In Washington’s elegant Union station Barack Obama’s face shines out from the newspaper stacks and the shops in the concourse are bristling with OB merchandise. I pass on the fridge magnets but I’m tempted by the T-shirts, many of which carry the words “change” and “hope” alongside his smiling portrait. Optimism is in the air as I make my way via metro to the National Institutes of Health in Bethesda. Security on this 300 acre campus, which encloses 27 different research institutes, is tight, and the perimeter fence forbidding – legacies of 9/11.
Vetted and badged I forge off into the wind and whirling autumn leaves in search of the National Library of Medicine and the Clinical Research Centre.
Standing in the imposing atrium of the latter, I note the sign on the wall. “The Institutes,” it says, are “dedicated to fostering discovery at the frontiers of science and medicine and uncovering new knowledge to improve the health of all Americans, and the human condition throughout the world.” It’s a good introduction to the library’s new global health exhibition which is germane to the meeting I am attending (see news item) on “The role of science in advancing global health diplomacy,” organised by the Fogarty International Center.
The exhibition (which is designed to tour and will come to the UK) pushes the message that global health depends on providing all people, in all countries, with food and clean water, health information, and access to affordable health care. It also enshrines the message that health should be seen as a human right – and protected as such. It aims is to raise awareness and provoke debate on how community health initiatives and health activism can improve health and reduce health inequities. A range of different past and ongoing initiatives and campaigns which are charted and celebrated in photographs and video links. These can be downloaded, and feedback and participation is encouraged. China’s barefoot doctors feature. So does the work of Partners in Health and International Physicians for the Prevention of Nuclear War. The success of AIDS activist in combating stigma and discrimination and improving access to treatment is also well illustrated. One current example explores the reasons why obesity and malnutrition co-exist in Brazil and the attempt by the programme “Fome Zero” (Zero hunger) to tackle this by improving access to affordable nutritious food.
Back in the Clinical Center, Dr David Henderson, deputy director for clinical care, shows me wards, equipment and facilities that look second to none in terms of technology and design. Given that all the patients in this 225 bedded hospital are enrolled in Phase 1 or 2 clinical trials and hence undergoing new therapy which has not been tried in humans before, the need to be patient centred is taken seriously. Originally most patients were referred from tertiary centres, now, most are self referred. People turn to the centre in the hope that the access it provides to innovative yet unproven treatments -whose merit has yet be proven, will help them. After assessment, after which many patients have to face the disappointment of being turned down, selected patients are enrolled into trials and receive free treatment.
One intriguing new programme that the National Institutes of Health has recently mounted, the Undiagnosed Diseases Program, has also resulted in public interest outstripping the ability to respond fully to demand. Once the word got out that NIH was conducting research into patients with “mysterious conditions that have long eluded diagnosis’ the floodgates opened. Dr Bill Gahl, who heads the programme, sits ruefully in his office surrounded by daunting piles of patient records. Few of these contain histories that look like meeting his exacting requirements for novel diseases. Most are stories of functional disease where patients and doctors have become mutually disenchanted. Our eyes wander out of the window to the tall tower of the National Naval Hospital. “Three helicopters flew in together earlier today,’ Gahl says, “That a pretty sure sign that Bush has come in for a check up.” Three helicopters are the norm so that no one knows which one he is in.
Talk of the end of the Bush regime and the promise of change under Obama cheers Gahl, as it does all the doctors I meet. It’s not hard to see why. Harold Varmus, former director of the National Institutes of Health, has been Obama’s science advisor during the election campaign. Obama is known to be positive about stem cell research and his stance on abortion and the role of abstinence in tackling HIV/AIDS could not contrast more to that of President Bush. Furthermore, the brother of his new chief of staff, Emanuel Rahm, just happens to be head of bioethics at the Clinical Center. No wonder the medical fraternity here in Washington (along with nearly everyone else it seems) has a smile on its face.
Tessa Richards, 14 November 2008