Making Sports Healthy and Safe

When you talk to your neighbor about the upcoming Super Bowl, what is the first topic that comes to mind? The teams, the odds of your favorite winning, or the injuries that have rattled professional athletes all season long. Right now is prime time for the NFL, and their injuries list is often top of the sportscast. You might have discussed the hard hit on Buffalo Bills’ Tyrod Taylor that caused him to walk off of the field with a concussion. Or perhaps you are focused on Cowboys’ Randy Gregory suspension for failed drug tests. Perhaps the Super Bowl teams are on the forefront of your mind with Patriots’ Alan Branch sitting out due to a knee injury. But what about when you are talking about your son’s or daughter’s sports? Do those same injuries come into conversation?

CTE or chronic traumatic encephalopathy is a condition that has been hotly discussed over the past few years, particularly in relation to hard contact sports, like football. CTE is a “progressive degenerative disease of the brain found in people with a history of repetitive brain trauma…The repeated brain trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau.” Most notably is the understanding that concussion and repetitive hits to the head are risk factors for developing CTE. However, an article by CNN reveals new research on the complicated disease that is CTE. New evidence suggests that CTE, “can start early and without any signs of concussion.” This discovery could have profound implications on the understanding of the incidence and development of disease, because the progression no longer fits a long term time scale of neuro-degeneration in older adults. The disease could now be implicated in youth or have sudden onset of symptoms if the build up of Tau bodies is rapidly onset. “Currently, the only way to diagnose CTE is with an autopsy after death,” but these findings indicate that there are serious implications for the athletes potentially living with undiagnosed CTE. In fact, there is even a movement to limit tackle football among youth. Concussion Legacy Foundation’s Flag Football has an Under 14 initiative that “aims to warn parents about the dangers of football’s repetitive hits.”

Although CTE is most widely discussed among football players, there are other concerns for athletes that should be considered. There is even a list of the Seven Most Common Professional Sport Injuries, which indicates that injuries are not uncommon in the sports world. However, the injury risk appears to be a part of the game. That is, until an athlete has an injury so severe that it ends his or her career. In fact, a baseball player in the early 1900s even died from internal injuries sustained during a baseball game. Physical injuries are not the only health problems making waves in the news recently. The discussion of mental health among athletes has been growing.I n fact, the NCAA has an entire page dedicated to mental health resources on it’s website. The positive direction of mental health resources has been growing in trajectory. Michael Phelps even conducted an interview about his own struggle with depression among his Olympic victories earlier this week.

These findings, by no means, rule out sports as a form of physical fitness. Rather, it is important to understand the possible risks of contact sports and play safely. As scientists and organizations learn more about the negative impact of certain aspects of game play, rules and guidelines may change so that athletes can participate in sports in a safer manner.


Thanksgiving and Immunity

This Thanksgiving, let’s take a moment to look at the colonization through the lens of public health by examining the impact that intercontinental travel and first time contact with outside populations had on European settlers and the established Native American tribes in the Americas throughout the 15th to the 19th centuries.

Before contact with the Europeans, Native Americans suffered relatively few diseases (in comparison) and were generally very healthy. This is largely due to their culture and lifestyle. Native Americans did not often live in as close quarters as their European counterparts, giving infectious diseases fewer avenues to thrive and spread from person to person. Additionally, their culture supported the sharing of food and resources. This meant that very seldom did someone in a tribe go hungry or become malnourished because it was a source of pride and culturally normal to display wealth by sharing crops and resources with less fortunate tribe members. It is also important to understand that Native Americans did not domesticate animals in the same way that Europeans did. This reduced the opportunity for zoonotic infections to jump from animal hosts to human hosts. As a result, the prevalence and types on infections that permeated the communities in the Americas were inherently different than the landscape of European diseases. In the article “Health Conditions Before Columbus: Paleopathology of Native North Americans” indicates that while the Native American populations already experienced infectious diseases and chronic conditions, there are numerous diseases that caused epidemics upon the “discovery” of the New World by European explorers. Examples of “diseases that were not present in the Americas until contact include bubonic plague, measles, smallpox, mumps, chickenpox, influenza, cholera, diphtheria, typhus, malaria, leprosy, and yellow fever.” (Side note: You can read about the eradication of smallpox on the blog here!)

Many of the infections brought to North America by European settlers were completely foreign to the natives. As a result, these populations lacked immunity or sufficient resources to fight infection. Many of the most devastating infections from across the Atlantic were diseases that stemmed from the cramped living quarters in cities and contact with domesticated animals. The diseases spread among trade routes and other avenues, affecting many native populations long before they ever came into contact with the European explorers. The article “The Cultural Implications of European Disease on New World Populations with Primary Focus on the Abenaki, Powhatan, and Taino Groups” indicates that “the population of the American continents may have fallen by 90 percent between the beginning and end of the 16th century.”

