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Boston Globe
4 days ago
- Health
- Boston Globe
Lucian Leape, whose work spurred patient safety in medicine, dies at 94
He was chief of pediatric surgery at Tufts University in the 1980s when he noticed frequent mistakes leading to significant patient harm, even death. In a bold move late in his career, Dr. Leape left his full-time surgical practice and began collaborating with colleagues at Harvard University on a study that chronicled for the first time the number of injuries and deaths that resulted from medical error. Known as the Harvard Medical Practice Study, it examined a large population of injured patients in New York state. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up That study led to a landmark report, 'To Err Is Human: Building a Safer Health System,' published in 1999 by the Institute of Medicine (now the National Academy of Medicine). Advertisement In the report, Dr. Leape and his co-authors estimated that 44,000 to 98,000 Americans died each year from medical errors, a majority of which arose from dysfunctional systems -- not flawed individuals, as the medical profession and public had long believed. The idea of systemic error, though widely accepted in industries such as aviation and nuclear power, was an unfamiliar concept in medicine, and it rubbed against the grain of the dominant medical culture of individual accountability, as well as the malpractice system's tradition of seeking a culpable clinician. Advertisement The report, however, galvanized health care regulators and accreditors to enact tighter standards for hospitals, limit work hours by medical residents, and require public reporting of serious errors. As a result of regulations and public pressure, health care systems around the country began to tackle medical mistakes as a system-level problem, launching patient safety departments and hiring patient safety officers. 'He did more than make some critical insights,' Dr. Atul Gawande, a prominent surgeon and author who was assistant administrator for global health at the US Agency for International Development in the Biden administration, said in a 2023 interview for this obituary. 'He took on the entire medical profession.' Lucian L. Leape (he had no middle name, though the 'L' was included on his birth certificate) was born Nov. 7, 1930, in Bellevue, Pa. His father, Lucian Leroy Leape, was a purchasing agent for a small steel company. His mother, Mildred Grace (West) Leape, was a schoolteacher who later taught piano. After receiving his undergraduate degree in chemistry from Cornell University in 1952, he served as a lieutenant in the Navy, and in 1955 entered Harvard Medical School. He met Martha Kinne Palmer in 1951, when both were undergraduates at Cornell, and they married in 1954. Martha Leape, who held master's degrees in guidance counseling and psychology, became a premedical adviser at Harvard University and later ran the university's office of career services. She died this year. In addition to his son James, Dr. Leape leaves two other sons, Jonathan and Gerald, and seven grandchildren. Advertisement After receiving his medical degree in 1959, Dr. Leape trained as a pediatric surgeon at Massachusetts General Hospital and Children's Hospital in Boston. In 1973, he became professor of surgery at Tufts University School of Medicine and chief of pediatric surgery at Tufts-New England Medical Center (now Tufts Medical Center). 'Children are the world's best patients,' he said in an interview for this obituary in 2015. 'They're honest, and they don't have an overlay of neuroses.' In 1986, at age 56, Dr. Leape grew interested in health policy and spent a year at the Rand Corp. on a midcareer fellowship studying epidemiology, statistics, and health policy. Following his stint at Rand, he joined the team at Harvard conducting the Medical Practice Study. When Dr. Howard Hiatt, then the dean of the Harvard School of Public Health (now the Harvard T.H. Chan School of Public Health), offered Dr. Leape the opportunity to work on the study, 'I accepted,' Dr. Leape wrote in his 2021 book, 'Making Healthcare Safe: The Story of the Patient Safety Movement,' 'not suspecting it would change my life.' The most significant finding, he said in the 2015 interview, was that two-thirds of the injuries to patients were caused by errors that appeared to be preventable. 'The implications were profound,' he said. In 1994, he submitted a paper to The New England Journal of Medicine, laying out the extent to which preventable medical injury occurred and arguing for a shift of focus away from individuals and toward systems. But the paper was rejected. 'I was told it didn't meet their standards,' he recalled. Dr. Leape sent the paper out again, this time to The Journal of the American Medical Association. Dr. George Lundberg, then the editor of JAMA, immediately recognized the importance of the topic, Dr. Leape said. 'But he also knew it could offend many doctors. We didn't talk about mistakes.' Advertisement Dr. Donald M. Berwick, president emeritus at the Institute for Healthcare Improvement in Boston and a longtime colleague of Dr. Leape's, agreed. 'To talk about error in medicine back then was considered rude,' he said in an interview in 2020. 