When it comes to global public health, there’s plenty of news supporting optimists and pessimists alike. But the balance tips towards hope, said Donald Shriber, JD, MPH, who – as mentioned below – gave a talk yesterday at the Stanford Graduate School of Business.

In 2011, millions of people will die needlessly from preventable diseases, but the global public health community has plenty of simple and cheap interventions that could save most of them, Shriber, who works in the Centers of Disease Control‘s Center for Global Health, argued. In the subtitle to his presentation, which was part of the business school’s Global Health Series, he concluded that “the glass is half full.”

Shriber said the biggest long-term gains in global health will come from the efforts – of the CDC and other international agencies – to help build up public health agencies in foreign countries. Such initiatives include training epidemiologists and “disease detectives” overseas. But some simple and powerful reforms like recording births and deaths in official records can also be helpful in understanding and tracking the success of public health efforts.

Shriber also provided an eye-opening list of key low-cost, high-impact efforts that could together eliminate the majority of preventable deaths worldwide:

• When a country passes laws to guarantee clean air and water, control toxic substances, and provide for food and drug safety, massive gains in public health follow. Providing clean water and sanitation to the more than 2.5 billion people who lack it could prevent two million deaths from diarrheal diseases every year and cut cholera deaths more than 30 percent.
• Male circumcision is “as close as we’ve come to a vaccine for HIV,” said Shriber. There’s conclusive evidence that circumcision can cut HIV infection rates by 60 percent in countries where it isn’t already the norm; one HIV infection is avoided for every four circumcisions performed, according to this data.
• Pneumonia rates could be cut by as much as 67 percent with a combination of simple efforts, such as encouraging exclusive breastfeeding for the first six months of life, which reduces pneumonia infections by 15 to 23 percent.
• “Tobacco is the agent of death that exceeds all others,” said Shriber. Tobacco kills more people than HIV, tuberculosis, and malaria combined. Shriber argued that we know what to do about tobacco, but it takes simple policy interventions that may prove politically difficult: pushing through laws that protect people from the tobacco smoke of others, providing programs to help tobacco users quit, warning about tobacco’s dangers, and enforcing bans on tobacco ads and sponsorship.
• Ninety percent of all deaths on the roads occur in low-income countries, and these accidents are the leading cause of death of Americans living and working abroad. Again, proven prevention efforts are well known: limits on drunken driving and laws mandating seat belts, helmets, and speed limits.
• Nearly half of all cancers are preventable, with the use of vaccines for hepatitis and HPV, for instance. But simply working to increase fruit and vegetable consumption would also significantly reduce cancer numbers, according to Shriber.

Previously: A packed Stanford agenda on global health issues
Photo from the Stanford Graduate School of Business

This week brings to Stanford a packed slate of events that focus on the changes sweeping medicine and healthcare across the globe. Last night Donald Shiber, JD, MPH, who works for the Centers for Disease Control, gave a talk on government engagement in global health as part of the Stanford Graduate School of Business’ Global Health Series. And local readers might be interested in putting a few other events on their calendar:

• Later today, Stanford Biodesign presents a conversation with Ezekiel Emanuel, MD, PhD, a widely published and lauded bioethicist at the National Institutes of Health. This is the second From the Innovator’s Workbench event of the year, which features biomedical technology leaders in conversation with journalist David Cassack. It’s free for current Stanford faculty, staff and students who register for the event; Stanford alumni get a discount.
• Wednesday brings an all-day conference on healthcare innovation, sponsored by the Graduate School of Business. Scholars, physicians, and business leadership from a wide range of healthcare enterprises will explore new technologies and business innovations set to change global healthcare delivery.
• Finally, Friday brings Michele Barry, MD, FACP, to the Stanford Ethics at Noon speaker series. Barry is director of Global Health Programs at the School of Medicine, and she’ll discuss the ethical issues faced by medical researchers and students who work overseas in poorer countries.

