Ralph Nader: Warner Slack - Doctor for the People Forever

Source: InnovateMedTec

Have you ever been frustrated while trying to access your medical records?  Considering the abundance of medical records sitting in doctors' offices across the world, why has there not been a system (or systems) devised to give patients the access that is necessary to calm their minds.  Further, why have those same records not been 'anonymized' and made available to medical researchers to gather data across a greater patient population that could result in better medical care -- i.e. better medicine?  Surely, one of the many great physicians over the past few decades have conceived of such a system -- especially with the rise of technology is society.  In the blog post below, the iconic activist Ralph Nader introduces us to his good friend -- Dr. Warner Slack -- who passed away recently.  Dr. Warner Slack is one such physician who not only conceived of such a system, but worked tirelessly to advance the medical field to implement Electronic Health Records.

Electronic Health Records?

'Big Data' is a hot topic today.  The field of data mining with computers is taking on a new role from analyzing 'likes' on social media platforms to analyzing large data sets of pharmaceutical companies over the research and discovery of a new potential drug.  Which is why Electronic Health Records would be transformative for society and Dr. Warner Slack is honored for his ambitious pursuit over the decades as highlighted below in Ralph Nader's letter.  But first, let's take a step back and realize why having access to health records would make our lives better in the future.



In order to design a more effective drug, pharmaceutical companies need more information on the reactivity (i.e. efficacy, side-effects, costs, etc.) of a certain drug.  As I pointed out in the original post on drug discovery in an earlier post (over a year ago - here), the cost is tremendous -- around $1 billion dollars to bring the drug to market place over the course of 20 years.  Yes I said the process takes up to 20 years to get the drug from the university to the marketplace.  This covers the range of costs associated with discovery to patent through clinical trials -- which is no easy task.



Remember as I point out in an earlier post, the target (drug target) is discovered at the university level.  From there the drug target is tested against a wide variety of patented or proprietary test targets from a given pharmaceutical company. If a suitable match is found -- meaning a drug (or medicine) from a company is found to hit the target. Then the pharmaceutical company may be willing to take the drug to market - through clinical trials.  During clinical trials, the drug is tested on a specific population (limited but verifiable to U.S. standards).  Last but not least, the real 'data' on the drug comes from years of testing the drug in various doctors' offices across the world.  Which is why the data that is dispersed throughout the world could be fed back to the pharmaceutical company to optimize (refine or make a better) the drug which was brought to the market place.



People do not realize that as patients, they are testing the efficacy of the newly released medicine too.



Why are we still using a paper-based system of keeping track of patient's health rather than electronic health records?  At first sight, the answer might be related to the complexity with the whole process.  We are talking about hundreds of millions of patients just inside the United States -- not to mention other countries.  Or different countries might choose to use different file types which might not compatible across large populations to mine for researchers.



Global medicine is a topic among the upper echelons of the government and can be read about here.  Race, ethnicity, culture, and gender are increasingly important considerations when looking for effective and reliable treatment options for a given disease.  The more information we have to work with, the better the outcome.  Dr. Warner Slack has made this realization an issue which society has been forced to deal with and embrace in the pursuit of personalized medicine.  Don't take my word for it, read the letter below along with the cited article at the end of the letter about the wide range of Dr. Warner Slack's accomplishment for people during his career in medicine.



Without further ado, here is the letter written by Ralph Nader about his good friend -- Dr. Warner Slack shown below:

Warner Slack was a humble, multi-faceted great American physician at Harvard Medical School’s affiliated hospitals. Yet after he passed away last month at age 85, Dr. Slack did not receive the news coverage accorded numerous late entertainers, athletes, writers and scoundrels. In fact, his life was ignored by the Boston Globe, New York Times and the Washington Post.

Dr. Slack, in his pioneering, brilliant humane work, always focused on the lives of the American people whom he served in the millions, directly and indirectly.

It has been said that in a celebrity culture, we honor whom we value. Along the way the most important human beings who give us the blessings of liberty, justice, health, safety, knowledge and overall well-being mostly are missed or slighted by the priorities of a commercially driven culture. These people lift up our society every day on their largely anonymous, selfless shoulders.

In his final days, struggling with pulmonary fibrosis, I called Dr. Slack to express my deepest admiration and said: “For all your adult life, Warner, you have been a physician’s physician, a patient’s physician, a student’s physician, a citizen’s physician, and a champion of peace and justice.” This gentle, many-splendored medical doctor achieved such excellence in an age of specialization and amorality.

Dr. Sidney Wolfe, the nationally known long time director of Public Citizen’s Health Research Group, called Warner “a hero of mine.”

