& CareMarch 2021

The leading Israeli Medical centers and doctors

TABLE OF CONTENTS

04 Rambam: ’s strategic medical asset in the North 08 IMA: Taking care of doctors and public health 12 Beilinson: Introducing intrapreneurship 16 Soroka Medical Center: Five leading doctors talk about the Covid-19 pandemic 20 PAE - Prostatic artery embolization: A talk with Dr. Zalman Itzhakov 22 Opening a door to hope: A talk with Dr. Daniella Katz 23 How well does your mask protect you 24 ARC: Forging the future of healthcare 26 Medassist: A helping hand through the medical process 28 Personalized cancer treatment: No longer a dream, with new medical tech 30 Large population health screening: For early detection of chronic disease through AI 33 When will we declare victory over COVID-19?

Cover photo by Eric Gaillard/ REUTERS from the Editor

Dear Readers,

As Israel is taking its first cautious steps back to some normalcy, and a few days before Passover, we look back at the last year and are compelled to say thank you. Thank you to all the medical staff around the country: We are forever in your debt. However, we must remember that as we return to seeing friends and family once again, the medical teams are still very much in the midst of the battle, still working day and night to help those who are afflicted with the coronavirus. The dedicated teams are not yet out of the fray, but many of us have neglected to keep cheering them on. So let’s applaud our doctors and nurses, our innovators who work hard to improve the medical treatment for all of us in Israel and around the globe. Let’s continue to take pride in their admirable talent and devotion, their care and expertise.

Wishing you a very happy and healthy holiday,

Neria Barr 3 Innovation & Care RIsrael’sa mstratbaegic m: medical asset in the North

Rambam Campus, as seen from the Bay. (Courtesy of Rambam Health Care Campus)

aifa’s Rambam Health Care Campus is northern Israel’s only Level-1 and the referral for 12 district . When more than 60 missiles fired from Lebanon landed within meters of the campus during the Second Lebanon War, the hospital’s administration knew it needed to find a comprehensive solution that would allow its medical teams to safely treat while under fire. H The challenges Rambam faced in 2006 played a critical role in the planning process for its Western Campus. It includes fortification of the first three floors of each of its buildings: the Ruth Rappaport Children’s Hospital; the Joseph Fishman Oncology Center; and the soon-to-be-completed Eyal Ofer Heart Hospital and Helmsley Health Discovery Tower.

Going underground with the IDF 4 The most intrinsic element of the plan was the construction of the Sammy Innovation Ofer Fortified Underground Emergency Hospital, a 1,500-car garage capable & Care of being transformed into a 2,000-bed hospital within 72 hours. The largest RIsrael’sa mstratbaegic m: medical asset in the North By TALIA LEVIN‏

underground hospital in the world, it is fully fortified against biological, chemical, and conventional weapons. Dr. Michael Halberthal is Rambam’s general director. A pediatric intensive care physician by profession, he also teaches and trains medical centers around the world how to prepare for trauma and mass casualty situations. After the COVID-19 pandemic began, he was asked by Israel’s Ministry of Health to convert the hospital’s garage into a COVID-19 care facility, with space for 770 patients. Opened in September 2020 and closed in mid-March, the underground hospital served as the country's largest COVID-19 treatment facility. It was operated in collaboration with the IDF, marking the first time in Israeli history that the military partnered with an Israeli hospital to treat Dr. Michael Halberthal, Rambam’s General Director (Courtesy of civilians. Rambam continues to treat COVID-19 patients in other designated Rambam Health Care Campus) departments. World-class innovation and research 5 Through Rambam’s Clinical Research Institute, physician-researchers Innovation conduct research in many areas, such as , oncology, and medical & Care Rambam:

Two of the COVID-19 departments in Rambam's underground facility were maintained by the IDF. (Courtesy of Rambam Health Care Campus)

Dr. Netanel Horowitz, Director of Clinical Trials at Rambam’s Hematology Institute and Head of Operational cannabis. Innovative solutions are brought to fruition via Rambam MedTech, Hospitalization Logistics meets with a the hospital’s technology transfer company, and MindUP, a digital health team of physician-researchers. incubator launched as a joint venture of Medtronic, IBM, Pitango Venture (Courtesy of Rambam Health Care Campus) Capital, Impact 1st Investments, and Rambam, in collaboration with the Israeli Innovation Authority. Rambam’s collaborative partnerships with institutions in Israel and abroad such as Stanford , Memorial Sloan Kettering, and the Technion, ensure that its impact is felt worldwide. When completed, the Helmsley Health Discovery Tower will create an environment that fuels scientific investigation and discovery. By harnessing Helmsley Health Discovery the power of Rambam’s outstanding healthcare professionals, stellar academic Tower at the heart of the Rambam campus. (Courtesy of institutions, and Haifa’s vibrant biomedical ecosystem, this state-of-the-art Rambam Health Care Campus) innovation hub will secure Rambam’s position as a leader at the highest global levels. •

6 Medical staff discussing the status of a COVID-19 . Team members wear large name tags so Innovation they can be more easily identified by colleagues and patients.(Courtesy of Rambam Health Care Campus) & Care

Taking care of doctors and public health

By Neria Barr

he Israel Medical they define the working conditions Association was of the doctors, which concern not founded in 1912 by a only salary conditions but also pharmacist and six doctors quality of care, medical ethics, and who had immigrated to related issues. Israel. The IMA’s first The other issue we deal with is the protocol was written in quality of medicine. It is expressed T in three components. The first is Russian and included three main goals: To represent the doctors in the Scientific Council, which also Israel; to take care of the quality of has a statutory role by law. We medicine in Israel; and to promote are responsible for the world of public health. specialization in all its aspects. It Leah Wapner is the secretary also concerns the syllabus of doctors, general of the IMA. A lawyer by various committees and exams. The education, she has been its legal third component is the exams and adviser for more than 20 years. recommendations for a specialist On an international level, she is degree, We have 56 different medical the adviser to the World Medical professions. Association and secretary general A new topic is the Institute for of the European Forum of Medical Quality in Medicine, which was Associations. established six years ago. It is headed “There can be no reality in which by Prof. Leonid Eidelman. His you say the health care system will predecessors were Prof. Zimlichman have no resources and will not be and Prof. Rachmilevitch. good but the doctors will be good.” The latest topic is scientific Says Wapner. “Alternatively, it won’t journals, which are designed to be good for doctors and medical staff, engage and assist in the field of but the system will be wonderful. medicine. Our concern is not only for good In the realm of public health, we medical care and good doctors but have departments within the IMA also for health issue as a lifestyle. that deal with public health, medical The founders of the IMA thought policy, and everything related to about all these aspects more than decisions in the Knesset in the areas a century ago, even before the of medicine and health. Spanish flu. Since then, the IMA The IMA is built like a matrix. has undergone many changes, but On the one hand, every doctor is a the vision and tasks they set remain member of the association. On the a guiding principle to us.” other hand, they are also organized by fields. First of all, there are our associations and societies according Leah Wapner (Courtesy) What does to the scientific field, such as family the IMA do? medicine, , etc. In The IMA is first and foremost a addition, there can be a society for a forum of coronavirus consultants, workers’ organization, unrelated to sports, for teenage girls, etc. We which includes experts on infectious the Histadrut. It was founded before have over 200 such organizations. diseases, public health, family the Histadrut. We represent the An organization can comprise 20 to medicine, and internal medicine. 8 doctors in Israel. We sign collective 50 doctors or 1,000 or more. They In each subject, we have a group Innovation agreements with all the doctors who are the ones who advise us in all of unions. & Care work in the public system, where areas. For example, we have set up For example, if the Institute for As proven in a study conducted by the University of Berlin - A reusable face mask that destroys 99.9% of the coronavirus. Even now, when there are vaccines, we want one mask in our pocket that will always protect us. A reusable mask, with 3 layers and suitable for use for 210 days. Swiss technology that is scientifically proven and does not contain metals or toxic substances. The mask is treated with a unique substance that destroys viruses and bacteria, tested at the Standards Institute and by the Public Health Association. For more information: thelivinguard.com and call *5787

