Podcasts about harvard chan school

As we move towards a more sustainable future, renewable energy is reshaping the way we cook and consume food. So, this week on Room by Room: The Home Organization Science Insights Podcast, host Marie Stella interviews epidemiology researcher Dr. Matthew Shupler on the effect renewable energy has on our cooking habits. Based at Harvard Chan School of Public Health, Dr. Matthew Shupler conducts research on the effects of air pollution exposure on adverse pregnancy and early childhood outcomes. During his previous stints at the University of British Columbia and the University of Liverpool, he looked into the health effects of household air pollution exposure due to cooking with polluting fuels, such as wood and coal, in over a dozen countries. Additionally, Matthew has also worked as a Global Health Fellow at the United Nations Foundation's Clean Cooking Alliance. In this episode, Dr. Matthew Shupler highlights the pressing issue of climate change, and how fighting it from our kitchens, simply by converting to renewable energy, can make all the difference. He goes into detail about how renewable energy cooking can relieve a great deal of stress, for first-world nations and lower- to middle-income countries alike. Together, Marie and Dr. Matthew Shupler discuss affordable workarounds that may prove effective for renters and homeowners on a budget. So, tune in for an episode that delves into the exciting intersection of renewable energy and culinary practices. Follow Dr. Matthew Shupler's work via the following links: Harvard Chan School of Public Health: https://hsph.harvard.edu/profile/matthew-shupler/ University of Liverpool: https://www.liverpool.ac.uk/people/matthew-shupler Google Scholar: https://scholar.google.com/citations?user=z78QWwcAAAAJ&hl=en The Conversation: https://theconversation.com/profiles/matthew-shupler-1192562 Clean Cooking Alliance: https://cleancooking.org Modern Energy Cooking Services: https://mecs.org.uk CLEAN-Air(Africa): https://cleanairafrica.com Connect with Dr. Matthew Shupler via the following links: LinkedIn: https://www.linkedin.com/in/mshupler/ Twitter: https://twitter.com/matt_shup Produced by the Home Organization Science Labs, a division of LMSL, the Life Management Science Labs. Explore LMSL at https://lifemanagementsciencelabs.com/ and visit http://ho.lmsl.net/ for additional information about Home Organization Labs. Follow us on Social Media to stay updated: YouTube: https://www.youtube.com/channel/UCODVhYC-MeTMKQEwwRr8WVQ Facebook: https://www.facebook.com/homeorg.science.labs/ Instagram: https://www.instagram.com/homeorg.science.labs/ Twitter: https://twitter.com/HOScienceLabs LinkedIn: https://www.linkedin.com/showcase/home-organization-science-labs TikTok: https://www.tiktok.com/@home.org.science.labs You can also subscribe and listen to the show on your preferred podcasting platforms: Apple Podcast: https://podcasts.apple.com/us/podcast/room-by-room-the-home-organization-science-insights-podcast/id1648509192 Spotify: https://open.spotify.com/show/7kUgWDXmcGl5XHbYspPtcW Amazon: https://music.amazon.com/podcasts/37779f90-f736-4502-8dc4-3a653b8492bd iHeart Radio: https://iheart.com/podcast/102862783 Podbean: https://homeorganizationinsights.podbean.com/ PlayerFM: https://player.fm/series/3402163 Podchaser: https://www.podchaser.com/podcasts/room-by-room-the-home-organiza-4914172 

It's the start-of-the-new-year episode, where host Stephen Goldsmith and producer Betsy Gardner swap roles to discuss all things data, digital, governance, AI and policy-making from 2024. Listen to Pr. Goldsmith's reflections on the last twelve months and predictions on 2025, with a bonus lightening round of questions!  References include Data-Smart City Pod Episode 67, Episode 65, and Episode 62, and articles about Tacoma, Tucson, and Nashville.  Music credit: Summer-Man by KetsaAbout Data-Smart City SolutionsData-Smart City Solutions, housed at the Bloomberg Center for Cities at Harvard University, is working to catalyze the adoption of data projects on the local government level by serving as a central resource for cities interested in this emerging field. We highlight best practices, top innovators, and promising case studies while also connecting leading industry, academic, and government officials. Our research focus is the intersection of government and data, ranging from open data and predictive analytics to civic engagement technology. We seek to promote the combination of integrated, cross-agency data with community data to better discover and preemptively address civic problems. To learn more visit us online and join us on Twitter, Bluesky, Facebook, or LinkedIn.

The World Health Organization says smoking is the leading cause of global preventable death, killing up to 8 million people prematurely every year—far more than die in wars and conflicts. Yet the emotions evoked by national and international anti-smoking campaigns and the impact of those emotions has never been fully studied until now. HKS Professor Jennifer Lerner, a decision scientist who studies emotion, and Vaughan Rees, the director for the Center for Global Tobacco Control at the Harvard Chan School of Public Health, say their research involving actual smokers in the lab shows that sadness—the emotion most often evoked in anti-smoking ads—can actually induce people to smoke more. Lerner and Rees' research also found that evoking gratitude, an emotion that appears to function in nearly the exact opposite manner to sadness, made people want to smoke less and made them more likely to join a smoking-cessation program. Lerner and Rees join host Ralph Ranalli on the latest episode of the HKS PolicyCast to discuss their research and to offer research-backed policy recommendations—including closer collaboration between researchers who study emotion science, which is also known as affective science, and agencies like the Centers for Disease Control.Policy Recommendations:Jennifer Lerner's Policy Recommendations:Foster active communication and collaboration between researchers and public health agencies (e.g., CDC, FDA) to co-create health communications that integrate the latest insights from affective science.Increase awareness among lawmakers and public health policymakers that affective science has progressed beyond intuition to research-validated models that can be predictive and beneficial for behavior change.Vaughan Rees' Policy Recommendations:Expand research into integrating emotion-based strategies, such as gratitude exercises, into school-based prevention programs for adolescents to reduce the risk of tobacco and other substance use, as well as risky sexual behaviors.Introduce research-backed, emotion-based components in cessation counseling and support systems, helping individuals better manage high-risk situations and maintain abstinence after quitting.Dr. Jennifer Lerner is the Thornton F. Bradshaw Professor of Public Policy, Management and Decision Science at the Harvard Kennedy School.She is the first psychologist in the history of the Harvard Kennedy School to receive tenure.  Lerner, who also holds appointments in Harvard's Department of Psychology and Institute for Quantitative Social Sciences, conducts research that draws insights from psychology, economics, and neuroscience and aims to improve decision making in high-stakes contexts. Together with colleagues, Lerner developed a theoretical framework that successfully predicts the effects of specific emotions on specific judgment and choice outcomes. Among other honors, Lerner received the Presidential Early Career Award for Scientists and Engineers (PECASE), the highest honor bestowed by the U.S. government to scientists and engineers in early stages of their careers. Lerner earned her Ph.D. in psychology from the University of California–Berkeley and was awarded a National Institutes of Health postdoctoral fellowship at UCLA. She joined the Harvard faculty and received tenure in 2007, and from 2018-2019 she took a temporary leave from Harvard to serve as the Chief Decision Scientist for the United States Navy.Vaughan Rees is Director of the Center for Global Tobacco Control at the Harvard T.H. Chan School of Public Health. The center's mission is to reduce the global burden of tobacco-related death and disease through training, research, and the translation of science into public health policies and programs. Rees also directs the Tobacco Research Laboratory at the Harvard Chan School, where the design and potential for dependence of tobacco products are assessed. Studies examine the impact of dependence potential on product use and individual risk, to inform policy and other interventions to control tobacco harms. Rees also leads an NIH funded study which seeks to reduce secondhand smoke exposure among children from low income and racially/ethnically diverse backgrounds. His academic background is in health psychology (substance use and dependence), and he trained at the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney, Australia, and did postdoctoral training through the National Institute on Drug Abuse in the United States.Note: Lerner and Rees collaborated on this research with former HKS doctoral student Charlie Dorison, who is now an assistant professor at Georgetown University, and former HKS doctoral student Ke Wang, who is now a postdoctoral fellow at the University of Virginia. Both were co-authors on the research paper on sadness and the research paper on gratitude, which were both published in the Proceedings of the National Academy of Sciences. Ralph Ranalli of the HKS Office of Communications and Public Affairs is the host, producer, and editor of HKS PolicyCast. A former journalist, public television producer, and entrepreneur, he holds an AB in Political Science from UCLA and an MS in Journalism from Columbia University.Design and graphics support is provided by Laura King, Lydia Rosenberg, Delane Meadows and the OCPA Design Team. Social media promotion and support is provided by Natalie Montaner and the OCPA Digital Team. Editorial support is provided by Nora Delaney and Robert O'Neill of the OCPA Editorial Team. Administrative support is provided by Lilly Wainaina.  

Harvard Chan School of Public Health's Dr. Troy Brennan argues in sum that because government Medicare, Medicaid and ACA marketplaces have grown and evolved, meaning the feds have improved their ability to competently regulate the healthcare market, employer-sponsored commercial plan coverage has become both comparatively unaffordable and increasingly irrelevant. Primarily for these reasons Dr. Brennan argues the US is headed toward or on the path to federally-sponsored and regulated healthcare administered by private or commercial payers. That is it appears increasingly likely the US will finally realize universal, socialized, single payer healthcare insurance or what he defines as Medicare For All, or more specifically Medicare Advantage for All in which commercial insurance plans serve a strictly administrative role.   Dr. Brennan's book can be found at: https://www.press.jhu.edu/books/title/53759/transformation-american-health-insurance. 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

