Dementia: A Forgotten Crisis

By Chino Kieran Eke

In the United States, there are approximately 5.8 millions Americans living with Alzheimer’s disease. This disease causes the slow loss of mental faculties, including memory, critical thinking, and the ability to carry out simple tasks. While the disease principally affects individuals in their mid-60s, it is projected to impact the lives of 13.8 million Americans by 2050 despite medical advances that have improved the overall quality of life of afflicted patients.

While the treatment for Alzheimer’s disease is largely ineffective in the pharmaceutical realm, complementary therapies have proven to help maintain or improve the quality of life of a person with Alzheimer’s. For example, music therapy has proven to treat the behavioral and psychological symptoms of dementia. It enables people with Alzheimer’s to form meaningful human interactions with the therapist. Although music therapy and other complementary therapies do not provide a cure for the disease, they improve the quality of life for those with Alzheimer’s.

Alzheimer’s is believed to be caused by the buildup tau proteins which form plaques that effectively block the spread of information between neurons. As more plaques form, the information flow between neurons becomes more restricted, impairing a neuron’s ability to function properly. These plaques eventually cause neuronal death which leads to the shrinkage of the brain and the loss of memory, control over reasoning, language and thinking. Ultimately, this disease has devastating effects on those it affects and their loved ones. 

In 1980, a Congressional Hearing was held on the impact of Alzheimer’s disease on America’s elderly in order to help establish public funding for citizens with the disease. During this hearing, Alzheimer’s patients without proper care were described as suffering an “unbearable loss of dignity and self-respect” which undeniably has had a “crushing impact upon their spouses.” This hearing, ultimately, lead to the establishment of public funding for hospice and long-term care through Medicaid which cost the government an approximate “$290 billion for Alzheimer’s or other dementias” in 2019. With a growing number of Americans expected to have Alzheimer’s by 2050, the annual spending is projected to increase to 1.1 trillion. The near quadrupling of the current cost demonstrates how Alzheimer’s and other dementias present a daunting crisis for society. 

Currently, pharmaceuticals such as “cholinesterase inhibitors and memantine only treat the cognitive symptoms of Alzheimer’s disease,” but no medications exist that directly treats or prevents the buildup of tau plaques in the brain. There have been a number of studies performed in the last decade that have led to major advancements in the understanding of the disease, but they have all been quite limited in scope. This is primarily due to “low recruitment and high attrition rates” of research subjects with Alzhermier’s disease or related dementias. The best solution to this research impediment is increasing awareness surrounding the importance of this type of research; perhaps, then, rates of public participation might actually rise and a pharmaceutical treatment that slows or prevents the progression of plaque buildup may become a reality. 

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The First Cancer Vaccine: Design, Barriers, and Importance

By Zsombor Gal

In 2018, the World Health Organization counted nearly 570,000 new cases of cervical cancer in addition to 310,000 deaths worldwide. Roughly 90% of these deaths occurred in low- and middle-income countries, where screening and treatment programs are not as readily available as in developed nations. Though it may be surprising, prevention of cervical cancer through vaccination has only recently been viewed as a comprehensive solution to this global health crisis.

21st century innovation provided the first vaccine specifically approved for the prevention of cancer. In 2006, the U.S. Food and Drug Administration approved a vaccine developed by Merck & Co. to prevent human papillomavirus (HPV) infection. The tetravalent vaccine, known as Gardasil, protects against four HPV strains known to cause cervical, anal, vulvar, vaginal, and penile cancers. More recently, Gardasil 9 was approved to protect against five additional HPV strains associated with cervical cancer. These vaccines contain virus-like particles, which consist of self-assembled HPV capsid proteins, but lack the viral DNA. Thus, the vaccine enables the recipient to produce antibodies against HPV virions while preventing the production of harmful viral proteins that are responsible for disease. HPV is an example of a transforming virus, in that it encodes proteins that inactivate tumor suppressor proteins within human cells. This causes the rapid proliferation of cells, leading to tumor formation. Hence, as HPV is the most common sexually transmitted infection, not only in the United States but globally, it represents a serious threat to human health.

Not everyone infected with HPV will develop cancer. In fact, HPV is typically cleared by the immune system or simply causes precancerous lesions such as skin warts. However, exposure to high-risk HPV strains or long-lasting infectious greatly increases the risk for cancers caused by HPV. Because the risk of death due to these cancers is exceptionally high, it is important that all children and adolescents receive the vaccine prior to becoming sexually active.

