Infectious diseases have plagued the globe for hundreds of years, and through those years, medicine has had its victories: the eradication of smallpox, vaccines for polio and other once-debilitating diseases, and the change from conditions originally thought to be killers, like AIDS and TB, to manageable chronic conditions.
Yet the battle against chronic infectious disease continues, and says the renowned Dr. Paul Farmer, the biggest problem we face today is one of health care delivery to treat – and possibly cure – those conditions.
Dr. Farmer, Kolokotrones University Professor at Harvard University and Chair of the Department of Global Health and Social Medicine at Harvard Medical School, provided a glimpse of the pitfalls and progress in combating infectious disease around the world in delivering the 123rd Shattuck Lecture presented by the MMS Committee on Publications as part of the MMS Annual Meeting on Friday, May 10.
Well known as the founding director of the nonprofit international agency Partners in Health that works in poor environments around the globe, Dr. Farmer suggested that medicine’s view of fatalism from infectious diseases has being undermined with dramatic improvements in life expectancy and new therapies to treat disease.
While he noted that global life expectancy depends on a variety of factors, among them nutrition, sanitation, delivery of medical services, preventions, and cures, he pinpointed health care delivery as key to sustained improvement. “Health care delivery is the “least well studied,” he said, “and the bias against serious scrutiny of delivery needs to be overcome.”
Recounting his experience in fighting chronic infectious disease in countries around the world such as Haiti and Rwanda – and noting the successes in those nations – he said that the best delivery in poor areas includes community-based health workers who compliment doctors and nurses and hospitals and clinics.
From his vast experience, Dr. Farmer offered five lessons learned in fighting chronic disease:
- Drug resistance is here to stay, but its rate of emergence and spread can be slowed.
- Even the tardy introduction of robust delivery platforms leads, in settings of poverty, to improved outcomes as long as what is delivered is clinically effective.
- A shift from hospital- and clinic-based to community-based care should occur for tuberculosis patients who do not need inpatient or laboratory services.
- Therapeutic innovations need to be linked more rapidly to equitable delivery mechanisms (the “equity plan”).
- It’s not clear that any disease is helpfully termed “untreatable.”
Dr. Farmer concluded his address on a positive note, saying “we have every reason to be optimistic, with new agents being developed, and the growing activity to build integrated health systems.”
Dr. Farmer’s presentation, and biographical information, may be viewed here.