Talking Health

Joshua Sharfstein, Maryland secretary of health and mental hygiene, says with all he does, seeing patients is “very rewarding.”
Joshua Sharfstein, Maryland secretary of health and mental hygiene, says with all he does, seeing patients is “very rewarding.”

Dr. Joshua Sharfstein has worked in a variety of diverse capacities. He worked on community health projects in South America before medical school, worked as a pediatrician, served as Baltimore’s health commissioner and deputy commissioner of the U.S. Food and Drug Administration under President Barack Obama and is now the secretary of Maryland’s Department of Health and Mental Hygiene.

It’s exciting to be Sharfstein, 44. He’s chairman of the Maryland Health Benefit Exchange, the group that oversees Maryland’s implementation of the Affordable Care Act, and, as a pediatrician, has recently started seeing patients again. The Baltimore Jewish Times sat down with Sharfstein in his Baltimore office to talk about the ACA, medical marijuana and a variety of other health-related topics.

JT: What kind of challenges did you face as the Baltimore health commissioner?
Sharfstein: Baltimore is a city with incredible public health needs but also with incredible public health resources. And so I defined the challenge, in part, as aligning the resources against the needs. We mobilized a lot of college students across the city in a program called Project Health, which is now called Health Leads. … We mobilized the medical community against drug addiction by training doctors and encouraging them to take care of drug addiction using a relatively new medicine … that contributed to a substantial decline in overdose deaths in the city. We tried to develop strong community responses to problems and support them in different ways by giving communities data about their health that they never had before.

President Obama tapped you to be a part of the FDA’s transition team as deputy commissioner. How did you approach that mission?
Dr. [Margaret] Hamburg (FDA commissioner) and I tried to bring the FDA back to its roots as a public health agency. … The agency became much more transparent; the agency took on some public health issues including food safety and tobacco among other types of issues. I was very involved in … dealing with certain unsafe products. So I do think that the FDA has done better.

Why did you decide to leave the FDA to become Maryland’s secretary of health and mental hygiene, and what issues have you been focusing on?
There’s an awful lot going on in health care right now, and I think it’s a unique opportunity to align the health-care system for health. We spend a lot for health care; we should be getting more health out of it.

We’ve been organized around certain public health outcomes, defining key public health outcomes for the state and bringing coalitions together to make progress on that. We’ve been rethinking different aspects of the health-care system, including strengthening primary care and reorienting the incentives in the hospital system to support prevention. We’ve been talking about integrating mental-health and substance-abuse treatment more into medical care. And of course, we’ve been implementing the Affordable Care Act.

Tell the JT about your role as chair of the Maryland Health Benefit Exchange and how things are going with enrollment so far.
It’s been a terrific experience. We’ve had to very quickly set up a whole legal structure and policy framework … [and] hire the right people — a whole range of different things to prepare to launch the exchange.

It’s been very impressive how much interest there is. I think one of the questions that came up was, “Do people really want health insurance?” In the end that question’s been answered, there’s a lot of interest. And we hear that not just from people we know, but also because so many thousands of people are calling the call center, so many people are talking to community health workers, and we’re hearing about it from hospitals and health centers. All across the spectrum there’s a lot of interest. And I think this is obviously a very challenging project. Our mission is to really meet that interest.

In the past, you’ve said you need more data on medical marijuana. Why did you support the most recent medical marijuana bill in Maryland?
This particular bill creates, essentially, a compassionate-use program for medical marijuana, which is modeled loosely on how FDA handles medications that haven’t been approved yet, but for which there is both evidence of benefit and harm. The way the FDA handles that is the patients have to consent, there has to be a clear reason to believe that it will work, and [a medical facility] has to collect data [on the use]. What we’re basically saying is those are the kinds of programs that could make marijuana available, and it should be under the umbrella of an academic medical center.

Why did you start seeing patients?
I just miss seeing patients. It’s very rewarding. I’m aiming for roughly once a month. I’d like to do more, but we’ll see.

What else is on your radar?
I would say that we’re really focusing on preventable illness and collaborations between the medical world and the worlds of public health and community health and using data that we have in-state to identify where we have a lot of preventable illness and then being strategic about how we try to prevent it.

Marc Shapiro is a JT staff reporter —

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