Adonis Diaries

Posts Tagged ‘health/medicine

Take dreams seriously or Don’t. The advantages are:

Mankind start dreaming in the last three months in the womb. During the day, what we think we saw, heard, touched, smelt…are categorized as conscious observations.  The vast majority of events and sensations are invariably registered and saved in the brain as “sensory observations”

The sensed observations are stored almost indefinitely in the brain. In dream periods, the brain exercises its own “rational logical” processing work in the form of telling a “story”. The brain tries to make sense of what it has stored in observations, conscious and sensorial, by developing a story.

The brain, very often, extract “facts” saved long time ago, as the story unfold and finds a need to insert long forgotten observations.  The brain has this main function of keeping a sense of continuity in our life so that we stay connected with our personal real world model as we perceive it…

We have this tendency of labelling “predictive power” or foreseeing incoming phenomena using the term “six sense”. Many take very seriously the connection of what was dreamt of and what occur during the next day.  The most plausible explanation is that, when we start taking dreams that seriously, we are tempted to watch out for events that corroborate our dreams. In a sense, we are “primed” and prompted to observe what others are not inclined to “see” or are willing to find links among observed phenomena.

Fact is, whatever happen during the day is basically random occurrences of events and sensations, except what we think we have some control over altering the course of events, and actually acting upon our convictions. Random events and sensations are happening all the time, whether we wish it or not.

Being pre-disposed to watch out for confirming events, we are at advantages to discriminating and “seeing” what common people are indifferent to see consciously. If we refuse to take our dreams seriously, we are adopting the situation of “what happen, happen”, “come what may”, “handle one situation as it comes”… and we are not affected by random events.

Taking things seriously, such as dreams or other mythical “knowledge” and superstitions, is hard work and very taxing to the nerves…But it has this advantage of keeping you on “your toes”, watching out for opportunities, alerting to conscious observations and connections.  We are prompted more than others “to see” and discriminate potential links among events and sensations: We are taking the habit of becoming more knowledgeable and connected to people and the environment around us.

Dreams might not have any relationship with next day events, most probably they have none, and yet, dreams are essential in our mental stability and re-organizing our perception of the world and life.  If we take seriously dreams for any other reasons than as essential for our well-being, such as having predictive values, I don’t see much harm in that belief, but a noticeable advantage

“I’m King of baby-nose aesthetic surgery”: Baby-nose specie?

I am investigating the rumors that a French First Lady underwent aesthetic surgery and paid a visit to the most famous surgeon in Paris and that since the 80’s.

The aesthetic surgeon is in his sixties, and was a star in his profession. You had to get an appointment two weeks in advance, and bring a picture of your face, black in white, no smiling please and no cosmetics, from a designated photographer by the clinic.

The clinic floor is in marble and antique statues and Persian rugs give the tone of what to expect.

Piles for selected women magazines and published articles on the surgeon are displayed for your perusal. The surgeon finally receives me in his luxurious office.

He is all smile and the skin of his face is smooth (must give an example of the value of plastic surgery?)  The surgeon is direct and says: “I am the king of the baby-face. Baby nose is my specialty. The secret of a perfect nose is the one of babies, tiny, straight, round...”  He went on: “Plato said the first in priority is health, the second is beauty. I wish you health.  As for beauty, I hope I earned your confidence…”

It cost 2,000 Euro for a nose job.

I asked the surgeon on the nose of Carla Bruni, current wife of French President Nicholas Sarkozy. He said: “She is a friend for more than 20 years”.

Before 1998, the French media never approached the topic of Carla plastic surgeries.  After her wedding with the French President, the Anglo-Saxon media covered it extensively.

In 2009, the German daily Bild asked the opinions of plastic surgeons who reported that “The high cheeks of Carla are not natural: She made use of Botox aplenty and had surely a lifting.

In March 2010, the British Daily Mail exposed an ancient picture of Carla for comparison sake: The nose, the cheeks, the upper lip the jaw have been transformed.  The strong and long nose of Carla’s sister Valeria is representative of the Bruni-Tedeschi family trademark

Photographer Thierry Le Goues recalls the strong and long nose of Carla when she was 16 years old:  He spent many week ends taking picture of Carla in 1983. He said: “Carla had a nose resembling the nose of Gisele Bundchen, the current top Brazilian model.  The previous boss of Vogue, Irene Silvagni, recalls that the most beautiful and exquisite Carla hated her nose. “She had her nose done when pretty young. And it was no secret in the modeling profession” said Irene.

Photographer Max Vadukul confirms that the face of Carla was changed.  Jean-Jacques Picart said: “When Carla had breast lifting in 1990, everyone talked about it: It was still not a common operation in France.  Carla was “avant-guard” in plastic surgery in the 80’s.”

At the beginning of her modeling career, the 20 year-old Carla  was upfront in telling jokes on how she performed plastic surgery “They roll-over your eyeballs before operating on your cheeks”. Carla revealed to a journalist: “When I was 13, I looked like a lobster (crevette).  I discovered that seduction is not related to beauty. All you had to do is work on your seduction techniques.

As Carla set her mind, at the age of 30, on her second career as a singer and in the music industry, she kept denying having any aesthetic surgeries.

To a Paris Match journalist she responded: “I had not changed anything in my facial look. Plastic surgery is not a taboo to me, but I am not that attracted to these kinds of operations.  You don’t see me throwing stones at women who opt of plastic transformations. I find that the end results are not conclusive and you don’t look any younger.  I don’t feel taking these risks…”

Note: I retrieved this article from a chapter in the French book “Carla: A secret life” by Besma Lahouri

Worst ecological disaster: Who is Pablo Fajardo Mendoza?

Texaco started oil operations in the State of Equator in 1964.  The location was in the Amazon provinces of Sucumbios and Orellana; the main towns are Largo Agrio and Shushufindi up north.  Texaco dug around 356 oil wells.  For every well, Texaco constructed five open-air basins for storing toxic waste and polluted water used for the operations of the wells.  All these basins were located by the river Rio Victoria so that the wastes are conveniently emptied to save on the safety requirements.  Roads were drenched with oil instead of asphalt.  For five decades, water, air, soil smelled and tasted oil. Texaco had built a 550 km pipeline to the pacific shore.

