Podcasts about global health institute

For much of history, the word 'epidemic' applied to infectious diseases. Large numbers of cases of disease caused by organisms such as bacteria and viruses that spread through water, air, or other means, sometimes transmitted from person to person, or back and forth between people and animals. Then came epidemics of chronic diseases such as obesity, diabetes, heart disease - diseases occurring in very large numbers and created not by infectious agents, but by drivers in our day to day lives, such as a bad food environment. A new paper was just published in the PLOS global health literature that I found fascinating. It focuses on another use of the concept of epidemics: market driven epidemics. Let's find out what these are and find out a little bit more about their implications for our health and wellbeing. Our guests today are two of the authors of that paper. Dr. Jonathan Quick is a physician and expert on global health and epidemics. He is an adjunct professor at Duke University's Global Health Institute. Eszter Rimanyi joins us as well. She works on chronic disease and addiction epidemiology at Duke university. Interview Summary Access the PLOS article “Dynamics of combatting market-driven epidemics: Insights from U.S. reduction of cigarette, sugar, and prescription opioid consumption.” So, Jono, let's start with you. Tell us what you mean by market driven epidemics. The pattern is familiar to people. There is a product that that humans like and the business community says we can make a lot of money on this unmet need. And so they do that and they start selling a lot of it. And then people start noticing that this thing that the humans like is killing some of them. And so, the scientists do the public health. And then the business community says these scientists are going to kill the golden goose. They buy up other scientists and try to defend themselves. And then it goes on and on before we really bend the epidemic curves. This pattern of consumer products that have harmful effects, those products are major contributors to the root causes of at least a million deaths a year in the US, and over 20 million deaths worldwide. So, to try to look at this from an epidemic point of view, we first established a case definition. Our definition of market driven epidemic is a significant increase in death, disability and other harmful effects on humans and human health and wellbeing. It's arising from a consumer product whose use has been accelerated by aggressive marketing. Whose harmful effects have been denied or otherwise minimized by producers. And for which effective mitigation is possible but actively opposed by producers. So, we looked at the natural history of this, and we found five phases through which these epidemics pass. There's market development, either inventing a new product, developing a product like prescription opioids, or transforming an existing product like tobacco. Phase two is evidence of harm. First, there's suspicion, astute clinicians, whistleblowers, and then eventually proof of harm. Phase three is corporate resistance. Companies deny harm, seek to discredit accusers, commission counter science, manufacture doubt, mount legal challenges. All the while deaths and social upheaval and economic costs are mounting. And finally, our next phase four is mitigation. We get some regulatory efforts going, and there's a tipping point for the consumption and resulting deaths. And then finally, phase five of this is market adaptation. In a response to decreasing or threatened consumption, companies and consumers typically seek alternatives. Adaptations can be positive or negative. Some are healthier, some are equally or more harmful. Thanks very much for that description. It really helps explain what the concept is all about. You chose three areas of focus. You could have chosen others, but you chose cigarettes, sugar, and prescription opioid use. Why those in particular? We wanted to identify differences in these market driven epidemics in a few product categories. We wanted to look at distinctly different consumer experiences so we could see what worked and what didn't in terms of bending the epidemic curve. We picked nicotine delivery, food, and prescription medicine. And to choose within those categories we established five inclusion criteria. So, number one, the product had to have proven adverse health effects. Number two, there needed to be well documented histories of product development, marketing, mitigation efforts, and so forth. Number three, the product needed to meet the overall case definition. That is, companies knew they were doing harm, continued to do harm, and fought that harm. Number four, there needed to be long term data available for product consumption and associated impact. And number five, most important, we chose products for which mitigation efforts had already resulted in significant sustained reduction in product consumption. Based on these three criteria, cigarettes, sugar, and prescription opioids came out as the ones that we studied. Thanks. I really appreciate that description. And when we get to the punchline in a minute, it's going to be interesting to see whether the behavior of the industry in this natural history that you talked about is similar, given that the substances are so different. We'll get to that in a minute. So Eszter, I'd like to turn to you. What kind of information did you pull together to write this paper? I think I looked at over a thousand different documents. But there were two clear types that I interrogated to pull together all of our background data. The first category was publicly available data, so that could have been a clinical study, epidemiological study, advertisement by the company, CDC or other government reports, mortality data, etc. But then there was also a distinct different type of data that we really looked at and that was really useful for putting together these pictures of the natural history, which was internal documents. In some cases, these could have been leaked by an internal employee, which was the case with the so called 'brown documents' with tobacco. But it also came from sometimes court hearings or as a result of lawsuits that the companies had to release internal data. It was really interesting to compile together the different sides, of the outside look from CDC reports, and then the insider scoop from Purdue Pharma. So, it's a very well rounded, interesting way to find all this data. I admire your effort. It's a big job to do a normal scientific review where you might have 50 papers and you were looking at things that were much harder to obtain and a vast number of things that are really quite different in character. Boy, congratulations for just reading all those things. Tell us what you found. Gosh, so even though there's so many distinct differences between a lot of these epidemics, what we actually found was that there was a lot of narrative similarities. And because of that, we could really create this holistic, but also really well-fitting idea of market driven epidemics. A lot of the corporate strategies were either mirrored, imitated, or in some cases quite literally lifted over because of overlapping ownership between the companies. One of the things that we really wanted to hammer into our article was that producers not only created their product, but they also manufactured doubt. Which means that they created, on purpose, public hesitancy around their product even when they internally knew that it was harmful to health. They wanted the public to be on the fence about what the health impact of their product was. There was a lot of different ways that they achieved that goal. Sometimes it was through showing propaganda films in high schools. Which I still can't believe that happened and then that was legal. But also in different ways, like co-opting science, paying scientists to publish articles in their favor. I know a really famous example of this that has now been public is that two Harvard researchers in cardiovascular disease published saying that sugar was not harmful to health. So, there's a lot of different ways that they achieved it, but the goals overall were very similar by all the companies. You know, you mentioned overlapping ownership. And so, you might have been referring specifically to the ownership of the food companies by the tobacco companies. Correct. Because it happened a while ago, that's not something that was well known. But there's a fascinating history there about how the tobacco industry used its technology to maximize addiction and used that to develop food products and to change the DNA of the food companies in ways that still exist today, even though that ownership ended many years ago. I'm really glad you pointed that out. Yeah, exactly. I think there's this shared idea that there's a turning point for companies. Where they know internally that their product is causing harm. And what really tips them over into becoming market driven epidemics is not actually coming out and saying that there's an issue with their product or not improving it. But you know really digging that information into the dirt and saying no we're going to protect our product and keep giving this out to the public despite the harms. You know, maybe we can come back to this, but the fact that you're finding similarities between these areas suggests that there are contingencies that act on corporate executives that are similar no matter what they're selling. And that's helpful to know because in the future, you can predict what these companies will be doing because there are many more similarities than differences. Jono let me ask you this. You've talked about this appalling period of time between when there are known health consequences of use of some of these things and the time when meaningful action occurs to curb their consumption and to rein in the behavior of the companies. How long is this gap, and what explains it? Kelly, this is one of the most fascinating things about this study. And it really highlights the importance of taking an epidemiologic approach. This is a behavioral epidemic, not a viral one. But it has so many characteristics. One of the key points is that is how important time is. And we see that in any epidemic curve when things start going exponential. If we take cigarettes, okay, the harms of cigarettes had long been suspected. But the first credible scientific publication was by a US physician, Isaac Adler, in a 400-page 1912 book where he first associated cigarettes with cancers. Fast forward over 40 years to British scientists Doll and Hill, and they did the epidemiology which definitively and convincingly links cigarette cancer with smoking deaths. So that gap was incredible and so that's one of the first examples. Once those articles were published, others followed the initial one. It took about a decade until the 1964 Surgeon General's report on smoking and health. And that was quickly followed by a series of federal actions. So, 1964, '63, '64 was the tipping point. Five decades after the initial suspicion. For sugar, the journey from suspicion to compelling evidence was more complex. There was a big debate between researchers, clinicians, scientific journalists, that began in the '50s. A diabetologist from Britain John Yudkin, argued in the 1957 Lancet piece, it's sugar that's equal or larger than fats. An American physiologist, Enzo Keyes, says au contraire. He said it on the cover of Time Magazine. From 1950 to 2000, there was this debate back and forth. Finally, sugar consumption in the US peaked in '99 when a sugar wary group of researchers, journalists, and advocacy groups began becoming really vocal. And that was the tipping point. The actual compelling science, it came a few years after the preponderance of folks engaged said, no, it's sugar. You got to do something. And finally, with prescription opioids: 1997, rural doctors Art Van Zee and another fellow, alerted Purdue Pharma, the producer of OxyContin, about rising overdoses. A year later, there was a publication that said the sustained release version of OxyContin, which was a hydrocodone that was sustained release, that they first tried it with morphine, and they had evidence from there that the sustained release drugs were a problem. And again, it was over a decade later that mounting prescription opioid deaths in the US convinced CDC to declare an epidemic of [00:14:00] opioid prescribing. This gap, if you look at it, to summarize, for cigarettes, the journey from credible suspicion of harm to consumption tipping point, five decades. Sugar, four decades. Prescription opioids, fourteen years. But the key thing is that the power of collective action, because today, only one in eight Americans smoke, and it was nearly 50 percent at the peak. The US consumption of sugar, which increased by 30 pounds between the year 1950 and the year 2000, when all this debate was going on. We picked up an extra 30 pounds of sugar consumption per person per year, but within two decades, that was cut back. We gave back 15 pounds of that. And now prescription opioids have gone back to a medically defendable level, having risen to 8 to 10 times that in the peak of the prescription opioid epidemic. Hearing you talk about that, it's nice that there's sometimes light at the end of the tunnel. But boy, it's a long tunnel. And that you can count the, the number of deaths during that tunnel period of time in the millions. It's just unspeakable how much damage, preventable damage gets caused. Now, and I'd like to, when I come back to wind up this podcast, I'd like to ask each of you, what do you think might be done to help narrow that or shrink that time gap and to prevent these long delays and to help address these corporate determinants of health. But before I get there, Eszter, you know, I'd like to follow up on the conversation we had earlier. You know where it's clear that sugar and tobacco and opioids are all quite different substances, but the companies, the natural history of these things looks quite similar. And you mentioned in particular the industry attempt to plant doubt. To create doubt in the minds of people about the stories they were hearing of the dangers of these things, whether they were true or not. And were there other things that the industry was doing during that time that you noticed might have similarities across these areas? Oh my gosh, so many. I have to go through all the examples in my head and make sure that I have a very crisp message out of all of them One of the ones that is interestingly being employed today in a very different epidemic with firearms and guns, is this idea of whose choice is the consumer product in its use. And today there's a lot of ideas that were initially created by tobacco, and then used by food, that are currently being used by gun lobbyists talking about individual freedoms. So with some of the previous market driven epidemics, like tobacco and prescription opioids, it's a way easier argument to make that the individual at some level does not choose to use the product. Maybe in the beginning, the first couple uses were their individual choice, but then there's on purpose, a really strong withdrawal response in the body and socially. The individual kind of had to continue using the product. But some of those ideas are being used today with firearms. The idea that somebody has the liberty to use this product or to purchase this product, which undoubtedly causes harm. You know, it's probably not really good for public health if this argument exists. And, in the cases with firearms, which I think is a little bit ironic and sad, a lot of the people that buy guns for their own self-defense actually experience those guns turned around and used on them, usually by the perpetrators of aggression. These ideas of individual freedoms usually backfire to the people that are consuming the products. It's interesting to me that a lot of these ideas were initially created for very different products, but are being used in the current day. So interesting to hear you say that because here we have yet another area where there are similarities with the firearms. And the companion argument to that idea that it's your personal liberty to use these things is the argument that there's overreach by government, big brother, things like that. When government wants to, you know. Yeah. It's so interesting. So one point on that. The market economy was never meant to be a free for all. Because the reality is that the market economy has brought billions of people out of poverty and saved more lives than most health interventions. But the problem is, as I said, it wasn't meant to be a free for all. And it depends on having good consumer information and when companies are distorting it, they're basically taking away the informed choice, which is critical. The other part of it is, when they are purposely engineering their products for maximal addictiveness, which is done with clicks and social media, and was done purposefully with the nicotine content in cigarettes, then you don't have a real informed choice. The freedom of choice. You've had your brain pleasure center hijacked by, by purposely addictive products. Right, and you didn't mention food, but there's another example of substances that are created to hijack the reward pathway in the brain. Absolutely. I'd like to ask each of you, what in the heck can we do about this? I mean, you've pointed out a massive problem. Where the number of lives that are sacrificed because of corporate behavior, just enormous numbers. What can we do about it? Jono, I will start with you. And, you know, you've written this very highly regarded book called The End of Epidemics. And you've talked about things like bending epidemic curves and accelerating shifts. But tell us more. What do you think can be done in the case of these market driven epidemics like we're talking about? Well, I think it's important to realize that both kinds of epidemics, viral and behavioral, are communicable. Both involve a lot of rumor, blame, uncertainty. And as we've talked about both cause deaths in the thousands or millions. And we haven't talked so much about the significant social disruption, and the cost. Trillions of dollars in economic losses and additional health burdens. So let me focus on four kinds of key actors because when it comes down to it, it's groups that that really start acting against these things. The first is the research community and its funders. You won't be surprised given the time it takes to get the evidence because what's clear is without clear evidence of product associated harm, we're not going to move the political agendas. We're not going to get public support for epidemic curves. So, we have really good researchers working in these areas. They need to guard against groupthink. That's what happened with our salt sugar 50 years of chaos discussion. And conflict of interest because companies do try to undermine the database. The second is the funders of research, foundations and all, and national health services need to have an early warning system and an annual research roadmap in this area. I think Eszter will probably talk about the importance of public health leaders, because she's looked a lot at that. Another community though is the different civil society groups that are active. Because there's Mothers Against Drunk Driving, there's the Sandy Hook group on gun shooting, and there are a variety of interest groups. But what we realize is that there are lots of different strategies for how you move decision makers and all. So, more information sharing from those groups, civil society groups and all across. And finally, companies. It's actually in their interest to be more forthcoming earlier on. With tobacco, with prescription opioids, and now with baby powder, with talc, what we're seeing is companies at risk of bankruptcy paying billions of dollars. And if their CEOs aren't looking at that, then their board needs to be. Can I ask you a quick question about that? When the chickens come home to roost, and those bad things befall a company, you know, really seriously damaging lawsuits, or the possibility that perhaps sometime the executives will go to jail for corporate malfeasance. You know, the behavior that caused all the millions of deaths occurred 15 CEOs before them. So, if you're a CEO and you know you have a certain shelf life as CEO, you want to maximize profit during that time. And by the time anything happens negatively to the company, you're on vacation, you're retired, or you're gone. So how do you deal with that? Here's the thing, it's having criminal and civil liability that can go back to the individuals involved. From a different sector, an example. The German executive who was head of Volkswagen over a decade ago when they cheated on their environmental issues. He's been criminally charged today, a decade later. And I think that sort of personal accountability, it'll be hard to get, but that's the kind of thing that will make CEOs and their boards, if their boards also become responsible for hiding information in a way that it resulted in deaths. I think that, unfortunately, that kind of hammer, although it's going to be hard to get, that's probably what's needed. Okay, that makes good sense to me, and I'm glad I asked you that question. And I appreciate the answer. Eszter, anything you'd like to add to what Jono said about what could be done. Yes. One of the amazing things about market driven epidemics was when we were creating the paper, we created a table of all the different types of actors that could have very successful mitigation. And that table actually ended up being cut from the paper because it was so long that the editor said that it might distract from the rest of the paper. But that's actually a very positive message because there are so many actors that can have positive change, I'm going to highlight a couple of them because I think there's a few things here that are fairly good core messages that we can take away. One of the ones is the need for a trusted public health authoritative voice. I think nowadays there's a lot of commotion over how much we trust the government. And how much we trust, for example, the head of the CDC and the types of data they're talking about in terms of public health. But in the past, when we had a very trusted public health voice, that was really crucial in getting consumers to change their behavior. For example, in the 1964 Surgeon General's report, seemingly overnight changed people's behavior. Before then, smoking was a common, everyday social event. And after that, people started viewing it as a deadly, bad habit that some people had. And that type of change was really hard to get in the modern day. When we were talking about public health crises that were viral. So, I think one of the things that we really need to get again in the modern day is this trust between the people and public health voices so that when we have such good forthcoming information those statements actually mean something. So much so that the consumers change their behavior. Another thing is with us individuals who maybe aren't part of public health, we actually play a pretty big role in how much other people consume these different products. I remember when I was researching cigarettes in particular and the intersection with social media. I think if somebody under 18 saw a peer smoking and posted that to Instagram, that doubled their likelihood of trying out smoking for the first time. You have to be really careful with how you show yourself in the presence of others, and online too with a new digital age. Because you might tip the scale in somebody trying out a product for the first time. Which then if it has a very strong withdrawal effect, you know that person might have to might feel that they have to continue using that product to avoid withdrawal. I think as an individual, you can be more mindful about if you have a certain product use that you don't want others to also pick up, to maybe not do it or not show it as much so that other people aren't interested in doing that. Okay, the last really positive message I have is that I think as my generation gets into higher positions of power, even within corporations, I think Gen Z and Gen Alpha and other young people have the sense of responsibility for others and for the planet. And I think if there was a young person in power in a corporation and saw that oh no this product that we've had is now there's evidence that's harmful. I think there would be more accountability and more of a want to do something that's good for the planet and for people. I'm hopeful that, maybe 50, 60 years ago, if people were more in favor of kind of brushing things under the rug, then maybe the young generation won't be as into those ideas. And we'll actually want to be accountable and do what's right. BIOS Jonathan D. Quick, MD, MPH (“Jono”) is adjunct Professor of Global Health at the Duke Global Health Institute, where he teaches global health policy, serves on foundation grant advisory boards, and mentors students. Dr. Quick's current research and writing focuses on market-driven epidemics, from tobacco to opioids to social media.  He is also Affiliated Faculty in Global Health Equity, Brigham and Women's Hospital/Global Health & Social Medicine, Harvard Medical School. Dr. Quick is the author of The End of Epidemics: The Looming Threat to Humanity and How to Stop It  (Australian, Italian, Korean, South Asia, U.K. and U.S. 2018/2020/2021 editions), creator of MDS-3: Managing Access to Medicines and Health Technologies and an author of  The Financial Times Guide to Executive Health, Preventive Stress Management in Organizations, as well as more than 100 other books, chapters, and articles in leading medical journals.  Eszter Rimanyi is a chronic disease epidemiologist working with Dr. Jonathan D. Quick at the Duke Global Health Institute. Her research interest centers around Market-Driven Epidemics, including tobacco, sugar, opioids, and breastmilk substitute/infant formula. She is currently working on applying the market-driven epidemics approach to new epidemics, such as social media and firearms. Rimanyi has authored scientific papers in journals such as PloS Global Public Health and MDPI.

