Thursday, October 27, 2011

Food for Thought - Comments on a Pediatrician's Reaction to the Haitian Earthquake

Last week, I had a chance to hear a pediatrician from Massachusetts (Dr. Dennis Rosen from Children's) talk about his experiences in Haiti in the months following the earthquake. Many of the experiences he described demonstrated the incredible ingenuity required to practice in such a resource poor and devastated setting. He told stories through pictures and the pictures spoke volumes about the condition health care in the country, both before and after the disaster.

When they could not find an incubator for preterm baby, one was fashioned from a cardboard box and a desk lamp. The baby in a box lived in soon they did this for many more. They saw many children who were malnourished and didn't quite know what to do. This was a condition the Haitian doctors and residents took great pride in knowing how to treat: " This we do very well."

Taking a photographic tour through the pediatric wards in Haiti - the small tents crammed with patients, parents sleeping underneath their children's cribs in streams of water flowing through the tents, parents taking children home with defects like omphaloceles - one found it difficult to not what to render assistance.  Stepping past the urges to offer assistance perhaps the most important lessons of the night were lessons of perspective.  There were numerous doctors in the audience who commented on a Haitian health care system that was largely in a similar condition when they visited 30 or 40 years ago.  Certainly the economy was no better at that time.  We discussed some of the disorganization that ensues when aid pours in from many sources.  When aid is given without regard to the specific needs on the ground, there tends to be a mismatch between what supplies are given and what is actually required. 


The take home? ... Perhaps aid is best rendered through established and organized groups instead of individual donations or traveling as part of a small contingent.

He reminded us of the Chinese proverb:

"Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime."
In some ways, rendering aid after the disaster works a bit like this.  There's an immediate need we need to help out with, but for a lasting change, aid needs to be delivered in a sustainable way that seeks to build up the infrastructure and the economy of the country in need.


Tuesday, October 25, 2011

Deadline for Photo Submission this Saturday!

The Committee on Global and Public Health is preparing a photographic newsletter featuring the public health and global health initiatives of medical students at various medical schools throughout the country. If you have photographs of members of your Chapter engaging in a global or community health project, working at a free clinic, teaching at a local school, etc. please send them along with a brief caption to Lauren.page.black@gmail.com by Saturday October 29th. Please note that in addition to this newsletter these photos may be used in other CGPH publications and programs.

Thanks,
Lauren Page Black
Vice-Chair, Committee on Global and Public Health

Tuesday, October 18, 2011

Soda, SNAP, and Policy

The Supplemental Nutrition Assistance Program (SNAP), formerly the food stamps program, was started in 1961 and was made permanent in 1964 with the goal of providing improved levels of nutrition to low-income households.  Almost 50 years later some 40 million individuals participate in the program but the nutritional state of this country is drastically different than it was in 1961.  While hunger still plagues individuals in the U.S., malnutrition due to overeating has been an increasingly larger problem.  This has led many, including Dr. Kelly Brownell, to question the role of SNAP in meeting its goals of improving levels of nutrition for all who participate. 

In August, the USDA denied a request from the state of New York to conduct a pilot program that would have allowed the elimination of sugar-sweetened beverages from SNAP in its state.  In a recent JAMA article, Dr. Brownell outlines the USDA's concerns for denying the proposal and argues that keeping sugar-sweetened beverages in the program only leads to an increase in obesity, diabetes, and heart disease.  If the USDA already denies non-essential items including those with adverse health effects (alcohol and tobacco) then it would seem logical to deny food items that offer no nutritional value to its participants.  Dr. Brownell also urges the USDA to fund research to generate the needed data to inform policy decisions when denying future pilot programs.

While the AMA does not have specific recommendations on the most recent decision denying the New York proposal, H-150.936 and H-150.937 from AMA policy clearly support the use of evidence based nutrition and reduced calorie-dense, nutrition-poor foods.  Dr. Brownell's article illustrates the need for the AMA and other professional healthcare organizations to become active in shaping nutrition policy by adopting a stance that supports optimal nutrition in government programs.  