Import and marketing of medical equipment and safety equipment www.gazit.co.il Quality in Medicine wants to such as benefits and professional cases where entire medical probably not reach a situation issue clinical guidelines on training, Last year, we established teams went into quarantine, where a hospital will be closed; home hospitalization, then it the online school of the IMA, and there were changes in the but if people in Israel receive backs up general medicine and where we transfer many new manpower agreements. In the less good treatment than they family medicine and tries to find skills that are needed. What we first period, hospitals stopped could have received, then that is what is acceptable and agreed did during the corona period all the elective medical activity certainly the case. If there is no upon by all unions so they can can be instructive regarding our and decided to wait and see place to put patients, not enough work according to one theory, activity there. what would happen. We had space in intensive care and not the important aspect being the When the coronavirus erupted to take care of the doctors who enough skilled workers, and the scientific part. into our lives, the first issue we went into quarantine by sending workers are exhausted, then it We also have organizations by had to deal with was setting food baskets and other needs. is clear what the conclusion is. workplace. When there is a state up four emergency focuses. Today there are fewer medical We are not learning or preparing employer, Hadassah, Clalit, it is The first issue was together staff members in quarantine. At for the next pandemic. In my clear that the working conditions with the Society for Infectious that time, we also contacted our opinion, we should not have had have nuances, and we allow the Diseases. At the outset, when the retirees. a third lockdown if there were organizations to organize state doctors wanted to get as reliable We did several things. We ran investments that were suitable in doctors, such as the organization information as possible, they the Institute for Medical Quality, advance. In the end, money that of doctors of Hadassah. Our would call and leave questions. which had many discussions and is not invested in the health care institutions enable dialogue It worked very well, but there issued position papers on various system over the years ultimately between the institutions and were so many inquiries that the issues. We have been working results in a much greater expense. the organizations. The IMA’s experts literally collapsed from tirelessly with the Ministry of Because at the moment of truth, institutions are a secretariat that the volume of questions. Health, we realized that in such there was a hysterical reaction. is basically a board of directors, Our second focus was a severe crisis, the last thing They equipped themselves with a central committee, along with on ethics. There were many the state and the doctors need unnecessary things on the one the scientific presidency and so questions of ethics in the context is a plurality of votes. Different hand but did not add positions on. We also deal with issues of corona. For example, doctors voices emerge anyway, but we and people. For example, of policy, health economics, asked if they were endangering tried to be as consistent as they said they would add 600 concern for the right funds themselves when treating a possible with them unless there positions, but then said ‘Maybe between HMOs and hospitals corona patient. Toward the were guidelines that we thought not now. Maybe we don’t need it.” and the like. middle of the hearing about were incorrect. After all, those One of the worst things that Then there is the IMA’s corona, the Bureau of Ethics who sit in the Ministry of Health has happened to us in the field Bureau of Ethics, Ir sets the together, with other officials, are also our doctors. of medicine is that the line principles and guidelines of the issued a position on priorities In addition, we set up a between politics and medicine Bureau of Ethics and instructs regarding administering Corona Consultants Forum. It has become blurred. This must doctors on how to proceed. respiration. The paper provoked was founded by Prof Zion Hagay, not happen. What I loved in Sometimes these are issues much controversy. It spoke of the chairman of the IMA. There the past is that there tends to between doctors that are social extreme cases, in a state of are also representatives of the be a distinction between politics issues. As the issues become scarcity when we still thought unions, relevant experts from and medicine. Unfortunately, more social, we try to keep in there would be a shortage of hospitals and the community. Covid-19 has blurred this thing, touch with other organizations respiration machines. The aim is to meet every week or and we have considerations that that deal with ethics in order The next issue was a focus of twice a week to discuss one of the are influenced by politics. Instead to issue some position paper labor law. The children at home issues, such as school openings; of medical considerations, there that will be acceptable not only have no framework. Is it possible lockdowns and when and how are political considerations. to the medical community to stay home; is it considered to exit them; vaccinations; People must think about the but something broader. The a day off? We gave individual serological tests. We discuss all comparison between Japan and Bureau of Ethics is very active answers to everyone. these and publish out position us: 100 million inhabitants and in position papers and also deals The fourth issue we did papers. Things have changed the same number of deaths. with complaints against doctors. together with the Eran, the over the year. There are things The test is not whether the Not in medical malpractice but mental hotline. We opened a we thought at the beginning of decision is right or not in a new ethical issues, such as how to special hotline for doctors who the pandemic that have evolved disease no one knows about. We behave and what to do. needed support. There were cases into what we know today. do not have complete certainty, In the end, we need to when we also enlisted the help At the same time, we are but the public wants to know that understand that this is a big of the Psychiatric Association, constantly fighting for the system the decision is made in the public operation and we are also a which provided help for the to receive resources. There are interest. Once the public is not member organization and must doctors. two things we have learned in the sure of the decision is medically take care of what employs them We had to enter into unique context of the pandemic. The first motivated and may be influenced in the professional field. It can collective agreements for the is that such a poor investment by political considerations, we be at the private level, such as first period. From the beginning, in the over the destroy public trust. Public trust 10 doctors who want to set up a especially considering that years is coming to fruition. The is something you can destroy in a Innovation private practice, how to do it, etc. the topic of protection was question is not whether the minute, and rebuilding it is very & Care Or it can be work-related issues, still unclear, there were many health system collapsing. We will difficult. •

‘intrapreneurship’

rofessor Dan Shechtman, winner of the 2011 Nobel Prize in Chemistry and the Israel Prize Pfor Physics in 1998, chairs the board of trustees of the Innovation Division at Beilinson Hospital, an initiative of the hospital’s CEO, Dr. Eytan Wirtheim. In this interview, Shechtman talks about the importance of innovation and having an intra- organizational entrepreneurship center as part of the day-to-day life at the Beilinson Medical Center. “The concept behind the innovation center initiative at Beilinson is to encourage intra-organizational entrepreneurship.” says Shechtman, who lectures on these issues around the world. “The idea is to establish a body of professionals within the medical center who will listen to ideas of the staff and sift through them and decide which suggestions warrant being promoted.”

What does that mean exactly? In any organization, the people who really know the details are the workers in the field. Management focuses on the organization’s goals, on tactics; but on a day-to-day basis, it is the workers who know what can really make a difference. In any workplace, everyone knows their own department. So the 12 employees of an organization Innovation have a tremendous economic & Care value for their organization, a Professor Dan Shechtman (Photo by Shlomi Yosef) ‘intrapreneurship’ By Neria Barr