In this fifth episode of our six-part miniseries (see notes for 'useful links' to other episodes), we examine the intersection of migration, displacement, and health systems in fragile settings. With over 1 billion people on the move globally, including 84 million forcibly displaced, this episode addresses the challenges and opportunities that migration presents to health systems. Our co-host, Dr. Joanna Raven, joins us alongside Professor Fouad Fouad and Dr. Santino Severoni, to share their experiences and insights on how health systems can respond to the needs of migrants and refugees through integration, cultural changes, and evidence-based practices.Chapters00:00 Introduction to the discussion on migration, displacement, and health systems resilience in fragile settings01:00 Meet the Experts: Professor Fouad Mohammad Fouad and Dr. Santino Severoni02:56 Global Migration and Displacement: Setting the Scene07:56 Challenges Faced by Health Systems09:13 Integration and Parallel Health Systems13:11 WHO's Role and Strategic Approaches17:11 Examples of Good Practices from Different Countries21:48 Final Thoughts and Advice for Future Work24:12 Conclusion and Next Episode TeaserIn this episode:Dr Joanna Raven - Reader in health systems, Liverpool School of Tropical Medicine Jo has worked in global health for more than 25 years, focusing on strengthening health systems. Jo is a researcher with a passion for co-designing and implementing health system research with local stakeholders including community members, health workers, health managers and decision makers. As a health worker herself, Jo's work focuses on supporting the health workforce to deliver people-centred care that is of good quality and leaves no one behind. Dr. Fouad Fouad - Professor of Global Health and Social Sciences, Liverpool School of Tropical MedicineFouad has extensive research on migration and health, focusing on multidisciplinary approaches to forced displacement, health systems in humanitarian settings, and the political economy of health in protracted crises. Fouad is also the IDRC Chair of the Forced Displacement Program in the Middle East and the Co-Director of the Refugee Health Program at the Global Health Institute. His role as a member of several technical working groups, including the WHO Global Consultation on the Health of Migrants and Refugees and the Global Research Agenda on Health and Migration, underscores his expertise and influence in the field. Fouad served as a commissioner in the UCL-Lancet Commission on Migration and Health (2018) and is currently a commissioner in the Lancet Commission on Health, Conflict, and Forced Migration. Dr. Santino Severoni - Director of the WHO Department of Health and Migration, World Health OrganizationDr. Severoni is the Director of the Department of Health and Migration at WHO headquarters in Geneva. With over 24 years of experience, he has held senior roles at the WHO Regional Office for Europe and worked globally in health sector reforms, system strengthening, and complex emergency management. His career includes serving as WHO Representative in Albania and Tajikistan. Since 2011, he has focused on public health aspects of migration, leading efforts to implement global migration and refugee compacts and coordinating WHO's first World Report on the Health of Refugees and Migrants.Useful linksWHO global action plan on promoting the health of refugees and migrants, 2019–2030Promoting the health of refugees and migrants: experiences from around the world - Compendium referenced by Dr. Santino

Dr Ghassan Abu-Sittah is no stranger to conflict zones, having  spent decades volunteering for medical charities in Palestine, Lebanon, Yemen, Syria, and Iraq. But the plastic and reconstructive surgeon says his latest experience in Gaza has no parallel. The scale of the current suffering in Gaza, “the intensity, the ferocity, the viciousness, and the deliberate targeting of the hospitals”, he says, was like "a tsunami”.Dr Abu-Sittah travelled to Gaza days after Israel began its bombardment in response to the October 7 attack by Hamas. He remained in the besieged enclave for 43 days, working mainly in northern Gaza as a volunteer for Médecins Sans Frontières (MSF).He was at Al-Ahli Hospital during the massacre on October 17, 2023, and was among the physicians who spoke to news media, surrounded by blood-stained bodies, in the attack's immediate aftermath. He later gave evidence to the International Court of Justice (ICJ) at The Hague about what he saw.In this moving interview with Maysa Jalbout, Dr Abu-Sittah shares his experiences of working in Gaza and what it was like knowing his wife and children were watching him caught up in the attacks in real time on social media.Since returning home to the UK, he has announced plans to set up The Ghassan Abu Sittah Children's Fund to pay for injured Palestinians to receive medical and rehabilitation treatment in Lebanon.Children have borne the brunt of this latest chapter of conflict in Palestine. Before October 7, there were nearly 200 war-related amputations among young people in Gaza as well as some 2,000 adults living with amputations from earlier conflicts. Dr Abu Sittah says there could now be as many as 5,000 child amputees, with many losing limbs due to an inability to treat what would ordinarily be very salvageable injuries.Children with amputations need new prosthetics every six to eight months as they grow and could require as many as 12 surgeries before they reach adulthood, he explained. In addition to the physical impact of their injuries, their mental health needs are also “life altering”. Dr Abu-Sittah was born in Kuwait after his parents were forced from their homes in Palestine in 1948 and became refugees in Gaza. He studied medicine at the University of Glasgow and after completing his Specialist Registrar training in London, he went on to do fellowships  in Paediatric Craniofacial Surgery and  Cleft Surgery at Great Ormond Street Hospital for Sick Kids and then a fellowship in Trauma Reconstruction at the Royal London Hospital. In 2010 he was awarded Fellowship of the Royal College of Surgeons (Plastic Surgery).  Dr Abu-Sittah has served as an associate professor and head of the Division of Plastic and Reconstructive Aesthetic Surgery at the American University of Beirut (AUB) Medical Center,  in 2015, became a founding director of the Conflict Medicine Program at AUB's Global Health Institute, and in March was named Rector of the University of Glasgow.The Impact Room is brought to you by Philanthropy Age and Maysa Jalbout. Find us on social media @PhilanthropyAge

À bien des égards, le réchauffement de notre planète est aujourd'hui le principal enjeu de notre époque. Or, nous ne considérons sans doute pas suffisamment le changement climatique en tant que menace pour la santé publique. Par exemple, que se passera-t-il lorsque de nouvelles régions du monde seront suffisamment chaudes et humides pour accueillir des moustiques vecteurs de pathogènes? Cet épisode entend le professeur Rachel Lowe de la London School of Hygiene and Tropical Medicine, le professeur Jonathan Patz, directeur du Global Health Institute de l'Université Madison du Wisconsin, et le Dr Florence Fouque, spécialiste de la lutte anti-vectorielle à l'OMS.

