LEADING THE REVOLUTION IN GLOBAL HEALTHCARE
THROUGH MEDICAL INNOVATION DECEMBER 2019 1
LETTER FROM THE EDITOR
THE SPIRIT OF SHEBA Welcome to Sheba Pulse magazine, which has been designed to acquaint you with Israel's Sheba Medical Center, a cutting− edge facility that NEWSWEEK magazine has lionized as one of the "Top 10 Hospitals in the World." Sheba Medical Center is indeed unlike any hospital you will ever encounter. As the largest facility of its kind in Israel and the Middle East region, Sheba Medical Center is renowned for being an "oasis of peace" within a turbulent region. On any given day, you will find Sheba's Jewish and Israeli Arab doctors and nurses working side−by−side in the Pediatric & Congenital Cardiothoracic Surgery Department at the Edmond and Lily Safra Children's Hospital, battling to save the lives of Kurdish Arab Moslem children who are in desperate need of heart surgery. Under the tutelage of the hospital's inspiring Director General, Prof. Yitshak Kreiss, it's not in the Sheba vocabulary to say "no" to a neighbor or a distant nation in need. Even after a challenging day in the hospital, a group of Sheba doctors could be summoned at a moment's notice to fly to nearby Cyprus with special medical equipment to save a pregnant woman's life or to faraway places such as Mozambique (Africa) and Guatemala (Central America) to assist populations devastated by natural disasters. These are dramatic, real−life heart−warming stories that you will rarely, if ever read about or see on TV. Sheba's global impact can also be witnessed inside the borders of its expansive 200 acre campus. It's not unusual to encounter a myriad of doctors from China, who are learning the latest medical techniques in order to upgrade the level of healthcare in their country.
At Sheba's new ARC innovation complex, high−ranking delegations from a phalanx of North American, European and Asian hospitals, multi−national corporations and pharmaceutical companies, can be seen brainstorming with ARC's tech professionals on ways to collaborate. ARC is also playing a critical role in the hospital's transformation from yesterday's Beit Cholim (Hebrew for 'house of the sick') into a futuristic "City of Health". Additional DNA for this quantum leap forward can be traced to Sheba's first−rate research facilities and the hospital's superior medical intellect. Sheba's doctors are able to translate science fiction into science fact using cutting− edge treatments to offer new leases on life for patients of all ages suffering from horrific diseases that until now, had no solutions. Inside this magazine, you will read uplifting stories about how Sheba's doctors and researchers are saving and extending the lives of patients through innovative medicine, as well as providing vital information about how to live longer, healthier lives. You will also read about the vital work performed by our growing network of Friends of….hubs across N. America and around the world, as they inject the 'spirit of Sheba' into their local communities. We encourage you to share this magazine with friends, family and colleagues, so they too can see and read about the future of global healthcare at Sheba Medical Center. Cordially,
Steve Walz, Editor
EDITOR−Steve Walz Contributing writers: Noa Amouyal (IMP), Sharon Gelbach (IMP), Red Banyan Public Relations (USA) Administration: Sheba Medical Center Director General: Prof. Yitshak Kreiss Dep. Dir. General: Prof. Arnon Afek Director−Sheba International: Yoel Har−Even Public Relations: Manager− Lee Gat (Israel); Steve Walz (Int'l) Marketing Director: Caroline Bats Magazine Sales & Production: IMP Media. Ltd−Gidon Katz Comments about the magazine: Sheba International− Yoel.Hareven@Sheba.health.gov.il Steve.Walz@sheba.health.gov.il Copyright/All Rights Reserved 2019
PROF. YITSHAK KREISS:
Shaping the Future of Global Medical Healthcare
hen Professor Yitshak Kreiss assumed the position of Director General at Sheba Medical Center in 2016, he came with unprecedented medical military and humanitarian outreach credentials spanning several decades, some of which made headlines around the world.
As the Israel Defense Forces' (IDF) Surgeon General, Prof. Kreiss was instrumental in creating an innovative field hospital on the Syrian− Israeli border, where seriously injured Syrian citizens caught up in the horrific civil war were able to receive life−saving treatments. Prof. Kreiss also spearheaded emergency humanitarian expeditions to disaster zones around the globe−from a devastating earthquake in Haiti to a monstrous typhoon in the Philippines. Following in the footsteps of Prof. Chaim Sheba, the first IDF Surgeon General, who transformed a former military hospital in 1953 into a civilian facility (Tel Hashomer) that provided medical care to anyone who came through its doors, Prof. Kreiss now commands the largest hospital in Israel and the Middle East. Prof. Kreiss, who holds master's degrees in Health Administration and Public Administration from both Tel Aviv University and Harvard University, has injected Sheba with a sense of pride and a vision for the future.
