Unlike many things from the 1967 “Summer of Love,” the Haight Ashbury Free Clinic survived.

The clinic, now part of a larger network, still operates out of a second-floor office overlooking Haight Street in San Francisco. A steep wooden staircase leads to a warren of small but airy rooms.

One exam room still has a wall covered by a faded psychedelic mural, featuring a collage of famous rock stars, naked bodies and peace signs.

The decor used to be even more colorful, according to lab manager Pam Olton. She has worked at the Free Clinic for more than 40 years.

“Pink, aqua, Day-Glo orange … all of these exam rooms were painted in those Day-Glo colors,” she says.

The colors helped the young patients feel welcome, Olton explains, easing their drug-induced paranoia or just reassuring them that the clinic was a safe and sympathetic space. In the summer of 1967, and for years after, the Free Clinic treated the countercultural denizens of the Haight-Ashbury neighborhood. They were often the patients that nobody else wanted.

“You had a big flash mob of kids coming to this neighborhood from all over — from everywhere in America,” Olton says. Most had no health insurance, and some were living in parks, on the street or sharing crowded apartments.

“They’re kids, they’re dirty, they’re a mess and they’re addicted,” Olton says. “But we have to take care of their medical needs first. And we have to be nonjudgmental. They’re human beings — they’re somebody’s kid and we need to take care of them.”

Dr. David Smith was a young faculty member at the University of California, San Francisco when he started the free clinic 50 years ago. He’s now 78 and still works in addiction medicine.

“We were kind of the caregivers to the love generation,” Smith says. At the beginning of 1967, he had one foot in the world of academic medicine and one foot in the burgeoning counterculture. He lived in the Haight and had experimented with drugs.

“I had an LSD spiritual experience, and a vision that denial of health care to one segment of the population is a denial to all,” Smith recalls. “So there was a transformation of me in that period, in ’67, like what happened to so many young people. I just happened to have a medical skill when that transformation occurred.”

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Dr. David Smith (second from left) helps a young woman by bandaging her feet as part of the clinic’s street medicine in 1968.

Courtesy of David Smith Archives

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Courtesy of David Smith Archives

‘Health care is a right, not a privilege’

Smith knew that thousands of young adults would flood into San Francisco that summer, and he was worried about who would treat them and how these young people would be treated by people in mainstream medicine.

“Some of us went to the city [health officials] and said, there’s going to be a huge problem this summer, and we need what we called then ‘a hippie clinic,’ ” Smith recalls. “And it was soundly rejected by the health department. They had no interest in this. They said, ‘We don’t want to take care of them. We want them to go away.’ “

Smith and some colleagues, along with residents of the Haight, started getting ready anyway. It was during one of their planning meetings that Smith stood up and declared: ” ‘Health care is a right, not a privilege.’

“It became the founding slogan of our Haight Ashbury Free Clinic,” he says.

The clinic opened on June 7, 1967, to a line of people stretching down the block. The team worked through the night and treated 250 people, Smith says. The next day, the staff treated 350 more.

At that time, the staff was entirely volunteer — a mix of sympathetic doctors, nurses and students from the local medical and pharmacy schools.

Keeping the clinic going was a struggle. Money for rent and supplies was in short supply. Police officers would frequently show up and search the rooms, looking for illicit drugs and underage runaways.

But Smith was determined to keep the clinic open. If hippies hurt themselves, many mainstream doctors thought they got what they deserved. Sometimes hospitals turned them away. And when they got sick from taking illegal drugs, or overdosed, or became psychotic, they were often shamed, restrained or thrown in jail. The Free Clinic offered a safe space.

“If you were taken to the Haight Ashbury Free Clinic, you would be put into a room … with a talk-down guide and a lava lamp,” he says. “You’d be examined by a physician to see if you needed medication to help you come down.”

After 1967, the clinic continued as a medical refuge and its compassionate approach endured through the harder drugs of the 1970s, and the AIDS epidemic of the 1980s.