Texaco claimed that oil does not pollute, that the Amazon basin is an oil land and nobody should be living there, that oil is biodegradable and its effects disappear within weeks, that cancer cases were related to the hygiene standards in the region…

Two of the five indigenous tribes in the region, the Tetete and Sansahuari, are extinct.  The other three tribes were forced to join the cheap labor force for lack of fishing and surviving of the forest bounties.  An ecological catastrophe devastated the entire region,  a calamity 30 times larger than the Exxon Valdez in Alaska.

Pablo Fajardo Mendoza was 14 of age, and the fifth of ten kids, when his parents moved from the province of Manabi to the town of Sushufindi, two decades ago.  At the age of 16, Pablo was leading groups of contestants to the ecological catastrophe: He was fired.

Pablo continued his education with the help of catholic Capuchin priests and obtained his law degree by correspondence at the age of 32.  Every time Pablo and his groups file suite, the Equator government would require a lawyer to represent them. Consequently, Pablo figured out that he will be the lawyer.  Pablo was under the strong impression that the government did its best to facilitate Texaco businesses.

As Pablo was resuming his high school education, the lawyer Judith Kimberling published “Amazon Crude” that made a long fire. In 1993, three separate US lawyers filed a suit in New York tribunals.  The US tribunals claimed their incompetence in the matter and suggested that the lawsuit be presented in Equator. In 2002, nine years later, the court of appeal decided that the case can be carried out in Equator.

By 2003, Pablo Mendoza lodged another lawsuit in the province of Sucumbio. 106 expert reports were presented, among them 56 of them financed by Chevron.  The cost of the 30,000 Equatorian plaintiffs was covered by the Philadelphia law firm of Kohn, Swift, and Graf.  The US law firm estimated the victims will cash in $28 billion in damages.

In 2004, 8 days before the start of the expertise phase in the judicial process, Pablo’s brother (28) was savagely assassinated.  Pablo escaped and scattered his family members for security reasons.

In February 2011, the tribunal in Lago Agria issued its verdict: Texaco-Chevron will pay $8.5 billion in damages, the saving that Texaco generated by flaunting the safety and health standards in the oil production.

The US judge Lewis Kaplan of South New York district declared that the verdict cannot be executed in the USA.  Texaco-Chevron have interests in 50 other States around the world, and damages will be collected from everywhere Chevron is doing business.

Note 1:  This article was inspired by a piece published in the French weekly “Courrier International” number 1078

Note 2: Texaco was purchased by Chevron in 2001.  Texaco was replaced by the State operator Petroecuador in 1990.

Note 3: The irony is that Texaco-Chevron invoked in 2010 the Federal law of “Racketeer Influenced and Corrupt Organization Act” to dismiss the case.  The plaintiffs are members of an organized criminal association!

“Info Deprivation Disorder”? Any link to “Augmented Reality”?

Have you experienced any kinds of withdrawal symptoms, such as trying to quit smoking or an addictive behavior? How would you feel if you are deprived of modern fast communication tools and application, such as smartphones or connections to social platforms?

Things are not getting easier for addicts to being connected to the modern “clouds” of data, and pieces of intelligence.  The parallel virtual world is already no longer that parallel:  It is integrated to the real world, and any user feels he is the center of attention, and the world might vanish if he disconnect or fails to acknowledge his presence, every day, several times, a day.

Augmented Reality is infiltrating urban environment, and transforming how we connect to and communicate with other and the surrounding environment.  For example, your smart phone, your smart eyeglasses, or miniaturized “wearable computing” devices, will superimposes data, info, and pieces of intelligence on whatever crosses your path or line of vision.  As you stroll streets, you can focus on a building and data on the kinds of businesses are located in the building are superimposed on your small screen.

For example, you don’t need to be a “famous and glamorous” personality advertised by traditional medias:  If you are a member of a social platform and your CV or profile is made universal to all to see then, anyone crossing your path may find your characteristics displayed on the screen of a smart phone.  A “stranger” might be preempted to open a dialogue with you, as if you were a very familiar person.

The bases of augmented reality are to extending in real-time, more data at a higher rate:  Data on everything that you happen to cross path with, people and environment, if you choose to focus on.  For example, in Amsterdam, you may telecharge for free on your mobile an application called Layar.  Wherever you are located in Amsterdam, you can read on the display or listen to info related to the block of buildings. These applications are also available in the US and England.

Wikitude.me has condensed the content of Wikipedia on 800,000 places of interest around the globe, and developed this system for Android.  Mobilizy has empowered the user to tag and add data on Wikitude.me.

Augmented reality will soon target health and educational domains.  Information become an integral part of the object or subject you are seeing:  An object is no longer inert, and subjects (people) are real people with known profile, before you even start a conversation.  For example,  your kitchen could be transformed into a virtual environment for playing games, such as racing virtual cars… Boring known environment would get a life of their own.

“As you are deprived of your smart equipments, you will feel handicapped: You have lost a substantial portion of your power of reflection.  You are very reliant on your “smart handicap” to facilitating your decision-making process.”

Maybe we are robbed of slower quality reflection processes, but our brain is becoming trained to link several interactions among more variables.  Maybe ancient slower philosophical processes are displaced by quicker scientific processes of comprehending many interactions for faster resolutions, a function that is the most important task for our developed brain, a function which has long be denied to us during our evolution. 

It is not the new technology that is robbing us from quality reflection:  It is the ideology being disseminated that “It is not productive and a total waste of time to allocating time for slower reflection processes…”

Is polio next to be eradicated? What disease was wipe-out anyway?

Melinda Gates spoke on TED (Technology, Education, and Design) and claimed that polio is 90% eradicated (kind of less than 2,000 cases last year).  She was apprehensive that the generous donors might be witnessing “polio fatigue”, and might be reluctant perusing donations after two decades of containing polio.

