By Lisa Brown
“Ways to and Opportunities for Team Science at BU”
Junior Faculty are particularly invited to attend this luncheon meeting
- Monday, March 7
- Noon-1 p.m.
- Evans Building, Wilkins Board Room, Room 108
Presenters: Drs. Katya Ravid, Francesca Seta, and David Center
Hosts: Clinical & Translational Science Institute (BU-CTSI) and Evans Center in collaboration with the office of Faculty Development
RSVP by Tuesday, March 1 to Robin MacDonald, email@example.com
Medical Campus students, faculty and staff are invited to a lunchtime lecture given by Colonel Doctor Tarif Bader, the Deputy Surgeon General of the Israel Defense Forces, who will speak about his experience leading the IDF’s mission to Nepal and Haiti, as well as his oversight in treating Syrian refugees. This presentation is part of a lecture series through Our Soldiers Speak, an organization that dispatches uniformed, active members of the IDF to speak overseas. The event will be moderated by Dr. Michael Grodin.
Feb. 22, Noon-1:30 p.m.
BUSM Instructional Building, Room L109
Please note that a BU ID is required for admission.
This event is sponsored by The Maimonides Society; The Emergency Medicine Interest Group; Boston University Hillel House; Health and Human Rights Caucus; Alpha Omega International Dental Fraternity.
More than 400 faculty, alumni, students, and staff of the School of Public Health gathered February 4 at the Algonquin Club in Boston to celebrate the School’s 40th anniversary.
BU Provost Jean Morrison applauded the SPH community for its rich history of research and education, saying the School’s “success and lasting contributions have changed our approach to so many societal challenges.”
Dean Sandro Galea recognized his predecessor, Robert Meenan, and founders of the School and thanked faculty, staff, and alumni for helping to move SPH forward.
“We are here because we believe that public health should be a central player in creating a better world,” Galea said. “When the day gets long, and when things are not going so well, knowing that you’re part of something bigger than yourself is the best way to say, ‘I am moving forward because what I’m doing is worth it.’”
Joel Lamstein, chair of the Dean’s Advisory Board and co-founder and president of John Snow, Inc., said SPH is well positioned to be a leader in elevating public health.
“If you think about it, public health has never really gotten its due, although it’s made major strides,” he said. With an increasing global focus on health, “this is the time for Boston University to be one of the leaders,” he said.
In a moment of levity, Lamstein referenced the Boston Globe’s ongoing home-delivery problems, saying, “You may not have always gotten the Boston Globe on Sunday—but you always got the Dean’s Note.”
Submitted by BUSPH Communications.
From Jan. 28-31, the Boston Convention and Exhibition Center was abuzz during the 41st annual Yankee Dental Congress (YDC), the largest dental meeting in New England, and the third largest meeting in the United States. The convention drew thousands of dental professionals from around the region, and featured hundreds of dental continuing education courses, lectures and events. Representatives of Boston University Henry M. Goldman School of Dental Medicine (GSDM) joined the hundreds of exhibitors in the center.
During the three days of the 41st Annual YDC, hundreds of alumni, students, residents, faculty and staff visited the GSDM booth, which featured the always popular alumni lounge—a place for alumni to sit, relax and enjoy refreshments. “I’m always excited to see the alumni who stop by year after year and help make our booth so much fun,” said Director of Alumni Relations and Annual Giving Ms. Stacey McNamee.
Descriptions of some of the many activities and events members of the GSDM community participated in are below.
Pre-doctoral Research Poster Presentations
Three GSDM students presented posters during YDC’s pre-doctoral research poster session, which took place on Saturday, January 30, 2016. The three student presenters were:
- Megan Sullivan DMD 18, “The Root of the Problem: Occurrence of Typical and Atypical Periapical Pathologies,” with Dr. Vikki Noonan, Associate Professor and Director of Clinical Oral Pathology in the Department of Oral and Maxillofacial Surgery and the Division of Oral Pathology; and Dr. George Gallagher, Professor of Oral and Maxillofacial Pathology, and Head of the Division of Oral and Maxillofacial Pathology.
- Jasmine Khedkar AS 17, “Introducing the Next Level in Ethics: Understanding Cultural Diversity,” with Dr. Larry Dunham, Director of Diversity & Multicultural Affairs and Clinical Assistant Professor in the Department of General Dentistry.