completed in the next few years, the "City of Health" will be the global standard for the "hospital of the future". The critical DNA for the success of the "City of Health" will emanate from Sheba's brand−new ARC (Accelerate Redesign Collaborate) innovation concept, which is already engaged in fomenting the worldwide digital healthcare revolution, with game−changing technologies. "We have injected the start−up nation mentality with the chutzpah of our talented physicians, who aspire to change the future of medicine and patient care, not just in Israel but around the globe. We call this the 'spirit of Sheba'," revealed Prof. Kreiss. "In tandem with the discoveries and breakthroughs in cancer, cardiovascular and rehabilitation treatments etc. that our doctors are performing throughout the year, Sheba is the perfect example of what Tikun Olam (repairing the world) stands for. It's where the impossible becomes possible. Steering a course for the future of global patient care is not a simple task. But with the talent we have harvested at Sheba, we are accelerating our plans to transform the dream of a futuristic 'City of Health' into a reality. "
Sheba Medical Center is renowned for being an oasis of peace in a turbulent region, and lauded for its humanitarian outreach around the globe. "Sheba is a hospital without boundaries, a bridge to the region, where an atmosphere of peace and humanity permeates throughout the hospital's hallways. Our hard−working doctors and nurses practice something that transcends medicine and we are doing this every single day of the year," Prof. Kreiss explained. He is also leading the radical transformation of Sheba Medical Center into a futuristic "City of Health"−− from strategic planning and hospital design, to operations, policy and leadership. When
Prof. Yitshak Kreiss, Director General of Sheba Medical Center.
PROMINENT TEANECK ATTORNEY ESTABLISHES PIONEERING PEDIATRIC BURN CARE CENTER AT SHEBA Sam Davis (right) with a young burn victim at an I−PEARLS event.
child with severe burns typically suffers from lifelong physical and emotional scars that can be debilitating on multiple levels. Traditionally, plastic surgeons have corrected burn scars by using grafting techniques and other painful invasive procedures that require general anesthesia and lengthy hospitalization with significant risk of infection and graft failure.
facility will also focus on teaching dermatologists and plastic surgeons the latest techniques in pediatric laser medicine, conducting research and publishing in the field of laser medicine for pediatric application, and hosting international symposia in the field of laser medicine in children.
For Sam Davis, who founded a 28−attorney personal injury law firm in Teaneck, New Jersey, these traditional techniques were not good enough.
“Burn injuries, whether from terrorist attacks or cooking accidents, leave traumatizing scars on children,” said Sam Davis. “Through our trailblazing pediatric aesthetic and reconstructive laser technology at I−PEARLS, we are transforming the lives of children who are burn victims.”
He felt that a better solution to treat children’s burn scars was attainable. Davis worked closely with Prof. Josef Haik, Director of Israel’s National Burn Center Intensive Care Unit at Sheba Medical Center, Tel HaShomer, to develop the first facility in the Middle East focused on non−invasive methods to heal scars.
Davis has also set up an I−PEARLS camp at Sheba called Camp Sababa.
“We salute Sam Davis on his life−saving, compassionate work, and thank him for choosing to establish I−PEARLS at Sheba Medical Center,” said Heffler.
Determined to make a difference, Davis found the time and strength to establish a state−of−the−art organization called I−PEARLS: Israel – Pediatric Aesthetic & Reconstructive Laser Surgery, located in Israel’s national burn center at Sheba. Now, through groundbreaking pediatric aesthetic and reconstructive laser technology, I−PEARLS is helping children overcome cosmetic and functional deficits. Driven by Davis’ visionary hope, I−PEARLS at Sheba Medical Center uses new laser technology, offering a safer and more effective approach to scar management that reduces scarring and itching, improves mobility, and repairs damaged self−esteem without the very real risks of open surgery, graft failure and infection. “Sam Davis is a man on a mission,” said Eric Heffler, Executive Director of American Friends of Sheba Medical Center, Tel HaShomer. “Sam knew that by investing in Sheba, Israel’s national hospital and most innovative medical research powerhouse, that a solution to replacing old and painful burn scar treatments with hope could be developed.” Under Davis’ leadership, Sheba aims to dramatically raise the standard for pediatric burn care. In addition to pioneering the use of medical lasers in the treatment of scars in children, the cutting−edge I−PEARLS
Chairman of Israel's Friends of Sheba Medical Center, Tel HaShomer Yoram Tietz (left) and American Friends of Sheba Medical Center Executive Director Eric Heffler (right) congratulate Ishaia Gol (center) on his new position as Chairman of the Board of American Friends of Sheba.
