Hearing About Today’s Medicine From the Doctors’ Mouth

He said, If you will heed Hashem your God diligently, doing what is upright in His sight, giving ear to His commandments and keeping all His laws, then I will not bring upon you any of the diseases that I brought upon the Egyptians, for I Hashem am your healer. Exodus 15:26

On a day in August, annually for the last 12 years, physicians and ordinary citizens take off for a face-to-face discussion of the latest in Israeli medicine. Some 1,500 people, most of them Jerusalemites, filled Teddy Hall (named in memory of the city’s legendary mayor Teddy Kollek) at the city’s International Convention Center for a full day that began with a videoed message of greeting from President Reuven Rivlin.

The highly varied agenda ranged from discussions of nutrition to providing healthcare to the elderly and saving wounded soldiers on the battlefield.

Israel Defense Forces (IDF) Maj.-Gen. Yitzhak Turgeman, who is head of the military’s technology and logistics branch, wowed his audience with a video of a non-piloted vehicle that evacuates up to two wounded soldiers on the battlefield and flies them to a safer place where they can be treated.

Turgeman, who was commander during a difficult battle during the 2014 Israel-Gaza conflict Operation Protective Edge, said that troops, if wounded by gunfire, expect that they will be evacuated as soon as possible. “We do everything we can to save them. It’s difficult to continue fighting if there are wounded soldiers lying there; they lose faith.

When there are fewer dead and wounded, we have more time to fight, and decision makers have more time to fight and less pressure to make decisions,” said the senior officer. “This is also part of the battle to make it clear who won – us or the enemy.”

The IDF has made great efforts, especially in the past few years to minimize the number of preventable deaths among battlefield soldiers. In the 1948 War of Independence, 46% of the wounded died. This was reduced to 15% in the First Lebanon War in 1982 and 9.2% in Operation Protective Edge. The main cause of death in soldiers who suffered preventable deaths is bleeding. About 83% of fallen soldiers die within an hour of being wounded, said Turgeman.

To prevent soldiers from being hurt, the IDF has in recent years introduced much advanced and expensive equipment, including flak jackets with ceramic plates, many-layered helmets, protective goggles and even a unique protective device that prevents the wearer from being stabbed in the neck from behind (developed when Palestinian terrorist stabbings in Jerusalem and elsewhere some four years ago were commonplace). The IDF even developed dry plasma that can be turned, with the addition of water, into precious liquid for transfusions on the battlefield.  

Brig.-Gen. Tarif Bader, a Druse pediatrician and professor who is IDF surgeon-general, added that “we have treated not only Israeli soldiers and civilians, but also people in faraway lands hit by earthquakes and other natural disasters by setting up mobile hospitals to treat them.” He also proudly noted that a quarter of IDF military corps officers are women.

Israel is less successful with regard to childhood and teenage obesity – ranking sixth worst in the world, said Deputy Health Minister Ya’acov Litzman, “Our consumption of sugar is among highest in world. Diabetes is a world epidemic, and it exists here as well.” But steps can and are being taken to minimize the problem. School vending machines will not be allowed to sell junk food; chocolate milk, very popular among Israeli children, is being made without sugar; and in 18 months, food products will have to show a green or red icon signifying whether they have healthful or excessive levels of sugar, salt and fat.

Prof. Jonathan Halevy, director-general for the last 31 years of Jerusalem’s 116-year-old Shaare Zedek Medical Center, told the audience that the hospital is booming, with 1,000 beds and delivering more babies per year – 22,200 – than any other hospital in the world. “Thirty to 40% of our patients come from outside our catchment area. We choose personnel not only for their medical skills but also for their empathy towards patients. As a voluntary hospital that depends on our income from patient care and without getting government subsidies, we still have the lowest operating deficit of any Israeli hospital.”

Director-General of the Hadassah Medical Organization, Prorf. Zeev Rotstein, said that it “won’t take long before cancer is treated like a chronic illness and not a disease that kills. Personalized medicine with treatment – even on single receptors — based on the genetic background of patients will become the norm.” He unveiled a new feature of its My Hadassah smartphone application – the first of its kind in Israel – in which every user can enter his disease and/or symptoms and find immediately the Hadassah physician, clinic and department that are most qualified to treat him based on experience, specialty and publications. This is the first such app in an Israeli hospital, he said, with more than 60,000 patients registered so far.