In India, a single case of polio generated the vaccination of 2 million kids in the region.  Ethiopia is witnessing a significant drop in infantile mortality rate because remote communities are training specialized nurses for vaccinating and delivering pregnant women.

Diseases like malaria, diarrhea, measles, tuberculosis, cholera, polio, and countless others banal diseases that have vaccines, or can be treated with antibiotics, are still rampant and killing everyday thousands of babies and adults in under-developed States, particularly, kids under 5 years of age.

For example, Cholera is back in force and threatening to spread in many neighboring States to Zimbabwe.  Mugabe of Zimbabwe refuses to step down as President and his State is suffering great famine, miseries, and the plague.  Thousands of people have contracted cholera and over 7,000 have already succumbed.   Cholera cannot be controlled; it could not be through the ages and current progress is not at a par with that plague.  Why?  Cholera has the capacity to mutate: an element of AND code new functions for the benefit of the bacteria, modifying its genome and increasing its adaptation to treatments or new antibiotics.

So far, medical research has not mapped out all the means of transmissions of Cholera.  It is possible that home pets, cats and dogs, carrying flea might be transmitters of the epidemic.  What is known is that older generations of antibiotics such as streptomycin, chloramohenicol, and tetracycline are increasingly inefficient against the bacteria of cholera.  The antibiotic based on fluoroquinolone might be of more effectiveness.

The best angle to analyze the topic of transmissible diseases to divide the diseases in three categories.  The first category represents the diseases that have effective and cheap vaccines and antibioticsThe second category represents disease that require costly vaccines, expensive treatments, and common surgeries but can effectively cure.  The third category is reserved for diseases that have no cures but can be contained for several years until progress is achieved like AIDS and a few other cancerous cases.

For the third category, funds are allocated to the under-developed States, simply because the rich States need guinea pigs to experiment with treatments that are traumatic in their own communities.

The first category is the most promising for decreasing drastically the casualties at an affordable cost.  Basically, the vaccines and the prior generations of antibiotics have already covered the expense of experimentation, and have been a cash cow for many decades.  The main expense would be to train local nurses in remote communities, and university students in medicine, to administer vaccines and inexpensive antibiotics that are still effective.

The second category is not as urgent for the under-developed States as the funding and the structural organizations for eradicating the diseases in the first category.  There has been a mobilization in 1994 for creating a world bank for medicament and vaccines and a few States invested funds in that bank but there was lack of active pursuit for the long term.  All the health related branches in the UN such as UNICEF, OMS, PAM, FUND, Red Cross, and Red Crescent have been working on the field for many decades, but diseases are gaining the upper hand.

The scarcity of resources allocated to fighting disease in the under-developed States need to be restructured.  Priority should be given to diseases in category #1, before attacking effectively diseases in category number two.  At least, trained nurses and medical students would be ready to tackle more complex treatments.

You may read my article https://adonis49.wordpress.com/2009/02/17/the-under-developed-countries-are-plagued-with-common-diseases-any-resolutions/

Note 1:  A short history on Cholera or plague.

Bubonic plague has a long history, through the ages, to devastating more than a third of a population as it hits.  Cholera lands suddenly, kills for a short period and then disappear for no known reasons.  The best remedy was to flee as quickly, as far away as is possible and not to return any time soon.

The Jews in Judea were decimated during David.  The troops of the Assyrian Monarch Sanhareeb, putting siege to Jerusalem in 701 BC, suffered the plague. Greece and Athens in 430 BC was devastated by cholera as Sparta was laying siege to Athens. Ancient Rome was plagued.  Cholera hit Byzantium during Justinian for one century and traveled around the Mediterranean basin; Pope Pelage II succumbed to cholera in 590.

In 1346, the Mogul troops, laying siege to Caffa in Crimea, were plagued and they catapulted infested bodies over the rampart of Caffa.  The Genoa defenders fled Caffa and transmitted the plague to all Europe; Spain, Marseille, Paris, England are contaminated and then Russia ten years later. France lost over a third of its population and Spain as many if not worse.

Cholera crashed London in 1665.   The English monarch and his family had to pay a long visit to the French Monarch.  The plague subsided when fire engulfed the better parts of the poorer quarters of London in 1666.

The last time, before Zimbabwe, that cholera expressed its virulence was in 1894 in south east China.

History accounts shows that cholera was carried by the Mogul troops arriving from Mongolia and Central Asia. As they sweep into relatively humid regions then plague settles in during summertime. India, Iran, Iraq, and Syria suffered plague during the Mogul successive invasions. I cannot but figure out a few hypotheses.

Note 2:  Alexandre Yersin, a French physician and bacteriologist, discovered in 1894 that Cholera is a bacteria but he failed to come up with a curative serum. Yersin still believed that rodents (rats) are the main culprit for transmitting this disease.  Only in 1898 did Paul-Louis Simond confirmed that cholera is transmitted by flea that quit dead rats to other greener pastures by sucking blood elsewhere.  Rats are infected with cholera but they are not affected or transmit it because they rarely bite humans.  Once a man is afflicted with cholera then the main transmitter of the epidemics are men.

Cholera infects people but does not bloom in dry arid regions.  Cholera is virulent in humid regions and during the hot seasons. Could it be because people sweat profusely? Especially because people failed to wash or take bathes in older days?  Or is it that since sweat excretes most of the salt in the body then cholera has an ideal medium of less salty body fluids to flourish and concentrate during the ripe seasons?

Placebo is neutral and inexpensive? Think again!

Placebo are supposed to have neutral effects in double-blind experiments on the effects of medicines, and they are thought to be very inexpensive products.

First, do you know that 80% of published peer-reviewed clinical research failed to describe the contents in ingredients and the components of placebo used in the experiments?  Fact is, placebo are not mere sugar, plain water, saline solutions… They do have ingredients “considered to be safe or neutral” by the researcher.  Remember the case of olive oil used as placebo while cod oil was the medicine of cure?  They both lowered cholesterol level!

Second, placebo are not cheap!  Placebo are usually more expensive than the actual manufactured medicine to test.  The placebo has to exactly resemble the medicine in form, shape, color, consistency, taste, credible in the logo and inscriptions… The pharmaceutical manufacturer has to redesign a new product for small quantities:  Thus, placebo are far more expensive than normally budgeted in the research grant. 