SHEBA'S TOP 10 ACHIEVEMENTS OF 2019
Clockwise from the top: Dr. Amir Tirosh, Prof. Gal Merkal, Dr. Talia Golan, Prof. Gili Kenet
By Steve Walz
uring the course of 2019, Sheba Medical Center's achievements, discoveries and innovations consistently drew attention from mainstream and health media outlets across N. America and around the world. Though we could probably fill all 20 pages of this magazine with Sheba's accomplishments, we decided to highlight the hospital's Top 10 accolades of 2019…
NEWSWEEK−World's Top 10 Best Hospitals For the first time in its illustrious 70 plus year history, Sheba Medical Center was cited by a prestigious international newsweekly. NEWSWEEK Magazine recognized Sheba as one of the World's Top 10 Best Hospitals in its annual Best Hospitals edition. NEWSWEEK wrote, "Sheba Medical Center— or Tel HaShomer Hospital—in Tel Aviv is a leader in medical science and biotechnical innovation, both in the Middle East and worldwide. The center’s collaborations with international parties have advanced innovative medical practices, hospital systems and biotechnology. The tertiary referral hospital, affiliated with Tel Aviv University, includes centers for nearly all medical divisions and specialties, and serves over 1 million patients per year. More than 25 percent of all Israeli medical clinical research takes place at its state−of−the−art facilities, and as a hospital it works with nearly every Israeli medical institute to educate students and advance the future of the medical profession."
Prof. Yitshak Kreiss in Bahrain The NEWSWEEK accolade alongside other noted achievements spurred President Donald Trump's, Secretary of the Treasury, Steven Mnuchin, to personally invite Dir. Gen., Prof. Yitshak Kreiss, to attend the June 2019 Peace and Prosperity Workshop in Manama, Bahrain. This prestigious event enabled Prof. Kreiss to meet with high−ranking executives from the Trump Administration, as well as many business leaders and politicians from various Gulf Arab nations. The two−day gathering was highlighted by a private meeting between Prof. Kreiss and His Excellency, Sheikh Khalid Bin Ahmed Al Khalifa, Bahrain's
Minister of Foreign Affairs, where they discussed future cooperation between Israel's "hospital of peace" and Bahrain.
Dr. Talia Golan Battles Pancreatic Cancer Dr. Talia Golan, the head of Sheba Medical Center's Pancreatic Cancer Center, who has been conducting on−going research and clinical trials with Astrazeneca and MSD (Merck), two of the world's largest biopharmaceutical companies, to evaluate the safety and test the efficacy of a new drug treatment regimen known as POLO in order to treat a specific type of metastatic pancreatic cancer ( in carriers of the BRCA 1 & 2 mutation) within patients around the globe, reported very promising results in the prestigious New England Journal of Medicine. "The POLO trial using the medicine Lynparza offers potential hope for those who suffer from metastatic pancreatic cancer and have a BRCA mutation," Dr. Golan revealed. Dr. Golan's indefatigable efforts to battle pancreatic cancer were also recognized by both Forbes Israel and Lady Globes, two prominent business magazines, which placed her amongst the most influential women in Israel.
Prof. Gili Kenet Combats the Scourge of Hemophilia Prof. Gili Kenet, the Director of the Israel National Hemophilia Center and Thrombosis Institute at Sheba Medical Center and her professional staff have been at the forefront of conducting various clinical trials to combat hemophilia using a variety of treatments including gene therapy. This experimental treatment uses the common adenovirus as a vector to deliver a healthy copy of a gene to compensate for the defective gene causing hemophilia. Given by infusion, the virus targets the liver, where the healthy gene permeates the liver cells, divides, and multiplies – thereby curing hemophilia through the subsequent production of clotting factors. So far 5 Israeli patients have taken part in this innovative international trial. The results are dramatic and promising. "This is a completely new era that offers a true cure to one of the severest coagulation disorders and I am proud to be able to provide it at Sheba," boasted Prof Kenet. (continued on pg. 9)
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Prof.Gal Merkal Zeroes in On Microbiome Prof. Gal Markel, Oncologist and Chief Scientist, at Sheba's Ella Lemelbaum Institute of Immuno−Oncology believes that a cure for many diseases, including cancer originates within your gut. The microbiome is the genetic material of all the microbes − bacteria, fungi, protozoa and viruses − that live on and inside the human body. The number of genes in all the microbes in one person's microbiome is 200 times the number of genes in the human genome. Prof. Markel and his ultra−talented team of researchers and cancer specialists have been working around the clock to unlock the mysteries of microbiome. As you are reading this, Prof. Markel was on the verge of revealing a radically new treatment for melanoma patients with stage−4 cancer using fecal matter (whose origins are microbiome based).