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. In August 2020, Shawky S. Amine Eddine, MD, became the EMS commander for the Beirut Port Explosion – the largest non-nuclear explosion in history. The blast killed 200, injured 6,500, and resulted in excess of 300,000 people suffering home damages and losses. In terms of medical facilities in the blast area, four hospitals we rendered totally out of action, with eight further healthcare centers damaged. The explosion added to an already pressurized healthcare system, as the country was at the height of the pandemic, as well as hosting over 900,000 refugees from war-torn Syria. In this episode of EMS One-Stop, Dr. Eddine joins host Rob Lawrence to discuss the backstory and devastation of the explosion, as well as the challenges to access, hospital capacity, communication, record keeping and the management of the dead. Tune in as Dr. Eddine shares 10 takeaways and lessons for responding to a large-scale MCI both identified from that eventful day (discussed in full in the broadcast): Don't fish in the same lake Factor emotions Leadership tokens are earned in management and spent in command Even in crisis … plan The importance of data Decision making You are not alone – coordinate and communicate Rescuers' wellbeing is a priority Don't forget yourself and don't lose yourself amidst the crisis We make mistakes About our guest Dr. Shawky Amine Eddine, MD, is a medical doctor with special interest in prehospital care, healthcare quality management and disaster management. He has served as an EMT in the Lebanese Red Cross (LRC) since 2007 and as head of station for Damour EMS Station, and is currently acting as LRC director for learning and development, assistant EMS director for training and quality, and COVID-19 response coordinator. Dr. Amine Eddine has commanded multiple crises including Lebanon fires in 2019, Lebanon floods in 2019, protests in 2019-2020, COVID-19 outbreak in 2020 and the Beirut port explosion in 2020. He has led the real-time evaluations of COIVD-19 response. Dr. Amine Eddine is also a disaster management instructor in the Humanitarian Leadership Diploma, offered by Global Health Institute at AUB, an assistant professor at the Faculty of Nursing of the Lebanese Red Cross and a consultant for multiple local, regional and global NGOs. Connect with Dr. Amine Eddine: Twitter: @SAmineeddine LinkedIn EPISODE CONTENTS 1:00 – Introduction Shawky S. Amine Eddine, MD 1:30 – Description of EMS in Lebanon 04:43 – The role of Jerry Overton in the development of EMS in Lebanon 06:18 – Setting the 2020 scene in Lebanon. 09:00 – Ammonium Nitrate – a bomb in the warehouse 12:00 – Gathering the situation: The fog of war! 14:00 – Loss of medical infrastructure due to the blast 17:00 – EMS resources deployed 18:00 – Command and control: The UK GOLD, SILVER and BRONZE system 23:00 – Lessons identified versus lessons learned 23:50 – Don't fish in the same lake 28:00 – Factor emotions 30:00 – Leadership tokens are earned in management and spent in command 33:00 – Even in crisis … plan 37:00 – The importance of data 40:00 – Decision making 41:40 – You are not alone: Coordinate and communicate 43:00 – Rescuers' wellbeing is a priority 45:30 – Don't forget yourself and don't lose yourself amidst the crisis 48:00 – I make mistakes Additional resources Rapid Response: Beirut blast serves as stark reminder of the power of energetic materials Beirut and beyond: Planning for explosives in your community Forensic review: The Beirut port explosion UN Report: Beirut blast

What are the current risks to our national and global food security? How do cyber-attacks play a role? What are the conflicts in the grain industry that prevent us from moving forward? Dr. Molly Jahn and Col. John Hoffman, two of the most sought-after food security experts in the world, provide their recommendations for real solutions to this growing problem.  About the guests: Dr. Molly Jahn is a professor at the University of Wisconsin-Madison where she holds appointments in the Department of Agronomy, the Nelson Institute, and the Global Health Institute. She is currently on an interagency personnel agreement from UW-Madison to work as a program manager at the Defense Advanced Research Projects Agency (DARPA). She is also appointed Joint Faculty at the US Department of Energy Oak Ridge National Laboratory (ORNL) where she chairs the Scientific Advisory Committee of the Energy and Environmental Sciences Directorate and sits on the Lab Director's SAC.  Col. John T. Hoffman is a senior research fellow with the Food Protection and Defense Institute (FPDI), a U.S. Department of Homeland Security Center of Excellence at the University of Minnesota. Col. Hoffman has extensive experience in developing, operating, hardening and sustaining extensive cyber systems.  Episode topics: Current global food security measuresImplications of cyber threats on food securityCyber-attack preparedness and current limitationsAction steps for the grain industryTo find more helpful resources, be sure to visit the GEAPS website and the membership page.   Grain Elevator and Processing Society champions, connects and serves the global grain industry and its members. Be sure to visit GEAPS' website to learn how you can grow your network, support your personal professional development, and advance your career. Thank you for listening to another episode of GEAPS' Whole Grain podcast.

Welcome back, friends, to our podcast, The Patients Speak. We're the podcast where we try to capture both the business and scientific innovation that's going on in healthcare with the patient's voice and what we can learn when we really listen to the patient. My guest today is Dr. Peter Small. He's an acoustic epidemiologist by training and by trade, but he's also leading the efforts to understand and quantify what cough can mean in a patient's overall healthcare picture. His background includes global efforts in TB, he has also worked in international work with the Bill & Melinda Gates Foundation, with the Global Healthcare Initiative, and with other foundations and organizations in the area of lung and cough. Not only does he come from a professional background as a physician and a scientist and working in the field of philanthropy, but he is actually a patient who had a refractory chronic cough for about three decades.He tells us that if you never cough, you'll probably die of aspiration pneumonia. On the other hand, it's a symptom of disease, if you're coughing a lot.Hyfe.AI is trying to do for cough what the thermometer did for fever. It made it real and quantifiable and actionable. By the use of acoustic artificial intelligence to be able to recognize the sound of a cough. The app can be downloaded for free. Not only does it detect and quantify a cough but it's got a list of other advantages:It's very helpful for chronic coughers in terms of empowering them in their conversations with their providersWomen who have stress incontinence, when they cough, it's super embarrassing, and so to be able to convey the magnitude of the problem to the provider Helps patients to take control of their own precipitators of their cough, change their lifestyle, and minimize their symptomsIt should help drug companies start using it to accelerate the development of better technologies and drugs. A patient selection tool for recruitment and clinical trialsIn summary, we see that technology has brought to the picture the central role that the patients themselves can play in selecting those innovations that make a difference. Those well-selected innovations have empowered patients to take whatever information they're acquiring, and bring it to their doctor, and insist that their doctor looks at it. Dr. Peter Small Dr Peter Small, M.D., built and ran the tuberculosis program for the Bill & Melinda Gates Foundation and conducted pioneering molecular epidemiologic research at Stanford University. He has spoken at the G3 Summit and long focused on the use of innovation to improve health care around the world. Dr Small founded the Global Health Institute and worked on the use of technology to improve health care delivery in remote Madagascar and Nepal. He is currently chief medical officer of Hyfe, the global leader in AI-powered cough detection and classification. Dr. Peter's Website @hyfeapp on Instagram @hyfeapp on Twitter Dr. Peter's Facebook page LinkedIn: https://www.linkedin.com/in/petermsmall/If you'd like to read more about patient empowerment – along with the 83bar patient recruitment platform – go to www.83bar.comBSB Media BSB Media

Epidemiologist Steffanie Strathdee and her husband, psychologist Tom Patterson, were vacationing in Egypt when Tom came down with a stomach bug. What at first seemed like a case of food poisoning quickly turned critical, and by the time Tom had been transferred via emergency medevac to the world-class medical center at UC San Diego, where both he and Steffanie worked, blood work revealed why modern medicine was failing: Tom was fighting one of the most dangerous, antibiotic-resistant bacteria in the world.Steffanie joins Greg this episode to discuss solving her husband's medical crisis, and what she learned from this horrific experience. They also discuss how Covid has ramped these trends up, how critical phages are for our bodies, and the open mindedness of PhDs vs MDs.Steffanie is Associate Dean of Global Health Sciences and Harold Simon Distinguished Professor in the Department of Medicine at the University of California San Diego School of Medicine. She is also an Adjunct Professor at Johns Hopkins and Simon Fraser Universities. She co-directs UCSD's new center for Innovative Phage Applications and Therapeutics (IPATH), Global Health Institute and the International Core of UCSD's Center for AIDS Research. Stefanie has co-authored her memoir all about her husbands illness titled, “The Perfect Predator: A Scientist's Race to Save Her Husband from a Deadly Superbug.”Episode Quotes:The need for a phage library[30:40] What we need to do is build a phage library that maps onto a superbug library. And, of course, these are going to be constantly needing to be updated because these are organisms that are co-evolving to attack one another.What's the future looking for the advancement of phage[37:55] I can imagine a situation in the future, though, where, because we have, sequencers that are portable and cheaper than ever before, that you'd be able to sequence a phage and sequence a bacteria and be able to have a database to say, okay, you know, this phage will match that bacterium or to even genetically modify or synthesize a phage. So in a 3D printing model, some of my colleagues in Belgium have, you know, been working on that. So, I think that there's going to be advances that are going to help us make this work. But right now, we need phage libraries. We need more investment in clinical trials.Pushing beyond boundaries leads to discovery[39:49] When your back is up against the wall, whether it's you as an individual, us as a society, or a planet, we can sometimes have creative ideas to come up with solutions that we wouldn't otherwise do. And that's what I'm hoping that we'll do now because both climate change and antimicrobial resistance are colliding.Show Links:Guest Profile:Faculty Profile at UC San DiegoFaculty Profile at John Hopkins Bloomberg School of Public HealthProfessional Profile at Canadian Association for Global HealthSteffanie Strathdee on LinkedInSteffanie Strathdee on TwitterSteffanie Strathdee on InstagramSteffanie Strathdee on TEDxNashvilleHer Work:Steffanie Strathdee on Google ScholarThe Perfect Predator Website

In this episode, we talk to Dr. Jeremy Lim, Associate Professor and Director of the Global Health Institute at the NUS Saw Swee Hock School of Public Health, on how the Singapore healthcare system works. Dr. Lim argues that a better understanding of health economics and the underlying political philosophies is the key to making fundamental changes to the healthcare system.

