America’s Baffling Opposition to the WHO’s Breastfeeding Resolution

It seems that any institution that is global or multilateral in nature or name elicits visceral opposition by huge swathes of the American public. While there has long been an undercurrent of insularity and outright hostility in America towards the rest of the world, it goes without saying that under the present administration — which came to power on a platform of nationalism, protectionism, and revanchism against foreigners — the sentiment has been worsened to the point of absurdity.

The most salient recent example is our strange response to a sensible resolution at the World Health Organization (WHO) that no one would have imagined was controversial. Continue reading

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The Hungarian Doctor Who Pioneered Handwashing

Handwashing is easy to take for granted. It is one of the earliest and most basic forms of etiquette and hygiene we that we learn, not to mention a major pillar of our individual and collective health.

But like so many other “givens” in modern medicine and public health, hand washing was not always so accepted, even among health professionals. In fact, it practically came down to one person to discover and advocate the importance of washing one’s hands: NPR tells the story of Hungarian medical underdog Ignaz Semmelweis and his semi-successful attempts to improve the lives of millions through this deceptively simple practice.

Semmelweis was a man of his time, according to Justin Lessler, an assistant professor at Johns Hopkins School of Public Health.

It was a time Lessler describes as “the start of the golden age of the physician scientist,” when physicians were expected to have scientific training.

So doctors like Semmelweis were no longer thinking of illness as an imbalance caused by bad air or evil spirits. They looked instead to anatomy. Autopsies became more common, and doctors got interested in numbers and collecting data.

The young Dr. Semmelweis was no exception. When he showed up for his new job in the maternity clinic at the General Hospital in Vienna, he started collecting some data of his own. Semmelweis wanted to figure out why so many women in maternity wards were dying frompuerperal fever — commonly known as childbed fever.

He studied two maternity wards in the hospital. One was staffed by all male doctors and medical students, and the other was staffed by female midwives. And he counted the number of deaths on each ward.

When Semmelweis crunched the numbers, he discovered that women in the clinic staffed by doctors and medical students died at a rate nearly five times higher than women in the midwives’ clinic.

But why?

Like any rational, scientifically-minded individual, Semmelweis carefully assessed the data and sought out some empirical basis for this pattern.

“What Semmelweis had discovered is something that still holds true today: Hand-washing is one of the most important tools in public health. It can keep kids from getting the flu, prevent the spread of disease and keep infections at bay.

Semmelweis kept trying to convince doctors in other parts of Europe to wash with chlorine, but no one would listen to him.

Even today, convincing health care providers to take hand-washing seriously is a challenge. Hundreds of thousands of hospital patients get infections each year, infections that can be deadly and hard to treat. The Centers for Disease Control and Prevention says hand hygiene is one of the most important ways to prevent these infections.

Over the years, Semmelweis got angrier and eventually even strange. There’s been speculation he developed a mental condition brought on by possibly syphilis or even Alzheimer’s. And in 1865, when he was only 47 years old, Ignaz Semmelweis was committed to a mental asylum.

The sad end to the story is that Semmelweis was probably beaten in the asylum and eventually died of sepsis, a potentially fatal complication of an infection in the bloodstream — basically, it’s the same disease Semmelweis fought so hard to prevent in those women who died from childbed fever.”

An ignoble and cruelly ironic end to a man whose findings are now the bedrock of public health and sanitation worldwide. Semmelweis was ridiculed, marginalized, and ultimately forgotten because his observations conflicted with the established scientific and medical opinions of the time; indeed, many doctors took offense at the idea that they should wash their hands — at the cost of their patients’ lives.

It was only two decades after his sad death that Semmelweis’s recommendations gained widespread acceptance: Louis Pasteur’s confirmation of the germ theory of disease, followed by Joseph Lister’s use of hygienic methods during surgery both validated the Hungarian doctor, who lacked the scientific means to explain his findings.

But given his dedication to the well being of patients, I would like to imagine Semmelweis would be pleased to see his ideas become conventional wisdom. He might also be amused that his name is used for the eponymous “Semmelweis reflex” or “Semmelweis effect”, which describes a tendency for new evidence or knowledge to be viscerally rejected because it contradicts established norms, beliefs, or paradigms.

