By Richard Jaffee, 1936-2018
Richard Jaffee, the chair of Rush University Medical Center‘s Board of Trustees from 2008 to 2013, died at Rush on Jan. 23. Among his immense contributions to Rush, Jaffee was the speaker at Rush University’s 2013 commencement. His speech reflects the intelligence, foresight and altruism that made Jaffee a transformational leader at Rush.
I selected health rather than health care as my topic as it encompasses all of us, not just the vast health care industry. 2053, my target year, will approximate the working life of our 2013 graduates. A look that far into the future removes us from immediate concerns and controversial issues.
Let’s look at our health in three time frames: past, present and future. As Lincoln said in his House Divided Speech “If we know where we have been and where we are now, we can best understand where we where we are headed.”
When I was born in 1936, I was expected to live to 61. If I were born today, that number would be 81. Now that I am 77, the statisticians have assigned me 10 more years. Thank you very much.
Infant mortality since the time I was born has been reduced by 90 percent.
The percent of mothers dying during childbirth is down 85 percent.
Since 1960, the death rate from heart disease is down 83 percent.
We’ve not done as well on cancer. But many forms that were once death sentences have become manageable diseases.
The past: A lifetime filled with medical advances
How did all this remarkable progress come about? Here is a partial list of medical developments during my lifetime:
Alexander Fleming discovered antibiotics. By 1945, penicillin was called “the wonder drug,” and he received the Nobel Prize.
Watson and Crick described the double helix, starting the genetics revolution. They also received a Nobel Prize. Interestingly, I met James Watson 10 years ago. I was delighted to learn that he attended the same Chicago public schools that I did before going on to the University of Chicago and Cambridge.
Vaccinations are another tremendous development. When I was a child, we all suffered thru childhood diseases. My brother survived scarlet fever, but only after being quarantined for weeks.
Infantile paralysis was particularly scary. There were kids in my grammar school classes — I can still remember their names — with distorted limbs and leg braces. President Roosevelt was afflicted and couldn’t walk without help.
Polio and many other diseases have been eradicated because of vaccines.
Developments in imaging, radiology, CTs, MRIs and ultrasound all have helped to improve diagnosis during my lifetime.
Drugs were developed that treated or controlled many troubling diseases and abnormalities. I suffered with poison ivy annually until I was 13, when cortisone became available. One summer it got so bad I was hospitalized in a children’s ward at the U of C for 2 solid weeks.
Complex surgical procedures, including the transplantation of all sorts of organs, have become routine.
There has been a parallel improvement in our understanding of the causes of health problems. Reducing tobacco use has been a tremendous help who have done so. I quit smoking in 1969. It was one of the best decisions I ever made. Better nutrition, more exercise, and healthier living choices have all contributed to these improved outcomes.
The present: A Dickensian paradox
But what of the present? I would characterize the current state of America’s health as Charles Dickens did in The Tale of Two Cities. “It is the best of times and it is the worst of times.”
More people are eating and living healthfully, and yet there is an epidemic of obesity. America’s health care industry develops more drugs, more new therapies, performs more surgical miracles than any country in the world, and yet does not rank at the very top in measuring important outcomes.
In spite of this embarrassment, our costs are way too high. And they are too high on almost every relative measure. Something has got to change.
Some advocate rationing as the answer. Dick Lamm, the three term Colorado governor, was one of my closest friends in college. Dick ended his political career by advocating reduced spending for end of life care.
The CEO of the Kaiser system wrote “We think the future of health care is going to be either rationing or re-engineering.”
I choose re-engineering as the most politically feasible alternative and the one that will provide the best outcomes.
I’m optimistic that the system can be re-engineered, and we can achieve the improvements in quality, expansion of access and cost reductions we all want. However, the way forward will not be easy, and you graduates will all play an important role in achieving these goals.
I’m optimistic that this can be done because I’ve seen it done in one industry after another. One example is communication and information retrieval.
When I was a kid, only Dick Tracy in the funny papers had a special wrist watch that doubled as a phone. Now we can’t imagine life without our smart phones and every imaginable information retrieval device.
Cell phones, when introduced, cost $4,000. Now you can get one that will do everything but cook dinner and do laundry for $99 bucks. I believe this can be done in health care as well.
The future: Revolutionary advances
Let’s peer into a crystal ball and seek out trends that are already here or will develop that bring this transformation about.