Professor Joseph Allen directs the Healthy Buildings Program at Harvard Chan School of Public Health. His expertise extends far beyond what makes buildings healthy. He has been a leading voice and advocate during the Covid pandemic for air quality and ventilation. He coined the term “Forever Chemicals” and has written extensively on this vital topic, no less other important exposures, which we covered In our wide-ranging conversation. You will see how remarkably articulate and passionate Prof Allen is about these issues, along with his optimism for solutions.A video snippet of our conversation: buildings as the 1st line of defense vs respiratory pathogens. Full videos of all Ground Truths podcasts can be seen on YouTube here. The audios are also available on Apple and Spotify.Transcript with External Links and Links to AudioEric Topol (00:00:06):Well, hello. It's Eric Topol from Ground Truths and I am just delighted to have with me, Joseph Allen from the Harvard School of Public Health, where he directs the Healthy Buildings Program that he founded and does a whole lot more that we're going to get into. So welcome, Joe.Joseph Allen (00:00:24):Thanks. It's great to be here. I appreciate the invitation.Joe Allen's Background As A DetectiveEric Topol (00:00:28):Well, you have been, as I've learned, rocking it for many years long before the pandemic. There's quite a background about you having been a son of a homicide detective, private eye agency, and then you were going to become an FBI agent. And the quote from that in the article that's the Air Investigator is truly a classic. Yeah, you have in there, “I guarantee I'm the only public health student ever to fail an FBI lie detector polygraph in the morning and start graduate school a few hours later.” That's amazing. That's amazing.Joseph Allen (00:01:29):All right. Well, you've done your deep research apparently. That's good. Yeah, my dad was a homicide detective and I was a private investigator. That's no longer my secret. It's out in the world. And I switched careers and it happened to be the day I took the polygraph at the FBI headquarters in Boston, was the same day I started graduate studies in public health.Sick vs Healthy Buildings (Pre-Covid)Eric Topol (00:01:53):Well, you're still a detective and now you're a detective of everything that can hurt us or help us environmentally and my goodness, how grateful we are that you change your career path. I don't know anyone who's had more impact on buildings, on air, and we're going to get into chemicals as well. So if we go back a bit here, you wrote a book before the pandemic, talk about being prescient. It's called Healthy Buildings: How Indoor Spaces Can Make You Sick - or Keep You Well with John Macomber, your co-author. What was it that gave you the insight to write a book before there was this thing called Covid?Joseph Allen (00:02:41):Yeah, well, thanks for making the connection too, my past career to current career. For many years, I thought there wasn't a connection, but I agree. There's actually a lot of similarities and I also am really appreciative. I am lucky I found the field of Public Health, it's clearly where I belong. I feel like I belong here. It's a place to make an impact that I want to make in my career. So yeah, the Healthy Buildings book, we started writing years before the pandemic and was largely motivated by, I think what you and others and other people in my field have known, is that buildings have an outsized impact on our health. Yet it's not something that comes to the forefront when you ask people about what matters for their health. Right, I often start presentations by asking people that, what constitutes healthy living? They'll say, I can't smoke, I have to eat well.(00:03:30):I have to exercise. Maybe they'll say, outdoor pollution's bad for you. Very few people, if any, will say, well, the air I breathe inside my building matters a lot. And over the years I had started my public health career doing forensic investigations of sick buildings. People really can get sick in buildings. It can be anything from headaches and not being able to concentrate all the way to cancer clusters and people dying because of the building. And I've seen this in my career, and it was quite frustrating because I knew, we all knew how to design and operate buildings in a way that can actually keep people healthy. But I was frustrated like many in my field that it wasn't advancing. In other words, the science was there, but the practice wasn't changing. We were still doing things the wrong way around ventilation, materials we put in our building, and I would lecture over and over and give presentations and I decided I want to try something new.(00:04:22):I do peer-reviewed science. That's great. I write pieces like you for the public, and I thought we'd try a longer form piece in a book, and it's published by Harvard Press. John Macomber for those who know is a professor at Harvard Business School who's an expert in real estate finance. So he'd been talking about the economic benefits of healthier buildings and some hand waving as he describes around public health. I've been talking about the public health benefits and trying to wave an economic argument. We teamed up to kind of use both of our strengths to, I hope make a compelling case that buildings are good for health and they're also just good business. In other words, try to break down as many barriers as we can to adoption. And then the book was published right as Covid hit.Indoor Air Quality and CognitionEric Topol (00:05:05):Yeah. I mean, it's amazing. I know that typically you have to have a book almost a year ahead to have it in print. So you were way, way ahead of this virus. Now, I'm going to come back to it later, but there were two things beyond the book that are pretty striking about your work. One is that you did all these studies to show with people wearing sensors to show that when the levels of CO2 were high by sensors that their cognition indoors was suffering. Maybe you could just tell us a little bit about these sensors and why aren't we all wearing sensors so that we don't lose whatever cognitive power that we have?Joseph Allen (00:05:56):Well, yeah. First I think we will start having these air quality sensors. As you know, they're starting to become a lot more popular. But yeah, when I first joined the faculty full-time at Harvard, one of the first studies I conducted with my team was to look at how indoor air quality influences cognitive function. And we performed a double-blind study where we took people, office workers and put them in a typical office setting. And unbeknownst to them, we started changing the air they were breathing in really subtle ways during the day, so they didn't know what we were doing. At the end of the day, we administered an hour and a half long cognitive function battery, and like all studies, we control for things like caffeine intake, baseline cognitive performance, all the other factors we want to account for. And after controlling for those factors in a double-blind study, we see that indoor air quality, minor improvements to indoor air quality led to dramatic increases in cognitive function test scores across domains that people recognize as important for everyday life.(00:06:59):How do you seek out and utilize information? How do you make strategic decisions? How do you handle yourself during a crisis and importantly recover after that crisis? I don't mean the world's ending crisis. I mean something happens at work that's stressful. How do you handle that and how do you respond? Well, it turns out that amongst all the factors that influence how we respond there, indoor air quality matters a lot. We call that study the COGfx Study for cognitive function. We replicated it across the US, we replicated it across the world with office workers around the world, and again, always showing these links, the subtle impact of indoor air quality on cognitive function performance. Now, that also then starts to be the basis for some of the economic analysis we perform with my colleague at Harvard Business School. We say, well, look, if you perform this much better related to air quality, what would happen if we implemented this at scale in a business?(00:07:51):And we estimate that there are just massive economic gains to be had. On a per person basis, we found and published on this, that's about $6,000 to $7,000 per person per year benefit across a company. It could lead to 10% gains to the bottom line performance of the company. And again, I'm a public health professor. My goal is to improve people's health, but we add a lens, mental health, brain health is part of health, and we add the economic lens to say, look, this is good for a worker of productivity and the costs are downright trivial when you compare it against the benefits, even just including the cognitive function benefits, not even including the respiratory health benefit.Eric Topol (00:08:33):And I mean, it's so striking that you did these studies in a time before sensors were, and they still are not widely accepted, and it really helped prove, and when we start to fall asleep in a group session indoors, it may not just be because we didn't have enough sleep the night before, right.Joseph Allen (00:08:56):It's funny you say that. I talk about that too. It's like, do we actually need the study to tell us to quantify what we've all experienced these bad conference rooms, you get tired, you can't concentrate, you get sleepy while you're driving your car. Yeah, a whole bunch of other factors. Maybe the speaker's boring, but a key factor is clearly indoor air quality and things like good ventilation, the chemical load in the space are all contributing.Eric Topol (00:09:20):Yeah. No, it's pretty darn striking. Now we're going to get into the pandemic, and this of course is when your work finally crystallized that you've been working on this for years, and then finally your collaboration with some of the aerosol experts. It was a transdisciplinary synergy that was truly extraordinary. And when you were on 60 Minutes last October, you said, “Think about the public health gains we've made over the past hundred years. We've made improvements to water quality, outdoor air pollution, our food safety, we've made improvements to sanitation: absolute basics of public health. Where has indoor air been in that conversation?” You brought it to us. I mean, you led the Lancet Commission on this. You've done a White House Summit keynote. You had a lot of influence. Why did it take us to finally wake up to this issue that you've been working on for years?Covid is Airborne, DenialJoseph Allen (00:10:31):Yeah. Well, I appreciate that, but I also liked what you started with. I mean, there's been a lot of us pulling on this, and I think one of the magical moments, if you could say that when the pandemic happened was that it forced these collaborations and forced a lot of us in our field to be a bit more vocal. And even that comment about the gains we made in public health, that comes from an article that we co-authored with 40 plus scientists around the world in science, trying to drive home the point that we've ignored one of the key factors that determines our health. We were all frustrated at the beginning of the pandemic. The first piece I wrote was January 2020, talking about healthy buildings as the first line of defense, airborne spread, ventilation, filtration. I could not get it published. I could not get it published.(00:11:20):So I moved it to an international paper. I wrote it in the Financial Times in early February, but it wasn't until mid-March that the Times took my piece on this airborne spread buildings ventilation. At the same time, we know people like Linsey Marr, Rich Corsi, many others, Shelly Miller out there publishing, doing the fundamental research, all trying to elevate, and I think we started to find each other and say, hey, someone's trying to hit the medical journals. We're not landing there. I'm trying to hit the Times, and we're not landing there. We're trying to get the reporters to pay attention. It's not landing there. Let's team up. Let's write these joint pieces. And I think what happened was you saw the benefit of the collective effort and interdisciplinary expertise, right? We could all start to come together, start instead of having these separate voices, a little bit of a unified voice despite important scientific minor disagreements, but start to say, hey, we started elevate each other and said, this is really important. It's the missing component of the messaging in the early days of the pandemic, and to know how to defend yourself.Eric Topol (00:12:20):Well, I think a lot of people think the big miss, and I know you agree, was the lack of recognition of aerosol transmission instead of just liquid droplets. But what you brought to this was really your priors on the buildings themselves and the ventilation systems and air quality that was highly, I mean, critical to it isn't just the aerosol, it's obviously how buildings are set up. Now, there's an amazing piece of course that appeared in the summer of 2021 called the Air Investigator, which profiled you, and in it brings up several things that finally are, we're starting to get our act together. I mean, ultimately there was in May 2023 years later, the CDC says, we're going to do something about this. Can you tell us what was this very distinct new path that the CDC was at least saying? And also couple that with whatever action if or not action has been taken.Joseph Allen (00:13:33):Yeah. So there really was a monumental shift that took, it was years in development, but we finally won the argument, collectively that airborne spread was the dominant mode of transmission. Okay, we got that. Then the question is, well, what changes? Do we actually get guidance here? And that took a little bit longer. I give Rochelle Walensky a lot of credit when she came into the CDC, we talked with her about this. That's when you start to first see ventilation starts showing up and the guidance, including guidance for schools. So I think that was a big win, but still no one was willing to set an official target or standard around higher ventilation rates. So that's important. Early in the pandemic, some people started to hear a message, yes, ventilation is important. What's the obvious next question, well, how much, what do I need? So in the summer of 2020, actually Shelly Miller and I collaborated on this.(00:14:23):We published some guidance on ventilation targets for schools. We said four to six air changes per hour (ACH) and target that. Well, it wasn't until 2023, spring of 2023 that you mentioned that CDC published target ventilation rates, and they went with five air changes per hour, which is right where we were talking about in summer 2020. It's what the Lancet of COVID-19 Commission adopted, but it's momentous in this way. It's the first time in CDCs history they've ever published a ventilation rate target for health. Now, I know this seems slow at the time, and it was, but if we think about some of the permanent gains that will come out of the pandemic. Pandemic changes society and science and policy and practice this, we are never going back. Now buildings will be a first line of defense for respiratory pathogens going forward that can no longer be ignored. And now we have the published target by CDC. That's a big deal because it's not just a recognition, but there's actually something to shoot for out there. It's a target I happen to like, I think there are differences between different scientists, but ultimately we've lifted the floor and said, look, we actually have to raise ventilation rates and we have something to shoot for. The public needed that kind of guidance a lot earlier, of course, but it was a big deal that it happened. It's just too bad it took until spring 2023.Eric Topol (00:15:46):Yeah, I certainly agree that it was momentous, but a year plus later, has there been any change as a result of this major proclamation, if you will?Joseph Allen (00:15:59):Well, I actually see a lot of change from a practitioner level, but I want to talk about it in two aspects. I see a lot of schools, universities, major companies that have made this shift. For example, in the 60 Minutes piece, I talk that I advised Amazon and globally they're measuring indoor air quality with real-time sensors in their buildings. I've worked with hundreds of school districts that have made improvements to indoor air quality. I know companies that have shifted their entire approach to how they design and operate their buildings. So it's happening. But what really needs to happen, Eric, if this movement is going to benefit everyone, is that these targets need to be codified. They need to go into building codes. It can't just be, oh, I've heard about this. So I made the decision. I have the resources and the money to make this improvement.(00:16:44):To create a healthy building or a healthy school, we need to be sure this gets built into our code. So it just becomes the way it's done. That is not happening. There are some efforts. There are some bills at the national level. Some states are trying to pass bills, and I have to say, this is why I'm optimistic. It feels very slow. I'm as frustrated as anybody. I wanted this done before the pandemic. As soon as the pandemic hit, we saw it. We knew what we needed to get done. It didn't happen. But if we think about the long arc here and the public health gains we're actually, it's remarkable to me that we actually have bills being introduced around indoor air quality that ASHRAE has set a new health focused target for the first time really in their history. CDC, first time. New buildings going up in New York City designed to these public health targets. That's really different. I've been in this field for 20 plus years. I've never seen anything like it. So the pace is still slow, but it really is happening. But it has to reach everybody, and the only way that's going to happen is really this gets into building codes and performance standards.The Old Efficient Energy BuildingsEric Topol (00:17:52):Yeah. Well, I like your optimistic perspective. I do want to go back for a second, back decades ago there was this big impetus to make these energy efficient buildings and to just change the way the buildings were constructed so that there was no leak and it kind of set up this problem or exacerbated, didn't it?Joseph Allen (00:18:19):Yeah. I mean, I've written about this a lot. I write in the book our ventilation standards, they've been a colossal mistake. They have cost the public in terms of its health because in the seventies, we started to really tighten up our building envelopes and lower the ventilation rates. The standards were no longer focused on providing people with a healthy indoor space. As I write in the book, they were targeted towards minimally acceptable indoor air quality, bare minimums. By the way that science is unequivocal, is not protective of health, not protective against respiratory pathogens, doesn't promote good cognitive function, not good for allergies. These levels led to more illness in schools, more absences for teachers and students, an absolute disaster from a public health standpoint. We've been in this, what I call the sick building era since then. Buildings that just don't bring in enough clean outdoor air. And now you take this, you have a building stock for 40 years tighter and tighter and tighter bumps up against a novel virus that spread nearly entirely indoors. Is it any wonder we had, the disaster we had with COVID-19, we built these bills. They were designed intentionally with low ventilation and poor filtration.Optimal Ventilation and FiltrationEric Topol (00:19:41):Yeah. Well, it's extraordinary because now we've got to get a reset and it's going to take a while to get this done. We'll talk a bit about cost of doing this or the investment, if you will, but let's just get some terms metrics straight because these are really important. You already mentioned ACH, the number of air changers per hour, where funny thing you recommended between four and six and the CDC came out with five. There's also the minimum efficiency reporting value (MERV). A lot of places, buildings have MERV 8, which is insufficient. We need MERV 13. Can you tell us about that?Joseph Allen (00:20:23):Yeah, sure. So I think when we think about how much, you have two ways to capture these respiratory particles, right? Or get rid of them. One is you dilute them out of the building or you capture them on filters. You can inactivate them through UV and otherwise. But let's just stay on the ventilation and filtration side of this. So the air changing per hour is talking about how often the air is change inside. It's an easy metric. There are some strengths to it, there's some weaknesses, but it's intuitive and I'll you some numbers so you can make sense of this. We recommended four to six air changes per hour. Typical home in the US has half an air change per hour. Typical school designed to three air changes per hour, but they operate usually at one and a half. So we tried to raise this up to four, five, or six or even higher. On the filtration side, you mentioned MERV, right? That's just a rating system for filters, and you can think about it this way. Most of the filters that are in a building are cheap MERV 8 filters, I tend to think of them as filters that protect the equipment. A MERV 13 filter may capture 80 or 90% of particles. That's a filter designed to protect people. The difference in price between a MERV 8 and a MERV 13 is a couple of bucks.(00:21:30):And a lot of the pushback we got early in the pandemic, some people said, well, look, there's a greater resistance from the better filter. My fan can't handle it. My HVAC system can't handle it. That was nonsense. You have low pressure drop MERV 13 filters. In other words, there really wasn't a barrier. It was a couple extra bucks for a filter that went from a MERV 8 might capture 20 or 30% to a filter, MERV 13 that captures 80 or 90% with very little, if any impact on energy or mechanical system performance. Absolute no-brainer. We should have been doing this for decades because it also protects against outdoor air pollution and other particles we generate indoors. So that was a no-brainer. So you combine both those ventilation filtration, some of these targets are out there in terms of air change per hour. You can combine the metric if we want to get technical to talk about it, but basically you're trying to create an overall amount of clean air. Either you bring in fresh outdoor air or you filter that air. It really is pretty straightforward, but we just didn't have some of these targets set and the standards we're calling for these minimum acceptable levels, which we're not protective of health.Eric Topol (00:22:37):So another way to get better air quality are these portable air cleaners, and you actually just wrote about that with your colleagues in the Royal Society of Chemistry, not a journal that I typically read, but this was an important article. Can you give us, these are not very expensive ways to augment air quality. Can you tell us about these PACs ?Joseph Allen (00:23:06):These portable air cleaners (PACs), so the same logic applies if people say, well, I can't upgrade my system. That's not a problem for very low cost, you could have, these devices are essentially a fan and a filter, and the amount of clean air you get depends on how strong the fan is and how good the filter is. Really pretty simple stuff here, and you can put one of these in a room if it's sized right. My Harvard team has built tools to help people size this. If you're not quite sure how to do it, we have a technical explainer. Really, if you size it right, you can get that four, five or six air changes per hour, very cheap and very quickly. So this was a tool I thought would be very valuable. Rich Corsi and I wrote about this all through the summer of 2020 to talk about, hey, a stop gap measure.(00:23:50):Let's throw out some of these portable air cleaners. You increase the air changes or clean air delivery pretty effectively for very low cost, and they work. And now the paper we just published in my team a couple of days ago starts to advance this more. We used a CFD model, so computational fluid dynamics. Essentially, you can look at the tracers and the airflow patterns in the room, and we learn a couple things that matter. Placement matters, so we like it in the center of the room if you can or as close as possible. And also the airflow matters. So the air cleaners are cleaning the air, but they're also moving the air, and that helps disperse these kind of clouds or plumes when an infected person is breathing or speaking. So you want to have good ventilation, good filtration. Also a lot of air movement in the space to help dilute and move around some of these respiratory particles so that they do get ventilated out or captured in a filter.Eric Topol (00:24:40):Yeah. So let me ask you, since we know outdoors are a lot safer. If you could do all these things indoors with filtration, air changing the quality, can you simulate the outdoors to get rid of the risk or markedly reduce the risk of respiratory viruses like SARS-CoV-2 and others?Joseph Allen (00:25:04):Yeah, you can't drop it to zero. There's no such thing as zero risk in any of these environments. But yeah, I think some of the estimates we've seen in my own team has produced in the 60-70% reduction range. I mean, if you do this right with really good ventilation filtration, you can drop that risk even further. Now, things like distancing matter, whether or not somebody's wearing a mask, these things are all going to play into it. But you can really dramatically drop the risk by handling just the basics of ventilation and filtration. And one way to think about it is this, distance to the infector still matters, right? So if you and I are speaking closely and I breathe on you, it's going to be hard to interrupt that flow. But you can reduce it through good ventilation filtration. But really what it's doing also is preventing super spreading events.(00:25:55):In other words, if I'm in the corner of a room and I'm infectious and you're on the other side, well if that room is sealed up pretty good, poor ventilation, no filtration, the respiratory aerosols are going to build up and your risk is going to increase and we're in there for an hour or two, like you would be in a room or office and you're exposed to infectious aerosol. With good ventilation filtration, those respiratory particles don't have a chance to reach you, or by the time they do, they're much further diluted. Linsey Marr I think was really great early in the pandemic by talking about this in terms of cigarette smoke. So a small room with no ventilation filtration, someone smoking in the corner, yeah, it's going to fill up over time with smoke you're breathing in that secondhand smoke. In a place with great ventilation filtration, that's going to be a lot further reduced, right? You're not going to get the buildup of the smoke and smoke particles are going to operate similarly to respiratory particles. So I think it's intuitive and it's logical. And if you follow public health guidance of harm reduction, risk reduction, if you drop exposure, you drop risk.(00:26:58):The goal is to reduce exposure. How do we do that? Well, we can modify the building which is going to play a key role in exposure reduction.Eric Topol (00:27:06):Now, to add to this, if I wear a sensor or have a sensor in the room for CO2, does that help to know that you're doing the right thing?Joseph Allen (00:27:17):Yeah, absolutely. So people who are not familiar with these air quality sensors. They're small portal air quality sensors. One of the things they commonly measure is carbon dioxide. We're the main source of CO2 inside. It's a really good indicator of ventilation rate and occupancy. And the idea is pretty simple. If the CO2 is low, you don't have a buildup of particles from the respiratory tract, right? And CO2 is a gas, but it's a good indicator of overall ventilation rate. This room I'm in right now at the Harvard School of Public Health has air quality sensors. We have this at Harvard Business School. We have it at the Harvard Health Clinics. Many other places are doing it, Boston Public schools have real-time air quality monitors. Here's the trick with CO2. So first I'll say we have some guidance on this at the Harvard Healthy Buildings page, if people want to go look it up, how to choose an air quality sensor, how to interpret CO2 levels.Carbon Dioxide Levels(00:28:04):But here's a way to think about it. We generally would like to see CO2 levels less than 800 parts per million. Historically, people in my field have said under 1,000 is okay. We like to see that low. If your CO2 is low, the risk is low. If your CO2 is high, it doesn't necessarily mean your risk is high because that's where filtration can come in. So let me say that a little bit better. If CO2 is low, you're diluting enough of the respiratory particles. If it's high, that means your ventilation is low, but you might have excellent filtration happening. Either those MERV 13 filters we talked about or the portable air cleaners. Those filters don't capture CO2. So high CO2 just means you better have a good filter game in place or the risk is going to be high. So if you CO2 is low, you're in good shape. If it's high, you don't quite know. But if you have bad filtration, then the risk is going to be much higher.Eric Topol (00:29:01):I like that 800 number because that's a little lower than some of the other thresholds. And why don't we do as good as we can? The other question about is a particulate matter. So we are worried about the less than 5 microns, less than 2.5 microns. Can you tell us about that and is there a way that you can monitor that directly?Joseph Allen (00:29:25):Sure. A lot of these same sensors that measure CO2 also measure PM 2.5 which stands for particular matter. 2.5 microns is smaller, one of the key components of outdoor air pollution and EPA just set new standards, right? WHO has a standard for 5 microgram per cubic meter. EPA just lowered our national outdoor limit from 12 to 9 microgram per cubic meter. So that's a really good indicator of how well your filters are working. Here again, in a place like this or where you are, you should see particle levels really under 5 microgram per cubic meter without any major source happening. What's really interesting about those like the room I'm in now, when the wildfire smoke came through the East coast last year, levels were extraordinary outside 100, 200, 300 microgram per cubic meter. But because we have upgraded our filters, so we use MERV 15 here at Harvard, the indoor levels of particles stayed very low.(00:30:16):So it shows you how the power of these filters can actually, they do a really good job of capturing particles, whether it be from our lungs or from some other source. So you can measure this, but I'll tell you what's something interesting, if you want to tie it into our discussion about standards. So we think about particles. We have a lot of standards for outdoor air pollution. So there's a national ambient air quality standard 9 microgram per cubic meter. We don't have standards for indoor air quality. The only legally enforceable standard for indoor particles is OSHA's standard, and it's 5,000 microgram per cubic meter 5,000.(00:30:59):And it's absurd, right? It's an absurdity. Here we are EPAs, should it be 12, should it be 9, or should it be 8? And for indoors, the legally enforceable limit for OSHA 5,000. So it points to the big problem here. We talked about earlier about the need for these standards to codify some of this. Yes, we have awareness from the public. We have sensors to measure this. We have CDC now saying what we were saying with the Lancet COVID-19 Commission and elsewhere. This is big movement, but the standards then need to come up behind it and get into code and new standards that are health focused and health based. And we have momentum, but we can't lose it right now because it's the first time in my career I felt like we're on the cusp of really getting this and we are so close. But of course it's always in danger of slipping through our fingers.Regulatory Oversight for AirEric Topol (00:31:45):Well, does this have anything to do with the fact that in the US there's no regulatory oversight over air as opposed to let's say Japan or other places?Joseph Allen (00:31:57):Yeah, I mean, we have regulatory oversight of outdoor air. That's EPA. There's a new bill that was introduced to give EPA more resources to deal with indoor air. EPA has got a great indoor air environments division, but it doesn't have the legally enforceable mandate or statute that we have for outdoor. So they'd give great guidance and have for a long time. I really like that group at EPA, but there's no teeth behind this. So what we have is worker health protections at OSHA to its own admission, says its standards are out of date. So we need an overhaul of how we think about the standards. I like the market driven approach. I think that's being effective, and I think we can do it from voluntary standards that can get adopted into code at the municipal level. I think that's a real path. I see it happening. I see the influence of all this work hitting legislators. So that's where I think the most promising path is for real change.The Risks of Outdoor Air Pollution Eric Topol (00:33:03):Yeah, I think sidestepping, governmental teeth, that probably is going to be a lot quicker. Now, before we get to the cost issue, I do want to mention, as you know very well, the issue of air pollution in Science a dedicated issue just a few weeks ago, it brought up, of course, that outdoor air pollution we've been talking about indoor is extraordinary risk for cancer, dementia, diabetes, I mean everything. Just everything. And there is an interaction between outdoor pollution and what goes on indoor. Can you explain basically reaffirm your concern about particulate matter outdoors, and then what about this interaction with what goes on indoors?Joseph Allen (00:33:59):Yeah, so it's a great point. I mean, outdoor pollution has been one of the most studied environmental pollutants we know. And there's all of these links, new links between Alzheimer's, dementia, Parkinson's disease, anxiety, depression, cardiovascular health, you named it, right? I've been talking about this and very vocal. It's in the book and elsewhere I called the dirty secret of outdoor air pollution. The reality is outdoor air pollution penetrates indoors, and the amount depends on the building structure, the type of filters you have. But let's take an infiltration value of say 50%. So you have a lot of outdoor air pollution, maybe half of that penetrates inside, so it's lower, the concentration is lower, but 90% of the breaths you take are indoor. And if you do the math on it, it's really straightforward. The majority of outdoor air pollution you breathe happens inside.(00:34:52):And people, I think when they hear that think, wait, that can't be right. But that's the reality that outdoor pollution comes inside and we're taking so many breaths inside. Your total daily dose of outdoor air pollution is greater from the time you spend inside. I talk about this all the time. You see any article about outdoor air pollution, what's the cover picture? It's someone outside, maybe they're wearing a mask you can't really see. It's smoky hazy. But actually one of the biggest threats is what's happening inside. The nice thing here, again, the solutions are pretty simple and cost-effective. So again, upgrade from MERV 8 to MERV 13, a portable air cleaner. We are just capturing particles on a filter basic step that can really reduce the threat of outdoor air pollution inside. But it's ignored all the time. When the wildfire smoke hit New York City. New York City's orange, I called colleagues who are in the news business.(00:35:48):We have to be talking about the indoor threat because the guidance was good, but incomplete. Talk about Mayor Adams in New York City. Go inside, okay, that's good advice. And go to a place that has good filtration or they should have been giving out these low cost air cleaners. So just going inside isn't going to protect your lungs unless you're actually filtering a lot more of that air coming in. So trying to drive home the point here that actually we talk about these in silos. Well, wildfire smoke and particles, Covid and respiratory particles, we're all talking about these different environmental issues that harm our health, but they're all happening through or mediated by the building performance. And if we just get the building performance right, some basics around good ventilation, good filtration, you start to address multiple threats simultaneously. Outdoor air pollution, wildfire smoke, allergens, COVID-19, influenza, RSV, better cognitive function performance, anxiety. You start addressing the root cause or one of the contributors and buildings we can then start to leverage as a true public health tool. We have not taken advantage of the power of buildings to be a true public health tool.Eric Topol (00:36:59):Oh, you say it so well, and in fact your Table on page 44 in Healthy Buildings , we'll link it because it shows quantitatively what you just described about outdoor and indoor cross fertilization if you will. Now before leaving air pollution outdoors, indoors, in order for us to affect this transformation that would markedly improve our health at the public health individual level, we're talking about a big investment. Can you put that in, you did already in some respects, but if we did this right in every school, I think in California, they're trying to mandate that in schools, in the White House, they're mandating federal buildings. This is just a little piece of what's needed. This would cost whatever trillions or hundreds of billions of dollars. What would it take to do this? Because obviously the health benefits would be so striking.What's It Gonna Cost?Joseph Allen (00:38:04):Well, I think one of the issues, so we can talk about the cost. A lot of the things I'm talking about are intentionally low cost, right? You look at the Lancet of COVID-19 Commission, our report we wrote a report on the first four healthy building strategies every building should pursue. Number one commission your building that's giving your building a tune-up. Well, guess what? That not only improves air quality, it saves energy and therefore saves money. It actually becomes cost neutral. If not provides an ROI after a couple of years. So that's simple. Increase the amount of outdoor air ventilation coming in that has an energy cost, we've written about this. Improved filtration, that's a couple bucks, really a couple bucks, this is small dollars or portable air cleaners, not that expensive. I think one of the big, and Lawrence Berkeley National Lab has written this famous paper people like to cite that shows there's $20 billion of benefits to the US economy if we do this.(00:38:59):And I think it points to one of the problems. And what I try to address in my book too, is that very often when we're having this conversation about what's it going to cost, we don't talk about the full cost benefit. In other words, we say, well, it's going to cost X amount. We can't do that. But we don't talk about what are the costs of sick buildings? What are the costs of kids being out of school for an entire year? What are the costs of hormonal disruption to an entire group of women in their reproductive years due to the material choices we make in our buildings? What are the costs to outdoor air pollution and cardiovascular disease, mental health? Because we don't have good filters in our buildings that cost a couple dollars. So in our book, we do this cost benefit analysis in the proforma in our book, we lay out what the costs are to a company. We calculate energy costs. We say these are the CapEx costs, capital costs for fixed costs and the OpEx costs for operating expenditures. That's a classic business analysis. But we factor in the public health benefits, productivity, reduced absenteeism. And you do that, and I don't care how you model it, you are going to get the same answer that the benefits far outweigh the cost by orders of magnitude.Eric Topol (00:40:16):Yeah, I want to emphasize orders of magnitude. Not ten hundred, whatever thousand X, right?Joseph Allen (00:40:23):What would be the benefit if we said we could reduce influenza transmission indoors in schools and offices by even a small percent because we improve ventilation and filtration? Think of the hospitalization costs, illness costs, out of work costs, out of school costs. The problem is we haven't always done that full analysis. So the conversation gets quickly to well, that's too much. We can't afford that. I always say healthy buildings are not expensive. Sick buildings are expensive. Totally leave human health out of that cost benefit equation. And then it warps this discussion until you bring human health benefits back in.Forever ChemicalsEric Topol (00:40:58):Well, I couldn't agree more with you and I wanted to frame this by giving this crazy numbers that people think it's going to cost to the reality. I mean, if there ever was an investment for good, this is the one that you've outlined so well. Alright, now I want to turn to this other topic that you have been working on for years long before it kind of came to the fore, and that is forever chemicals. Now, forever chemicals, I had no idea that back in 2018 you coined this term. You coined the term, which is now a forever on forever chemicals. And basically, this is a per- and polyfluoroalkyl substances (PFAS), but no one will remember that. They will remember forever chemicals. So can you tell us about this? Because this of course recently, as you know well in May in the New Yorker, there was an expose of 3M, perhaps the chief offender of these. They're everywhere, but especially they were in 3M products and continue to be in 3M products. Obviously they've been linked with all kinds of bad things. What's the story on forever chemicals?Joseph Allen (00:42:14):Yeah, they are a class of chemicals that have been used for decades since the forties. And as consumers, we like them, right? They're the things that make your raincoat repel rain. It makes your non-stick pan, your scrambled eggs don't stick to the pan. We put them on carpets for stain resistance, but they came with a real dark side. These per- and polyfluoroalkyl substances, as I say, a name only a chemist could love have been linked with things like testicular cancer, kidney cancer, interference with lipid metabolism, other hormonal disruption. And they are now a global pollutant. And one of the reasons I wrote the piece to brand them as forever chemicals was because I'm in the field of environmental health. We had been talking about these for a long time and I just didn't hear the public aware or didn't capture their attention. And part of it, I think is how we talk about some of these things.(00:43:14):I think a lot about this. Per- and polyfluoroalkyl substances, no one's going to, so the forever chemicals is actually a play on their defining feature. So these chemicals, these stain repellent chemicals are characterized by long chains of the carbon fluorine bond. And when we string these together that imparts this and you put them on top of a product that imparts the property of stain resistance, grease resistance, water resistance, but the carbon fluorine bond is the strongest in all of organic chemistry. And these chains of the carbon fluorine bond never fully break down in the environment. And when we talk in my field about persistent organic pollutants, we talk about chemicals that break down on the order of decades. Forever chemicals don't break down. They break down the order of millennia. That's why we're finding them everywhere. We know they're toxic at very low levels. So the idea of talking about forever chemicals, I wanted to talk about their foreverness.(00:44:13):This is permanent. What we're creating and the F and the C are the play on the carbon-fluorine bond and I wrote an article trying to raise awareness about this because some companies that have produced these have known about their toxicity for decades, and it's just starting the past couple of years, we're just starting to pay attention to the scale of environmental pollution. Tens of millions of Americans have forever chemicals in their drinking water above the safe limit, tens of millions. I worked as an expert in a big lawsuit for the plaintiffs that were drinking forever chemicals in their water that was dumped into the drinking water supply by a manufacturing company. I met young men with testicular cancer from drinking forever chemicals in their water. These really has escaped the public's consciousness, it wasn't really talked about. Now of course, we know every water body, we use these things in firefighting foams or every airport has water pollution.(00:45:17):Most airports do. Firefighters are really concerned about this, high rates of cancer in the firefighter population. So this is a major problem, and the cleanup is not straightforward or easy because they're now a global pollutant. They persist forever. They're hard to remediate and we're stuck with them. So that's the downside, I can talk about the positives. I try to remain an optimist or things we're doing to try to solve this problem, but that's ultimately the story. And my motivation was I just to have people have language to be able to talk about this that didn't require a degree in organic chemistry to understand what they were.Eric Topol (00:45:52):Yeah, I mean their pervasiveness is pretty scary. And I am pretty worried about the fact that we still don't know a lot of what they're doing in terms of clinical sequela. I mean, you mentioned a couple types of cancer, but I don't even know if there is a safe threshold.Joseph Allen (00:46:16):Eric, I'll tell you one that'll be really interesting for you. A colleague of mine did a famous study on forever chemicals many years ago now and found that kids with higher levels of forever chemicals had reduced vaccine effectiveness related to these chemicals. So your point is, right, a lot of times we're using these industrial chemicals. We know a couple endpoints for their affecting our bodies, but we don't know all of them. And what we know is certainly alarming enough that we know enough to know we shouldn't be using them.Eric Topol (00:46:51):And you wrote another masterful op-ed in the Washington Post, 6 forever chemical just 10,000 to go. Maybe you could just review what that was about.Joseph Allen (00:47:02):Yeah, I've been talking a lot about this issue I call chemical whack-a-mole. So forever chemical is the perfect example of it. So we finally got people's attention on forever chemicals. EPA just regulated 6 of them. Well, guess what? There are 10,000 if not many more than that. Different variants or what we call chemical cousins. Now that's important for this reason. If you think about how we approach these from a regulatory standpoint, each of the 10,000 plus forever chemicals are treated as different. So by the time EPA regulates 6, that's important. It does free up funding for cleanup and things like this. But already the market had shifted away from those 6. So in other words, in the many thousand products that still use forever chemicals, they're no longer using those 6 because scientists have told people these things are toxic years ago. So they switch one little thing in the chemical, it becomes a new chemical from a regulatory perspective.(00:47:57):But to our bodies, it's the same thing. This happens over and over. This has happened with pesticides. It happens with chemicals and nail polish. It happens in chemicals in e-cigarettes. It happens with flame retardant chemicals. I wrote a piece in the Post maybe six years ago talking about chemical whack-a-mole, and this problem that we keep addressing, these one-off, we hit one, it changes just slightly. Chemical cousin pops up, we hit that one. Five years later, scientists say, hey, the next one doesn't look good either. We're doing this for decades. It's really silly. It's ineffective, it's broken, and there are better ways to handle this going forward.Eric Topol (00:48:31):And you know what gets me, and it's like in the pharma industry that I've seen the people who run these companies like 3M that was involved in a multi-decade coverup, they're never held accountable. I mean, they know what they're doing and they just play these games that you outlined. They're still using 16,000 products, according to the New Yorker, the employee that exposed them, the whistleblower in the New Yorker article.Joseph Allen (00:48:58):That was an amazing article by Sharon Lerner talking to the people who had worked there and she uncovered that they knew the toxicity back in the seventies, and yes, they were still making these products. One of the things that I think has gotten attention of some companies is while the regulations have been behind, the lawsuits are piling up.Joseph Allen (00:49:21):The lawsuit I was a part of as an expert for that was about an $800 million settlement in favor of the plaintiffs. A couple months later is another one that was $750 million. So right there, $1.5 billion, there's been several billion dollars. This has caught the attention of companies. This has caught the attention of product manufacturers who are using the forever chemicals, starting to realize they need to reformulate. And so, in a good way now, that's not the way we should be dealing with this, but it has started to get companies to wake up that maybe they had been sleeping on it, that this is a major problem and actually the markets have responded to it.Eric Topol (00:50:02):Well, that's good.Joseph Allen (00:50:03):Because these are major liabilities on the books.Eric Topol (00:50:05):Yeah, I mean, I think what I've seen of course with being the tobacco industry and I was involved with Vioxx of course, is the companies just appeal and appeal and it sounds really good that they've had to pay $800 million, but they never wind up paying anything because they basically just use their muscle and their resources to appeal and put it off forever. So I mean, it's one way to deal with it is a litigation, but it seems like that's not going to be enough to really get this overhauled. I don't know. You may be more sanguine.Joseph Allen (00:50:44):No, no, I agree with you. It's the wrong way. I mean, we don't want to, the solution here is not to go after companies after people are sick. We need get in front of this and be proactive. I mentioned it only because I know it has made other companies pay attention how many billion does so-and-so sue for. So that's a good signal that other companies are starting to move away from forever chemicals. But I do want to talk about one of the positive approaches we're doing at Harvard, and we have a lot of other partners in the private sector doing this. We're trying to turn off the spigot of forever chemicals entering the market in the first place. As a faculty advisor to what we call the Harvard Healthier Building Materials Academy, we publish new standards. We no longer buy products that have forever chemicals in them for our spaces.(00:51:31):So we buy a chair or carpet. We demand no forever chemicals. What's really neat about this is we also say, we treat them as a whole class. We don't say we don't want PFOA. That's one of the regulated chemicals. We say we don't want any of the 10,000. We are not waiting for the studies to show us they act like the other ones. We've kind of been burned by this for decades. So we're actually telling the suppliers we don't want these chemicals and they're delivering products to us without these chemicals in them. We have 50 projects on our campus built with these new design standards without forever chemicals and other toxic chemicals. We've also done studies that a doctoral student done the study. When we do this, we find lower levels of these chemicals in air and dust, of course. So we're showing that it works.(00:52:19):Now, the goal is not to say, hey, we just want to make Harvard a healthier campus and the hell with everybody else. The goal is to show it can be done with no impact to cost, schedule or product performance. We get a healthier environment, products look great, they perform great. We've also now partnered with other big companies in the tech industry in particular to try and grow or influence the market by saying, look how many X amount of purchasing dollars each year? And it's a lot, and we're demanding that our carpets don't have this, that our chairs don't have it, and the supply chain is responding. The goal, of course, is to just make it be the case that we just have healthy materials in the supply chain for everybody. So if you or I, or anybody else goes to buy a chair, it just doesn't have toxic chemicals in it.Eric Topol (00:53:06):Right, but these days the public awareness still isn't there, nor are the retailers that are selling whether it's going to buy a rug or a chair or new pots and pans. You can't go in and say, does this have any forever chemicals? They don't even know, right?Joseph Allen (00:53:24):Impossible. I study this and it's hard for me when I go out to try and find and make better decisions for myself. This is one of the reasons why we're working, of course, trying to help with the regulatory side, but also trying to change the market. Say, look, you can produce the similar product without these chemicals, save yourself for future lawsuits. Also, there's a market for healthy materials, and we want everybody to be a part of that market and just fundamentally change the supply chain. It's not ideal, but it's what we can do to influence the market. And honestly, we're having a lot of impact. I've been to these manufacturing plants where they have phased out these toxic chemicals.Eric Topol (00:54:03):That's great to hear.Joseph Allen (00:54:06):And we see it working on our campus and other companies' campuses.Eric Topol (00:54:10):Well, nobody can ever accuse you of not taking on big projects, okay.Joseph Allen (00:54:15):You don't get into public health unless you want to tackle the big ones that are really going to influence.Micro(nano) PlasticsEric Topol (00:54:20):Well, that's true, Joe, but I don't know anybody who's spearheading things like you. So it's phenomenal. Now before we wrap up, there's another major environmental problem which has come to the fore, which are plastics, microplastics, nanoplastics. They're everywhere too, and they're incriminated with all the things that we've been talking about as well. What is your view about that?Joseph Allen (00:54:48):Well, I think it's one, well, you see the extent of the pollution. It's a global pollutant. These are petrochemicals. So it's building up, and these are fossil fuel derivatives. So you can link this not just to the direct human health impacts, the ecosystem impacts, but also ecosystem and health impacts through climate change. So we've seen our reliance on plastics grow exponentially over the past several decades, and now we're seeing the price we're paying for that, where we're seeing plastics, but also microplastics kind of everywhere, much like the forever chemicals. Everywhere we look, we find them and we're just starting to scratch a surface on what we know about the environmental impacts. I think there's a lot more that can be done here. Try to be optimistic again, at least if you find a problem, you got to try and point to some kind of solution or at least a pathway towards solutions.(00:55:41):But I like some of the stuff from others colleagues at Yale in particular on the principles of green chemistry. I write about them in my book a little bit, but it's this designing for non-permanence or biodegradable materials so that if we're using anything that we're not leaving these permanent and lasting impacts on our ecosystem that then build up and they build up in the environment, then they build up in all of us and in our food systems. So it seems to me that should be part of it. So think about forever chemicals. Should we be using chemicals that never break down in the environment that we know are toxic? How do we do that? As Harvard, one of the motivating things here for forever chemicals too, is how are we ignoring our own science? Everyone's producing this science, but how do we ignore even our own and we feel we have responsibility to the communities next to us and the communities around the world. We're taking action on climate change. How are we not taking action on these chemicals? I put plastics right in there in terms of the environmental pollutants that largely come from our built environment, food products and the products we purchase and use in our homes and in our bodies and in all the materials we use.Eric Topol (00:56:50):When you see the plastic show up in our arteries with a three, four-fold increase of heart attacks and strokes, when you see it in our testicles and every other organ in the body, you start to wonder, are we ever going to do something about this plastic crisis? Which is somewhat distinct from the forever chemicals. I mean, this is another dimension of the problem. And tying a lot of this together, you mentioned, we are not going to get into it today, but our climate crisis isn't being addressed fast enough and it's making all these things exacerbating.Joseph Allen (00:57:27):Yeah, let me touch on that because I think it is important. It gets to something I said earlier about a lot of these problems we treat as silos, but I think a lot of the problems run through our buildings, and that means buildings are part of the solution set. Buildings consume 40% of global energy.(00:57:42):Concrete and steel count for huge percentages of our global CO2 emissions. So if we're going to get climate solved, we're going to have to solve it through our buildings too. So when you start putting this all together, Eric, right, and this is why I talk about buildings as healthy buildings could potentially be one of the greatest public health interventions we have of this century. If we get it right, and I don't mean we get the Covid part, right. We get the forever chemicals part, right. Or the microplastics part, right. If you start getting this all right, good ventilation, better filtration, healthy materials across the board, energy efficient systems, so we're not drawing on the energy demand of our buildings that are contributing to the climate crisis. Buildings that also address climate adaptation and resilience. So they protect us from extreme heat, wildfire smoke, flooding that we know is coming and happening right now.(00:58:37):You put that all together and it shows the centrality of buildings on our collective health from our time spent indoors, but also their contribution to environmental health, which is ultimately our collective human health as well. And this is why I'm passionate about healthy buildings as a real good lens to put this all under. If we start getting these right, the decisions we make around our buildings, we can really improve the human condition across all of these dimensions we're talking about. And I actually don't think it's all that hard in all of these. I've seen solutions.Eric Topol (00:59:12):I'm with you. I mean, there's innovations that are happening to take the place of concrete, right?Joseph Allen (00:59:20):Sure. We have low emission concrete right now that's available. We have energy recovery ventilation available right now. We have real time sensors. We can do demand control ventilation right now. We have better filters right now. We have healthy materials right now.(00:59:33):We have this, we have it. And it's not expensive if we quantify the health benefits, the many, many multiple benefits. So it's all within our reach, and it's just about finding these different pathways. Some of its market driven, some of it's regulatory, some of it's at the local level, some of it's about raising awareness, giving people the language to talk about these things. So I do think it's the real beginning of the healthy buildings era. I really, truly believe it. I've never seen change like this in my field. I've been chasing sick buildings for a long time.Joseph Allen (01:00:11):And clearly there's pathways to do better.Eric Topol (01:00:13):You're a phenom. I mean, really, you not only have all the wisdom, but you articulate it so well. I mean, you're leading the charge on this, and we're really indebted to you. I'm really grateful for you taking an hour of your busy time to enlighten us on this. I think what you're doing is it's going to keep you busy for your whole career.Joseph Allen (01:00:44):Well, the goal here is for me to put myself out of business. We shouldn't have a healthy buildings program. It just should be the way it's done. So I'm looking forward to the time out of business, hopefully have a healthy building future, then I can retire, be happy, and we'll be onto the next big problem.Eric Topol (01:00:57):We'll all be following your writings, which are many, and fortunately not just for science publications, but also for the public though, they're so important because the awareness level as I can't emphasize enough, it's just not there yet. And I think this episode is going to help bring that to a higher level. So Joe, thank you so much for everything you're doing.Joseph Allen (01:01:20):Well, I appreciate it. Thanks for what you're doing too, and thanks for inviting me on. We can't get the word out unless we start sharing it across our different audiences, so I appreciate it. Thanks so much.Eric Topol (01:01:28):You bet.***********************************************A PollThanks for listening, reading or watching!The Ground Truths newsletters and podcasts are all free, open-access, without ads.Please share this post/podcast with your friends and network if you found it informative!Voluntary paid subscriptions all go to support Scripps Research. Many thanks for that—they greatly helped fund our summer internship programs for 2023 and 2024.Thanks to my producer Jessica Nguyen and Sinjun Balabanoff for audio and video support at Scripps Research.Note: you can select preferences to receive emails about newsletters, podcasts, or all I don't want to bother you with an email for content that you're not interested in. Get full access to Ground Truths at erictopol.substack.com/subscribe