Eric Smith (no relation to the clinic’s founder) remembers visiting the Free Clinic about 15 years ago. He was living on the streets of San Francisco and using heroin. He can’t remember why he went there for care, but he does remember what it felt like to be there.

“I went in there — there was a whole bunch of people hanging out. It was cool,” Eric says. He remembers the staff and others asking, ” ‘How can we help you out?’ “

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Eric Smith, left, talks to a homeless couple in San Francisco during neighborhood rounds. He’s patient coordinator at the Haight-Ashbury Free Clinics, and wants to make sure they know they can get health care and addiction treatment there.

Carrie Feibel / KQED

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Carrie Feibel / KQED

“People were eating,” he recalls. “Some girl asked if I was hungry. She brought me a vegetarian burrito. It was very welcoming, and I didn’t feel nervous or ashamed being in there. You know? I felt like these are my people, they’ll help me out. I can be honest with them. I think that carries on right now.”

Meeting modern challenges

Eric Smith eventually got off drugs, and for the last two years has worked for the clinic as a patient coordinator.

When patients come to the clinic, Smith makes sure they are connected to the services they need — whether that’s medical or dental care, therapy, detox or a drug recovery program.

And he walks the neighborhoods of San Francisco, doing outreach.

He brings naloxone for opioid overdoses and a CPR mask. He has a big backpack full of snacks to hand out, along with gloves, socks, condoms and toothbrushes.

On the day I join him for his rounds, Eric stops by a row of tents on Folsom Street. Men gather around as he passes out supplies.

“You guys know who I work with, right?” he asks as he hands out socks and granola bars. “So, you guys need any services at all? Is there anything you need?”

On this particular day, none of the men are interested in visiting the clinic.

Eric just smiles and moves on. No encounter is ever wasted, he tells me.

“I have to build a trust and rapport with the individual, so they know — no matter what they tell me — that it’s safe,” he says.

“You want the best for everybody, but you can’t really push yourself too hard on them,” he added. “You’ve got to meet them where they’re at, and in their time they’ll come around eventually, you hope.”

Erie Street is just one block from the Haight Ashbury Free Clinic’s location in the Mission district. It’s a long alleyway of sharp shadows and slants of sunlight. On the day we walk past, there is a tent at the far end, and a guy on a stepladder, spray-painting a mural on a large blank wall.

“It’s heartbreaking — I used to get high in this alley, too,” Eric says. “I feel for these individuals.”

He spots some new faces.

“Hey, guys,” he booms, smiling and striding over. “You need any socks?”

A man and a woman are cuddled together with just thin sleeping bags against the hard sidewalk.

Nearby is a shopping cart stuffed with belongings and a cooler. A pit bull puppy flops across their legs. They sit up and happily accept everything Eric offers.

“Hey, so you guys, you guys need any medical attention at all?” Eric asks. “Do you got Medi-Cal?” he asks, referring to the Medicaid program in California — the health insurance for low-income people.

The young couple — Sean and Kat — are from Mendocino County, they tell us, and have been in San Francisco for only a month. They are trying to a quit a drug habit, and NPR agreed not to use their last names. They need advice, and Eric has plenty: They talk about places to get day-old pastries; charities that offer free breakfast or lunch; and places to shower. Eric points out the nearby clinic. They discuss getting the puppy fixed at the SPCA, which is also in the neighborhood.

“You guys use?” Eric asks. “I mean I’m an old junkie, all right?”

“We’re working on quitting,” Kat says.

“Oh what, heroin?”

“No,” says Sean.

“Meth?”

“Yeah.”

“Slamming it?”

“No.”

“Smoking?”

“Yeah, we smoke.”

Kat tells Eric she used to slam, meaning she used to inject the drug. But after meeting Sean, she was able to stop that. He helped her “get off the needle.”

Eric jumps on this point: “Really? So you guys are together. And you’re supporting one another, all right?”