Better understanding of the genetic and molecular basis of diseases, combined with more rapid and more precise diagnoses, will revolutionize the treatment and prevention of many illnesses. A patient’s genetics and how it affects treatment will allow clinicians to design special therapies and prescribe unique drugs. A patient’s own immune system will be trained to fight disease.
New diagnostic tests will be developed. One will determine which prostate cancer should be treated and which can be left alone.
Tests will not only check lipids, but whether one is at risk for the plaque to break off and cause a heart attack like the one that killed my dad in his 56th year. Continuous monitoring will allow early intervention before troubles develop.
Remarkable things will be done to regenerate failing organs. Ways will be found to grow new ones. Already, researchers can turn skin cells into stem cells that will be implanted to do miraculous things. All of this will be developed and become standard by 2053.
Advances in technology will pay huge dividends. Rush’s Epic system allows our caregivers to know what drugs their patients are taking and what tests have been done, and to do a better job by not repeating procedures or prescribing counter-indicated drugs.
We’ll go beyond that and be able to share data with others and access databases with helpful and relevant information.
Telemedicine is already here. The Rush stroke program uses it extensively. Using the internet, consultations can be done in real time across the Medical Center or across the globe. Medicine will not be immune from globalization. Radiology reports are already being read overnight thousands of miles away.
Marty Cooper, the inventor of the cell phone, when interviewed on National Public Radio, talked about its use in health care. It’s already capable of doing ultrasounds, electrocardiograms and pulmonary function tests.
Role of caregivers will change, and grow even more important
With all these advances, the role of the caregiver, you graduates, becomes even more important, because with high tech, human compassion and human communication become even more critical.
The workforce and where health care is provided will change and expand dramatically. Physician assistants, advanced practice nurses and the medical home are already filling the gap. Pharmacies and other retail outlets are opening clinics offering flu shots and other services. More will be done in the home and done by the patients themselves.
Diversity and immigration will contribute enormously, as they have already. During my lifetime, our society has progressed toward acceptance of people for what they can contribute rather than their gender, skin color or belief system. This movement toward a meritocracy will continue to benefit us all.
What else patients can do for themselves? They can make better choices. The current system, where much of the bill is paid by a third party, makes very little economic sense. I often think that if buying an automobile was like health care, the parking lots would be filled with Rolls Royce’s.
But hospital billing will have to become more understandable. Comparative outcomes must become better known and more widely distributed.
Most importantly, individuals must and will make better lifestyle choices. The best way to improve health outcomes and reduce cost is not to get sick in the first place. My own company has a wellness program where stopping smoking, exercise and weight reduction are celebrated and rewarded.
I’m sure there are many other things that I could have mentioned. Most important will be you graduates, who will bring about these improvements in our nation’s health and the desperately needed re-engineering of the health care system.
Let me close by again congratulating you. Congratulations not just for completing your course of study, but for the career path you have chosen. Health care is a noble profession. You will help patients and their families at the most vulnerable times in their lives. You will assist them to come to good decisions and to improve their health and the health of their loved ones. Nothing could be more important for them, and nothing can be more rewarding for you.
‘You make a life by what you give’
Finally I’d like to share some things I have learned since I was in your shoes.
Think positively: Focus only on those things within your control.
Never stop learning: Albert Einstein was still working on the mysteries of the universe in his final hours.
Work hard, but always productively: My dad challenged me. “Don’t tell me how hard you worked. Horses work hard; tell me what you have accomplished.”
Focus your energy: You can’t do everything, and if you try, you probably won’t accomplish very much.
Never give up: Commit yourself to your goals until you reach them or until you find a better path.
Don’t be afraid to think differently: Great achievers are always renegades in one form or another.
Communicate respectfully and openly with all: It will be appreciated and effective.
Be honest and dependable: When you make mistakes (and you inevitably will), take responsibility. We all do make mistakes, but most people, me included, have very little tolerance for defensiveness and attempts to cover up.
Be humble: Leadership is not about people following you; it is about people joining you.
Winston Churchill, another of my heroes, authored many memorable quotes. I learned a new one the night we opened the Tower. Inscribed on the donor’s wall I read: “You make a living by what you get. You make a life by what you give.”
I urge you to go forth from this day and make your living in this noble profession, but of even greater importance, I charge you to go forth to benefit mankind, and as you do, you will make a wonderful life.