This week on the Rick Flynn Presents podcast: "A living, breathing, example of what happens when education enters your life" ---Rick Flynn Dr. Candice Carpenter is Co-Founder, Co-Chief Executive Officer, and Chief Strategy Officer of The Boston Public Congress of Public Health, and also serves as Co-Editor-in-Chief of HPHR Journal. She is Executive Producer of the Great Health Debates, Inaugural Director of the BCPH Public Health Institute and Medical Academy, and Faculty for the BCPH Academy. She also serves as President/CEO/Founder of Candice Carpenter Ventures LLC and Infinity Ivy Consulting, a boutique academic/educational consulting firm. She is a physician-entrepreneur, healthcare innovator, educator, and social justice activist.She has participated in a number of prestigious fellowships, including the Biodesign Healthcare and Technology Fellowship at UCLA, the Equity/Diversity/Inclusion Fellowship at Harvard Chan School of Public Health, the Congress of Neurological Surgeons Leadership Program Fellowship, the Oxford Women Leaders in Entrepreneurship Programme, and the Oxford Social Entrepreneurship Program.She holds an MPH in Public Health Leadership and Health & Social Behavior from the Harvard Chan School of Public Health, an M.B.A. from Oxford University Said Business School, an M.D. from the University of Cincinnati College of Medicine, an Ed.M. in Mind, Brain, Education from the Harvard Graduate School of Education, and a B.A. in Psychology from Yale University. She is a licensed physician in California.She has been published in the Harvard Public Health Review, Oxford Business Review, and other scientific and academic journals. In addition to the several websites mentioned at the end of this show, Dr. Carpenter may also be reached on LinkedIn. --- Support this podcast: https://podcasters.spotify.com/pod/show/rick-flynn/support