The implication of these disease exposures was one of the largest unintended upheavals of human population in recent history. And while infectious diseases are known to be large factors in shaping the course of human history and evolution, this historical event was largely unprecedented in that is virtually pitted one evolutionary line against another in an “Old World versus New World” sort of fashion. In fact, an article in Science Magazine indicates that due to exposure to new illnesses, specifically during the occurrence of a smallpox outbreak approximately 175 years ago, there was a genetic shift in the genome of the Native American population. What is significant about this shift is that the change occurs in the portion of the genome responsible for the composition and function of our immune system. It appears that there was some sort of genetic selection occurring that had a huge impact on our genome as a population. Due to the increasing globalization since that time, the article states that there are some relatively new (in the history of living species) genes that appear with almost 100% in the human genome that were not as prevalent almost 200 years ago.

While there is infinitely more we could do to delve into this topic, a brief reminder of the unique history of the Americas, particularly as it pertains to our health. Today, have a happy thanksgiving and be thankful for your amazing immune system!


Air Pollution

Air pollution is unfortunately not a new issue among our civilization. There have been health risks and diseases linked to poor air quality documented since at least the beginning of the Industrial era. In fact, this is not even the first time I have discussed the negative effects of air pollution in a blog post. I discussed “The Great Pea Souper” on The Phiver blog for UT Dallas’s Public Health Initiative back in February. This was a smog event in London in 1952 that caused thousands of respiratory problems and deaths due to stagnant, polluted air in the city. The city was essentially shut down until the weather patterns changed and moved the smog out of the city. The UK’s BBC has a video about it here.

Recently, there has been a similar smog covering the city of Delhi, India. Due to the severity of the pollution, CNN states, “all public and private schools [were closed], requesting instead that … children remain indoors… they banned incoming trucks and halted civil construction projects” and are even contemplating a partial ban on private car use as a means to limit the resident’s contribution to the polluted air in the city. To put this into perspective, Berkeley Earth has a study that equates air pollution to damaged caused by smoking cigarettes.

Air quality levels are monitored globally due to their link to health conditions. The WHO outlines the process of measuring condition and why it is so important. Of all the cities that the WHO collects air quality data on, 14 of the 15 worst cities are located in Asia and the Middle East. The lone remainder is Cameroon in Africa. The US cities with the worst air pollution and with the cleanest air levels are determined in an annual State of the Air report. National Geographic does a great job of breaking down the report into brief highlights about the US regions. This makes the states of US air quality a little easier to grasp. While we are not the worst country for air pollution, we certainly do have our problems with achieving clean, healthy air.

If you are interested in determining the quality of the air in your zip code, you can determine this on the American Lung Association’s website.

Famous Names · Uncategorized

Dr. Harvey Cushing

This month, for the third edition of “Famous Names in Public Health!” I will focus on the medical side of healthcare by recognizing a figure who contributed significantly to the fields of neurosurgery and epidemiology, Dr.Harvey Cushing.

Dr. Cushing graduated from Harvard Medical School in 1895 and he continued his medical training in surgery at Johns Hopkins Hospital. During the time of his training, neuroscience was a rapidly growing field of medicine making numerous advances and discoveries. Neurosurgery claimed Dr. Cushing’s professional interest as he drifted from general surgery into peripheral-nerve surgery. After this, he became more and more focused on the brain, ultimately making neurosurgery his focus for his career. In 1913, Dr. Cushing accepted a position as the surgeon in chief at Peter Bent Brigham Hospital that was associated with Harvard. He continued to practice neurosurgery even in this position. According to the article “Harvey Cushing: A Life in Surgery,” Dr. Cushing’s major interest was cerebral tumors, leading him to study and treat more than 2,000 verified tumors. These studies are documented within 5 books published between 1912 and 1938.

Throughout his years of practice, he developed the Cushing Brain Tumor registry in 1902. It is an archive “of over 2,200 case studies which includes human whole brain specimens, tumor specimens, microscopic slides, notes, journal excerpts and over 15,000 photographic negatives dating from the late 1800’s to 1936. ” What makes this collection even more unique is that Cushing was an avid bibliophile, so he meticulously recorded and documented each patient story, including the stories of the patients of the collected specimens. Today, this provides a unique history of neurosurgery’s progression throughout his career.