value that very often is not A second advantage is that And it can improve the quality Plus Ultra being utilized. That value is employees will feel like they of life. These improvements have Innovation their knowledge and their are partners in the organization social and health consequences, ideas about how to promote the and are communicating with so it is important that everything Dr. Eytan Wirtheim, director organization in various ways. I the management to improve the be done in the best way possible. of the call it ‘intrapreneurship.’ organization. The third thing is Beilinson is one of the largest (Beilinson and Hasharon) of Intrapreneurship means that if the management wants hospitals in the country and is the Clalit Group, is leading that there are already two to know who deserves to be a leader in some areas. There is an innovation strategy that points of view. The first is the promoted, it is the people with a large team of experts in the connects the medical, research and development capabilities management’s. The second the good ideas who deserve it. different departments. I have of a hospital, together with is that of the employees. In a They should not only rely on been meeting with them every the ecosystem of the Israeli hospital, I am talking about the the recommendation of their day. I see this as a mission. start-up nation. That is how entire staff at all levels, not just direct boss, but the management In practice, we have a they are promoting the next doctors. Everyone. will know this doctor, this framework of six key people breakthrough that will improve Management should inform nurse. Employees with good who help me promote the lives of millions of people. employees that it expects them ideas deserve to be promoted intrapreneurship, There is also an The following is what to come up with ideas, solutions, because they can advance their advisory committee -- experts in Wirtheim says on the subject: and innovations. The changes staff and the organization. That different fields. Most of them are When we talk about they might suggest could be is what underlies the concept of doctors, but some are from other innovation, we always look related to medical procedures or intrapreneurship. backgrounds, essential experts ahead. But because innovation new equipment, ideas to refine to the organization. They are is also thinking differently, I the treatments, or a different way How is it implemented at wonderful people who want to choose to start by sharing to organize the operating room. Beilinson? help and contribute and set up a a story from 500 years ago. These types of innovations are Beilinson is a hospital that is great atmosphere in the hospital. According to mythology, in the for the benefit of the patients, close to my heart because I was In my opinion, this concept Straits of Gibraltar the Pillars the staff, and the hospital in born there 80 years ago. When is important not only in a of Hercules were inscribed with general. That is what stands I was born, the hospital was hospital but as a general idea the phrase “Non plus ultra” behind the management’s point seven years old. I also grew up that should be implemented in -- “Nothing farther beyond.” of view. in a neighborhood bordering the any organization. In Israel, we are The giant pillars marked the In addition, management hospital. very good at intrapreneurship. boundary of the known world should tell employees that if A hospital is a very complex But it is not possible for every and warned sailors not to go someone comes up with a good institution. The public sees employee who has an idea to any farther lest they fall off the idea, it will implemented, and only the result. A patient is contact the general manager. “end of the world.” In the 16th the person will be adequately hospitalized, cared for, and that’s At Beilinson, that is where my century, to encourage Spanish rewarded – financially or it. But a hospital is a much more organization comes in. It is the explorers to sail into the ocean otherwise. The employees complicated organization. For mediator between the hospital and discover the New World, need to know that management all systems to work toward the staff and the management. the king of Spain coined the expects them to come up with benefit of the public, a lot of things In practical terms, we sort phrase that is Spain’s motto ideas, anything that can promote have to happen; and a lot of things out the proposals, decide which to this day: “Plus ultra.” The the organization, streamline it, can fail when they are not done ones to support, and then present message became “Dare to go or perfect communication. optimally. So in a hospital, there them to the management, farther!” This is the vision of is a real need for intrapreneurship. recommending which ideas innovation of Rabin Medical What are some of the benefits? In addition, there are a lot of should be promoted. When we Center, and this is the future There are several benefits. doctors, the people who take receive a good suggestion from of medicine: to always strive One advantage is that the care of human lives. Anything an employee, it also helps us forward, to look beyond -- and 13 ideas that come from the field that can help them to provide to recognize who deserves a to dare. Innovation will advance the organization. better care can be life-saving. promotion. At Beilison and Hasharon & Care hospitals (Rabin Medical Center), we provide the best medicinal attention every day, and we think about tomorrow’s medicine every day. That is the only way to promote medicine, research, and innovation. As part of our strategy, we have established the Innovation Division – a spearhead that will enable us to continue the innovations and achievements that have been made here for more than 80 years. We have recruited the best people. Prof. Dan Shechtman, a great scientist and Nobel laureate in chemistry, serves as chairman of the board of trustees of the Innovation Division. Prof. Ran Kornowski, director of the Cardiology Department, a leading cardiac catheter expert and world- renowned researcher, chairs an advisory committee with 12 leading physicians. Dr. Leor Perl returned to us from Stanford, the world’s leading Dr. Eytan Wirtheim (Photo by Shlomi Yosef) center in medical innovation, and brought with him the outline for an incubator of innovation and path that may end in patent Nobel Prize winners, and an annual integrative connections. The result registration, establishing a start-up, research budget of half a billion is the creation of a unique model, and sustainable products. Led by Dr. dollars. Digital health, big data, which places us as the medical- Perl, a vibrant innovation center has and artificial intelligence -- the technological spearhead of the been built that connects physicians, future of medical innovation that Start-Up Nation. researchers, and academics, as we promote with in-house teams Innovation flows in the well as industry, entrepreneurs, and with the help of Clalit’s support, blood of medicine. Without and investors. The combination which allows us to create platforms entrepreneurship, courage, and of a clinical environment, studies, of algorithms and deep learning huge investment, the world would medical staff at the patient’s bedside, through constant diagnosis and not have been vaccinated against a and a rich database creates great treatment that is more exact than deadly virus in less than a year since value. In the age of digital health ever before. Customized medicine its inception. This is the medical and big data, it is the perfect which we will launch here this innovation of the 21st century: laboratory for developing solutions year at Clalit’s genomic flooring the ability to bring about change that see the patient throughout his center, and next to it a tissue bank that will directly affect human life. or her medical journey. that will complement the research Therefore, innovation is located at Our innovation system has capabilities in complex diseases. the core of our strategic compass other layers. For example, basic Integrated diagnostic capabilities in the medical center as a cross- and translational research at the that connect information and data cutting component, affecting Felsenstein Institute, affiliated from imaging systems, pathology every field and creating the DNA with University and the tests, omics (genomic information of the organization: free thinking, Clinical Research Authority -- an and functional information at the continuous improvement, and area in which we’re leading with protein level) and other modules. connection of capabilities that will about 1,000 new studies that passed The picture is clear: Rabin bring the next breakthroughs. the Helsinki Committee in 2020. Medical Center is not only Clalit’s In this spirit, we have established Breakthrough technologies that flagship branch, but it is also the an incubator for development our senior physicians develop ‘aircraft carrier’ of innovative and innovation. It is based on the and implement, which place us at medicine, whose staff and the tools understanding that solutions grow the forefront of medical progress. on it can decide a battle. This war 14 from the field and encourage all International connections with is being waged for the health of Innovation our employees to identify needs, leading centers such as UTSW millions of people, and we intend & Care promote ideas, and embark on a in Dallas, an institution with six to win it. • Health 100%, Activity 100%

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By Neria Barr

FOUR HEADS OF CORONA UNITS AND THE MEDICAL DIRECTOR OF INNOVATION AT SOROKA MEDICAL CENTER, PART OF CLALIT HEALTH ERVICES, SUM UP A YEAR OF CORONA

(Photo by Ron Miller) (Photo by Rachel David) Prof. Leonid Barski Dr. Amit Frenkel Head of the Internal Medicine Department F Critical care outreach team, General intensive The department was the first at Soroka to become a corona care unit, and the medical manager of Soroka’s department. innovation directorate

During our normal work on normal days in the inpatient wards, Soroka is leading hospital in Israel, and the only hospital we are confronted with people of all ages in all situations – including serving the region, with a population of over one ventilated patients, connected to machines. We are in close contact million people. Therefore, with the outbreak of the corona with the community, and this knowledge created our ability to pandemic, it was clear that in order to continue to lead adapt quickly and become a corona ward. in the level of medical care, all of the hospital’s staff may When the pandemic broke out and we were asked who was be involved in care, alongside innovative technology as willing to take on the task, I volunteered. To my great joy, most a force multiplier. of the doctors and nurses in my department joined me, as well as First, the hospital’s computing unit was tasked with those from other departments. We have learned how to cope and introducing technologies that enabled corona wards to be how not to become infected. viewed using CCTV cameras, including the use of voice The entire team worked together as one. It is not only the patients capabilities to make remote calls. A situation room was and their families that need emotional and physical support, the set at the entrance of the ward, where the medical staff staff also need a lot of support. can monitor patients from afar. These monitors included Our treatment of corona patients included keeping in touch heart monitors, respirators, and automatic medication with the families, especially families of elderly patients who were injection pumps. in critical condition. Our family care team included a social worker, At the same time, we began intensive collaboration with nurses and doctors. When treating a corona patient, a protected the aerospace industry to establish a project called the team enters, and they all help each other. The doctors, nurses, ‘cockpit.’ This project uses technology from the world of and physiotherapists support each other because we must treat military aviation, according to which the critical information the patients quickly. is projected in real time in front of the pilot’s eyes. Another important element that helped us Robots were used as a communication relay cope was the support we received from the with the patients. Capable of connecting to hospital management – administrators, the Internet, driven remotely, they were logistics, computing, spokespersons. All brought into the corona wards and carried the other departments gave us tremendous medical equipment with them, while support. They all worked in coordination photographing what was happening there. and together. For example, our unique The hospital continued to provide the corona department, with all the special best care for corona patients, despite technologies and the construction of the heavy workload on the various the tele-medicine (remote medical departments, while demonstrating system), was built very quickly. flexibility, openness, and Thanks to all this, we believe that in technological creativity that will the end we will defeat the coronavirus continue to accompany us in the 16 and return to a normal life. • years to come. • Innovation & Care University Medical Center

(Photo by Ron Miller) (Courtesy)

Prof. Victor Novack Prof. Yaniv Almog Director of the Department of Internal Medicine H. Head of the Internal Medicine Intensive Care Head of the Research Authority Unit for COVID-19 patients

During the corona period, the Internal Medicine Department The medical of the hospital became the corona department for 4 months, while during the was basically converted into the corona intensive rest of the year we were treating an ever-increasing number of care unit. We treat the most critical patients. When other patients. It was a very challenging year for the whole team. they come to us most patients already suffer from A health system is not unlike the military: in the same way that collapsed lungs and cannot breathe on their own. the military trains all year round for war, the health system trains These are difficult and challenging patients because for medical emergencies. Now a medical crisis has come, and I their condition often deteriorates fast and the think we have fulfilled our mission exceptionally well. mortality rates are high. In my position, as a head of the research authority, I work closely I feel that we are coping well, but the duration of with other hospitals all over the world. In general, despite all the process has an important impact, adding to the the criticism about the government’s conduct during the corona difficulty, unlike other emergency situations that we crisis, I think our health system has managed to deal with the have grown accustomed to, which usually end after crisis with excellence. Despite the intimidation, we were never a few days or weeks. We need to cope with a very on the verge of collapse. We know how to function in stressful intensive period that continues over many months, situations and be very effective on a daily basis, despite the fact and the fact that the end is not visible, makes it even that health spending in Israel is relatively low compared to many more challenging. Although the economy is slowly other countries. In a way, our national health system turned to opening up, the struggle has not really ended, and be well prepared to deal with the crisis of such a proportion. Yet, the end is very far. we must admit – without a change in the approach to medical The staff members draw strength from each other care on the governmental care, in the near future we will be not and from understanding the magnitude of what able to deliver the best of medical care to our patients. it is that stands before them, the importance of We must remember that we have not yet dealt with the the mission. complications of the recovery. Some patients have recovered We also draw strength from the inner cohesion of from the coronavirus, but their long-term health consequences the intensive care team. This is a significant coping can be severe. I believe that many people who suffered severely resource. Losing patients is painful, but we draw from COVID-19 may experience chronic conditions for a long strength from those we manage to save, and there time, possibly a lifetime. are many of them. As a doctor in intensive care Dealing with this disease has had a humbling you need to balance things out, to choose what you effect on us. We know today that there are things take home with you at the end we do not understand. We do not always have of the day, and patients who answers. The coronavirus does not always behave recover and come back to as expected. We just have to learn to say we do visit later, give us strength. not know. That is fascinating to me. The fact that Covid-19 is a serious I don’t know is an important starting point to disease, and recovery start exploring. from it is very The pandemic gave a boost to research complex. These processes and now we need to leverage what are very slow and we have learned. Innovation in the medical long processes. system is critical and corona taught us There are that we can significantly shorten the many patients time from the laboratory development w h o h a v e to the patient bed. • seemingly 17 Innovation & Care recovered from the life-threatening stage, but they are left with many side effects, such as oxygen dependence and a host of other manifestations such as confusion, pain, and general weakness. Overall, as a result of the pandemic, I don’t think that medical procedures will change, but some things will happen. I believe the volume of telemedicine will occupy a much larger share. Telemedicine can shorten appointments, as treatment in outpatient clinics can be done that way. We now have the ability to give treatments without the patient going out of the house or ward. Another thing is our ability to deal with accepting situations beyond our control. I think that life in general and medicine in particular present many situations that are out of our control. Doctors are not omnipotent, and I think the coronavirus emphasizes that. It asks us to take an in-depth look at our ability to live in peace with situations that are beyond our control. Perhaps that will reshape the way we confront the medical world. •

(Photo by Ron Miller)

Dr. Carmi Bartal Head of the Corona Departments Director of the Internal Medicine Department.

