In 1812, the year the New England Journal of Medicine and Surgery first started to publish, medical knowledge in the U.S. and in the world was limited. We had no understanding of infectious disease. Health outcomes were particularly poor for women and children. Surgery was unsanitary and performed without anesthesia.
Cancer was largely unrecognized because so few people lived long enough to develop it. Two centuries later, people in the U.S. live longer and better than ever before imagined. This film explores three remarkable stories of medical progress. It looks at researchers and clinicians, patients and their advocates.
and at how information is translated into action. Progress has been uneven, but the advances have shown us that we can get better. I'm a general and an endocrine surgeon.
I take emergency calls, but much of my practice is in a very specialized area, which are tumors of the endocrine glands. Eileen is a 50-year-old graphic designer who... was found to have a nodule in her thyroid. I found the lump myself, and I was like, I don't remember this being here before. Whole thyroid's coming out.
You agree? I'm going to put a mark on your neck so everybody knows. Eileen's primary care physician sent her to see Dr. Dr. Gawande, who performed an open biopsy on her thyroid a month earlier.
It came back positive, and in fact it had spread out of the thyroid into the lymph nodes, metastatic disease. So we need to remove the entire thyroid and lymph nodes. Dr. Suzanne Kleiner is Eileen's anesthesiologist for her surgery today.
We use a special endotracheal tube for this type of procedure that helps us monitor... We used to say... Don't worry about the surgery.
It's the anesthesia you gotta worry about. And we can't say that anymore. The field of anesthesiology is continuously changing.
There's new products, new research that come out all the time. In the last 25 years in particular, we went from 1 in 5,000 patients dying from their anesthetic itself to less than 1 in 200,000, as rare as a plane crash. You understand our purpose? Yes. Before the introduction of ether anesthesiology, surgery was just brutal, terrifying.
Apply the tourniquet. The patient would already be inebriated with alcohol and other kinds of substances. Knife, please.
It was incredibly bloody and gruesome. Yaaay! Typically an intervention of last resort. No anesthesia, limited understanding of how blood clots, an embryonic understanding of anatomy and what blood vessels fed what structures. So speed was of the essence.
I don't think I would have been a very good surgeon if I had to hold someone down in order to do an operation. In 1846, Boston dentist William Boston, who had been experimenting with ether as an anesthetic, persuaded Dr. Jacob Bigelow and Dr. John Collins Warren, one of the world's most prominent surgeons at the Massachusetts General Hospital, to try his preparation to relieve pain during surgery. While medical students watched, Boston administered ether to a patient using a glass vial and a breathing tube. John Collins Warren.
removed a tumor in this Boston laborer's neck. The patient woke up minutes after the surgery and said that he'd felt some scratching, but hadn't felt pain. It was such a momentous occasion, Dr. Warren called the surgical team and the patient back for a photograph.
Dr. Bigelow wrote a report that was published in the Boston Medical and Surgical Journal, a forerunner of the New England Journal of Medicine. Probably the most famous article in the journal's 200-year history, it was followed a month later by Dr. Warren's description of ether anesthesiology in several more cases. But what's so surprising is that some of the properties of ether were known for half a century.
Why was it not immediately applied? I think it just has to do with the fact that surgery was considered to be essentially painful and that the relief of pain was not seen as a dominant goal. In a matter of months, the published reports of the successful use of ether inspired enough surgeons that it became standard practice. Putting it into the public domain where other...
Clinicians could observe it and begin to learn from it and try it themselves was crucial. The introduction of ether anesthesia in the mid-1840s really revolutionized the practice of surgery and opened up the possibility of working on the body and working in the body in ways that just were not possible before that. Even with anesthesia.
Surgery remained extremely dangerous with high mortality. Early in surgery, many of the patients could have an operation, let's say, but would die from infection, and we didn't understand what was the cause of the infection. There were many debates about what caused patterns of disease, how would they be understood, was disease in the air, was it in the body, was it in something you couldn't see? In 1847, a Hungarian physician, Ignaz Semmelweis, made a breakthrough in the battle against infection.
