Frontlines Spring/Summer 2012
Quick updates about the latest public health news from across the School and beyond.
Gender Nonconformity May Raise Risks for Kids
Young children in the U.S. whose preferences for activities and pretend play fall outside those typically expressed by their biological sex—as many as one in ten kids—are vulnerable to abuse and posttraumatic stress disorder (PTSD), according to a study from Harvard School of Public Health researchers. An analysis of survey data from nearly 10,000 young adults found that men and women who were in the top 10th percentile of childhood gender nonconformity were more likely to have been physically, sexually, or psychologically abused by age 17 than those below the median of nonconformity. Rates of PTSD were almost twice as high among young adults who were gender nonconforming in childhood than among those who were not. The researchers recommend that pediatricians and school health providers consider abuse screening for this vulnerable population. Learn more
Alumna Appointed Minister of Health and Social Protection in Colombia
Beatriz Londoño Soto, MPH ’90, was appointed Colombia’s minister of health and social protection on January 24, 2012. She previously served as deputy minister of health. A physician specializing in anesthesiology, Soto has been a consultant for several national and international institutions, including Mount Sinai Medical Center in New York and the World Heart Federation. She served on the World Health Organization’s Commission on Social Determinants of Health.
Excess Weight May Lower Men’s Sperm Count
A new study coauthored by Jorge Chavarro, assistant professor of nutrition and epidemiology at Harvard School of Public Health, finds that overweight and obese men are more likely than their normal-weight peers to produce lower numbers of sperm, or even no sperm at all. While the results don’t prove that excess weight leads to fertility troubles, a lower sperm count can make it more difficult for men to conceive. The researchers combined data from 14 studies comparing sperm count in overweight, obese, and normal-weight men, along with data from an infertility center.
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Who Gets Cancer? Some Answers, Many Questions
It’s heartbreaking to realize that more than 2.4 million cancer deaths—especially from children’s cancers—could be avoided each year in developing countries, simply by using affordable prevention and treatment tools. A new report, “Closing the Cancer Divide: A Blueprint to Expanding Access in Low and Middle Income Countries,” organized by the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries and hosted by a consortium of organizations that includes HSPH, inspired a recent symposium in Boston that explored solutions. Attending the symposium were representatives from developing countries’ governments, civil organizations, the private sector, and academia. Among the lead authors of the report were Felicia Knaul, director of the Harvard Global Equity Initiative and associate professor at Harvard Medical School, and HSPH Dean Julio Frenk.
While some cancer deaths worldwide are clearly preventable, more puzzling is the increased risk among men for most cancers—even after adjusting for factors such as smoking, alcohol, and environmental hazards. In a new study led by Gustaf Edgren, research fellow in HSPH’s Department of Epidemiology, scientists concluded that for more than one-third of cancers that disproportionately strike men, the male excess risk is probably explained by intrinsic, sex-specific biological factors or a gender difference in susceptibility to risk factors. “For many of these cancers, the male excess risk is very strong,” says Edgren. “We simply have no idea why.” Learn more
Harnessing Health and Education Policy to Counteract “Toxic Stress” in Childhood
“Toxic stress” caused by adversity in early childhood can lead to a lifetime of mental and physical problems, including problems with metabolism and brain development. At a February 7 Forum event, Jack Shonkoff, director of the Center on the Developing Child at Harvard University and professor of child health and development at Harvard School of Public Health, spoke about the urgent need to revamp health and education policies to deal with the lifelong effects of early abuse, neglect, and economic hardship. Watch video
Ministerial Leadership in Health Program Launches in South Africa
Dean Julio Frenk, together with South African Deputy President the Hon. Kgalema Motlanthe, launched the new Ministerial Leadership in Health Program at an event in Pretoria, South Africa, on November 4. The launch was attended by current and former ministers of health and cabinet-level officials from more than 20 countries. The Program—a joint initiative of Harvard School of Public Health and Harvard Kennedy School, in collaboration with the Children’s Investment Fund Foundation—will recognize and promote transformational leadership in health at the ministerial level, with the aim of strengthening health systems and improving service delivery and health outcomes in developing and emerging economies. The first cohort is expected to include 20 serving health leaders at the ministerial level from Africa, Asia, and Latin America, and will meet in June.
The Progam Advisory Board is chaired by Dean Frenk and includes Harvard Kennedy School Dean David Ellwood. The joint vice chairs are Lord Nigel Crisp, former UK health secretary, and Joy Phumaphi, former minister of health of Botswana. Learn more
Surgery Pending? Don’t Eat that Steak
The counterintuitive—but compelling—evidence is in: limiting protein or amino acids for several days before surgery may reduce the risk of surgical complications such as heart attack or stroke. The findings were published in Science Translational Medicine on January 25. The HSPH mouse study was led by James Mitchell, assistant professor of genetics and complex diseases, and Wei Peng, former HSPH postdoctoral fellow. Next steps: a clinical trial of hospital patients on protein-free diets before surgery, and the development of drugs that potentially target the biological pathway activated by amino acid deficiencies. Learn more
Rotavirus Vaccine Proves Safe
More than 500,000 babies around the world die each year from severe diarrhea and dehydration caused by rotavirus. A widely used vaccine for the pathogen was pulled from the market in 1999 out of concerns that it raised a baby’s risk of developing intussusception, a potentially deadly intestinal blockage. Now, a study by Harvard School of Public Health research fellow Irene Shui finds that the orally administered RotaTeq® vaccine, one of several options, does not elevate intussusception risk. Shui conducted the research while at Harvard Pilgrim Health Care Institute. She and her colleagues examined nearly 800,000 doses of vaccination from infants in the U.S. who had been given RotaTeq® vaccine.