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Hero Highlights: Project Prakash

Of the world’s 1.3 million blind children, India is home to the world’s largest population, with estimates ranging from 200,000 to 700,000. As in many developing countries, a child born blind faces enormous social and economic hurdles: in addition to being stigmatized and marginalized in their communities, the vast majority of blind children are unable to get an education or a job. Many face physical and sexual abuses. At least half do not survive to adulthood.

In addition to regressive social attitudes, a lack of medical care access, and little to no disability-friendly institutions and infrastructure, the problem is made worse by the pervasive idea that, once a child reaches seven or eight years of age, their blindness is irreversible and untreatable. Yet the prevailing cause — congenital cataracts — is an otherwise easily treatable condition in the developed world. Imagine a lifetime of being disadvantaged and ostracized for something beyond your control and which could easily be addressed if there was the will and money. It is a disease of poverty.

Enter Project Prakash, founded in 2002 by Dr. Pawan Sinha, an Indian-born graduate of MIT. Named after the Sanskrit word for “Light”, he started the organization after a trip to rural India, where he witnessed the first hand the scale and severity of child blindness. After obtaining a grant from the U.S. National Eye Institute, he assembled team of about 20 clinicians, scientists, and outreach personnel to provide cataract surgery for as little as $300 per patient (though those too poor to pay get it for free). He tells the story in great detail Scientific American (sorry for the paywall.) Continue reading

The Impact of Vaccines

Most of developed world take vaccines for granted. Indeed, there is a growing number  of people in wealthy countries, often the most privileged, who outright fear and dislike vaccines. Yet the data are overwhelming: vaccines have not only been pivotal to virtually extinguishing all sorts of previously common diseases (measles, polio, pertussis, etc.), but they have continued to reap dividends for the millions of human who live in the developing world, where public health otherwise remains weak.

As reported in IFLS:

Vaccines are well regarded as one of the most cost-effective health care actions that a country can pursue, and since 2001 the United Nations has been running a program in 73 low and middle-income countries to prevent 10 diseases. It is now expected that when the project is completed in 2020, it will have resulted in averting around 20 million deaths, while at the same time saving a staggering $820 billion.

“Our examination of the broader economic and social value of vaccines illustrates the substantial gains associated with vaccination,” explained Sachiko Ozawa, who led the research, in a statement. “Unlike previous estimates that only examine the averted costs of treatment, our estimates of the broader economic and social value of vaccines reflect the intrinsic value that people place on living longer and healthier lives.”

And these economic benefits, it turns out, are huge. The researchers have calculated that when the vaccination program comes to an end in 2020, it will have saved around $350 billion when it comes to health, but overall this balloons to an astonishing $820 billion across the 73 low and middle-income countries in which Gavi is operating.

This is not only through reduced health care costs as diseases are prevented before they become an issue, but also due to those who are vaccinated being healthier and so working for longer and thus increasing productivity in these nations over their entire lifetimes.

Social and economic benefits aside, the most important results are the human ones: the prevention of over 500 million illnesses, 20 million child deaths, and 9 million cases of long-term disabilities. So much pain and suffering and loss will be unknown — and unfortunately unappreciated — because of such a cheap and relatively easy intervention.

When Helping People Isn’t “Sustainable”

Count on America’s venal financial class to engage unironic self parody.  According to a recent CNBC report, Goldman Sachs, one of the largest financial institutions in the world, asked whether the use of cutting-edge genetic therapy to cure patients is a “sustainable business model”: Continue reading

How an International Coalition is Tackling One of the World’s Most Widespread Diseases

Hepatitis C is a nasty and virulent liver disease that affects over 71 million people worldwide and kills 400,000 people annually. While highly effective medicines are available, their high cost — from $12,000 in Chile to over $84,000 in the U.S. for a 12-week treatment course — means barely 3 million people get treatment.

Enter globalization: a Swiss nonprofit dedicated to providing low-cost medical treatments, the Drugs for Neglected Diseases initiative (DNDi), has teamed up with an Egyptian drugmaker, Pharco Pharmaceuticals, to create a cheaper treatment program based on two U.S.-made drugs that are too expensive for most people.

Continue reading

The End of Smallpox

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Yesterday, December 9th, came and went like any other day. But on that day in 1979, one of the most groundbreaking endeavors in human history was accomplished: a group of eminent scientists commissioned by the United Nations World Health Organization (WHO) certified the global eradication of smallpox, the only human disease thus far to have been completely eliminated from nature. The WHO officially confirmed and announced this momentous achievement a few moments later:

Having considered the development and results of the global program on smallpox eradication initiated by WHO in 1958 and intensified since 1967 … Declares solemnly that the world and its peoples have won freedom from smallpox, which was a most devastating disease sweeping in epidemic form through many countries since earliest time, leaving death, blindness and disfigurement in its wake and which only a decade ago was rampant in Africa, Asia and South America.