The Lullaby Project brings together expectant mothers with professional songwriters to write, record, and perform an original lullaby for their baby. In 2017, Massey Hall and Roy Thomson Hall brought this heartwarming initiative to Toronto, and invited partners to participate, including Dr. Esther Bui, a neurologist who specializes in treating women with epilepsy. Today, we're exploring whether participating in a project like The Lullaby Project can improve overall mental health for pregnant women who are living with epilepsy. Featuring: Dr. Esther Bui - Neurologist and epilepsy specialist focusing on women's neurological health; Assistant professor and clinician educator within the Division of Neurology, Department of Medicine at the University of Toronto. Dr. Bui founded Canada's first and only accredited Women's Neurology Fellowship at the University of Toronto. She is currently the co-Director of the Women's Neurology Fellowship Program and the Director of the Epilepsy Fellowship program. Sharon Ng - Graduate student in neuroepidemiology at the Harvard Chan School of Public Health. She was previously a research assistant for Dr. Esther Bui at UHN, and worked with Dr. Bui to conceptualize the Lullaby Project Study. Sharon is now a collaborator on this study.Julianne Hazlewood – CBC journalist for more than a dozen years, at newsrooms across Canada. Her true love is longform audio storytelling. Becoming a mother is the latest and most joyous chapter in her life.  Additional resources: The Lullaby Project The Lullaby Project PlaylistJulianne Hazlewood's CBC radio documentary on White Coat Black ArtDr. Esther Bui interviewed in Season 2 of Your Complex Brain podcast - A New Era in Women's Brain Health: Closing the Gap on Delayed DiagnosisAdvancing Women's Neurology through Education, Research and Advocacy (U of T story featuring Dr. Esther Bui & Dr. Aleksandra Pikula)Dr. Esther Bui featured in UHN Foundation ‘Know Your Heroes' seriesThe Your Complex Brain production team is Heather Sherman, Jessica Schmidt, Dr. Amy Ma, Kim Perry, Sara Yuan, Meagan Anderi, Liz Chapman, and Lorna Gilfedder.The Krembil Brain Institute, part of University Health Network, in Toronto, is home to one of the world's largest and most comprehensive teams of physicians and scientists uniquely working hand-in-hand to prevent and confront problems of the brain and spine, such as Parkinson's, Alzheimer's, epilepsy, stroke, spinal cord injury, chronic pain, brain cancer or concussion, in their lifetime. Through state-of-the-art patient care and advanced research, we are working relentlessly toward finding new treatments and cures.Do you want to know more about the Krembil Brain Institute at UHN? Visit us at: uhn.ca/krembilTo get in touch, email us at krembil@uhn.ca or message us on social media:Instagram - @krembilresearchTwitter - @KBI_UHNFacebook - https://www.facebook.com/KrembilBrainInstituteThanks for listening!

Richard Denniss (pictured) heads The Australia Institute and is alarmed at the Australian Labor Government's latest Budget that champions gas, a fossil fuel. "More than 200 authors renew call for Baillie Gifford to divest from fossil fuel"; "Solicitor general to appeal over case of climate activist who held sign on jurors' rights"; "Wet winter could cut UK food self sufficiency by about a tenth"; "Talking Shop: Telling the Climate Story Locally"; "The unsung heroes keeping our lights on"; "The 1.5C global heating target was always a dream, but its demise doesn't signal doom for climate action"; "DeSantis signs bill scrubbing ‘climate change' from Florida law"; "Estuaries provide more than a billion dollars in environmental benefits, research shows"; "Solar power occupies a lot of space – here's how to make it more ecologically beneficial to the land it sits on"; "Consumer groups criticise energy companies charging solar panel owners for exporting power"; "Gas giants dodge tougher tax hike in Labor-Greens deal"; "Clean energy slump – why Australia's renewables revolution is behind schedule, and how to fix it"; "Denser housing can be greener too – here's how NZ can build better for biodiversity"; "Biden Looks to Thwart Surge of Chinese Imports"; "How Biden's Trade War With China Differs From Trump's"; "Copernicus: Record May wildfire emissions in British Columbia mark the start of the Canadian wildfire season"; "Microsoft's AI Push Imperils Climate Goal as Carbon Emissions Jump 30%"; "Summer 2023 Was the Northern Hemisphere's Hottest in 2,000 Years, Study Finds"; "How Wild Rice Forecasts Climate Change"; "The U.S. just took its biggest step yet to end coal mining"; "Industrial emissions aren't falling fast enough to meet US climate goals"; "‘Tone-deaf' fossil gas growth in Europe is speeding climate crisis, say activists"; "Wildfires keep thousands evacuated in Canada, even as conditions improve"; "Northeast B.C. was parched throughout winter. It's already on fire"; "How wildfire smoke is erasing years of progress toward cleaning up America's air"; "New tougher U.S. air pollution standards shaped by Harvard Chan School research"; "As Florida Smalltooth Sawfish Spin and Whirl, a New Effort to Rescue Them Begins"; "Climate Change Concerns Dip"; "La Niña is coming, raising the chances of a dangerous Atlantic hurricane season – an atmospheric scientist explains this climate phenomenon"; "New Rules to Overhaul Electric Grids Could Boost Wind and Solar Power"; "How Wildfires Can Affect Climate Change (and Vice Versa)"; "Converging Climate Risks Interact to Cause More Harm, Hitting Disadvantaged Californians Hardest"; "An NRL player died at training due to exertional heat stroke. What is it and what should coaches and athletes know?"; "Car companies spending up on ads for SUVs despite Australia's new fuel efficiency standards"; "Breathing Wildfire Smoke Could Raise Dementia Risk, New Study Finds". --- Send in a voice message: https://podcasters.spotify.com/pod/show/robert-mclean/message

A drive to reduce suicide mortality rates is a key indicator of the United Nations Sustainable Development Goals. Psychiatrist Shekhar Saxena, who led the World Health Organization's mental health and substance abuse program after working in clinical practice for more than two decades, says that although progress is being made, a worryingly high number of young people are choosing to end their lives.“They have to struggle through the school education, competitive examinations, then they have to struggle for a job,” says Saxena, who now teaches at Harvard Chan School of Public Health, in Cambridge, Massachusetts. “And many young people decide that dying is easier than struggling through for many years, which is very sad. It reflects the society that we live in where a young person does not feel that life is worth living.”In the third episode How to Save Humanity in 17 Goals podcast series, Saxena welcomes the inclusion of mental health in SDG 3 and its aim to ensure healthy lives and promote well-being for all at all ages. But he points out that countries on average spend less than 2% of their health budget on mental health, when the disease burden is around 10%. Each episode in the series features researchers whose work addresses one or more the targets. The first six episodes are produced in partnership with Nature Food, and introduced by Juliana Gil, its chief editor. Hosted on Acast. See acast.com/privacy for more information.

This bonus episode of Climate Rising features an episode from the Harvard Chan School of Public Health's podcast "Better Off" that explores the intersection of decarbonization and public health. While decarbonization requires shifting away from fossil fuels, this episode emphasizes the equally crucial health reasons to do so – especially for natural gas stoves. Tune in for a thoughtful conversation led by Anna Fisher-Pinkert of the Harvard Chan School of Public Health and her guests Brady Seals, Drew Michanowicz, and Jon Kung. Guest/Host: Anna Fisher-Pinkert, Director of Digital Strategy at Harvard T.H. Chan School of Public Health Brady Seals, Manager of RMI's Carbon-Free Buildings program Drew Michanowicz, senior scientist, PSE Healthy Energy Jon Kung, Chef For transcripts and other resources, visit climaterising.org

This month we're talking to a distinguished social epidemiologist and behavioural scientist at the Harvard Chan School of Public Health. Her name is Professor Bryn Austin, and her research focuses on public health approaches to eating disorders. Our conversation begins with an overview of the web that connects consumer culture, corporate exploitation, and the pervasive influence of diet culture on body image. “We've known for decades how harmful the consumer marketplace can be with diet culture, the diet industry, diet pills and supplements, and all the negative body image pressures that come through media, social media and advertising,” she says. “People have been writing about this for decades.” The problem is we still need to more deeply understand–and do more to address—what corporations are doing to exploit diet culture for profit. Don't miss Professor Austin's wise perspective. Not only does she share her thoughts on the complexities of the body image and eating disorders landscape, but she also discusses the transformative potential of strategic initiatives, including what her Harvard-based laboratory did to protect young Americans from predatory diet-industry profiteering. FIND OUT MORE ABOUT PROFESSOR BRYN AUSTIN READ ABOUT AUSTRALIA'S NATIONAL EATING DISORDERS STRATEGYSee omnystudio.com/listener for privacy information.

In August of 2023, the Food and Drug Administration issued something known as a direct final rule, disregarded trans fats in the food supply. Consumers won't notice changes as the rule just finalizes FDA's 2015 ruling that partially hydrogenated oils - trans fats - no longer had "GRAS status." GRAS stands for generally regarded as safe. We cover this issue today because this trans fat ban was the product of lots of work by a key group of scientists, the advocacy community, and others. The anatomy of this process can teach us a lot about harnessing scientific discovery for social and policy change. At the center of all this is today's guest, Dr. Walter Willett. Willett is one of the world's leading nutrition researchers. He is professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health, and for many years served as chair of its Department of Nutrition. He's published extensively, been elected to the National Academy of Medicine, and it turns out, is the world's most cited nutrition researcher. Interview Summary   There are so many things I could talk to you about because you do work in such an array of really important areas and have just made contribution after contribution for years. But let's talk about the trans fat because you were there at the very beginning, and it ended up with a profound public policy ruling that has major implications for the health of the country. I'd like to talk about how this all occurred. So, tell us, if you would, what are trans fats, how present were they in the food supply over the years, and what early discoveries did you and others make that led you to be concerned?   Yes, this is a story from which I've learned a lot, and hopefully others might as well. Trans fats are produced by the process called partial hydrogenation. This takes liquid vegetable oils, like soybean oils, corn oil, canola oil, and subjects them to a process with high heat and bubbling hydrogen through the oil. What this is doing is taking essential molecules, essential fatty acids like the omega-6 and omega-3 fatty acids and twisting their shapes just subtly, and this turns them into a solid fat instead of a liquid fat. And, of course, the food industry likes this because our culture, the Northern European eating culture, emphasizes solid fats like butter and lard. Industry really didn't know what to do with all the liquid oil that they were able to produce by another process that was discovered back in the late 1800s. The partial hydrogenation process was actually developed in about 1908, and someone actually got a Nobel Prize for that. It wasn't used widely in the food industry till the 1930s and 1940s when it was upscaled because it was cheaper, for multiple reasons, to partially hydrogenate oils and turn them into solid fats like Cricso and margarines. I got worried about this, actually, back in the 1970s, when other scientists were discovering that these essential fatty acids are important for many biological processes, clotting, arrhythmias, inflammation, and counteracting inflammation. I realized while studying food science at that time that there was nobody really keeping an eye on this. That there were these synthetic fatty acids in massive amounts in our food supplies. Margarines, vegetable shortenings were up to 30% and 40% made of trans fatty acids. And that may me concerned that this could have a big downside. So, back in 1980, with the help of some people at the Department of Agriculture developing a database for trans fats in foods, we began collecting data on trans fat intake in our large cohort studies. And about 20 years later, we saw that trans fat intake was related to risk of heart disease. We published that in 1993. That got us started on the pathway to getting them out of our food supply.   Let's talk about how present they were in the food supply. You mentioned some things like margarine and Crisco, but these fats were in a lot of different products, weren't they?   Yes, they were almost everywhere. You could hardly pick up a product that had a nutrition facts label that didn't say partially hydrogenated fat on it. It was really in virtually everything that was industrially made in our food system.   Just because they could produce them at low cost? Or did they have other properties that were desirable from the industry's point of view?   These trans fats had multiple characteristics. One, they could be solid. And again, because they mimicked butter and lard, it fit into lots of foods. Second, they had very long shelf life. Third, you could heat them up and use them for deep frying, and they could sit there in fryolators for days and not be changed. So, this was all good for the food system. It wanted really long shelf life and started with cheap ingredients.   So, after those initial findings that raised red flags, what kind of research did you do subsequently and at what level of proof did you feel policy change might be warranted?   Within our own group, we continued to follow our participants. These are close to 100,000 women in the Nurses' Health Study, and also another 50,000 in the health professionals follow up study. We confirmed our initial findings and then found that trans fats were related to risk of many other conditions, from diabetes to infertility. And simultaneous with our work in the 1990s, some of our colleagues in the Netherlands were doing what we called controlled feeding studies. These studies take a few dozen people and feed them high trans fat or low trans fat for a few weeks and watch what happens to risk factors like cholesterol levels and triglyceride levels. And they found that trans fats had uniquely adverse consequences. They raised the bad cholesterol, LDL cholesterol, and reduced the good cholesterol, HDL cholesterol. So, they had unique adverse biological effects. It was really that combination of that short-term kind of study and the long-term epidemiologic studies we were doing that made a compelling case that trans fats were the cause of cardiovascular disease.   So, a line of considerable work took place over a number of years, and then got to that point where you felt something needed to be done. And the fact that you did that science and that you were worried about these trans fats in the first place is impressive because you were really onto something important. But what happened after you did the series of studies? What steps occurred and who were the key actors that finally led to policy change occurring?   Well, as we expected, there was pushback from the industry about this because they were so invested in trans fat. And I was actually disappointed that a lot of our colleagues in the American Heart Association and others pushed back as well. They didn't want to distract from saturated fat. But, when studies were reproduced, it was really undeniable that there was a problem. But, if the studies had just been put on a shelf and sitting there, probably nothing would've happened. And it was really important that we partnered with advocacy groups, particularly Mike Jacobson, Margo Wootan at the Center for Science in the Public Interest, because they had a readership and audience that we didn't have. And they also were more familiar with the workings of the Food and Drug Administration and government in general. But I also was told somewhere around that time that women, who are the main food purchases, pay most attention to a lot of the women's journals, Family Circle, those kinds of journals. And actually, for good reasons. Their journalists are very good. So, I've talked to those journalists every opportunity. And it turned out it was really important to have some public awareness about this problem. If it was just good science and things worked as they should have, the FDA would've looked at the evidence and just ruled out trans fat from our food supply early on, but they didn't. It really took major concerted effort by the combination of the scientific community and the advocacy group.   Did you bump into conflict of interest problems with other scientists who were receiving funding from the industry and you know them talking to the press or speaking at conferences or things like that?   Well, there's plenty of conflicts of interest within the nutrition community, but actually, I don't think that was so much of an problem here. In some ways, there was a conflict of sort of personal commitment to entirely focusing on saturated fat and not wanting to see any distraction. I don't think a conflict of interest in the economic monetary sense.   Walter, I remember back when this discussion was occurring and industry was fighting back. They made claims that food prices would go up, that the quality of foods would go down, that it would be a real hit to their business because consumers wouldn't like products without the trans fats. What became of all those arguments?   It's interesting and it's important to keep in mind that the industry is not monolithic. And I have to credit Unilever, actually, with paying attention to the scientific evidence, which was really rejected here. Interestingly, at that time, all the major margarine manufacturers were owned by the tobacco industry. And you can imagine that those CEOs were not getting out of their bed in the morning and saying, well, what can I do to make Americans healthier? No, they were not interested in health. But Unilever was a food company and it was invested in staying as a food company for the continuing future. And they did realize that this was a problem, and they invested a lot of money to re-engineer their products, re-engineer their production of margarine and shortening. And they did take trans fat out of their products. They obviously did a lot of taste testing to make sure they were acceptable. And once they did that, the industry could no longer say that it's impossible to do it. It's sort of like the automobile industry when Detroit said, you just can't build low pollution cars, but then the Japanese did it and then they could no longer deny it.   Boy, it's such an interesting story that occurred. With Unilever getting involved as they did. That must have been a very positive push forward. They're second biggest food company in the world.   That was really helpful. And again, I think it was because they had a lot of scientists, both nutritionists and food chemists. I was told they had about 800 such employees at that time. They could see, if you looked at the evidence honestly, this was a serious issue. One of their chief scientists later told me that it was actually one of our editorials in the American Journal of Public Health where we estimated that there would be about 80,000 premature deaths per year due to trans fat. And once they saw that, they said, we can't have Willett going around saying there's going to be 80,000 premature deaths, and they realized they had to do something. It's interesting, you write an editorial, you don't know who's going to read it, but sometimes it hits one person who can really make a difference.   It is nice to know that people read things like that once in a while. Let's go to where you were at that point. You produced a lot of science. You were communicating this to professional audiences, but also to the general public with interviews and magazines and things like that. And the advocacy community, especially the Center for Science in the Public Interest, got activated. What happened then?   Well, a couple things happened. One is that they brought up and proposed labeling trans fat on the nutrition facts label and submitted that to the FDA. The FDA sat on it. There was, of course, lots of backdoor action by the American food industry that did not want to change what they were doing. And despite some prodding by CSPI over the years, that sat there for about 10 years almost. Ironically, there was a faculty member at Harvard Chan School of Public Health at that time who had seen a display we had done on trans fat. We built a big tower out of blocks of trans fat and had a little poster there talking about it. He went to Washington and became a senior person at the Office for Management and Budget. And Mike Jacobson went to go visit him with a petition to label trans fat, and our faculty person said, I know about trans fat because Willnett had that display in our cafeteria. He wrote a letter to the FDA that was quite unprecedented, basically saying that either put trans fat on the food label or tell us why not. Which is a quite strong letter. And then the wheels started turning, and there was delay and delay for a pushback on the food industry. But by 2008, trans fat actually did get on the food label. And that had a very major impact, because once it had to be on the label, the food industry took it out. They sort of knew it was coming because they didn't want to admit it publicly. But I think they understood for quite a while that they were going to have to get it out, but that was really the turning point. All of a sudden, almost all the food products had zero on the trans fat line there.   Let's talk about the public health impact of this. You mentioned 80,000 or some deaths occurring each year attributable to consumption of trans fat. Can we conclude from that that we're saving that many lives now with trans fat out of the food supply? And does that mean 80,000 lives year after year after year?   It's hard to know exactly and of course, so many things are going on at the same time. And the trans fat didn't go down abruptly because Unilever was, even in the American market, a pretty major producer, starting by the mid 1990s, trans fat intake actually did start to go down. And other things are going on, obviously obesity epidemic counterbalancing a lot of positive things that were happening. But, there were some economists looking at communities that adopted trans fat bans early on versus those that did not, and they could show there was a divergence in heart attacks and hospitalizations for heart disease. So it's hard to pin an exact number on it, again, because all these things happen at the same time. But it's quite clear that we would be having quite a bit more heart disease if trans fat had not been eliminated. I would also look back to another important step in the process because even though we got trans fat on the food label, and the products that had it quite quickly became, almost all of them, zero trans fat, but that didn't deal with a restaurant industry, which was also a very big source of trans fat. And there it took community activists to make this happen. There was a small community in Northern California that was really the first community that banned trans fat in restaurants, and a few other places did. But then Mayor Bloomberg of New York, there's another backstory why he got interested in this. But it's one of these things, you put out information and you don't know who's going to read it, and someone had read some of our work and to convince his health department and Bloomberg himself that trans fats had to go, and New York banned trans fats. And then some other communities, Massachusetts and elsewhere in the food industry, the restaurant industry realized they couldn't have a patchwork distribution system. And so that was a tipping point that trans fat was eliminated in the food service industry long before the FDA finally made the ruling. In fact, by the time the FDA made the ruling about trans fat and pressure hydrogenated fat, it was almost gone.   To go back and look at the history of this, it's a relatively small number of key people taking the right actions at the right time that ultimately led to change. And thank goodness for those people like you and Mike Jacobson, Margo Wootan, and Mayor Bloomberg, and a few other people in political circles that took the bull by the horns and really got something done. Very impressive. As you look back on this, what lessons did you learn that you think might be helpful for future policy changes?   I think there are a number of lessons. I'd like to think, first of all, that solid good science is really important. Without that, we couldn't have a hard time making changes that we need to do. But that's usually not going to be enough. It's really important to work with advocacy groups like CSPI. It's important, sometimes, to work with journalists and provide good information, education. But it's hard to know exactly which path is going to be successful. One thing is quite clear, in this country, in many areas, change does not happen from the top. It's not enough just to have good science. And oftentimes, changes happen from the bottom up at the local level, the state level, and the national government may be the last place where action occurs.   So what changes in the food supply do you feel would be most pressing right now?   We certainly have a lot of problems in our food supply. If you look around, most people are consuming diets and beverages that are quite unhealthy. And there are so many issues, I think, still and we've worked on this issue is a sugar sweetened beverage issue, and we've had some real progress in that area, but still, there's a huge way to go to reduce sugar sweetened beverages. But that's part of a bigger problem in terms of what we're consuming. And I would call that carbohydrate quality, that about half of our calories come from carbohydrates. In about 80% of that half, in other words, about 40%, of all the calories we consume are refined starch, sugar, and potatoes which have adverse metabolic effects, lead to weight gain, lead to diabetes, lead to cardiovascular disease. So that's a huge area that we need to work on.   You've talked, so far, with the trans fat and, you know, and with other things in the food supply like salt, these are things that you'd be taking out of the food. That all makes good sense. What about putting things in? Talk about things that might support the microbiome, more fiber, or things that might support brain health and things like that, so what are your feeling about those things?   You're right, our problems are both what's there in quantities that are unhealthy and also what's missing. Inadequate fiber intake is actually part of the carbohydrate problem. Clearly, we should be consuming many more whole grains compared to the amount of refined grains that we consume. And, of course, we get some fiber from fruits and vegetables. So I think, in addition to this huge amount of unhealthy carbohydrates and inadequate amount of whole grains, we do need to be consuming more fruits and vegetables. And then on the sort of protein source side, we're clearly consuming too much red meat and replacing that with plant protein sources like nuts, legumes, and soy products would be really important for direct human health. But also, that's an area where the environmental and climate change issues are extremely pressing and shifting from a more animal-centric diet to more plant-centric diet would have enormous benefits for climate change as well as direct effects for human health.   Bio   Walter C. Willett, M.D., Dr. P.H., is Professor of Epidemiology and Nutrition at Harvard T.H. Chan School of Public Health. Dr. Willett studied food science at Michigan State University, and graduated from the University of Michigan Medical School before obtaining a Masters and Doctorate in Public Health from Harvard T.H. Chan School of Public Health. Dr. Willett has focused much of his work over the last 40 years on the development and evaluation of methods, using both questionnaire and biochemical approaches, to study the effects of diet on the occurrence of major diseases. He has applied these methods starting in 1980 in the Nurses' Health Studies I and II and the Health Professionals Follow-up Study. Together, these cohorts that include nearly 300,000 men and women with repeated dietary assessments, are providing the most detailed information on the long-term health consequences of food choices. Dr. Willett has published over 2,000 original research papers and reviews, primarily on lifestyle risk factors for heart disease, cancer, and other conditions and has written the textbook, Nutritional Epidemiology, published by Oxford University Press, now in its third edition. He also has written four books for the general public. Dr. Willett is the most cited nutritionist internationally. He is a member of the National Academy of Medicine of the National Academy of Sciences and the recipient of many national and international awards for his research.  