- Manisha Pradhan AS 17, “Oral and Dental Healthcare among Children in Foster Care and Out-of-Home Placements: Exploring the Practice and Perspectives of Child Protection Workers,” with Mona C. S. Schatz of the University of Wyoming.
Sullivan was declared the winner of the pre-doctoral research poster session, which featured posters from several other students from regional dental schools.
Dean Jeffrey W. Hutter remarked, “I would like to congratulate Ms. Megan Sullivan for winning the YDC pre-doctoral research poster session. Her research certainly required her to go above and beyond, and I am happy to see her rewarded as the winner of the session.”
She will again present her poster at the 2016 Annual Session of the American Association of Dental Research in March 2016 in Denver.
GSDM Student Debate Team
Two GSDM DMD students participated in a student debate on Saturday, January 30 that involved all five schools from District One of the American Student Dental Association (ASDA) as well as one team consisting of pre-dental students.
The GSDM debate team consisted of Asia Yip DMD 19 and Ashish Agarwal AS 17. Also assisting with the coordination of the GSDM debate team were Monica Schmidt DMD 17, John Barrett DMD 17, and McAllister Castelaz DMD 17.
The GSDM team debated a team from the University of New England (UNE) about whether affordability or access is the greatest barrier to receiving care in underserved and rural communities. While the GSDM debate team took home the top prize in 2015, the team in 2016 was not able to move into the final round of this year’s debate which was won by the UNE team.
ACD Student Leadership Award
On Saturday, Jan. 30, GSDM DMD 16 student Matt Mara received a special award at the 41st annual YDC. Mara received the American College of Dentists New England Section’s Outstanding Student Leader Award. While Mara was not able to attend because he was in Guatemala on a dental service externship, his parents accepted the award from Dean Jeffrey W. Hutter on his behalf.
Both Dean Hutter and Clinical Associate Professor in the Department of General Dentistry, Assistant Dean of Students, and Director of Geriatric Dental Medicine Dr. Joseph Calabrese congratulated Mara’s parents on his accomplishments.
From Jan. 28-30 a total of 19 DMD students, AS students, and students in the Preceptor Program, volunteered their time at a special booth in the exhibit hall to provide information to conference-goers about HIV. The GSDM student volunteers joined students from other Boston-area dental and dental hygiene schools as well as staff from GSDM and the Boston Public Health Commission (BPHC).
The event was coordinated by the BPHC HIV Dental Program, which offers education, dental referrals, and advocacy for people with HIV/AIDS. In addition, the BPHC HIV Dental Program gives students an opportunity to learn more about issues related to HIV/AIDS. The program has provided an educational exhibit on HIV/AIDS oral health issues and infection control at YDC for 18 years.
GSDM Volunteers handed out information packets, talked to visitors, and assisted in collecting consumables to donate to programs for people living with HIV/AIDS in Massachusetts.
Clinical Instructor Department of Health Policy & Health Services Research and Oral Health Promotion Director Ms. Kathy Lituri Ms. Kathy Lituri said, “The students had a great on-site experience and left knowing a little more about HIV and oral health. They were able to spend time with people living with HIV/AIDS, and learn firsthand about the oral health issues they encounter. Thank you for all of your efforts.”
The GSDM volunteers were Chiho Ahn, DMD 17; Chiyoon Ahn, AS 17; Ali Alrubaye, Preceptor Program 16; John Barrett, DMD 17; Aashima Chopra, Preceptor Program 16; Jaehyuk Choi, DMD 18; Tamara Gordon, DMD 18; Tripti Gupta, AS 17; Syed Iqba, Preceptor Program 16; Navtej Kang, AS 16; Jin K Lee, DMD 16; Pooja Palaksha, AS 17; Krupa Patel, Preceptor Program 16; Paulomi Salvi, Preceptor Program 16; Mansi Shah, AS 17; Kushan Shah, AS 17; Chandini Shaikh, DMD 19; Priyanka Sheshagri, Preceptor Program 16; Bhandal Sukhmandeep, AS 17; Parnian Paymozd Yazdi, DMD 17; Moaz Zarbarakji GPH volunteer.
Team Smile Volunteering & Leadership Institute Graduation
Team Smile and the MDS Foundation (The charitable arm of the Massachusetts Dental Society) joined forces to host a free dental clinic on Jan. 28 and 29 at the 41st Annual YDC. The Team Smile Clinic offered free dental services including triage, X-ray, filling, sealant, prophylaxis and oral health education to underserved Boston area children. A total of 24 members of the GSDM community volunteered at this special dental clinic.