'Errors were what we call normalized. Bad things happen, and that's just the way it is. 'But then you had Lucian,' he added, 'this quite different voice in the room saying, 'No, this isn't normal. And we can do something about it.'' Dr. Leape's paper, 'Error in Medicine,' was the first major article on the topic in the general medical literature. The timing of publication, just before Christmas in 1994, Dr. Leape wrote in his 2021 book, was intentional. Lundberg knew it would receive little attention and therefore wouldn't upset colleagues. On Dec. 3, 1994, however, three weeks before the JAMA piece appeared, Betsy Lehman, a 39-year-old health care reporter for The Boston Globe, died after mistakenly receiving a fatal overdose of chemotherapy at the Dana-Farber Cancer Institute in Boston. 'Betsy's death was a watershed event,' Dr. Leape said in a 2020 interview for a short documentary about Lehman. The case drew national attention. An investigation into the death revealed that it wasn't caused by one individual clinician, but by a series of errors involving multiple physicians and nurses who had misinterpreted a four-day regimen as a single dose, administering quadruple the prescribed amount. The case made Dr. Leape's point with tragic clarity: Lehman's death, like so many others, resulted from a system that lacked sufficient safeguards to prevent the error. Advertisement The report 'To Err is Human' was released in 1999, noting that the 44,000 to 98,000 annual deaths from medical mistakes were the equivalent of a jumbo jet crashing every day. That alarming comparison drew significant media attention, and the report led to substantial new federal funding to address the problem of medical errors, along with efforts to educate providers and administrators about the new systems approach to errors. 'There might have developed a patient safety movement in health care without Lucian, but he made it happen years before it otherwise would have,' Berwick said. 'He was probably the first pedigreed specialist from the mainstream of health care to give this problem a name.' Gawande said he believed it was the confidence Dr. Leape had acquired as a surgeon that girded him in the face of strong resistance from colleagues. 'He had enough arrogance to believe in himself and in what he was saying,' Gawande said. 'He knew he was onto something important, and that he could bring the profession along, partly by goading the profession as much as anything.' In 2007, the National Patient Safety Foundation, which Dr. Leape had helped found in 1997 to support the growth of the nascent field, created a patient safety think tank, the Lucian Leape Institute, which is now part of the Institute for Healthcare Improvement. This article originally appeared in
Time of India
11-06-2025
- Health
- Time of India
Trump admin set to destroy vital HIV meds and contraceptives worth $12 million following closure of USAID
The Trump administration may destroy $12 million worth of HIV and birth control medicines. These medicines were bought by USAID, a U.S. government group that helps people in poor countries. Trump closed USAID in January, and since then, the medicine has been left unused in warehouses in Belgium and the UAE, according to The Washington Post. Now, officials are being told: 'Sell the medicine or trash it', according to someone familiar with the case. The supplies have 26 million condoms, 2 million birth control shots, millions of birth control pills, hundreds of thousands of implants, and over 50,000 bottles of HIV-prevention medicine., as per reports. These were supposed to go to 18 different countries, but now they may never get them. A senior U.S. State Department official told The Independent the story is 'fake news' and full of errors. But Dr. Atul Gawande, who worked at USAID before, said destroying the medicine is something he just can't imagine. Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like This Man Revealing His Strategy To Earn Upto 3K-5K Daily Income thefutureuniversity Learn More Andrew Natsios, a former USAID head, called the idea 'crazy' and said, 'Why not just give the medicine to people instead of throwing it away?' Trump stopped USAID's spending because he said it was 'not in line with American interests.' The Trump team also plans to ask Congress to cut $8.3 billion from global aid programs, including for climate and LGBTQ+ support, as per the report by The Independent. Big consequences Experts say ending USAID could stop progress on fighting AIDS. AIDS-related deaths could rise from 6 million to 10 million in the next 5 years. 3.4 million more kids could lose a parent to AIDS. 600,000 more babies could be born with HIV by 2030. Live Events Prof. Francois Venter, a top HIV doctor from South Africa, said, 'The progress we made in 20 years will be reversed.' Hadja, a 27-year-old mom in Uganda, told The Independent she already lost access to her HIV medicine. She said, 'Without medicine, our lives become shorter. If I die, my children will suffer,' according to The Independent. FAQs Q1. Why might HIV and birth control medicines be destroyed? Because USAID was shut down and the medicines are stored with no plan to send them out. Q2. What could happen if these medicines are not used? More people could get sick and die from AIDS, and many children could lose their parents.