He had discovered in childbirth that if obstetricians and midwives washed their hands, they could prevent childbed fever, puerperal fever, the biggest killer of mothers in child delivery in hospitals in the world. Unable to offer a scientific explanation for his findings, Semmelweis published but not in a way that could be verified by his peers. He was insulted by calls for proof and lashed out at his detractors, dooming his discovery. He was a failed genius because he could observe what he was doing, recognize something that needed to be done, but he never actually published it as a study to demonstrate to his colleagues in a respectful way why what they were doing needed to change. Ten years later, French chemist Lewis Pasteur presented his research on fermentation, arguing that microorganisms in the air caused infection.
His work marked the birth of bacteriology and established the germ theory of disease. In 1865, the British surgeon Joseph Lister learned from a paper by Pasteur that certain chemical agents killed microorganisms. Lister recognized that carbolic acid could lower the bacteria count, and he extrapolated from that to say, well, why don't we put it on our hands, and then why don't we aerosolize it in the operating room or spray it on our wounds and see if that decreases the risk of infection, which it did.
Lister reported in The Lancet that he could reduce infections. It was roundly dismissed by many surgeons, including the first report in the New England Journal that alleged him to have been deeply mistaken. Lister's articles and his approach were controversial because they implied that it was surgeons bringing these infections into the surgical theater. There was really at least two to three decades of debate about what's the best approach and really are there microorganisms.
Eventually there was a shift from antiseptic to aseptic surgery, and that is the paradigm today. What the discovery of anesthesia and the discovery of how to prevent infection allowed us to do was more ambitious operations for the first time. We don't have a recipe for surgery.
It can go wrong and change in unexpected ways. What you need is a team that can work together to handle the unexpected. There are more than 150,000 people who die within 30 days.
after surgery. And then if we can put this over here. This has been a kind of invisible epidemic.
Here we have five times as many people dying after surgery as die after road traffic accidents. To make surgery safer, Dr. Gawande has pioneered the use of a checklist, like pilots use, that ensures surgeons don't forget key life-saving steps. Use a checklist before anesthesia. and another before surgery.
It begins with the introduction of the surgical team. I'm the resident, Patricia Chewy. Each step is a mix of some different techniques. Dumb checks. Do we have the right patient?
So, this is Eileen Callahan. She's here for a total thyroidectomy. She's in the correct position, which is supine.
We have the correct equipment available in the room. Do we have blood available? Have we given any?
antibiotic on time. We want the anesthesiologist to talk about the medical issues that that we have to be aware of, the nurse to talk about equipment and any questions that they may have. I need the 5-0 monoclonal.
Okay. And only then going ahead with the incision. Marking pen. To our surprise, the checklist has had dramatic effects in reducing deaths.
Marking. Now we'll look for the lower parathyroid, which is right there, sitting on the capsule. So you need the bipolar for this.
Looks like this is bigger. We've gone from a place where two generations ago we had only a handful of therapies. that were highly effective in the pre-penicillin era to one today where we have 6,000 drugs, we have 2,500 surgical procedures, 1,500 non-surgical medical procedures that you can do.
See this, Jessica? This is different from the nodes we've been looking at. Now being able to handle the extreme complexity at such a large scale with so many people that we take care of has become our major challenge. So this is going to be right thyroid lobe. Sorry, left thyroid lobe.
Thank you. Dr. Gawande ends Eileen's surgery with the sign-out checklist. The nurses account for all the sponges and surgical instruments. The team confirms...
what happened in surgery. The specimens I will reconcile, we had specimen number one, right lobe, stitch and upper pole. Correct.
Specimen number two was left lobe. Safe. Everything went really well. I like to pretend I'm a young surgeon.
I've been in practice now. This is my ninth year. During that time, already there are changes from what I learned. Even more emphasis on minimally invasive techniques. So everything will be fine.
