Meet Our Docs: Dr. Mark Dowell thinks ‘life is full of pus-abilities'
By Kristy Bleizeffer Jun 9, 2014
As an infectious disease specialist, Dr. Mark Dowell wears his chlamydia proudly. He does the same with his syphilis, gonorrhea and West Nile. Depending on the color of the clean shirt hanging in his closet, he chooses which infection he’ll take to work. Tuberculosis pairs nicely with light blue, anthrax with red or gray.
If you’ve ever met Dr. Dowell, you’ve probably seen one his neckties featuring graphics of the viral and bacterial infections he treats. He gets them from Infectious Awareables, a website selling “unique, science-based products designed to promote health awareness.”
“They also sell scarves, boxer shorts and other things, but the ties are the main sellers,” Dowell said. “I have a couple pairs of the boxer shorts, but let's not go there.”
Dowell is founder of Rocky Mountain Infectious Diseases, the first full-time infectious disease practice in Wyoming. And though it has a close relationship with Wyoming Medical Center, it remains private even as similar practices are being absorbed by hospital systems. Dowell is also the County Health Officer for Casper-Natrona County Public Health Department.
The Pulse sat down with Dr. Dowell to talk about the early days of the HIV outbreak, new treatments for old infections, and why every kid should be vaccinated – period.
But first, about those neckties …
How many years have you been collecting them?
A number of years, I do not know how many. A patient actually got me my first one many years ago – the gonorrhea tie – and then I started looking at that website. Infectious disease guys are pretty warped, so I thought, “What a conversation piece.”
So, explain why you’d wear, say, a chlamydia tie.
Well, as an infection guy it is fun. Patients love it. Some of my patients actually want me to tell them what kind of tie I am wearing, hoping that I am wearing some weird bug.
I have worn them to formal dinners; I will sometimes wear them when I give lectures. I have people just stare at my tie, and hopefully the knowledge comes off the ties and into their heads. The ties have "special powers." I think they are as important to the recovery of may patients as antibiotics.
Do new patients recognize the ties as having some kind of virus or bacteria on them?
Yes. The problem is that I have some Jerry Garcia ties, and they sometimes think those represent bacteria. I say, "No. They represent a guy who was a little deranged."
Tell us how you got into infectious disease.
My father was a virologist, a researcher, and it never crossed my mind that I would ever go into infectious diseases or even to medical school. But in college, I enjoyed microbiology and chose it as a major. At the end of the day I said, “Well, do I want to spend the rest of my life in a lab, or do I want to do something a little more outgoing?” I did not know anything much about medical school, but one thing led to another. I thought infectious disease was pretty interesting and I could use my microbiology background. Here I am.
Where did you grow up?
We moved while my dad was pursuing his Ph.D., and we lived everywhere. I was born in Dallas. We lived in New Orleans, a couple of places in California, and ended up in Amherst, Massachusetts.
What about microbiology interested you?
The role microbes play in our environment and our health is fascinating and always changing. Microbiology is a dynamic field. The basic immunology truly piqued my interest while in college, but was not as complicated as it is now. Now, it is just amazingly complex.
Let’s talk about what brought you to Wyoming Medical Center.
Very good, I am glad you did not have to walk.
It is interesting because this state had never had a full-time infectious disease physician in its history. I was in Houston and, although I liked the city, I did not want to live there longterm. So, in 1992, a Wyoming Medical Center recruiting postcard came across my desk, but it did not say “Casper.” It just said “Rocky Mountains” and “fly fishing.” I called the number and they said they were in Casper, Wyoming. I said, “Where is that?” I had never been up to this part of the country, and in September I flew up for a weekend to look around and interview. I saw that mountain and I saw the river running. It was really beautiful. When I learned that no physician had provided infectious disease care up here, I thought: “I don’t know what I’m getting myself into, but I am young so let’s give it a shot.”
Did you have a family?
No kids, just a wife.
But you have kids now?
Two, and they are native to Wyoming. One is a freshman at the University of Oregon, and my son is a junior at Natrona County High School.
How was the hospital different then?
