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Death of Liberian patient in the Texas hospital, and the infection of health care worker have opened holes in fight against Ebola. It conveys defeat at two fronts- first,  we could not eliminate Ebola from the main source, and 2) Ebola successfully traveled all the way to the land of the United States. It is off course a great matter of concern, and it is logical  why people of country should get panic. Keeping these entire things in mind, Center for Diseases Control and Prevention (CDC) has to give the live update on Monday morning. Since I received email on updates, I followed it online.

Now I am crippled with many questions: how nurse got infected with Ebola, did she break any protocol? How our hospitals are prepared to tackle any cases? How can we stop Ebola at the main source? Does travel ban on people coming from Ebola stricken countries will work? How our front-line healthcare providers, especially doctors and nurses are enough trained to treat patients with Ebola? Since Ebola’s case fatality rate is very high, how potent enough we are to avoid mortality? how successfully we will be able to break the transmission? How much funding is assured from federal government and how fast it will be disbursed to healthcare emergencies?

Is travel ban feasible, more importantly is it worth? Recent survey showed that 58 percent of Americans are in favor of travel ban on three Ebola stricken African nations, and few of Democrats and Republicans support that same echo.  However, Dr.Freiden, CDC chief, was little reluctant to buy travel ban theory which is quite both fathomable and logical in light of transnational interest.

The main source of infection is Western African countries including Liberia, Sierra Leone and Guniea. Why not stopping the Ebola at the source? Why not stopping patient harboring infection or potentially infected or the person at risk before boarding the plain? Why not working hard to stop Ebola menace in Africa only, once source is eliminated, there wont be any further infection. However, it is time taking process. According to World Health Organization, it is road-map of between six to nine months. Does it mean we should keep ourselves at risk till Ebola get eradiated from Africa? And if we want to impose travel ban, what about our citizens working in those countries and would like to return the USA is also point of concern. Travel ban won’t work, because the person who want to visit USA may chose other routes too reach Untied States. While incubation period of Ebola is two to three weeks, patient can transmit to other person (if comes in contact with fluid) during that period. If we want to impose ban, then effective international collaboration will be needed, which though seem apparently possible, but not practically possible. And again, how many countries we are going to impose travel ban, are we ready to include Nigeria? 150 detectives are already working in Western Africa on the behalf of CDC.

The engagement of non-profit organization like doctors without borders in training physicians and nurses makes greater sense.There is need to break the transmission chain. We can divide population at risk into two categories: 1) finding out the people with whom index patient had contact before getting hospitalized, 2) finding out the people index patient came in contact in hospital.Starting isolated clinic for suspected patients in every hospital ,or in emergency room. JFK has started screening patients even  from last Thursday.

 

When I contacted one of my friends in Nebraska University and when I disclosed to her that we have new dean for student affairs from her school, she told me one word about Dr.Ashish Joshi, ‘implementer. His brief speech at our alumni meeting (1st October) was flowing of ideas and I found him proactive, charismatic, energetic, innovative, encouraging, open-minded, warm, responsible, outstanding, ambitious, progressive, logical, diligent, enterprising, prideful and inspiring. He is highly accomplished and is also good at oral, written and visual communication.

Our Alumni meeting was well attended by 15 members, mostly represented by board members.  I express my thanks to president Dr.Welch, board members and other members. I also express my gratitude to Attiqa for arranging things well before time. This meeting, in a sense, was interplay of ideas!

Dr.Joshi has numerous publications to his name; and he has been mentoring many students. Also, by giving his own example to motivate us, he mentioned how he had published eleven papers during his maters degree, which is itself a staggering number. To underline his helping nature and his fund generating capacity through grants, he told us that he funded three PhD students and twelve master students. One of his student, just 9, had even published paper on music. To improve health outcomes at global level, Dr.Joshi has been part of many innovative interventions and has been recipients of many grant (recent R21). He has been blending clinical experience with technology.

