To circumcise or not...

According to a definitive Kenyan study, conclusive data shows that male circumcision reduces men’s chances of contracting HIV by 51-60%. Other studies project that in the next decade, male circumcision could prevent 2 million AIDS infections and 300,000 deaths. Last year alone, 2.8 million people in sub-Saharan Africa became infected with HIV, and 2.1 million people died from its effects. Circumcision holds enormous potential benefits and can be an effective preventative measure for the global HIV/AIDS pandemic, especially in Kenya (or similar countries) where circumcision rates fall around 50%.
These new findings have sparked volatile debates regarding the necessity of circumcision. From a health perspective, it seems obvious that we should push for 100% of males to be circumcised worldwide. Some talk of changing the health guidelines surrounding circumcision and initiating a circumcision mandate have been raised. Circumcision rates have decreased worldwide, but this trend could reverse with a large-scale pro-circumcision movement. However, such discussion inevitably provokes sensitive religious and cultural issues that may eclipse the proposed health benefits, as great as they may be.
In addition to the religious and cultural issues that arise in response to the promotion of circumcision, ethical issues will surface concurrently. What is more important: an individual’s personal beliefs/preferences or the health and well-being of the global population? If we choose the latter, is it ethical to enforce a circumcision mandate despite personal beliefs/preferences? How do we fight opposition from the healthcare sector? Should a mandate be enforced only in specific countries where HIV/AIDS rates are especially high (i.e. countries in Africa, India) and is that ethical? Personally, I don't think circumcision can be enforced here, or in any other developing nations. Proponents will meet so much resistance that a mandate will never work. Massive health promotion and educational dissemination efforts need to take place before religious and cultural barriers become displaced. There are so many loaded ethical questions surrounding this issue, and it will be interesting to see how it resolves over time.

Should we be afraid to fly?

This week's topic on disaster management and preparedness has hit a little close to home for me. The case study article discussed the IATA recommended emergency response plan for air carriers. My father and my brother are both commercial airline pilots so they can certainly agree with the need for an effective emergency response plan to deal with public health emergencies.
After 9/11, airline security has seemingly gone out of control. People without printed tickets and proper identification are no longer allowed beyond the security checkpoints. TSA officials screen passengers for everything, from firearms and knives, to nail files and any liquids not in a 3 oz. container. Lines at security checkpoints are horrendous as people slowly remove their shoes and place them on the conveyor belt. Onboard the aircraft, bullet proof doors have replaced the previously flimsy cockpit doors and young boys aspiring to be pilots are no longer allowed into the cockpit, where they would once receive their gold wings. Undercover armed air marshals even fly alongside the crew. But are these measures even enough to prevent terrorist attacks from happening? Probably not.
For starters, pre-flight screening for firearms, knives, and other possible weapons will never suffice. There are numerous objects already onboard or that will pass inspection that can be used directly or modified in the advent of a terrorist attack. Keys and pens make great weapons, and so will a broken bottle of liquor. Also, the bullet proof doors installed after 9/11 are not man-proof. They may stop a bullet from penetrating, but a moderatley sized man could easily throw himself into it and knock down the door. Even though pilots carry firearms in the cockpit, most of them are not trained to use them properly. And one or two air marshals probably won't effectively stop determined terrorists from hijacking the plane.
It's scary to think that no one is safe while flying - we never were and we never completely will be. However, there are other preventative measures airlines can take to better ensure everyone's safety. Although it is necessary to screen passengers for potential weapons, efforts to screen for every little thing will prove not only useless, but time consuming as well. TSA needs to stop where it's at now, and other avenues should be considered. Two cockpit doors can be installed on every aircraft instead of just one. Once installed, only one door should be opened at a time. Pilots should be trained to use firearms and they should also be required to take continuous self defense training. Their first priority to is to protect themselves so that they can ensure the safety of everyone else. Public service announcements should also be made in terminals and on the aircraft pre-flight that educate passengers about how to recognize and react in a terrorist situation. Flying is a rather risky way to travel nowadays, and it can be pretty scary for many people. But, the more people are aware of what to look for and how to handle such events, the better prepared we will be in responding to airline emergencies.