Less than a decade before, the end of smallpox would have seemed the remotest possibility. As recently as 1967, the WHO had estimated that 15 million people contracted the disease, and that two million had died that year alone — the average number of annual deaths since the turn of the century. Continue reading

An Effective Ebola Vaccine Has Been Developed

Following a horrific epidemic in West Africa that claimed the lives of over 11,000 people — the deadliest the world had ever seen — we finally have a breakthrough vaccine against Ebola. As Vox.com reported:

Today, the same researchers — who hail from the World Health Organization, Guinea’s Ministry of Health, Public Health England, and other international partners — have unveiled their final results in the Lancet, and they’re just as remarkable. The vaccine was tested in a trial involving nearly 12,000 people in Guinea and Sierra Leone during 2015 and 2016. Among the 5,837 people who got the vaccine, no Ebola cases were recorded. By comparison, there were 23 Ebola cases in the control group that had not gotten the vaccine.

“This trial, confirming the 100 percent efficacy of the rVSV Ebola vaccine, is a simply remarkable outcome”, Dr. Jeremy Farrar, the director of the Wellcome Trust, said of the research. “We’ve shown that by working collaboratively, across international borders and sectors, we can develop and test vaccines rapidly and use them to help bring epidemics to an end”.

You can read the published study here. It was one of fifteen clinical trials for an Ebola vaccine conducted around the world in a single year, and is a vindication of what collective action and responsibility by the international community — including the U.N., NGOs, and national governments — can accomplish. It is a shame it took so many deaths spanning a nearly three year period to finally come up with a promising form of prevention, although the vaccine is far from ready to hit the market.  Continue reading

Video: How We Think About Death And Honor Life

It is long been observed that it is not so much death that scares people, but the act of dying. Whereas the moment of our demise is, far as we can tell, painless, the hours, days, or even months leading up to that point can be painful in both a physical and emotional sense.

To that end, palliative care expert and physician BJ Miller leads a powerful TEDTalk that challenges us to think about how we handle those approaching death — namely, by making the medical system less focused on curing diseases and more oriented towards the overall wellness of patients. That means providing more comfort, dignity, and even “play” to the lives of the dying.

The seminar is well worth viewing in its entirety below.

To read a transcript of the above TED Talk, click here.

Given the rapidly growing ranks of the world’s elderly, who will make up the bulk of those requiring palliative care, Miller’s point could not be any more salient. I imagine that as populations around the world continue to age, matters of death and how we ease into it will become more prevalent topics of discussion.

What are your thoughts?

The Unknown Chinese Woman Who Helped Find a Treatment for Malaria

Among the three scientists awarded the 2015 Nobel Prize in Physiology or Medicine for work against parasites was Tu Youyou, an octogenarian pharmacologist whose work led to the development of the most effective treatment against malaria. But despite her invaluable role in saving millions of lives from this public health scourge, her contributions remained largely unknown, even in her own homeland.

Vox.com recounts the amazing story that led up to her breakthrough discovery.

In 1967, Chairman Mao Zedong set up a secret mission (“Project 523”) to find a cure for malaria. Hundreds of communist soldiers, fighting in the mosquito-infested jungles of Vietnam, were falling ill from malaria, and the disease was also killing thousands in southern China.

After Chinese scientists were initially unable to use synthetic chemicals to treat the mosquito-borne disease, Chairman Mao’s government turned to traditional medicine. Tu, a researcher at the Academy of Traditional Chinese Medicine in Beijing, had studied both Chinese and Western medicine, according to a New Scientist profile, and was hand-plucked to search for an herbal cure.

By the time I started my search [in 1969] over 240,000 compounds had been screened in the US and China without any positive results,” she told the magazine. But, she added: “The work was the top priority, so I was certainly willing to sacrifice my personal life.”

Tu’s dedication included first testing the promising treatment on herself, to ensure that it was safe. Once it was proven to have no side effects, she organized clinical trials for people with malaria, all of whom were incredibly cured of the disease within no more than a day. Continue reading