He updated us about his initiatives for our school and he illustrated how things have been changing. Important areas of concerns he has noted down in our CUNY SPH schools are 1) There is no support from career services, which is absolutely right.. 2) Most of students have to commute a long distance to reach school. 3) There is lack of communication among alumni.

Since he has taken an initiative to start various concentration (stream) clubs (total ten clubs are on the card) and   few of those clubs  have already started functioning. To make things easier for access, he has started even virtual clubs. He also shared his own innovative idea of  HealthATM smart card. It was one of the first preventive health care initiatives. He is also considering to start dietary helpline. Quick results are already on plate. Last week I attended lecture by Dr.Johnson  on walkability and neighborhood at Hunter College and honestly, I was astonished by students followup question to Dr.Johnson, which reflects their interest in innovative technology.

One of major issues Dr.Joshi threw light on included mentoring program for students. One of Alumni members shared her experience how one of the students asked her about bio-statistics while doing internship with Epidemiology. I think offering mentors-ship is also an art and it also depends how interested you are to provide mentor-ship. Its not mandatory either! Besides, Dr.Joshi also insisted on electronic portfolio of students/alumni, that is interesting and potentially helpful idea. He is contemplating to hold career job fairs for students and alumni.

“Obstruction is an opportunity, innovation is struggle.” Well said during talk. When I thought of starting nutrition program, I met few challenges (May 2012). I then contacted MPH advisory board member, Stefania Patinella, who guided me later (October 2013), after more than one year.

We are nine hundred alumni, so big number, can’t we create potentially relevant platform? Can’t we make our voice louder through numbers?  We all need to coalesce into one unit. Yes, we are embarked on ambitious path under the inspiring leadership of Dr.Joshi! In my words, Dr.Joshi is innovative officer for CUNY SPH.

 

 

 

It was timely and overdue presentation, ” The imperative of Immediate Action ,Here and Abroad ” by Dr.Jay Verma and Dr. Widney Brown on Ebola. Dr.Jay Verma  is the Deputy Commissioner for Disease Control at the New York City Department of Health and Mental Hygiene (NYCDOHMH). Dr. Verma’s division is one of the largest division in the department, employing more than 1100 employees and operating 17 clinical facilities. He attended Harvard, and the University of california.From 2003-2011, he worked in infectious disease control in Bangkok and Beijing. Windney Brown is Director of Programs for Physicians for Human Right (PHR). She is a JD from New York University School of Law where she was Root-Tilden Scholar. I feel pride in meeting Dr.Farley while I was interning at DOH in 2012. Trained as pediatrician, Dr.Farley is also co-author of prescription for a Healthy Nation.

Considering the gravity of the problem in Western Africa; and the recent death of Western African, Mr.Duncan, in the Texas; realizing the global fabric of New York City; understanding the population dynamic of New York; fathoming its diversity and underlining two major airports in City, this presentation holds meaningful spot in policy issues. How does Ebola infect, how does it transmit, what is the source of infection, what precautions should be taken, what treatment is available and more importantly what is the response of NYCDOH so far. Most of these queries were addressed well by Dr.Verma and Dr.Brown. During panel discussion Dr.Thomas Farley asked few interesting and engaging questions which really stimulated audiences to ask curious questions about Ebola. He updated us about the ongoing airport services to examine people coming from West Africa. Dr.Brown stressed that quarantine is not a human right violation, as speculated by few organizations.

I picked up an opportunity to ask  about the United States resolve to eradicate Ebola as it successfully did for polio.  President Roosevelt personally took initiative since he was himself inflicted with polio. He provided all way help to Dr.Salk to advance research on developing vaccine. Since my sister has polio , I can feel the importance of vaccine for the following generation. Responding to my question, Dr.Verma added that the United States helped and took efforts on prioritized basis such as HIV, malaria and cancer. Thanks to international generosity, fight against many infectious challenges are ongoing at global level.