In this episode, Alexandrine Pirlot de Corbion, our Director of Strategy, speaks to Nour El Arnaout, from the Global Health Institute, American University of Beirut, Lebanon and Yousef Khader, from the Global Health Development, Eastern Mediterranean Public Health Network and the Faculty of Medicine, Jordan University of Science and Technology, Jordan, about digital health in the Middle East and North Africa and in particular digital maternal health and family planning initiatives they are working on, the impact of gender inequality, and the risks involved. Nour El Arnaout is a division manager at the Global Health Insitute at the American University of Beirut, where she also co-ordinates the Institutes's E-Sahha programme focussed on e-health and digital health. She has more than 7 years experience in projects and programmes management, operational management and research, and leads the implementation of large scale field based projects in underserved communities in Lebanon including refugee settlements. She is working on a project called: The Gamification, Artificial Intelligence and mHealth Network for Maternal Health Improvement. Yousef Khaderb is a professor of Epidemiology and biostatistics at the Faculty of Medicine at the Jordan University of Science and Technology, he is a fellow for public health at the royal college of physicians UK through distinction and has published more than 650 scientific papers in highly reputable journals. He is working on a project called: Governing Digital Personal Data to Strengthen Reproductive, Maternal, Newborn and Child Health Services Delivery in Fragile Settings in Palestine and Jordan. Both projects are funded by IDRC: https://www.idrc.ca/en. Links - Read more from Yousef and Nour about their projects, and gender and power in maternal health: https://ai-med.io/analysis/context-gender-power-and-choices/ - Read more about Nour's project: https://ghi.aub.edu.lb/esp/ - You can read more from Yousef in the below papers which he contributed to: - Midwives and women's perspectives on family planning in Jordan: human rights, gender equity, decision-making and power dynamics: https://pubmed.ncbi.nlm.nih.gov/34458635/ - Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives: https://pubmed.ncbi.nlm.nih.gov/34319250/ - Do modern family planning methods impact women's quality of life? Jordanian women's perspective: https://pubmed.ncbi.nlm.nih.gov/31615524/

Dr. Molly Jahn is a professor at the University of Wisconsin-Madison where she holds appointments in the Department of Agronomy, the Nelson Institute, the Global Health Institute (on leave 2019-20 for Government Service), and a $0 appointment in the Wisconsin School of Law. She is currently on an Interagency Personnel Agreement from UW-Madison to work as a Program Manager at the Defense Advanced Research Projects Agency (DARPA). Tune in to learn more about: The risks in the US food system and why they should be a concern; The multiple breadbasket failure; How COVID revealed the fragility of the food system; The negative effects of driving diversity out of the food system; How conflicts are a real threat to the stability of the food system; The future of microbial foods.  To learn more about Dr. Jahn and her work go to https://jahnresearchgroup.net/who-we-are/molly-jahn/. 

Dr. Steffanie Strathdee is Associate Dean of Global Health Sciences and Harold Simon Distinguished Professor in the Department of Medicine at the University of California San Diego School of Medicine. She co-directs UCSD's new center for Innovative Phage Applications and Therapeutics (IPATH), Global Health Institute and the International Core of UCSD's Center for AIDS Research. An infectious disease epidemiologist, she has spent the last two decades focusing on HIV prevention in marginalized populations and has published over 600 peer-reviewed publications. She has recently begun working to move bacteriophage therapy into clinical trials at IPATH. She has co-authored her memoir, The Perfect Predator: A Scientist's Race to Save Her Husband from a Deadly Superbug. In this podcast we talk about Dr. Strathdee's experiences learning about bacteriophage (phage) therapy treatment through a personal experience where her husband became extremely ill from antimicrobial resistant bacteria. She learned that stigma in part was how phage therapy had become forgotten in North America--stigma toward scientists with different beliefs and training than the mainstream, stigma toward viruses that maybe perceived "at the borderline of life", and stigma toward research based on geopolitics (including the "Russian taint"). Steffanie inspires listeners with her discussion of the power of global collaboration, advocacy in healthcare, and the importance of making (rather than waiting for) miracles to happen. Episode hosted by Dr. Carmen Logie. Supported by funding from the Canada Foundation for Innovation and Canada Research Chairs program. Original music and podcast produced by Jupiter Productions, who have various production services available to support your podcast needs.

Trending Technologies in Life Sciences - A Special episode series of Voices in Validation   This week, Stacey is joined by Dr. Peter Small, from Hyfe about an AI cough monitor that detects and records every cough and turns that into reliable clinical data.  We are working at accelerated speeds to digitalize and automate across pharmaceutical and medical devices. There are unique challenges inherent to emerging technologies in clinical trials development, scale-up, and manufacture. As we begin to harness the data delivered through AI, and further refine the processes around automation, IVT Network strives to bring to light some of the most innovative products and uses for the benefit of the entire life sciences industry. About Our Guest: Dr. Peter Small has had an eclectic career, with the common theme being the use of innovation to improve health care. He was chief medical resident at UCSF during the dawn of the HIV epidemic, did pioneering molecular epidemiologic research at Stanford University, and built and ran the TB program for the Bill and Melinda Gates Foundation. In 2015, he founded the Global Health Institute at Stony Brook University focused on the use of technology to deliver health care in remote Madagascar and Nepal. In 2019, he stepped in as the technical lead of a Gates-funded design-build firm which he recently left to focus on making cough count.   Voices in Validation brings you the best in validation and compliance topics. Voices in Validation is brought to you by IVT Network, your expert source for life science regulatory knowledge. For more information on IVT Network, check out their website at http://ivtnetwork.com. 

In this episode, I spoke with a global leader in medical innovation. He shared his work around cough and innovation to help alleviate suffering for patients around the world. Hear his thoughts on a range of issues related to global health and innovation!Dr. Peter Small is currently the Chief Medical Officer at Hyfe, pursuing his vision to make cough quantifiable and diagnostic. In the distant past he was a medical resident and chief medical resident at UCSF during the dawn of the HIV epidemic. He then moved to Stanford where he completed an Infectious Disease fellowship and spent about a decade on the faculty of Stanford's Infectious Disease Division. During these years, he published pioneering molecular epidemiological papers that helped to shape the public health response to the resurgence of tuberculosis and seminal papers on mycobacterial genomics.In 2002 he was one of the early employees of the Bill and Melinda Gates Foundation where he developed their tuberculosis strategy, built the foundation's core partnerships and country programs, hired and manage the Foundation's TB team and oversaw a large portfolio of vaccine, drug and diagnostic product development activities. In 2011, he relocated to India where he established the foundation's tuberculosis program in India.In 2015 he joined Stony Brook University as the Founding Director of the University-wide Global Health Institute focused on the use of technology to delivery health care in remote Madagascar and Nepal. He continues to oversee grants and mentor students on tuberculosis research, especially in innovative ways of delivering care such as drone observed therapy.More recently he was a Rockefeller Foundation Fellow exploring a number of efforts culminating in ways to improve medication adherence and Director of Global Health Technologies at Global Health Labs (formerly Global Good) in Bellevue.More About Hyfe AI and Dr. Small- https://www.hyfe.ai/- https://www.hyfe.ai/news/hyfe-appoints-dr-peter-small-as-chief-medical-officer

Every time we turn around, someone in our circle tests positive.UW Health's Dr James Conway-Is Omicron more contagious than the other variants? -Is 'FluRona'  a thing?-When does this variant peak? Dr James Conway knows his stuff.  This is why he's on our show! About Dr. James ConwayJames H. Conway, MD, FAAP, is a professor in the Department of Pediatrics, Division of Pediatric Infectious Diseases at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin, where he is also very active in Global Health, serving as the Associate Director for Health Sciences in the Global Health Institute.Dr. Conway's primary area of interest is with immunization program improvement and he currently has projects investigating influenza transmission and prevention, the effectiveness of pertussis vaccines and understanding issues of vaccine hesitancy

In the month of December we will be spotlighting some of the most popular episodes of our first year. Missed a show? Don't worry here's your chance to catch up on these powerful interviews!Todays Spotlight Episode: Dr JP Farrell!!Dr. JP Farrell is an internationally recognized and board certified pioneer in healthcare, distinguished professor, and best-selling author. As a clinician, Dr. Farrell directs the Farrell Clinic for Immediate Healing & Rehabilitative Care in Princeton, a 501c3 program and the Farrell Center for Aesthetic Improvement & Anti-Aging in NYC.  He directs the Advanced Training Fellowship In Rapid Healing for physicians, healthcare professionals, and chaplains enrolled at College of Sacred Surgeons. Dr. Farrell is the recipient of multiple grants from major medical and pharmaceutical corporations in recognition of his frontier research. In 2007 Dr. Farrell received the CIIMA Award for Courage in Integrative Medicine at the Global Health Institute, New York City, and the Pioneers in Integrative Medicine Award in 2011. Dr. Farrell is also the author of best-selling “Manifesting Michelangelo,” published internationally by Simon & Schuster, which chronicles his spiritual journey of discovery, breakthrough, and subsequent decade of research and development of advanced Spiritually-Based Interventions.We are so happy to present this video podcast,   Welcome to The Circle

Dr. JP Farrell is an internationally recognized and board certified pioneer in healthcare, distinguished professor, and best-selling author. As a clinician, Dr. Farrell directs the Farrell Clinic for Immediate Healing & Rehabilitative Care in Princeton, a 501c3 program and the Farrell Center for Aesthetic Improvement & Anti-Aging in NYC.  He directs the Advanced Training Fellowship In Rapid Healing for physicians, healthcare professionals, and chaplains enrolled at College of Sacred Surgeons. Dr. Farrell is the recipient of multiple grants from major medical and pharmaceutical corporations in recognition of his frontier research. In 2007 Dr. Farrell received the CIIMA Award for Courage in Integrative Medicine at the Global Health Institute, New York City, and the Pioneers in Integrative Medicine Award in 2011. Dr. Farrell is also the author of best-selling “Manifesting Michelangelo,” published internationally by Simon & Schuster, which chronicles his spiritual journey of discovery, breakthrough, and subsequent decade of research and development of advanced Spiritually-Based Interventions.We are so happy to present this video podcast,   Welcome to The Circle

We discussed a number of things including: 1. Richard's background and his impact on population health worldwide 2. Progress on the COVID-19 response - vaccines and treatments 3. Concerns about inequity in relation to the pandemic 4. Programs that are addressing these challenges Since the beginning of the AIDS epidemic, Richard Marlink, MD, has worked to establish HIV/AIDS research, training, and clinical care programs in the United States and abroad. He was instrumental in setting up the first HIV/AIDS clinic in Boston, and in the mid-1980s in Senegal, he was part of the team of Senegalese, French, and American researchers who discovered evidence for and then studied the disease outcomes of the second type of human AIDS virus, HIV-2. Previously at Harvard, Marlink helped create two partnerships with the government of Botswana: the 1996 Botswana-Harvard Partnership with the Harvard AIDS Initiative, where he was executive director, and the African Comprehensive HIV/AIDS Partnerships, a public-private partnership with the government of Botswana that was launched in 2000 with funding from the Bill and Melinda Gates and Merck foundations. Also in 2000, Marlink founded the Kitso AIDS Training Program, which would become Botswana's national AIDS training program. Kitso means “knowledge” in the local Setswana language. Marlink was the principal investigator for “The Tshepo Study,” the first large-scale antiretroviral treatment study in southern Africa, funded by the Bristol-Myers Squibb Foundation's Secure the Future initiative. His research in the region also includes clinical and epidemiological evaluations to help determine how antiretroviral treatment and national treatment programs can best be accomplished in Africa. Since 2000, programs he has created and/or led have trained tens of thousands of health care workers and helped establish national programs on the care, treatment, and prevention of HIV/AIDS in several African countries. Following the 2003 launch of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) to combat global HIV/AIDS, the largest commitment by any nation to combat a single disease in history, Marlink was Botswana's country director for the Botswana-Harvard PEPFAR effort. In addition, while serving as scientific director and vice president for implementation at the Elizabeth Glaser Pediatric AIDS Foundation, he was principal investigator of Project HEART, another PEPFAR Track 1.0 effort in five African countries. Project HEART began in 2004 and by 2011 had placed more than one million people living with HIV into clinical care sites in Cote d'Ivoire, Mozambique, South Africa, Tanzania, and Zambia. More than 565,000 were placed on life-saving antiretroviral treatment.