Actually, a new field is emerging for graphic designers called “placebo designers” with objective of finding creative and credible placebo.

Third, autosuggestion that placebo is the proper medicine has demonstrated to be a potent factor in the cure of many patients.  For example, in 17% of the cases when patients were informed to be taking placebo, it had a positive influence.  Fabrizio Benedetti used saline solution on Parkinson patients.  The activities in the corresponding cerebral region diminished significantly:  The trembling ceased.

Do you know that between 2001 and 2006, the number of “faked medicines” on the market that didn’t reach phase 2 in the testing (limited number of patients experimented on) increased 20%?  That marketed faked medicines that didn’t pass phase 3 increased 11%?

Do you know that the Canadian Journal of Psychiatry revealed in April 2011 that 20% of medical practitioners administered placebo on their patients without the knowledge of the patients?  That 35% of the prescribed medicines had low weak doses of potent ingredients?

Using placebo in chronic patients, familiar with the taste and consistency of the real medicine, generate negative counter-reactions in the mind of patients and called “nocebo”:  The chronic patients are no fools and can discriminate a placebo from normal medicines; they are used to taking regularly particular medicines. 

The role of autosuggest is very important in curing patients.  Consequently, unless the clinical experimenter is thoroughly aware of the types of illnesses that can be cured by autosuggest, if he fails to factor-in this variable in controlling the experiment, the results would be confounding:  Further investigations, analysis, or redoing the experiment with a reviewed design would be required.

Note:  Idea extracted from an article in the “Courrier International”

Chicago: Short history of public health

Part of Commencement Address given by Dr. Bechara Choucair to Feinberg PPH, May 4, 2011

“Today is about you. You decided to invest in your education. You decided to focus on public health. You worked hard. You read many articles.

I am sure you wrote many papers. You participated in many work-groups. You sat for many exams. You gave many presentations. It is all paying off today.

Brief description of the history of public health in Chicago.

The population-based approach of public health has had a tremendous impact on the health of our communities for almost two hundred years.  In Chicago, the formal establishment of public health took place in 1834, when the Board of Health was established to fight the threat of cholera.

During this Early Sanitation era, sanitation and quarantine were our best tools for fighting disease. The first sanitation regulations were passed and required all men over 21 years old to help clean the city’s streets and alleys.

We conducted home visits to persons with infectious diseases and boarded ships in Chicago’s harbor to check on the health of crewmen.   Our deepest public health roots can be traced to disease control.

The earliest public information efforts starting in the 1850’s. 

The efforts in the era of sanitary reform, focused heavily on sewers, water and food and dairy. During this period, the Health Department issued regulations governing the drainage and plumbing of new buildings (1889); we initiated meat inspections at Chicago’s Union Stock Yards (1869), and full milk inspection activities began (1892).

We saw some of our highest death rates during this era due to diphtheria, typhoid and scarlet fevers, measles and whooping cough. Using his regulatory authority, the health commissioner at the time, Dr Oscar Coleman De Wolf, required the reporting of contagious diseases by physicians in 1877.

By 1887, our advancements in medical understanding helped us see that typhoid would continue to kill, unless we stopped the flow of contaminated water into Lake Michigan–the source of the water we drank, the water we cooked with, and the water in which we bathed.  Building the 28-mile Sanitary and Ship Canal, which reversed the flow of the Chicago River by 1900, was a major medical/public health intervention.

With the advent of the Hygiene Movement (1880’s-1950’s), and the continued advances in understanding disease and medical practice, the focus of public health shifted to individual hygiene and medical care, particularly children’s health.

In 1890, a Chicago child had only a 50% chance of reaching 5 years of age. By 1900, the odds of surviving to age 5 had increased to 75%.

In 1899, with the support of 73 physician volunteers, the City initiated its first campaign against infant mortality.

Service delivery focused on the provision of dental services in schools in 1915, public health nurse home visits to infants in 1925 and educational campaigns against venereal disease in 1922.   These remain among our priorities today.

The early public health nurses at work.

The nurses “finders of sick infants” would seek out sick babies and refer them and their mothers to Tent Camps, where they would receive medical treatment and hygiene education.

In 1956,  516 persons were stricken with polio. Public health authorities assigned 90% of the city’s health workers to reach a goal of one million inoculations in 2 weeks. One year later, Chicago had only 28 cases, and in 1959 when the U.S. went through a record- breaking year for polio, Chicago had only one case.

The 1950’s saw the beginning of dramatic growth in medical interventions which prompted the era of health care services. During this time, the delivery of personal health care services, primarily to low-income populations, was becoming the primary public identity of public health in Chicago.

In 1959, the Health Department opened the Mid-South Mental Health Center, the first of what would become a network of community mental health centers by the early 1970’s.

The first half of the 1970’s  saw the development of several Department neighborhood health centers, under the federal Model Cities Program.

The first of our centers, in the Uptown community, was established in 1970. On this slide, you can see our clinics in Lakeview, and the 1987 groundbreaking for the expansion of our West Town clinic.

The 1960’s and 1970’s brought significant changes at the federal level as well. The passage of Medicare and Medicaid in 1965 greatly expanded access to care for some of our most vulnerable populations.

Since that time, CDPH has greatly expanded its capacity in Epidemiology, Policy, Planning, Resource Development, and more recently, Information Technology, while maintaining its efforts in critical public health functions such as disease prevention and control, and in the last decade, emergency preparedness.

Note:  This article is part of the Commencement Address at Feinberg School of Medicine at Northwestern University, delivered by Dr. Bechara Choucair, Commissioner of public health of the city of Chicago.  This speech covered all the grounds and it is impressive.

Clinical medicine versus public health? What Dr. Bechara Choucair said?

From the Commissioner of public health of the city of Chicago in his Commencement Address at Feinberg School of Medicine at Northwestern University on May 4, 2011

Any intersection between clinical medicine and public health?