A Global Leader in Life−Saving CAR−T Therapy Sheba has become one of the world's leading hospitals providing life−saving CAR−T immunotherapy treatments to both children and adults suffering from stage−4 leukemia/lymphoma cancers. CAR−T (Chimeric Antigen Receptor T cells) treatments use the patient’s own immune system to fight the disease by genetically engineering their cells to target and combat the cancer. Over 100 patients have been treated by Sheba's first−class CAR−T oncology/ hematology team, which includes Prof. Arnon Nagler, Dr. Avraham Avigdor, Prof. Amos Toren and Dr. Elad Jacoby. This ground−breaking treatment, which can cost nearly $1 million dollars in the USA, is provided "free of charge" to Israeli citizens. Thus, the Jewish State has become the first nation in the world to cover the costs of this expensive treatment, as part of the basket of health services offered to citizens through their HMO's.
Dr. Amir Tirosh Warns Against Harmful Preservatives
the skin" of a growing number of severely burned patients, including children from Israel, Palestinian Authority, Cyprus and beyond. A prime example… After barely escaping a house fire that burned 50% of her small body, an 18−month−old Palestinian girl was rushed to Sheba where she received life−saving treatment in the hospital's renowned National Burn Unit. Prof. Josef Haik, along with his team of plastic surgeons− Dr. Moti Harats, Dr. Gregory Troddler and Dr. Ayelet Di Segni− utilized Sheba’s Kauffmann−Green Skin Engineering Laboratory to grow new skin from the child's own remaining healthy skin in a bold attempt to repair the extensive skin damage. "Using one’s own skin to grow additional skin in a laboratory and graft it back onto the body is essentially the best treatment available for burn victims today,” said Prof. Haik. “Our talented team was able to treat the girl with this new method, and now she is in the midst of a long and hopeful rehabilitation program."
HIPEC & IORT Surgical Procedures Extend the Lives of Cancer Patients
Dr. Roy Beinart and a visiting colleague from the UK.
Prof. Aviram Nissan, Head of Sheba's, Department of General and Oncological Surgery−Surgery C, along with Dr.Almog Ben−Yaacov attending surgeon, Department of General and Oncological Surgery−Surgery C are extending the lives of desperately ill stomach cancer patients by performing innovative HIPEC and IORT (cold plasma) surgical procedures. Both HIPEC−hyperthermic intraperitoneal chemotherapy, a process in which heated chemotherapy is pumped directly into the abdomen after surgery and IORT− Intraoperative radiation therapy, which delivers targeted intensive radiation while sparing normal surrounding tissue is also being used extensively in North America with positive results. Prof. Nissan is also actively looking for other game− changing devices and methods, as part of the hospital's ARC Innovation Center "Surgical Hub".
Many of us are unware of the harmful side− effects of common food preservatives. Dr. Amir Tirosh, Director of the Institute Dr. Roy Beinart Gets to the Heart of Endocrinology at Sheba Medical Center, along with colleagues at Harvard of the Matter Prof. Kreiss with His Excellency, Sheikh University revealed a troubling connection Dr. Roy Beinart, Director of Sheba's Khalid Bin Ahmed Al Khalifa, Bahrain's between a common food preservative Davidai Center for Rhythm Disturbances Minister of Foreign Affairs. called propionate, which is found in baked and Pacing has created new hope for goods such as bread and an increased risk of sufferers of arrhythmia, by using a non− obesity and diabetes. The groundbreaking invasive procedure. research was published in the Science Translational Medical Arrhythmia is an irregular heartbeat that impacts blood flow in Journal. the body. The condition has a vast history of complicated and “The dramatic increase in the incidence of obesity and diabetes often ineffective treatments that require extensive invasive over the past 50 years cannot just be attributed to genetic changes. surgery−until now. They also involve contributing environmental and dietary Earlier this year, Dr. Beinart, along with Prof.Tzvi Symon, head factors,” said Dr. Tirosh. “One such factor that warrants attention is the extensive use of chemicals in the processing, preservation, of Sheba's Radiation Oncology Department, used a pioneering non−invasive procedure by targeting a radioactive beam at a and packaging of foods." specific point in a patients' body that shocked the heart back Prof. Josef Haik Grows Human Skin to Save Burn Victims into a safe and healthy rhythm without damaging any other portion of the body. This was only the second time in the world Prof. Haik, Director of the Plastic Surgery Division and the that this unique procedure, which took less than 20 minutes, was National Burn Intensive Care Center at Sheba is literally "saving performed with almost immediate success.