As the Covid19 pandemic rages on, billions of people around the world await a safe and effective vaccine, which will be key to ending the crisis. In the Gulf region, vaccination has been going at a very impressive and fast pace. Several vaccine options have now been approved and made available, and are being rolled out on a voluntary basis.  MetLife Gulf's Head of Disease Prevention & Wellbeing Nancy Mourad (MSc. MPH) sat with Dr. Shadi Saleh (PhD, MPH) Founding Director of the Global Health Institute and Professor of Health System and Financing at the American University of Beirut, and Dr Zartash Khan (MD), Infectious Disease Consultant Travel Medicine at Clemenceau Medical Center to shed more light on this topic, and leverage their views & expertise. Listen to what they had to say. 

"This is the worse superbug you can get," said her husband's doctors when diagnosing him with a life-threatening multidrug resistant bacterial infection.  But Steffanie Strathdee put her research skills to work and eventually was able to convince doctors to treat him with an experimental phage therapy that ended up saving his life. Listen and learn Why no other solution was working to cure her husband of this superbug, How the history of phage therapy versus antibiotics has played out, and Why the problem of antibiotic resistance may be addressed by utilizing bacteriophages. Steffanie A. Strathdee is the Associate Dean of Global Health Sciences and the Harold Simon Professor in the Department of Medicine at the University of California San Diego School of Medicine. She helped found and co-directs UCSD's new center for Innovative Phage Applications and Therapeutics (IPATH) and also works with the Global Health Institute and the International Core of UCSD's Center for AIDS Research.  An infectious disease epidemiologist, she's also the author of The Perfect Predator, which tells the story of her husband's struggle with a superbug and the successful effort to help him recover with phage viruses. Phages are viruses that infect bacteria, and are emerging as a potential winner as scientists struggle with how to prevent superbugs from causing deadly infections.  She gives listeners a fascinating history of how politics and war kept phage therapy out of American medicine for decades. First discovered by a French Canadian microbiologist, their adoption by Russians pre-World War II marked them as off-the-table for the American medical field. But they are emerging again as having great potential, and Steffanie Strathdee helps enlighten listeners by describing the process and why they can be effective. First, scientists are able to pick and choose their phages, testing to make sure what bacteria the phages will infect. They can get specific, killing only the bacteria they want to target. Ideally, they'll collect a couple of different phages for the best chances of success, then make isolates of them.  The most difficult stage is the purification, she says. Scientists are moving ahead, designing clinical studies. Listen in for more exciting news about this life-saving treatment. For more, see the Innovative Phage Applications and Therapeutics (IPATH) website. Available on Apple Podcasts: apple.co/2Os0myK

The United States is confronting its worst surge in coronavirus cases since the start of the pandemic. Governors are rushing new lockdowns into place as hospitals nationwide burst at the seams. The death toll is, yet again, setting daily records. Maybe by the time you listen to this episode of the Mother Jones Podcast, the US will have passed another dire milestone (of so many): a quarter of a million coronavirus deaths. Inside our newsroom, reporters and editors are determined to put science—and the voices of scientists—at the heart of our ongoing coronavirus coverage. That's why, earlier in the outbreak, we launched a series called "Pandemic Proofing America", an evolving oral history collection featuring incisive interviews with the nation's top scientists and public health experts. The central question we posed was this: With a scandalously enfeebled government hampering the country's response, what are the most important steps we can take to make sure we're better prepared next time around? Their responses were wide-ranging, often damning in their criticism of the current administration's failures, and sometimes hopeful that we might find common purpose in listening to science. For this episode of the podcast, the brains behind this series, Mother Jones's Atlanta-based Senior Editor Kiera Butler, has assembled a selection of these big thinkers to weigh in on how to survive America's coming dark winter, and how the country can begin to imagine a pandemic-free future by combating disinformation and collaborating across disciplines, and beyond our borders. You'll hear from top experts like Timothy Caulfield, from the University of Alberta's School of Public Health; Laurel Bristow, from Emory University's Vaccine Center; Ashish Jha, at Harvard's Global Health Institute; and Andy Slavitt, President Obama's top healthcare advisor. For the entire showcase of nearly 20 interviews to date, click here.

Dr. Ashish Jha, the new dean of Brown University’s School of Public Health, arrived this month from Harvard with an international reputation – and plans already to help move Brown and the state of Rhode Island into the forefront of domestic and global efforts to improve the health of all people. In this interview with The Journal, Jha said he also hopes he and Brown can contribute to moving the state toward a better healthcare system. As step in that direction came in June, when the leaders of Lifespan and Care New England, Rhode Island’s largest and second-largest systems, agreed to new talks that could lead to a merger that would include Brown. Jha also spoke at length about the #coronavirus #pandemic – what the state might expect this fall and winter, the status of vaccines and more. As faculty director of Harvard’s Global Health Institute, Jha long before COVID-19 led ground-breaking research about preparations for pandemics, which have plagued humanity throughout recorded history. @gwaynemiller #podcast for @projo - #video and story at providencejournal.com See omnystudio.com/policies/listener for privacy information.

Testing is down 40% in two of the hardest-hit states — Texas and Florida. Ashish Jha of Harvard's Global Health Institute explains what might be going on. NPR's Alison Aubrey describes a new COVID-19 test developed by Yale University that works with saliva. And NPR's Kirk Sielger reports on a school district in Idaho that's preparing to reopen — and possibly close right back down again. Find and support your local public radio station.Email us at considerthis@npr.org.

Testing is down 40% in two of the hardest-hit states — Texas and Florida. Ashish Jha of Harvard's Global Health Institute explains what might be going on. NPR's Alison Aubrey describes a new COVID-19 test developed by Yale University that works with saliva. And NPR's Kirk Sielger reports on a school district in Idaho that's preparing to reopen — and possibly close right back down again. Find and support your local public radio station.Email us at considerthis@npr.org.

Mark Herz fills in for host Arun Rath and speaks with Dr. Ashish Jha from Harvard's Global Health Institute about the recent uptick in coronavirus numbers in Massachusetts and what it means for reopening schools. We'll also hear Arun's conversation with Lou Woolf, head of Boston-based Hebrew SeniorLife, on how the pandemic has hit nursing homes and long-term living facilities.

Mark Herz fills in for host Arun Rath and speaks with Dr. Ashish Jha from Harvard's Global Health Institute about the recent uptick in coronavirus numbers in Massachusetts and what it means for reopening schools. We'll also hear Arun's conversation with Lou Woolf, head of Boston-based Hebrew SeniorLife, on how the pandemic has hit nursing homes and long-term living facilities.

Lois Reitzes interviews director Wayne Patterson and actors Bethany Anne Lind as well as E. Roger Mitchell about the film "Second Samuel"; Chris Escobar about the Plaza Theatre's drive-in screenings; and Pam Redmon of Emory's Global Health Institute as well as authors Beth Bacon and Kary Lee, winners of the COVID-19 children's book competitionheld by Emory University

The map, created by the university's Global Health Institute, colors also displays contact tracing, rigorous testing and stay at home orders. Learn more about your ad choices. Visit megaphone.fm/adchoices

Whether or not you've been exposed to the virus, the COVID-19 pandemic impacts everyone's sense of well-being. Three scholars in the field of global mental health look at the various ways loss, fear, anxiety—and on top of it, a massive global recession—weigh on the mental well-being of different groups. And they anticipate a surge in demand for mental health services as a result of the pandemic.Although the contemporary world has never seen the likes of such economic contraction as we have now, the recession of 2008 might be an instructive case. Vikram Patel, professor of global health and population, explains what is known about the mental health impacts stemming from that recent recession. Mary-Jo DelVecchio Good, a sociologist and medical anthropologist, gets inside the mind and experiences of the doctors and healthcare workers who are taking care of us (and it's not necessarily what you would expect). And psychiatrist Dr. Giuseppe Raviola gives an unflinching look at what American families and kids are struggling with during lockdown.The scholars also discuss the fraught state of mental health service delivery in the US, and advocate for adopting an approach to mental health services very different from the US's hierarchical system of licensed specialists.Finally, our guests confront the great disparities in the hardships this pandemic creates: in short, wealthy people are doing just fine and have all the advantages, while for others, the pandemic has taken away so many of the resources they once had, causing enduring stress.Disclaimer: This podcast was recorded on May 22, 2020 when the US had approximately 1.5 million positive COVID-19 cases.Host:Kathleen Molony, Director, Weatherhead Scholars Program.Guests:Vikram Patel, Faculty Associate. The Pershing Square Professor of Global Health and Wellcome Trust Principal Research Fellow, Department of Global Health and Social Medicine, Harvard Medical School. Professor, Department of Global Health and Population, Harvard T.H. Chan School of Public Health.Mary-Jo DelVecchio Good, Faculty Associate. Professor of Global Health and Social Medicine, Department of Global Health and Social Medicine, Harvard Medical School, and Department of Sociology, Harvard University. For the past thirty years, she has cohosted the Friday Morning Seminar in Culture, Psychiatry, and Global Mental Health at the Weatherhead Center.  Giuseppe (“Bepi”) Raviola, is a board-certified child, adolescent, and adult psychiatrist, and the Director of Mental Health for Partners in Health, a Boston-based humanitarian healthcare organization that serves ten countries. Bepi is actively involved in training contact tracers in Massachusetts through Partners in Health.Producer/Director:Michelle Nicholasen, Editor and Content Producer, Weatherhead Center for International Affairs.Related Links:Deaths of Despair and the Future of Capitalism by Anne Case and Angus DeatonUN leads call to protect most vulnerable from mental health crisis during and after COVID-19 (UN News, May 14, 2020)“Physician Burnout, Interrupted” by Pamela Hartzband, M.D., and Jerome Groopman, M.D. (The New England Journal of Medicine, June 25, 2020)EMPOWER: Building the Mental Health Workforce, Global Health Institute, HarvardFollow the Weatherhead Center for International Affairs:WCFIA WebsiteEpicenter WebsiteTwitterFacebookSimplecastSoundcloudVimeo

Lois Reitzes talks with Pam Redmon of Emory's Global Health Institute as well as authors Beth Bacon and Kary Lee, winners of the COVID-19 children's book competitionheld by Emory University; Shankar Vedantam, host of NPR's "Hidden Brain"; Charles Stephens and Thandiwe Thomas De Shazor about Out of Hand Theatre's virtual reading of the play "One In Two"; and Director Barry Jenkins and actor Trevante Rhodes about the film "Moonlight."

As the United States nears 100,000 coronavirus deaths and states begin to re-open, what's next for the country? Dr. Ashish Jha of Harvard's Global Health Institute cautions it's still early in the crisis. Researchers have found the coronavirus was introduced to the U.S. in part by affluent travelers — but those weren't the people hit the hardest. Cathy Cody owns a janitorial company in a Georgia community with a high rate of COVID-19. Her company offers a new service boxing up the belongings of residents who have died. Read or listen to the full story from NPR's Morning Edition.Plus, rollerblading is having a moment.Find and support your local public radio stationSign up for 'The New Normal' newsletterThis episode was recorded and published as part of this podcast's former 'Coronavirus Daily' format.

As the United States nears 100,000 coronavirus deaths and states begin to re-open, what's next for the country? Dr. Ashish Jha of Harvard's Global Health Institute cautions it's still early in the crisis. Researchers have found the coronavirus was introduced to the U.S. in part by affluent travelers — but those weren't the people hit the hardest. Cathy Cody owns a janitorial company in a Georgia community with a high rate of COVID-19. Her company offers a new service boxing up the belongings of residents who have died. Read or listen to the full story from NPR's Morning Edition.Plus, rollerblading is having a moment.Find and support your local public radio stationSign up for 'The New Normal' newsletterThis episode was recorded and published as part of this podcast's former 'Coronavirus Daily' format.