Great. There were a couple more enlarged lymph nodes, so I removed, when you go home, you can take a shower. This is, you can get this wet. You know, the old dictum that was popular when I was coming along was that, you know, surgeons were physicians who operate. And I always liked that phrase because, you know, we think as a doctor first, and then intervene surgically if we have to.
I think conservatism is a good thing for surgeons. How many have cancer in the U.S. today? No man knows. What causes this is one of the riddles men puzzle over in their laboratories through a lifetime. In the 1930s, a diagnosis of cancer was always grim.
We had surgery, and surgeons were perfecting their technique, trying to take out more and more of a tumor. And then you had radiotherapy, but radiotherapy was very crude in the 1930s. And with cancers like leukemia that are disseminated in the blood, there was no cure. Because you couldn't give radiation to the whole body without killing the patient, and you couldn't obviously do surgery with the whole body involved.
In a basement lab at Children's Hospital in Boston, a pathologist named Sidney Farber was trying something new. He was looking for a way to kill childhood leukemia with chemicals. Sidney Farber was not well loved in Boston.
He was this autocratic, stern kind of person which tends to put people off. So nobody wanted to give him facilities to do what he wanted to do because they thought it was crazy. In 1946, a colleague of Farber's, a chemist named Yelapragada Subarau, had shown that folic acid could cure a certain kind of anemia.
Dr. Farber thought, well, maybe this could be effective in acute leukemia, since they were both blood disorders. He obtained some folic acid from Dr. Subarau and injected it into children with acute lymphoblastic leukemia, an always fatal disease. He was a pathologist. He was not trained to take care of people, let alone little people. So you can imagine the attitude toward what he was doing.
The experiment backfired. The folates only stimulated the cancer cells. Well, that seems like a disaster, and today, of course, it would be a disaster. But, of course, that gave...
gave him another idea. Naturally, he said, well, if folates increase the growth, why not try antifolates? This time, Farber got an antifolate, a drug called aminopterin, and gave it to 16 children with ALL. And much to his surprise, this time, instead of stimulating the leukemia, it massively destroyed the leukemia.
It was unprecedented that you could see a remission from giving a chemical to a patient. It was written up in the New England Journal of Medicine, where it stirred a small controversy because the patients all relapsed. There are lots of papers written by a very famous hematologist who said you shouldn't do this because you know you may think it's really a terrific thing but you're still patients are all dying and so it doesn't mean anything.
But it meant something to people who were thinking if we're going to make progress in cancer we had to do something about these cells that are circulating around the bloodstream. Tonight we take you to a little fella named Jimmy. Jimmy is suffering from cancer. Cancer needed a poster child....of his favorite team, the Boston Braves.
Hi, Jimmy. My name is Bill Macy. In 1948, Farber helped launch the Jimmy Fund, which would raise millions for the cause. Dollars poured in and went to new cancer research centers and new cancer drugs, like methotrexate, a relative of aminopterin that was easier to produce. The drugs were all highly toxic and they worked in a crude way, killing healthy cells along with the cancer cells.
Sometimes patients died from the side effects. We didn't know how to use them. We didn't know which patient to use them in. In Memphis, Tennessee, at a newly opened children's research hospital, a team of clinicians were studying how to use chemotherapy drugs more effectively. The hospital was opened and Dr. Pinkel and a few early colleagues got together and systematically thought about how can we develop a protocol that might address all the problems seen in the 50s and really try to produce curative therapy.
They tried longer chemotherapy treatments in different combinations. They added cranial radiation. They gave the methotrexate directly into the spinal column and within 10 years they were curing. half of all cases of ALL.
It was progress, but what about the other half? What was different about these children and their cancers? In the 1970s, scientists would find out, as they began to unlock the mystery of the cancer cells. When we had deciphered these groups called T-cell leukemia, B-cell leukemia, or B-progenitor cell leukemia, they were entirely different diseases.
We'd been grouping them and treating them all the same. They didn't respond all the same. The field of cancer genetics would continue to evolve over the next 30 years, revealing hundreds of variations in almost every kind of cancer.