Clinical medicine and public health are often seen separate.

We often understand these two words as different disciplinary silos in which many of us spend entire careers. Ted Schettler, the Science Director of the Science and Environmental Health Network, frames both disciplines with respect to focus, scale, ethics, education and the nature of the science.

1. Focus: Clinical medicine focuses primarily on the individual, while public health focuses on the community.

2. Time frame: Relevant time frames in Clinical Medicine are usually single lifetimes, while public health thinks in terms of generations.

3. Ethics: From an ethics perspective, clinicians advocate for individual people. Public health practitioners advocate for the community, for a group of people.

4. Rights: In clinical medicine we focus on individual rights of a patient. In public health, we think about human rights, social justice, and environmental justice.

5. Education: From an education perspective, in clinical medicine we focus on the biomedical model with more emphasis on cure than prevention (although this is shifting now). In public health, we learn more about sociology, epidemiology, cultural anthropology, economics and more.

Think for a moment about the evidence of the science.

In clinical medicine we love to talk about controlled, double-blind clinical trials. We don’t find that type of approach often in public health.

Clearly, there are differences: differences in focus, differences in scale, differences in ethics, differences in education and differences in the nature of science.

But the reality is that the health of the individual and the health of the community are inter-related and inter-dependent. Maintaining two disciplinary silos is NOT the answer.

Bridging the gap is critical if we are serious about improving the quality of life of our residents.

Bridging the gap starts with education.

We have to enhance the understanding of public health principles among our students in the clinical field and we have to enhance the understanding of clinical medicine principles among our public health students.

Bridging the gap happens in research. We have to expand our research portfolio to focus on health disparities and other population level research.

Bridging the gap will not be successful unless we translate what we learn in research all the way into public policy.

And finally, it is people like you, like the faculty here and like me, who will take the lead in bridging this gap.

The good news is that here in Chicago, there are great people who have done great work in bridging this gap. I am forever grateful for their contributions.

At the Chicago Department of Public Health, we are exploring how to fully exploit the intersection of public health and medicine. We are excited about having the opportunity to use, as the foundation of such efforts, the proliferation of HIT initiatives, particularly in under served communities.

A major federally-funded initiative to help us achieve this goal is CHITREC, housed here at Feinberg and funded through stimulus funds (American Recovery & Reinvestment Act).

CHITREC (Chicago Health Information Technology Regional Extension Center) provides technical assistance to primary care providers serving predominantly uninsured, under insured, and medically under served populations in developing an Electronic Health Records system that will improve health outcomes.

CHITREC is collaboration between Northwestern University and the Alliance of Chicago Health Center Services, a health center-controlled network. It builds upon extensive collective Electronic Health Records implementation and clinical informatics experience.

We anticipate that as the participating providers come on line, there will be wonderful opportunities to use the wealth of data available through an Electronic Health Record to measure population health and be able to pinpoint where particular interventions are needed to improve outcomes.

Other federal funding, including the 2010 Patient Protection and Affordable Care Act, has provided additional opportunities for investments in the electronic data infrastructure supporting population health. Chicago Department of Public Health (CDPH) is positioned to become a leader in the public health applications of Health Information Technology. Current CDPH activities include:

  •  Funding of 26 acute care hospitals in Chicago to assist in their efforts toward establishing capacity to transmit data of public health significance to CDPH;
  • Partnering with the Centers for Disease Control and Prevention (CDC), GE Healthcare and the Alliance of Chicago in a pilot evaluation the feasibility of targeted, pubic health-oriented clinical decision support for ambulatory providers, delivered at the point of care through Electronic Health Records;
  • Supporting Stroger Hospital of Cook County and two major Federally Qualified Healthcare Center (FQHC) networks (ACCESS Community Health Network and the Alliance of Chicago) in their efforts to establish robust transmission of immunization administration data to the Illinois immunization registry;
  • Engaging with the Illinois Office of Health Information Technology in statewide efforts to build a sustainable Health Information Exchange (HIE);

Feinberg PPH: Commencement Address given by Bechara Choucair, May 4, 2011

Note: Dr. Bechara Choucair is Commissioner of public health of the city of Chicago.  I liked his Commencement Address at Feinberg School of Medicine at Northwestern University and decided to publish the speech and three sections of the speech on wordpress.com.

This speech covered all the grounds and it is impressive.  I found it acceptable to edit out sentences that are not closely related to the subject matter in order to shorten the message.

Feinberg PPH: Commencement Address given by Bechara Choucair, May 4, 2011

Dr. Bechara Choucair is Commissioner of public health of the city of Chicago.  I liked his Commencement Address at Feinberg School of Medicine at Northwestern University and decided to publish it on wordpress.com.  This speech covered all the grounds and it is impressive.  I found it acceptable to edit out sentences that are not closely related to the subject matter in order to shorten the message.

“Today is about you. You decided to invest in your education. You decided to focus on public health. You worked hard. You read many articles. I am sure you wrote many papers. You participated in many work-groups. You sat for many exams. You gave many presentations. It is all paying off today. Congratulations.

My mom, dad, my sisters and my grandfather came along to my college graduation. I was so excited to have made it through College. At that time, I was accepted into Medical School at the American University of Beirut. I was really happy with the progress I made. My grandfather, who graduated from the same school 60 years earlier, gave me a big hug and said: “I could not be any more proud!” To this day, these are the words that come to mind anytime I think of him. He passed away a few years later. I am so glad I made him proud.

I have no doubt that many of your loved ones could not be any more proud today. To your loved ones: Thank You. Thank you for your support. Thank you for your love. And most importantly, thank you for being there.

As I reflect back on how my career has evolved, I can’t help but wonder if I would be here today if I did not work with Dr Hamadeh as my community medicine project mentor in my second year of medical school. Dr Hamadeh is a Family Physician with a Masters in Public Health. I worked closely with him and I realized that there is a lot more to Medicine than seeing patients. I saw the potential power that public health has, to truly make our population healthy. Every time I go back to Lebanon to visit with family, I make sure to stop by his office. I hope he knows how critical his role was, in shaping my career.