Our life during the corona period has been a trajectory the frustrating experience of treating corona patients. of ups and downs and various trends. We have gone We have weekly group meetings with various experts through closures, a period of enthusiasm about the from our center and outside to help the staff deal with vaccine, and now many believe that everything is behind the difficulty, and it works very well. The team is solid us and that life is getting back on track. It is very gratifying. in regard to personal and emotional resilience. But when I look at my wards, we are still very busy. We see The political system must find a way to strengthen patients of all ages, from 20 to 80 and both departments the internal departments in the country. are full. The reason is that we have a large number of Fortunately for Israel, the teams that make patients from a population that has not been vaccinated. up the health system are our X factor. Working in the Corona Department poses very difficult That is what gives us the strength to physical and emotional challenges for the whole team. The work under conditions and provide emotional loads are very deep for several reasons. We are quality medicine at a high level. The faced with a disease for which we have very few tools. It is a question is how long we will be able disease that deceives us. It is very destructive, and patients to keep it up. • can deteriorate rapidly. A serious illness and a toolbox that is not efficient enough is a frustrating combination. Added to that is the fact that some people still say it is the flu, which is something I cannot understand. The coronavirus is a disease that causes rapidly deteriorating severe pneumonia, ending in many cases with irreversible lung destruction- respiratory failure and death. The rapidity and the high rate of mortality when respiratory failure is presented has not been familiar to us. One way to deal with the situation is to have a change of scene from time to time. You have to go up to a regular ward for a period of time to refresh yourself. Even I, who have 30 years of experience as a doctor and have gone through many difficult times and dramatic events, I must say that this is thechallenging time in my life. 18 Not so much professionally but more emotionally and Innovation & Care If only It were allowed, we would hug you.

SuzukI thankS you, the medIcal teamS who are up to the taSk of carIng for and SupportIng patIentS, and gIveS you a SpecIal benefIt

For details, contact us: Promotion valid until 1.4.2021, subject to regulations, according to 01/2021 price list. Specifications of the promotion’s models are published on the site www.Suzuki.co.il. Minimum 50 units in stock, photos for illustrative purposes only. E&OE Prostatic artery embolization (PAE) – the innovative way to treat lower urinary tract symptoms due to benign prostate enlargement

A talk with Dr. Zalman Itzhakov, Interventional radiologist and the director of Diagnostic Imaging institute at E.

by NERIA BARR

enign enlargement especially in middle-aged and What are the or weak urine stream. urinary of the prostate often older men. It can reach up to 50% symptoms? retention that may require causes urinary at age 50; 60% at age 60; and 70% catheter insertion, and s y m p t o m s at age 70 and up. In some cases, Common symptoms include impotence as a side effect of and significant despite a significant increase in difficulty starting urination, a the medications that can treat impairment of prostate volume, the patient does feeling of a lack of emptying, the problem. quality of life. The not feel the symptoms and does frequent urination, especially The recommended treatment B at night, straining to urinate problem is quite common, not require treatment. depends on the severity of the symptoms. There is a wide selection of treatments, ranging from medication to surgery. Without proper treatment, benign prostate enlargement can lead to dangerous complications.

What is PAE? “Embolization of the prostate arteries is an innovative and minimally invasive treatment for the problem,” explains Dr. Itzhakov. The purpose of the procedure is to block the blood flow to the prostate. Without blood flow, the prostate degenerates and shrinks. Dr. Itzhakov is a pioneer in prostate artery embolization 20 Benign Prostate Innovation Enlargement and is the most experienced & Care (Photo by Shutterstock) professional in the country. EndoRad is a private clinic founded and managed by Dr. Zalman Itzhakov, an interventional radiologist who specializes in minimal invasive procedures. In his public position, Dr. Itzhakov is the director of the diagnostic imaging institute at the Wolfson University Medical Center in . (Courtesy) In the past, he was head of the vascular and interventional unit at Shamir Medical The treatment is approved option for appropriately for surgery but can be Center (Assaf Harofeh). by the English National selected patients. excellent candidates for Dr. Itzhakod completed his Institute for Health & Care, The Societies recommend PAE,” the societies say in internship in diagnostic and Excellence, and in the US PAE as a valuable minimally the statement. invasive radiology at Shamir by the FDA. invasive option for patients “Most patients feel no Medical Center (Assaf Harofeh); “The procedure takes who cannot tolerate or who pain during the procedure. participated in a fellowship in Italy about two hours,” continues have failed medical therapy, During the first days after at San Rafael Milan Hospital. Dr. Itzhakov, “During PAE, as well as those who are the procedure, patients The staff at EndoRad Clinic local anaesthetic and mild poor surgical candidates may experience a few renders high-quality customer sedation medication is or refuse invasive surgery. minor symptoms such as service, providing personal given, a catheter is inserted Recent studies, revealed mild pelvic pain, frequent guidance to each patient from the into an artery while using that the new treatment urination and burning first stages through to recovery. image guidance. The has shorter recovery and sensation in the urethra The clinic performs all types of catheter is directed to fewer complications than and anus, that can be easily vascular catheterization, such as the arteries on both sides traditional surgery and relieved with pain killers,” thrombosis of the deep vein system of the enlarged prostate improves symptoms and says Dr. Itzhakov. in the lower extremities, diagnosis gland. Then small beads quality of life to a greater Recent studies show that and treatment; treatment of degree than medical therapy. chronic limb ischemia; repairing are injected to block the patients who underwent blood flow to the prostate, Furthermore, the position embolization of the prostate of aortic aneurysmsa.Pelvic statement says that PAE is “a congestion syndrome. which results in the gland’s arteries did not experience shrinkage. Unlike surgery, definitive treatment option impairment in their sexual PAE avoids access through for multiple under-served function. Such damage the urethra, anesthesia, and patient groups who may not usually occurs after surgery hospitalization. have satisfactory urologic treatment options.” These safety and Current patient groups include EFFICACY evidence older patients with multiple medical conditions; patients PAE is safe and effective According to a with very large prostates; for treating enlarged position statement from patients with bleeding from prostate. Following interventional radiology the prostate; patients with embolization, the volume professional societies long-term bladder catheters; of the prostate decreases in the US and Europe, patients who cannot which results in significant PAE is a safe, effective, stop anti-coagulation improvement of the urinary and minimally invasive therapies; and patients who symptomss. • treatment for enlarged desire to preserve sexual 21 prostate and should be function. “These patients For more information, Innovation presented as a treatment are often poor candidates visit www.endorad.com. & Care Opening a door to hope By Neria Barr

