Feature Article
Profile of a new director:
Eric Larson takes the helm November 1
By Katie Saunders
Eric Larson, MD, MPH, cites plenty of reasons for wanting to become
director of Group Health Center for Health Studies—a job he’ll assume this
November 1.
One is shared history. Larson—who is currently director of the
University of Washington Medical Center—worked with CHS leadership to
establish CHS in 1983. "I was part of the group at CHS and UW
planning aging-related health promotion studies in the early days of the
Center and I saw its capacity to do great work," he says.
His twenty years of experience conducting research on aging among the
Group Health population is another plus. Larson says the relationship
allowed him to witness the Center’s emergence as a highly regarded
research institution firsthand.
But in the end, it was his two-day interview at the Center last spring
that clinched the decision. "I was just really impressed with how
nice people were and how committed they were to their work," he says.
Commitment to work is an understatement when it comes to Larson.
On-call 24 hours a day, 7 days a week, 365 days a year during his 13-year
tenure as UW Medical Director, Larson states the obvious—"I really
throw myself into my work."
In discussing his career, several themes emerge that may help explain
Larson’ drive—the thrill of discovery, an insatiable intellectual
curiosity, and a commitment to health care quality, whether in the
capacity of researcher, administrator, teacher, or practitioner.
At Harvard Medical School, Larson’s training in general internal
medicine encompassed two lines of inquiry—"conventional"
course work such as biology, physiology, and anatomy, and "social and
community" medicine. A central underpinning of the latter concept is
that medicine should not be concerned solely with the absence of disease,
but also with the impact of social, economic, and environmental conditions
on health. Under the auspices of this program, Larson studied issues
related to environmental health (exposure to lead among low-income
children and asbestos poisoning), health care economics (how the number of
providers affects health care), and "ecologic" medicine (the
study of how medicine is actually practiced).
An early interest in technology assessment: "When all you’ve got
is a hammer…"
Following his interest in "non-molecular" medicine, Larson
enrolled in the first class of the Robert Wood Johnson Scholars Program in
Seattle in 1975. His major focus was on technology assessment,
particularly computed tomography (CT). It was new in 1973 and "a
wonderful technique that opened up the brain for imaging," he says.
Larson and colleagues demonstrated that the availability of CT scans on
an outpatient basis largely obviated the need for invasive inpatient tests
such as cerebral angiograms in patients with brain tumors and seizure
disorders.
However, as is the case with any new technology, Larson found that
discretion was needed. "When all you’ve got is a hammer, everything
looks like a nail," says Larson, and that’s how it was in the early
days of CT. While headaches are a common medical condition in the U.S.—resulting
in 16 million visits per year—primary brain tumors number only in the
few thousands. In spite of these statistics, Larson found that the most
common use of CT in the mid-1970s was to rule out brain tumors among
headache patients.
Similarly, in a study conducted in the late 1970s at three hospitals,
including the UW, Larson and colleagues found that CT scans were commonly
used to rule out organic causes (e.g., brain tumors) of psychiatric
disorders. Such widespread, indiscriminate use of a powerful procedure
such as CT results in higher health care costs and an increased occurrence
of false positives, which can lead to more tests and unnecessary anxiety
for the patient.
Based on these findings, Larson argued for a "rule-in" rather
than "rule-out" approach. This means a CT is recommended only if
the type and pattern of headache or the specific nature of abnormal
neurological findings indicates a higher likelihood of a true positive
finding. Summing up this research, Larson says "the notion of the
hazards of the rule-out approach to diagnosis has now been fairly well
accepted."
Aging and dementia: "What I was seeing was different from what I’d
been taught."
In 1978, Larson immersed himself in the discipline that was soon to
become the main focus of his research—aging and dementia. A colleague
asked him to assist with a new clinic, "Geriatrics and Family
Services," which was the first outpatient clinic to perform
comprehensive geriatric evaluations for demented patients and their
families.
"I had just finished being chief resident and thought I knew
everything," Larson muses. "I got in there and realized that
what I was seeing and observing was very different from what I had been
taught."