Dr.Verma termed anxiety among people about Ebola as epidemic of hysteria. At the end of session I asked him about the New York city’s response to Ebola so far. He was very polite and detailed in his reply where he told me about the programs already started by DOH with involvement of communities. Adding further, there are even mental health programs in place for relatives of people  stuck in affected areas in Africa. I am looking forward to meet Dr.Verma again!

Though we have left infectious disease era long time back, global dynamic population, increased number of travelers, increased interdependence among nations and global trade growth put us at a risk to global infectious diseases. Whether it is SARS, or flu, whether it is Ebola or cholera; we need to prepare for any health emergency and outbreak. We are equal stakeholders for those health problems. Taking all pieces together, it can be concluded that United States , being superpower in both economy and resources, being global health leader, have an opportunity-cum- responsibility to invest in infectious diseases related research. Since there have been collaboration between CDC and World Health Organization (WHO) on many global health projects, it would be interesting to see how both work on Ebola together.

Thanks DR.Lawrence Moss!

 

 

 

 

 

 

 

I am not sure whether I will attend next year National Comprehensive Cancer Network (NCCN) conference, but I went through its few of topics, potentially part of conference. agenda.  While revising glial cell tumor yesterday,  I am left  with many question : Where is curative intervention for malignant glial cell tumors? Combination of surgery, chemotherapy and radiation therapy improves the survivial, but unfortunately nor more than two years. Even worse, Glioblastoma multiforme, one of the types of astrocytoma, has prognosis of less than one year. What is the role of public health professionals in  glial cell tumors, what is the role of oncologists/oncosurgeons,  what policies can bring down the number of incidence of such tumors? Annually 10,000 cases of malignant glial cells tumors are reported in the United States annually. Half of them lose their battle in one year, and only 25% cross two years.  Former senator, and champion of equal healthcare, Ted Kennedy was also the victim of this dreadful cancer.

Neurons are the structural and functional unit of nervous system; glial cells are the supporting cells for neurons. Glial cells are present in both central and peripheral nervous system. Astrocytes, microglia, olegodendrocytes and ependymal cell are the types og glial cells [resent in the central nervous system, whereas shchwan cell and stellate cells are in the peripheral nervous system.

Estimating the burden of disease is also component of epidemiology. Survival rates for astrocytomas may vary according to geographic region. The presence of astrocytoma in genetically conditions like tuberous sclerosis supports the role of genes in the etiology of glial cell tumors. Children with ALL treated with radiation are at higher risk for developing gliomas. Several genetic mutations has been suspected in the etiology of gliomas. Tumor p53 gene mutation, and EGFR mutation is believed to play role in the fast division of cancer cells.

Having bad prognosis, second and advance-staged astrocytoma have higher mortality rates. Astrocytoma in pediatric age group is mostly benign, but adult astrocytoma is usually malignant. Primary cell lymphoma is one of the most common tumors in HIV patients, especially when CD4 count is less than 50. Oligodendriglioma is not common. Ependymoma is the cause of hydrocephalous. Shwannoma is mostly benign tumor, and it usually involve eith cranial nerve. Surgical removal is advised. Neurofibromatosis is seen to have shwannoma.

Astrocytoma was shown in John Travolta’s movie, in which Travolta develops astrocytoma. The movie rightly shows the fatality of the tumor, however, over intelligence and extra power in the character because of the tumor is not digestible.

There is need of more investment in genetic centric intervention research when it comes to glial cell tumors. Temazolide has improved the survival rate marginally, but I hope extensive research in that direction would come up with substantial cure. National Cancer Institute (NCI) has a division of cancer control and population sciences which support various grants for epigenetics related studies. For example, Dr.Wiencke of university of California received the grant to study the biomarkers of survival in glioma epidemiology.