r. Daniela What happens when you and studies and new methods. Katz is a break bad news to cancer Sometimes it is important for specialist patients? patients just to hear that they in internal From my experience over the are in good hands and are being medicine years, I have realized that what treated well. Sometimes when and a medical patients and families lack is close they hear more data, they can Doncologist. She professional guidance. We know brainstorm with the doctor about trained at Hadassah Ein Kerem that when patients receive the more treatment options and and completed a two-year news of a cancer diagnosis, their find out if the information they fellowship at MD Anderson in world is turned upside down. received is complete and how Dr. Daniela Katz (Photo by Yossi Aloni‏) Houston. Dr. Katz specializes They enter a new world with a they can get through everything in the translation of genetic new vocabulary. When the doctor more easily. testing to personalized therapies gives the patient the news for Many people will wonder, what this is when we have to look for in breast cancer and sarcoma. the first time, in most cases the is the thing you like most in your things out of the box. Until recently, she was the head patient is not really able to hear job, if such a thing exists? of breast and sarcoma services and absorb what is being said. Not everything is gloomy in What is your experience with at the Assaf Harofeh Medical The stress is too great. my field. I most enjoy informing patients seeking for second Center. She is a leading sarcoma I once heard a lecture by Dan patients good news. If after a few opinion? specialist. Katz is an active Ariely, who said that when people weeks of treatment, we meet and When I am asked for a second member of the EORTC sarcoma are in a state of stress, they lose the results of the CT scan show opinion, I always request to be group and serves as a reviewer of up to 15 IQ points. The stress that the treatment is working given all the material in advance several journals, such as Annals and the anxiety interfere with and the tumor has shrunk, that so that I can go through it and of Oncology. their ability to understand and is excellent news to break. And sort out the essential information. remember what was said. Many there’s nothing more rewording It is important for me to make Why did you choose to work times patients say to me ‘Why than giving a patient good news. sure I don’t miss anything. When in the field of cancer? didn’t they tell me?’ But they the patient arrives, I can devote What attracted me was the probably did say it; the patient And when the news is less all my time to discussion. From ongoing relationship with the just couldn’t remember. That is good? my experience, patients are very patient. When you are a doctor why I always recommend writing The most important thing is comfortable with this concept in the field of internal medicine, down every word the doctor says. to keep hope alive. We must feeling that they really made you are used to taking care of all not take hope from the patient. good use of the consultation time. the patient’s problems. That is, What is the benefit from taking Even when negative news is are Many times they leave relived you are the patient’s doctor, and a second opinion? delivered, we must deliver it and, as they better understand their you accompany the patient all After receiving the bitter news, at the same time, open a door to disease and treatment options. the way. In the field of internal I think it is very important for the world of hope - meaning that My role as a Medical medicine, you can specialize in a patients to get a second opinion. there is something to be done and Oncologist is to reassure patients wide range of fields. But this way, Not because they don’t trust the suggest the next practical steps. that nothing is overlooked and you are actually treating a narrow doctor – we have great doctors When a person is told that there they are getting the best therapy part in a very specific area and in Israel and excellent medicine. is nothing to do, it is worthwhile that will make them better. • are seeing the patient only But another opinion can help getting another opinion. It is through that prism. In oncology, the patient understand things possible there are other options. Dr. Katz receives patients in you remain the patient’s doctor in depth and accurately. After, Sometime, genetic information Jerusalem and Tel Aviv. All HMOs and you are in constant contact the news sink, more questions can help with unique treatments except Maccabi reimburse the with the patient, which is what arise that can be referred to tailored to the patient or abstracts services provided by Dr. Katz. I wanted. That is why I chose another doctor. In many cases, presented at recent medical To schedule an appointment, oncology. But because the field simply to know that what was meetings. As doctors, we have call 050-404-8867 or email 22 is very broad and has a lot of recommended is correct and up to be empathic but at the same [email protected]. For more Innovation subspecialties, I chose breast to date. In the field of oncology time be paternalists and outline a information, visit the website & Care cancer and sarcoma. there are constant developments map with practical steps. I believe https://www.dkatzmd.com/katavot. does your mask protect you? By Neria Barr

ded Gazit is the owner of Amos Gazit Ltd., a company that imports, sells, children, so masks will be with and distributes us for quite some time. Oded Gazit, head of Amos Gazit (Courtesy) Omedical and There is also the issue of personal protective equipment. traveling abroad. There are that can be severe. We have This is what he has to say about countries where the situation is found that wearing a mask helps alongside other particles. The masks in general and Livinguard more difficult, and the dangers to prevent infection in virtually fabric from which the mask is masks in particular: are extreme, not to mention any disease. made is treated with substances Masks are here to stay. the flight itself. It is therefore If the price of being healthy that cause viruses (whose ions Whether we are on the street important that we always have is to walk around wearing a in their shell are negative) to be or in a crowded place, we don’t at least one reliable mask in our mask, especially in crowded “magnetized” to the mask and know who has been vaccinated pockets. places where the risk of being become neutralized upon its and who has not. In addition, we When we buy a mask in a infected is higher, it is not a surface. don’t know whether those who store, it is difficult to know bad solution at all. It is very The mask can then be washed have been vaccinated can infect which type is safe and which is important in crowded places with warm water, but not in a others ,and moreover – Covid-19 not. Most of the masks we use such as airports, sporting events, washing machine. The mask isn’t the only disease out there. As are not hermetically tight from and mass cultural events. Perhaps maintains its filtration and anti- long as there are people who have the sides and bottom, thus we are getting used to wearing a mask viral qualities for up to 7 months not been vaccinated, we will have breathing unfiltered air, prone is not such a bad idea. and up to 30 rinses with water. to protect ourselves. We don’t to infection. We need a reliable, high- Livinguard comes in two want to be infected or infect others, Professional terminology quality mask. It is important sizes: large (adults) and medium especially makes a distinction between to choose one that has been (women and children). Unlike a mask that protects us from scientifically proven to destroy other masks, it is completely infecting others and a bacteria and viruses. Livinguard, opaque at the top, so eyeglasses respirator that protects the masks our company imports don’t get fogged up. us, those who wear. Both to Israel, are being sold all over Researchers from the Free are called masks, but we the world. The mask was develop University of Berlin at the want the one that will ed in Switzerland and has an Institute for Animal Hygiene and both protect us from ingenious solution. It protects Environmental Health have now the surroundings and the wearer without the use of been able to demonstrate that protect others from us. toxic metals or toxic substances. textiles treated with Livinguard This winter, we The mask’s unique technology Technology can destroy 99.9% understood how well destroys the virus and almost of SARS-CoV-2 (the virus masks help prevent every bacteria, virus or fungi. that causes COVID-19). These infection. We saw the The mask is made up of three scientific results follow on similar proof in the dramatic layers. The inner layer and outer findings from the University of drop in flu morbidity. We wore layer are made of high-quality Arizona, Tucson. • masks, and the number of flu cotton that is soft to touch victims decreased significantly. and treated with the anti-viral Livinguard masks are available There were hardly any cases. It is properties. In the middle, on the company’s website, as 23 important to remember that the there is a filter that filters up to well as at Shufersal Be stores. Innovation flu is an unsympathetic disease 99.9% of viruses and bacteria, www.gazit.co.il * 5787 & Care Forging the future of health care

By Neria Barr

he ARC (accelerate. chief innovation officer at Sheba, Zimlichman redesign, collaborate) leads the enterprising ARC center. Innovation Center at “About five years ago, we started looking the in for ways to channel innovation for the accentuates a improvement of medical services on a global unique strategy. It accelerates scale. There are many gaps between what Tinnovation and redesigns health modern medicine can offer patients and what care by collaborating with partners. actually reaches the patients. We wanted to “Our mission is to transform health care find ways of bridging these gaps in a proactive delivery and improve patient care through way,” Zimlichman explains. innovation,” says Professor Eyal Zimlichman, “Very often, we wait for a start-up company deputy director general, chief medical officer, to reach us with ideas, but we are being and chief innovation officer at ARC Sheba proactive – we want to turn the vision into Medical Center. reality by looking for solutions to problems. Professor Zimlichman is an internal We have invested a lot of effort, together medicine physician, healthcare executive, with our international partners, to create 24 and researcher who focuses on assessing the medical vision for 2030. This is a very Innovation and improving health care quality and value, ambitious goal. In order to reach it, we & Care patient engagement, and patient safety. As developed ARC – Accelerates innovation Professor Eyal Zimlichman (Photos courtesy of Sheba)

