Opinion by Fogarty Director Dr Roger I Glass
A congressman recently invited me to speak with him about global health research supported by NIH and Fogarty. He was doubtful about the value of this work and needed ammunition to respond to his constituents, many of whom were unemployed, and concerned that their taxes were not being well spent. I responded directly and asked: What are the key health concerns of people in your community? Are they worried about the health of their children, the elderly, cancer, heart disease or Alzheimer's disease?
Children seemed a great starting point so I queried: In most communities, diarrhea is one of the most common causes of hospitalizations among children. Do you have any families with small children in your district who suffer bouts of severe diarrhea?
He nodded yes. I responded, Do you know where the treatment for childhood diarrhea was first discovered and proven to be effective? He was unaware.
In Bangladesh, I responded, cholera is the most severe of the diarrheal diseases, often causing epidemics of huge proportions. NIH and CDC researchers wanted to develop a simple treatment for cholera, the most severe and rapidly fatal diarrheal disease known to man. American and Bangladeshi investigators developed a simple, homebased remedy - a package of oral rehydration salts - that when added to water could exactly replace the fluids and electrolytes lost from the disease and save the patient's life. This recipe developed through clinical trials in Bangladesh and Calcutta has been adapted to treat the common diarrheal illnesses that we see at home. The medical journal The Lancet touted this as one of the greatest public health breakthroughs of the 20th century and has attributed this treatment to saving one million lives a year.
I queried further if he was worried about the growing problem of Alzheimer's disease that might affect perhaps one-third of all elderly Americans. He acknowledged the problem. I followed by noting that some of the most important secrets of this disease might first be revealed by studies of a small population in Colombia carrying an unusual genetic mutation that raises the risk of both early onset Alzheimer's - as young as 35 years - and its rapid progression to severe senility. If we are to learn by imaging brains with this disease, finding new biomarkers to monitor disease progression over time and testing new treatments to slow down or ultimately halt its progression, this is a key population. We need to conduct some of our research in collaboration with our Colombian colleagues.
The U.S. National Institute on Aging (NIA) is studying some of these patients and others are being enrolled in clinical trials of new therapeutic agents. So with Alzheimer's being one of the bank-breaking and evolving pandemics of our time, part of the solution will likely come from research in global health.
I continued and asked if anyone in his constituency had suffered from cancer and received chemotherapy? Did he know where the first link that a virus could cause cancer was found?
Another negative look appeared on his face and I responded. It was in Uganda, when Dr. Dennis Burkitt established the link between a newly discovered virus, the Epstein-Barr virus, and African Lymphoma. Burkitt then visited the U.S. where chemotherapy for cancer was first being developed and brought back a new drug regimen, which he administered to a child with full-blown disease. The tumor melted away in several weeks and became the treatment of choice for this lymphoma, demonstrating that some cancers could be cured.
My time was up so I left him with a final thought. In almost every branch of medicine, research overseas has allowed us to advance our discoveries faster, cheaper and more efficiently than we ever could have at home. We are leaders in global health because we have been able to reach out and engage others to do studies that are locally relevant but can have clear implications for us at home. Global health research truly is the new frontier of science.