 

CUNY SPH has recently started the EPI seminar series, and a part of it, Dr.Denis Nash and Dr. Mary Irvin presented their research work. HIV is community problem, major public health issue, clinical challenge for physicians and  broader research field for epidemiologists. Dr.Nash travelled us through his epidemiology slides, (slide showed the map of HIV global prevalence)  , HIV cases in New York city in graphical presentation (good example of visualization), and many useful references. Few cohort studies, which showed hoe several factors determined the outcome of interest: viral load suppression. Dr.Nash also highlighted the engagement of clients with primary care.On this collaboration between department of health and public health school, Dr.Aymen El-mohandes, once reportedly said “This is an example of the collaborative work that our faculty are engaged in with the practice community. Implementation science that expands the relevance of evidence-based to practice-based success is aligned with the School of Public Health’s mandate.” (*)

Taking a leaf from his presentation, I studied Dr.Nash research work for all night, went through the most of his (abstracts).  I also revised cox regression analysis with SAS and SPSS. In between I discussed viral load and other parameters with my classmate from medical school(Internal medicine resident at Baltimore medical center). To make my interest flowing and more engaging, I went through the setting of his studies, type of study, analysis, predictor and variable in studies, and conclusion part. Most of his studies have setting of Sub-Saharan Africa, and specially Rwanda, and New York City. When it comes to the analysis, many of studies has used cox-regression model and adjusted odd ratios. I could locate one study using survival analysis. Finding out the reason behind the non-compliance to treatment was goal of few studies.

Dr. Mary Irvine described Ryan White Care Coordination program in far systematic way; it was well divided into components and tracks.).  I was also interested to know excel adherence calculator.Dr.Nahs and Dr.Irvine, both are joint investigator for this project.It even reminded me of the program planning course  Professor Tsui instructed us, which I tried to correlate with the program discussed by Dr.Irvine.

I asked the question on second slide of Dr.Nash’s presentation. Since it shows the prevalence of HIV and his 7th slides talk about HIV1, so I was curious to know the epidemiology of HIV1 and HIV2, and since the outcome of interest was viral load suppression, I was interested in knowing the federal guidelines for viral load measurement in HIV2 patients. Other student asked the question on difference between hospital based and community based setting and their advantages/disadvantages. Dr.Thorpe asked about the alternate source of data other than e-share. Responding to Dr.Thorpe. Dr.Irvine spoke on HOUSA data.

In nutshell, this presentation was full of knowledge and information, and I enjoyed it to the hilt. Dr.Nash is wonderful researcher and we CUNYites are fortunate to have him. Also, one topic crossed my mind when Dr.Nash was presenting his findings, and that inspired me to write literature review on something related to viral load. I hope I will get to see Dr.Nash again so that I can learn more from him and his enriched experienced would nourish my passion for epidemiology, research, and global work.

Thanks very much for cheese and wine, Professor Thorpe J

Epidemiology of esophageal cancer has been undergoing significant change over the past 30 years; it wont be extra-aggregate to term it one of the biggest epidemiological shifts in the cancer domain in the Unites States. Squamous cell carcinoma used to be the most common histological type of  esophageal cancer, but it was replaced by adeno-carcinoma. Esophageal adenocarcinoma is one of the most lethal cancers in the US with a five-year survival of less than 20%. The relative rarity and high lethality of esophageal adenocarcinoma make this a challenging yet crucial malignancy to study. It highlights the importance of prevention when compared to the effect and cost of cure. The risk of esophageal cancer is greatest among those with the lowest socioeconomic status (SES). In case-control studies, income, education and occupation are assessed to measure the SES. Gastroesophageal reflux is proved to be the culprit of adenocarcinoma. Do you have heartburn? How long and how often determines the magnitude of the risk of developing esophageal adenocarcinoma in individuals.

Despite investment of many years and lot of resources including money, we are not succeed to say certainly which patients are going to get what cancer. But recent study by leading investigators at National Cancer Institute, Dr. Michael Cook , is somewhat right step in that direction, which found monotonic relationship between the duration of the symptom of heartburn and the magnitude of the risk of getting adenocarcinoma of esophagus.