PROF. MORDECHAI SHANI: THE PROTÉGÉ WHO BECAME A LEGEND By Ken Stephens
hen Prof. Chaim Sheba passed away in 1971 and Prof. Mordechai Shani unexpectedly inherited his mantle, he realized that the hospital desperately needed to transform itself into a modern medical center to meet the needs of the fast−growing Jewish State. "It was quite a challenge at age 33 to step into the shoes of one of the greatest people in Israel," Prof. Shani admitted. Over the span of four decades (1971−2004) Prof. Shani had a direct hand in shaping the hospital's physical structure, as well as enhancing the quality of healthcare in Israel. "In 1971, it was understood that we needed to build a modern hospitalization tower, in several phases, as well as creating a one−of−a−kind facility rarely found in the world, where all patient services would be provided and concentrated on one campus — from acute care to rehabilitation. This would include everything from surgical and neurological to physical, psychiatric and geriatric rehabilitation." Prof. Shani also revealed that Sheba began to have both a regional and global impact based on the presence of several elite doctors, led by Dr. Bruno Lunenfeld. Prof. Shani recalled, "Dr. Lunenfeld gave a tremendous boost
to the medical center's ability to deal with a variety of women's issues ranging from the introduction of hormone treatments for sterile women, which eventually led to in−vitro fertilization treatments and the first Israeli 'test−tube' baby born at Sheba in 1982. In fact, Dr. Lunenfeld was also responsible for the birth of over a million children who would not have been born had he not help develop Pergonal (together with its derivatives (Metrodin, Puregon etc.), which has been used in nearly all fertility treatments for nearly over 50 years! The first pregnancy in the world based on Dr. Lunenfeld's fertility treatments took place in 1961." In 2009, Prof. Shani received The Israel Prize, the most prestigious civilian award in Israel. The prize committee wrote, "Prof. Shani was central to the establishment and development of the Sheba Medical Center; the reorganization of Israel's psychiatric services; the founding of the school for health policy at Tel Aviv University; the drafting and passage of Israel's national health insurance policy and legislation; and the founding of many medical research institutes and scientific foundations; and the mentoring of generations of doctors at Sheba."
IDF MEDICAL CORPS & SHEBA'S ARC TO COLLABORATE ON INNOVATION
he Israel Ministry of Defense and Israel Defense Forces' Medical Corps (IDF) are actively looking for start−ups, which can address the various health challenges that the army will facing on and off the battlefield of the future. According to the Yisroel Hayom newspaper, the goal of the start− up initiative is to create highly−advanced medical technological systems that will enable the IDF to create a "super soldier", who will have a better chance of survival on the battlefield. Sheba Medical Center's ARC innovation concept will play a vital role in this initiative. The IDF Medical Corps' Surgeon General, Brig. General Tarif Bader maintains that innovation and partnership are key factors in bringing the Medical Corps to excellence. This has lead to the establishment of a first of its kind innovation unit within the IDF,
with Lt. Colonel Ariel Furer, being appointed to head the team. The IDF Medical Corps' trains many of its combat medics at Sheba Medical Center using the hospital's MSR (Medical Simulation) unit, where various combat scenarios are played out using real− life actors, soldiers and dummies. MSR was created by Prof. Amitai Ziv, a former Israel Air Force pilot, who is also playing a key role in ARC's start−up ecosystem. The IDF Medical Corp's recently opened an office within the ARC complex at Sheba and is already advancing several concepts revolving around wearables, AR glasses and drones, which would enable an IDF operator to consult on−line with the most experienced surgeons (at various hospitals including Sheba) to help save lives of combat casualties.
SHEBA’S GATEWAY TO THE FUTURE
By Noa Amouyal
With the opening of ARC, Israel’s largest hospital is ushering in the next technological revolution in digital healthcare
magine a one−of−a−kind space where the hottest start− ups, multi−national companies and academic institutions are all converging into one spot and offering the latest in cutting−edge medical services.
