?' I'd like you to sponsor the meeting with me because I'm not regarded as a tuberculosis authority and you are. Again a short pause, but he agreed to do so.

He came to Boston. We did have that meeting. The results were presented and people were quite overwhelmed. We were invited, Paul and Jim and I were invited to Geneva within a few weeks to make a presentation at WHO. And, it wasn't long before the World Health Organization had changed its approach.

Shortly afterwards the Gates Foundation heard about our work. Now, I lapse into the first person from time to time - our work is their work - but since I've joined them I indulge myself and speak about 'we' and 'us'. The Gates Foundation had heard about this work and gave $40 million to take was being done in a couple of barrios in Lima and prepare it for dissemination throughout Peru and ultimately around the world. And now, MDR-TB, a problem of growing importance and of enormous potential harm, that program to deal with it is the program that Paul and Jim put together in that barrio in Lima and is now to be found in, in many, many countries.

Born in 1925, American Howard Hiatt set up one of the first medical oncology research and training units in the US and has headed up some of America's most prestigious medical institutions. Hiatt attended Harvard College and received his MD from the Harvard Medical School in 1948. He was a member of the team at the Pasteur Institute, Paris, that first identified and described mRNA, and he was among the first to demonstrate mRNA in mammalian cells. From 1991 to 1997, he was Secretary of the American Academy of Arts and Sciences, where he began and directs the Academy's Initiatives For Children program. He is also committed to helping disadvantaged people access decent health care.

Listeners: Milton C. Weinstein

Milton C. Weinstein, Ph.D., is the Henry J. Kaiser Professor of Health Policy and Management at the Harvard School of Public Health and Professor of Medicine at the Harvard Medical School. At the Harvard School of Public Health he is Academic Director of the Program in Health Decision Science, and Director of the Program on Economic Evaluation of Medical Technology . He is best known for his research on cost-effectiveness of medical practices and for developing methods of economic evaluation and decision analysis in health care. He is a co-developer of the CEPAC (Cost-Effectiveness of Preventing AIDS Complications) computer simulation model, and has conducted studies on prevention and treatment of HIV infections. He is the co-developer of the Coronary Heart Disease Policy Model, which has been used to evaluate the cost-effectiveness of cardiovascular prevention and treatment. He is an author of four books: Decision Making in Health and Medicine: Integrating Evidence and Values; Cost-Effectiveness in Health and Medicine,the report of the Panel of Cost Effectiveness in Health and Medicine; Clinical Decision Analysis; and Hypertension: A Policy Perspective.He has also published more than 200 papers in peer-reviewed medical, public health, and economics journals. He is an elected member of the Institute of Medicine of the National Academy of Sciences, and a recipient of the Award for Career Achievement from the Society for Medical Decision Making. Dr. Weinstein received his A.B. and A.M. in Applied Mathematics (1970), his M.P.P. (1972), and his Ph.D. in Public Policy (1973) from Harvard University.

Tags: Haiti, World Health Organization, Gates Foundation, Paul Farmer, Jim Yung Kim, Tom White

Duration: 5 minutes, 53 seconds

Date story recorded: September 2006

Date story went live: 24 January 2008