Of the hundreds of thousands of doctors working today, most toil in relative obscurity. Often, when one does achieve prominence, it's because of an important scientific discovery, like developing a new vaccine or cancer drug. Sometimes it's because he or she works for a venerable institution or is in charge of a major hospital. But every once in a while a doctor becomes famous—a celebrity, even—because of a patient she treats. That is certainly what happened to Kristi Funk, a 44-year-old breast cancer surgeon and a founder of the Pink Lotus Breast Center in Beverly Hills, on May 14 of this year. All it took was one sentence, published in an op-ed in the New York Times, to introduce her practice to the world: "Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries."
Brad is Brad Pitt, and the patient—and the writer of the article—is Angelina Jolie. Funk performed a bilateral mastectomy on the 38-year-old actress, who had the procedure because she carries a rare mutation of one of the BRCA genes, which she inherited from her mother. The mutation substantially increases her risk of developing breast and ovarian cancer. Fewer than 1 percent of women have this genetic defect, which can make their risk of breast cancer as high as 85 percent and their risk of ovarian cancer more than 50 percent. Preventive, or prophylactic, removal of the breasts and ovaries reduces the risk a great deal.
Jolie's story generated rabid interest, as it combined a deadly and rare genetic defect with a potentially disfiguring surgery affecting the breasts of one of the world's leading sex symbols, one known as much for her private life as for her work as an activist. It was at some level also a glimpse into a kind of medical care that most people think is reserved for the rich. The test for the BRCA mutations, marketed exclusively by Myriad Genetics at the time Jolie had her operation, costs more than $3,000. The company behind it cultivates a glamorous image; during the world's largest cancer meeting this spring in Chicago, it held its reception at a Rolls-Royce dealership. (Myriad may face some competition soon, because of a Supreme Court decision that threatens some of its patents.)
As a lung physician and researcher at Memorial Sloan-Kettering in New York City, I was intrigued. When I visited the Pink Lotus clinic several weeks after Jolie's announcement, the practice was visibly overwhelmed. Dr. Funk's husband Andy, an entrepreneur and investor, has run the center since it opened, four years ago. Following the announcement, its 100 inbound phone lines were all in use. At one point patients—and the media—were being put on hold for more than an hour and a half. "And they were still happy when they finally got through," Andy insists. New patient appointments are being scheduled two to three months in advance, although the center continues to prioritize those who have a diagnosis of cancer and need treatment, usually fitting them in within a week.
I had flown to Beverly Hills worried I was about to walk into a Truman Show version of a doctor's office. I imagined a place that would downplay the seriousness of breast cancer, as if it were a minor inconvenience like a sprained ankle, rather than the killer it can be. Breast cancer ranks second only to lung cancer in the number of women in the U.S. killed each year, and more than 40,000 will succumb to it this year—more than 100 each day. But I had it completely wrong. Yes, everyone who works in the clinic wears black and pink scrubs, and a few too many items, down to the coffee cups, bear the clinic's logo. But as a whole the place is rather unassuming.
I met Kristi Funk in the middle of a busy day. Her blond hair was pulled back, not elaborately done up. Her surgical scrubs were a little rumpled. Her mind was on her next patient. She explained her strong work ethic and focus by quoting her longtime mentor, John Ryan, the former chief of surgery at Virginia Mason Medical Center in Seattle, where she trained: "You're doing one thing right now. One thing. Do it right." But I had yet to see her in action.
She met me early in the morning at the back entrance of the clinic, the one used by high-profile patients like Sheryl Crow, who is a breast cancer survivor, and Jolie. Inside was a young woman who had also tested positive for a BRCA mutation. "She's an Angelina patient," Funk says, meaning that she came to the doctor after reading about the Oscar winner's treatment. She was now scheduled to have the same sequence of procedures.
Funk then performed a nipple-sparing surgery on her, the first in a three-step process. This operation involves detaching the nipple from the breast tissue underneath it, which is removed during the next phase. She got the idea of adding this step from plastic surgeons, who routinely perform multistep procedures. It means more work than a routine prophylactic mastectomy, and it's not well reimbursed. But the cosmetic outcome is better for some women. Prophylactic mastectomies are on the rise, not only for women who have the potentially deadly mutation but for women who don't have it and are still worried about getting breast cancer. The latter is a trend that experts, including the renowned breast cancer authority and author Susan Love, find worrisome. Love places the blame, in part, on the medical profession. "We have little to offer young women to prevent the disease," she says.