Lois Reitzes interviews Pam Redmon of Emory's Global Health Institute as well as authors Beth Bacon and Kary Lee, winners of the COVID-19 children's book competition held by Emory University; Carol Hunter of Truly Living Well Center for Natural Urban Agriculture and J. Olu Baiyewu of Food Well Alliance about the importance of knowing how food is grown; and filmmaker Joe Talbot along with actor Jimmie Fails about the film "The Last Black Man in San Francisco."

Infectious disease expert Greg Gray, MD, PhD, FIDSA, discusses why COVID-19 spread so quickly, why it’s so deadly compared to other viruses, and what we should be doing to prevent another pandemic. Dr. Gray Is an infectious disease epidemiologist, professor of medicine in the Division of Infectious Diseases, and member of the Duke Global Health Institute. Transcript: Lindsay Key: Welcome to HeadScratchers, a minicast from the Duke University School of Medicine. We ask Duke experts to help us understand the questions in science that have us scratching our heads. Today we're speaking with Dr. Greg Gray, an expert in infectious disease. Dr. Gray, the coronavirus has spread quickly around the globe. What makes this virus so special? Why did it catch us so off guard? Dr. Gray: Well, this virus is unique in that 100% of people, essentially, are susceptible to infection. And it is highly infectious. And it has a long incubation period. It's a real super challenge, if you will. It's difficult to control. LK: As an infectious disease researcher, is this epidemic that we're experiencing? Is it something that you thought might happen one day or were you really surprised by it? GG: Yeah, I think those of us in infectious disease epidemiology recognize that in the last 25 years, we've had seven or so of these events. This is not the first one. And it's a repetitive issue: we see the emergence of a virus that causes an epidemic in man, we try to understand it, we mitigate it. And we do the best that we can to put out the fire. So what can we do when the next virus surfaces? We need to do a better job. What we need to really be doing is looking at the human-animal interface and monitoring for novel viruses that might emerge from that interface. Looking at people who have close contact with animals and seeing when they have evidence in their respiratory tract of a new virus that's emerged from the animals, and then making preparations way before the virus cycles over and over and becomes highly infectious to man. And we can do that -- and the way to do it is through something called One Health. Working together with human health, veterinary health, environmental health on specific problem areas like these, to get ahead of this, so we're not always responding to the latest threat. Often we've been to that in partnership with the animal industries, animal production industries. You might not know it, but there have been three emerging coronaviruses that really had a big negative impact on the swine industry, they've not affected humans. But we could help, and at the same time we're looking for novel viruses that would have an impact on humans, we could help them get a handle on the viruses that are going to only cause deaths in their animals. We talk about zoonosis as a pathogen that causes disease. And usually we talk about a pathogen that moves from animals to man. But we can also see zoonosis, sometimes called reverse zoonosis, where a pathogen that is normally affecting man moves to the animals. And that's another reason to do One Health -- because understanding zoonosis, we can help not only human health, but animal health and the animal industries. So, Duke has been a great place to do the research we do, because Duke is very forward thinking and we're very connected to the Global Health Institute. And we have studies right now in about 14 countries and many of these studies are looking for zoonosis. Right now we're doing big studies and northern Vietnam. We just wrapped up a study in Yangon, Myanmar. We're wrapping up a study that was conducted in South Africa. And over the last several years, we've done studies in many different places. Yeah, we’ve found some pretty unusual things right now that we're still working them up -- some viruses that shouldn't be in humans, and unless you look for them, you can't easily find them. But we're able with some of the technologies that we've adapted or developed here

Superior, Wisconsin, was once home to booming industries, which have all but disappeared. But recently, a new opportunity for economic development came knocking: a 625 megawatt gas-fired power plant on the banks of the Nemadji River, which feeds into Lake Superior. While for some this sounds promising, for others in Superior and nearby communities, there are serious concerns: not only would the plant contribute billions of tons of carbon emissions over its lifetime, contributing to climate change, but it would also require destroying wetlands along the river, the very wetlands that help to reduce the flooding that have ravaged this community in recent years from heavy rain events. Plus, the plant would require more water each day than the entire City of Superior uses per day, threatening to put a strain on the groundwater many people rely on. In this episode, we go to the banks of the Nemadji River in Superior to talk with local residents and learn about what this gas plant could mean for the area if it is built. Learn more about this proposed project and sign up for updates about ways you can help block this plant at www.cleanwisconsin.org/stop-nemadji Background reading: We bust the myth that gas plants help support renewable energy, as the utilities behind this proposed plant have argued. We don’t get into it in the episode, but a big reason why we don’t need gas plants is because of the rise of energy storage solutions. We unpack how batteries will play a role in Wisconsin’s energy future. Katie Nekola mentions that the lifespan of this plant conflicts with Gov. Evers’ goal to have Wisconsin carbon-free by 2050, which he announced in August 2019. We delve into the governor’s goal and why it matters. You can watch our video on this issue, which features many of the people you heard in the episode. Special thanks to Dr. Jonathan Patz of the Global Health Institute at the University of Wisconsin-Madison; Pastor Bridget Jones of Bethel Lutheran Church in Superior; Sandy Gokee of the Red Cliff Band of the Lake Superior Chippewa; and Katie Nekola of Clean Wisconsin. … Subscribe to State of Change on Apple Podcasts, Google Play Music, Spotify, or wherever you get your podcasts. Be sure to rate our show and give us a review. It helps other people find us. You can learn more about Clean Wisconsin and our work at www.cleanwisconsin.org Sign up to get the latest news from Clean Wisconsin in your inbox at www.cleanwisconsin.org/email Like State of Change? Help support our podcast and our work to protect Wisconsin’s environment at www.cleanwisconsin.org/donate

Greg is a pioneer in the research of individual and group well-being and leadership, national best-selling author, and co-founder of FosterHicks, a company that helps people and organizations achieve success. Since 1995, Greg and partner, Rick Foster, have traveled to all 50 states, 7 continents, and over 60 countries finding and interviewing people and communities that thrive. From their acclaimed research, they developed the FosterHicks system of nine behaviors. Greg and Rick’s first book, How We Choose to Be Happy – The 9 Choices of Extremely Happy People (Penguin Group), became an immediate national bestseller and has been on bestseller lists ever since. Available in 22 languages, it was selected by the Book of the Month Club as one the Best Books of the Year, and was nominated as Best Motivational Book by the prestigious Books for a Better Life.In 2003 Hicks wrote LeaderShock –And How to Triumph over It (McGraw-Hill). Based on the FosterHicks system, it was selected as the #2 best business book by Amazon that year.Through their energetic and transformational presentations, Greg has inspired people all over the world at large global conferences and has been on the faculties of the American Hospital Association’s Fellowship Programs, the UC Berkeley School of Public Health (where they recently taught Leadership, Sustainability, Happiness and Health for graduate students), San Jose State University, and they continue to be a frequent lecturer at Stanford University and the Global Health Institute at the University of Wisconsin in Madison.Hicks has appeared on numerous national T.V. and radio shows and have been featured in the New York Times, Wall Street Journal, and magazines such as Health, Fitness, Self, Good Housekeeping, Fit, Working Mother, Redbook, Prevention, and Readers’ Digest.On this episode:Learn how Greg started his career on a completely different path. He didn't find his true calling until 30.Greg unpacks his passion for travel.Discover why you should live your life with intentions, not goals.Greg Hicks;http://greghicks.comhttp://fosterhicks.comHow We Chose to Be Happy: https://amzn.to/301GnfILeader Shock: https://amzn.to/2QD0BJKHappiness and Health: https://amzn.to/2QChdkDSchedule a free 15 minute call with Hans here:https://calendly.com/h-struzyna/15minFor more information about Hans Struzyna and Another Way to Play, visit:anotherwaytoplaypodcast.com See acast.com/privacy for privacy and opt-out information.

Ep. 65:  Dr. Molly Jahn - Prof. Univ. of Wisconsin-Madison - Dept. of Agronomy; the Nelson Institute; the Global Health Institute; and chairs the Scientific Advisory Council of Energy & Environment @ DOE Oak Ridge Labs || Dr. Molly Jahn is a professor at the University of Wisconsin-Madison in the Department of Agronomy, the Nelson Institute, and the Global Health Institute, and chairs the Scientific Advisory Council of the Energy and Environmental Sciences Directorate at the US Department of Energy Oak Ridge National Laboratory.   Professor Jahn leads a global alliance of research organizations focused on building and testing modern knowledge systems for sustainability. An award-winning teacher and researcher, Jahn also consults globally for business, governments, philanthropic organizations and others. During our 45 minute conversation we gain Dr. Jahn's perspective on what it'll take to address climate change on a planet of 7.6 billion people. We also discuss how our current approach in producing food and using water are in fact one of the most pressing National security concerns. Dr. Jahn shares how the Government shutdown at the end of '18 / early '19 is impacting real science which so vital in dealing with climate issues in a timely fashion. And, how that science is now losing traction under current governance. Dr. Molly Jahn has previously served as dean of the University of Wisconsin’s College of Agricultural and Life Sciences, and Director of the Wisconsin Agricultural Experiment Station.  From 2009-10, she served as Deputy and Acting Under Secretary of Research, Education, and Economics at the U.S. Department of Agriculture. Jahn has >100 peer-reviewed publications and >60 active commercial licenses.   She has numerous awards, fellowships and lectureships for her research, teaching and outreach.  In 2014, she was named the first Lilian Martin Fellow at the University of Oxford’s Martin School.  Her innovative approaches to inter-sector partnership, engagement with emerging institutions and integrated large projects focused on impact and technology transfer have been highlighted in a number of studies and books.  She has served on numerous boards and scientific advisory panels around the world including the US National Academies of Science Board on Agriculture and Natural Resources, NASA’s Applied Sciences Advisory Council. It was an honor getting to speak with Dr. Molly Jahn about food, science, the climate and about the power of hope and potential.  TuneIn to hear more. www.SourcingMatters.show

Climate change isn’t just an environmental problem – it’s also a health hazard. Air pollution and changing weather patterns give rise to heat-related illnesses, asthma and allergic disorders. Hurricanes and other disasters leave hospitals scrambling to save patients without power and resources. According to the Centers for Disease Control, insect-borne diseases have tripled in the United States in recent years – and warmer weather is largely to blame. Jonathan Patz, of the Global Health Institute calls climate change “one of the most important public health challenges of our times. Guests: Jonathan Patz, Director, Global Health Institute, University of Wisconsin-Madison Su Rynard, Director, “Mosquito” (Discovery Channel, 2017) Chuck Yarling, Triathlete Jessica Wolff, Director, Climate and Health Program, Healthcare without Harm