Most notably, Dr. Cushing made numerous contributions to science and medicine, including the control of bleeding with silver clips, the development of electro-surgery, the development of technical methods for performing surgical operations, an increased understanding of intracranial pressure, the development of the pathological classification of glioma, and the description of pituitary basophilia (also known as Cushing Syndrome). Through this work on the pituitary gland, Cushing is also considered to be one of the founders of endocrinology. Even more of his pioneering research and medical practice can be found here.


Development and Implementation of Gene Therapy Treatment

Many of you may be aware that earlier this week, news broke that the FDA approved the second ever gene therapy treatment for adult aged individuals with non-Hodgkin lymphoma. This cancer accounts for about 4% of all cancers in the USA, and the B-cell category of non-Hodgkin lymphoma is a particularly difficult type of cancer to treat.Yescarta

genetically modifies the patient’s own white blood cells, which are injected back into them, as a means of targeting and killing cancer cells. The treatment can be given at certified hospitals and the treatment is still undergoing observational study to ensure the safety and effectiveness of the therapy. This is particularly due to the potentially serious side effects that can result from using the therapy. The FDA’s approval of this gene therapy treatment shows its continued support and enthusiasm towards turning gene therapy from a theory into an effective, accessible treatment for so many people. In fact, the FDA Commissioner Scott Gottlieb was quoted on the FDA website saying, “This approval demonstrates the continued momentum of this promising new area of medicine and we’re committed to supporting and helping expedite the development of these products…We remain committed to supporting the efficient development of safe and effective treatments that leverage these new scientific platforms.”

This comes shortly after the FDA approved the first every gene therapy treatment plan for use in the USA in August of this year. The first treatment type approved was Kymriah, a treatment approved for patients under 25 years of age with B cell acute lynphoblastic leukemia (ALL). Understanding the need to follow patients closely, especially since gene therapy is such a new treatment method, Novartis, the producer of Kymriah is planing on a long term follow up study to evaluate lasting risks and health outcomes.

Of note, these are not the only gene therapy treatments available globally. In fact, in 2003, China approved a therapy called Gendicine for head and neck squamous cell carcinoma. This treatment causes tumor cells to upregulate their expression of the p53 oncogene. This gene is implicated in tumor and cancer development, and the increased expression of the gene causes the cell to marked at damaged. These cells then undergo apoptosis (cell death) or are attacked by the body’s natural tumor fighting immune responses. Due to the diverse nature of cell types and cancer types, many of these treatments available on the market or under development are only available to a specific subset of the population.

Although gene therapy research and development has evolved enormously over the last 15 years (at least), this article, ‘Gene Therapy for Cancer Treatment: Past, Present and Future’ posted in Clinical Medicine and Research is a great resource that explains the 3 main categories of gene therapy development and treatment methods. The article is a little dated, since it was published in 2006, but is never the less a great resource! As these sources point out, most of these treatments plans are recommended for patients who have failed to respond to the other available treatment options and have no other choices left, and many are recommended to be used in conjunction with existing treatment methods. Looking into the price of these new gene therapy options shows one limiting factor- cost. A single Kymriah treatment costs $475,000! Ideally, as the development and use of gene therapy methods increases, the price will decrease, and we will replace older, less refined treatments with a new standard of care. The battle with cancer has been a long and winding road, but it looks that a major breakthrough in treatment and patient management is in our future!


V-v-v-vaccines: Part 3: Facts and Myths

In the United States, the CDC recommends that all children follow a vaccine schedule, outlined from birth to 18 years of age, to minimize risk to serious infection and reduce the spread of specific diseases. Childhood vaccines are important because they improve the health of our population’s children, reduce their risk of acquired disabilities or death, and prevent outbreaks of illnesses. Additionally, vaccines are an important element of public health. Expectant mothers can protect their unborn child through their routine vaccines and healthcare practices. Vaccinated members of the community help protect those who cannot be vaccinated due to health conditions, and additional vaccines and resources are available to individuals with compromised immune systems. In face, The National Foundation for Infectious Diseases states, “Approximately 50,000 adults die each year from vaccine-preventable diseases in the US.” So, not only do immunizations help the individual stay healthy, they also elevate the health of the whole population.

Despite this information, there remains some controversy in the United States regarding the effectiveness, safety, and necessity of these vaccines. Much of the hesitancy grew from a fabricated and poorly conducted study released by Dr. Wakefield in 1998. He falsely linked the MMR vaccine to the development of autism, which has led to a concern over the safety of vaccines and a subsequent increase in unimmunizated children. It is important to note that numerous studies have failed to confirm any sort of connection between vaccines and developmental delays or behavioral diagnoses. NY Times explains how Dr.Wakefield’s study was retracted from the publishing journal and he was stripped of his medical license upon recognition of the fallacies included in the claims of the study. Furthermore, concerns that spurred from the public as a result of this dramatic event are clearly addressed in the CDC’s website, citing the CDC’s own research as proof against the theory.