However, this has unfortunately not been the case. In 2017, the Centers for Disease Control and Prevention reported that only 49 percent of adolescents in the United States are up to date on HPV vaccination. Many developing nations fall short of this statistic or have only recently introduced countrywide vaccination programs. The reasons for low vaccination rates encompass a variety of factors, including awareness, healthcare accessibility, cost, and misguided parental decisions.

Cancer-causing viruses are not a recent discovery, but public awareness of genital and oropharyngeal cancers caused by HPV is strikingly low. Additionally, because HPV is typically diagnosed in sexually active adults, many pediatricians are either unaware of the cancer risk or unwilling to discuss sex with the parents of younger children. The HPV vaccine may be suffering from an “image problem,” as it is often portrayed as a sexually transmitted disease vaccine, not as a cancer prevention vaccine. This contributes to parental anxieties that receiving the vaccine may encourage sexual promiscuity at a young age.

Poor access to healthcare and infrequent medical check-ups also contribute to low vaccination rates. Citizens of developing nations and minority populations face difficulties in obtaining regular care by a physician at all and thus have lower vaccination rates overall. Further complicating the matter is the fact that the HPV vaccine is rather expensive. Those without health insurance can expect to pay $250 dollars per dose for Gardasil in the United States, which consists of three doses!

The HPV vaccine clearly needs a rebranding. As the world’s first vaccine against cancer, and perhaps the simplest form of cancer prevention aside from lifestyle change, it seems illogical that parents should reject vaccination for their children. Initiatives must be put into place to serve populations without reliable and inexpensive access to healthcare, as well as in developing nations with high incidences of HPV infection. There is hope: leaders in these countries may choose to follow the example of Rwanda, a sub-Saharan nation that has achieved 93% vaccination coverage. Rwandan leaders combined the expertise and influence of state agencies, infectious disease entities, and international vaccine providers to reach a substantial portion of the population within a short period of time. The elimination of preventable cancers such as HPV would be a major milestone in the history of medicine.

The Resurgence of Measles in the U.S.: Causes, Consequences, and Future Directions

By Madeleine Winter

Within the past decade, there has been a significant resurgence of measles outbreaks in the United States. Between January 1 and March 14 of 2019, the CDC reported 268 individual cases of measles in 15 states. In 2018, the CDC reported a total of 372 cases of measles and in 2014, a record number of 667 cases in 27 states. Measles was declared as eliminated from the United States in 2000, which makes these recent statistics particularly concerning.

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Human Trafficking and Healthcare: Using a Public Health Approach to Combat and Prevent Human Trafficking

By Nathnael Mengistie

According to the International Labor Organization, human trafficking is the act of controlling or exploiting a person for sex, labor, or other services through fraud, force, or coercion. This grave human rights violation affected an estimated 20.9 million or more individuals worldwide in 2016. In recent years, however, numerous countries, including the United States, have passed different laws to combat this issue. In fact, on January 9th 2019, President Donald Trump signed into law the reauthorization of the Trafficking Victims Protection Act (TVPA), a law that aims to prevent human trafficking, protect victims, and punish offenders not only in the US, but also abroad. This legislation was first passed in 2000 and has since been expanded and reauthorized numerous times. This landmark anti-trafficking law formed the Office to Monitor and Combat Trafficking in Persons, which publishes a yearly Trafficking in Persons Report (TIP), and it also established the T-visa, which allows trafficking victims who came from outside the US to become permanent residents. Furthermore, the current administration has also authorized $430 million to fight human trafficking and passed additional laws, such as the Abolish Human Trafficking Act, which increases the prosecution of traffickers. Although these efforts are certainly commendable, American law regarding human trafficking still focuses on prosecution and fails to recognize the importance of a victim-centered approach to end this heinous crime. In fact, the Bureau of Justice Statistics stated that there was a 41% increase in the number of prosecutions for human trafficking offenses from 2011 to 2015, which illustrates the government’s focus on the criminal justice aspect of human trafficking. Although it is important to prosecute traffickers, members of the anti-trafficking movement should also focus on identifying human trafficking victims and providing long term support to human trafficking survivors. One of the reasons why this is not the case is because it is challenging to identify trafficking victims due to the obscure nature of the crime.  Nevertheless, framing human trafficking as a public health issue and increasing the involvement of healthcare professionals will not only allow us to identify trafficking victims and empower survivors, but also help us address the socio-economic determinants that facilitate human trafficking by working with policy makers, clinical professionals, law enforcement, and educators because human trafficking is a multifaceted problem. By using a public health approach to combat human trafficking and collaborating with different professionals, we are increasing our scope and our reach because public health is concerned with the well-being of entire populations and not just specific individuals.