Today, I wanted to do 3 things:

  1. I will briefly describe the history of public health in Chicago
  2. I will talk about the intersection between public health and medicine
  3. I will tell you about the future of public health in Chicago

The population-based approach of public health has had a tremendous impact on the health of our communities for almost two hundred years.  In Chicago, the formal establishment of public health took place in 1834, when the Board of Health was established to fight the threat of cholera.

During this Early Sanitation era, sanitation and quarantine were our best tools for fighting disease. The first sanitation regulations were passed and required all men over 21 years old to help clean the city’s streets and alleys. We conducted home visits to persons with infectious diseases and boarded ships in Chicago’s harbor to check on the health of crewmen.   Our deepest public health roots can be traced to disease control.

[Slide 1]   Earliest public information efforts.

Starting in the 1850’s,efforts in the era of sanitary reform, focused heavily on sewers, water and food and dairy. During this period, the Health Department issued regulations governing the drainage and plumbing of new buildings (1889); we initiated meat inspections at Chicago’s Union Stock Yards (1869), and; full milk inspection activities began (1892).

We saw some of our highest death rates during this era due to diphtheria, typhoid and scarlet fevers, measles and whooping-cough. Using his regulatory authority, the health commissioner at the time, Dr Oscar Coleman De Wolf required the reporting of contagious diseases by physicians in 1877.

[Slide 2]   By 1887, our advancements in medical understanding helped us see that typhoid would continue to kill unless we stopped the flow of contaminated water into Lake Michigan–the source of the water we drank, the water we cooked with, and the water in which we bathed.  Building the 28-mile Sanitary and Ship Canal, which reversed the flow of the Chicago River by 1900, was a major medical/public health intervention.

With the advent of the Hygiene Movement (1880’s-1950’s), and continued advances in understanding disease and medical practice, the focus of public health shifted to individual hygiene and medical care, particularly children’s health.

In 1890, a Chicago child had only a 50% chance of reaching 5 years of age. By 1900, the odds of surviving to age 5 had increased to 75%.   In 1899, with the support of 73 physician volunteers, the City initiated its first campaign against infant mortality.

Service delivery focused on the provision of dental services in schools in 1915, public health nurse home visits to infants in 1925 and educational campaigns against venereal disease in 1922.   These remain among our priorities today.

[Slide 3]  Early public health nurses at work.

On the bottom is one of a group of nurses known as “finders of sick infants.” These nurses would seek out sick babies and refer them and their mothers to Tent Camps where they would receive medical treatment and hygiene education.

[Slide 4]These pictures are from 1956 when 516 persons were stricken with polio. Public health authorities assigned 90% of the city’s health workers to reach a goal of one million inoculations in 2 weeks. One year later, Chicago had only 28 cases, and in 1959 when the U.S. went through a record breaking year for polio, Chicago had only one case.

The 1950’s saw the beginning of dramatic growth in medical interventions which prompted the era of health care services. During this time, the delivery of personal health care services, primarily to low-income populations, was becoming the primary public identity of public health in Chicago.

In 1959, the Health Department opened the Mid-South Mental Health Center, the first of what would become a network of community mental health centers by the early 1970’s.

[Slide 5]The first half of the 1970’s also saw the development of several Department neighborhood health centers under the federal Model Cities Program. The first of our centers, in the Uptown community, was established in 1970. Here you can see our clinics in Lakeview and the 1987 groundbreaking for the expansion of our West Town clinic.

The 1960’s and 1970’s brought significant changes at the federal level as well. The passage of Medicare and Medicaid in 1965 greatly expanded access to care for some of our most vulnerable populations.

Since that time, CDPH has greatly expanded its capacity in Epidemiology, Policy, Planning, Resource Development, and more recently, Information Technology, while maintaining its efforts in critical public health functions such as disease prevention and control, and in the last decade, emergency preparedness.

We have a public health history to be proud of. From the early days of the sanitary reform era to running medical care facilities, I can’t be any prouder of our history as a City. We always invested in building a healthier and a safer Chicago.

The intersection between clinical medicine and public health. These two worlds are often seen separate. We often see them as different disciplinary silos in which many of us spend entire careers. Ted Schettler, the Science Director of the Science and Environmental Health Network, frames both disciplines with respect to focus, scale, ethics, education and the nature of the science.

Clinical medicine focuses primarily on the individual while public health focuses on the community. Relevant time frames in Clinical Medicine are usually single lifetimes, while public health thinks in terms of generations.

From an ethics perspective, clinicians advocate for individual people. Public health practitioners advocate for the community, for a group of people. In clinical medicine we focus on individual patient rights. In public health, we think about human rights, social justice, and environmental justice.

From an education perspective, in clinical medicine we focus on the biomedical model with more emphasis on cure than prevention (although this is shifting now). In public health, we learn more about sociology, epidemiology, cultural anthropology, economics and more.

Think for a moment about the evidence of the science. In clinical medicine we love to talk about controlled, double-blind clinical trials. We don’t find that type of approach often in public health.

Have you ever asked yourself where do you fit better? Have you ever seen yourself in one of the two worlds?

Clearly, there are differences: differences in focus, differences in scale, differences in ethics, differences in education and differences in the nature of science.

But the reality is that the health of the individual and the health of the community are inter-related and inter-dependent. Maintaining two disciplinary silos is NOT the answer. Bridging the gap is critical if we are serious about improving the quality of life of our residents.

Bridging the gap starts right here. It starts with education. We have to enhance the understanding of public health principles among our students in the clinical field and we have to enhance the understanding of clinical medicine principles among our public health students.

Bridging the gap happens in research. We have to expand our research portfolio to focus on health disparities and other population level research.

Bridging the gap will not be successful unless we translate what we learn in research all the way into public policy.

And finally, it is people like you, like the faculty here and like me, who will take the lead in bridging this gap. The good news is that here in Chicago, there are great people who have done great work in bridging this gap. I am forever grateful for their contributions.