The international Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON) was formed in 2005. The primary aim of BEACON is to provide an open scientific forum for epidemiological research into the etiology and prevention of both Barrett’s esophagus and esophageal adenocarcinoma by facilitating the sharing of data across population-based studies. Although previous studies have provided evidence for the positive association between GERD and esophageal adenocarcinoma risk, it was unknown to what extent these associations vary by sex, BMI, and cigarette smoking, or whether duration and frequency of GERD symptoms confer risk independent of each other. In this study of BEACON data, Cook et al not only found strong associations between GERD and esophageal adenocarcinoma, but also found that the relationship between GERD duration and esophageal adenocarcinoma was monotonic: Odds ratios (ORs) were 2.80, 3.85, and 6.24 for symptom durations of <10 years, 10 to <20 years, and ≥20 years, each compared with no GERD symptoms. Researchers also observed that both frequency and duration of GERD were independently associated with higher risk; individuals who had both high frequency (≥weekly) and long duration (≥20 years) were at a much higher risk of developing esophageal adenocarcinoma (OR=9.27, 95% CI: 5.02, 17.10), compared to those without GERD. Results were not notably altered when stratified by sex, BMI or cigarette smoking.Limitations of this analysis include the moderate-to-high heterogeneity associated with a majority of summary estimates presented–cautious interpretation as to the magnitude of these estimates is therefore warranted.

(I interviewed Dr. Michael Cook , scientist at National Cancer Institute, on his recent study: Gastroesophageal Reflux in Relation to Adenocarcinomas of the Esophagus: A Pooled Analysis from the Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON).)

Smoking has various dimensions: cultural, political, religious, geographical, racial, ethnic, health, corporate and gender. To counter smoking,  public health also had to use multi-dimensional approach. In the February edition of 2006, American Journal of Public Health (AJPH ) discuss the status and perception of smoking among physicians in the earliest twentieth century. Tobacco companies exclusively used doctors to market their brands as pharmaceuticals companies do today to sell its drugs. For example, to advertise camel brand cigarette, Reynolds Company in 1940s,used catchy quotation, “More doctors smoke Camels than any other cigarette.” Advertisements of various cigarettes brands kept medial journals and organizations solvent. It finally came to rest when American  Medical Association (AMA) publicly disapproved the Kent Ad campaign. . In short, smoking cigarette was fashion and was believed  healthy those days. Manufacturer Allen and Ginter were even offered prize for innovative work of building machine to fasten the process of producing cigarettes at higher rates. First world war also helped in popularizing smoking among soldiers. They believed that smoking relieved them from stress. And they even considered tobacco as important as guns in war.

Those days, stomach cancer was the leading cause of cancer deaths. Lung cancer was rapidly taking the second position because of increasering reports of new lung cancer cases. Fritz Lickint,German physician first published the possible association between smoking and lung cancer. Few years later, Muller reported the finding of case control study, which underlined smoking as the cause of lung cancer. In the United States, Hammond and Wynder provided evidence for the causation link.

More than 50 carcinogens have been reported in cigarette ingredients as potential carcinogens. Smoking causes elastin damage and cause peri-acinar emphysema, it also damages cilia epithelium. It hastens multiple sclerosis and other white matter degeneration disorders. The association between lung cancer anf smoking is well established. However, not every lung cancer is related to smoking, for example bronchoalveolar cancer and carcinoid are not associated with smoking. Smoking is strong risk factor for cardiovascular diseases. It is also concluded from the analysis that if with zero smolers in the United States, one in three cancers are completely avoidable. Smoking  effect is highly perceived  in head neck cancer studies; it is routine independent variable for many multivariate model. Smoking also has effect on the pregnant women and their babies. There are more cases of still births, preterm births and ectopic pregnancy in pregnant women who are smokers. Risk of developing diabetes is high in smokers compared to non-smokers. Smoking even decreaes the productivity at work place, and increase utilization of health care services, resulting in increase health care cost.