Two boys in Phoenix, Arizona, illustrate the importance of these variations. Adam O'Connor was diagnosed with a leukemia called pre-B cell ALL. When he was four years old, he was treated with the standard methotrexate-based regimen.
It worked. I've been cancer-free for 11 years. I do triathlons. It's just an amazing thing that I could beat a disease like that and feel completely normal. So, did your Christmas presents come yet?
Haziel Olmeda has the same pre-B-cell ALL. and got the same methotrexate-based regimen. But after three years, his cancer came back. Cancer genetics revealed why.
When we looked back at Haziel's leukemia to try to sort out why was it his leukemia that came back so fast and so widespread, it was determined that he had a chromosome abnormality that actually now is considered a very poor prognostic factor. ALL, like most cancers, is the result of several chromosomal abnormalities. An adult cancer called CML, for Chronic Myeloid Leukemia, has just one abnormality, the Philadelphia chromosome. The abnormality was due to a translocation from two genes.
One piece of the chromosome broke off, went to another one, and when the two joined, they made a new gene. And it's that gene... It's driving the cell division, you know, it's just saying go, go, go, go until the patient dies of leukemia.
Every single patient has the same oncogenic abnormality, the Philadelphia chromosome, and most other cancers are far more heterogeneous. At his research lab in Portland, Oregon, Dr. Brian Druker was working on away to target just this one mutation. If cancer is sort of like a light bulb being stuck on, chemotherapy was, let's just take a baseball bat and knock out the light.
And I looked at that and said, we've got to figure out why that light bulb's stuck on. And if we can figure out why it's stuck on, then we can shut it down and we'll leave everything else intact. This is what we used to dream of when I started in the field, that you could actually have this kind of specificity.
A lot of people said, well, we tried that, we've thought about it, it's never going to work. Just get a bigger baseball bat. In 1995, Judy Oram learned that she had CML and was told that she had three to five years to live.
She was given the standard therapy, a drug called Interferon. The Interferon really didn't do much for me. I was on it for three years. The best I got was down to six. ...the percent Philadelphia chromosome, which was not very good.
Dr. Druker was testing a class of drugs that would target just the Philadelphia chromosome. He tried one called imatinib, also known as Gleevec. We'd get patients to donate some of their leukemia cells, and we set them up in some assays with the drug, and we actually found that their leukemia cells didn't grow out in our cultures, but their normal cells did. And so it was absolutely clear that we were killing leukemia cells and not harming normal cells in cell lines, animals, and in patient samples.
And that gave me great confidence that we needed to move this drug into people and see if it would work. I have a friend who called me and said, Judy, they announced on the radio and it was in the newspaper that the Leukemia and Lymphoma Society had given Dr. Druker a translational grant to take a study from, you know, the Petri dish to get ready for human trials on CML. And I think you should get your name in there.
She did. And when the first clinical trial began in 1998, she was on it as patient number nine. I started feeling better. I got my appetite back, my sense of smell.
I put on weight. Within three months, the imatinib had nearly eradicated her CML, with no side effects. They were able to actually get rid of the Philadelphia chromosome. When they interferon, I got down to 60% Philadelphia chromosome.
On this, I got down to 5%. Judy was one of the people that I remember and always referred to when people say when did you know your drug worked. Word spread quickly in the CML community.
Patients began to band together and realize that as a rare disease they could actually help one another, navigate through the channels, get their doctors to refer them, get themselves referred and share information about the disease when nobody had information before. People were soon lining up for the phase 2 trial with this miracle drug, but there was a problem. Novartis said, we're not sure the drug is going to make enough money for us.
If it's going to really hit enough people, we might stop. Well, all of us who are doing well are just panicked. Patients caught wind of that and started to lobby the drug company for access to clinical trials. They're kind of in a spot of, do we stop something that's working for people? And the drug company realized they needed to ramp up production, they needed to get into phase two quickly.
Finally, the phase two trial went forward with great success. Results were reported in the New England Journal of Medicine in April 2001. It was one of the paradigm-changing publications because it is the first proof of principle of targeted therapy. Just one month later, imatinib was approved for human use by the FDA. For this one cancer at least, it was the holy grail that scientists had been looking for since the days of Sidney Farber. The last results you probably saw.