Giving up the needle is a small step, but a positive one. It’s a little less harmful. Eric wants them to know he gets it: They’re trying.

“So, you guys, come and talk to me, OK?” he tells them. “Seriously, if you want help at all. I don’t care if you don’t want recovery or not, but just to know that there’s someone out there. I used to get high right here in this alley, dude — back in the day.”

Survival in consolidation

Today, the Haight Ashbury Free Clinics are part of an umbrella organization called HealthRIGHT 360. It’s a large network of social service agencies tackling a variety of issues besides health care: domestic abuse; rehabilitation for ex-inmates; gay, lesbian and transgender health issues, and addiction.

Consolidating with other agencies helped the Haight Ashbury Free Clinic survive.

Seven years ago, in 2010, it was struggling financially. Some staffers had been caught embezzling, and the clinic couldn’t afford the transition to electronic medical records — a requirement of the Affordable Care Act.

In 2011, the Free Clinic joined forces with Walden House, a nearby addiction recovery center. Other nonprofits soon joined as well, and HealthRIGHT 360 became the umbrella brand, allowing the smaller agencies to pool resources for administration, electronic records and fundraising.

Dr. David Smith, who started it all, applauds the decision to consolidate with other nonprofits. But he does miss the intimacy of those early days, he says, when volunteers from the neighborhood worked at the clinic.

When money got tight back then, they held benefit concerts, featuring local bands — like Big Brother and the Holding Company, during the time Janis Joplin was the lead singer.

After 1967, free clinics opened in Seattle, Los Angeles and Berkeley. By the end of the 1960s, the U.S. had dozens of free clinics — a third of them in California.

This story is part of a NPR’s reporting partnership with KQED and Kaiser Health News.

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On a Monday afternoon in October, a panel of Iowa state legislators gathered in the statehouse to discuss the opioid epidemic.

Doctors, law enforcement officials and health insurers all took turns at the lectern.

One of the witnesses was Deborah Thompson.

She’s testified in front of state legislators plenty of times. As the legislative liaison for the Iowa Department of Public Health, she’s often asked to provide legislators a window into what the epidemic looks like in Iowa. The information can be wonky at times, like how many morphine equivalent milligrams are prescribed each year, or cold facts, like that year’s death toll.

Last year in Iowa, there were 80 opioid-related deaths. In 2017, there are projected to be 201.

This time, there was something else she wanted to share.

“Today would have been my seventh wedding anniversary,” she told the panel. “My husband, Joe Thompson, passed away from an accidental heroin overdose last September. He left me and his 1-year-old son, Lincoln.”

For years, Thompson had worked on policy related to the opioid crisis in Iowa while keeping her own family’s struggle with addiction in the background. She’d told a couple of state legislators she had close relationships with, but sharing her story in public was a big moment.

Thompson went back and forth about whether she could keep this to herself. She saw her role as the policy expert working in the background, not a face of a national problem.

“I wasn’t really sure I was going to, and I just couldn’t shake the fact that it was our wedding anniversary, and that had to mean something,” she tells NPR’s Robert Siegel. “The coincidence was too great. Joe had always gravitated toward the helping professions, he wanted to be a nurse or a counselor or something like that, and it would be quite an anniversary gift to give him, to be able to, maybe grant that wish through me, if it helped a lot of people. It was probably one of the better gifts I gave him. I was never very good at our anniversary gifts.”

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Joe Thompson holds his son Lincoln.

Deborah Thompson

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Deborah Thompson

Joe Thompson’s struggle with opioids started back in 2004. After he was in a serious car accident, Thompson says her husband was likely over-prescribed medication to treat the pain. He started going from doctor to doctor, a practice called doctor shopping, to get new prescriptions or refills. At his job as a package handler for UPS, he started swiping prescription drugs being shipped through the mail.

Joe tried to get help. He enrolled in an outpatient facility. Several times he got sober, sometimes for several years at a time. He even went back to school and got his nursing degree. But then he would relapse again.