Larson proceeded to read everything he could about dementia and
realized that even the most current research did not reflect what he was
seeing firsthand. Exploring this discrepancy, he identified two major
culprits. Much of the written literature described dementia among
inpatients, the majority of whom were under age 60. In practice, patients
with dementia are typically outpatients who are quite elderly—rates of
cognitive impairment soar after age 80. Another problem, according to
Larson, was that the literature tended to focus on reversible vs.
irreversible forms of dementia. Larson argued that concentrating on this
distinction between dementia that was reversible and irreversible,
treatable and untreatable, detracted from the overall care of the patient
and his or her family. Indeed, this dichotomy is out of favor today.
"It was just one of those opportunities where, as a researcher, if
you are discovering things that are new to you, you realize that they are
probably new to other people," says Larson. "The discovery part
of it just fascinated me."
Larson further explains that the elderly go through a whole set of
changes, similar, but often in the opposite direction to, those
experienced by infants, adolescents, and young adults. In contrast, the
years between young adulthood and elder age are relatively stable. "I
realized that if you look at where the action is in medicine—where the
chance to affect the patient’s well-being is the highest—it’s
probably around pre-conception, pre-natal, and birthing, and the late
parts of a person’s life where you have lots of conditions that impair
function and that we treat."
Seizing this opportunity to impact seniors’ health and quality of
life, Larson and colleagues embarked on a series of ground-breaking
studies in the 1980s and 1990s. They established a widely-accepted new
work-up for dementia that deviated from the previous gold standard in both
content and setting (outpatient instead of inpatient).
Larson’s work helped draw attention to the importance of adverse drug
reactions among the elderly and demonstrated that elderly people with
dementia were more likely to fall, resulting in higher fracture rates.
Drugs that adversely affect balance were later implicated by Larson and
colleagues in the insidious relationship between dementia and falls. The
researchers also demonstrated that elderly patients often suffer from
depression and dementia at the same time, contradicting the widely held
belief that the two conditions usually manifested themselves separately,
as either dementia or pseudodementia.
No description of Larson’s research would be complete without
mentioning Alzheimer’s disease. Having received a continuous stream of
federal funding since the mid-1980s for Alzheimer’s research, Larson and
colleagues have sought to increase understanding of this neurological
disease that primarily impacts society’s "oldest old"—the
fastest growing population segment in the U.S. In collaboration with CHS
investigators Ed Wagner and Andrea LaCroix, Larson and Walter (Bud) Kukull
in the UW Department of Epidemiology, along with co-investigators Jim
Bowen, Wayne McCormick, and Linda Teri, established an Alzheimer’s
disease registry among Group Health enrollees aged 65 and older. The
researchers also conducted a prospective cohort study in the Group Health
population, enrolling disease-free seniors and following them over time to
see who develops Alzheimer’s. (For more information on Larson’s
Alzheimer’s disease research at Group Health, see CHS
Research News, Fall 2000).
Larson is also involved in the Kame project, an epidemiological study
of Alzheimer’s disease and other forms of dementia in Japanese Americans
living in King County, which is coordinated with similar studies in
Hiroshima and Honolulu. His expertise in this area is widely recognized,
having been one of the original members and eventually chair of the
Advisory Panel on Alzheimer’s Disease for the Office of Technology
Assessment in the U.S. Department of Health and Human Services.
Teaching, practicing, and leading one of the nation’s top-ranked
hospitals
In the mid to late 1980s, in addition to conducting research, Larson
taught at the UW Medical School as an associate professor. He also
maintained a practice of general internal medicine.
Then, in 1989 Larson became director of the UW Medical Center. As
director, he is responsible for the medical care delivered in the
hospital, a charge that encompasses quality, risk management, patient
safety, planning, and compliance with external regulations.