The Independent
05-06-2025
- Business
- The Independent
Trump team set to destroy $12m worth of HIV drugs and contraceptives that were bought before closing USAID
Roughly $12 million worth of HIV-prevention drugs and contraceptives purchased by the U.S. Agency for International Development will likely be destroyed after President Donald Trump dismantled the organization, according to a report. These drugs have been sitting in distribution centers in Belgium and the UAE since January, when Trump ended the agency's spending, The Washington Post reported. Now, negotiators have been instructed to sell the drugs or else they'll be thrown out, according to the outlet. 'The mandate that [the USAID negotiator] has been given is 'get us money for it, and if you can't do that, we're just going to trash it,'' someone with knowledge of the situation told the Post. These supplies include more than 26 million condoms, 2 million doses of injectable birth control, millions of packages of oral birth control, hundreds of thousands of implantable contraceptive devices, and over 50,000 vials of a drug that prevents HIV contraction, the Post reports. Some of these supplies were earmarked for 18 countries, meaning those governments may never get the aid even though it was already purchased, according to the Post. When contacted for comment, a senior State Department official told The Independent that the Post has 'once again delivered fake news' and the 'story is full of inaccuracies.' Atul Gawande, a former assistant USAID administrator, told the Post the potential destruction of these drugs is 'inconceivable.' Meanwhile, Former USAID head Andrew Natsios called the decision 'nuts.' 'At this point, just give it away instead of destroying it, for heaven's sakes,' he told the Post. Trump cut off USAID funds in January, saying the organization that provides humanitarian aid abroad is 'not aligned with American interests.' The Trump administration is also poised to ask Congress for $8.3 billion in cuts to foreign aid efforts, which range from climate work to LGBTQ+ programs, The Independent previously reported. The decision has derailed the projected end of the AIDS pandemic and means the number of AIDS-related deaths could jump from six million to 10 million in the next five years unless aid is reinstated, The Independent previously reported. Data projections indicate there will be 3.4 million more orphans who have lost at least one parent to AIDS, and 600,000 more newborns could contract HIV by 2030. 'All the gains that we've seen over the last 20 years will start being steadily reversed,' Professor Francois Venter, a leading HIV doctor at the University of Witwatersrand in Johannesburg, previously told The Independent. Hadja, a 27-year-old mother of three in Uganda, previously told The Independent she has lost access to lifesaving medication since Trump effectively shut down USAID. 'Our lives depend on medicine – without it, our lives are shortened,' she said. 'If I die, my children will suffer.'
CBS News
05-02-2025
- Health
- CBS News
As Trump shuts down USAID missions, officials warn Ebola outbreak in Uganda will spread
Some health officials in the U.S. fear the shutdown of U.S. Agency for International Development missions may have disastrous results, as the stalling of foreign aid has forced delays in what they said was the "chaotic" early U.S. response to Uganda's swelling Ebola outbreak. The outbreak marks Uganda's eighth from an Ebola virus. The first confirmed case in the outbreak was a nurse at a hospital in the nation's capital, Kampala, who contracted Ebola on Jan. 20 or Jan. 21 and died on Jan. 29. There are now six confirmed and six suspect cases. In two of the suspect cases, according to an internal slide shared with CBS News, health authorities have identified no epidemiological link to the other cases. More than a dozen Americans in Uganda are also among those so far known to have been exposed to Sudan virus, the type of Ebola that had infected the initial case. Those people so far have not shown symptoms, two people familiar with the situation told CBS News. There is no vaccine or treatment approved by the Food and Drug Administration for Sudan virus. This Ebola strain has been fatal in at least 41% of reported cases during past outbreaks, according to the World Health Organization. The new outbreak coincides with the Trump administration's pause in foreign aid — including its response to international outbreaks that could spread. This has spawned uncertainty among health nonprofits, which now face unpaid debts and a sweeping freeze on much of their U.S. funding. "What we're talking about are disaster relief workers, we're talking about health workers and people who are doing good and protecting America around the world," Dr. Atul Gawande, a former USAID global health director, told CBS News on Monday. The pause has resulted in understaffed contact tracing and screening of departing international travelers in Uganda, one U.S. official said, since many experts funded by the U.S. around the region have been laid off or ordered to stop work. USAID is set to put virtually all its staff on leave on Friday and is shutting down overseas missions. "It puts the world at risk," said one USAID official in a message. "I'm not an alarmist, but this is very bad," the official added. In 2022, an outbreak of Sudan virus in Uganda prompted a large American response. The U.S. ramped up screening and preparedness for the virus here and sent staff and resources to aid Uganda's efforts to contain its spread. Uganda's healthcare system had already been stretched thin in recent months, battling a separate outbreak of a different disease – mpox – that has resulted in at least 2,031 cases, according to the WHO. Spokespeople for the State Department and USAID did not immediately respond to a request for comment. President Trump has also ordered the U.S. withdrawal from the WHO, which was paired with a demand for all U.S. government staff to immediately sever collaboration with the U.N. agency that is helping to coordinate the response within the country. A U.S. health official said that CDC usually works closely with the WHO and a country's health authorities, often meeting daily to coordinate the response to outbreaks like this. Despite the president's order regarding WHO, "CDC has been cleared to speak one-on-one with WHO counterparts related to response