The CDC does a great job of addressing these concerns by explaining that both vaccine-induced immunity and natural immunity are both considered active immunity because they utilize the host’s own immune system to develop antibodies and launch a defensive attack. Despite this information, many parents and patients have questions about the other ingredients contained in the vaccine and how vaccines differ from the real-deal illness. There is a wonderful, plain language parent’s guide on the CDC’s website that not only explains the content of a vaccine (dead versus weakened pathogens and additional content), but it also addresses the patient’s risk of contracting the illness and patient rights regarding immunizations. It is important to note that the diseases we vaccinate against are still very much prevalent in our community. In addition to this, the World Health Organization addresses the importance of global vaccines and the impact it has on disease through their website. They even host an annual World Vaccination Week. For patients and their families to understand the importance of their role in this public health endeavor, the WHO is a great resource. It really puts your individual actions into the context of a collective goal. For instance, did you know that “Polio cases have decreased by over 99% since 1988. Today, only 3 countries (Afghanistan, Nigeria and Pakistan) remain polio-endemic, down from more than 125 in 1988.”

For families that choose to vaccinate your children, do not fret about the doctor’s visit! Most children dislike shots (as do most adults!) However, there are numerous resources on the web about how to care for your children after their appointment or make the process less stressful. For instance, tips such as modeling behavior by keeping calm and being truthful about the appointment can calm your child’s nerves and prevent unpleasant surprises. There are even suggestions on comforting ways to hold your child during the appointment to reduce stress or struggling during the shot. If you are a parent and you feel that you need more information, please browse the information on the CDC’s website that is specifically aimed at educating parents. Additionally, do not forget to address your child’s physician for further information or advice. For parents that are considering not vaccinating their children, please understand your responsibility fully before making the decision. Know the symptoms of diseases we vaccinate against as well as the potential outcomes. Be aware if these diseases are in your community, especially during an outbreak, and understand the seriousness of contracting these conditions. Knowing your role as a caregiver means that you understand the risks and responsibilities of your choices.

I feel that it is important to include a personal note here. Many parents I talk to feel like we vaccinate against many mild illnesses that are not common in our community, without understanding the very serious complications of some of these diseases. Additionally, for more serious diseases, parents often feel like those things “only happen to someone else”- like these diseases don’t happen in their community or even in our country. It is important to understand how false these assumptions are. In my personal experience in the emergency room (here in the urban USA), I have seen bacterial meningitis, viral meningitis, chickenpox (vericella), mumps, and whooping cough (pertussis). As much as I want to say that our medical care techniques have advanced enough to provide each child with a positive outcome and full recovery, it’s simply not true. We have lost patients to these illnesses, sent many to the ICU, and had many leave with life altering complications from their diseases. Caring for your children is an important responsibility. Being educated on diseases and vaccines is an important element of parenting that should not be overlooked.

If you would like to see the other posts in this series, please check out Part 1 and Part 2!

<You can find the first to parts of the series on the blog. Here are the links for Part 1 and Part 2.


Gun Violence

Hello everyone! The past few weeks have been quite an adventure in my personal life due to family members moving, medical school interviews, and the unfortunate febrile illness going through the house. It was never my intent to leave readers hanging without a weekly post, but here we are, unfortunately.

Due to the recent mass shooting attack on the eve of October 1st at the Route 91 Harvest Festival in Las Vegas, Nevada, I would like to bring recognition to gun violence and its associated research, or lack thereof. I have already written a post regarding these issues when I was an author with UT Dallas’ Public Health Initiative. My post, with pertinent links and sources, can be found here. Although the article primarily focuses on the single victim incidents that were relevant at the time of my post (made almost a year ago in November 2016), the information is still pertinent to the mass shooting that occurred recently.

Unfortunately, mass shootings have occurred multiple times throughout the US and elsewhere across the globe in recent history. The Las Vegas shooting is the most deadly mass shooting attack in US history. In response to the recent mass shooting, there have been calls to continue to address the issues surrounding firearm safety. The NRA has even spoken out about the need for more regulation on some types of firearm equipment, most notably the bump stock, which can make guns perform more like automatic weapons. The gun control debate is still ongoing in light of recent events.

I would like to extend my thoughts and condolences to individuals, families, and friends affected by gun violence, as well as my support and recognition to all of the service men and women in out health care, public safety, and protection services that have lent their expertise and support to all who have been affected. Gun violence is not the solution to our country’s issues.