and Redesigns health care by Collaborating artificial intelligence (AI); precision medicine is leading currently is the control tower. with partners – which will help us get there,” (aka personalized medicine); telemedicine; “Hospitals are very intricate organizations. he asserts. virtualization in medicine; and innovations There are many characteristics that a hospital The concept is based on four principles, in surgery and rehabilitation. and an airport have in common; but while he elaborates. Telemedicine received a lot of attention an airport is run in a very meticulous and “The first principle is focusing on the recently, when many hospitals started using it effective way, hospitals are not. We want to transformation to digital medicine. We look to treat corona patients. “We recognized the build a control tower of sorts for hospitals for innovation in other fields, such as pharma importance of telemedicine five years ago. that will become the new standard of running and medical equipment, but the focus is So when the COVID-19 pandemic broke a medical center,” he says. The underlying on digital medicine. The second principle out, we were ready to launch. The fact that idea is that while in an airport the commuters is open innovation, meaning that we work we started a few years ago prepared us for and staff have a systemized path they move with the industry, not against it. Our third the pandemic. Sheba was ready when the through, in a hospital things are not as well principle is creating a global ecosystem -- pandemic hit us, and were able to administer organized. partnering with international organizations treatment using telemedicine,” says Prof. Another project focuses on the future of that have similar visions and goals, with a Zimlichman. the surgical arena. “We believe that in 10 focus on innovation. We were very busy in He adds, “Personalized medicine, virtual years’ time, most surgeries will be done by the last years looking for the right partners. reality, and augmented reality may take center robots. Much like the automatic pilot that flies The fourth principle is the infrastructure. stage beyond just training, rehabilitation, and airplanes. Just as pilots still sit in the cockpit Innovation needs infrastructure – both physiotherapy. We talk about using these for emergencies, so will robots perform most physical and in terms of data -- as well as techniques for the treatment of pain, anxiety, parts of the surgery. This will improve the creating a legal and financial base. After all, and depression. These techniques are part quality of medicine that we will be able to innovation and development need funds,” of the digital medicine that ARC is involved offer patients in the future,” he states. he says. in developing.” Prof. Zimlichman stresses that robotics “In recent years, we’ve managed to enlist will help reach more patients and administer many international partners who connected The future of surgery better medicine to remote parts of the world. with our vision. Today, we work with more Two other hubs include the future of “The surgeon can be in Shiba, while the than 100 partners who are now part of ARC, surgery and rehabilitation. Both are from patient may be in . This project will such as leading hospitals and medical centers the focal point of digital medicine. “Digital make access easier for patients living in in North America and around the world, medicine will completely transform the remote areas,” he explains. through partners in the industry, as well as future of surgery and rehabilitation,” says Another ambitious ARC project is being more than 70 start-up companies,” he adds. Zimlichman. developed in Chicago. “We have just signed “There are more than 50 people working an agreement to build a new ARC center Innovation hubs in ARC, all of whom focus on innovation. in Chicago,” says Prof. Zimlichman. “The Within digital medicine, says Zimlichman, They facilitate the work. Later, the people project is creating a lot of enthusiasm. There, ARC focuses on specific hubs. ARC has who will implement the new technologies the focus will be on healthy living. The idea established five innovation hubs to foster will be the doctors and nurses. They are the is to implement new technologies and digital the development of unique digital health ones who also come up with the ideas. They medicine in areas such as healthy lifestyle 25 capabilities across the spectrum of care. Each tell us what they need,” he says. and improve conditions in lower-income Innovation is headed by a clinical champion: big data and One of the concepts that Prof. Zimlichman neighborhoods.” • & Care Daniel Koulikov, Founder of MedAssist (Photo by Alexander Dodin)

A professional helping hand through the medical process

By Neria Barr

aniel Koulikov and Alexander When an institute doesn’t talk to a clinic, who requires any type of treatment simply has Charny are founders of or a hospital doesn’t communicate with an to contact MedAssist, and we will take the MedAssist, a streamlined insurance company, the patient has to run matter into our own hands. We accompany organization that helps between them, and there is no single uniform patients all the way, regardless of which people access medical platform that enables information to be company they are insured with or if they pay services quickly and transferred efficiently and securely. for the treatment out of pocket. We work with Defficiently. People with private health insurance need insurance companies from Israel and abroad. Mr. Koulikov spoke to us and explained first to fill forms. But the information is not easy to And we can usually solve any medical problem, why he and his partner decided to establish gather, especially when there are a few medical be it a test or treatment, within 72 hours. MedAssist’s unique medical service and its establishments involved. If the patient cannot Here is an example. A man who had smooth operation: for some reason take care of transferring the been in Israel for several months for work Mr. Koulikov: “Technologically, Israel is at medical files in the correct way, this may cause had a car accident. He called his insurance the forefront of world medicine. However, it delays and other difficulties. The problem is company abroad and was told that he had to suffers from a few problems, and it was the even more complicated when the patient is take care of being flown home on his own. period of the Covid-19 pandemic that revealed not an Israeli citizen or is a new immigrant But the patient was hospitalized and was not several difficulties that exist between medical who doesn’t speak Hebrew. mobile. He contacted us, and we took care services and the people who require it. Five years ago, after we had worked in the of everything. We took care of the financing There are three main problems that make private medical field and had set up medical from the insurance company, filled out all it difficult for patients to access medical departments in Israel and abroad, we decided the paperwork in English, and translated the services: (1) The complex administration – to create something new - a platform that medical documents. We also helped his family i.e, the bureaucracy; (2) the long waiting would enable anyone to have access to Israeli members, which included coordinating their time for medical procedures; (3) the lack medical services quickly and efficiently: arrival from abroad and meeting them at the of communication among the various MedAssist. airport. 26 establishments, such as insurance companies, We have built something that consists Another case involved a 35-year-old Israeli Innovation organizations that administer treatments, of technological tools, as well as a human career woman who discovered a lump in her & Care clinics, testing institutes. approach and appropriate manpower. Anyone breast. She was under a lot of stress and tried a test or to collect test results. These are just some of the many problems we take care of. Our hotline operates 24 hours a day, seven days a week. Sometimes, if we have to pay the treatment organization before the insurance company has made the payment, we pay and then collect from the insurance. If the patient pays out of pocket, we have a payment plan. First we take care of the patient’s medical needs, then we deal with the payment. The Covid-19 pandemic really exposed and highlighted the problems that the Israeli public health system suffers from. At the beginning of the pandemic, many people were wary of going to clinics or laboratories. Because we want to solve our patients’ problems, we found a way to make medical care accessible to patients. We were able to reach patients with tests, and even with tests such as ultrasounds. In general, alongside all the sorrow and suffering and pain, the pandemic taught us a lot. We have greatly improved in everything related to logistics and reaching patients. We have learned to be more effective and efficient. During the pandemic our service became very popular, and we doubled our number of employees. When talking about medical situations, and in regard to Israeli and foreign insurance companies, as well as medical institutions, to coordinate between the private doctor and He requires a quote in English to send to the patients may lose precious time contacting the testing institutes. Her friends and family insurance company, but they can’t give it to and receiving service. We know how to contact knew how difficult it was for her, but they him. The bureaucratic process can take weeks. the companies, obtain the information, and couldn’t undertake doing the paperwork, So the patient contacted us, and we took care explain to the patients what their conditions transferring documents from place to place, of everything. are, what they have to pay, what the insurance and coordinating appointments for treatments We don’t leave an issue until we receive a company will pay, etc. and tests. commitment from the insurance company. If We have created a mechanism that That’s where we come in. We take the necessary, we make the interim payment for works effectively and connects systems issue into our own hands. We have a lot of the patients, accompany them to treatments, that fail to communicate with each other. experience and expertise. We know the forms and inform them at every stage. Sometimes The management of our company consists and how to translate them when needed. We it is simply a matter of knowing where to of experts in the field of private medicine. know the insurance companies, how to collect transfer the disk with the results or filling out The expertise of each of us has enabled us documents, and where to transfer them. And the form correctly. As far as we’re concerned, to develop new mechanisms and learn from we do all this behind the scenes quickly and the patients are having enough difficulty as what exists in hospitals around the world. efficiently, without involving the patients. is, so they shouldn’t have to do any of the leg We learned things and were able to integrate They simply receive the results. They receive work. They just have to call us, and we will them here. We are very proud of what we have the name of the doctor, the name of the tests, arrange everything for them, usually within created. We were able to develop methods that and the times of the appointments. And we 72 hours. enable people to go through the entire process accompany them throughout the process. Some time after we opened MedAssist, without having to log in to an app or search Here is another example. A man from we realized that there were some issues for online. All they have to do is contact us by South Africa had come to Israel to work for which we hadn’t found solutions. For example, phone, WhatsApp or fax. We provide service a hi-tech company. He suddenly suffered a certain tests have very long waiting times. That in Hebrew, English, French and Russian. back problem and needed an MRI. This is is why we opened our own medical centers, We are on the constant alert for tourists, an expensive test. He was asked to do the in which we have specialists and experts in travel companies, and international insurance test, pay for it, go to an orthopedist with many medical fields, such as companies, We have become a veritable the results, and send them to his insurance neurological clinic, a specialist clinic, and one-stop shop. From tourism companies company. When he called the institutes to an ultrasound clinic, and more. Our specialists to insurance companies around the world, make an appointment for an examination, include doctors from a variety of fields, from many of them contact us and ask us to solve he realized that he would have to pay several to breast health. problems. thousand shekels on the spot. He contacted We treat 600 to 700 patients a month. Some People can apply to MedAssist directly or the insurance company and asked for some of them are people who just don’t have the time through their insurance company. We are quotes. Now, getting a quote from a hospital is to sit on the phone to make an appointment. also very active online, but I must admit difficult enough, and getting a translated quote People work long hours, and long lines at that most patients come to us through the 27 is even harder. The patient has to approach the clinics don’t fit into their schedules. So people recommendations they have received from Innovation department secretary or the institute secretary. contact us if they need an appointment for our clients. • & Care Large population health screening for early detection of chronic disease through AI

by Zohar Elhanani, Zebra Medical Vision CEO

(Courtesy)