Dr. Jim Cleary talks with Dr. Pennell about this new resource-stratified guideline, which provides guidance to clinicians and policymakers on implementing palliative care in resource-constrained settings.   Welcome back, everyone, to the ASCO Journal of Oncology Practice podcast. This is Dr. Nate Pennell, medical oncologist at the Cleveland Clinic and consultant editor for the JOP. Now over the last decade or so, there has been a major change in our approach to the care of advanced cancer patients with the recognition of the importance of palliative care. There have been a number of trials now showing that integrating palliative care into cancer patients' care can make a major impact on their quality of life and possibly even their survival. And as a result, the involvement of palliative medicine has become part of treatment guidelines. However, much like cutting edge biomarker testing or expensive drugs, specialist-driven palliative care also takes a fair amount of resources that are not available everywhere. So joining me today to talk about this is Dr. Jim Cleary, who just moved from the University of Wisconsin Carbone Cancer Center, where he started the palliative care program in 1996 and for the last seven years, has led the Pain and Policy Studies Group, a WHO collaborating center for pain policy and palliative care. He's now been recruited to the Indiana University School of Medicine in Indianapolis, where he'll be the professor of medicine and Walther's senior chair in support of oncology and director of the supportive oncology program at the IU Simon Cancer Center. He's going to focus on building a program focusing on global supportive care and palliative care, which makes him the perfect person today for us to talk to about the recommendations of an expert panel that's going to be published this month in the JOP titled, Palliative Care in the Global Setting ASCO Resource-Stratified Practice Guideline Summary. Jim, thanks so much for joining us. Why, thank you very much for having me-- a real honor. So can you start out a little bit by telling us about the progression of the role of palliative care in oncology, and what has led to the impetus for forming the panel that you were a part of? So if we look back historically to the introduction of palliative care throughout medicine, it's actually been primarily in cancer care. If we go back to the original WHO guidelines in the 80s, it was all focused on cancer patients. And it's interesting if one looks at the very definition of palliative care from the word go, they said all the principles of palliative care can be applied upstream, earlier in the course of patients' illnesses from the-- even from the 80s. But as we look at it historically, and particularly in the US, with the introduction of the Hospice Benefit, palliative care really became brink of death care. So that you didn't get hospice or pallative care involved until someone was actively dying. So we were missing out on that very principle of-- let's address all the issues, the skills that palliative care provides early on. Let's address these earlier on in the course of people's illness, particularly when it comes to people with advanced disease. And it doesn't just have to be advanced disease to be including the skill set. So people who are getting chemotherapy, some may support it or call it supportive oncology, but really, it's the same principle-- supportive oncology, palliative care. It's total person care of patients with cancer and dealing with cancer. So as we look at those, the studies have been coming out saying it improves quality of life. You mentioned the survival benefit that's been suggested or hypothesized. And while that may be there, for me, that's not the primary reason for doing this. It's the right thing to be doing-- to be addressing quality of life. And even trying to get us to move beyond what seems to be that magic mark of survival-- length of survival or time of survival may not be the only important thing. Quality of life is becoming increasingly important as we address many of these issues. ASCO has recognized this, and in 2016, they actually published a paper-- again, a guideline-- the integration of palliative care into standard oncology care. And that was released in 2016, and it was based on what we would call research that was done in maximal resource institutions, largely in the high income countries. The United States, Canada, Western Europe, Australia-- those sorts of countries. What the situation is in the world is that probably 80% of the cancers are now being diagnosed in low and middle income countries. And in those countries, most people are actually being diagnosed with advanced disease. And this comes from the paucity of person power in terms of diagnosis, the lack of surgeons, the remoteness that these people-- where they live. They're really presenting in different ways. So as ASCO looked at this, and they've done this as well with cervical cancer, they said, let's get a guideline that is resource-stratified. So let's look at the issues that low and middle income countries face in getting this integration of palliative care and supportive oncology across the board. And that's what we aim to do in this setting. No, that sounds like a very important intervention. I have a soft spot in my heart for this topic. Because when I was a fellow at Mass General Hospital, that was when Jennifer Temel was running her initial trial of head of care that led to this possible survival benefit, which was just suggested retrospectively, or at least post hoc, in that analysis, but I remember when this was greeted with a lot of skepticism-- that palliative care was that important in cancer care. And of course, now people broadly accept how important it is. So I'm great to see that this is going to be extended outside of just academic centers in the United States. So one of the questions I have for you before we kind of delve into your paper, and this is a conversation I've had with Dr. Temel, as well. Most of the data is not just in maximized resource centers and countries, but also seems to focus on specialists trained in palliative medicine. Do we understand the aspects of palliative medicine, and what leads to quality of life benefits, enough to be able to extract those different pieces out and then extend them out beyond palliative care trained physicians? I don't think we do yet. And we need to do more research on this. And I know that Jennifer currently has a query study that is looking at the role of telemedicine. At about the same time that Jennifer was doing the study in Boston, we actually did a similar study out of the University of Wisconsin, which looked at an internet intervention through CHESS-- Comprehensive Health Enhancement Support System-- and the service was integrating palliative care information, internet support for both patient and caregiver. And we actually found a survival benefit that mirrored this-- the Temel effect-- for people who use the internet system. So I don't think we have a very good start understanding at all. I think Charles von Gunten has equally identified that there is this difference between primary, secondary, and tertiary palliative care. And primary palliative care is what all clinicians should be able to do. In Charles' papers that he's written on this, he's talked about oncologists should have a secondary level of palliative care knowledge and experience and be able to do this. And then really you need the tertiary level, or the specialty team, involved in palliative care for the difficult cases. I'm not convinced, still to this day, that I need to see every cancer patient with advanced disease. What we need to do in palliative care teams is actually fill in the holes when the current treating oncology team is not able to provide them. And if you have an oncologist who is excellently trained in symptom management, communication-- together with good nurses and social workers, pastoral care, spiritual care, who can come in and help with this-- the role of the palliative care physician may actually go on the palliative care team. Maybe a little moot in most settings, but really, it's filling in the holes and coming in and making sure that patients are getting the appropriate level of care. That appropriate level of care really does become tough in resource poor-- resource challenged settings. And that's probably true even in the United States, as well as in low and middle income countries. If the only health care center within 100 miles is actually with a primary health worker with minimal training, how do you get appropriate oncology care, let alone an appropriate palliative care integrated into that? And I think one of the challenges that some of our panelists from low and middle income countries had was, well, how do you actually define good cancer care in our country? And that continues to be a country many people-- and I'll come back to remind listeners that hepatocellular cancer is actually one of the most common cancers in the world. And many of these people who have, and end up dying of, hepatocellular cancer never actually see an oncologist. Now I agree that that makes sense in so many places-- just even in our own country here, patients struggle to reach specialist oncology care. And so I think the idea of Jennifer's, of trying to be able to do palliative medicine consults with telemedicine, is certainly an interesting potential solution for that. So let's just dig into the panel's recommendations here, shall we? The guidelines are divided into different sections. And each section is very nicely broken down into what you term as basic, limited, enhanced, and maximal sections, depending on the available resources. So maybe we could go through them one at a time, and you can talk a little bit about them. So I think the first section is called, "Palliative Care Models." Can you talk a little bit about that? So what we were doing with the palliative care model with the [? gain, ?] if you think about some of these basic, limited, enhanced, and maximal, we were saying, hey, basic is the primary health care center which I mentioned. It may be a community health worker, or a clinical officer as they are commonly called. It may not be a physician. There may be a nurse, but they may not even be a nurse in some of those settings. So the recommendation is that we should be training and addressing these people to actually even start thinking about palliative care needs in this setting. So it's saying throughout the whole system, we need to be building in palliative care needs. Particularly in advanced cancer, one of the issues that comes up significantly, and is under Item 7, is ensuring that we have access to opioids for pain relief. And this becomes very difficult if you're talking about a rural community-- no one with a physician license or a nurse license. How do we actually get appropriate pain relief to these people, who may never see an oncologist, as they're dealing with advanced cancer needs? So we've gone through and actually looking at the strength of evidence saying, yes, this has to be integrated throughout the whole health care system. And there are evidence from different models as we look at places like Kenya and Malawi as they've introduced palliative care throughout these settings. It's quite possible. Uganda actually has nurses out in many of the districts in Uganda, who are now licensed because of their special training, to actually dispense morphine. And that's a real change. We go to other countries, which have a shortage of physicians interested in palliative care and doing this, and there are physician groups who actually say, there's no way nurses are ever going to be able to do that. Professional protectivism, if you want to look at it-- boundary protecting. No right answers, but I think these need to be considered. And we need to think outside the box with the models of care that we're providing to ensure the appropriate people are getting them. I visited a hospital in Zambia-- the Children's Hospital in Lusaka-- where each child with leukemia had a small bottle of morphine on the top of their locker, which the parents were administering to the children for appropriate pain relief because of their leukemia. Really quite incredible to watch this going on in a resource poor setting, and this was entrusted to the parents to do with appropriate education. Because they're the ones who are most concerned and available to do this sort of work. I've actually been to hospitals in other parts of Africa where the drug cupboard has actually been empty and the lock broken, and it takes 15 to 20 minutes to go to central pharmacy to actually get some morphine. So when someone is complaining of pain, that's not a good situation. So we need to make sure that all of these things actually fall into place and develop good care models. And that's really what recommendation number one does. Recommendation number two goes to look and talks about timing. And this comes up as a critical-- when should you get palliative care needs addressed? And as I said with the primary, secondary, and tertiary, really, they should be addressed from the point of diagnosis, if not even before diagnosis if you suspect someone has advanced disease. And so you're really saying, hey, let's consider this from the word go with everyone in the course of the illness-- a palliative care team, not just the needs of the patient. But a team, in the basic and limited settings, should probably get involved with overwhelming symptoms, particularly metastatic disease. And if a decision not to go for life prolonging therapy is made, that's when I think we need to be engaging teams at that stage. And really, it's coming in with the maximal. And if you've got the appropriate resources, it's saying everyone. And this comes from the 2016 guidelines as well. We should have this integration early in the diagnosis and ideally within eight weeks of diagnosis. The palliative care team should actually be involved at that stage. Oh, that makes perfect sense. I certainly remember when this idea of early palliative care started coming out. And it's so much easier for the patients when they are plugged in and connected with the palliative medicine team earlier in their disease, rather than trying to call them in late. And it's much more jarring and disturbing to them, and they don't get nearly as much of the benefit of the care, I think, at that point. And often pain control is a way I get involved early on. Other symptom management-- how can we help you through chemotherapy? Some of the issues go on. It does actually open up opportunities. Yes, I can maybe spend some more time there than the oncologist. Many nurse practitioners-- advanced practice nurses-- are actually doing this on their own. But it's coming in and helping the oncologist. It's building up that team. And as the disease transitions, that jarring nature of all this-- this guy who's now coming to meet you because I've run out of options. No, you're part of the team from the word go and will continue to stay involved. Yeah, absolutely. I think that has been my experience, that that makes the best sense. So the third section of the guideline addresses the workforce knowledge and skills. And how does that vary from the various resource levels. So this comes up, the resource levels and if you even go back to the WHO definitions of palliative care, we use the term interdisciplinary. It's very hard to be interdisciplinary when you're a single person. Although I often joke that Dame Cecily Saunders, who started the modern hospice movement, was trained as a nurse, a social worker, and a physician. So she could have a multidisciplinary team all by herself. So it's the basic level. If you're a single clinical officer, that may be very difficult. A single nurse-- that interdisciplinary team is really something that may be hard to come by. But having those basic skills is something that we need to teach. But as we move up into the limited or district level facilities, working on building teams together, and teams in some cultures-- and particularly with the nurse-physician relationship not being as strong as I think we see in most places in the United States, Europe, and Australia and New Zealand-- often these are real issues of hierarchy between the physicians and nurses. But we need to be ensuring that they do function as a team to maintain and provide the best level of care. So that's one of the things that we're looking at, recognizing that we are a team that does this. And that team continues to grow, particularly, we hope, with regional facilities or the enhanced level with the introduction of a counselor into that level. Again, if you look at the resource poor areas when you start talking counselors, one statistic I've heard is that there are three psychiatrists for the Horn of Africa, which is Ethiopia, Somalia, and those areas. And you think of only three. So the ability to train-- or having trained counselors around-- is something that is not common. So it's really integrating across the board, particularly as we move up to higher levels-- regional facilities and then to maximal, national cancer centers-- making sure that we have appropriately trained social workers and counselors available to join this team. So addressing all of the members of the team-- you know, the nursing roles, the spiritual care, the counseling-- and then just the recognition that in some places it may end up being the caregiver, or the physician, or whoever they are dealing with, that has to assume many of these roles, I think, is a nice recognition. Ideally, you'd love to have a large interdisciplinary team. But it's having the available resource, rather than who does it, that is important. Exactly right, and in many cases, it may actually be the nurse who is doing most of this work. And we even find that in our own situations here, it's often the nurses giving chemotherapy who may be doing a lot of the counseling with patients while they're administering the chemotherapy. I even make the comment to our own folks in in-patients, it may actually be the person who's working on housekeeping who is actually doing a lot of interaction and hearing of the needs of the patient, just because they feel comfortable talking to them, whereas they don't share that with others. So we don't exclude any member of this team across the board. That's really interesting. I don't know if you read Bloom County, the comic strip, but there is a storyline over the last couple of years of a sick child in the hospital. And it's the maintenance man who ends up providing most of the support to the child in this family and it's a really touching storyline. It reminds me of that a little bit. So I hope that's not because we weren't providing it, which is often something that can happen. But I think it reflects some of the comfort that people do have in dealing with like people. White coat syndrome, I think, applies as much to adults as it does to children. We need to look at those issues, that talking to that man-- that person in the white coat who stands at the end of the bed with 15 other people. That's not really a situation where you can share your inner thoughts and feelings. No, I think that's true. And then you touched on this a little bit earlier, but the seventh and certainly a very critical component of this, is the availability of opioids to help deal with pain. I guess it hadn't really occurred to me that this was a major problem, because drugs like morphine should be relatively inexpensive. But this is I'm guessing a major issue throughout the world. So 80% of the world's population lack access to appropriate pain control. And it's even made worse by the current dilemmas that we're facing, the unbalanced situation that we have in the United States with the current heroin and fentanyl crises. And I say that, because I think we've moved somewhat beyond most of the deaths being caused by prescription opioids. There's increasing evidence that people in the United States are getting first access through heroin and illicit fentanyl. So that these people are lacking access to the basic essential pain medicines, both postoperatively and as they deal with advanced cancer. And so we're even seeing some of that now reported in the United States, that people are actually being denied access to opioids, because of shortages in this country, as they deal with cancer. So it's a critical issue. We need to make sure these are all available. We saw even back in the 90s-- we saw some pharmaceutical companies in China saying, you guys don't need an immediate release morphine. Just use sustained release morphine. The reality is that immediate release morphine, even a morphine solution, together with injectable morphine, is something that should be available at the most basic settings for pain control of cancer patients. And then we can move up oral morphine together with sustained release, if you need to, in different forms. The costs can change. We see some countries in the world with fentanyl patches as the primary medicine used. But the cost of these is dramatically much greater than, in fact, it is for immediate release morphine. People say that levels are steadier, it's better pain control, and things with fentanyl patches, but the evidence doesn't necessarily support that overall. And so we will come back to the gold standard being very much based on oral morphine and making sure that's available in different formulations. And I will stress while this guideline was for adults, one of the advantages of a morphine solution does allow you to titrate and dilute the morphine appropriately for children across the board. You can't do that necessarily with tablets. So I think there are absolutely access to medicines-- and not just the opioids, but particularly the opioids-- is something that's being addressed with a number of levels and making sure that the current situation in the United States doesn't come back and not only rebound here for cancer patients, but really impact cancer patients around the world. Yeah, that's certainly a major topic in the United States, and I'm sure that's true elsewhere, as well. Well, so that brings me to my next question, which is-- while these recommendations make wonderful sense, and in many ways it's kind of reassuring. Because in some places when I talk about palliative care, and they say, well, you know, we don't really have access to specialist palliative care, a lot of this can be done just about anywhere as long as there are recognized the aspects of palliative medicine that are available and necessary. So what are the next steps to this? So the guideline is going to be published. How is ASCO going to work to try to make some of this more available? So I think it reflects the impact of ASCO around the world. ASCO is-- while it's the American Society of Clinical Oncology, it actually has very, very real impact. We're starting to see research take place. So the African Palliative Care Association is already beginning to use a palliative care outcomes scale, together with King's College in London to bring about this. So it's actually-- we're seeing a push. I think we're going to see some of the QOPI measures come out and be part of this international work. So for instance, as you mentioned, getting chemotherapy in the last two weeks of life is a negative QOPI indices. Getting people into hospice, we're seeing as a positive as we move forward. So I think that we're going to see this overall from ASCO coming out and saying, this is absolutely critical. ASCO is a player on the international scene. Works with a number of international organizations-- the NCI, Global Health Institute, the NCCN, and others are looking at the-- the Breast Health, Global Initiative. So this is all moving forward together with the World Health Organization, the Union for International Cancer Control, UICC. Many people are targeting this, and I think it's actually going to be the overall recognition of the importance of this. Many people have followed for years, saying we will do what ASCO does. ASCO is now saying, this is important. And I think we're going to see this change in low and middle income countries because of ASCO's leadership, and that's going to be critical. Well, I certainly hope that's the case. Because this really does sound like an incredibly important initiative. So Jim, do you have any take home points you'd like to give to our listeners as we wrap up the podcast? So take home points are to realize, within your own practice, that palliative care is important to integrate. But I think at this stage, it's an awareness of the importance of palliative care in cancer care around the world. We don't often think of that outside of our own settings. But it's absolutely important. Become involved in advocacy as you move forward. And promote this, both regionally within the United States, and for those listeners who are listening outside of the United States, work with your oncology organizations to say, what are we doing with palliative care and cancer care across the board? And I think it's those sorts of things where we're actually going to be seeing those changes as we move forward. Well, Jim, thank you so much for joining me today on this podcast. I'm sure our listeners are really going to appreciate this. Thank you very much, Nate. And I also want to thank the listeners who joined us for the podcast. The full text of the paper is available at ASCOpubs.org/journal/JOP published online in July of 2018. This is Dr. Nate Pennell for the Journal of Oncology Practice signing off.