Wednesday, October 5, 2011

Regarding Male Circumcision

Male circumcision is an issue discussed in the MSS house a couple of times in recent years (2000, 2009).  One resolution was a request for CEJA to investigate the implications of such a practice and the other asked for our section to oppose the practice.  Both were not adopted as policy, though I remember significant heated testimony on the issue.

It's not just the MSS that's been dealing with the issue.  The discussion has taken place in many states across the country and the AAP is readdressing their current policy (that circumcision may have some health benefits, but that data doesn't necessarily support routine circumcision).

This week, JAMA published an commentary no the issue with some interesting public health arguments.  In brief:  imagine a vaccine that would reduce the risk of HIV transmission by 60% (verified in 3 RCTs) and reduce the risk of herpes and high risk HPV transmission by roughly 30%.  That would be huge news!  The authors argue with these and several other points that male circumcision does in fact have a significant long-term pubic health benefits.  With the publication of new data to this end over the past few years, they encourage everyone to take a new look at the body of data before coming to conclusions on the practice.  Read the rest of the article here: http://jama.ama-assn.org/content/306/13/1479.extract

JAMA.2011;306(13):1479-1480. doi:10.1001/jama.2011.1431

Monday, October 3, 2011

Send us pictures of your Chapter!

The Committee on Global and Public Health is preparing a photographic newsletter featuring the public health and global health initiatives of medical students at various medical schools throughout the country. If you have photographs of members of your Chapter engaging in a global or community health project, working at a free clinic, teaching at a local school, etc. please send them along with a brief caption to Lauren.page.black@gmail.com. Please note that in addition to this newsletter these photos may be used in other CGPH publications and programs.

Thanks,
Lauren Page Black
Vice-Chair, Committee on Global and Public Health

Monday, September 19, 2011

Report: Local Strategies to Combat Obesity

Your Committee on Global and Public Health has just submitted a report to AMA Staff for review.  Titled  Physician Based Education to Combat Obesity on the Local Level, this report stems from a resolution referred for study at the Interim 2010 meeting in San Diego.  Keep your eyes peeled for the final publication of this report at Interim 2011!

Included in the report is a review of the current Supplemental Nutrition Assistance Program (SNAP -- the new generation of "food stamps") and a cursory review of many community based initiatives which have been successful at combating obesity and improving health in various communities.

Wednesday, September 7, 2011

World Suicide Prevention Day

It's National Suicide Prevention Week which corresponds with Sunday Sept 10th as World Suicide Prevention Day.

So why should you pay attention?

I just lost a friend to suicide.  He was a 24 year old Marine Sergeant who was home.  He shot himself.  Our soldiers are supposed to be out of harms way once we bring them state-side. It's heart wrenching to watch a college-aged friend have to bury her brother.   

Unfortunately, I know my experience isn't unique.  Just take a look at why are our adolescents and young adults dying.  It's accidents, homicides, and suicides.

Let me translate:  we do stupid things, we kill each other, and we kill ourselvesThat's preventable death.

Here's some statistics -- we're losing 12.7 young adults per 100,000 every year to suicide.  It's worse in the military -- active duty soldiers are committing suicide at a rate of 16.3 soldiers per 100,000 per year.  There's only old data for physicians -- but we're quoted as having a suicide rate of 28-40 doctors  per 100,000 in an AMA study.

Put another way, thats upwards of 400 physicians committing suicide a year.  Or one a day.  Or the entire medical school class from a large school (or 2 whole years at my school). ...Each year.

So take some time and consider the topic of suicide this week.  Pass this around. Discuss this with other medical students.  Check in on people who may be hurting. Let's work to reduce these numbers.  After al, these numbers aren't just numbers -- they're family and friends and co-workers.


Other sources: Pediatrics Vol. 120 No. 3 September 1, 2007 pp. 669 -676 (doi: 10.1542/peds.2007-1908)