To See or Not to See...

The picture on the top is a beautiful sunset view of Quezon City, which is part of the Philippines' Metro Manila. On the bottom is a picture I took of the Quezon City Dump Site. Notice any differences? We rode there by jeepney from downtown Manila, and I could not go long without attempting to filter out the polluted air with my T-shirt. By the time we arrived at the city dump, I was sweating and my lungs and throat actually hurt from breathing the air that has now become visible having acquired a grayish-yellow tinge. The literally breathtaking view looked nothing like the picturesque scene on the left. The dump could be smelled for miles. Hundreds of squatter homes lined the edges of the dump. Dump workers scoured the garbage hilltops for a measly couple dollars a day while children played in black river nearby.

In light of our recent discussion on the environmental sustainability and the two diametric picture above, I invite you to read Dr. Sanjay Gupta's blog on Al Gore's Academy Award winning documentary, "An Inconvenient Truth". He gives a visual representation of the current environmental and health implications of global warming as we spew out carbon emissions from the use of fossil fuels at a lightning pace. Most people view the documentary as a wake-up call for an emergency crisis that has emerged as a result of our indifference and/or ignorance. Global warming already has immediate impacts in our lifetime - in fact, I experienced them first-hand in Quezon City -and they most certainly will for our future loved ones.

In case you don't get a chance to read the blog and corresponding comments, I want to at least make available what someone said in response to this global crisis:

"First off, a politician writing a film on Global warming is absolute garbage. Secondly, most physicists do not even believe in global warming. What people consider "global warming" is the +2 degrees Celsius change that we have seen over the past few years. Big deal. In a real data set, this would be considered noise. I think global warming is equivalent to religion and it's an act to try and control the masses and to tell them to do "what is right" for their planet. Which, this is easy to do given the persuasiveness of politicians and our president and the relatively low IQ level of the average human being." Posted By Ashley, Fulton, NY : 2:53 PM ET

I have no comment...

It's all in your mind

I thoroughly enjoyed Rosie's presentation on somatization last week. I had heard of the concept before, just never knew the medical term to describe such an interesting phenomenon. I'm sure everyone has experienced this sensation at some point in their lives...after all, we are all grad students and stress is no stranger to us! To my understanding, there is no clinical way to diagnose a patient with somatization. It seems to be a last resort diagnosis when all other tests come back negative. This can be quite a problem when physicians are short of time, and cannot find an answer. However, many patients who indeed have serious complications that perhaps, have not physically manifested themselves, get overlooked in this loose screening process.

I don't deny that many patients do indeed experience somatization. And if that is the case, the treatment can be relatively easy compared to severe acute and chronic diseases, depending on one's resources. But in order to prevent misdiagnosing patients who have serious underlying illnesses, physicians must run a quality assessment and really listen to patients' concerns. From a patient's perspective, one must be clear and accurate when explaining symptoms and health behaviors. An intuition is also a very strong feeling. If a patient inherently knows something is wrong, he should get a second opinion regarding a possible premature somatization diagnosis.