At that point, it was really not the true multi-specialty tertiary center it is now. There were a group of us young crazy guys who were recruited to Casper when the hospital had the vision of expanding services statewide and really bringing it up to referral center level. Dr. Hiser was already here. Dr. Rupp of nephrology was here, Dr. Schlidt, Dr. Novick, Dr. Don Smith; Those specialists blazed a new trail and expanded the outreach. I started, even though I was on my own, going out to clinics in Riverton and Gillette. I was trying to create name recognition, build a reputation, help the hospital. For docs in my specialty, we need the intellectual stimulation of the cases, the volume of patients, and a place to practice with multiple specialties. This referral center expanded rapidly thereafter.
So having a wide range of specialists available allows you to take a team approach to acute cases?
Acute and chronic cases. The neat thing about my specialty is that it knows no boundaries. As, infectious disease physicians, we travel statewide, and we work with everybody to develop solid relationships. What usually happens is the infection part of the case is turned over to us to manage. Then, we dovetail with all the other specialties as we go along. Decisions about surgeries, orthopedic issues, pneumonia issues, these are quite complex. We develop relationships not only with the local specialists and primary care doctors, but with providers across the state. We collaborate with healthcare providers in western Nebraska, and at times in northern Colorado, southern Montana, Powell, Worland over to Newcastle, sometimes Rapid City. We have quite a regional reach.
Rocky Mountain physicians are HIV specialists. How has the treatment of that disease changed over the years? I assume, with education and new treatments, those cases would have decreased. Is this true?
Actually, the numbers are slowly increasing in Wyoming, but a lot of the people infected by HIV have moved to Wyoming from elsewhere. When I started HIV care in 1985 or 1986 in Texas, it was a war zone. It was unbelievable. Now, it is more like managing a diabetic.
If you become infected today with HIV and you behave yourself – you take your medications and you get regular follow-ups – your life expectancy can be within 10 years of normal. This is phenomenal. When I started, if patients did not die when I hospitalized them, they died within two to four months. It was a different disease than it is now. It is amazingly different. I see my patients every three to four months now and they are healthy. It allows those afflicted to remain healthy and productive.
In 1985, when you started getting those first cases, did you have any idea what you were dealing with?
No. We just knew it was some kind of immunodeficiency condition. When I was down in Galveston, there was a huge number of patients, mostly men, coming from southeast Texas and down around southwestern Louisiana. They would come in really sick. That is where, at the beginning, it was felt to be somewhat of a gay disease. Obviously, this has changed.
Have you seen that kind of marked improvement in other infectious diseases?
We are seeing that in hepatitis-C care now. In the early to mid-'90s, when we finally figured out what the virus was, the treatment was brutal and the cure rate was 7 percent. Within the past few months, some new medications have been released which are tolerated much better. More are on the way, and we are looking at a cure rate in the 90 percent.
I read something about that recently. There is a new drug, but the cost of it means insurance companies don’t want to pay for it.
The cost is ridiculous. The cost of the 12-week treatment is somewhere around $150,000. Now, we are all looking at healthcare costs. The debate is whether we perform liver biopsies on people before we commit those kinds of dollars? If patients have very little liver damage from hepatitis-C, and most people do not die from the infection, we need to probably direct our resources to those who have major damage. This is controversial. Our practice is very much at the cutting edge of this. Treatment is evolving, and there will be more competition as we go along. It is such a slowly progressive disease that we have time to fine tune these complex decisions.
What are the biggest infections or health concerns you see in Natrona County and in Wyoming?
My biggest concern is always the immunization issue. I feel strongly that we have a moral obligation to immunize our children and protect other children, and to make sure they are not put in harm’s way. I have said that in the press quite a bit. That is an ongoing battle.
The whole issue of immunizations causing autism, developmental delay, Guillan-Barre, multiple sclerosis -- I could go down the road with this line -- none of it is true. For example, there is a very small risk of Guillan-Barre with an influenza immunization, but a much greater risk if you get the actual flu infection.
There are people who come in and say they want a religious exemption from vaccinations for their children. They tell me it's God’s will that their children not be vaccinated. As the Natrona County Health Officer, I denied these religious exemptions in the past because I felt it was my moral obligation to protect children from dangerous and potentially life-threatening infections. However, the Wyoming State Supreme Court ruled we could no longer deny those exemptions. It made those of us in the field of infectious diseases furious. It still does.
