Michael Saag, MD came to Birmingham in 1981 to begin his residency in internal medicine at UAB with plans become a cardiologist. A few days after arriving in the city, the U.S. Centers for Disease Control reported eight cases of “unusual opportunistic infections” in gay men. The discovery of Acquired Immune Deficiency Syndrome (AIDS) soon sent Saag down a career path he never imagined.
As more became known about human immunodeficiency virus (HIV) and AIDS, Saag became attracted to the field of infectious disease with its variety and unpredictability. During his fellowship, he encountered two patients who peaked his interest in HIV and later found himself immersed in the search for a way to save the many AIDS patients who were dying from the disease.
“Three things factored into my decision to focus on infectious disease, AIDS in particular,” he says. “The disease was enigmatic. It wasn’t clear exactly what was happening and why so many people were dying. Secondly, the affected people were my own age, so it hit close to home for me. Third, it was a cause. I was too late to protest the Vietnam War, so this was my cause.”
Because of the hard work and dedication of Saag and many others around the world, the threat of death from HIV/AIDS has been greatly reduced over the past few decades. Saag, director of the Center for AIDS Research at UAB, says that success is the result of basic science being translated rapidly into therapeutics.
“Once the virus was discovered, its key components were evaluated and drugs were designed to inhibit its life cycle in a targeted way,” he says. “Activists pushed hard, and collaboration between the pharmacy companies and the government to get the drugs to market rapidly was critical.”
Toward the end of his fellowship, Saag helped establish the 1917 Clinic in Birmingham for treatment of HIV/AIDS patients. “We designed the clinic as a true medical home before it became popular to provide primary care in that type setting. It functions as a one-stop location where patients come to be assessed, to receive medicines, pain management, and even spiritual and psychosocial counseling. It is a place where people can feel supported for all of their needs associated with the illness,” he says. “I’ve often said that while I don’t want to have HIV, I would love to be treated in a place like that.”
His years of working with these patients has revealed to Saag the deficiencies of the U.S. health care system. “We often hear that our health system is the best in the world, but the reality is that infant mortality in our country is twice as high as in Sweden and Germany, and American maternal mortality is twice as high as the United Kingdom,” he says. “The U.S. system is far and away the globe’s leader in one category – cost. Payments for procedures and drugs are significantly more expensive than in other developed countries.”
Saag recently published the book Positive that highlights his career and discusses the dysfunctional U.S. health care system. He suggests remedies drawn from his experiences. He talks about the success of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, named for an Indiana boy who had hemophilia and contracted AIDS through a blood transfusion. “The act was passed in 1990 and was designed to close the gap between the ‘haves’ and the ‘have-nots’ who have HIV,” Saag says. “It has done exceedingly well, so much so that a 2012 study could not demonstrate any differences in health outcomes between those with financial means and those with incomes below 100 percent of the federal poverty rate. This is remarkable because in almost every other disease state, poor patients in the United States have much worse outcomes in every category.”
Saag hopes his book will spark debate about the quality of our current health system and how positive changes can be made. “What I hear in the news is mostly argument about The Affordable Care Act and what it offers and doesn’t offer,” he says. “It is an attempt to help, but it is just the first step. We have a long way to go.”
Our current system, Saag says, is not focused on the patient. “Our system is designed too much for profits, not enough for patients,” he says. “We’ve blamed each other for what doesn’t work instead of working as neighbors to fix the problems. When attitudes like ours harden into policy, you get the kind of health care system America has today – wasteful, short-sighted, disorganized, and ineffective.”
To improve the system, patients and providers must become allied so that everyone is working together, Saag says. “In our broken health care system, I believe that the ‘safety net’ that keeps patients from falling through the cracks is made up solely of health care workers who give a damn. In the case of HIV patients, those tenacious workers were paid and equipped in large part through the Ryan White program,” he says. “I shudder to think what would have become of those patients if Ryan White had not been created. And I lose sleep – particularly when it’s budget reauthorization season on Capitol Hill – thinking about what would happen if Ryan White went away.
“While this is my nightmare, other health care professionals lay awake at night because they have no Ryan White equivalent. They have no supplemental, gap-closing program for whatever disease has their attention as HIV/AIDS has mine,” Saag says. “They have no dedicated source of additional funding to do for their disadvantaged patients what the current health care system fails to do.”
No other country in the industrialized world has a Ryan White program, Saag points out. “Why? Because they don’t need it. Their patients have full access to care without such a program, because each of these countries has a system of universal health care that covers all of their citizens in a coherent, reliable fashion,” he says. “Compared to the U.S. system, those countries’ systems deliver health outcomes that are better by almost every measure and accomplished at about half the cost.”
Saag hopes his book will help spark the changes that are needed in the U.S. “The point is, something has to provide a comprehensive safety net. Too many people are making money off the chaos we have now. That has to change, and I hope the stories in my book will motivate people to work together to make our health care system better.”