Just what did Warner Slack do to receive such encomiums? First, he was an early vocal medical practitioner who supported universal health insurance, when few were urging such humanity. He was among the first physicians in the world to see and apply the potential of computers in healthcare delivery but declared that advances mattered only if they advanced patients’ wellbeing. He insisted on patients being informed, on being empowered, and he led the way from his clinical practice in ending the absurdity of prohibiting patients from accessing their own medical records. Over the opposition of most of his profession and hospitals, he pressed on until this basic patient right was enacted as part of the Health Insurance Portability and Accountability Act.

Dr. Slack founded the Division of Clinical Computing from which flowed many professional articles and studies including prescient warnings about how computers misused can invade patients’ privacy and waste a ton of taxpayer money. He also pointed out that mindless converting from paper records to digital records might ill-serve the patients.

Once in a rare while, we meet relentlessly honest and courageous people who instinctively and cognitively see through the ruses, the snares and the delusions, and the profiteering propaganda that harm innocent, trusting people in so many grave ways.

Unlike many innovators, who bask in the limelight of praise, Dr. Slack humbly kept at it pressing for how his breakthroughs could actually benefit patients and not be hijacked for the all-mighty dollar. Human beings were never to be reduced to numbers.

As his son, author Charlie Slack wrote:

[Warner Slack’s] article “The Patient’s Right to Decide,” published in the British journal The Lancet, put forth a then-radical idea of “patient power”—encouraging patients and physicians alike to overturn the traditionally paternalistic nature of healthcare. Patients, Dr. Slack believed, should play a crucial part in determining their own care. Their insight, he often said, was “the least utilized resource in healthcare.

As an original thinker, a visionary, and a rigorous conveyer of medical ethics and responsibility to the hundreds of young clinicians he mentored or trained, Dr. Slack, maintained his steadfastness with a remarkable congeniality and the human touch.

In pain and hospitalized for weeks, he never complained. His demeanor and continual regard for the orderlies, nurses, and physicians, who took loving care of him, revealed his authentic character.

An early inchoate defender of the underdog, he was among the first physicians to publically oppose the Vietnam War, to go down South to help injured civil rights marchers, even working to help ease the integration of the University of Wisconsin football team. While in his seventies, he twice went to Honduras to provide medical assistance to residents of remote, impoverished villages.

A Princeton classmate of mine, Warner and I got to know each other better in 1980 when he and our Center independently issued tough critiques of multiple-choice standardized testing (SATs, etc.). As the author or co-author of many articles, book chapters, newspaper op-eds and books, such as Cybermedicine: How Computing Empowers Doctors and Patients for Better Health Care, Warner was very aware of phony studies, deceptive statistics, and other technical ways to manipulate persons.

Together with his colleague, Douglas Porter, he authored, in the Harvard Educational Review, the myth-busting article, “The Scholastic Aptitude Test: A Critical Appraisal.” They demonstrated that, contrary to ETS’s defiant assertions, aptitude was not frozen and its test scores could be raised by study and training for the tests. They also showed that SAT scores are poor predictors of college academic performance compared with high school grades.

Our study, “Reign of ETS: The Corporation That Makes Up Minds,” added that non-quantifiable traits, such as diligence, creativity, stamina, and even motivational idealism, can be more important as predictors of college performance.

This year, Warner’s critiques were further vindicated by the news that, joining some other colleges, the University of Chicago, has dropped these standardized tests as a requirement for admission.

Warner managed his interests and professional activities and duties without sacrificing being with his wife, Carolyn, their three children, and seven grandchildren. He relished these gatherings where he expressed his limitless curiosity about the world and continued to be, in Charlie’s words, “a person defined mainly by his youthfulness.”

Someone once said that “the only true aging is the erosion of one’s ideals.” No one who knew and worked with Warner viewed him as “elderly.” He couldn’t have been more contemporary and forward-looking with his classmates whenever they gathered for meetings regarding their unique alumni class organization—Princeton Project 55, which placed Princeton undergraduates and graduates with systemic civic groups around the country.

Dr. Slack was as complete a brainy, humane, down-to-earth, big picture human being as you could ever meet.

He left this life in Carolyn’s arms on the morning of their 62nd wedding anniversary.

His legacy is strong, deeply rooted in his many students and colleagues, and is lastingly conveyed in his writings and exemplary career, under pressure and controversy.

A biography of Warner Slack and his times needs to be written.

Conclusion...

Dr. Warner Slack has been hailed by others as the 'pioneer' of electronic health records.  Read here about his envision of artificial intelligence and computers playing transformative role in medicine.  With the rise of technology coupled with Dr. Warner Slack's vision, we have arrived at pursuits toward precision medicine like "All of Us" trial being conducted by the National Institutes of Health.  In the future, we will thank heroes like Dr. Warner Slack who have paved the way toward a better understanding of health by giving access (and better care) to patients through making the data (medical records) available to both patients and researchers.  The future of medicine should be exciting through both participants eyes.  Thank you Dr. Warner Slack for your work.  And Thank you Ralph Nader for bringing our attention to lesser known heroes like Dr. Warner Slack.



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