Leana Wen, Baltimore’s public health crusader

By: Daniel Leaderman 

Note: Originally Appeared in The Daily Record (May 22, 2016)

Just a few months after Dr. Leana Wen took over as Baltimore’s health commissioner, the Freddie Gray riots drew renewed national attention to the city’s struggling neighborhoods and public health challenges including opioid addiction, gun violence and disparities in life expectancy across different zip codes.

Immediately after the riots, when several pharmacies were damaged or closed and left older residents struggling to get their medications, Wen and her staff went door to door in senior-living buildings to spread the word about how the department could help them obtain their prescriptions, food and transportation.

Residents kept asking what candidate they were campaigning for and whether they were conducting a survey, Wen said.

“They weren’t trying to be upset with us,” she said. “They were saying they always saw us — whatever ‘us’ is, the health department, the city, the people in power … as wanting stuff from them for our needs instead of the other way around. And so we’ve completely taken the opposite approach and said, ‘We’re coming to you.’”

In a recent interview with The Daily Record, Wen discussed what she sees as the three key principles of effective public health and how services need to be delivered: that health services need to be delivered where the people are, rather than expecting them to always come to hospital or doctor’s offices; that health is tied to everything, from business to education policy; and that the community must be engaged at every step.

The emergency room doctor also discussed the city’s efforts to confront these issues, the challenges of securing funding, the looming threat posed by the Zika virus and the need for a cultural change regarding prescription drugs.

What follows is a condensed version of that interview.

Are efforts to reduce opioid addiction and overdoses, including expanded access to the overdose antidote Naloxone, starting to show results?

This is where public health gets messy, because it’s harder to track our results than it is to track [those] of public works … we know the number of naloxone kits we’ve distributed, we know that we have trained over 11,000 people since 2015. That’s a lot of people … police have already rescued more than 20 people [from overdoses] themselves, and we know there have been hundreds of others saved across our city. Those are numbers that are satisfying.

What is not so satisfying is the number of overdoses continues to climb … [but] if you look at the trends across the country, the number of people overdosing in the last 10 years has quadrupled; in Baltimore City it’s climbed, but it hasn’t even doubled. I’m not saying it’s good that the number of overdoses has continued to increase, but it’s a matter of how you measure it.

Also, another reason why our naloxone training alone is not enough is what I saw in the [emergency department]. You have a patient who comes in and overdoses again and again, but unless you’re able to get them into treatment you’re just treading water. And so we started a 24/7 phone line [to help people connect with drug treatment].

That number started in October, [and] we get 1,000 calls a week. It’s amazing, I think, but that illustrates a need that’s there. We still need to expand access to treatment.

 Is there enough focus being put on addiction prevention? Is there some strategy that hasn’t been tried, but should?

Prevention is a double-edged sword: on the one hand, of course I completely agree that prevention is important. I don’t want people getting started on heroin, I don’t want people getting addicted to prescription drugs … 80 percent of people who use heroin first got started using prescription drugs. …

Our society and our perception needs to change because our kids are seeing this quick-fix culture. If you sprained your ankle 10 years ago, you’d put ice on it … you wouldn’t go to the doctor saying, “Can I get prescription painkillers for it?”

Our culture has gotten to a culture of excess, where we’re prescribing 259 million prescriptions for opioids every year — that’s one for every adult American. We are 5 percent of the world’s population, but 80 percent of the world’s opioid prescriptions. There’s a bigger issue of culture that has to change. …

I agree that [prevention] is important but we still have, in our city, 20,000 people who use heroin now. We have many more thousands of people who are addicted to other drugs now. We can’t just say “let’s prevent people from getting addicted” without also focusing on the need for treatment.

 Is your department getting the support it needs from the Hogan administration?

We have faced cuts in the last year and a half … I mean, I’m stating facts … we’ve faced cuts to some of our key programs that thankfully we have been able to restore through the state legislature … The reasons that we are given [for the cuts] often reflect the fact that other places across the state also need funding, which is probably a true statement because public health overall is underfunded. But I will always continue to make the case … and this is not specific to the Hogan administration, this is really across the board … that resources should be directed to the areas of greatest need. It is not appropriate and not common sense and not evidence-based to spread the resources evenly. It just does not make sense. When Baltimore city is over 50 percent of all the overdose deaths … over 50 percent of resources should be targeted to us.

[We’re now] facing Zika … the places that are the hardest hit by Zika are urban areas facing concentrated poverty, with vacant properties and urban blight. I mean, Baltimore is set up for that, and so resources for Zika, just like for everything else, should be targeted for areas of greatest need.

Last month the health department released its action plan for Zika, which included using larvacide and removing standing water. Is adequate funding in place for these efforts?

As a result [of Congress not allocating emergency preparedness funds], we either had to cut [our emergency preparedness team] from six to four people and not be able to respond to Zika, or we had to find the money some other way.

[Mayor Stephanie Rawlings-Blake] has, through the Zika citywide plan, allocated half a million dollars in a very difficult time, I mean, our city is facing huge budget deficits and all of our agencies were being asked to cut 8 percent from our budgets. So I’m very thankful she was able to make that a priority. She really understands that we have to be on top of this.

Zika seems to be a bigger concern in southern states because of the higher temperatures. Your feeling is that Baltimore is a place where Zika could emerge?

Every day, there is new information coming out about Zika. Several months ago, we were saying that the mosquito that transmits Zika is found in southern states and we’re not in danger … now studies have shown that another kind of Aedes mosquito also can transmit Zika. The question is, do we wait until we find out for certain that it’s come to Baltimore and we have hundreds of kids born with this birth defect? Ever year there are 9,000 pregnant women [in the city]. …

If it doesn’t come to Baltimore, we breathe a sigh of relief and say thank you to whatever entity we all believe in or don’t believe in. If it does come to Baltimore at least we can say we were prepared, we took proactive steps and we were ready.

Dr. Leana Wen

 Age: 33

Born: Shanghai, China

Education: California State University in Los Angeles, B.S. in Biochemistry; Washington University in St. Louis, M.D.; University of Oxford, M.Sc. in Economic and Social History, M.Sc. in Modern Chinese Studies.

Previous Jobs: Emergency medicine attending physician and director of patient-centered care research, the George Washington University Hospital; assistant professor of emergency medicine and health policy, the George Washington University; emergency medicine physician, Brigham and Women’s Hospital/Massachusetts General Hospital.

Family: Married (husband Sebastian Walker), lives in Fells Point

Last book read: “Inside the Middle East”by Avi Melamed

Favorite Movie: “The Gods Must Be Crazy”(“The Godfather, Part II”is too common!)