May 26, 2018
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Shall we be safe, or shall we be brilliant?

By David R. Colman, Special to the BDN

Recent health care debate reports in the Bangor Daily News reveal the basic problem — there is the “of course we need quality affordable health care, but …” sentiment in Congress. But all “stakeholders” must be accommodated. But government can’t run health care. But small business owners must not be penalized. But we need good value for our tax dollars. And so on.

Once this silliness enters the debate, progress on the issue is doomed. This is not the time for cautious evaluation of all the details and possible pitfalls of a universal health plan. Would that Congress had been so thoughtful when it came time for trillion-dollar wars and corporate bailouts!

In terms of health, Maine is actually poised to solve its problems in the long term. We only need to take a different approach. We just need some foresight and courage to implement a novel solution, by coupling health care delivery with creative research efforts. In fact, the best experience shows that the two are, in fact, inseparable, except by politicians with little or no imagination.

Why not create the first new serious academic medical center of the 21st century right here in Maine? The key word is “academic,” which means outstanding, innovative biomedical research programs run by first-rate scientists and clinicians in broad-based university-hospital communities. Thousands of these folks are already working in the state, albeit in dispersed, poorly integrated settings.

Academic medical centers around the world house graduate schools and grant advanced diplomas whose recipients are poised to do meaningful research (in particular, M.D., Ph.D., RN, OT-PT degrees). These centers provide state-of-the-art health care, and boost the local economy by creating jobs for a wide variety of professionals. And, successful academic medical centers draw fee-for-service patients from all over the world.

I am an American who summers in Maine, but I work in Montreal, where I am a hospital and institute director. In Quebec, whose profile in so many ways closely resembles that of Maine, hundreds of millions of dollars are brought into the economy annually through the research and clinical activities of its academic medical centers. These dollars in part serve to alleviate the problems of health care delivery that have so stymied our Congress. Quebec physicians are salaried, by the way, and on a much lower scale than in other parts of North America, but by far most choose to remain in the province, and in cities like Montreal, because of the quality of life, and the stimulating academic environment in which they work.

Maine already has a remarkably well developed platform from which to launch this new effort, but the state is (unwittingly I’m sure) keeping this a secret. Maine has, right now, truly prominent universities and a surprising number of institutes with strong or ready-to-be-expanded research profiles. For example, there are several well-established institutes specializing in environmental issues, and others in genetics, whose research efforts may be expanded with an eye toward solving problems in human health and disease aggravated by climate change, other environmental factors and social pressures (numerous common and chronic debilitating illnesses arising from tobacco, alcohol and drug abuse). New and exciting programs can be created that will attract millions in new grant funds and private philanthropy. The opportunities — and there are many — to jointly configure new research efforts all along the Atlantic coast — from the Maritimes to Florida — are without precedent at this time.

In addition, Maine has large hospitals, some of which are even financially successful. The problem is that real, broad-based, fund-attracting new programs require commitments and courage and carry some degree of risk. The jury is still out on what I see as “Band-Aid” solutions, like primary care programs that incorporate out-of-state M.D. students to satisfy the state’s primary care crisis. Furthermore, to try to drastically alter established cultural patterns — like attempting to attach research programs to clinically strong osteopathic training that has never had a research base — is unlikely to yield a favorable outcome.

What is missing is the state government and private donor commitment to provide enough of the initial investment to integrate the various components into a well-planned, world-class, outstanding academic “State of Maine School of Medicine.” It is long, long overdue. This is not the time to offer timid platitudes to deflect the residents of this state from innovation.

As the philosopher George Santayana famously admonished his students: “Don’t be safe, be brilliant!”

David R. Colman, a summer resident of Deer Isle, is a professor of neuroscience at McGill University and the director of the Montreal Neurological Institute and Hospital.

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