At the Chicago Department of Public Health, we are exploring how to fully exploit the intersection of public health and medicine. We are excited about having the opportunity to use, as the foundation of such efforts, the proliferation of HIT initiatives, particularly in under served communities. A major federally-funded initiative to help us achieve this goal is CHITREC, housed here at Feinberg and funded through stimulus funds (American Recovery & Reinvestment Act).

CHITREC (Chicago Health Information Technology Regional Extension Center) provides technical assistance to primary care providers serving predominantly uninsured, under insured, and medically under served populations in developing an Electronic Health Records system that will improve health outcomes. CHITREC is collaboration between Northwestern University and the Alliance of Chicago Health Center Services, a health center-controlled network. It builds upon extensive collective Electronic Health Records implementation and clinical informatics experience.

We anticipate that as the participating providers come on-line, there will be wonderful opportunities to use the wealth of data available through an Electronic Health Record to measure population health and be able to pinpoint where particular interventions are needed to improve outcomes.

Other federal funding, including the 2010 Patient Protection and Affordable Care Act, has provided additional opportunities for investments in the electronic data infrastructure supporting population health. Your Chicago Department of Public Health (CDPH) is positioned to become a leader in the public health applications of Health Information Technology. Current CDPH activities include:

  •  Funding of 26 acute care hospitals in Chicago to assist in their efforts toward establishing capacity to transmit data of public health significance to CDPH;
  • Partnering with the Centers for Disease Control and Prevention (CDC), GE Healthcare and the Alliance of Chicago in a pilot evaluation the feasibility of targeted, pubic health-oriented clinical decision support for ambulatory providers, delivered at the point of care through Electronic Health Records;
  • Supporting Stroger Hospital of Cook County and two major Federally Qualified Healthcare Center (FQHC) networks (ACCESS Community Health Network and the Alliance of Chicago) in their efforts to establish robust transmission of immunization administration data to the Illinois immunization registry;
  • Engaging with the Illinois Office of Health Information Technology in statewide efforts to build a sustainable Health Information Exchange (HIE);

What is the future of public health in Chicago?

[Slides 6 and 7]

During my tenure at the Chicago Department of Public Health, which has been about a year and a half so far, I have stressed the importance of focusing on public health strategies that effectively address the actual causes of death, rather than what is found on a death certificate. Groundbreaking work done by McGinnis and Foege at CDC in the early 1990’s, and fine-tuned since then, demonstrated that the actual causes of death are largely related to individual health behaviors and social circumstances — not genetics, not access to health care.

Dr. Thomas Frieden, Director of CDC, looked at these, took it all in, but then went further and asked:  “now that we have a better understanding of the actual causes of death, how can public health, charged with improving the health of the population, best intervene?”

[Slide 8]

The most effective interventions, at the base of the pyramid, address the social determinants of health and the way that our society is structured.  Taking this approach to heart, I challenged our team at the Chicago Department of Public Health to develop a draft of a public health agenda that best meets this current understanding of effective public health interventions. And while our emphases have been near the bottom on the pyramid, I recognize that there is a need for effective programs at each level.

If you follow Chicago government, you might know that Mayor Emanuel committed to releasing a public health agenda for the City of Chicago in the next 100 days (well, 97 days by now since he’s been in office for 3 days already!) Our public health agenda is a blueprint for action intended to serve as a framework for a focused, yet comprehensive, approach to how the Chicago Department of Public Health will lead and work with partners to improve the health and well-being of the people in Chicago.

Our public health agenda:

  • identifies priorities to guide our public health work over the next five years;
  • sets measurable targets, achievable by 2020, to improve the health and well-being of Chicagoans;
  • sets policy, programmatic and educational & public awareness strategies that can be measured and monitored; and
  • serves as a vehicle to engage communities, partners, and other public health stakeholders in health improvement efforts.

The priorities presented in this agenda were identified through an assessment of public health data and resources, as well as current or potential stakeholder involvement. Reflecting a multi-tiered public health approach, for each priority area, this agenda presents strategies organized into three sections:

  • ·      Policies, including regulatory changes and laws that will be pursued to improve the public’s health;
  • ·      Programs and services that will be delivered, and
  • ·      Education and public awareness

I am sure it is no surprise to anyone if I share our priorities with you. I am talking about Obesity Prevention, Tobacco Use, HIV Prevention, Teen Pregnancy Prevention, Cancer disparities with a use case on breast cancer disparities in Chicago. I am also talking about heart disease and stroke, about violence prevention and about access to healthcare among others.

These are exciting times in Chicago. In 97 days, our City will have a clear public health agenda. We will have a focused set of priorities. We will make our targets public. We want the public to hold us accountable. Chicago invests around $200M every year in our public health system. We owe it to Chicagoans to do our best to stretch those dollars and get the best return on investment. This is my commitment to you today. As you get ready to start the next phase in your career, I call on all of you to join me in this journey. I guarantee you it will be a lot of hard work but a lot of fun and we will get a healthier city.

 

There are many ways to have an impact on health:

  • ·      Treating the sick –
  • ·      Preventing the illness in the first place through screenings
  • ·      Population-based prevention strategies

I hope in your work in public health, regardless of the setting, you keep in mind the concept of the “third revolution” (Breslow) in public health. Now that we have made significant progress in addressing communicable disease (first revolution) and made progress in chronic diseases (second revolution), we are poised to embark on the third, where communities are healthy and the goal is promoting health and not just preventing disease: “Health promotion reaffirms considering not only how to avoid being sick, a negative concept, but also how to expand the potential for living, a positive view: The main difference between health promotion and disease prevention is the premise of health promotion regarding health as a resource of everyday life”.

We all know the impact of clinical medicine on public health.  To promote health, we need to think beyond just clinical medicine. We have to be involved in social policy.  All social policy is public health.  Fiscal policy is health policy.  Education is public health. Housing is public health.

Perhaps in your schooling, or on your own, you saw the film “Unnatural Causes: Is Inequality Making Us Sick?” Through four hours of excellent documentary film making, it makes crystal clear what needs to change in our society if we are going to be truly healthy:

  • ·      It’s less poverty
  • ·      It’s quality housing
  • ·      It’s quality education
  • ·      It’s viable communities filled with resources geared to the needs of the particular population

I grew up in Lebanon in the midst of a civil war. I saw the impact of violence on individuals, on families, on community and on the whole country. I suffered the impact of violence myself.  I saw the impact on my own family, in my own community.

