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First, Do No Harm: 'Escape Fire' Tackles the Healthcare Crisis

By Denise O'Kelly

With a long history of making films on some of the most pressing social issues of our time, such as poverty, addiction and hospice care, Susan Froemke and Matthew Heineman collaborated with a team at HBO on the groundbreaking, Emmy-nominated series The Alzheimer's Project. Together again, these filmmakers produced and directed Escape Fire: The Fight to Rescue American Healthcare, a project of IDA's Fiscal Sponsorship Program. Considered by many to be the Inconvenient Truth for the American healthcare debate, the documentary premiered at the 2012 Sundance Film Festival and went on to win the Kathleen Bryan Edwards Award for Human Rights at the Full Frame Documentary Film Festival and the React to Film Social Issue Award at Silverdocs.

Escape Fire, whose title alludes to the practice of starting a small fire to provide shelter from an oncoming blaze, tackles one of the most pressing issues of our time: how we can save our badly broken healthcare system. Interweaving dramatic personal arcs of patients and physicians with the stories of leaders battling to transform healthcare at the highest levels of medicine, industry, government and even the US military, the documentary presents attainable solutions--ways to light "escape fires"--to find our way out of the current crisis and fix healthcare.

We spoke with Froemke and Heineman via e-mail.


Courtesy of Roadside Attractions


Documentary: In your working together as co-directors of this film, how do you balance and complement each other?

Susan Froemke and Matthew Heineman: We are very fortunate in that we see the importance of character and stories in a very similar way. We both were committed to describing the problems and obstacles in reforming our healthcare system but also presenting possible solutions, or “escape fires,” that pioneers are developing and implementing. We both wanted to find great "voices" to explain this incredibly complex system in an understandable way, but also find compelling narratives of individual patients and doctors who could touch the audience and exemplify that change is possible.


D: Inasmuch as they are different, can you describe your individual approaches to the filmmaking process?

SF and MH: Besides the difficulties in gaining the intimate access we needed to tell this story, the biggest challenge we faced was the topic itself: healthcare. It’s a hot-button issue. But when you scratch beneath the surface, it gets complicated and wonky pretty quickly. So, from day one, we have acknowledged these challenges, and we tried to construct a film that was both entertaining and intellectually stimulating. Given our previous collaborations, we knew that our approaches to filmmaking are really quite similar. We’ve interwoven a chorus of experts, animation, and archival footage with personal stories in order to show the healthcare system from all angles. It’s a hybrid style, but at the film’s heart is the tradition of cinéma vérité--the art of capturing life as it unfolds before the camera. The personal stories of patients and physicians are all filmed in this vein, and provide the dramatic arc of the film.


D: In your film, Dr. Andrew Weill describes the current American Healthcare system as "a disease-management system"; Dr. Don Berwick affirms, "Good people, bad system"; Dr. Steven Nissan states baldly, "When medicine became a business, we lost our moral compass." Is there any feasible escape fire in prospect?

SF and MH: There are a number of solutions, or “escape fires,” that we highlight in Escape Fire: A program developed by Dr. Dean Ornish at the Preventive Medicine Research Institute--now reimbursed by Medicare after a 16-year struggle--combines exercise, diet, stress reduction, and social support to prevent and potentially reverse heart disease. At the Pentagon, there’s a special task force within the office of the US Army Surgeon General dedicated to using alternative techniques like meditation and acupuncture to wean injured veterans off heavily addictive narcotics used for pain and PTSD [post traumatic stress disorder].

The Cleveland Clinic—which both President Obama and Gov. Romney praised in Wednesday’s opening debate—has a team-based approach, putting its physicians on salary, and rewarding them for quality, not quantity. At the University of Arizona, Dr. Andy Weil re-trains doctors in preventive medicine and advocates for treating a patient as a whole person, rather than as a bionic sum of specialist and sub-specialist parts. Safeway and other corporations are starting to provide incentives for their employees to lose weight, reduce blood pressure and stop smoking. Many of the needed "escape fires" can take place today in local communities, in local hospital settings, and in individual medical schools to begin to find a much better balance between healthcare and disease management in our overall system.