No children, no marriage

At least in America, feelings about homosexuality have slowly begun to see a more liberal side. However, for most of the world, the idea of homosexuality is condemned and often ignored. I just watched a video on CNN.com that completely redefines our legal perspective on the institution of marriage and its possible consequences for future marriage hopefuls and thousands of married couples nationwide. Gregory Gadow, the author of Initiative 957, is currently collecting signatures in Seattle, Washington, to make procreation a requirement for married couples. Under 957 couples will have three years to have at least one child, or their marriage will be annulled, and newlyweds will have to prove that they can have children before receiving a marriage certificate. His initiative stems from his belief that the current ruling, which states that "Procreation between opposite-sex individuals within the framework of marriage was a legitimate government interest", is logically flawed. The ruling essentially says that from a legal standpoint, the only reason homosexuals can't get married is because they can't procreate. Gadow wants to demonstrate such ludicracy by imposing the same reasoning on heterosexual couples who cannot procreate as well.
Although I personally believe in a person's right to sexual preferences, I don't think Initiative 957 is going to solve the problem of discrimination on homosexual couples who want to get married. By fighting for the rights of homosexuals, 957 will then impinge on the rights of heterosexuals. As cliche' as this sounds, two wrongs don't make a right.
Is Gadow's logic flawed as well? Is this considered an "attack on marriage" or is it simply a defense for something bigger, say, human rights? Are our conflicting views on the definition of marriage going to one day spread and start a worldwide debate? What are the implications of such an event?

And one more thing...

One more question regarding Pharmacogenetics...

- How will religion affect the progress of Pharmacogenetics? Unmapping one's genome to reveal any genetic predispositions to disease can challenge "God's ultimate plan". Are we playing with destiny or is this scientific revolution destiny working in disguise?

Ready or Not...

I thought the presenters today did an excellent job raising thought provoking issues. I specifically wanted to comment on Andrea's presentation on Pharmcogenetics. It is such an interesting topic, one I must admit not being too familiar with. Although I agree that genetic variation amongst individuals can lead to a slew of drug responses, and quite possibly unintended adverse reactions as pointed out in class. It can potentially take our health and health care into an entirely new era - one loaded with health prevention possibilities and the knowledge to fine-tune medication to specific admixed populations.

However, as grand as it all sounds I can't help but wonder:
- In a society who's constituents constantly seek control over everything, especially their own lives, can we even handle the truth about our genetic predispositions? I wouldn't be surprised to see suicide rates rise, psychiatrists' patient lists lengthening, increased stress leading to the onset or worsening of chronic diseases, overuse of and burden on the healthcare system, etc.
- Also, are we in over our heads? We can barely take care of our nation's health when we force admixed populations into single racial/ethnic categories. With that in mind, how can we possibly attempt to manage health problems on an individual level based on one's genetic make-up?

I was just wondering what people's thoughts are... :0)

H5N1 Genetic Mutation Observed in Egypt

The Avian Flu article presented for the case discussion presented some eye-opening worldwide implications of a potential pandemic and some recommendations which might help alleviate its impact on healthy and functioning societies all around. To piggyback on this issue, according to the WHO, we are currently at level 3 (no or very limited human-to-human transmission) of the global influenza preparedness plan.
As if this intermediate level of preparedness isn't already a cause for concern, the WHO has recently alerted the public that a H5N1 genetic mutation has been observed in Egypt in two related individuals. Both infected individuals were admitted to a hospital in mid-December of 2006, and were prescribed 2 tablets per day of Oseltamivir - an antiviral drug that is used in the treatment and prophylaxis of both Influenzavirus A and Influenzavirus B. However, laboratory testing has revealed moderately reduced susceptibility to Oseltamivir in both patients due to the genetically mutating virus. The infected pair died before even seeing the new year.
The WHO has not changed their antiviral treatment reommendations for individuals infected with H5N1, nor have they changed the level of preparedness. Moreover, these mutations show no indication of human-to-human transmissibility yet. However, this is how a pandemic starts - transmission from an animal vector to humans, antiviral resistance due to viral mutations, and finally, transmission between humans. It's rather unsettling to hear that the WHO has tackled awareness on such a small scale. The preliminary stages of an upcoming pandemic are clearly revealing themselves at an increasing rate. Why have they not taken further steps to alert everyone so that they may increase their level of preparedness or initiate a plan of action if one has not already been implemented? As Larry Brilliant said in his lecture on epidemics and pandemics, the key to eradicating disease and preventing potential pandemics is "Early detection [and] early response." The WHO has already detected the warning signs prior to an outbreak; what they need to do now is take more aggressive measures to prevent a future disaster from unfolding.