In medical school at the American University of Beirut, I spent time seeing patients in Palestinian Refugee camps in Beirut. I talked to so many people who lived their whole lives in an environment where I might not choose to live.  I saw firsthand the impact of forced migration on health.

In Houston, at Baylor College of Medicine, I trained in a community health center serving mostly Mexican immigrants who struggled to make a decent living. I learned about homelessness by providing clinical services to people living in shelters, under bridges, in cars and on the streets.  I saw firsthand the impact of poverty and lack of housing on individuals.

In Rockford, at Crusader Community Health, I served as a medical director of a community health center network. I learned about more migrant communities. I learned more about public housing. I learned more about HIV/AIDS.  I saw firsthand the impact of poverty on different communities.

At Heartland Alliance for Human Rights and Human Needs, I worked with immigrants and refugees on the North side of Chicago. I also worked with many of the Heartland Alliance global health team:

  • ·      the team working on HIV Prevention among Men who have sex with men in Nigeria
  • ·      the team working on sexual and gender-based violence in Sulaymaniyah, Iraq,
  • ·      the team working on torture and trauma treatment in Momostenango, Guatemala
  • ·      the team working on Maternal Child Health in Patzcuaro, Mexico
  • ·      the team working on child soldier reintegration in Srilanka

I visited with some of these sites and learned from the Heartland staff and most importantly I learned from the participants in these programs.  What I learned from all of these experiences is simple.

To empower individuals to achieve their human rights, and to empower communities to achieve their potential, we cannot think about health care alone. We have to think about healthcare. We also have to think about housing. We have to think about economic security. We have to think about legal protections.  This is what public health is all about.  This is what we need to address as public health people.

I hope that with your public health education and approach you will keep in mind that a healthier society is a society where healthier choices are the default choices.  A healthier society is a society where children have good schools to attend, and safe neighborhoods to play in.  A healthier society is a society where parents have enough resources to provide their children with a rich experience in life.

What do you need to do to be a better person?  What will you do to build a healthier society?  How can you contribute to social justice?  What role will you play to advance human rights?  Join me today in dreaming big for our communities.  I always did. I always will.

From being a little kid playing on the beach of a small Mediterranean town in Lebanon, dreaming about a safer Lebanon to the conversation I had the last week with Mayor Emanuel when he asked me to stay as part of his Cabinet, I always dream big for our community.

Today is a milestone in your career. Please join me in dreaming big.

Our body. “A short history of nearly everything” by Bill Bryson

The building blocks of life might be the 20 elements of amino acids that combine in certain sequences to form the 700,000 kinds of proteins in our body.  The number of proteins discovered is increasing and might be in the range of one million kinds.

Hemoglobin is only a chain of 146 amino acids long, a runt by protein standards in length, and yet it offers 10 at an exponent of 190, of possible amino-acid combinations in order to have the exact sequence of the different kinds of amino acids.

To make the protein called “collagen” you need to arrange 1,055 amino acids in precisely the right sequence which means you need 1,055 spinning wheels with 20 symbols in each wheel to coincide exactly for the jack pot!

Thus, the odd that any protein was formed by hazard is nil.

Any protein cannot reproduce itself and it needs DNA, which is a whiz in replicating itself.

DNA can do nothing but replicating proteins and proteins are useless without DNA.

Are we to assume that these two organisms arose simultaneously with the purpose of supporting each other?

No atom or molecule has achieved life independently; it needs some sort of membrane to contain them so that they come together within the nurturing refuge of a cell.

Without the chemicals, the cell has no purpose.  It is little wonder that we call it the miracle of life.

Forming amino acids is not the problem because if we expose water to ammonia, hydrogen sulphide and methane gases and introduce some electrical sparks, as a stand-in for lighting, then within days you will have amino acids, fatty acids, sugar and other organic compounds.

What was needed is a process of a few of these amino acids to procreate and then cluster to discover some additional improvement.

What do we know about cells so far?

A single cell splits to become two and after 47 doublings you have 10 thousand trillion cells and ready to spring forth as a human being.  Each cell carries a copy of the complete genetic code, the instruction manual for your body, and it knows far more about you that you do, and is devoted in some intensively specific way to your overall well-being.

The human body has at least a few hundred types of cells and they vary in shape, size, and longevity; we have nerve cells, red blood cells, photocells, liver cells that can survive for years, brain cells that last as long as we live and they don’t increase from the day we are born, but 500 die every single hour, and so forth.  The components within a cell are constantly renewed so that everything in us is completely renewed every 9 years.

The outer casing of a cell is made up of lipid or light grade of machine oil but on the molecular level it is as strong as iron, then the nucleus wherein resides the genetic information and the busy space called cytoplasm. The cell contains about a thousand power plants or mitochondria that convert processed food and oxygen into ATP molecules or battery packs.

A cell would use up one billion ATP molecules in two minutes or half the body weight every day. The electrical energy activities in a cell is about 0.1 volts traveling distances in the nanometers; or when this number is scaled up it is the equivalent of 20 million volts per meter or the amount of what a thunderstorm is charged.

Each strand of DNA is damaged 10,000 times a day and swiftly repaired if the cell is not to perish by a command received from a hormone.

When a cell receives the order to die then it quietly devour its components. For example, nitric oxide is a formidable toxin in nature but cells are tremendous manufacturers of this substance which control blood flow, the energy level in cells, attacking cancerous cells, regulating the sense of smell, and penile erection among other things.

Our body contains 200,000 different types of protein and we barely understand a tiny fraction of them

Enzymes are a type of protein with tasks to rebuild molecules and marking the damaged pieces and other protein for processing. 

A cell might contain 20,000 different types of protein.

In the 1860s, Louis Pasteur showed that life cannot arise spontaneously but come from pre-existing cells.


adonis49

adonis49

adonis49

June 2021
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