Yeah, everything looks perfectly stable. There's absolutely no question that the work I did was built on the shoulders of giants. 50 years after Sidney Farber's work, we have a huge understanding of the genetic basis of cancer and even some of the true biochemical and metabolic differences between a cancer cell and a normal cell.
And all those are becoming amenable to targeting. It's a promising time to be an oncologist. So you're going to get this final tap, and then you'll get your chemo for five days. There has been incredible progress over the last four decades. Forty years ago, it was a death sentence.
Barely any children would survive their acute lymphoblastic leukemia. Now, we are curing leukemia with a cure rate of almost 95%. Haziel's case is a tough one.
While some children with ALL have the Philadelphia chromosome, Now a druggable target, he has an abnormality which has not yet been targeted. And so his doctor relies on larger doses of standard chemotherapy. When Haziel relapsed, we knew that it was an aggressive type of leukemia.
And so at that point we decided that in order to give him his best chance of cure, we would perform a bone marrow transplant. So we will use his 10-year-old brother as his match-doning sibling. So we're hoping that these donor cells are going to work and cure his leukemia, right? Yeah. Yeah, I think they will.
I have a good feeling about it. I do too, because he had the same numbers on everything. As advances in research and therapy continue, the hope is that all cancers will one day become, if not curable, then chronic and manageable diseases. Now we have lots of patients who have been treated and are cured. I think as we go in the future you're going to see more and more patients followed by the primary care physician and I think it's a good thing.
She Lewis, a singer and AIDS educator, has been HIV positive for almost 25 years. Good job. I went for the blood test for my marriage license, and then three weeks later on April 12, 1987, my 33rd birthday, three months before my wedding day, the doctor called and told me on the phone that I was, in fact, positive.
At that time, it was practically a death sentence. The first time I encountered patients with HIV was during my residency training in Boston in 1985. Most of the patients had very advanced disease, and we didn't have any treatment. People didn't make it out of the hospital. In the late spring of 1981, on my desk was the June 5th issue of Morbidity and Mortality Weekly Report. Five gay men from Los Angeles, very, very sick with a pneumonia that you only see in people who are immunosuppressed.
One month later was the second report of 26 individuals, again curiously all gay men, from LA, San Francisco and New York. All presenting with this unusual syndrome of not only pneumocystis pneumonia, but several of them had Kaposi's sarcoma. And I can remember thinking, my goodness, this is something really new and really scary. Physicians, even in infectious diseases and in internal medicine, were quite afraid.
The first patient that was admitted, the reaction of the staff to this individual was as if he were carrying smallpox. It was not recognized at all at the time of the New England Journal of Medicine paper in late 1981 for the potential seriousness of what it really was. It was very frustrating because we were seeing multiple infections in a single individual in a fashion that was just overwhelming and disfiguring. We had to deal with end-of-life issues on a regular basis.
To make matters worse... The disease carried a terrible social stigma because it was seen most commonly in gay men and IV drug users. People would say, well, you know, you deserve this for this terrible life that you're leading.
There was a lot of bad stuff there with regard to stigma, intolerance, insensitivity to what these people were going through. The CDC established in 1982 that the virus was transmitted sexually. and by infected blood to drug users and hemophiliacs.
But that didn't stop the speculation, misinformation, and fear. People believed HIV was transmitted by mosquitoes, or toilet seats, or by kissing, or eating on utensils, or drinking from people's water glasses, all sorts of things. In 1984, French and American researchers discovered the cause of AIDS.
It was a retrovirus they called human immunodeficiency virus, or HIV, that attacked the immune system and integrated into the genome of our CD4 cells. Within a year, a blood test for AIDS was developed. It revealed that the virus could lay dormant for years, suggesting that we were seeing just the tip of the iceberg. Even those of us who were in it from day one were shocked. by the enormity of the problem.