“I think it’s hard to understand that,” Deborah Thompson says. “I think logically your mind can get there, but your heart hurts … the way the disease manifests itself, it’s selfish, things are done to you, money was stolen from me, lies were told to me, and it’s hard to wrap your mind around the idea that it’s a disease causing this behavior while you’re in it.”

It took Thompson a while to really grasp that her husband was sick — that his addiction was not just a bad habit he couldn’t kick, but a disease that was really hard to climb out from.

“I just kind of equate it to, when my mother had brain cancer, we could see the tumor on the X-ray scans, we knew that something was growing and taking over her brain,” she says. “I wish I’d known more about the science when we were in it. … I felt like I was finally ready to deal with Joe’s addiction, and then time ran out.”

Joe Thompson died in September 2016 from a heroin overdose. He was 35.

Joe may not have beat his addiction, but Thompson is confident Iowa can.

She says new funding has helped, as well as changes in the law that have given states additional flexibility to respond to the crisis. One policy change that she says could help save lives right now is requiring doctors in every state to check prescription monitoring databases — information that would prevent doctors from prescribing or refilling opioids to people who don’t actually need it or are dealing with an addiction. She says waiting for doctors to voluntarily adopt best practices simply isn’t enough.

Deborah Thompson is also hoping her unique position at the crossroads of policy and personal experience can help move her state just a little bit closer to curbing the epidemic.

“Just looking at how many community partners that are involved, that run the gamut of law enforcement, the healthcare community, public health professionals, community agencies, coming together in Iowa to fight this, I can’t imagine we’ll lose,” she says.

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The Mayo Clinic is building its future around high-tech approaches to research known as “precision medicine.” This involves gathering huge amounts of information from genetic tests, medical records and other data sources to ferret out unexpected ideas to advance health. But one longtime scientist at the Mayo Clinic isn’t playing along.

Dr. Michael Joyner is a skeptical voice in a sea of eager advocates. Joyner’s lab studies exercise. It is, fittingly enough, in a hospital building founded in the 1880s. While Mayo has built all sorts of new labs at its sprawling campus in Rochester, Minn., Joyner can conduct his work without glitzy DNA sequencers and other high-tech tools of precision medicine.

And it’s not simply that he’s an old-school devotee. He believes that the solution to our most pressing health problems lies in thinking about whole human beings, not breaking everything down to DNA sequences.

“The enthusiasm for this [precision medicine] is occurring in a country where life expectancy is actually falling,” he says as he walks through the old linoleum-tiled halls of St. Mary’s hospital.

That fact alone leads Joyner to ask whether the money being poured into high-tech medical research is really solving the nation’s stark health problems, like obesity, heart disease, high blood pressure, diabetes, Alzheimer’s disease and cancer.

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Volunteer Greg Ruegsegger is outfitted with monitors, a catheter threaded into a vein and a mask to capture his breath in an experiment run by Joyner to measure human performance.

Richard Harris/NPR

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Richard Harris/NPR

Joyner says there are certainly appropriate places to use this technology, and he doesn’t dispute the individual stories of success his colleagues tout. But he believes the best way to address the health concerns facing the nation is by studying — and treating — whole people, not by breaking the problems down to billions of genetic bits and pieces.

He practices what he preaches in both his personal life — his thorough exercise routine includes commuting by bicycle — and his physiology lab.

On the day I visited at the end of August, volunteer Greg Ruegsegger was outfitted with monitors, a catheter threaded into a vein and a mask to capture his breath. He would exercise to the point of exhaustion while scientists studied him. This is far more informative than any genetic test, Joyner says.

“People have looked at 3,000 elite endurance athletes — these are people who compete in the Tour de France and win Olympic medals in cross-country skiing and distance running — and [scientists] have been unable to find any genetic marker for superior performance.”