What is the danger to the rest of us when children aren't vaccinated?
You can see what happens with pertussis and measles outbreaks. I respect religious beliefs and rights, but when you look at history and 50 million children have died from measles, a preventable infection, it is hard for me to understand how a parent can deny a child that protection.
Are you seeing infectious diseases pop up that you had not heard of for a long time?
Yes, there are measles outbreaks in the United States that should not be happening. There have been pertussis outbreaks every year in Wyoming, a large one in Idaho, and other outbreaks related to vaccination declination. I have kids in school, and I absolutely feel it is unfair to potentially endanger my kids. There are some people who would disagree with me, but the vast majority of the population understands the benefits of the immunizations in keeping children healthy and preventing permanent disabilities resulting from dangerous infections.
My job is to advocate for health and advocate for the safety of the children. I am dead set against immunization exemptions, absolutely.
Have you personally treated children who got infections they should not have?
Yes. It’s disappointing because pertussis infections can lead to long-term lung troubles. It is one thing if you get an infection that you cannot prevent, as things happen to all of us and we must accept that. When science is able to help prevent a disease and, in turn, keep Wyoming healthy, everyone wins. If people choose to ignore the devastating history associated with these childhood infections, it is just painful for an infectious diseases physician to watch.
What trends in infectious disease are you excited about?
Some of the biotechnology and our ability to detect what organism is causing a serious infection much earlier. At Wyoming Medical Center, if you have a serious infection and it turns out to be Staphylococcus growing in your bloodstream, we have the ability within two hours to tell us whether it is the resistant type of staph (MRSA). It completely changes our treatment, and in some cases, is probably going to save lives. It is not cheap technology, but as a referral center, these are some of the kinds of abilities that we have. We have PCR technology now that allows us to detect diseases much more quickly, like gonorrhea and chlamydia. Although not life threatening, it's important for the people who have those bugs to know they have them and the knowledge may help to slow their spread.
What should people know about Rocky Mountain Infectious Disease?
We provide comprehensive care with 24-hour availability. We go to Gillette every week, to Riverton twice a month and to Lander once a month. It is within the mission of Wyoming Medical Center as a tertiary care referral center and is good for patient continuity. I think people appreciate the fact that a specialist will come to their communities to see them. For example, we care for HIV and hepatitis- C on an outpatient basis. We provide intravenous antibiotics for patients all over the state.
We provide travel medicine. If you are traveling to Africa, come see us and we will sit down with you and personally design a little travel kit for you – determine what immunizations you need, what anti-malarial you need, etc.
What has kept you in Casper this long?
I could not recreate what I have here in private practice anywhere else. I love the colleagues I work with. It is extremely professionally satisfying to see the kind of cases I see, to get good outcomes, to be able to see the patient in the hospital and then follow them as an outpatient and hopefully play a significant role in their cure. A lot of infectious disease practices have just a hospital-base focus: They do not see patients after they are discharged. At Rocky Mountain, we provide direct patient care and are county health officers. We collaborate with the State of Wyoming Health Department on a regular basis. Ours is a very unique practice. I have never regretted my decision to come to Wyoming.
There is no hospital like Wyoming Medical Center in the region. It is much like the Billings Clinic system, I would say. There is an extremely high level of medical care, and it is pleasant to practice in. I like living in Wyoming. It is where I started my family. I plan on staying as long as we can provide good care in the state. Even when the kids are done, I plan on staying here.
Anything else you’d like to add?
I think the message to the people of Wyoming is: You do not realize how state-of-the-art the medical care is that is offered in your state. To have access to a top-notch referral hospital like Wyoming Medical Center, given the population of our region, is rare anywhere in the United States. WMC recruits specialists into Casper from all over the country. The new tower is going to truly upgrade the facilities.
I am proud to practice here, I really am – this is not a paid ad. I know what kind of care we deliver and the outcomes we get. I am really really pleased to play a role in keeping Wyoming folks healthy.