Center for disease control and prevention (CDC) estimates that 42 million adult Americans are smokers, which stands at 18% (declined from 20% to 18% from 2005 to 2012) of  adult population of country and prevalence of smoking is more in men than women. Adding further, people who are below poverty lines are more likely to smoke (27% vs 18%). Applying GIS knowledge, Midwest of United States has higher prevalence of 26% while west has far less prevalence of 14%. Prevalence of smoking in Harlem is 22%, which is more than national average of 18% and far more than northeast region 16.5%. 20% of children in Bronx have asthma, and smoking prevalence in the area is the key reason. Globally,Russia has one of the highest prevalence of smoking, around 40% population of Russia smokes. Cigarettes shortage triggered riots in Russia some twenty years ago.It is 29% in Europe. Indonesia and East Timor has more than two third men indulge in smoking, which elucidates the dangerous trend in these countries. In developing countries, smoking is more common in men than women. But for few years, percentage of new smokers among women has been increasing.

I lived in more than 20 neighborhoods in New York, and generally I observe smoking pattern on the street or open space. So in my observation, I found that there could be high prevalence of smoking in the Flushing area. Further supporting my  observation, I am also adding my experience of living in the Flushing neighborhood. Wonderful place for food , great diversity  and good nightlife!  I was sharing apartment with Chinese friends . I don’t know why that house didn’t have the smoke detector in place. I became public health officer for our apartment.  My African friend also moved from DC to stay in our house. It was African, Chinese and Indian staying under same roof. We had always-friendly altercation on smoking issue. My observation was apparently right; except for Native Americans (ritual value for smoking), Chinese American has the highest prevalence rate of smoking than all other ethnicities.

Native Americans have used tobacco for religious/ceremonial reasons. Judaism and other religions prohibited smoking once its harmful effects were established. For example, Rabbi Kagan prohibited smoking on the basis of health effects. Zorastrism prohibit smoking but with different rationale. It actually termed it abuse of fire. Sikhism is the religion, which clearly denounced smoking on the basis of Gurus teaching.

Few examples of the past witness the  policy of smoking ban, for instance,  Roman catholic banned smoking in mexican church, but I didn’t get any evidence that it was because of any health concern. Policy in United States has taken a long miles journey to reach the situation where we are comfortably placed. New York City reflects successful story in the framework of public health to counter smoking. Ex-mayors  Bloomberg’s work was exemplary, and perhaps why many people termed him public health mayor. It wasn’t easy walk. It wasn’t cakewalk. Corporate interests were fought first time in the history for the cause of public health. Corporate were the interest group and pressure group for every government, but public health advocacy made biggest impact. It is the biggest victory when we think in terms of health policy.  Now even CUNY has anti-smoking polic in place. Restaurants and bars do not allow smoking now.  Policy included increasing prices of cigarettes, researched found that with every 10 cent increases, smoking reduced by 2 to 5 percent. Banning at public places, and issuing harsh fine also work. New Yorks clean air indoor act has resulted in positive changes. Eight percent of population favored the law where one their to one half of adult smokers. As a result of strong policy in place, significant drop was noted in nicotine by-products in the air at restaurants and bars. New York city extended this ban to Beeches and parks.As a result of policy, smoking rates in the city has come dramatilly down.

 While  visiting Facebook profiles of African American friends,  displeasure (anger) over the recent incident in the state of Missouri is quite palpable. After pondering over this issue in light of public health, I think economic disparity is the root cause;  economic gap is the root cause; and even when if we think of stereotyping, it is also somewhat related with economic differences. There might be many angles involved, but solution lies in reducing this disparities. And coupling it with closing  educational gap!

