As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Dr. Melinda Elliott. She is the chief medical officer of Prolacta Bioscience where she serves as the voice of the patient, working to ensure that the needs of critically ill and premature infants are being articulated and that the relevant treatment and product opportunities are identified. As an experienced neonatologist and researcher in neonatal intensive care, Elliott has committed her career to the care of vulnerable, premature infants and has researched the benefits of an Exclusive Human Milk Diet (EHMD) for extremely low birth weight premature infants in the NICU.
I always wanted to be a pediatrician. Even as a very small child, my best friend and I had a plan: I was going to be a baby doctor and she was going to be a baby nurse. Well, we both succeeded in doing just that. She just retired after a long career as a pediatric nurse, and I am a practicing neonatologist (a doctor specializing in the care of sick and premature newborns). I actually never had a plan to do anything other than clinical neonatology and have worked in the neonatal intensive care unit (NICU) for over 30 years. In 2011, one of my patients was a very sick, very premature baby who developed a problem called necrotizing enterocolitis (NEC), a deadly disease that affects the intestines of premature infants. This baby was in my NICU for eight and a half months, an extremely long time for any patient to be in the hospital. Sadly, I did not win the battle to save this baby’s life.
To provide some background, premature infants have huge nutritional needs that their mother’s milk alone can’t meet. Requiring up to 40% more calories and protein than a full-term baby, premature infants need to make up for the growth they missed due to their early birth. To provide the needed additional calories and protein, NICUs often add a “human milk fortifier” to mother’s own milk or pasteurized donor human milk. There are two types of human milk fortifiers available to NICUs today: cow milk–based and donor human milk–based. Cow milk–based fortifiers were the first fortifiers available and are still used in many NICUs. Cow milk products, however, have been linked to an increased risk of complications, many of them life-threatening for the smallest babies.
After my experience with the baby who lost his life to NEC, I felt that there had to be something better than cow milk products to feed very ill premature infants who need more than their mother’s milk alone can provide. That is when I became aware of Prolacta Bioscience, the world’s leading hospital provider of 100% human milk–based nutritional products. I soon started using Prolacta’s human milk–based fortifiers in my NICU and immediately saw a huge change in how well the babies did. I was so impressed and passionate about the results I was seeing in my neonatal patients that I published a study with our results and met some of the people working at Prolacta. I was inspired to find a way to help every premature or ill baby have access to Prolacta’s lifesaving nutritional products and thus joined the company. As Prolacta’s chief medical officer (CMO), I serve as the voice of the patient, and I have an opportunity to help provide these lifesaving human milk–based fortifiers and formulas to babies who need them. For me, it is all about the chance to provide the best outcomes for sick newborns and their families everywhere.
Because we’re becoming an increasingly global company, I have had the privilege to travel to large portions of the world with Prolacta. A couple of years ago, I went to Japan and had the honor of having dinner with a distinguished professor there. He hosted us at one of his favorite restaurants. I am allergic to shrimp, and I had to tell my host at the beginning of the meal, since shrimp is a common food in Japan. He personally ordered our meal for us, and I was conscious of eating everything so as not to cause any embarrassment. The first course was raw baby squid. We were all sharing, so I ate my two pieces. I love calamari, but raw was not quite the same. The next course was tiny white shrimp tempura. It looked delicious, but I could not have that due to my allergy. The professor graciously gave me his portion of the baby squid! I got them down (barely) and prevented some embarrassment for all. After that, the rest of the dinner was amazing.
I’m not sure how funny this is, but I can tell you that my colleagues at Prolacta and I still joke about this. Prior to joining Prolacta in 2016, I had only ever worked as a doctor in the NICU. So, my first board meeting was really new to me. During the meeting, I was asked how some of our nutritional products could be used. Whenever I talk about human milk–based products, I become quite passionate. I tend to get very excited and talk about all the benefits I have seen in my patients and what other potential benefits may be seen in the future. I believe every ill newborn can benefit from being given human milk exclusively. After we finished for the day, one of my colleagues came over to me and half-jokingly said that he might lose his job because the board would now expect sales to increase exponentially as I had made it sound like every hospital in the world would immediately buy our products based on how passionately I spoke about them. I learned to think carefully about what I am being asked before I answer.
I am not sure I have an exact quote, but I will tell you what I have learned over the years and what I always tell my residents and students.
Don’t make snap decisions about lifelong career choices. Take a good look at what your life might be like 10 years down the road when you’re trying to choose your path. If, 10 years from now, on the worst day you can imagine, you still want to go back to work the next day, then you have chosen the right path. I remember this advice every time I have a bad day. In medicine, some days are really bad. Even as CMO, some days are pretty bad. Most of the time, though, there’s some good even on a bad day. That’s what I focus on. I have always wanted to go back to work the next day.
An excellent health care provider is one who listens to you. It’s someone who takes you as you are and accepts you as you are without judgment. Obviously, a health care provider has to be well trained, but I consider good training a basic requirement. A great provider will help you move forward with whatever problem you come to him or her for. It’s that person who will listen to your concerns and not dismiss you. It’s someone who treats you as if you are the most important person in the room at that time. A great provider is the one who really tries to put himself or herself in the shoes of the patient and do everything he or she can to help that person as he or she would a close family member or friend.