Pay-for-Performance Programs Are Underperforming
Paying hospitals to improve their quality of care, known as pay-for-performance (P4P), has gained wide acceptance in the U.S., and Medicare has spent tens of millions of dollars on bonuses and rewards for hospitals to improve. However, little is known about whether pay-for-performance actually helps patients. A new study from Harvard School of Public Health finds no evidence that the largest hospital-based P4P program in the U.S. reduced 30-day mortality rates, a gauge of whether patients survive their hospitalization. Given that the Affordable Care Act calls for the Centers for Medicare & Medicaid Services to expand pay-for-performance to nearly all hospitals in 2012, the findings suggest a need for heftier financial incentives and a sharper focus on patient outcomes. Learn more
Off the Cuff
Mosquitoes, Sex, & Malaria
Flaminia Catteruccia, Associate Professor of Immunology and Infectious Diseases
Q: You study how genes affect mosquito fertility and mating, a potentially groundbreaking way to prevent malaria transmission. In perfecting this approach, you work with Anopheles gambiae, the chief vector of malaria—but also one of the most notoriously difficult insect species to adapt to the laboratory. What were the technical hurdles?
A: To reproduce in a laboratory the way mosquitoes mate in the wild is not easy—we had to create our own protocols. To begin with, these mosquitoes mate just once a day. The males get together at sunset and swarm for 10 minutes or so, before it becomes dark. So first, since we study a process that happens briefly at dusk, we created a twilight lighting system that slowly dims the illumination. Second, for females to be inseminated, there has to be a correct ratio between males and females. When the males are swarming, we slowly add females to the cages so we can observe precisely when mating happens and later do time courses in the females to track which genes are induced or repressed. Finally, for females to lay eggs and bear progeny, they need to feed on blood. But it may not be the right time of the day for them to feed, or they may have fed on sugar two minutes before, so they’re not hungry. Sometimes males disturb the females, because the males want to mate while the females want to feed. With mosquitoes, you can draw human parallels.
Vaccine Effectiveness Threatened by Everyday Chemical
HSPH’s Philippe Grandjean answers questions about PFCs
In January 2012, a study in the Journal of the American Medical Association (JAMA) showed that perfluorinated compounds (PFCs)—which are widely used in manufactured products such as nonstick cookware, waterproof clothing, and fast-food packaging—dramatically lowered children’s immune response to tetanus and diphtheria vaccinations. The report suggested that these chemicals may be undermining one of the keystones of public health: childhood immunization. Lead author Philippe Grandjean, adjunct professor of environmental health at HSPH, talked about the study’s wide-ranging implications with Harvard Public Health editor Madeline Drexler.
Q: You found that 7-year-olds with twice the blood concentration of PFCs had about half the levels of antibodies in the blood to tetanus and diphtheria, compared with children with average PFC levels. Were you jolted by this finding?
A: Very much. I’ve talked to pediatric immunologists about this, and they have never seen anything like it. HIV infection, rare inborn diseases, or treatment with chemotherapy can do the same thing. But apart from those situations, these colleagues had never seen these kinds of effects.
Q: How exactly do PFCs dampen immunity?
A: Apparently, these compounds hinder communication between white blood cells—the cells that tell the body, ‘There is a foreign microorganism or foreign protein that is causing a possible danger, and the body needs to deal with it.’ We were misled to believe that the PFCs wouldn’t be active biologically, as they are very stable. But it turns out that they fit into certain proteins or receptors in the body.
Q: Are the effects limited to tetanus or diphtheria vaccines? Or are these signs of broader problems in immunity?
A: We looked at tetanus and diphtheria because both of those vaccines are proteins. But we don’t think that what we have seen is specific to tetanus or diphtheria. We think there is something going on there that reflects a more general immunotoxicity. I call it a sluggish immune system. Whatever is going on here, it’s the same system that kicks in when we are infected by disease-causing microorganisms.
Q: Would this fundamental damage to the immune system trigger such things as allergies or other conditions?
A: Possibly. The immune system is responsible for allergy development—and we know that there’s an allergy epidemic. Could these immunotoxicants be kicking the immune system out of balance?
You may even speculate further, because the immune system is also involved in conditions like autoimmunity and protection against cancer. We are not just talking about direct organ-related toxicity—to the brain or the reproductive system or the liver or the kidneys. We are talking about something that affects our whole body. It opens up a new perspective for studying how environmental chemicals affect public health.
Q: Why are these damaging substances so prevalent in our lives?
A: When the federal Toxic Substances Control Act was enacted in 1976, it only covered safety-testing requirements for new chemicals—all of the existing chemicals, such as PFCs, were grandfathered in. In the U.S., the production of PFOS [perfluorooctane sulfonate], one of the most common PFCs, ceased in 2002. But now PFOS is produced in increasing amounts in China, so we may be importing products that contain or have been treated with these chemicals from other countries. Though concentrations of PFOS in blood have come down over the last six or eight years in the U.S., we are being increasingly exposed to other PFCs which are, as a class, exempt from the strict rules that apply to new chemicals. Industry is introducing these chemicals as alternatives—but only now are we beginning to identify the toxic risks.
Q: What advice would you give consumers?
A: Minimize exposure to those substances as much as possible. PFCs serve some extremely useful purposes. They make your raincoat water repellent. They act as stain repellents on rugs. Food-wrapping materials like paper plates, microwave popcorn bags, and pizza boxes often contain these compounds.
The trick is to find alternatives that are just as useful but do not cause toxic effects. You can now get rain gear, wall-to-wall carpeting, and other products that are labeled “PFC-free” or “eco-friendly.” If consumers vote with their wallets and scientists push, then industry will realize there is a new market niche.
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Images: Tony Rinaldo, Shaw Nielsen, Photo Researchers, Inc., Aubrey LaMedica, Tony Rinaldo