Any doubts I had were unfounded. Funk's surgical expertise was apparent from the first moment, her hands moving in synchrony with her operating room nurse's, banter flying back and forth about kids (the Funks have triplet boys) and the latest episode of The Following. She moved around the table as she operated, setting up her body and her hands at different angles for each part of the procedure. Watching her reminded me of my medical training at Johns Hopkins, where I had been lectured over and over that getting yourself and the patient in the right position before performing a procedure was critical to avoiding complications.
Afterward we discussed the fame she has achieved as a result of being Jolie's surgeon. "The decision to go public came entirely from her," Funk says. "She and Brad hope their situation can resonate with other women. They are busy in their respective lives and could not be happier than to allow the word to travel farther and louder because I can be the voice. Whatever criticism there is that I am taking advantage of my clientele is overruled by the good that is done."
Funk says that Jolie's decision to come to her was made over a period of several years, during which time Jolie sought many options. In the end, all roads led her to Pink Lotus. Ryan, Funk's mentor, wasn't surprised. "When I heard the story the first thing I said to my wife was, 'I bet Kristi was her surgeon,' " he says, noting the reputation she has earned as a discreet and highly skilled doctor to the Hollywood set. Landing Jolie as a patient may have given rise to resentment from other breast cancer surgeons, who are generally among the most supportive in the medical ranks. Not a single colleague in the Los Angeles area called after the news broke. "People are funny," Funk says by way of explanation.
Starting her own breast cancer clinic in the middle of Los Angeles, a city crowded with healthcare providers, has proved challenging. Funk grew up in Pacific Palisades, a tomboy surrounded by brothers, an unknowing overachiever who didn't realize she was first in her high school class until Stanford asked for a ranking on its college application. She studied psychology there with plans of becoming an actress, but after spending several months at Oxford and volunteering in Africa, she says she realized that she "could have a broader reach and a higher impact" by pursuing medicine. She enrolled at a top-flight medical school, at the University of California at Davis, and followed with training at Virginia Mason.
Some doctors relish taking care of patients' chronic medical problems through relationships that span many years. Funk is not that type of doctor. She's a prototypical surgeon: a doer, someone instinctively ready to solve problems with her own hands. After her general surgery training she discovered her specialty when she was given the opportunity to become a director of the breast surgery program at Cedars-Sinai, in Los Angeles. The ability to focus on a single disease and achieve mastery of it suited her. The inspiration for Pink Lotus came, in part, after she saw the healthcare system routinely failing to support women after an abnormal mammogram or a positive test for a BRCA mutation. "Women are anxious, and no one talks to them," she says. "I'm a good listener, and I know how important it is to get people answers right away."
Andy Funk echoes the sentiment, with a businessman's spin. He says that Cedars-Sinai and other big hospitals in Los Angeles are not designed for the patients they serve. Specialist doctors each do their own thing, and patients bounce around among them, having to make their own appointments and even carry their own records from place to place. As a result, no one seems to have a plan, and nobody is in a particular rush to communicate with the patient. This rings true to me, after years of seeing patients so frustrated by the disarray in healthcare and the contradictory messages they get from doctors that they end up more worried about understanding the healthcare system than they are about the condition they're trying to get treated.
Pink Lotus has on-site most of what is needed to make an initial diagnosis after an abnormal mammogram, so women get answers—and one-on-one attention—within a few days. The Funks are building satellite locations for mammography around Los Angeles and have plans for comprehensive breast cancer care centers in other cities. They are also currently fielding inquiries from physicians at major cancer centers who are interested in practicing the kind of patient-centered medicine so many doctors would like to be able to deliver.
Making the business work is a challenge, particularly because Funk is committed to caring for any woman who wants to come in. The center takes Medicare, Medi-Cal (California's Medicaid program), and uninsured patients. The Funks have been working on a charity, Pink Lotus Petals, which will help women pay for care if they have abnormal mammograms but no insurance or can't cover the costs. Although the women don't have to go to Pink Lotus for that care, they can. They can also go to any other doctor who will accept the rates the charity will pay, which will be below those paid by the government. Funk says one of the roles of the various celebrities in her Rolodex will be to help raise money for this effort. Clearly this has already begun: The mammography services at Pink Lotus bear Crow's name, and Jolie has raised awareness to unprecedented levels.
Funk is taking it one day at a time. "There are big foundations focused on research and finding another magic drug. But women are dying all around them while they spend billions to find a very elusive cure. In my lifetime," she says, "there is something I can do about that."