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The pied pipers of medical anthropology


PACT: Prevention and Acces to Care Treatment
Howard Hiatt Physician
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In Haiti, there is more HIV infection, there is more AIDS than in any other country in the western hemisphere.

Paul began treating AIDS in Haiti in precisely the way that he and Jim treated tuberculosis, that is, using community health workers, so that patients who are in need of the antiretroviral drugs get them, not as prescriptions or as bottles of pills, but rather from community health workers who come see that they're treated and, as a result, the treatment results are no different than those that we see here in Boston. Indeed, in some instances better than we see with some people in Boston, the poorest people, are the people who do less well.

And, in fact, the approach that has been taken, the use of community health workers has been replicated here in Boston in Boston's inner city in a program that's called PACT. A program that is directed by one of the doctors trained by Paul and Jim, Heidi Behforouz, a remarkable physician who has identified patients here with AIDS, patients who were being hospitalized at the Brigham once a month or once every two months with infections of one kind of another at enormous cost to society, since these patients obviously are not able to pay their bills. Heidi has trained community health workers in Boston's inner city and these health workers call on the patients, see that they get their drugs, and so many of these people have now been restored to full function in our community. This approach, incidentally, the use of community health workers, is one that many people feel has enormous potential for dealing with chronic illness of all sorts in this country as well as elsewhere.

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, Boston, Heidi Behforouz

Duration: 2 minutes, 39 seconds

Date story recorded: September 2006

Date story went live: 24 January 2008