This unprecedented concept drives Sheba Medical Center's new ARC (Accelerate Redesign Collaborate) innovation concept, which is changing the way the hospital develops market−ready digital solutions in healthcare. This endeavor seems like a natural fit for Sheba, which is located a short−distance from Tel Aviv − one of the richest start−up ecosystems in the world. The ARC Innovation Center highlights 6 development 'hubs', each of which is headed by a senior physician within Sheba. The 6 development hubs are: Precision Medicine, Tele−Medicine, VR (Virtual Reality), Sagol Center for Digital Innovation focusing on Big Data and AI (Artificial Intelligence), Surgical Innovation and Rehabilitation.
“This physical space allows us to work closely with outside parties. Israel is bustling with great start−ups and Sheba works with these start−ups in every way imaginable in order to accelerate the development process and implement innovation at Sheba,” Dr. Eyal Zimlichman, Deputy and Chief Innovation Officer at Sheba Medical Center, explained.
So what are the roots of ARC's conceptual strategy? Sheba has been paperless for years now, making the hospital a treasure trove of digital data (aka Big Data). This data is critical for start−ups who rely on this information to shape and validate their concepts. “There’s always issues with providing access to start−up companies, because privacy needs to be maintained and regulations must be put in place. But start−ups need access to our data and can work onsite on our databases. This could be revolutionary in AI solutions, for example, which can be tested and then integrated into the hospital,” Dr. Zimlichman maintained. (continued on pg. 13)
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Aidoc is a prime example. The fast−rising start−up, which was praised by TIME magazine, applies proprietary artificial intelligence to the millions of images generated every year by CT scans in order to catch serious issues before a human radiologist even has a chance to review the results. The start−up analyzes 40 terabytes of data a day, a level of productivity even the most efficient radiologist could never reach. Aidoc's AI technology, which has been integrated into Sheba's systems have already saved lives. The company, is also expanding its AI technology to other parts of the human body. Aidoc highlights just one example of a start−up that successfully tested its' unique technology at Sheba with real world implications that will redefine patient care in the 21st century. Sheba is also working with huge household name multi− nationals such as Microsoft, Johnson & Johnson, as well as major international healthcare providers highlighted by the Mayo Clinic, who also want a slice of the ARC pie. And this is just the beginning. Dr. Zimlichman revealed that even more partnerships will be announced. “We signed with several large companies. Most of them are coming in and renting space inside our new building,” Dr. Zimlichman added. ARC is also teaming up with the private sector. Last year, it inked a major $45 million deal with venture capital fund Triventures.
That substantive figure will go toward a seed fund where ARC will nurture and spearhead innovative solutions. Therefore, ARC is not only Sheba’s pathway to the future, it will be a major revenue stream for the hospital moving forward. As such, ARC is growing exponentially. What began last year with 5 employees has now grown to 20. They will eventually be housed in a massive 22,000−sq.−meter (237,000−sq.ft.) complex comprised of several buildings. ARC has also branched out beyond Israel’s borders. This past summer, Sheba launched the ARC model at Ottawa Hospital − the largest medical center in Canada. While this is the first international ARC branch, many more are expected in the years to come. “I think ARC has grown to sizes we never imagined. Internationally, there's huge amounts of attention that is being drawn to the program,” Dr. Zimlichman said. “ARC has expanded beyond my imagination. My initial dream was to create an ecosystem that will truly be able to redesign healthcare on a global scale within the next decade.” Within the last month, ARC has also signed agreements with other hospitals in Canada, as well as Denmark. “Together with partnerships, we’re getting to our ultimate goal through collaboration. We’re sharing ideas and best practices on a global scale. We’re working with academic networks, start−ups, government entities and the private sector. Within this realm, everyone has a seat at the ARC table,” he said.