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Dealing With the First Genetically-Edited Birth

By Shaffin Siddiqui

On November 25 of 2018, Chinese scientist He Jiankui announced one of most seminal  and controversial moments in the history of genetics: the birth of the first genetically-edited babies. According to an early report by the MIT Technology Review, the two twins, “Lulu and Nana, came crying into the world as healthy as any other babies.” Their birth, not only a biological landmark, has become the center of tremendous ethical debate.

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Are Daffodils the key to beating cancer?

By Nicholas Persaud

Daffodils may be something you plant in your garden or perhaps put in a bouquet of flowers for a loved one. However, research suggests that daffodils have much more to offer than their appearance. Daffodils have been used for multiple medicinal purposes including treating asthma and inducing vomiting. More recently, research has unveiled the prospect of daffodils as anti-cancer agents. The RNA Molecular Biology Laboratory at the Université Libre de Bruxelles Cancer Research Center recently published a paper entitled “The Amaryllidaceae Alkaloid Haemanthamine Binds the Eukaryotic Ribosome to Repress Cancer Cell Growth”, which describes the potential for daffodils to prevent cancer cell proliferation. To be more specific, scientists in this laboratory extracted the compound haemanthamine from daffodils. Haemanthamine is an alkaloid which means that it is a chemical compound produced by a living organism.  The researchers concluded that haemanthamine inhibits both the activity and production of ribosomes. It is this function of haemanthamine that makes it such a strong contender as an anti-cancer agent. To fully understand the value of this function, one must understand the purpose of the ribosome and the nucleolus.

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Report on Research on Displaced Children with Cancer in Lebanon

By Andrew Wu

One of the greatest current humanitarian catastrophes is the worsening refugee crisis caused by the conflict in Syria, which has many unfortunate implications in public health, especially pediatric care. According to the United Nations High Commissioner for Refugees (UNHCR), there are around 554,288 displaced Syrians under the age of 18 in Lebanon (this is an underestimate due to a halt on refugee registration). Assuming the annual incidence of pediatric cancer is 17 in 100,000 children; there are 90 new cases each year. Lebanon, which borders Syria on the north and the east, is bearing some of the burdens of an increasing population of displaced peoples. All Lebanese citizens have some form of healthcare coverage, with almost two-thirds of its citizens relying on a national healthcare plan. However, these government plans do not offer optimal treatments to conditions that may require long-term care, such as cancer. Thus, an influx of displaced refugees can further exacerbate the country’s public health system. Besides the limited aid from various nongovernmental organizations, displaced patients with pediatric cancer lack sufficient finances for treatment and can expect little support from the government or other third-party entities. A research article published by Saab et al. explores these issues, analyzing the mounting challenge of untreated pediatric cancer and possible solutions.

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Little Creatures, Big Improvements: The Success Story of a Decreasing Newborn Mortality Rate

By MaryAnn Placheril

According to a recent UNICEF report, the newborn mortality rate in Bangladesh has significantly decreased.

Back in 1990, when the mortality rate was 64.2 for every 1,000 newborns, births were assisted by family members without medical training. In these conditions, asphyxia was the leading cause of newborn mortality. Asphyxia occurs when the body is deprived of oxygen and thus, cannot breathe and regulate its functions. This then leads to death. In newborns, asphyxia frequently occurred during difficult or obstructed labor, yet, the untrained family did not know how to prevent it or treat it. Their lack of medical expertise in these cases proved fatal.

To fight this common trend, the Bagladeshi government made a significant push against the problem in 2010. It opened centers for childbirth, trained personnel, and encouraged families to have births outside the home. Much of this development was funded by other governments, international organizations, and non-governmental aid groups. This technique proved successful for as described by the UNICEF report the rates have decreased and are predicted to continue to fall.

Bangladesh’s success shows that with monetary investment and governmental support, many health problems in developing countries are wholly treatable. Maybe in the future other medical problems will be solved!

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