And when it comes to the health of ordinary people, Joyner talks about real-world studies, which show that walking or biking to work has four- or fivefold more influence on a person’s body mass index than that person’s genetic profile.

Joyner is focused on how the body’s systems work together during exercise, but the same interconnectedness applies to many diseases. That’s why cancer drugs that target one biological pathway generally don’t last long. Tumor cells simply find workarounds, exploiting the redundancies deeply embedded in biology. And that’s why Joyner has so little faith in science that keeps trying to focus down on smaller and smaller details.

“One of the things we have to ask ourselves when we get these big initiatives is, ‘What’s the definition of success?’ ” he says.

Scientific discoveries alone don’t do it for him. Doctors need to build effective treatments — and patients need to follow along. This is the promise of precision medicine in the long run, but Joyner has published articles (like this one) skeptical of the drive to collect vast piles of information, hoping to make sense of it later.

“Is this just going to be a biological Tower of Babel,” he asks, or will this information also lead to discoveries that translate beyond the laboratory and actually change public health for the better?

He doesn’t doubt that DNA sequencing and other tools of precision medicine are useful in specific instances, such as for diagnosing rare diseases. There are a few uses in cancer treatment, but so far there has been just one randomized study of patients assigned to treatments based on their tumor’s DNA profile, and it showed no advantage over traditional medical judgment.

This isn’t a popular point of view elsewhere at the Mayo Clinic, which is sinking hundreds of millions of dollars a year into precision medicine. The shiny new labs across campus seem a world apart from Joyner’s physiology lab.

After my conversation with Joyner, Mayo public affairs officers eagerly led me to a series of scientists there who disagree with him. One stop was at the Medical Genome Facility.

This room is chock-full of machines that cost many hundreds of thousands of dollars apiece. They can analyze DNA from a person, a tumor or even a single human cell. They can read out an entire genome, or just a subset, which is called the exome.

“I really do believe that understanding our genome is fundamental,” says Julie Cunningham, one of the facility’s three co-directors. Like other scientists at Mayo, she has had swaths of her own exome sequenced.

“I learned that by and large I’m really lucky, but I learned that I have two [genetic] variants that affect how I respond to particular drugs that are out there.” She had actually known that before for one of those drugs, “but now I know exactly why I have it and it’s potentially serious. That has to be good. There’s nothing wrong with that.”

Bad drug reactions are a serious medical problem, so in principle, a genome profile should help reduce that risk. The reality, though, is that the vast majority of genomic tests for drug sensitivity give ambiguous answers.

One of the most carefully studied examples involves the blood thinner warfarin. Four separate studies show that people who got genomic testing for this susceptibility did no better — or only marginally better — than patients whose dosages were determined by traditional strategies.

This lack of strong data is a problem for many areas of precision medicine.

“Although we think conceptually this is going to be of high value, and it will ultimately improve health care with better quality and lower cost, we have to prove that,” says Keith Stewart, a hematologist who directs Mayo’s Center for Individualized Medicine. “If it doesn’t all pan out the way we expect that’s OK. But I think there will be plenty of unexpected areas that we haven’t conceptualized yet, so I think it’s a very worthwhile investment on the taxpayers’ point of view.”

Whether precision medicine is going to be a boom or a bust, “right now it’s just speculation on both sides,” he says.

“It is somewhat inevitable that every person in this country will have their genome sequenced.” he adds.

Gianrico Farrugia, a gastroenterologist who is chief executive officer of the Mayo Clinic in Florida, agrees.

“What we’re beginning to see is that technology is invading and replacing traditional testing,” says Farrugia. For example, it is already used to determine treatments for lung cancer and diagnose rare diseases.

And, in any event,he says medicine is already moving aggressively into this new territory and there’s no going back. “That’s not only wrong,” he says, “it’s impossible.”

With the momentum now built up behind this enterprise, precision medicine will be judged like much of modern medicine: in hindsight, after it becomes entrenched in clinical practice.

You can contact Richard Harris via email.

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