Photo by Jim Ceballos

The good news: Childhood lead poisoning cases have been cut enormously. The bad news: Preventable lead poisoning robs America of $50.9 billion in lost economic productivity as the pollutant destroys the intellectual potential of affected children.

That’s only one of the cost estimates coming out in a new paper by Leonardo Trasande, MD, of the Mount Sinai School of Medicine and Yinghua Liu, MD, a scientist with the National Children’s Study. Starting with the dollars that a healthy person would generate in their lifetime, the scientists calculated how downtime and early death resulting from toxic chemicals like lead and mercury in the environment costs the whole society.

The economic productivity losses that pollution causes totalled $76.6 billion at the end of the analysis, or 3.5 percent of all U.S. healthcare costs in 2008. Trasande commented in a press release that:

despite previous efforts to curb their use, toxic chemicals have a major impact on health care costs and childhood morbidity… The prevalence of chronic childhood conditions and costs associated with them may continue to rise if this issue is not addressed.”

The study updates a previous estimate based on 1997 data conducted by Philip Landrigan, MD. In a separate article in the same issue of Health Affairs, Landrigan suggests three efforts that, if pursued seriously, could greatly reduce the effects of toxic chemicals on children’s health and the associated costs to society:

• Require the examination of chemicals already on the market for potential toxicity, starting with the chemicals in widest use, using new, more efficient toxicity testing technologies.
• Check all new chemicals for toxicity before they are allowed to enter the marketplace, and maintain strictly-enforced regulation on these chemicals.
• Increase ongoing research and monitoring of children’s environmental health to better understand, and prevent, the health impact of chemicals on children.

Previously: Home can be a toxic playground for babies
Photo by HaPe_Gera

The crowd that packed the sweltering geology lecture hall last night came to hear the wisdom and word-craft of Stanford physician and bestselling writer Abraham Verghese, MD.

The conversation touched on all of Verghese’s work, including the memoirs The Tennis Partner and My Own Country, and his most recent novel, Cutting for Stone. Verghese spoke as a part of the long-running How I Write series, free public author interviews offered once a quarter and hosted by author and Stanford lecturer Hilton Obenzinger, PhD.

Some choice quotes, featured on the Stanford School of Medicine’s live Twitter feed from the event:

• “I see myself entirely as a physician. I don’t wear two hats, doctor and writer, like some people think.”
• On life in India, Ethiopia, Tennessee, and Texas: “There [are] advantages to the writer to be an exile, to feel like you don’t belong.”
• “I think an important ritual takes place when interacting with a patient – it can mark a departure, a transformation. One individual comes to another, says things they wouldn’t tell anyone, disrobes, and allows touch.”
• “It is a great privilege to witness the compressed lives of the dying. They can’t postpone the search for the meaning to life. The dying ask ‘where does meaning reside?’ Most find relationships – love of parents, children, friends – most important.”

Verghese, who will be the Stanford Summit@Medicine2.0 opening keynote speaker in Sept., leaves on a book tour tomorrow. You can download a free recording of his How I Write talk through Stanford’s iTunesU offerings in a few weeks.

Previously: Hands on: Abraham Verghese teaches bedside skills, Abraham Verghese at Work: A New York Times profile, How a battle with Napoleon helped Abraham Verghese write his novel and Physicians turn to books to better understand patients, selves

A new technology developed with the help of Stanford immunologist Garry Nolan, PhD, could help accelerate cancer and immune system research. The instrument improves upon a cornerstone method in immune research that catalogs and counts large numbers of cells according to the proteins they specialize in producing.

By swapping rare-earth metals like neodymium with the fluorescent dyes usually used, the new approach provides a big leap in the number of ways cells can be sorted the new approach provides a big leap in the number of subtypes and activation states of cells can be indentified simultaneously. The method also provides a much more detailed look at the interior of cells, providing even more ways to distinguish cell types. From our release:

In [a study appearing in Science], Nolan and his colleagues simultaneously monitored 34 different substances found inside and on the surface of different cell types produced in human bone marrow, the place where all immune and blood cells, as well as blood disorders such as leukemia, originate.