D: The US is as low as 50 on the list highlighting countries with a healthy life span. Half of television advertisements are for pharmaceuticals. Three hundred billion dollars a year is spent on drugs. There is a national dependency on prescription drugs, and lobbyists and pharmaceutical reps are in cahoots.

SF and MH: One of the major themes of the film is the tension between the business of healthcare and the delivery of healthcare. The film presents dedicated physicians who care about their professional obligations, but are concerned about the corrosive effects of a single-minded pursuit of profit in medicine. Another theme expressed by the experts in the film is that we pay for procedures, not good results. In America, you’re twice as likely to get your knee replaced as you are in other Western countries. You’re two or three times as likely to get a heart catheterization or have a stent put in your coronaries. We’ve set up a reimbursement system that often pushes physicians and hospitals into doing more. It doesn’t reward doctors for doing a better job. It doesn’t reward them for keeping their patients healthy. It rewards them for delivering more care. And driven by these perverse economic incentives, doctors are doing a lot of procedures to people that they don’t need and, in fact, may cause harm.


D: In 2005, Steve Burd, president and CEO of Safeway, lowered the company's healthcare premiums by 40 percent by implementing a remarkably effective strategy, the drive being to facilitate smart choices for company employees. Is this a salutary template for others to adopt?

SF and MH: Nearly 180 million Americans receive their health insurance through company plans. Many large companies are experimenting with programs like Safeway's. These programs can be important for employee’s well-being (Roughly 30 percent of Safeway employees quit smoking; 21 percent of their formerly obese workforce are no longer obese.), but they can also help companies save in terms of overall healthcare costs. Potentially, it could be a way to reduce the rate at which national health costs are rising. What’s so powerful in the Safeway story is how the company succeeded in creating a culture of health and fitness with its headquarters employees. In the long run, these employees will be less of a burden on the Medicare system of the future. It’s an approach that both sides of the aisle in Washington believe in and support.


D: The story of young combat veteran Sgt. Robert Yates is an astonishing transformation from self-professed hillbilly-"Hold my beer while I shoot this gator"--to proof-positive that alternative means can heal on all levels.

SF and MH: Our greatest challenge was getting access to a compelling story with the US military. As with the rest of America, there is a default reliance on using pharmaceutical drugs when treating injured soldiers, and unfortunately this often leads to reliance on potentially addictive painkillers. We found out about a novel study to reduce drug use by testing acupuncture for pain relief in injured soldiers on a medivac plane returning to the US. We spent nearly a year trying to get permission to film aboard the plane. It was less than two weeks before the flight, and we were nervous that we were going to miss the opportunity. Finally, just before Christmas in 2010, we got the signoff from the US Army and the US Air Force.

Shooting aboard the C-17 Air Force medivac plane was definitely an exhilarating, moving experience. We got some of our most gripping footage on the flight and met an amazing young soldier, Sgt. Robert Yates, who was heavily overmedicated with painkillers. We were fortunate enough to follow him for months as he attempted to wean himself off a deadly cocktail of drugs through the help of an innovative program at Walter Reed Medical Center. In the edit room, the story of Sgt. Yates’ battle to recovery became the narrative backbone that arcs through the film. He’s one of those great vérité characters that documentary filmmakers pray for. His story is sad, it is courageous, it is inspiring. After countless screenings, we are still moved viscerally by him. And, ultimately, his story shows what happens when we open up our minds to something different—a prescient lesson that our healthcare system could learn from.


Courtesy of Roadside Attractions


Escape Fire opens in theaters October 5 through Roadside Attractions.


Denise O'Kelly is a writer, editor and translator living in Santa Monica.


Editor's Note: This is a reworked version of the article that was published on September 13.