Essa semana continuamos a nossa conversa com o André Nogueira. Ele nos deu exemplos de práticas sustentáveis, que mostram como esses princípios realmente podem guiar a realidade. Conversamos também sobre fronteiras, nacionalidades, etc. - assuntos para instigar futuras conversas! O André Nogueira fez mestrado, pós e graduação em Arquitetura e Urbanismo, no Brasil e hoje é estudante PhD em Design com interesses em espaços complexos de inovação, formulação de políticas públicas, regeneração urbana e soluções sustentáveis. Tem experiência com projeto de design de organizações, desenvolvimento de negócios, desenvolvimento sustentável, planejamento e desenho urbano e arquitetura, tanto no Brasil, como no México e nos Estados Unidos. Ele faz parte do corpo docente como professor adjunto e auxiliar em cursos de mestrado e graduação do instituto de tecnologia de ilinóis (IIT). E trabalha como pesquisador assistente na Harvard University, no Global Health Institute e em uma pesquisa premiada para o Design de Soluções Sistêmicas Sustentáveis no The Plant, em Chicago. Para mais sobre ele: https://soundcloud.com/apenan/apena-010-principios-sustentaveis-andre-nogueira Sobre The Plant: http://plantchicago.org/ Mais sobre The Plant: http://plantchicago.org/2017/09/26/introducing-plant-chicagos-research-steering-committee/ Onde você nos encontra: Medium: medium.com/apen%C3%A3 Facebook: www.facebook.com/ApenanPod Twitter: @ApenanPod iTunes: apple.co/2s8vESn Feed: http://feeds.feedburner.com/Apenanpod

No fim do mês passado eu estive em um evento de Ecologia Industrial na UIC (University of Illinois at Chicago) e tive o prazer imenso de encontrar um brasileiro incrível por lá, o André! Dividimos a conversa em duas partes, nessa falamos sobre vários aspectos da sustentabilidade, desde como termos uma mobilidade urbana mais sustentável (claro, eu não podia deixar de mencionar bikes!), até o empreendedorismo sustentável, o que é ecologia industrial e muito mais! O André Nogueira fez mestrado, pós e graduação em Arquitetura e Urbanismo, no Brasil e hoje é estudante PhD em Design com interesses em espaços complexos de inovação, formulação de políticas públicas, regeneração urbana e soluções sustentáveis. Tem experiência com projeto de design de organizações, desenvolvimento de negócios, desenvolvimento sustentável, planejamento e desenho urbano e arquitetura, tanto no Brasil, como no México e nos Estados Unidos.  Ele faz parte do corpo docente como professor adjunto e auxiliar em cursos de mestrado e graduação do instituto de tecnologia de ilinóis (IIT). E trabalha como pesquisador assistente na Harvard University, no Global Health Institute e em uma pesquisa premiada para o Design de Soluções Sistêmicas Sustentáveis no The Plant, em Chicago. Mais sobre The Plant: http://plantchicago.org/2017/09/26/introducing-plant-chicagos-research-steering-committee/ Onde você nos encontra: Medium: medium.com/apen%C3%A3 Facebook: www.facebook.com/ApenanPod Twitter: @ApenanPod iTunes: apple.co/2s8vESn Feed: http://feeds.feedburner.com/Apenanpod

Listen NowIn mid-January the CDC abruptly canceled a three-day "Climate and Health Summit" the Center had been planning for months.  The meeting was intended to discuss public health risks caused by the climate crisis and steps being taken to reduce the emissions of carbon dioxide and other greenhouse gases or its adverse consequences on human health.   (It was speculated the meeting was canceled because the CDC did not want to run afoul of the incoming president who has repeatedly called climate change a “hoax” perpetrated by the Chinese.)   The American Public Health Association (APHA) and others however went ahead and held a one-day meeting on February 16 titled,"Climate and Health" at the Carter Center in Atlanta.  The meeting was keynoted by former Vice President Al Gore.   Dr. Jonathan Patz, the Director of the Global Health Institute at the University of Wisconsin-Madison, was one of the meeting's organizers and participants.    During this 24 minute conversation Dr. Patz discusses how the meeting came about and what was accomplished, e.g., he summarizes the afternoon's panels that discussed what's being done to reduce green house gas emissions.  He also discussed how to better involve the professional medical community  and how to effectively communicate the reality of the climate crisis. Dr. Jonathan Patz is the Director of the Global Health Institute at the University of Wisconsin-Madison.  He is a professor and the John P. Holton Chair in Health and the Environment with appointments in the Nelson Institute for Environmental Studies and the Department of Population Health Sciences.  For 15 years, Dr. Patz served as a lead author for the United Nations Intergovernmental Panel on Climate Change (or IPCC)—the organization that shared the 2007 Nobel Peace Prize with Al Gore.  He also co-­chaired the health expert panel of the U.S. National Assessment on Climate Change, a report mandated by the Congress.  Dr. Patz has written over 90 peer-reviewed articles, a textbook addressing the health  the health effects of global environmental change and co-edited the five volume Encyclopedia of Environmental Health (2011).  He has been invited to brief both houses of Congress and has served on several scientific committees of the National Academy of Sciences.  Dr. Patz served as Founding President of the International Association for Ecology and Health.  He is double board-­certified, earning medical boards in both Occupational/Environmental Medicine and Family Medicine.  He received his medical degree from Case Western Reserve University (1987) and his Master of Public Health degree (1992) from Johns Hopkins University.A webcast of the February 16 meeting is at: https://www.climaterealityproject.org/health.  Listeners are particularly encouraged to listen to Vice President Gore's 30 minute keynote address.  For more information concerning the Medical Society Consortium on Climate and Health go to: https://medsocietiesforclimatehealth.org/.Since I mention during the discussion the Obama administration's 2016 "The Impacts of Climate Change on Human Health in the US: A Scientific Assessment," a review of the paper is, again, at: http://altarum.org/health-policy-blog/nature-bats-last-a-warming-earth-will-exact-adverse-health-effects-but-our-responsibilities-are.    This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Microbiologist Jenna Capyk joins Joe, Toren, and Kevin to talk about Hansen's disease, also known as leprosy. What the heck is it? Does it cause your body parts to fall off? Are there any other animals that can get leprosy? What have we done in the past to keep lepers separate from society? All these questions and more are answered in this episode of Caustic Soda! News update: Since recording a study strongly suggests that leprosy can transfer from armadillos to humans. "Our research provides clear DNA evidence that the unique strain found in armadillos is the same as the one in certain humans," said Stewart Cole, of the Global Health Institute in Lausanne, Switzerland. Music: "Gimme Some Skin" The Andrews Sisters Movies: Ben Hur Kevin: 10/10 Princess Mononoke Toren: 8/10 Joe: 8/10 The Fog (John Carpenter) Toren: 5/10 Kingdom of Heaven Toren: 4/10 Joe: 4/10 Kevin: 5/10 Braveheart Joe: 9/10 Kevin: 9/10