By this time, AIDS was spreading exponentially in developing countries. My first experience with HIV as a physician really happened when I was a medical student in 1986. I was shuttling between Harvard and Haiti at the time. The epidemic had hit the urban areas. Before we knew it, we had patients of our own from central Haiti.
It was a very different epidemiology than what we saw in the United States. AIDS was incapacitating to men and women, and especially women. It was clear that it was more readily transmitted from men to women than women to men. The stigma of AIDS was different in the developing world as well. Way beyond the question of its mode of transmission, there is always a stigma associated with any wasting.
...consumptive disease that takes young lives. Farber and his colleagues at Partners in Health had to beg for resources to care for the AIDS patients and their families coming to his clinics. People would say, well, you can't throw money at it. Well, please, you know, throw some. Just cold, hard cash, because that can bring in human resources and help build up health systems.
In spite of the evidence of the growing severity of the epidemic in the U.S. and globally, the federal government was slow to respond. President Reagan didn't even mention the word for years and years and years. Thousands of people had died. The gay and HIV-infected communities mobilized to demand care and affordable access to the first HIV drug, AZT. The AIDS Coalition to Unleash Power, ACT UP, took to the streets.
They did some outrageous things that are now part of the manual of activist activities. If you listened to what they were saying, they were really making sense. They were developing drugs, and those folks who stood the benefit the most from the drugs had no role of influence that process. We decided that we were going to force them to know that we were there. result of that.
We put a face to AIDS and we refused to go away. And that really started off what turned out to be now intensive involvement of activists in virtually every phase of what we do with HIV AIDS. AZT extended lives, but drug resistance always emerged. By 1994, the number of AIDS cases in the U.S. had surpassed 400,000.
AIDS had become the leading cause of death in Americans ages 25 to 44. And pregnant women infected with the virus were passing it on to their babies. One of the biggest breakthroughs in the history of HIV prevention is signified by AIDS Clinical Trials Group or ACTG 076. If you treat a pregnant woman with AZT during the pregnancy and during delivery and then treat the baby for a certain period of time, You can dramatically decrease the likelihood of transmissibility. The 076 trial was a bit of a personal epiphany for me because a lot of the debate back then was about prevention versus care. The debate was where should we put our resources since we don't have treatment.
Then we put them all into prevention. But again, that made it sound like we had good prevention technologies, which we didn't. There was no vaccine. The main prevention strategies included condoms, which were usually controlled by men, and so-called abstinence approaches. So along comes 076. And 076 is about a drug.
The use of AZT to prevent mother-to-child transmission. introduced HIV drugs to the developing world and was the first truly effective step in combating AIDS in resource-poor settings. But there was still no durable treatment.
Phil Wilson had been diagnosed with AIDS in 1982. There are often days when I would spend the morning taking care of my partner. Followed by a doctor's appointment for my own health. Followed by visiting another friend in a hospice care.
Followed by attending a funeral. Followed by a rally. Followed by preparing for a meeting with a policymaker or an elected official. Followed by taking care of my partner again. In the early 90s, researchers were making progress approaching the virus from multiple directions.
To do one drug, like AZT, it was good for a short while to suppress the virus and then the virus figured out a way to escape it. So it was very clear that we had to get combinations of different targets. Trials involving several antiretroviral drugs targeting the virus's protease enzyme began in the mid-90s.
Word of these promising agents spread rapidly through the HIV community. Finally, a string of breakthroughs. The AIDS Clinical Trial Group 320 was the first study to show the full clinical benefit of highly active antiretroviral therapy, HAART.
While we were very actively clinically testing different combinations of drugs, we reached the point where, for the most part, the virus couldn't escape, that you kind of boxed it in. I was involved in some of these trials as a site investigator and when we started to see the patient's clinical status improving, it wasn't so clear what was happening. But after patients had been on the study for four to six months, we really started to notice that nobody was getting sick. Many of us experienced that Lazarus syndrome where we were on death's door. I was in the intensive care unit in a coma.
and the doctors had given me less than 24 hours to live. I went on heart and got better, and the rest, I guess, is history in the making. I epitomize what happens when people with HIV have access to proper care and treatment.