By measuring large numbers of cell features all at once with the new technology – called mass cytometry – the team could capture subtle transitions between cell states in, essentially, a high-resolution snapshot of the entire blood-forming system, he said.

…

“In essence,” said Nolan, “we are interviewing or interrogating the cells, forcing them to reveal their inner thought processes.”

Photo of the mass cytometer and Garry Nolan by Norbert von der Groeben

Approximately 38 million Americans suffer from impaired hearing and it’s estimated that dangerous levels of noise in the workplace will result in one in four workers developing hearing loss, according to the Center for Hearing and Communication.

In recognition of International Noise Awareness Day today, take a moment to reflect on how noise might be disrupting your daily life and, possibly, harming your health. According to a recent report by the World Health Organization’s European office:

There is sufficient evidence from large-scale epidemiological studies linking the population’s exposure to environmental noise with adverse health effects. Therefore, environmental noise should be considered not only as a cause of nuisance but also a concern for public health and environmental health.

…at least one million healthy life years are lost every year from traffic-related noise in the western part of Europe.

The study breaks out the results into several specific types of noise health impacts. Every year in the EU, noise is estimated to cause:

• 61,000 lost years of healthy living due to noise-related heart disease
• 45,000 years lost due to cognitive impairment of children
• 903,000 years due to sleep disturbance
• 22,000 years due to tinnitus
• 587,000 years due to annoyance

At Stanford, scientists are exploring stem cell-based research to better understand the molecular basis of hearing in order to develop better treatments for hearing loss. Although they’ve made significant progress, treatments are still a ways off so it’s best to protect your hearing.

Previously: Getting a good night’s sleep, Popular vuvuzela poses health risk to World Cup fans and Growing new inner-ear cells: a step toward a cure for deafness
Photo by: mollypop

At 77, my mom is sharp as a tack. She’s a daily crossword devotee and voracious reader, having heard that mental activity can prevent age-related memory and thinking declines. According to new research, her active volunteer life and packed social schedule may have just as much to do with her mental resilience.

According to a report (registration required) just published in the Journal of the International Neuropsychological Society:

On average, the most socially active individuals [the top 10 percent] experienced only one quarter of the rate of cognitive decline experienced by the least socially active individuals [the bottom 10 percent].

Their conclusion that social activity slows the fogging of mental processes relies upon a unique data set collected by scientists at the Rush University Medical Center in Chicago. They’ve had 1,138 older adults come in for annual checkups, including a long list of memory tests and measurements of the speed and accuracy of their thinking. Half of the participants have been followed for longer than 5 years.

The researchers ruled out lots of factors that might undermine their conclusions. After accounting for age, other long-term health problems, and even personality traits, social activity still protected thinking and memory. The benefits of interacting with friends and relations added to the known brain-health benefits of physical activity and cognitive exercises like my mom’s habitual crosswords.

The authors list a few limits to the study. For instance, participants had to rely on memory to report their social activities over the year between their checkups. That’s a long stretch to cover, trying to account for every social activity, even for a person at their peak brainpower.

Also, participants joined the study at an average age of 80. So this group may be especially healthy survivor-types compared to the general population of older adults. There were far more women participants than men and few minorities in the study. Finally, the researchers caution:

Current social activity in old age may reflect life-long patterns of behavior, changes in lifestyle initiated in later life, or a combination of both….The greatest effect on cognitive health is likely achieved through a lifetime of social activity.

Although my California-based brothers and I would like to see more of my mom, this study makes me glad she’s in Houston with her friends and fellow volunteers. Not only is she happier, we’ve made it easy for her to keep up her life-long brain-healthy social habits.

Related: To be healthier in the new year, resolve to be more social, Does the brain retire at retirement? and Can good friends help you live longer?
Via Newswise
Photo by Pedro Ribeiro Simoes

If you take antidepressants to manage depression, anxiety, or other conditions, new research suggests using caution when you reach for anti-inflammatory drugs such as aspirin and ibuprofen.