The free dental clinic was set up at the YDC exhibit hall. It contained multiple dental chairs and a large supply of dental instruments that allowed volunteers to perform dental work under OSHA, HIPAA and Massachusetts Board of Registration in Dentistry guidelines.
The goal of Team Smile is to communicate the idea that oral health care is vitally important to long-term health by developing a bond between children’s organizations, oral health professionals, surrounding communities, and professional sports organizations.
Boston Red Sox mascot Wally the Green Monster and New England Patriots mascot, Pat Patriot, along with New England Patriots cheerleaders were there to cheer up the children receiving oral health care.
While the event was organized by Team Smile and the MDS, three GSDM community members had a large role in planning the School’s involvement in the Team Smile event. They are Dr. Pelly Chang, Clinical Associate Professor in the Department of General Dentistry; Dr. Eleni Kanasi, Assistant Professor in the Department of General Dentistry and the Department of Periodontology, and Practice Leader in the Pre-doctoral Patient Treatment Center; and Dr. Annetty Soto, Geriatric Dental Medicine Fellow PGY2.
The three GSDM community members helped recruit the 24 GSDM volunteers who were stationed at the Team Smile clinic. They did this as part of the requirements of the two-year-long MDS Leadership Institute, which requires participants to attend four half-day meetings, and serve on a special ad hoc committee in which they work toward resolving an issue affecting the dental profession.
At YDC, Dr Chang, Dr. Kanasi and Dr. Soto all received plaques honoring their completion of the Massachusetts Dental Society’s Leadership Institute, and their dedication to the profession.
Dr. Chang said she is especially thankful to Dean Jeffrey W. Hutter and Dr. Celeste Kong for their presence at both the Team Smile Clinic and the Leadership Institute Graduation Ceremony.
Dr. Chang also praised the assistance of Dr. Celeste Kong, Professor and Chair Department of General Dentistry; Dr. Joseph Calabrese, Assistant Dean of Students, and Director of Geriatric Dental Medicine; and Dr. David Russell, Assistant Dean for Patient Care, and Clinical Associate Professor in the Department of General Dentistry.
Student volunteers at Team Smile:
Sultan Basha, AS 17; Grace Hannawi, AS 17; Vaibhav Jagad, AS 17. Mohammad Khan, AS 17; Jasmine Khedkar, AS 17; Bart Knowles, DMD 19; Bhoomi Kotak, AS 17; Jignesh Rudani, AS 17; Maedeh Sedaghati, AS 17; Megha Shah, Preceptor Program 16; Rohan Shah, AS 17.
Faculty volunteers at Team Smile:
Dr. Pelly Chang, Clinical Associate Professor in the Department of General Dentistry; Dr. David Dano, Clinical Assistant Professor in the Department of General Dentistry and Practice Leader in the Pre-doctoral Patient Treatment Center; Dr. Simran Grover, Clinical Instructor in the Department of General Dentistry; Dr. Roxana Hashemian, Clinical Instructor in the Department of General Dentistry; Antoine Hraiz, Clinical Instructor in the Department of General Dentistry; Dr. Eleni Kanasi, Assistant Professor in the Department of General Dentistry and the Department of Periodontology, and Practice Leader in the Pre-doctoral Patient Treatment Center; Dr. Waleerat Kaweevisaltrakul, Clinical Assistant Professor in the Department of General Dentistry, and Practice Leader in the Pre-doctoral Patient Treatment Center; Dr. Theodore Markos, Clinical Associate in the Department of General Dentistry; Dr. Dmitry Merzon, Clinical Associate Professor in the Department of General Dentistry; Dr. Debra Pan, Clinical Associate Professor in the Department of General Dentistry, and Director of the Pre-Doctoral Preclinical Remediation Program; Dr. Parvis Sadooghi, Clinical Associate Professor in the Department of General Dentistry; Dr. Cameron Shahbazian, Clinical Instructor in the Department of General Dentistry; Dr. Athanasios Zavras, Professor and Chair in the Department of Pediatric Dentistry.
Representatives of Continuing Education (CE) at GSDM were also present on the YCD exhibit floor throughout the conference.
“Attending Yankee Dental Congress was very beneficial for CE. We had the opportunity to promote our Continuing Education program and conduct a short survey to gauge what kind of courses dentists, hygienists, dental assistants, and office staff are looking for,” said Business Manager of Continuing Education Ms. Stephanie Grignet.