Dr. Andrea Feigl is a distinguished expert in healthcare economics. As the Founder and CEO of the Health Finance Institute, and with a background in research at Harvard Chan School of Public Health, her expertise spans health systems financing, governance, universal healthcare, and cost-effective interventions for chronic diseases, particularly in developing nations.In our discussion, Dr. Feigl emphasizes the game-changing potential of healthcare investment, especially in chronic disease management. We'll touch on health finance, strategies for promoting healthy behaviors on a large scale, and integrating private and public sectors to address significant challenges. Join me for this enlightening discussion with Dr. Andrea Feigl, a Health Economist, Scientific Advisor, and the visionary CEO of the Health Finance Institute.Link to purchase:Purchase Your Berry Blaster HereFYLPxWRDSMTH Merch Collaboration*suggestion is to size upDownload this episode of For Your Listening Pleasure wherever you get your podcasts! Make sure you follow us on Instagram @foryourlisteningpleasure Click here to listen to the For Your Listening Pleasure Theme Song Playlist on Spotify.To continue the conversation, feel free to DM me at https://www.instagram.com/foryourlisteningpleasure/ or email me at foryourlisteningpleasure@gmail.com.

In the International Series, we interview international vascular surgeons and trainees with the focus of learning and exploring how vascular surgery is practiced around the world and by doing so, gain new insight into how we practice vascular surgery in the United States. In today's episode, Ezra Schwartz interviews Dr. Ahmed Kayssi, a vascular surgeon in Canada.    Dr. Ahmed Kayssi is a vascular surgeon at Sunnybrook Health Sciences Centre, an Assistant Professor at the University of Toronto and an associate scientist in evaluative clinical sciences at the Sunnybrook Research Institute. Dr. Kayssi completed his general surgery residency and vascular surgery fellowship at the University of Toronto and a limb preservation and wound care fellowship under the supervision of Dr. Richard Neville. Dr. Kayssi holds a Master's degree in Public Health from the Harvard Chan School of Public Health and is currently pursuing a Doctorate of Public Health in Health Policy and Management from the Johns Hopkins School of Public Health under the supervision of Dr. Lilly Engineer. Dr. Kayssi recently joined the editorial board of Seminars in Vascular Surgery.  Contact Information:  Dr. Ahmed Kayssi  Email: ahmed.kayssi@sunnybrook.ca Twitter: Dr. Ahmed Kayssi (@ahmedkayssi) Dr. Ezra Schwartz (@ezraschwartz10) Dr. Morgan Gold (@morgansgold) University of Toronto Division of Vascular Surgery Articles, resources, and societies referenced in the episode: Canadian Society of Vascular Surgery Research Committee Wounds Canada and Wounds Canada Research Committee Canadian Medical Protective Association Dr. Charles de Mestral University of Toronto Limb Preservation Fellowship Dr. Heather Gill,  The PREHAAAB Trial, and Preoperative Exercise Rehabilitation in Cardiac and Vascular Interventions International Symposium on the Diabetic Foot SVS Vascular Annual Meeting 2024 Canadian Society of Vascular Surgery Annual Conference Health Canada. Canada's Health Care System - Canada.ca.   Canada: Health system review. Health Systems in Transition

If your business is anchored in driving social change like ours is at Safi Media, you'll resonate with the challenge that exists around using your business as a container to drive systemic change in the world. Eleanor's guest this week is a powerful example of a woman entrepreneur who is using the vessel of entrepreneurship to right a global wrong, specifically, the wrong that is chronic disease.   Dr. Andrea Feigl, PhD MPH, is the founder and CEO of the Health Finance Institute, a former researcher at Harvard Chan School of Public Health, and a former health economist with the Organization for Economic Cooperation and Development. Her work is all about solving some of the thorniest issues that continue to plague the world, and she's here this week to share how she's using her business to make a difference in the international development space.   Get full show notes and more information here: https://safimedia.co/ai12

This week on Faisel & Friends, we are discussing Proactive Preventive Primary Care. We are talking with Dr. Troy Brennan, an Adjunct Professor at the Harvard Chan School of Public Health.Our conversation explores improving access to care with technology, forging intimacy and trust in different situations, and primary care outside of the hospital.

Honored to be among such brilliant minds and change-makers. Mental health should not be the sole responsbility of the individual but a collective concern at the community & federal levels. Here are my takeaways! #mentalhealth #awareness #healing #stigma #harvard @Harvard Chan School

Why is whole-person care so important? And, is it even possible to shift our current model in that direction? Former North Carolina Secretary of Health Dr. Mandy Cohen joins us to talk about why a shift to whole-person care is the right approach and how she generated bi-partisan support for North Carolina's groundbreaking Healthy Opportunities Pilots which are providing food, housing and other services to Medicaid enrollees. She shares leadership lessons from COVID and perspectives on the data infrastructure states will need to support whole person health. Relevant LinksHealth Affairs article: “Buying Health for North Carolinians”https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.01583Federal approval of Healthy Opportunities Pilotshttps://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/nc-medicaid-reform-demo-cms-approval-attachment-g-healthy-opport-pilots-eligib-services.pdfKaiser issue brief on North Carolina Pilotshttps://www.kff.org/report-section/a-first-look-at-north-carolinas-section-1115-medicaid-waivers-healthy-opportunities-pilots-issue-brief/About Our GuestDr. Mandy Cohen served as the Secretary of Health in North Carolina from 2017 to 2022, where she led the State's COVID response and the transformation of the Medicaid Program - focusing on whole-person care and the social drivers of health. Dr. Cohen also served as the COO and Chief of Staff at CMS, helping implement the Affordable Care Act. She was recently named the EVP of Aledade Inc and the CEO of Aldade Care Solutions - scaling value-based care with doctors in charge. Dr. Cohen received her MD from Yale University School of Medicine and her Masters in Public Health from Harvard Chan School of Public Health. Dr. Cohen has been elected to the National Academy of Medicine and is an adjunct professor at the UNC Gillings School of Global Public Health. She trained in internal medicine at Massachusetts General Hospital. Connect With UsFor more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow Claudia on twitter @claudiawilliams and LinkedIn https://www.linkedin.com/in/claudiawilliamshealthdata/

In this episode, we speak with Thamara Subramanian on a broad range of topics on Diversity, Equity, Inclusion, and justice. Thamara is a born and bred Kansas Citian passionate about the intersection between health and social justice. She currently serves as the Equity Audit and Strategy Manager for The Winters Group. She is responsible for uncovering insights in data to help organizations embed anti-racism and reimagine how their policies and practices either support or impede equity and justice. Thamara shares her insights and leadership throughout the community with involvement with Girls on the Run and Big Brothers Big Sisters KC. Thamara has a BS in Psychology and Anthropology from the University of Michigan and an MPH in Health and Social Behavior from the Harvard Chan School of Public Health, where she served as an Equity, Diversity, and Inclusion Fellow.

As COVID-19 swept through American prisons and jails in 2020, wardens scrambled to keep prisoners and corrections officers from getting sick. One strategy was to increase solitary confinement. Health experts warn that solitary confinement increases the risk of mental illness and suicide, but the practice continues. Today, about 2 million people are incarcerated in the U.S. In this episode of the Better Off podcast, we'll ask: Is it possible to build a corrections system that accounts for their health and safety? Guests:Jasmine D Graves, Ph.D. student, Population Health Sciences program, Harvard T.H. Chan School of Public HealthMonik Jimenez, Assistant Professor in the Department of Epidemiology, Harvard T.H. Chan School of Public HealthCredits:Host/producer: Anna Fisher-PinkertThe Better Off team: Kristen Dweck, Elizabeth Gunner, Pamela Reynoso, Stephanie Simon, and Ben WallaceAudio engineering and sound design: Kevin O'ConnellAdditional research: Kate Becker

Jan. 11, 2023 - Before 2022 ran out, Gov. Kathy Hochul vetoed legislation that would have prohibited the sale of over-the-counter diet pills and dietary supplements to minors. Harvard Chan School of Public Health professor Dr. Bryn Austin explains the safety concerns with non-prescription diet offerings and discusses how the proposed restrictions would protect young people.

Jan. 11, 2023 - Before 2022 ran out, Gov. Kathy Hochul vetoed legislation that would have prohibited the sale of over-the-counter diet pills and dietary supplements to minors. Harvard Chan School of Public Health professor Dr. Bryn Austin explains the safety concerns with non-prescription diet offerings and discusses how the proposed restrictions would protect young people.

Jan. 11, 2023 - Before 2022 ran out, Gov. Kathy Hochul vetoed legislation that would have prohibited the sale of over-the-counter diet pills and dietary supplements to minors. Harvard Chan School of Public Health professor Dr. Bryn Austin explains the safety concerns with non-prescription diet offerings and discusses how the proposed restrictions would protect young people.

Guests:Ana Rausch, Vice President of Program Operations at Coalition for the Homeless of Houston/Harris CountyKimberley Richardson, therapistMaggie Sullivan, family nurse practitioner, Boston Health Care for the Homeless and instructor and human rights fellow, FXB Center, Harvard UniversityCredits:Host/producer: Anna Fisher-PinkertThe Better Off team: Kristen Dweck, Elizabeth Gunner, Pamela Reynoso, Stephanie Simon, and Ben WallaceAudio engineering and sound design: Kevin O'ConnellAdditional research: Kate Becker