According to the US census, the poverty rate among African American has increased from 25% to 28% in last ten years between 2005 and 2014. Single mother with children is the most suffered group in the framework of poverty. Statistics reveal shocking layer of the truth when poverty rates among single mothers with children is compared to married couple black families. (its 47% vs 8%). There is need to find out the reason behind this sordid condition of single mothers.  There are 43 million American living under poverty line, of which almost 10 million are African Americans, which means 25% of poor Americans are represented by African Americans. Doesn’t this statistics tell the crux of story? However, everything is not like discouraging, rates have dramatically come down from 1960 statistics.

According to US Bureau of Justice Statistics, nearly 40 percent prison population is non-hispanic blacks, if we imagine its implications such as what happen to their families, who take care of them, what happen to their children, are they more prone to fall into crime like their father (the crime for he was arrested) or sibling committed? Do we have such program in place to observe (just observation) the living condition of relatives or dependent of the person who is in jail? 40% of black population of jails is there for drug and robbery related crimes compared to 30% of others.

It’s a complex issue, it can’t be sorted out overnight, however, sincere and honest initiatives by government and active participation from rich educated members of the community can definitely help in tailoring required program and its effective implementation. Such program, if in place and effectively executed, have potential to produce desirable outcome and long sustaining impact.

It is not that government has closed its eyes ( based on the statistics). Many assistance programs are running well, for example.39% of African Americans are on Medicaid, 25 percent of them are recipients of food stamps, 13% get cash assistance and 11 percent get housing help. Deeper insight into Medicaid reveals that major chunk of Medicaid beneficiaries are children.

In the context of health, African Americans are not only more prone to get disease; they are more likely to die from it. I attended one lecture by family medicine practitioner (also health activist) at Hunter college auditorium, who told surprising fact that African Americans are least likely to obtain retirement social security benefits even though they contribute during their working years. Why? Life expectancy of black is 73, which is five years less than white counterparts. There are few more disturbing stat: almost 80% of black women above 20 are overweight and 40 percent of black men above 20 are living with hypertension.

(Special note: I apologize if there is any statistics or sentence, which is wrongly placed, or convey message that, in case, if hurt someone. This is my sincere attempt to present reality in the context of public health)

One of the brightest and highly accomplished epidemiology era of this century ends with the passing of  Dr.Mervyn Susser….. We all will miss you, but will find you in public health/epidemiology books!!! RIP.

Journey of Dr. Susser was full of zeal, passion and enthusiasm to work for the betterment of community health. Since Epidemiology gives the base for public health action, and policy executes it, the contribution of Dr. Mervyn Susser to the epidemiology and somehow to the policy ( in light of his struggle in South Africa) is immense.His contribution to public health began long time ago in South Africa when only fifteen percent population of the country had privilege to enjoy all power including voting rights. He was then one of the companions of Nelson Mandela in the fight against then ruling government. He was an activist, and he left South Africa with his wife to mark the protest against apartheid. He moved from there to Uk and then to Columbia University.

Those days when Dr.Susser made up his mind for epidemiology, epidemiology was not the part of curriculum in medical school. Dr. Mervyn had no formal training in epidemiology when he joined the department of epidemiology in Columbia’s school of public health in 1966. Contrast to British, United States was still belong to infectious disease era.Measles vaccine implementation program was in place (since measles vaccine was discovered in 1962).In other words, Dr.Susser was witness of  the era  changing  from infection diseases to chronic disease. He proficiently  targeted the social aspect of diseases, perhaps thanks to his appointment  as professor for social and preventive medicine while he was in UK.

Dr.Susser had one of his best publications on the’ future of epidemiology’ with his daughter and he also had many publications with his wife Zena. He married Zena when both were in medical school. Later they both started medical care in Alexandria town. They were medical practitioner and eventually they became epidemiology practitioner. Dr.Susser held Dr.Brad Hill in high regards. He also regarded as one of three fathers of social epidemiology.