Link: http://www.who.int/csr/don/2007_01_18/en/index.html

Prevention vs. Treatment

The discussion this past week on the tensions between public health and physicians representing evidence-based medicine bothered me. True, there may be tensions regarding the methods to administer help, but the intentions should still be the same...to improve everyone's quality of life. There should be a balance between prevention and treatment, for not all diseases can be prevented. Instead, we should focus on people as a whole, who's quality of life can many times, determine health status. Here' s a couple good quotes that summarizes these intentions:

“The quality of life is more important than life itself”
~Alexis Carrel

"What's wrong with death sir? What are we so mortally afraid of? Why can't we treat death with a certain amount of humanity and dignity, and decency, and God forbid, maybe even humor. Death is not the enemy gentlemen. If we're going to fight a disease, let's fight one of the most terrible diseases of all, indifference. "
"A doctor's mission should not just be to prevent death, but also to improve the quality of life. That's why, you treat a disease...you win, you lose. You treat a person, I guarantee you, you'll win, no matter what the outcome."
~Patch Adams

Ted Talks

This video was not 28 minutes...it felt like 5! Professor Rosling's lecture was so educational while being completely entertaining at the same time. I would first like to comment on his amazing ability to utilize computer animation to demonstrate trends in data. Secondly, aside from the obvious humor apparent in his comparison between the intelligence of Swedish students and chimpanzees, Rosling makes a notable observation. He blames this inadequacy not on ignorance, but on preconceived ideas. Each student, and everyone else for that matter, has certain experiences that lead them to believe things to be true. These preconceived beliefs influence one's so-called "educated" answer to the questions being dealt. Such is the case in the real world; educated persons impose their biases on an unknown subject. By bringing in previous outside knowledge, one can often be lead to formulating the wrong answer, which emphasizes the need for more education. Although, I do believe that, "Knowledge is power," I must point out that this inevitably leads to an endless cycle between education and biased opinions.
Rosling's demonstration on the strong linearity between countries' wealth (in dollars) and health (in rate of child survival) was right in line with the neverending discussion in our public health classes. We're constantly reintroduced to the idea the correlation between wealth or SES and health status. It was interesting to see however, how the linearity strengthens over time and also how it's spread across each country as well. Thus, health improvement must be highly contextualized.

"It's impossible, but we can't do it!" ...Enough said...

Link to video: http://www.ted.com/tedtalks/tedtalksplayer.cfm?key=hans_rosling&flashEnabled=1

Inspiration

I had the chance to meet and talk with renowned plastic surgeon, Dr. Fereydoun Parsa, just last month, and found him to be absolutely inspiring. Not only is he an accomplished surgeon with his own practice, but he is the Chiefl of Plastic Surgery at the John A. Burns School of Medicine, has been invited to do numerous surgeries internationally, and provides free aid to underserved populations abroad. His entire family is involved with providing medical care in one way or another.
An article was written about him in 2004, which gives a glimpse into his philanthropic life. Relating to this class, the article is titled: Surgeon’s family spreads its wealth
Dr. Don Parsa's global humanitarian missions inspire his children to pursue careers in health. I would go even further to say that his work probably inspires many fellow healthcare professionals and hopefuls, alike, to provide aid around the world. What probably inspired me the most is his belief that, "Doctors should be able to travel without politically imposed boundaries. I feel where there's a need, one should be there to help." His heart is really in the right place, and I will continue to admire all his altruistic work.

The article can be found at: http://starbulletin.com/2004/08/22/news/story6.html

1st day of class

I'm a little overwhelmed with all the information at the moment. But I am also very excited to be taking this class. There seems to be a wealth of valuable information we will learn from this course, and it's all new to me. Here we go!