This week, please join author Judith Hochman, Editorialist Steven Bradley, and Guest Host Mercedes Carnethon as they discuss the article " Survival After Invasive or Conservative Management of Stable Coronary Disease" and editorial “If the Fates Allow: The Zero-Sum Game of ISCHEMIA-EXTEND.” Dr. Greg Hundley: Welcome everyone to our new year 2023, and we are here on this January 3rd edition of Circulation on the Run. I'm Dr. Greg Hundley, Associate Editor, Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Peder Myhre: I am Dr. Peder Myhre, Social Media Editor and doctor at the Akershus University Hospital and University of Oslo. Dr. Greg Hundley: Very nice. Well, welcome listeners and this week's feature, ah, very interesting. You know many times patients with stable coronary artery disease, we're seeing a lot in the literature about an invasive strategy versus a conservative strategy. But what happens long term for these patients? What's their prognosis? Well, more to come in the feature discussion. But first, how about we grab a cup of coffee and we discuss some of the other issues in this session. Peder, would you like to go first? Dr. Peder Myhre: Yes, Greg I would love to and the first paper today is very interesting and relates to one of the most important challenges globally, namely climate changes and extreme temperatures. And in this paper, which comes to us from corresponding author, Barrak Alahmad from Harvard Chan School of Public Health in the United States, together with a large international group of authors, investigated the associations between extreme temperatures and cardiovascular cause-specific mortality in 567 cities in 27 countries from 1979 to 2019. Dr. Greg Hundley: Wow Peder, that is a really large comprehensive study. So, how did they perform this analysis? What did they find? Dr. Peder Myhre: So Greg, the investigators collected city-specific daily ambient temperatures from weather stations and analyzed cause-specific cardiovascular mortality and excess deaths in association with extreme hot and extreme cold temperatures. And in total, the analysis included more than 32 million deaths from any cardiovascular cause, which were subdivided into deaths from ischemic heart disease, stroke, heart failure and arrhythmia and at extreme temperature percentiles. And that is defined as heat above the 99th percentile and as cold below the first percentile were associated with a high risk of dying from any cardiovascular cause, ischemic heart disease, stroke and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. And Greg, across a range of extreme temperatures, hot days above the 97.5 percentile and cold days below the 2.5 percentile accounted for more than two and more than nine excess deaths for every thousand cardiovascular death respectively. And heart failure was associated with the highest excess death proportions from extreme hot and cold days. So Greg, it seems like extreme temperatures really impact the cardiovascular mortality across the globe. Dr. Greg Hundley: Yeah, beautiful description Peder. And I think what was really exciting about that particular article is you had results from 27 countries. Wow, so really quite a global study and very informative. Dr. Peder Myhre: Yes, indeed very impressive. Dr. Greg Hundley: Well, Peder my next study comes to us from the world of preclinical science. And Peder, these investigators led by Professor Jose Luis de la Pompa from CNIC, evaluated two structural cardiac diseases, left ventricular non-compaction and bicuspid aortic valve. And they wanted to determine if those two conditions were caused by a set of inherited heterozygous gene mutations affecting the notch ligand regulator, Mind bomb-1 and co-segregating genes. Dr. Peder Myhre: Okay Greg, so we are looking at mechanisms for non-compaction and bicuspid aortic valve. What did they find? Dr. Greg Hundley: Right Peder, so whole exome sequencing of the left ventricular non-compaction families identified heterozygous missense mutations in five genes co-segregating with E3 ubiquitin protein ligase-1 Mib-1 as well as left ventricular non-compaction. And corresponding mouse models showed that left ventricular non-compaction or bicuspid aortic valve in a notch-sensitized genetic background. Now, also gene profiling showed that increased cardiomyocyte proliferation and defective morphological and metabolic maturation in mouse hearts and human pluripotent stem cell cardiomyopathy. Biochemistry suggested a direct interaction between notch and some of the identified gene products. And so, these data Peder support a shared genetic basis for left ventricular non-compaction and bicuspid aortic valve with Mib-1 notch playing a crucial role. And thus, identification of heterozygous mutations leading to left ventricular non-compaction or bicuspid aortic valve may allow us to expand the genetic testing panel repertoire for better diagnosis and or risk stratification of both of these conditions, left ventricular non-compaction and bicuspid aortic valve. Dr. Peder Myhre: All right, that is really great and novel linking left ventricular non-compaction to bicuspid aortic valve, really great. And now Greg, we're going to go back to clinical science and we're going to talk about lipoprotein(a) or Lp(a). And as you know, elevated Lp(a) is a common risk factor for cardiovascular disease outcomes with unknown mechanisms. And the authors of this next paper coming to us from corresponding author Olli Raitakari from University of Turku in Finland, examined Lp(a)'s potential role in identifying youths who are at increased risk of developing adult atherosclerotic cardiovascular disease, ASCVD. And they did this by measuring Lp(a) in youths nine to 24 years old and linking that to a diagnosis of ASCVD as adults and also linking it to carotid intermediate thickness in the Young Finns Study. And in addition, these results were validated in the Bogalusa Heart Study. Dr. Greg Hundley: Oh, very nice Peder. So, what did they find? Dr. Peder Myhre: So Greg, those who have been exposed to high Lp(a) levels in youth and that was defined as greater than or equal to 30 milligrams per deciliter, had about two times greater risk of developing adult ASCVD compared to non-exposed individuals. In fact, all the following youth risk factors were independently associated with a higher risk. Lp(a), LD, cholesterol, body mass index and smoking all independently associated with ASCVD. And similar findings were made in the validation cohort who were participants with a high Lp(a) had 2.5 times greater risk of developing adult ASCVD compared to non-exposed individuals. And this also persisted in adjusted models. Now, what about the carotid intermediate thickness? In that analysis, there were no associations detected to youth Lp(a) levels in either of the cohorts. Dr. Greg Hundley: Very nice, Peder. So, great description of the utility of lipoprotein(a) measurements in the youth and for predicting future major cardiovascular events. Well, the next paper goes back to the world of preclinical science. And Peder, cardiac hypertrophy increases demands on protein folding, which causes an accumulation of misfolded proteins in the endoplasmic reticulum. Now, these misfolded proteins can be removed via the adaptive retro-translocation, poly-ubiquitylation and a proteasome mediated degradation process. The endoplasmic reticulum-associated degradation, ERAD, which altogether as a biological process and rate has not been studied in vivo. So, these investigators led by Dr. Christopher Glembotski from University of Arizona College of Medicine, investigated the role of ERAD in a pathophysiological model and they examined the function of the functional initiator of ERAD, VCP-interacting membrane protein and positing that the VCP-interacting membrane protein would be adaptive in pathological cardiac hypertrophy in mice. Dr. Peder Myhre: Thanks Greg. So, we're talking about degradation of the endoplasmatic reticulum and the association to hypertrophy. So, what did these investigators find, Greg? Dr. Greg Hundley: Right, Peder. So, this was really the first study to demonstrate that endoplasmic reticulum-associated protein degradation or ERAD is responsible for degrading and thus, regulating the levels of a cytosolic non-endoplasmic reticular protein. The results reported here describe a new mechanism mediating the pathological growth of the heart, such that in the healthy heart SGK-1 levels are low due to ERAD-mediated degradation. While in the setting of pathology, ERAD-mediated degradation of SGK-1 is disrupted, allowing the pro-growth kinase to accumulate and contribute to pathological cardiac hypertrophy. And so Peder, the clinical relevance of these findings is that the investigators found that a variety of proteins that constitute the ERAD machinery were decreased in both mouse and human heart failure samples while SGK-1 was increased, supporting the possibility that SGK-1 is a contributor to the disease phenotype. And this is notable and that these studies could lead to the development of new therapeutic approaches for managing pathological cardiac hypertrophy and heart failure that target the ERAD to restore efficient SGK-1 degradation. Dr. Peder Myhre: That was an excellent explanation of a very difficult topic. Thank you, Greg. Dr. Greg Hundley: Well, Peder how about we take a look and see what else is in the issue? And now I'll go first. Well, first there's an In Depth by Professor Ntsekhe entitled, "Cardiovascular Disease Among Persons Living with HIV: New Insights into Pathogenesis and Clinical Manifestations within the Global Context." And then, there's a Research Letter by Professor Verma entitled, "Empagliflozin in Black Patients Versus White Patients With Heart Failure: Analysis of EMPEROR results-Pooled." Dr. Peder Myhre: Great Greg and there is an On My Mind by Gabriel Steg entitled, "Do We Need Ischemia Testing to Monitor Asymptomatic Patients With Chronic Coronary Syndromes?" Very timely and interesting. And finally, there is an AHA Update from Michelle Albert, the President of the AHA entitled, "Tackling Adversity and Cardiovascular Health: It is About Time." Dr. Greg Hundley: All right. Well Peder, how about we get onto that feature discussion looking at survival after invasive or conservative management in stable coronary heart disease? Dr. Mercedes Carnethon: Thank you so much for joining us for this episode of Circulation on the Run. I'm Mercedes Carnethon, Professor and Vice Chair of Preventive Medicine at the Northwestern University, Feinberg School of Medicine. And I'm very excited today to have as a guest, Dr. Judith Hochman, who is going to be discussing the long-awaited findings from the ISCHEMIA-EXTEND trial that are looking at survival after invasive or conservative management of stable coronary disease. Really pleased to have you with us today, Judy to hear about these findings. Dr. Judith Hochman: It's a pleasure to be here. Dr. Mercedes Carnethon: Thank you. So, just to start off, can you tell us about this study? What motivated this long-term follow-up of this particular trial? Dr. Judith Hochman: Yeah, so as I think the viewers or the listeners will recall, we built on a wealth of data from COURAGE and BARI 2D, some of the landmark trials that looked at revascularization versus optimal medical therapy or guideline-directed medical therapy alone. We tested an invasive strategy versus a conservative strategy dating back already to 2012 is when we started. And we had a five component primary outcome, which included cardiovascular death, myocardial infarction or hospitalization for unstable angina, heart failure or resuscitated cardiac arrest. And at the end of 3.2 median years of follow-up, we saw no difference in the primary outcome in that the curves crossed with some excess risk upfront due to periprocedural MI and decreased risk of spontaneous MI long-term. But the net overall timeframe spent free of event was similar between the groups. So, we did observe improved quality of life for the invasive strategy, but in terms of clinical outcomes there was no difference. So, cardiovascular death at the end of that time period was no different between the groups, all-cause mortality was no different, non-cardiovascular death, there was actually an increase in the invasive group, which was somewhat of a mystery. We can get into that a little bit later because I think that becomes important. But 3.2 years meeting and follow-up is relatively short. So, everyone was very interested in what would the long-term outcomes be. So, we had another grant from the National Heart, Lung and Blood Institute to follow these patients long-term. And this is an interim report with seven years of follow-up, a median of 5.7 years. And the bottom line is that all-cause mortality was the same at seven years but for the first time, an invasive strategy resulted in lower cardiovascular mortality, which was very interesting and very exciting except that it was offset, exactly offset by the continued excess that we had previously observed in non-cardiovascular mortality. And that's basically the upshot of what we just reported and why we continue to follow patients and why we're going to continue to follow patients and have a final report in 2026. Dr. Mercedes Carnethon: This is really fantastic work. As you point out, the initial follow-up was fairly short and the findings were so critically important demonstrating that there were subtle differences between the two approaches but that overall, things appeared relatively similar. Did it surprise you? Oh, please correct me. Dr. Judith Hochman: I should point out that because there were less spontaneous MIs during follow-up and spontaneous MIs are associated with a heightened risk of subsequent death more so than the periprocedural MIs, we did hypothesize and we're very interested in longer term cardiovascular and all-cause mortality thinking that those reduced spontaneous MIs in the invasive group would be associated with reduced cardiovascular death and perhaps reduced mortality. As I did indicate, cardiovascular death mortality was reduced but all-cause mortality was the same with a hazard ratio of 1.0. Dr. Mercedes Carnethon: Well, nothing seems more clear than a hazard ratio of 1.0 with those very tight confidence limits so thank you so much. I'm really pleased that our editorialist, Dr. Steve Bradley was also able to join us today because to hear his thoughts about where this fits in the context of what we know can be really insightful. So, I'd really love to turn to you, Dr. Bradley. In your opinion, why was this study question so important and tell us a little bit about how you think the clinical field should use these findings. Dr. Steven Bradley: Absolutely and thanks for having me. I think there were some indication that perhaps the farther we follow the patients out from the original ISCHEMIA trial that we might start to see some evidence of benefit for revascularization. I think Dr. Hochman spoke about the evidence of more of these spontaneous myocardial infarctions that were happening in the non-revascularization arm of the study and an association with worse cardiovascular outcomes in patients that experience spontaneous events. And so, the thoughts might be that over time we would see the benefit of that. And certainly if you parse out cardiovascular versus non- cardiovascular outcomes, we do, we see lower rates of cardiovascular death in the patients who undergo revascularization but it's balanced out by non-cardiovascular death. And so, it becomes a zero sum game for a patient. They want to be alive, it doesn't matter by what mechanism. So, if we have a therapy that doesn't actually prolong their life but it leads to different mechanisms by which they have an outcome, that's important for us to understand. This adds to an already robust evidence-based that ISCHEMIA really did inform and it gives us that long-term trajectory to help us understand for patients what the implications are. I will note that and we've commented in the editorial and this is something that was shown in the original ISCHEMIA trial, that it's not just about mortality for patients, it's important that we help them live better as well. And certainly we know that revascularization is associated with quality of life improvement so that's an important part of the conversation with patients. But again, continuing to refine our understanding of what the implications of revascularization are for mortality is where this study leads us now. Dr. Mercedes Carnethon: Thank you so much. One of the things that I find so impressive about clinical trials of this scale are that you incorporate such a broad audience. I note that 36 countries contributed data to this particular trial. I wonder whether, did you have an opportunity to investigate whether these findings were similar in low and middle income countries as compared with higher income countries? And how would you expect clinicians in low and middle income countries to use this information? Dr. Judith Hochman: That's a great question and yes, the treatment effect was similar across regions, didn't really have any very low income regions but we did have India was in the study and a number of South American countries. And I think it's incredibly important for those countries where there are very limited resources to reassure them, the practitioners and their patients that just because they can't afford an expensive invasive procedure, stenting or bypass, does not mean it's going to cut their life shorter, it's not going to make them survive for a shorter amount of time. Therefore, they can limit the use of scarce resources to the most severely impaired in terms of quality of life, the patients with the most frequent angina. It also became extremely relevant during COVID. Dr. Mercedes Carnethon: Tell me more. Dr. Judith Hochman: Well, elective procedures were shut down during COVID and more publications that cited the ISCHEMIA trial to say that they felt comfortable not being able to do elective stenting in patients with stable ischemic heart disease that would've met the ISCHEMIA trial criteria, which by the way we should add was preserved ejection fraction, we excluded ejection fraction less than 35, patients had to be stable. They could not have had two coronary syndrome within the last few months. They could not have had angina refractory to medical therapy and they could not have had left main disease. So, those are key. There are other exclusion criteria but those are the key exclusion criteria. Dr. Mercedes Carnethon: Thank you for that. And I can really see a corollary and I appreciate the messaging around similar outcomes and preserving resources. And I think certainly even within our own country where we see vast differences in access to intensive medical therapies or tertiary care medical centers who do these procedures on a higher volume, at least we can feel reassured that outcomes may be quite similar as far as mortality. What do you- Dr. Judith Hochman: If they take their guideline-directed medical therapy. Dr. Mercedes Carnethon: Thank you for pointing that out. Dr. Judith Hochman: It's incredibly important. John Curtis' group looked at adherent patients by the modified Morisky score versus non-adherent patients. Non-adherent patients don't have as good a health status as adherent patients. So, just that also adds to a wealth of literature that you have much better outcomes if you actually take your medications. Dr. Mercedes Carnethon: No, I think that's a very good point. What are your thoughts, Steve on what the next steps might be? Dr. Steven Bradley: Well, I know that as was pointed out earlier, there's going to be the opportunity to see additional longer term follow-up beyond this interim analysis. So, it'll be interesting to see what that continues to show us in terms of understanding applications on mortality. I'll pose a question that we posed within our editorial around trying to identify non-fatal outcomes to see if there are any opportunity to capture those non-fatal outcomes to give us an understanding of potential mechanisms for why there is this cardiovascular versus non- cardiovascular mortality difference by treatment arm? Certainly, that may be helpful. Dr. Judith Hochman: Sorry. We're very, very interested in the excess in non-cardiovascular death. So, we are as a result of this interim analysis, revising our case report form, which was very lean, pragmatic because the funding is relatively limited to include especially collection of data around malignancy. Because as we reported before, the non-cardiovascular deaths were largely malignancy and to some extent infection. And what was driving the difference, the excess in non-cardiovascular death as we published in American Heart Journal in the invasive group was excess malignancy. Dr. Mercedes Carnethon: That's really interesting. Dr. Judith Hochman: To our deep surprise and shock, it appeared that the only variable associated with that excess risk was the number of tests or procedures you had that involve radiation. And of course, we're talking about medical doses of radiation. And this short timeframe, three and a half to seven years, which is when the curve started to diverge to three and a half, we filed to seven years is not thought to ... it's thought to be too short a timeframe for exposure to radiation to lead to excess malignancy. So, we have partnered with some radiation experts, we are adding much more details to our case report form, not only in terms of death from malignancy but just the occurrence of malignancy. Did you get malignancy during the course of follow-up? And that's really critically important. We are not adding information about additional myocardial infarctions. We think that the key, if we're going to focus on site burden and how much they can actually collect, is to look at the mechanisms of death and the occurrence of malignancy, whether that leads to death or not, those are our top priorities at this point. Dr. Mercedes Carnethon: I could go on and on, I'm learning so much speaking with the two of you. And again, that really is the primary goal of our podcast to really have an opportunity to extend beyond what's written in the paper and really hear directly from the authors who led the study to hear your thoughts as well as those of the editorialists on where this is going. I really want to thank you both for the time you've spent today to share with our audience of the Circulation on the Run podcast. Dr. Judith Hochman: You're very welcome. Dr. Steven Bradley: My pleasure. Dr. Mercedes Carnethon: I just want to thank all of our listeners for joining us on this really stimulating discussion today on this episode of Circulation on the Run. Please tune in next week where we will have more exciting discussions like this one. Thank you. Dr. Greg Hundley: This program is copyright of the American Heart Association 2023. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

Today, we're excited to get to know Caitlin Reiche, Chief Commercial Officer at Zus Health — the first Chief Commercial Officer we've had on the podcast! Founded in 2020, Zus Health is a health data platform designed to accelerate healthcare data interoperability by providing easy-to-use patient data at the point of care. At Zus, Caitlin leads the commercial organization with the goal of growing the Zus builder community and is responsible for marketing, sales, partnerships and customer success. Prior to Zus, Caitlin was the Chief Operating Officer of Buoy Health and led Product Strategy at Patient Pop and Athenahealth. She graduated with a MS in Health Policy and Management from Harvard Chan School of Public Health and a BA in Psychology from Middlebury College. In 2021, Zus raised a $34M Series A financing led by Andreessen Horowitz and followed by F-Prime, Maverick, Rock Health, Oxeon and more. In this episode, Caitlin shares about her various roles in health tech, building community in the health tech space, the new era of Data as a Service companies, and what it means to be a Chief Commercial Officer at a quickly-growing startup.

Guests:  Shruthi Mahalingaiah, assistant professor of environmental reproductive and women's health, Harvard T.H. Chan School of Public HealthTamarra James-Todd, Mark and Catherine Winkler associate professor of environmental reproductive epidemiology, Harvard T.H. Chan School of Public HealthVisit our website to learn more about our guests, and to find a full transcript.Credits:Host/producer: Anna Fisher-PinkertThe Better Off team: Kristen Dweck, Elizabeth Gunner, Stephanie Simon, and Ben WallaceAudio engineering and sound design: Kevin O'ConnellAdditional research: Kate Becker