I love to read, but I am not as good at listening to podcasts. The books that mean the most to me as a healthcare leader are the ones that make me look at the past: the struggle to improve care and the mistakes we as a society have made. I learn a lot from history. Some of the books that have inspired me include: “The Immortal Life of Henrietta Lacks” by Rebecca Skloot, “Women in White Coats” by Olivia Campbell, “Bellevue” by David Oshinsky, and “And the Band Played On” (I know, it’s an old one) by Randy Shilts. These books have all affected my interactions with my patients and my career as CMO. They are all very different, but each one tells stories of past incorrect assumptions when it comes to healthcare and the results of those assumptions. Each one reminds me to not make assumptions without getting the facts and to not jump to conclusions too quickly.
The things that get me excited involve helping a baby who had few other choices in the past. Prolacta is working on a new human milk–based fortifier for critically ill term newborns with severe congenital heart disease who require surgery shortly after birth. We know that all newborns should have their mother’s milk. Sometimes babies require more calories and protein than mothers’ milk alone can provide. Historically, all we’ve had in the past for any infant who needs these supplements to mother’s milk have been cow milk–based products. Since Prolacta came on the scene, we now have an alternative for premature infants, but we’ve never had something for term babies. The potential to bring better human milk–based nutrition to additional patients is exciting, and we hope this new product will soon be available. I think it will be a game changer for these extremely ill babies and lead to better growth and development.
Additionally, we have learned through research that not all human milk products are created equally. Human milk must be treated to prevent transmission of infectious diseases to babies receiving milk other than their mother’s own. Of processed products, Prolacta’s fortifiers retain the most essential bioactive components in human milk due to our vat pasteurization process. Bioactivity is important because these components in human milk are essential for supporting premature infants’ immunity, growth, neurodevelopment, and overall long-term health. We’re discovering more benefits of human milk every day and will continue to research how it benefits premature and critically ill infants.
I believe the biggest reason is that healthcare is not the same for everyone. If we all had access to the same, high-quality health care, we could likely decrease many of the major health issues in the US today. Good, equitable access to health care for everyone would lead to better health outcomes.
Another contributor to the poor US healthcare ranking is a lack of emphasis on maternal and pediatric care, again in an equitable fashion. All women of childbearing age should get regular preventative care. All pregnant women should have access to excellent prenatal and postnatal care. Family leave after the birth of a newborn is abysmal here. All families should get paid maternity and paternity leave. All newborns should receive the best care possible, and it needs to be equitable. For example, Black premature babies are four times more likely to die from complications of prematurity than white babies.
This is because many safety net hospitals lack access to the highest standard of care. Children are the country’s future, so every dollar spent on improving their health only benefits the country long-term.
Lastly, mental health care needs to be inclusive and complete. Mental illness has been stigmatized for too long, and it is time we address it.
Sadly, I don’t believe there is a simple quick solution. There are a lot of steps we all can take, however. As individuals, we can learn more about our own health and become true partners in our own health care. We can take ownership of our own health. As corporations, we can support the movement to address the inequities in the healthcare system. As communities, we can support our neighbors and those in our neighboring communities. As leaders, we need to speak up for the inequities in the system. We can work toward a fair system for all. We can start with mothers and children as they are our future. Paid family leave should be routine.
The COVID-19 pandemic shined a spotlight on health care inequity. For example, the impoverished communities of essential workers were the hardest hit. Hospital intensive care units (ICUs) were overflowing, and health care workers were pulled to work in the ICU from other units. Burnout of staff is a major and real problem. I have seen many reports of doctors and nurses leaving their careers due to the stress and burnout of COVID-19. Many are exhausted by the pandemic and want out of their careers in healthcare.
We immediately need to address this burnout and give the health care workers the support they need. We need to provide mental health support and find a way to allow them to heal. It needs to be acceptable to receive mental health care in the medical profession. Giving time off (if possible), staffing adequately, and paying the staff well will go a long way to relieving stress, if accompanied by the right mental health support.
We need to prioritize primary care physicians and incentivize medical students to choose primary care. We need to pay them appropriately and provide them with the tools they need to be successful. This must include a good, easily portable electronic medical record (EMR). EMRs are improving, but there are still multiple different ones, and they do not communicate well with each other. We need to put health care back into the hands of the health care practitioners and decrease the exhaustive paperwork. We need to consider medical school loan forgiveness. A student who is hundreds of thousands of dollars in debt from medical school will be less likely choose a lower-paying primary care specialty.
Start with improving inner-city schools and giving kids the chance to see themselves as doctors. Support them with whatever is necessary to allow them to grow and thrive. This could include meals, computers, role models, and full scholarships all the way through medical school. They might need a place to study after school or on weekends. We need to help the communities build a positive path for children.
This status quo is partly responsible for the great disconnect between mental health care and physical health care. Mental health care is inextricably intertwined with physical health. Unfortunately, mental illness has a stigma attached to it, such that many people with mental illness never get care. Psychiatric care is becoming hard to find and is often now only available to those who can afford to pay for it. Insurance has moved mental health coverage to the side, and it is often very poorly covered. We need mandatory coverage for mental health care, and it should be fairly compensated. Patients should be able to receive care for both mental and physical health at the same time and in the same clinic. They are too interrelated to be so separated.
I would work to improve schools in poverty-stricken areas to give the next generation the education it deserves. This likely would involve an entire community approach to help families and kids. The movement would be community-focused, likely involving not just the schools but before and after school care, meals as needed, computers, Wi-Fi, and more. It would also include paying teachers a good salary to teach there. If we give the children and families a future, this could make a huge difference in a single generation.