Although the Israeli population is relatively young compared to that in Europe, it is aging. Dr. Yuval Weiss, medical director of the Jerusalem region of the Meuhedet health maintenance organization. “In a decade, there will be 600,000 people over the age of 75. Already today, there are hospital internal medicine departments near collapse in the winter flu season. The HMO has thus decided to launch home hospitalization, whenever possible, with nurses and doctors coming to homes to install medical equipment and give proper treatment. A pilot program will begin in the fall. Physicians have to keep on their toes, said Weiss, as many ordinary patients come in with printouts from “Dr. Google,” listing treatments published in The New England Journal of Medicine or other journals relating to their conditions.

Even in periods of terrorism and war, Israeli hospitals are “islands of sanity,” said Rabbi Yechiel Eckstein, president of the International Fellowship of Christians and Jews, which raises funds abroad for many Israeli causes. “In hospitals, the walls that divide us collapse, especially with its mixed population. Suddenly, everybody helps everybody else. Despite the power struggles, Israeli society must learn from you doctors, and nurses on how to be better, to care for people.”

The food industry here is changing rapidly, said Prof. Eyal Shimoni – vice president for vision and technological strategy at the Strauss Group food conglomerate. “People eat differently, at different times of the day than they used to. I don’t believe in trends. The demand for healthful food will continue. We at Strauss stopped using trans fat 15 years ago. We have cut sugar without telling customers so they don’t suddenly say the food is less tasty. In recent years, 120 of our products have undergone revision for better health. If we had sold chocolate milk without sugar four or five years ago, the produce would have failed. Today, there is more awareness.”

Zeev Pikovsky, chief scientist of the Israeli food conglomerate Tnuva, said there will be 10 billion people in the world by 2050, but there will be less usable land and water. “Global warming, the aging population, changes in family structure and different consumer views based on science and personal beliefs will cause a shakeup.” While most people will give up animal products, many more will be “flexitarians” eating less meat, more vegetarians and more vegans. Food company labels will have to be clearer, and their products will be less processed with less synthetic compounds.

The Mediterranean diet of vegetables, fruit, olive oil, nuts, pulses (beans), whole grains, fish and poultry – eaten in family meals, perhaps with a siesta during the day – is the best diet in the world for health, said Prof. Jacob Klein, head of cardiovascular rehabilitation and prevention at Shaare Zedek. “There is a direct connection between heart diseases and diabetes on the one hand and poor diet, smoking and inadequate physical activity on the other.”

Various international studies have shown that heart disease mortality differs by country, with much lower rates in Mediterranean countries like Israel, Italy and Greece, compared to the US, for example.”

Fatty liver – hepatic steatosis, a reversible condition in which large amounts of triglyceride fat accumulate in liver cells – exists in a quarter to a third of all people in the world, said Prof. Rifat Safadi, head of the liver unit, gastroenterology and liver diseases at the Hadassah University Medical Center in Jerusalem. “Fatty liver can lead to cirrhosis and even liver cancer. If you lose 3% of your body weight, you will be much better off; if you lose 10%, you will be much better and reduce scarring of the liver,” he said. He recommended eating much less processed carbohydrates and saturated fatty acids. Avoid high-fructose corn syrup high protein, high fructose corn syrup, soft drinks and red meat as much as possible. Processed sugar, he added, is “more violent than sugar from fruits.” Espresso coffee, by the way, can improve fatty liver.

Israeli hospitals perform the highest rate in the world of in-vitro fertilization to produce pregnancies, said Shaare Zedek fertility and IVF department director Prof. Hananel Holzer. The national basket of health services pays for IVF to produce two healthy babies in women up to the age of 45, he said. Most countries do not cover such costs. Every year, 43,000 IVF cycles are performed in Israel, more than in actual numbers than in many other countries, because of the desire here for offspring.

The IVF success rate over 43 years is only about 3%, but the Health Ministry has not decided to reduce the maximum age, even though the money saved could be spent on other medical needs, said Holzer. In addition, two embryos are returned to the womb after IVF here. When he worked in a leading Montreal hospital, the rule was to return only one because of the increased risks in multiple pregnancies.

This year’s Israel Medical Conference was the most interesting so far; it is hoped that organizer Prof. Avi Rivkind of Hadassah will make the next one even better.

To ask a medical question for an expert to answer, email Judy Siegel-Itzkovich at [email protected], giving your initials, gender, age and place of residence.

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