Bringing Heart and Humanity to Hematology | New
June 21, 2022 – Australian hematology fellow Eddie Cliff, MPH 22, cares just as much about the well-being of his patients as he does about improving healthcare systems as a whole. He is also a published writer for The New York Times and NPR, a Fulbright Scholar, and an advocate for healthy foods and sustainability.
I grew up in Australia, where my grandmother was a nurse educator and my mother is a pediatric neurologist. None of them pushed me to take an interest in medicine, but I had experience working with a neurologist, a gastroenterologist and a primary care physician and found that the combination of solving interesting problems and working with people appealed to me.
I fell in love with hematology by accident. I had planned to be an endocrinologist and work clinically on diabetes and obesity, with a parallel career in public health focusing on non-communicable diseases and nutrition policy. Then I was enrolled in a hematology rotation, treating myeloma and lymphoma patients with CAR T-Cell therapies – in which their own immune cells are genetically modified to fight their cancer – and I became fascinated by Science. With blood cancers and other blood disorders like sickle cell disease, you are dealing with complex diseases, with interesting treatments, that affect people from all walks of life. Hematology also has a powerful human side; When I give a patient a lab result with good or bad news, I think carefully about how to deliver the news, and for each patient we design a personalized treatment plan incorporating the values and priorities most more important to him.
Working in Australia during the COVID-19 pandemic, I faced difficult conversations both on COVID-19 wards and subsequently with blood cancer patients about end-of-life decisions as members of the family were excluded from the hospital under the COVID policy. I wrote about these dilemmas in an essay in JAMA Oncology titled “A split decision is a halved decision.” Australia’s strategy for COVID was excellent, among the best in the world, and it saved tens of thousands of lives. That’s not to say there haven’t been unintended consequences that we may not have paid enough attention to – including patients and families unable to be together – and those stories are equally valid. worth telling.
What brought me to public health was hearing from leaders in the field like Atul Gawande and Michael Marmot, and getting involved with a non-profit organization focused on preventing non-communicable diseases. called NCDFree, which I volunteered for while in medical school at Monash University. If you look at society, the biggest killers are heart disease and stroke, and the biggest risk factor for these diseases, especially in countries with low smoking rates, is our food system. Big food companies are manipulating our evolutionary drive for high calorie, high sugar and low nutrient foods such as sugary drinks. I helped organize a food festival called festival21 with many members of the NCDFree team, led by Sandro Demaio, for 3,000 people that highlighted the intersection of food, health and sustainability. I also got involved with the Australian Association of Medical Students to advocate against government moves to dismantle universal health coverage and deregulate university fees; advocate for a soft drink tax; and contributing to campaigns on student mental health and blood donation.
The highlight of my time at Harvard was a course called Reimagining Global Healthtaught by [the late Partners In Health cofounder] Paul Farmer and three other leading medical anthropologists, Arthur Kleinman, Salmaan Keshavjee and Anne Becker. What was so life-changing was how they took concepts from anthropology and social theory and applied them to their first-hand experiences in Peru, Haiti, Rwanda, Russia, in China, Fiji and elsewhere. For low- and middle-income countries, multilateral organizations often prioritize the most “profitable” things; for example, they may say that these countries “don’t need cancer drugs because we need to cure them of HIV and TB first”. But global health isn’t just about tackling the perceived “low-hanging fruit” like distributing mosquito nets to prevent malaria, it’s also about building hospitals, training doctors and nurses, and developing a health care delivery system. The course made me want to understand how we can influence global systems to ensure better access to therapies around the world, like PEPFAR [The U.S. President’s Emergency Plan For AIDS Relief] and a similar program have done with HIV drugs, instead of just giving up and saying it’s too hard.
For my current research, I work with Harvard Medical School Aaron Kesselheim and his group called PORTAL (Program on Regulation, Therapeutics and Law), to help advocate for lower drug prices and to make them more accessible. Many of the lessons I learned about Big Food also apply to Big Pharma. Just to give an example of how pharmaceutical companies exploit the system to their advantage, one company holds 88 patents on a drug called ibrutinib, which is used to treat chronic lymphocytic leukemia (CLL). Patents prevent generic competitors from entering the market so that they can profit from it for as long as possible. Sometimes in medicine the basic science of curing cancer is really emphasized and celebrated, but if we have these drugs and people can’t access them because they’re too expensive, well, don’t we have failed in our work anyway?
I am now doing a scholarship at PORTAL, at the intersection of blood cancer medicine and public policy, researching drug pricing and regulation and cell therapies such as CAR T cells. My dream job would be to be an academic hematologist who could use my clinical work to inform research, policy and advocacy work to improve the functioning of society and the health system for all.
I am very passionate about classical music, and I play oboe and percussion in orchestras. They are very different types of instruments, but I like them both. The oboe is a key player in the middle of the orchestra, where you feel like you’re in the heart of the matter, whereas with the percussion you’re more exposed and you can’t hide. Turns out my Harvard Chan advisor, Michael Barnett, is also an oboist! Music is a very conscious activity, where you learn early on to block out the crying baby in the second row of the audience. When they tried to teach us about mindfulness in medical school, I realized that I had already learned it by playing music.
photo: Alex Lebrowski