Videos: DR. SCOT YOUNGBLOOD AT SAN DIEGO CITY COUNCIL MEETING (12:36) Edward Dowd Interviews (47:25) Quercetin helps to reduce the risk of pancreatic cancer Univ. of Hawaii and Univ. of Southern California, November 1, 2022 Quercetin, which is found naturally in apples and onions, has been identified as one of the most beneficial flavonols in preventing and reducing the risk of pancreatic cancer. Although the overall risk was reduced among the study participants, smokers who consumed foods rich in flavonols had a significantly greater risk reduction. This study, published in the American Journal of Epidemiology, is the first of its kind to evaluate the effect of flavonols – compounds found specifically in plants – on developing pancreatic cancer. Researchers from the Univ. of Hawaii and Univ. of Southern California tracked food intake and health outcomes of 183,518 participants in the Multiethnic Cohort Study for eight years. The study evaluated the participants' food consumption and calculated the intake of the three flavonols quercetin, kaempferol, and myricetin. The analyses determined that flavonol intake does have an impact on the risk for developing pancreatic cancer. The most significant finding was among smokers. Smokers with the lowest intake of flavonols presented with the most pancreatic cancer. Smoking is an established risk factor for the often fatal pancreatic cancer, notes the research. Among the other findings were that women had the highest intake of total flavonols and seventy percent of the flavonol intake came from quercetin, linked to apple and onion consumption. It is believed that these compounds may have anticancer effects due to their ability to reduce oxidative stress and alter other cellular functions related to cancer development. Previously, the most consistent inverse association was found between flavonols, especially quercetin in apples and lung cancer, as pointed out in this study. No other epidemiological flavonol studies have included evaluation of pancreatic cancer. While found in many plants, flavonols are found in high concentrations in apples, onions, tea, berries, kale, and broccoli. Quercetin is most plentiful in apples and onions. Hops may help lower Alzheimer disease risk University of Milano-Bicocca (Italy), November 9 2022. Hops, the plant whose flowers are used to make beer, could have a future in the prevention of Alzheimer disease according to research reported in the journal ACS Chemical Neuroscience. “The search for natural compounds, whose intake through diet can help prevent the main biochemical mechanisms responsible for Alzheimer disease onset, led us to screen hops,” Alessandro Palmioli of the University of Milano-Bicocca and colleagues wrote. Acting on other positive findings for hops, the team identified feruloyl and p-coumaroylquinic acids, flavan-3-ol glycosides and procyanidins as compounds responsible for the plant's neuroprotective action. These molecules interacted with amyloid-beta (a substance that forms sticky plaques in the brains of Alzheimer disease patients), to prevent it from forming fibrils and becoming toxic. Hops extracts were also found to prevent cell death by inhibiting oxidative stress and inducing autophagy, a process by which cells break down and destroy old or damaged proteins or other substances. The Tettnang variety of hops proved to be the most successful of the four varieties tested. “The identification of natural compounds or natural mixtures, such as nutraceuticals, exploitable for the development of preventive strategies against Alzheimer disease (and other neurodegenerative diseases) appears as a better alternative to the treatment of symptoms, as the neuronal damage associated with the disease is irreversible,” the authors remarked. “Our results show that hop is a source of bioactive molecules with synergistic and multitarget activity against the early events underlying Alzheimer disease development. We can therefore think of its use for the preparation of nutraceuticals useful for the prevention of this pathology.” Healthy plant-based diets better for the environment than less healthy plant-based diets Harvard School of Public Health, November 10. 2022 Healthier plant-based dietary patterns are associated with better environmental health, while less healthy plant-based dietary patterns, which are higher in foods like refined grains and sugar-sweetened beverages, require more cropland and fertilizer, according to a new study led by researchers at Harvard T.H. Chan School of Health and Brigham and Women's Hospital. The findings also showed that red and processed meat had the highest environmental impact out of all food groups in participants' diets, producing the greatest share of greenhouse gas emissions and requiring the most irrigation water, cropland, and fertilizer. “The differences between plant-based diets was surprising because they're often portrayed as universally healthy and good for the environment, but it's more nuanced than that,” said Aviva Musicus, postdoctoral research fellow in the Department of Nutrition at Harvard Chan School and corresponding author of the study. Previous research has documented that different types of plant-based diets have various health effects. For example, plant-based diets higher in whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee are associated with reduced chronic disease risk, while plant-based diets high in fruit juices, sugar-sweetened beverages, refined grains, potatoes, and sweets/desserts are associated with an increased risk of chronic disease. Yet little research has been conducted to determine the environmental impacts, such as greenhouse gas emissions, use of high-quality cropland, nitrogen from fertilizer, and irrigation water, of these dietary approaches. The researchers analyzed the food intakes of more than 65,000 qualifying participants, and examined their diets' associations with health outcomes, including relative risks of cardiovascular disease, and with environmental impacts. Higher scores on the unhealthy plant-based diet index indicated higher consumption of refined grains, sugary drinks, fruit juice, potatoes, and sweets/desserts; while higher scores on the healthy plant-based diet index indicated higher consumption of vegetables, fruits, whole grains, nuts, legumes, vegetable oils, and tea/coffee. Participants who consumed healthy plant-based diets had lower cardiovascular disease risk, and those diets had lower greenhouse gas emissions and use of cropland, irrigation water, and nitrogenous fertilizer than diets that were higher in unhealthy plant-based and animal-based foods. Participants who ate unhealthy plant-based diets experienced a higher risk of cardiovascular disease, and their diets required more cropland and fertilizer than diets that were higher in healthy plant-based and animal foods. The findings also reinforced earlier studies showing that diets higher in animal-based foods, especially red and processed meat, have greater adverse environmental impacts than plant-based diets. Removing digital devices from the bedroom can improve sleep for children, teens Penn State University, November 4, 2022 Removing electronic media from the bedroom and encouraging a calming bedtime routine are among recommendations Penn State researchers outline in a recent manuscript on digital media and sleep in childhood and adolescence. The recommendations, for clinicians and parents, are: Make sleep a priority by talking with family members about the importance of sleep and healthy sleep expectations; Encourage a bedtime routine that includes calming activities and avoids electronic media use; Encourage families to remove all electronic devices from their child or teen's bedroom, including TVs, video games, computers, tablets and cell phones; Talk with family members about the negative consequences of bright light in the evening on sleep; and If a child or adolescent is exhibiting mood or behavioral problems, consider insufficient sleep as a contributing factor. “Recent reviews of scientific literature reveal that the vast majority of studies find evidence for an adverse association between screen-based media consumption and sleep health, primarily delayed bedtimes and reduced total sleep duration,” said Orfeu Buxton, associate professor of biobehavioral health at Penn State. The reasons behind this adverse association likely include time spent on screens replacing time spent sleeping; mental stimulation from media content; and the effects of light interrupting sleep cycles, according to the researchers. Black Sesame Seed Reduces High Blood Pressure Mahidol University (Thailand), November 10, 2022 Research from Thailand's Mahidol University has found that black sesame seeds can significantly reduce blood pressure among men and women. The research tested 30 men and women with an average age of 50 years old. They were considered ‘pre-hypertensive' as their blood pressure levels were high but not yet high enough to be prescribed medication. During the four week study, the patients did not take any medications or dietary supplements. The volunteers were divided into two groups. One group was given six placebo capsules per day, and the other group was given six capsules of 420 milligrams of black sesame seed meal. Each person in the sesame seed group was given a total of 2,520 milligrams (2.5 grams) per day. According to the USDA, a tablespoon of sesame seeds weighs about nine grams. This would mean that the subjects were given a little less than a quarter tablespoon per day. The research found the sesame seed meal significantly decreased the blood pressure among the treated group. Their average systolic blood pressure after the four weeks was 121 mmHg, while the average blood pressure of the placebo group was 129 mmHg. The sesame seed group also showed decreased levels of malondialdehyde and increases in their blood vitamin E levels. Malondialdehyde is an indicator of the amount of lipid peroxidation taking place within the bloodstream. As other research has shown, lipid peroxidation is linked to the blood vessel damage seen in atherosclerosis. This is a relationship of free radical oxidation. When low-density lipoproteins are oxidized, they can damage blood vessels because they effectively steal electrons from blood vessel wall cells. Conversely, higher vitamin E levels are typically linked with lower lipid peroxidation because vitamin E is an antioxidant. The researchers analyzed the black sesame seed meal, and it was found to contain 105 micrograms per gram of tocopherols – primarily gamma tocopherol. By the way, this is a different configuration of synthetic vitamin E found in most supplements – rac-α-tocopheryl acetate – referred also as alpha-tocopherol. The main medicinal constituents of black sesame seed include sesamol, sesamin and sesamolin, which are known to be antioxidants. They also contain catechins, known for their anticancer properties. Is muscle weakness the new smoking? Grip strength tied to accelerated biological age, study shows University of Michigan, November 10, 2022 Everyone ages at a different pace. That's why two 50-year-olds, despite living the same number of years, may have different biological ages—meaning that a host of intrinsic and extrinsic factors have caused them to age at varying paces with different levels of risk for disease and early death. Lifestyle choices, such as diet, and smoking, and illness all contribute to accelerating biological age beyond one's chronological age. For the first time, researchers have found that muscle weakness marked by grip strength, a proxy for overall strength capacity, is associated with accelerated biological age. Specifically, the weaker your grip strength, the older your biological age, according to results published in the Journal of Cachexia, Sarcopenia and Muscle. Researchers at Michigan Medicine modeled the relationship between biological age and grip strength of 1,274 middle aged and older adults using three “age acceleration clocks” based on DNA methylation, a process that provides a molecular biomarker and estimator of the pace of aging. The clocks were originally modeled from various studies examining diabetes, cardiovascular disease, cancer, physical disability, Alzheimer's disease, inflammation and early mortality. Results reveal that both older men and women showed an association between lower grip strength and biological age acceleration across the DNA methylation clocks. “We've known that muscular strength is a predictor of longevity, and that weakness is a powerful indicator of disease and mortality, but for the first time, we have found strong evidence of a biological link between muscle weakness and actual acceleration in biological age,” said Mark Peterson, Ph.D., M.S. at University of Michigan. “This suggests that if you maintain your muscle strength across the lifespan, you may be able to protect against many common age-related diseases. We know that smoking, for example, can be a powerful predictor of disease and mortality, but now we know that muscle weakness could be the new smoking.” The real strength of this study was in the 8 to 10 years of observation, in which lower grip strength predicted faster biological aging measured up to a decade later, said Jessica Faul, Ph.D., M.P.H., a co-author of the study and research associate professor at the U-M Institute for Social Research. Past studies have shown that low grip strength is an extremely strong predictor of adverse health events. One study even found that it is a better predictor of cardiovascular events, such as myocardial infarction, than systolic blood pressure—the clinical hallmark for detecting heart disorders. Peterson and his team have previously shown a robust association between weakness and chronic disease and mortality across populations.

What makes a healthy home? In 2022, that question feels more important than ever. What are the right foods to eat? The least-toxic shampoos and sunscreens? The best way to prevent loneliness while working from home? On Season 2 of the Better Off podcast, we'll look at the research behind some of those big questions. We'll also ask what happens to our health when “home” is a tent encampment, or a 6x9 solitary jail cell.Through six new episodes, host Anna Fisher-Pinkert will talk to leading public health experts about the questions she's had on her mind as a health communicator, a mom, and a person with more than a little skepticism about the things our culture tells us are “healthy.”Better Off: Home starts November 2. Subscribe to get episodes as soon as they drop. Visit hsph.me/better-off to learn more about this season.

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 this edition of EMS One-Stop, Rob Lawrence welcomes Sean M Kivlehan, MD, MPH; and Kevin Collopy, MHL, FP-C, NRP; to discuss the search for the next big EMS speaker as well as the Harvard initiative to provide mass casualty training to Ukraine. EMS World Expo takes place October 10-14 in Orlando and one of the returning sessions this year is “Stand and Deliver,” a presentational opportunity for speakers to audition for their place on the national stage.  The program was the brainchild of Kivlehan and Collopy, and participants get their chance to present at a national conference as well as receive coaching and constructive feedback on their sessions. The Stand and Deliver winner then gets the opportunity to present their session at the Expo general session at the end of the week. The guests also discuss the Harvard Humanitarian initiative focusing on emergency health systems in conflict and austere environments. When the Ukraine/Russian war escalated, the Harvard group were approached to provide CBRN and mass casualty training throughout Ukraine.  About the guests Sean M Kivlehan, MD, MPH, is the director of the Global Emergency Medicine Fellowship at Brigham and Women's Hospital in Boston. He is a practicing emergency medicine physician in the level one trauma and burn center, and core faculty for the Harvard Affiliated Emergency Medicine Residency. He is an assistant professor of emergency medicine at Harvard Medical School; assistant professor of global health and population at the Harvard Chan School of Public Health; and faculty at the Harvard Humanitarian Initiative. He has worked as a consultant for the World Health Organization's Emergency, Trauma and Acute Care Program and was a New York City paramedic and instructor coordinator for 10 years. Kevin Collopy, MHL, FP-C, NRP, CMTE, is the clinical outcomes and compliance manager for Novant Health AirLink/VitaLink where he oversees the program's research, education, risk management, quality management and reimbursement programs. He regularly speaks across the United States and has taught emergency and wilderness medicine on three continents. He's an author of over 200 articles and book chapters, including 18 peer-reviewed research abstracts and papers. In addition, he serves on several national and international advisory boards, teaches the paramedic program at Cape Fear Community College and is currently overseeing multiple clinical trials. He also maintains his LEAN Healthcare Blackbelt certification, has a master's in healthcare leadership, and is known for developing and innovating quality management solutions in prehospital care systems.

Troy Finn leads campaign and fundraising efforts for the University of New Hampshire across 13 colleges and schools, athletics, centers, and institutes. He joined UNH in 2017 from Development Guild DDI where he provided campaign and fundraising counsel to institutions ranging from large, research-intensive public universities to private liberal arts colleges, schools, and non-profit organizations. Having been a member of fundraising teams during campaigns of historic magnitude at Harvard Chan School of Public Health, Columbia University Medical Center, and Dana-Farber Cancer Institute, Troy has led both front-line philanthropy efforts and back-end development operations. Troy obtained a master's degree in Management and Finance from Harvard University Extension School and a bachelor's degree in philosophy from the College of the Holy Cross. He's the youngest of ten kids and loves exploring the northern New England coast with his husband and their German Shepherds, Candide and Cunegonde.Debbie Dutton has served for the past nine years as the Vice President of Advancement and President of the Foundation at the University of New Hampshire (UNH) where she leads a team of 130 advancement professionals in the leadership phase of capital campaign that follows the University's most ambitious and successful capital campaign to date, Celebrate 150, the Campaign for UNH. During this effort, UNH has surpassed all previous records in fundraising and engagement and just closed the campaign June 2018 at $308M well above the $275M goal. Prior to this role, she served as vice president for development and alumni relations at Colby College. During her six-year tenure at Colby, and before being promoted to vice president, she served as campaign director and led the school's largest fundraising effort, the Reaching the World campaign, which surpassed its goal to raise $376 million when it concluded in 2010.Debbie's career in development began at the Maine chapter of the National Multiple Sclerosis Society. She has held development positions in major gifts and senior management at three Harvard teaching hospitals: the Massachusetts Eye and Ear Infirmary, Children's Hospital, and the Joslin Diabetes Center. She also was a senior leadership giving officer at Bates College.Debbie earned a Bachelor of Arts degree in journalism from the University of Maine and a Master of Science degree in business management from Lesley College. She lives in Kennebunk, Maine with her husband and their two children.

According to a new nationwide poll, more than three-quarters of adults have been personally affected by extreme weather in the past five years — and that experience makes them more likely to call climate change a crisis than those who haven't experienced a heat wave, hurricane, flooding or the like. The poll is from the Robert Wood Johnson Foundation, NPR and Harvard Chan School of Public Health, and also measures attitudes about health and economic impacts of extreme weather. We speak with Robert Wood Johnson Foundation Chief Science Officer Alonzo Plough.

According to a new nationwide poll, more than three-quarters of adults have been personally affected by extreme weather in the past five years — and that experience makes them more likely to call climate change a crisis than those who haven’t experienced a heat wave, hurricane, flooding or the like. The poll is from the Robert Wood Johnson Foundation, NPR and Harvard Chan School of Public Health, and also measures attitudes about health and economic impacts of extreme weather. We speak with Robert Wood Johnson Foundation Chief Science Officer Alonzo Plough.

Sen. Bill Cassidy of LA, who is also an MD specializing in GI or liver disease, had an interview with POLITICO for the Harvard Chan School of Public Health series Public Health on the Brink on May 19. He has claimed to be unapologetically “prolife”, but said in this interview when asked what needs to be done about LAs high maternal mortality rate, “About a third of our population is African American; African Americans have a higher incidence of maternal mortality. So, if you correct our population for race, we're not as much of an outlier as it'd otherwise appear. Now, I say that not to minimize the issue but to focus the issue as to where it would be. For whatever reason, people of color have a higher incidence of maternal mortality.” I discuss these statements with Charles Johnson who founded of 4Kira4moms on 2017 after losing his wife Kira Dixon Johnson during a routine cesarean at Cedar Sinai hospital in Los Angeles. He is a voice for families facing unnecessary maternal loss and ending the maternal mortality crisis in this country. Recently, he worked with congress to pass the preventing maternal death act which is the first ever to combat the maternal mortality crisis in the US. The bill was signed into law on 12/21/2018 and dedicated to the memory of Kira Dixon Johnson. --- Support this podcast: https://anchor.fm/adoctordeliverspodcast/support

A press conference from the Harvard T.H. Chan School of Public Health with Stephen Kissler, research fellow in the Department of Immunology and Infectious Diseases. This call was recorded at 12:30 p.m. Eastern Time on Wednesday, March 23rd.

Maternity ward closures are increasingly common. According to recent reporting by Vox, many of these closures are happening primarily in rural areas and predominantly Black and Latino neighborhoods. For more on this, The Takeaway spoke with Alecia McGregor, Assistant Professor of Health Policy and Politics at Harvard Chan School of Public Health, and Katy Backes Kozhimannil, professor at the University of Minnesota and director of the university's Rural Health Program.

Maternity ward closures are increasingly common. According to recent reporting by Vox, many of these closures are happening primarily in rural areas and predominantly Black and Latino neighborhoods. For more on this, The Takeaway spoke with Alecia McGregor, Assistant Professor of Health Policy and Politics at Harvard Chan School of Public Health, and Katy Backes Kozhimannil, professor at the University of Minnesota and director of the university's Rural Health Program.

Naomi chats with Dr. Bryn Austin of Harvard Chan School of Public Health about the importance of advocacy for eating disorders at the state and federal level. Dr. Austin is the Founding Director of the Strategic Training Initiative for the Preventing of Eating Disorders (STRIPED) where she and her colleagues help train the next generation in eating disorder prevention. In this episode, Dr. Austin shares how the CDC recently removed questions pertaining to disordered eating habits on the Youth Risk Behavior Surveillance System, a survey the agency issues every other year and whose data is essential for researchers working in public health. The sudden elimination of the questions was a call-to-action for the eating disorder community. Note: Take a listen after the interview for an exciting update on this issue!Dr. Austin is also an active member of the Eating Disorders Coalition, an advocacy group that works to advance the recognition of eating disorders as a public health priority by building relationships on Capitol Hill.Links/Resources mentioned in the episode:1) STAT Article, "A decade without data: Eating disorder researchers say a gap in CDC survey has left them flying blind" [link]2) Harvard STRIPED [link]3) STRIPED Advocacy Playbook [link]4) The Eating Disorders Coalition (EDC) [website]5) Register for EDC's Virtual National Advocacy Day - May 17, 2022! Registration here and more information hereQuestions, comments, or suggestions? E-mail the host: naomi.charalambakis90@gmail.com 

În cadrul ediției de pe 8 februarie 2022 a emisiunii #știința360 de pe Radio România Cultural, Dr. Marius Geantă, Președintele Centrului pentru Inovație în Medicină #inomed, a comentat topul săptămânal Esențial Covid-19 de pe Raportuldegardă.ro. Spikevax este al doilea vaccin care primește aprobare completă din partea FDA (BLA), cu indicație în prevenția bolii COVID-19, la persoanele de peste 18 ani. Vaccinul Comirnaty (Pfizer) a primit aprobarea completă în august 2021, la persoane cu vârste de peste 16 ani. Acesta este primul produs al companiei Moderna care primește aprobare în SUA. Vaccinul era disponibil sub autorizație în regim de urgență încă din decembrie 2020. Aprobarea completă se bazează pe date suplimentare din studiul de fază III, care includ o perioadă mai lungă de follow-up, precum și date legate de procesul de fabricație. Peste 20 de experți din cadrul Harvard Chan School of Public Health au introdus un nou termen, primary pandemic prevention, pentru a defini un set de acțiuni care au ca scop identificarea surselor de agenți patogeni cu potențial pandemic, înainte ca acestea să se răspândească la om. Investițiile în prevenția primară a pandemiilor ar reprezenta doar 5% din costurile asociate vieților pierdute anual din cauza bolilor infecțioase. Studiul a fost publicat pe 4 februarie în Science. Metode precum testarea, purtarea măștilor, vaccinurile și tratamentele, previn decesele, dar nu previn apariția noilor agenți patogeni. Planurile internaționale de pregătire contra pandemiilor se concentrează în prezent pe detecția și stoparea bolilor zoonotice după ce acestea au infectat omul. În cadrul lucrării publicate în Science se recomandă revizuirea fazelor definite de OMS pentru apariția bolilor infecțioase pentru a se include o fază specifică ce ar surprinde momentul în care acestea ar putea să se răspândească de la sursă. Mai multe detalii - https://bit.ly/3HM6Rqn și https://raportuldegarda.ro/stiri-covid-romania/

The Epstein-Barr virus (EBV) causes multiple sclerosis based on a new monumental study in young adults serving on active duty in the US military. The study found that the risk of developing MS increased 32-fold after infection with the Epstein-Barr virus. EBV causes infectious mononucleosis, spreads through saliva and infects B immune cells.  Alberto Ascherio MD DrPH shares his group's recent findings, published in Science. Epstein-Barr virus treatments in clinical trials reviewed including vaccination studies with the goals of stopping disease progression and preventing MS from ever occurring. The impact of vitamin D, smoking, and obesity on the risk of developing multiple sclerosis is reviewed.  Howard Weiner MD details the genetic risk factors for developing multiple sclerosis such as human leukocyte antigen (HLA) and risks of passing the disease onto children. The role of gut organisms, known as the microbiome, in both potentially causing multiple sclerosis and protecting people with the disease is explored. Strategies for a multiple sclerosis cure are highlighted. Barry Singer MD, Director of the MS Center for Innovations in Care, interviews: Howard Weiner MD is the Robert L. Kroc Professor of Neurology at the Harvard Medical School, where is has been on faculty since 1976. He is the Director and Founder of the Partners Multiple Sclerosis Center as well as the Co-Director of the Center for Neurologic Diseases at the Brigham & Women's Hospital in Boston. He is also a film writer, director and author. Dr. Weiner is the author of “Curing MS.” His latest book is “The Brain Under Siege: Solving the Mystery of Brain Disease, and How Scientists are Following the Clues to a Cure.” Alberto Ascherio MD DrPH is Professor of Epidemiology & Nutrition at the Harvard Chan School of Public Health. Dr. Ascherio obtained his medical degree at the University of Milan in 1978.  His research group focuses on identifying causes, risk factors and biomarkers of susceptibility and early diagnosis of multiple sclerosis including key research on Epstein-Barr virus and vitamin D. Season 4 MS Living Well podcast is sponsored by Octave. Visit www.mslivingwell.org for more information.

A press conference from the Harvard T.H. Chan School of Public Health with Rachel Piltch-Loeb, Globe Preparedness Fellow in the Division of Policy Translation and Leadership Development and a research associate in the Department of Biostatistics. This call was recorded at 1:00 p.m. Eastern Time on Monday, December 13th.