Under Larson’s leadership, the UW Medical Center has earned a
reputation for quality, recently ranked 11th in U.S. News and
World Reports’ Honor Roll of best U.S. Hospitals. Another analysis,
based on morbidity and mortality benchmarks, reveals that the UW Medical
Center’s performance in many areas is far superior to that of other
institutions. While Larson is extremely proud of this commitment to high
quality, he has not become complacent. "We can’t ever rest on our
laurels. I hope I’ve established that, as a feature of a high-performing
organization, you can’t get comfortable feeling that you’re so good,
that you don’t have to improve anymore," he says.
Larson will bring this same drive for high performance to CHS where, as
director, he will be responsible for the Center’s scientific and
administrative leadership. He sees CHS as constantly changing, not in
fundamental character, but in lines of inquiry. "I think part of the
dynamism of the Center has been its ability to look for new areas of
investigation and to identify new areas of relevance," he says.
Regarding the Center’s future growth, Larson is hopeful but feels it
is dependent on the availability of funding and the talent and imagination
of the investigators. Larson says his own planned research pursuits at the
Center will include Alzheimer’s/dementia, successful aging, chronic
disease and quality, and the use of information technology and the media
to change social patterns of behavior as they relate to health, especially
around exercise and aging.
Directing Group Health Center for Health Studies: "A job that clearly
resonates with me."
In addition to his scientific duties, Larson will assume substantial
administrative responsibilities at the Center, some of which involve the
larger Cooperative. He is looking forward to working with Group Health CEO
Cheryl Scott, with whom he attended graduate school. Larson feels that the
most recent strategy sessions between CHS and Group Health leadership
crystallized the Center’s relationship with the Cooperative, showing how
the Center is definitely affiliated but somewhat independent from the
Co-op. Group Health leadership also acknowledged CHS as a vital—and
potentially even more vital—asset, says Larson.
Larson is comfortable working within the context of the
"parent" HMO organization, having been a fan of Group Health
since he came to Seattle in 1975. "Over the years I’ve become even
more cognizant of the fact that a group banded together to make sure that
people had affordable healthcare," he says. "That model turned
out to be the HMO model built around primary, comprehensive medical care
as opposed to episodic medical care. That clearly resonates with me."
Larson does not plan big changes at CHS. "The Center is not a
place that needs to be fixed—it’s running well," he says. Larson
extends major credit for this successful state to Dan Cherkin, the Center’s
acting director since September 2000. Larson adds that Cherkin has been
"incredibly generous with his time and wisdom" in orienting
Larson to his new job.
Larson did not mention any specific actions he’ll take at CHS,
emphasizing that he’ll be doing a lot of learning and listening at
first. But he’s committed to mentoring junior scientists and to
empowering the staff as a whole. "I want to establish and communicate
that all staff are genuinely partnered in pursuing a common good, looking
for a common goal," he says.
After becoming CHS director, Larson will continue to care for patients
in the small, part-time, 25-year-old primary care practice at UW Medical
Center–Roosevelt General Internal Medicine Clinic.
Given an opportunity to comment further on his professional
accomplishments, Larson chose instead to talk about his family. His wife,
Kathryn Zufall-Larson, MD, is a "wonderful" violinist (he’s
a "less wonderful" pianist) and a primary care doctor in
Shoreline. They have three children—Peder, 22, a graduate student at
Stanford University; Kris, 20, an undergraduate at Stanford; and Paul, 18,
a senior at Shorewood High School. In addition to the piano, Larson’s
outside interests include gardening, squash, biking, reading, hiking,
climbing, and skiing—a sport that the entire Larson family enjoys. He
has volunteered on the Stevens Pass Ski Patrol for nearly 25 years and
currently serves as the director of the Ski Patrol’s volunteer medical
advisors. In August 2002, Larson and his family took a much-anticipated
trip to the wilds of the Brooks Range in Alaska.
Given the world of possibilities open to a person of Larson’s
caliber, it speaks well of the Center that he has accepted a position as
its director. As Larson told the Seattle Post-Intelligencer,
"There are very few jobs in Seattle I would love to have, and this is
one of them."
Top |
search