e can’t discuss findings and assist with the actual analysis of innovation i n medical imaging scans ,leveraging advanced medical care without algorithms to offer human doctors incredibly mentioning AI .Machine thorough and beneficial patient care. intelligence is increasingly As of today ,AI medical imaging analysis becoming a tool to assist when implemented in population health Wdoctors in the analysis can support chronic disease management of medical imaging .The idea here is and early detection of heart disease and twofold :To reduce radiologist workload osteoporosis .When looking at the largest 28 by taking the more monotonous tasks off expenses in global healthcare 90% ,of the US Innovation their hands ,thus boosting efficiency and 3.5$trillion healthcare spend is for chronic & Care enabling physicians to detect incidental conditions according to the CDC. During a global pandemic, Such AI based“ Population front 1( in 3 American adults dies when routine check ups aren’t health screening tools ”can detect from a cardiovascular event ,)the performed regularly and healthcare disease ,alert it immediately and detection and analysis of coronary systems are deeply burdened help promote better patient care and artery calcium on chest CT scans and backlogged ,AI can assist lower costs as diagnosed patients allows for the stratification of by“ mining ”information in rich are referred for preventative care patients at risk for a cardiovascular medical images to identify patients treatment. event in the next 5 years .AI with undiagnosed/underdiagnosed One of the most interesting and technology is able to highlight conditions without the need for common cases of population health those at risk early on ,and direct additional tests. is Osteoporosis early detection and them to preventative behavior prevention ,an area which Zebra- and pharmaceutical intervention. Med has made huge progress The preemptive strike against (Courtesy) -from securing CE and FDA any kind of cardiovascular event regulatory clearances ,to running starkly lowers these patients ’risk joint programs with Oxford for coming face to face with one. University ,NHS in Scotland ,and AI’s potential in medical imaging even publishing its first research and population health management on“ Nature ”magazine .In the case will be one of the fastest moving of bone health ,a fully-automated medical developments as we identification of vertebral continue into 2021 and beyond, compression fractures enables as it has far-reaching implications physicians to more swiftly detect for both physicians and patients, potential osteoporosis fractures. more so than any Triage solution As such ,it’s easier to diagnose ever introduced in the medical osteoporosis in patients ,meaning imaging AI industry .Beyond a greater number of patients with the chronicled benefits that quite the condition are actually treated literally improve the lives of for it early on .Treatment for patients ,AI analysis in medical osteoporosis is crucial ,as it can imaging is only the beginning. prevent morbidity and mortality Machine learning algorithms will associated with hip fractures .When eventually transform medicine it comes to treatment for such altogether ,and Zebra Medical conditions ,the earlier ,the better. Vision is happy to be leading the On the cardiovascular crucial charge. •

(Courtesy)

29 Innovation & Care Personalized cancer treatments no longer a dream with new medical tech

ADVA X3 is a device that can create life-saving drugs automatically and customized for each individual patient

by TALIA LEVIN

n the past, when carried out for other cancers and produced on-site in a few weeks.” of cell engineering, which up biologists and other autoimmune diseases. until now could only take place scientists were asked This is undoubtedly the Why has such a small amount in a lab. You add the patient’s what their greatest beginning of a revolution. For of the drug been produced over blood in one side, and the dream was, almost all of the time being, however, these the last three years? contents that enable the cells to them would reply that, treatments will be available only “First of all, the treatment be genetically engineered to the without a doubt, their to a tiny group of terminally costs $500,000 per patient. As a other. The process takes seven to I greatest ambition was ill cancer patients for whom result, even though theoretically 10 days, at the end of which you to find a cure for cancer. Now, no other treatment has been we have a practical solution for have ready-made, customized at a time that many researchers beneficial. patients with leukemia and engineered blood that can be are currently working diligently Fewer than 2,000 patients have autoimmune diseases, there’s re-infused into the patient. This on COVID-19 issues, it might been treated using this innovative almost no chance that they device provides a customized, surprise some people to know method over the last three years. will actually receive the drug high-quality solution at a much that there already is a cure – or The reason is a combination of unless the patient is extremely lower cost than has been available at least a partial cure – for some cost, logistics, lack of technology wealthy and also very lucky. But up until now and with much types of cancer. and conservative outlook. it’s not just a matter of money. greater accessibility. CAR-T (aka Chimeric “To date, this drug has only Granted, Israel’s healthcare According to Noam Bercovich, Antigen Receptor) cells are T been manufactured manually in basket allocated tens of millions VP of development of ADVA cells that have been genetically large clean rooms in the US or of shekels for this drug last year, Biotechnology, “The biggest engineered to produce an Europe, and not in hospitals,” but this amount can only help a advantage of the ADVA X3 artificial T-cell receptor for explains biologist Dr. Ohad few dozen patients due to the is that it considerably lowers use in immunotherapy. This Karnieli, the founder and complicated logistical issues.” manufacturing costs, since you breakthrough came three years CEO of ADVA Biotechnology, Five years ago, Dr. Karnieli, no longer have to send the blood ago, following more than 20 which developed the ADVA who has a PhD in genetic overseas with a large team of years of research. X3, a device that can create engineering and stem cells, biologists trained in this field Here is how it works. White these same life-saving drugs recognized that the CAR-T so that they can engineer the blood cells harvested from a automatically and customized cell cure was an effective blood and then bring it back. person are activated, expanded for each individual. The ADVA treatment. But in order to make With the ADVA X3, you have a and genetically engineered. X3 can do this efficiently, while the treatment accessible to as machine that sits on top of your Afterward, these resulting also dramatically reducing many patients as possible, he table and any technician working CAR-T cells are re-infused manufacturing costs, which understood that a technological in a hospital can operate it.” into the patient so they can would make these treatments revolution must be initiated. ADVA Biotechnology was attack and destroy tumors. accessible to a much larger “On the one hand, my field is created four years ago when This method for curing cancer number of patients. As it stands stem cell research, but I also have Karnieli and his partners realized is already being used to combat today, even if a patient is entitled a technological background. It that the methodology that certain types of leukemia, has to this drug, he or she most was crystal-clear to me that this pharmaceutical companies were received FDA approval and has likely will not receive it, since was the winning combination.” currently following was illogical 30 been added to Israel’s healthcare the process for producing it is Dr. Karnieli’s solution is and could not be adapted to Innovation basket. In addition, hundreds of complex and can take months. a printer-like machine that modern personalized medicine. & Care clinical trials are currently being With ADVA X3, the drug can be replaces the biological process “Imagine if we could put a few of these machines in every hospital,” sales. Our model enables all of the method, in the hope that soon they continues Karnieli. “They could market players to improve access to too will be able to use our machine to then be used to produce a specific this life-saving medicine. Hospitals increase the hospital’s ability to treat customized drug for each cancer and medical centers will be capable more patients. In practice today, many patient. This would be tantamount of producing the drug on their own, hospitals are producing a small amount to a revolution, not only by making which will make treating patients so of medicine since the large companies this treatment accessible to every much simpler. are failing to meet demand. single patient, but by changing the “In addition, this also provides “Think about it this way: Pharma model according to which the industry pharma companies with an excellent companies have invested millions of functions.” solution. One option is that they can dollars to build factories that produce produce and distribute just the API this drug, but in actuality they’ve only How would you characterize the [Active Pharmaceutical Ingredient], managed to produce less than 2,000 pharmaceutical industry as it stands the component that enables genetic doses over the last three years. They today? manipulation, and then the production are far from meeting demand. Even if “Pharma companies carry out their can be carried out in hospitals. A people have the money to pay for the manufacturing in large factories and second possibility is that pharma treatment, it’s not always manufactured charge thousands of dollars for each companies will build a number of in time. This was the impetus behind dose of this treatment. Once this drug centers in certain countries, which our development of the ADVA X3, can be manufactured in hospitals would still be simpler than how the which makes this life-saving drug so or at small local labs owned by drug is manufactured today in large much more accessible.” pharmaceutical companies, this will clean rooms and then distributed make production and transport much worldwide. In this model, there’d be How realistic is your model? more accessible than it is today.” a decentralized distribution network “In our opinion, it’s extremely Some of the challenges experienced that produces customized drugs in realistic, since our machine will thus far are no longer obstacles. The closer proximity to patients.” work well in the scenario in which technology that will replace the manual production will take place inside method used in labs up until now Is there a demand in hospitals for hospitals, with the API being supplied already exists. this service? by pharmaceutical companies, and “The machine works and we have “Yes. A number of hospitals around also for the possibility that the pharma already completed quite a few runs, the world are already using our device. companies will carry out production in so this stage is now behind us,” says At Sheba, for example, they’ve been local centers [there will be one for all Karnieli. “Now, we need to overcome using our device for a few years already. of Israel, for example]. Both of these the next challenge: marketing and They are using the regular manual scenarios will become much simpler

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31 Innovation & Care when used in conjunction with our machines. “The ADVA X3 will simplify production and ensure that immune cell therapy will be more cost effective and speedier,” explains Karnieli. “Instead of pharma companies having one massive factory with lots of employees who are carrying out the production of the drug manually, it will employ many of these devices, which will greatly speed up output. Imagine how much quicker it will be if we have a center here in Israel that could supply doses to all of our hospitals. This will solve the problem of long lead time and the complicated logistics of transporting materials overseas and then back to Israel.”