“Genes load the gun, the environment pulls the trigger.”Team, today world-renowned Professor Paul Franks joins us to discuss diabetes, genes vs lifestyle, the nature vs. nurture idea, precision nutrition and more! Professor Franks received his B.S. from Brunel University, his M.S. from Exeter University, his M.Phil. from Cambridge University, and his Ph.D. from Cambridge University. Clearly, the man is a weapon. He focused his education on epidemiology, biostatistics, and genetics and then concentrated his research to study Type 2 Diabetes, specifically lifestyle interventions to improve health. Currently, he is the Genetic Epidemiology and Deputy Director at Lund University Diabetes Center in Sweden, the Genetic & Molecular Epidemiology Unit., and he is an Adjunct Professor at Harvard Chan School of Public Health in Boston. Professor Franks is truly one of the most knowledgeable people I have had the privilege to talk to in this space. He is also an elite athlete having run 50ks at 11 years old and having completed his first Iron Man at 21. In this episode we discuss what disease is, specifically diabetes, and how it is affected through genes, lifestyle, and the ways we can prevent it. Specifically, we discuss:How to eat, train, and get good sleep all in a way that is healthy, disease preventative, and ENJOYABLE. In this episode we breakdown the nature vs nurture mythHow can we adopt a healthy lifestyle to prevent diabetes and improve our performance when the foods offered to us are in direct contradictionDoes our current science telling us how to improve the way we eat decrease mortality or do we need a better approach?We dive into using machine learning to find the best optimized food for individuals to combat diabetes We explain precision nutrition and how it can be used to prevent diseaseWe discuss the struggles in accumulating strong nutritional dataAnd Professor Franks provides a rule of thumb to ensure you are eating healthy:Less processed foodsPlant centric Everything in moderationLegends! I am so thrilled to have the opportunity to learn from professionals such as Professor Paul Franks, and I owe so much of this opportunity to you my epic team so I want to say THANK YOU!You can find Professor Paul Frank's info below:Professor Frank's TwitterProfessor Frank's Harvard Page

The world is grappling with another spike in the number of coronavirus infections. While European countries had to issue lockdown orders again to curb the spread of the virus, some U.S. hospitals in the Midwest and the South are being stretched thin. Dr. Michael Mina from the Harvard Chan School of Public Health fears the virus will spread further during the winter months.All 50 states are supposed to turn in COVID vaccine distribution plans to the Centers for Disease Control and Prevention by the end of this week.  2020 has been a banner year for health insurance companies. But with so many of us staying home and skipping all kinds of medical exams and procedures, insurance companies are reaping the benefits.Firefighters are trying to battle fires while fighting off COVID-19.Air filtration systems are flying off the shelves across the country. USA TODAY's Jennifer Jolly says the shopping frenzy for air purifiers will likely last.  To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Featured Interview: Korea's response to COVID-19 outbreak Guests: Professor Eric Ding, Harvard Chan School of Public Health

In the last decade, Americans' relationship with cannabis has transformed: today, dozens of states have legalized marijuana for medical or recreational use and American farmers can grow hemp on an industrial scale. Meanwhile, shoppers can find cannabidiol (CBD), which is derived from cannabis but does not produce a “high” like marijuana, in everything from oils to vapes, chocolate bars, cosmetics—even dog treats. Some say CBD can relieve stress, pain, anxiety, and more, with no side effects. But the evidence for many of these claims is limited, and state and federal laws around the sale of CBD are still evolving. Drawing on a newly-released poll by POLITICO and the Harvard Chan School, this Forum examined public attitudes toward CBD products and recreational marijuana. Panelists examined how research studies of both recreational and medical marijuana offer insights into the current debate. They also discussed the current state of policy and research regarding recreational marijuana in particular, and consider various solutions that have emerged to understand and regulate these rapidly growing industries. This Forum event was presented jointly with POLITICO on December 3, 2019. Watch the entire series: https://theforum.sph.harvard.edu/

Are you someone who frequently enjoys sugar sweetened drinks? Well, new research from Harvard may have you wanting to pour out that soft drink, and reach for some water! Dr. Vasanti Malik is a research scientist in the department of nutrition at the Harvard Chan School of Public Health, and I caught up with her to  learn more about her research into the impact of  sugary drinks on your health… Guest: Claire Allen Simi Sara Show Contributor

In this uniquely insightful Forum, experts examined key health and education policies — and their broad implications — that are likely to be enacted by the new Congress. The panelists discussed the current climate, including the government shutdown. For background, the discussion drew on a newly-released poll by POLITICO and the Harvard Chan School. This Forum event was presented jointly with POLITICO LLC on January 23, 2019. Watch the entire series: https://theforum.sph.harvard.edu/

Do you make better food choices when you see calorie counts listed on restaurant menus? Do you think food stamp recipients should be able to buy unhealthy foods, like sugary drinks? And what role should the government play in our food choices? We'll explore these questions on The Leading Voices in Food with Dr. Sarah Bleich. About Sara Bleich Sara Bleich is professor of public health policy at the Harvard Chan School of public health. She is also the Carol K. Pforzheimer Professor at the Radcliffe Institute for Advanced Study. Her research provides an evidence base to support policies to prevent obesity and other related diseases, particularly among vulnerable populations. The signature theme that we've seen through her work as an interest in asking simple, meaningful questions which can fill important knowledge gaps. Her work has been published in the top journals in the field such as the New England Journal of Medicine, the British Medical Journal, Health Affairs, and American Journal of Public Health, but has also been featured for the public and outlets such as New York Times The Washington Post, Wall Street Journal, and National Public Radio. Sara's received numerous awards including one for excellence in public interest communication. From 2015 to 2016. She served as a White House fellow where she worked as a senior policy advisor to the US Department of Agriculture and also to the First Lady's Let's Move Initiative. Interview Summary To begin with a discussion of Federal menu labeling of legislation: after many delays, the Federal menu labeling rule was implemented this past May. Would you explain what the legislation is all about? Is the beginning. Sure, so included in the Affordable Care Act, which passed in 2010, which is also known as Obamacare, there was this little provision which had bubbled up from the local level and required that large chain restaurants are required to post calories alongside price. This first started in New York City and then by the time it got to the Federal level, more than 20 cities or localities around the country had adopted some version of this. And so the Federal role was an attempt to make a uniform rule that applied to chain restaurants around the country. And then one thing that happened is that the role was expanded to not just apply to chain restaurants, but to also think about how people eat today. So it includes entertainment venues and ice cream shops and movie theaters. And all those places, as of May 2018 when the rule was implemented, are required to post calories alongside price. The legislation was passed in 2010 and now we're in 2018, why in the world did it take so long? Yeah. Well, there, there are a number of reasons why it sort of got kicked down the road. It was delayed by both the Obama Administration and the Trump administration and a lot of the delays related to key push back from different industry groups. So for example, one industry group that was really opposed to the legislation was the pizza lobby. They felt like it was burdensome to have to apply calories to all the different variations that you could make for a pizza. And another key group that opposed the legislation where the grocery stores, the small grocery lobby. But in the end, you know, this rule was backed by a large chain restaurants because for them it was very, very challenging to have one set of rules in one city and other set of rules in another city. And so yes, it did take eight years for the rule to get implemented, but now it is, and should be available all around the country. What impact do you think this will have on the population's health? Well, the original thought behind menu labeling was you put calories alongside price and that provides transparency to consumers and helps them make better choices at the point of purchase. And since the law was implemented or passed in 2010 there have been lots and lots of opportunities to study the effect of menu labeling on consumer behavior. Because there've been all these local policies that have passed and the takeaway from more than 55 or 60 studies focused on consumer behavior is that menu labeling appears to have little to no impact on what consumers are doing at the point of purchase. The exception is maybe in certain venues like cafes or in coffee shops. Consumers do tend to purchase a little bit fewer calories, but what the evidence instead suggests is that the story of menu labeling is not that consumers are changing their behavior, but the story of menu labeling is that restaurants are changing their offerings in response to the transparency that menu labeling demands. And so we've done a lot of work over the past several years tracking the largest chain restaurants around the country. So these are the largest revenue generating restaurants. Your McDonalds, your Chipotles your Cheesecake Factories and so on. And what we find is that if you compare items that are newly introduced year over year, we find that the calories and newly introduced menu items are going down over time by about 60 calories or 12 percent. And interestingly that the highest calorie items appear to be dropping off the menu. Very impressive change. So there are many things that could be responsible for that in addition to menu labeling, is it possible to define the impact of menu labeling per se? It's not. And you know, one of the things that's interesting is the trend data that we have is available starting in 2012 and obviously the Federal Menu Labeling rule started in 2010. And so ideally we would have data before and after, so we can answer that exact question to what extent are the observed changes in restaurants are attributable to menu labeling versus something else. It very well could be part of a larger secular trend. We have done work looking at restaurants who voluntarily said even in the absence of the Federal rule being implemented, we're going to go ahead and post calories. So Mcdonalds is an example of one restaurant that did that and when you compare restaurants that voluntarily posted labels to those that did not, what you find is that that average calories among those with voluntary labeling was lower. So there does appear to be some sort of trend that's happening that may be above and beyond menu labeling. And from my perspective, you know, the why it's happening for a population health perspective is less important than the impact that it could potentially have. And so on a typical day, a third of kids and a third of adults eat at chain restaurants, particularly fast food restaurants. And the beauty of these supply side changes that we're observing is that unlike the consumer side, which demands that you see the calories and that you change your behavior and response, changes that are happening on the menu are largely invisible to consumers and they're not requiring individuals to change their behavior--which is very resistant to change. And because we're seeing calories being pulled off of menus and it doesn't take a lot of extra daily calories to drive obesity, the potential impact of this cycle, of this change of restaurant behavior could have a positive impact on population health. You have a fascinating perspective on this. I'd like to ask a particular question about the history. So before I came to Duke, I was at Yale University for a number of years with our group at Yale was working to some extent with the New York City Department of Health when they passed the first set of regulations around menu labeling. And one of the things that I thought was historic about it, there were the impacts on the restaurant behavior, consumer behavior that you've just now addressed, but it also seemed to me it was historic because it was the first time to my awareness that a city department of Health had express jurisdiction over the long-term consequences of food. The short term consequences of food, you know, people getting sick from tainted us in a diner there, they are all over and they, the cities have expressed long-term interest in educating people about the long-term consequences of food, but had never, to my knowledge, gotten in and done anything in a regulatory way about this. And it was interesting in that New York City said we have jurisdiction here and it's in our legal purview to do something about diabetes, heart disease, and the other things they could follow from a lifetime of eating some of these unhealthy foods. Does it, do you. Do you think that's true that that was in a historic breakthrough when the menu labeling legislation you've got introduced? I do think it was a historic breakthrough and I think it was an example that was then followed by several other cities that also adopted that same legislation and you know, New York and a lot of ways has been on the vanguard of progressive obesity policies. So an example where New York attempted to establish jurisdiction but was unable to, was the portion cap role where they tried to pass a law saying that anything larger than a 16 ounce size beverage could not be served within New York City limits. And that was passed but then overturned based on the claim that New York City didn't have jurisdiction. So I think it's something which has been tested and pushed by health departments, but I, I do think it was historic when it comes to menu labeling and I suspect for, for leading health departments like New York, like Philadelphia, or probably see more of this in the future. We had Shiriki Kumanyika come and do a podcast with us, which was terrific and she explained a lot about disparities by race and income. And I know you worked on that as well. What are you think are some of the interesting policy solutions to disparities? Yeah, well I'm so glad that you had Shiriki on the podcast because she obviously is a leading thinker in this area. My thought around health disparities, which certainly when it comes to obesity and lots of diet related diseases, they're very persistent. So if you look over time, there are these very longstanding, for example, black, white gaps in the prevalence of obesity where you have higher rates among black Americans and white Americans. Similarly by income, higher rates of obesity and diet related conditions among low income versus high income populations. And I think where a lot of the policy opportunities lie is looking outside of specifically health and thinking more broadly about the social determinants of health. And so that refers to things like where a person is born, where a person grows up, where they live, where they work. And there's all sorts of things about those factors, which if they were modified, they could actually have a meaningful impact on disparities. So, for example, if you know that for a lot of people the biggest barrier to getting healthy food is a reliable source of transportation, then the way to get better access to healthy food is then to fix that transportation problem. Similarly, if you know that based on if someone has unreliable housing and because they have unreliable housing, they don't have a place that they can even store food and say a fridge or other places. Then thinking about how you actually help people find long-term housing that is stable. And so I think that, you know, to really address some of these longstanding disparities, we have to look outside of health and think about the broader factors that shape the way that a person lives, and those would include trying to address maybe income, maybe education, maybe job status, maybe housing, maybe transportation and lots of other factors which are strongly contributing to why we see these huge black white differences and, and along other race and ethnicity lines. And the challenge obviously is none of that is very easy to do, but I think what it requires this republic health to look, you know, outside of the usual partners and look to other parts of the, the city infrastructure and the state infrastructure and think about how can we join forces and by and doing so sort of promote health and reduce disparities at the same time. This sure argues as well for coordination between agencies at all levels of government. And I'm wondering when in your time as a White House fellow, whether you saw any examples of agencies cooperating on these kinds of issues. Yeah, so I think one's experience in government is very dependent on the administration. And so when I was a White House fellow, it was under the Obama administration. It was year seven in an eight year administration. And certainly a really important piece of that administration was interagency collaboration. And the area that I worked in was really around nutrition policy. And what was interesting is that it was probably the first time and more than 50 years that both the east wing, which is where the first lady said, since she had the Let's Move campaign, the West Wing, which is where the president sits and USDA, which is in the executive branch, it's the department of Agriculture and overseas nutrition assistance programs, among other things. There was tremendous alignment around improving nutrition and also around reducing poverty and then that then trickled out to other agencies and, and so for example, transportation was involved and housing was involved. And so I think there was a lot of effort in the last administration, and health and human services to think about how do we lift families out of poverty and how do we, at the same time improve nutrition. Much of that work did take place between the White House in USDA, but certainly it's the case that there was interagency work trying to facilitate that process. The Federal government has a great many nutrition assistance programs, as many as 15. What are some of the ways in your mind these programs could be leveraged to better promote health and diet? That's right. So I'm under the US Department of Agriculture there are 15. There's sort of this suite of nutrition assistance programs. The most widely known is SNAP, which stands for the Supplemental Nutrition Assistance Program. It's formerly known as food stamps, which is how many people know it. That program alone has a budget of $70 million a year and it helps roughly 40 million, low income Americans, about half of them are children afford food on a daily basis. And so when you sort of think about both for snap and across the programs, you know, what are some of the things that could be done to improve nutrition among the many, many millions of families that benefit from them. In my mind, one of the key ones is thinking about, you know, what is the role of sugary beverages within these programs? And so stepping back for a second, we know that sugary beverage consumption is very strongly linked to obesity to type two diabetes and a host of other conditions, we know that over time the levels of sugary beverage consumption have been going down over the past decade or so, which is a good thing, but the levels remain unacceptably high among low income and minority populations. And so if you look just at the SNAP program, formally food stamps right now, the way that the benefits are administered as you can purchase virtually anything with those benefits. And so one important policy change would be to think about should we restrict the ability of participants to use their snap benefits to purchase sugary beverages because we know of this very strong negative health outcome that's associated with consuming those drinks. A second is that if you look across all the different Federal nutrition assistance programs, sugary beverages can be currently made available without reimbursement. So one example would be CACFP, which stands for the Child and Adult Care Food program. So what that means in practice is in a childcare center, sugary beverages can be made available to children, but the programs can't be reimbursed for them. And so then what are the important policy change would be to prohibit those beverages from being served at all so they can't be reimbursed and they can't be served and it is small changes like that, which may sound minor, but essentially it's modifying the environment. In this case, children, it's modifying their exposure to sugary beverages, which will hopefully help set their pallets for things that are less sweet when it comes to beverages, so maybe they'll prefer water if they're not exposed to sugary beverages so early. And similarly within the SNAP program, the vast majority of participants, 75 percent have income from other sources. And so you could make the argument that they could rely on those resources if they wanted to buy sugary beverages and not use program resources to do so. This has been a highly controversial policy proposal to government might actually do this. Yeah, I mean when it comes to nutrition policy, this is like the third rail and you're exactly right that it's been so controversial in the sense that there've been a number of states which have requested waivers. So in order for states to have the ability to restrict what someone can and cannot purchase in snap states have to go to USDA and say we'd like permission to be able to do this. And there've been four or five attempts by states and within those states, they've tried multiple times and they've all been denied. So to answer your question, you know, will this happen in the future? I don't know. I think that it's unlikely that it'll happen in this current administration. I think in the last administration, there was some warming to it towards the end, but it never actually happened. And you know, the reality is that there are a lot of strong arguments on both sides. So people that oppose this talk about the potential increased stigma for participants because what it would mean is that when you're at the point of purchase new UPC codes, which defined beverages would have to be entered in so that those would be excluded from the basket of things that can be purchased with the SNAP benefit. People that support these policies say yes, it's possible that stigma can be increased, although unlikely, because it's so easy to reprogram computers, but the potential benefit in terms of population health far outweighs the potential negatives around stigma. So I think it's something that's going to remain front and center right now. The best possibility for a pilot to be conducted would be have to be authorized through the 2018 Farm Bill, which is not going to be going anywhere anytime soon. So I think we sort of are in a wait and see period. If you could think of a single strategy that might be most effective at addressing the problem of obesity, what would you say? So recognizing that there is not a single thing which will alone solve their problems with obesity. I would say that if I could wave my magic wand, it would be a sugary beverage taxes. And the reason for that is a couple, one is that sugary beverage tax has have the potential to decrease consumption among everyone because we know that generally people drink sugary beverages quite a bit, but we also know that the consumption is highest among low income and minority populations. So one thing that sugary beverages can do is that they can both reduce consumption and potentially improve health equity, which is really important. The second thing that makes sugary beverage taxes very promising is that they don't. They are a very strong nudge and we know that if you change prices, it can really affect behavior. And the empirical evidence on sugary beverages from places like Mexico and from places like Berkeley is that it does appear to reduce consumption and purchases. Those drinks taxes appear to do so most among low income populations. And because it's such a strong environmental nudge, it's less reliant on people sort of thinking very carefully about their behavior and more just respond to these cues in the environment. And I think a third reason why they're promising is that they have the potential to raise a lot of money for localities that pass them. And so if you look, for example, at Philadelphia, which has a one point five cent per ounce beverage tax that has the potential to generate roughly $90,000,000 a year and the way that Philadelphia is repurposing those dollars is in universal Pre-K and green space and other improvements to the city. And so there's ways to also give those dollars back to populations which are more vulnerable. And then because final point is that because of the revenue that's being generated, it also makes you beverage taxes attractive for cities and localities that need extra revenue. And so I'd say for all those reasons, one of the most promising possibilities, although very politically challenging, are sugary beverage taxes. Another advantage of the sugary beverage taxes is almost everything else that you might think of to address obesity. More treatments, let's say more education or anything else, costs money. And there's a question about whether government will actually come up with money to do those things no matter how good the ideas are. And as you mentioned, the sugary beverage tax would not only not cost money but raise money for important causes. So there are, there really are a lot of benefits, aren't there? I completely agree. That's a great point.  

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