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Q&A with Dr. Lee Hartwell (Part I)

Applying Science to Improve Healthcare and Education


How did sustainability become part of your research?

I met Michael Crow a few years ago, relatively recently, maybe three-four years ago, when we were on a trip together in the Galapagos. I’ve been following his vision here for Arizona State University, and it’s really, completely in line with my thinking about the future, which is that we need to take the science that we have gleaned over the last several decades and begin to apply it in a more effective way to human problems.

What is your sustainable health project?

My history is about 40 years as a basic scientist and more than a decade being the director of a cancer center. As a result of that experience, I’ve become, first, very aware of some important limitations in our application of science to medicine. So that’s one of my interests and we put it under the rubric of sustainable health.

I think we’re all aware of the fact that medicine is becoming prohibitively expensive in this country and around the world and that it’s not really giving us that much for our money. At least half of the expense or so is being spent on people in the last two years of their life, so it’s not really contributing the way we think it should to the whole of our lives. The real need is to move interventions so that they’re addressing prevention and earlier-stage disease rather than focusing just on very late-stage disease where our interventions are pretty ineffective and where the complete emphasis is upon trying to find a magic pill.

How will you address the sustainable health challenge?

What I believe is possible, as a result of advances in the last decade or so, is vastly improved diagnostic information that will lead to an identification of people at risk for disease, of people who have early-stage disease where we think the interventions can be much more effective. Our project there addresses the opportunity from new technologies, the need that I just expressed, but thirdly the fact that no one is really fulfilling this need – that the standard model for taking a new finding from the laboratory to the clinical medicine arena is the commercial model, where it’s developed by some company and sold at an exorbitant price.

That doesn’t work for diagnostics for two reasons. One is that the return on investment is too small to warrant the investment that’s needed to really validate the information. But secondly, the model is to take one thing forward. In a therapeutic, that’s appropriate: one molecule. But in a diagnostic, with current technologies, it’s not. We need to take panels of markers forward that are informative in a disease, and neither of those things are being done properly. So our model has to do with incubating the validation phase much longer in the nonprofit sector before turning it over to the commercial sector.

How will your sustainable health initiative make a difference?

Our mission in the healthcare arena is to improve outcomes and reduce costs. We think that’s possible through improved evidence for medicine based upon molecular and other diagnostic technologies. The way we see it is that recent technologies are identifying hundreds to thousands of pieces of information that could be used in healthcare, but can’t get there. So our challenge is to build that road that gets the fundamental science into the clinic. Now, that takes a very systematic, comprehensive approach and highly interdisciplinary activity, so we need clinicians who are expert in the disease informing us. We need economists who analyze the costs and the outcomes. We need databases that are collecting the right information. We need the technology people to be applying their different technologies to the problem.

So the question is, where and how can we assemble a huge team like that? We found that, so far, we haven’t been able to do it in the U.S. There are a few healthcare systems like Geisinger or Kaiser that sort of get it, but can’t quite devote their attention or resources to it. But we found that some other countries, where there are single-payer systems and they understand the potential for cost savings – which we don’t seem to understand in this country – are getting behind it. So we have a huge activity going on in Taiwan, at Chang Gung University and Hospital, where they have both the technology at the university and the clinical expertise in the hospital. They care for somewhere between 25 and 40 percent of the population of Taiwan, which is 22 million people. And then another 10 or so institutions in Taiwan are joining this effort. That, so far, is our focal point, but we also have a center being formed in Sun Yat-sen University, just right across the strait from Taiwan in China.