The studies, first conducted in mice and later confirmed in human patients, showed that the most widely prescribed type of antidepressants – including fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) – were less effective when taken together with common over-the-counter medications such as Bayer, Advil, and Aleve. The surprising clash between the two common types of drugs is reported today in the Proceedings of the National Academy of Sciences (registration required).

A press release reports the large effects and quotes lead researchers, Jennifer Warner-Schmidt, PhD and Paul Greengard, PhD, on what their findings mean for patients and physicians:

The effect was rather dramatic since, in the absence of any anti-inflammatory or analgesic use, 54 percent of patients responded to the antidepressant, whereas success rates dropped to approximately 40 percent for those who reported using anti-inflammatory agents.

“The mechanism underlying these effects is not yet clear. Nevertheless, our results may have profound implications for patients, given the very high treatment resistance rates for depressed individuals taking [selective serotonin reuptake inhibitors],” notes Dr. Warner-Schmidt.

Dr. Greengard adds, “Many elderly individuals suffering from depression also have arthritic or related diseases and as a consequence are taking both antidepressant and anti-inflammatory medications. Our results suggest that physicians should carefully balance the advantages and disadvantages of continuing anti-inflammatory therapy in patients being treated with antidepressant medications.”

Previously: Antidepressants don’t improve all symptoms of depression
Photo by psyberartist

Although incredibly tiny, viruses have cast an enormous shadow on human history. Viral diseases disrupted some societies so tremendously, that people came to think of them as gods (registration required).

Viruses infect us by exploiting our most intimate human behaviors, from eating to sex, sometimes with life-or-death consequences. That’s why medical school immunologist Robert Siegel, MD, PhD, says the way humans deal with viruses raise questions about right and wrong.

Last Friday, Siegel gave an invited talk on ethics in human virology during the long-running Stanford Ethics at Noon public seminar. He emphasized that many of those dilemmas don’t have such clear-cut solutions.

For example, probably the biggest victory in humanity’s fight against viral diseases, the smallpox vaccine, came from a risky experiment: Physician Edward Jenner deliberately infected a child with the deadly virus, not knowing whether the vaccine would protect him. Yet, that one experiment probably saved more lives than any other in the history of medicine.

Siegel spoke with enthusiasm and at a rapid pace. Still, in an hour he could only provide us with a glimpse of the long list of moral issues that have emerged in humanity’s long struggle against viruses.

For more information about the talk, head over to the Ethics at Noon website, where you can read student-written responses to Siegel’s talk, which they will post over the next week.

Photo by Keith Rozendal

Is it possible that one day your physician may prescribe a walk in the woods for what ails you? Although writer Richard Louw’s notion of a “Nature Deficit Disorder” doesn’t appear in medical manuals of diagnosis and treatment, a growing body of studies may suggest the notion has some merit.

This effort to understand whether nature might heal drives the research of Frances “Ming” Kuo, PhD, who directs the University of Illinois’ Landscape and Human Health Laboratory. Debra Levey Larson got an update from Kuo on this work for Futurity, just in time for Earth Day:

Access to nature and green environments yields better cognitive functioning, more self-discipline and impulse control, and greater mental health overall, while less access is linked to exacerbated attention deficit/hyperactivity disorder symptoms, higher rates of anxiety disorders, and higher rates of clinical depression.

…Greener environments enhance recovery from surgery, enable and support higher levels of physical activity, improve immune system functioning, help diabetics achieve healthier blood glucose levels, and improve functional health status and independent living skills among older adults.

By contrast, environments with less green space are associated with greater rates of childhood obesity; higher rates of 15 out of 24 categories of physician-diagnosed diseases, including cardiovascular diseases; and higher rates of mortality in younger and older adults..

Previously: Out-of-office autoreply: Reaping the benefits of nature
Photo by Craig Wyzik