His publication, ‘Epidemiology in the united States after world war second, the evolution of technique’  has been guiding torch for epidemiologists for many years. Underlining the evolution in epidemiology, he noted how theory and method became part of epidemiology training. Earlier, the only route to enter epidemiology was through medicine. Considering it as evolution, non-medicine researcher also started entering epidemiology, For example, Austin Bradford Hill was not physician. In his words, ‘newly minted epidemiologists’ were mix of many disciplines.Further adding in his article, he emphasized that Koch’s germ theory shifted epidemiology from miasma to germ-based theory. He beautifully explained how Framingham study was the foundation of the chronic disease studies, and how it denied the notion those only prospective studies could be funded. This paper tactically shows the journey from case control to cohort to the multivariate model study. I consider this paper integral part of epidemiology study.

He was  editor of American Journal of Public Health (AJPH) for six year between 1992 and 1998.  Recognizing  his contribution to epidemiology, American Public Health Association bestowed him With John  Snow Award. Richard Mayeux reportedly told New York Times, ‘his profound impact on critical thinking and causality set the framework for modern epidemiology.’ Tons of respect e to great scientist who will keep enlightening physicians to serve community, and epidemiologist not to forget considering social aspect of causation.

 

When we will turn over pages of public health history in future, battle against HIV would be remembered the same way as we do battle of Austerlitz of the Napoleon era or Trojan war of Greek epic. Of course, characters of the history (in making)  such as Dr. Wafa Sadr, Dr.Anke Ehrhardt, Dr. Anthony Fauci, Dr.James Curran and Former President Bill Clinton would be termed as Heroes. Since we are still many miles away from the actual victory, two names–who shared the same cause, who shared the same passion and unfortunately shared the same end (in death)—really worth to be mentioned for many fights we won so far against HIV. In 1998, we lost Dr. Jonathan Mann in ill-fated Swiss airflight111 crash when he was on the way to UN AIDS vaccine conference. And after 16 years, we lost Dr.Joep in unfortunate Malaysian crash. One accident as natural tragedy and another was human made accident. Crashed two bodies, not vision!

Dr. Mann was former head of WHOs AIDS program. In the very first leg battle against HIV/AIDS, when it was sort of emerging plague, the role of Dr. Mann is very important. He was the architect in defining the problem of HIV AIDS as global. According to James Curran of Center for Disease Control and prevention (CDC), Dr. Mann considered HIV/AIDS as human right and global cause. Dr. Mann used to say, the way you define the problem will determine what you do about it. He started AIDS program with one assistant and in the span of just four years, he made it the biggest program of WHO with 280 employees with annual budget of 100 million dollars. As he always said,‘Against AIDS we will prevail together‘. WHO started award after his name.

Dr.Joep(Joseph Marie Albert) Lange was president of AIDS society in between 2002 and 2004. He was on the way to annual AIDS conference to be held in Australia this year. He was pioneer in making AIDS drugs available to Africa. He used to say, ‘If Coca-Cola can deliver cold beverages to Africa, why can’t we deliver HIV medication?’ and he accomplished this feat in connecting pharmaceuticals to Africa. He also founded ‘pharm access foundation.’ Recently he argued that PreP is more effective than other modes of HIV prevention. At the time of death, he was the director of Amsterdam Institute for Global Health and Development (AIGHD). He also founded Journal Anti-retroviral therapy and remained editor in chief till last moment. He published more than 350 papers and had mentored many PhD students. He conducted several clinical trials on antiretroviral therapy. He was scientist, physician and more importantly he was health right activist.

Dr.Jonathan Mann defined HIV/AIDS as global problem, and Dr. Joep Lange championed the cause of solution in form of treatment globally. We lost both of them, but in Dr. Mann’s word, ‘Against AIDS we will prevail together.’ Their legacy on HIV/AIDS will live on. We are determined to finish the work they wish to see it happen. We will have vaccine what Dr. Mann dreamed of and we will have treatment globally available what Dr.Lange dreamt of. And Finally, we should still be proud of human race whenever people like Dr. Mann and Dr.Lange are born!!

 

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