Dr. Eyal Zimlichman
HER HEART'S DESIRE
By Sharon Gelbach
With the help of cutting−edge technology, Sheba Medical Center enabled cardiology patient Raram Musalbat to live a life as normal as possible while waiting for a heart transplant
or the first sixteen and a half years of her life, Ra'ram Musalbat, the daughter of a Christian Arab family from the village of Maghar in the Lower Galilee, was a normal kid dealing with normal stuff, just like all her friends. And then, a year and a half ago, after returning from a field trip with her 10th−grade class, she suddenly collapsed — and life was never the same again. "We were told that on the trip she caught a virus that caused serious harm to her heart and lungs," Ra'ram's father, Gattas Musalbat shared. "Since then, we were in and out of different hospitals, but since April we've been at Sheba Medical Center. Her situation deteriorated so badly, that she needed round−the−clock care and I had no choice but to leave my job as a construction manager." For Ra'ram and her family, going home seemed like an
impossible dream. "Until Ra'ram receives a heart transplant, she's dependent on mechanical circulatory support – an 'artificial heart'," explained Dr. Amir Vardi, head of the ICU at the Edmond and Lily Safra pediatric hospital at Sheba Medical Center. The artificial heart is a complex and cumbersome mechanism comprised of two pumps, to simulate processes of both the right and left sides of the heart. Patients who are attached to an artificial heart must remain hospitalized so that in the event of malfunction, they can have immediate access to an emergency backup system. The mechanism keeps the patient alive — until they can receive a heart transplant. The staff and volunteers at Sheba all worked in tandem to keep Ra'ram occupied and happy, and the room she occupied for close to half a year reflected that, decorated (Continued on pg. 17)
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with family photos as well as the artwork she created at the hospital. "They have plenty of games and activities, and she studied math and English so she wouldn't fall too far behind in her schoolwork," said Gattas. And yet, there's no place like home. "I'd show Ra'ram pictures of our house, the village, and the family, and she'd be happy, but also, homesick," Gattas said. While Ra'ram's doctors at Sheba were primarily concerned with ensuring that she wouldn't have to fight for every breath, they never lost sight of her as a person. And when it seemed that she would have to miss her brother's wedding, planned for the beginning of September, they made every effort to find a solution that would enable Ra'ram to leave the confines of the hospital. "We imported an artificial heart from Germany that's much lighter and more compact than the one we use in the hospital," Dr. Vardi said. "It has a longerâˆ’lasting battery and a builtâˆ’in backup system in case of emergency. As far as I know, it's the first time this device is being used in Israel." The new compact artificial heart, produced by medtech company Berlinheart, was designed to allow patients to live at home. While it's a big responsibility for the family, they received thorough guidance on how to handle the device,
and were gratified with the greater freedom it had given them and Ra'ram. When she came home, Ra'ram received a hero's welcome. "The whole village came out to greet us with fireworks, music and dancing, a huge celebration. And it was wonderful that we could go all be present at the wedding," said Gattas. The new mechanism translated into greatly improved quality of life for Ra'ram. "We still go once a week to Sheba for a checkup, but I'm so happy to be back in my own house, in my own room. My friends can come to visit more, too," she said. For her parents, it was more of a mixed blessing. "It's frightening. We're always afraid for her," Gattas said. "Meanwhile, the waiting is difficult." The great news came in October. Ra'ram and her family were ecstatic to hear that a donor heart had been found. Within hours she was already being prepped for the complicated open heart surgery, performed by renowned heart surgeons Drs. Yigal Kassif and David Mishaly. Ra'ram is now back in Sheba's pediatric ward, but this time it's a whole different story. "We're very grateful to Sheba for all they've done for us," Gattas said. "Ra'ram is recovering slowly but surely, and we're hopeful that the heart transplant will give her a new lease on life!"
Ra'ram celebrating at her brother's wedding with her artificial heart device. Days later, she underwent a heart transplant at Sheba.
WEIGHING IN ON THE OBESITY EPIDEMIC
Dr. Gabriella Lieberman
Dr. Ruth Percik
Prof. Amir Tirosh
By Ben Horodenker
or the lucky ones, weight gain is limited to a few extra pounds put on over the holidays and lost in the weeks thereafter. But for those with a predisposition for overweight, the "battle of the bulge" is a lifelong struggle punctuated by physical and emotional challenges. Given the range of serious medical issues associated with overweight, from diabetes, hypertension, cardiovascular disease and cancer to infertility, sleep apnea and skeletal pain it comes as no surprise that the medical community considers obesity as a disease unto itself. Shocking statistics indicate that 90% to 95% of people with obesity who diet and lose weight will gain it back within the first year, often with "interest." The urgent need for an innovative approach to treat and cure this disease has led to the establishment of the Israeli Center for Obesity Management, a division of the Department of Endocrinology at Sheba Medical Center. In the words of Dr. Gabriella Lieberman, Senior Specialist at Sheba's Endocrine Institute and director of the Center: "There's no one obesity, but obesities. People who suffer from overweight have different problems. That's why the one−size−fits−all approach often fails." When seeking the main culprit responsible for the obesity epidemic, a phenomenon identified only in the last 50 years, it's impossible to ignore the advent of processed foods and the accompanying plastic packaging and preservatives. "We're exposed to hundreds of chemical additives, categorized by the FDA as GRAS (generally recognized as safe) but whose long−term effects have not been thoroughly examined," explains Professor Amir Tirosh, director of the Division of Endocrinology, Diabetes and Metabolism at Sheba Medical Center. "We can assume that most are indeed safe, but we don't need more than a couple dozen that are not so safe to suffer the consequences." In a ground−breaking study conducted together with colleagues from Harvard University, Tirosh observed the effects of propionate, a common preservative found in bread and baked goods. The findings indicated that the
chemical can cause elevated glucose levels, impacting insulin sensitivity and metabolism. While the findings are not yet thoroughly validated in humans to warrant a recommendation to ban propionate, they do point to the need to more closely assess the potential long−term effects of this chemical, and perhaps others.