activities in Uganda," a CDC spokesperson said in a statement. The CDC said such conversations are also allowed regarding responses to other outbreaks of concern in Tanzania and the Democratic Republic of the Congo. Attempts by U.S. agencies to deploy staff to aid the outbreak response have also been delayed, one official said, amid government-wide pauses to travel and spending. While officials secured a waiver on Saturday from the State Department to free up some funds for the response, many recipients of U.S. funds have been reluctant to accept the money because of the turmoil in Washington, two people familiar with the situation said. Nonprofits have also been grappling with a growing number of demands imposed by the Trump administration as a condition for receiving funds, like a sweeping order to purge all mentions of gender and diversity "at every level and activity, regardless of your location or the citizenship of employees or contractors" supported by U.S. dollars. In Uganda, groups are still waiting for clarification from their in-country contacts at USAID about how the waiver would apply to their work, the people said, wary of incurring more expenses that might never be repaid. Following Mr. Trump's executive orders, the country's health ministry urged all staff backed by CDC and USAID to "continue working in the spirit of patriotism as volunteers," in a letter obtained by CBS News, as Ugandan officials sought "to restore normalcy." "Radio silence" from the CDC The growing outbreak in Uganda has also left some state and local health authorities befuddled with the "radio silence" from the CDC, officials told CBS News. In past outbreaks, CDC officials were quick to start ramping up preparedness for the possibility of cases spreading to the U.S. External meetings and information sharing that health authorities usually rely on to communicate with CDC officials were canceled amid the communications "pause" across the Department of Health and Human Services, or HHS. An HHS spokesperson did not immediately respond to a request for comment. The communications pause was initially expected to end this past weekend, but many federal health officials say they're still facing delays or denials in getting approval to publish information or participate in external meetings. "HHS continues to increase staff levels as we look forward to the new Secretary leading the agency. HHS has approved numerous communications related to critical health and safety needs and will continue to do so," Andrew Nixon, the department's communications director, told CBS News in an earlier statement. As a stopgap, some states have been working on informal partnerships to ramp up their own preparedness for the arrival of potential cases, officials said. The CDC was able to publish a travel alert on Wednesday about travel to Uganda, but it left out links and information from the WHO's updates about the outbreak. Other donors stepping in Not all health experts are alarmed about the current situation. Two U.S. infectious disease physicians who have worked with outbreaks in the country expressed confidence that other groups and countries would be able to fill the void left by American support, but acknowledged they're concerned about the possibility of undetected spread and delays in the response. In past outbreaks of Ebola, the U.S. has often funded many of the key steps to contain the outbreak in its earliest days, including rushing to set up isolation facilities and support the outbreak response from an array of non-governmental organizations with workers in the country. U.S.-funded laboratories have usually been on the front lines of past responses to outbreaks, through institutions like the Uganda Virus Research Institute. Some groups, like Médecins Sans Frontières and the WHO, have tried to cover the shortfall. The WHO recently touted its launch — with the help of Canada and Europe — of a vaccination trial in response to the outbreak.
Khaleej Times
28-01-2025
- Health
- Khaleej Times
Trump order set to halt supply of HIV, malaria drugs to poor countries, sources say
The Trump administration has moved to stop the supply of lifesaving drugs for HIV, malaria and tuberculosis, as well as medical supplies for newborn babies, in countries supported by USAID around the globe, a memo reviewed by Reuters showed. On Tuesday, contractors and partners who work with the United States Agency for International Development (USAID) began receiving such memos to stop work immediately, sources said. The move is part of a wider freeze on US aid and funding put in place since Trump took office on January 20, while programmes are reviewed. One such memo went to Chemonics, a large US consulting firm which works with USAID on the supply of medicines for a range of conditions worldwide. The memo covers the firm's work on HIV, malaria and tuberculosis as well as contraception and maternal and child health supplies, one USAID source and one former USAID official told Reuters. "This is catastrophic," said Atul Gawande, former head of global health at USAID who left the agency this month. "Donated drug supplies keeping 20 million people living with HIV alive. That stops today." Chemonics and USAID did not immediately respond to Reuters' requests for comment. Interruptions in treatment for diseases mean that patients risk getting sick, as well as, in the case of HIV in particular, transmitting the virus to others. It also means drug-resistant strains may emerge, Gawande said. He said other partners had also received notices that meant they would be unable to deliver medicines to clinics even if they had them in stock, or open the clinics if they are funded by the US. That includes organisations working with 6.5 million orphans and vulnerable children with HIV in 23 countries, he said. Trump ordered a 90-day pause in foreign development assistance on January 20, the day he took the oath of office, pending assessments of efficiencies and consistency with US foreign policy. His administration has also put on leave about 60 senior career officials at the USAID, sources familiar with the matter told Reuters on Monday. The administration's actions threaten billions of dollars of life-saving aid from the world's largest single donor. In fiscal year 2023, the US disbursed $72 billion in assistance. It provided 42 per cent of all humanitarian aid tracked by the United Nations in 2024.