What kind of savings are we talking about? “Production in hospitals will cost one-quarter of the current price. They won’t... take $300,000, but less. And

we want to be able to produce much (Photo by Freepik.com) more than 2,000 doses over three years. Why should a cancer patient have to next big thing is enabling everyone who What has the response been like? suffer through such a long battery of needs their drug to have access to it. “Absolutely fantastic! We’ve had treatments and then still have to wait for “Two years ago, we were busy filling such great feedback from medical his turn to perhaps receive a dose of this bottles and tubes. We lit our burners, professionals, industry leaders and unique treatment when there’s a way began recruiting people to join our investors, too. Our biggest challenge to overcome this obstacle? And once team, and then founded our company. is penetrating such a conservative patients learn about this treatment that Our clients around the world include market. Biologics are so much more can save their life, why would they be pharmaceutical companies, hospitals complex than chemical drugs. They are willing to suffer through extensive and live cells that need to be re-engineered difficult treatments when they know and universities. We produced the there’s very little chance of it being treatment for them, proving that our so that they can attack an extremely effective? Why not give patients the machine is capable of producing the specific cancer. Most scientists are chance to receive the drug at an earlier same exact drug in a much more conservative and are extremely stage in the disease? It’s not just an issue efficient, cost-effective and simpler way. cautious when it comes to this type of money. Only pressure from the public Over the next year, these institutions of technology, since they are used to will influence the regulator to approve will receive one of our machines so they working a certain way. production.” can begin experimenting with them. “We totally get that lab work is not The next stage will hopefully be large- industrial, but what we can accomplish What type of personnel are needed scale production.” with our machine does not completely for this type of production? eliminate the need for lab work. We “In hospitals, biologists are in charge What’s your vision? have a challenge before us. No hospital of the production process. Doctors “To make these amazing life-saving or company has told us our device is choose which patients are eligible treatments accessible to patients,” amazing, but that’s okay because it for the treatment, and they instruct says Ofra Toledo, VP of business takes time for people to get used to us regarding their goal so that we can development for ADVA Biotechnology. using new methods. We are planning to understand how to engineer the cells “To offer everyone the opportunity to carry out a number of pilot programs exactly as needed for each individual receive the best treatment that has been here in Israel, as well as overseas, so patient.” personalized just for them. It’s already that our clients can experience the It’s pretty amazing to realize that in happening. We are targeting both the success of our platform first-hand. 2021 we have the capability not just Israeli and international markets. We Then we will start manufacturing on to prolong cancer patients’ lives, but have quite a few interested clients in a larger scale.” • to heal them. Now the challenge for Europe, the US and the Far East, and we 32 ADVA Biotechnology, which develops are currently introducing our product Translated by Hannah Hochner. Innovation and manufactures its products here in into hospitals and medical centers here This article was written in & Care Israel, is to convince the world that the in Israel.” cooperation with Adva. will we declare victory over COVID-19?

By Lisa M. Krieger

year into the pandemic, for manufacturing vaccines, infection rates are President Joe Biden now falling. Hospitals are promises enough vaccine supply quieter; morgues for every adult in America by the are emptier. end of May. Some states, such Emboldened by as Texas, are already racing to vaccines, fully reopen. A w e ’ r e But there is increasing dropping consensus that COVID-19 is o u r masks and here to stay, causing intermittent, stepping closer. Slowly we’re limited outbreaks in countries reopening indoor dining, with well-developed vaccination theaters, museums and schools. programs but causing significant Will we declare victory over ongoing disease in parts of the COVID-19? world where access to vaccines No, say public health experts. is more limited. But we’ll negotiate an uneasy “Unless you’ve completely truce. Rather than completely eradicated a disease, you’re eliminating the virus, we can always at risk for having create a strict containment an outbreak,” said Stanford strategy, building public health A health worker administers the Pfizer-BioNTech COVID-19 vaccine in a infectious disease epidemiologist vaccination center in Nice, France, March 13, 2021. (Eric Gaillard/REUTERS) bulwarks to help fend off an Dr. Yvonne Maldonado. enemy that is wily, adaptive and Why is eradication so hard? enduring. It’s because pathogens, once to have originated in bats. clinical affairs at UCSF, imagines This means accepting a certain established, hardly ever go With COVID-19, “it’s a day “when the incidence of level of risk as society returns to extinct. definitely not about getting to COVID declines to the level normal, they add. The easiest diseases to control zero risk. Because that’s not where we no longer need to have “Here’s what we can call are those that are quickly feasible,” California’s surgeon special processes. It becomes like ‘victory’: Learning how to live diagnosable or recognizable, general Dr. Nadine Burke Harris another infectious disease that’s with this virus in a way that according to the American said this past week. part of our general environment.” allows us to continue to enjoy Society of Microbiology. But So what is an acceptable “We will simply have a number life,” said Dr. John Swartzberg of COVID-19 is hidden, spreading number of deaths? of patients that may have COVID, UC Berkeley’s School of Public before people get sick. And up It’s likely that we’ll accede just like we have a number of Health. to 40% of cases are surreptitious, to a disease that behaves like patients that have flu, or severe Over time — as vaccines causing no symptoms. influenza, public health experts herpes infection, or what have improve, death tolls fall and Additionally, a COVID-19 say. While deadly, especially you,” he said. we adopt new behaviors, like diagnosis requires testing by for elders, the flu isn’t seen as In the meantime, we should wearing masks when we’re sick — skilled medical professionals. a special threat that requires an set intermediate goals, said UC we’ll accommodate it, just as we A disease can also be readily exceptional societal response. San Francisco epidemiologist do with other deadly infectious controlled if, like polio, it “We just seem to take it, on Dr. George Rutherford. diseases, he said. lives only in humans and faith, that every year there’s One goal is to prevent another In the past year, there have been has no animal “reservoir” going to be a flu epidemic,” said surge of cases, so hospitals aren’t 33 unimaginable strides against the where it persists. That’s not Maldonado. overwhelmed. Additionally, we Innovation virus. With accelerated plans COVID-19, which is presumed Dr. Joshua Adler, vice dean for need to offer better medications, & Care A soothing hand for dry skin

r. Fischer recently The Effective Care line is made with formula that is rich in omega 9 and omega introduced a new line triple-active formulas to provide optimal 6, antioxidants, and vitamins. of Effective Care hand and intensive hydration, preventing dryness, In addition, Dr. Fischer’s U-Lactin line and body creams. They which is common during the winter and for very dry skin has introduced Forte hand may well be an ideal gift spring. cream, which can fill the bill for those in the for your host this holiday Hemp oil, which is rich in omega 3 and midst of Passover cleaning. Targeting dry, Dseason. omega 6 acids, has a rehabilitating effect on rough skin, the U-Lactin line includes body The creams, enriched with hemp oil, the skin due to the fact that its composition butter that is very effective. It is enriched contain cotton, avocado, coconut, and argan is similar to the oil-acids we have in our skin. with a special formula that contains 0.5% oils, as well as cocoa butter. The cream not The creams absorb quickly, leaving the skin lactic acid and 7% urea, which help balance only smell divine but are also truly effective. moist and instantly relieved. moisture in the skin, as well vitamins and an All the creams were tested in European labs The Effective Care cream enriched oil complex. Daily application of U-Lactin and were proven to hydrate the skin for 72 with cocoa butter is made with a unique creams relieves dryness and skin irritation.• hours.

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will we declare victory over COVID-19?

so people who become infected the COVID-19 vaccines are for the virus to move through a they would “definitely not” get rarely die. Currently, patients better than flu vaccines, and can population. The risk to people vaccinated. hospitalized with COVID-19 be promptly modified. who cannot get vaccinated drops Yet even as we work toward face nearly five times the risk “I am confident that things will dramatically. That’s when it feels more complete vaccination, we’ll of death than those with the get quite a bit better than they are safer to go back to our cherished slowly inch toward safety. Even flu, according to a major study today. Does that mean that you gatherings. Think big weddings. partial herd immunity can save published last December. can live completely risk-free? I Football games. Music festivals. lives. And when variants emerge, don’t think so,” said Adler. “But Right now, that’s a challenging But managing our new we must be poised to respond, it may be a low enough risk that target. Why? Children account relationship with COVID-19 Rutherford said. most of us feel comfortable with for about 22% of the population will require constant monitoring, Then, like influenza, “new it .” and they won’t be vaccinated potential revaccination, strains will fade into the Eventually, so-called until clinical trials are completed treatment of isolated cases and background and become part community immunity, or “herd later this year. Reluctant adults rigorous contact tracing. of the milieu, transmitted every immunity,” will protect us. could represent another shortfall. “It’s not over,” said Adler, “but year but at much, much lower At that point — when 70% According to U.S. Census data it’s certainly heading in the right 34 levels,” he said. to 90% of the population is released in late January, about direction.” • Innovation Over time, the risk will recede, protected through vaccination or 14% of adults said they would & Care experts predict. That’s because prior illness — it is much harder “probably not” and 10% said The Mercury News (TNS)

& Care

CEO Jerusalem Post Group V.P of Commercial Jerusalem District Manager Advertising Inbar Ashkenazi & Strategic Partnerships Itai Benvenisti Tel: +972 3 761-9002 Editor Galit Erez Graphic Designer Neria Barr [email protected] Noa Zolty