But the drugs were expensive, and it was hard to get them to the developing world. So we went to the manufacturers of the drugs and said, you know, give us a hand, help us out. And a number of drug companies did get involved. So we went from $10,000 per patient a year to about $1,200. It wasn't until we went to the generic manufacturers and said, we need not just thousands of people in care, we need millions.
And that's what really permitted the scale up. That's under $100 per patient per year. Those steps have saved millions of lives.
I've had now a number of patients born with HIV who are adults and have children of their own and did not pass on HIV to their children. There was no possibility of putting millions of dying people on therapy without the Global Fund and PEPFAR, President's Emergency Plan for AIDS Relief. People were really surprised when the Bush administration decided to launch the largest global health effort in history. Dr. Tony Fauci was working with the White House to make a plan. But first it had to get past the Office of Management and Budget.
He called a small group together, including Paul Farber, to go to Washington to make the case. He said, I'm sending you in to the White House as my expert witnesses. And, you know, I thought... I thought...
That sounds scary to me. But we knew what we were doing was right. It's just that we had so little experience.
And Tony knew that if PEPFAR became a major program, that we could break that cycle of poverty and disease and strengthen health systems, which is not a very attractive, sexy thing to fund, but critical to the survival of lots of people with other problems beyond AIDS. The meeting was held in late 2002. When we said, but we know it'll work, we've already done it. We have people who've come back from the dead. And the White House staff said, well, but that's because you're an infectious disease doctor. And I said, no, no, this is care delivered by community health workers and my Haitian colleagues.
I would say that that small cohort of first patients from Haiti had a big impact. Challenges remain. In the developing world, only half of the 14 million people infected with HIV who should receive care antiretroviral therapy are actually getting it.
In Los Angeles, 90% of Judy Currier's patients are doing well on their treatment. She Lewis started antiretroviral therapy in 1997 when she began to have symptoms. It changed the direction of my life, which of course was supposed to be a very short one, but thankfully it's been a full life. Some of the complications that we see in our patients who've had HIV for a long time are things like osteoporosis, cardiovascular disease.
We're trying to sort out really to what extent these are due to the normal aging process or due to side effects of HIV medications or chronic HIV infection. Any other questions? Still, the progress in the last 30 years is undeniable. You're all good.
The AIDS story is actually... A success story, and I'm not sure everybody knows that. It's a scientific success, it's a development success, and it's a delivery success.
We've delivered the medicines. Now, we haven't done it well enough, but I think it's huge that you have millions of people on therapy for a chronic disease that afflicts mostly poor people. There's no other example of that yet. This is Jeffrey Drazen, Editor-in-Chief of the New England Journal of Medicine. We wish to extend our thanks to all of the patients and their families, their clinicians, the researchers and advocates around the world whose courage and perseverance have helped us all gain the knowledge we need to get better.
You look back at all of human history and you realize that disease was the principal problem. ...of life and existence, and you realize it's only in this most recent period that we've gotten these very strong scientific and technical apparatus available to really modify it in some way. I am very thankful that we live in the age that we do, that something like this can be taken care of.
When you think about global health, you know, what we do as physicians is not just in our hospital, but it's around the block, it's in our county, in our state, in our region, in our nation, but also across the world. No matter how you look at it through the lens of gender or sexual orientation or age or socioeconomic class or level of education or region of the country where you live, black people bear the brunt of the AIDS epidemic in America. It's been a really important part of HIV research is to have the voice of the community and to have people pushing hard for what we need to do. I think it's made us all better.
We are in the throes of needing to go from a system that's trained, hired, and rewarded people for being cowboys and trying to become one that trains, rewards, and hires people to be like pit crews working together. for a patient. Imagine trying to read the New England Journal of Medicine in rural Africa, you know, 25 years ago. And now I can tell you that my colleagues in Rwanda and rural Haiti, and they have access to journals, they have access to search capacity right there in these rural regions. That's huge.