Personalized Medicine At the Obesity Center in Sheba, patients undergo a thorough assessment by a team of experts, including an endocrinologist, dietician, psychologist, and sports medicine expert. After measuring the patient's metabolic rate as well as body composition, the experts will consult and evaluate all this information to build a tailor−made plan that will suit the individual's distinctive needs and parameters. After receiving their individualized plan, patients come periodically to the clinic to meet with the professionals and track their weight loss. Depending on the circumstances, patients might be candidates for GI procedures such as intra−gastric balloons and duodenal devices, endoscopic gastroplasty or bariatric surgery. Additionally, there are relatively new weight loss drugs available today that have taken the medical community by storm. Saxenda and Belviq work by suppressing appetite and have relatively few side effects, which usually disappear with time. Naturally, the first question that people ask is, "How much weight will I lose with this drug?" Lieberman is quick to explain that there is no way she can predict weight loss. "There is an average weight loss, but each individual will experience different results. Some people may lose more than the average; for others, the drug may be less effective." Although she's seen patients make tremendous progress with the help of meds, Lieberman makes it clear that the drug can never replace lifestyle modification. The good news is that it doesn't take much to achieve a drastic improvement in health. According to Prof. Tirosh, (Continued on pg. 19)
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"in order to treat metabolic disorder, prevent diabetes, and improve high blood pressure, the goal is to lose 7% of body weight. If a patient can maintain that long term, I'm very pleased."
In the Pipeline According to Tirosh, one of the most exciting breakthroughs in obesity research is in the field of genetic screening. "We're performing clinical studies here at Sheba, and can now screen for mutations to determine if patients have a genetic propensity to obesity. It's extremely validating for patients who have been struggling all their lives with obesity to know that they're not to blame; it's not because they're lazy, or because they lack willpower." In a departure from conventional methods, Dr. Ruth Percik, senior specialist at the Endocrinology Institute at Sheba Medical Center, is researching weight loss solutions to obesity employing neurofeedback – training the brain and harnessing its power to gain greater self−awareness and increase self−control, willpower, and mindfulness. The notion that obesity could be treated via the brain occurred to her during her stint at the Max Plank Institute for Brain Research in Leipzig, where she learned that the behavior patterns linked to obesity were clearly evident in brain scans. "Scientists at Max Plank observed that the people who had lost their excess weight and kept it off for a decade, so−called Sustained Weight Losers, all had something in common: a high level of self−discipline, which is clearly discernible in brain imaging," Percik explains. "To illustrate, when obese people were shown an image of their favorite food, all the pleasure centers in their brain lit up, light those of an addict. By contrast, when SWLs were shown their favorite food, only part of their brains was stimulated; the rest was quiet. This
indicates an internal restraint mechanism, which translates as their ability to adhere to their menu plan." A year−and−a−half after the study, 70% of participants have managed to keep the weight off, corroborating Percik's hypothesis. In clinical studies at Max Plank, neurofeedback is measured via fMRI, which is not economically feasible for widespread use. Percik and her team are currently exploring a device that is compact, portable and user−friendly, to be incorporated at Sheba's Obesity Center.
Nutritional 'Blues' After all is said and done, it comes down to food intake. Dana Weiner, director of the Department of Nutrition at Sheba Medical Center, debunks the myths of traditional dieting. "When people come to me, they expect me to hand them a diet. But I don't believe in one diet that suits everyone. Even the Mediterranean diet, which I agree is an excellent food plan, is not suited to everyone." Dana believes that like all areas in medicine, nutritional science is moving in the direction of a more personalized diet, based on a person's genetic makeup and where they live. She brings evidence from study of the "Blue Zones," five areas in the world whose inhabitants exhibited greatest longevity and quality of life, yet each have distinctively different diets. What they all do have in common in terms of regimen is a plant−based diet, strategies to prevent overeating, limited alcohol consumption, and physical activity as a way of life. "My dream as a dietician at Sheba is to establish nationwide programs to educate families about healthy lifestyle and proper eating habits — along with food security for everyone," Weiner maintained.