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Countdown to Childx: Q&A with pediatric health expert Alan Guttmacher

jumpforjoyIt's just a few weeks until the inaugural Childx conference, a TED-style meeting at Stanford that will highlight innovations in health problems of pregnancy, infancy and childhood. (Conference registration for the April 2-3 event is still open, with details available on the conference website.) Childx is attracting nationally and internationally prominent speakers: keynotes will be given by Alan Guttmacher, MD, head of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and by Rajiv Shah, MD, former head of USAID.

I spoke recently with Guttmacher about the upcoming conference. Because I spend most of my time working with scientists who focus their attention on specific research niches within obstetric and pediatric medicine, I was interested in getting his take on the "big picture" of these fields. An edited version of our conversation is below.

What are you planning to say in your keynote address at the Childx conference?

Children’s lives are about more than just health. While biomedical research is crucial to improving kids’ lives, we should put it in the larger context of kids’ lives and do not just research that has an impact on health, but also on children’s overall well-being.

Within the health sphere, I’ll talk about several areas where we need more research. We need to study how to do a better job of preventing prematurity, both to gain a better understanding of biological and environmental causes of preterm birth, and also of how to do a better job of employing the knowledge we already have.

Another topic I’ll address is vaccination: How do we both pursue the science of vaccination to figure out how to make more vaccines more effective, and also, how do we work with parents so they make decisions about kids’ lives that are in the best interests of the kids and are evidence based, rather than based on, say, something they recently read on the web?

I’ll also discuss the developmental origins of health and disease. Pediatricians have always been very invested in anticipatory guidance, telling families about the kinds of things to do to prevent future disease for their children. But this goes farther; this is the idea that health factors, not only in childhood but even in utero, have lifelong impact on health. For instance, what happens in pregnancy potentially has large impact on whether someone develops hypertension in their 60s or 70s. We’re beginning to do science that will tell us the connections between early factors and later health, that will actually influence health along the entire age span. It’s an area of very important research.

And I’ll address intellectual and developmental disabilities. We need research to figure out how to more effectively prevent intellectual and developmental disabilities, research to understand how to allow kids who have these disabilities to function more effectively in society, and also research to figure out how to have society function better in the lives of kids with intellectual and developmental disabilities.

What message do you most want to convey to the public about the value of pediatric health research?

I want the public to know both that pediatric research improves children’s lives and that we are now just beginning an era where that research will improve the lives of those children throughout their life span, not just in childhood.

For example, now, for the first time, we understand and can decipher individuals’ genetic makeup, and can begin to understand the way environmental factors and genetic makeup interact to cause health and disease. Part of this understanding is coming from the field of epigenetics, where we are learning how environmental exposures (and I mean the whole environment, not just toxic things that come from smokestacks, although that’s a part of it) modify one’s genome early in life. And how that genetic modification helps set an individual’s later course toward health or disease.

If you could have one wish granted in the form of a scientific advance in pediatric medicine, what would it be?

If I had to pick one scientific advance to wish for, in terms of enhancing our understanding, it might be this epigenetics, how the environment really modifies one’s biological makeup. That’s a huge issue, though, not a single research question. That would make a huge difference.

If you look at just one disease, in United States anyway, the biggest issues of morbidity and mortality still come from heart disease. Being able to understand very early risk indicators or risk factors for later cardiovascular disease would be a huge benefit. If you had to pick one area to focus on, that would be a good one.

And for children’s health specifically, I would wish for the prevention of prematurity. A couple of generations ago, it would have been prevention of infectious disease, but we’ve made such strides there. Now it would be the knowledge to prevent preterm birth.

What do you hope may come from the Childx conference?

Having a diverse group of researchers talking to each other can both broaden individual researchers’ thinking in a way that can really be powerful, and also create connections among researchers, fertilizing collaborations.

I also hope the conference will reach thought leaders in research, healthcare, and in society more generally. So much of what we need to improve in kids’ lives really hinges on societal decisions: about resources for research, resources for health care; and also resources more broadly, for education and early childhood stimulation, for instance. So reaching thought leaders is also something I’d like to see come out of this.

Previously: Countdown to Childx: Stanford expert highlights future of stem cell and gene therapies and Stanford hosts inaugural Childx conference this spring

Photo by Martin Talbot

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