“We plan to incorporate the results into our future course offerings,” she said.
In addition, members of CE utilized the conference to learn more about the dental market, and meet potential speakers for courses. They also built relationships with dental companies and local dental associations, along with GSDM alumni.
John Golden Award
On Wednesday, Jan. 27, Dr. John Carl McManama, Professor in the Department of General Dentistry, received the John Golden Award at the 41st Annual YDC Presidential Awards Ceremony and Reception, which took place at the Plaza Ballroom in the Seaport Hotel. This award is in recognition of Dr. McManama’s extraordinary service to the Yankee Dental Congress organization over the past 15 years most recently serving as Yankee Dental Congress General Chair.
The following GSDM faculty and alumni played a large role in organizing and arranging this year’s YDC, Dr. Kathy Alikhani, DMD 88, Endo 90; Dr. Charles Badaoui, DMD 89; Dr. Nathan Birnbaum Pros 74; Dr. Courtney Brady DMD 11; Dr. Gennaro Cataldo; Dr. Pelly Chang, DMD 89; Dr. Nicholas Dello Russo, Perio 72; Dr. Mark Doherty, Jr., Endo 05; Dr. Gerard Dorato; Dr. Debbie Eisen, CAS 84, DMD 88; Dr. Mark Ferriero; Dr. John Fiore, DMD 89, AEGD 90; Dr. Paula Friedman, DPH 88, MPH 00; Dr. John Guarente, DMD 89; Dr. Harish Gulati, PGOE 05; Dr. Deedee Gurin, DMD 97; Dr. Dennis Jodoin, DMD 95, Perio 98; Dr. Suneel Kandru, Endo 07; Dr. Zachary Kano, DMD 96; Samer Khayat, Pros 04, Endo 08; Dr. Iman Labib, DMD 96; Endo 01; Dr. David Lustbader, CAS 86, DMD 86; Dr. Carl McManama; Dr. Debra Pan, MsC 86, DMD 01; Dr. Mina Paul, SPH 97; Dr. Gustavo Perdomo, Pros 85, DMD 99; Dr. Sean Rayment, DMD 97, DSc 00; Dr. Jared Reid, DMD 04; Ms. Leila Joy Rosenthal; Dr. Ronni Schnell, DMD 81; D. Maryam Shomali, CAS 87, Endo 93; Dr. Richard Short, CAS 76, DMD 82; Dr. Lakshmi Thalanki, DMD 88, Ortho 02; Dr. Mark Wang, DMD 94; and Dr. Howard Zolot, Perio 85.
The following GSDM faculty and alumni gave courses at YCD, Dr. Neal Fleisher, DMD 84, Perio 86; Dr. Ronald Fried, DMD 83; Dr. Anita Gohel; Dr. Sheldon Itzkowitz, Perio 92, AEGD 94; Dr. Judith Jones, DPH 00, DSc 02; Dr. Elliot Kronstein, Pros 77; Dr. Bing Liu DMD ’03, DSC ’90; Dr. Carl McManama; Dr. Gigi Meinecke, DMD 88; Dr. Ronni Schnell, DMD 81; Ms. Mary Ellen Sholes, MET 78; Dr. Richard Short, CAS 76, DMD 82; and Dr. Linda Vidone, DMD 93, AEGD 94, Perio 97.
Story submitted by GSDM Communications.
The Team Science Pilot Grant Program, which is funded by the BU Clinical and Translational Science Institute (BU-CTSI), is requesting applications.
EMAIL APPLICATION SUBMISSION: Deadline Wednesday, Feb. 17 by 5 p.m.
Purpose of the RFA: To stimulate individual and team science in all areas of translational research related to the prevention, diagnosis, and management of human disease. Researchers engaged in basic research, patient-oriented research, implementation science research, community engagement research, and population-based research are encouraged to apply.
Funding Available: Direct costs up to $20,000 may be requested.
Full details including how to apply, please go to here
Questions/Inquiries: We encourage inquiries concerning this RFA and welcome the opportunity to answer questions from potential applicants
MED offshoot now an international leader in research, graduate education
When the School of Public Health launches a yearlong celebration of its 40th anniversary tonight, it will be celebrating one of Boston University’s great success stories. The school has grown from a small department within the School of Medicine to become an international leader in graduate education and research, placing 10th in the most recent U.S. News and World Report rankings.
By all accounts, the appointment of Sandro Galea as dean has been a shot of adrenaline for the SPH graduate study and research programs and interdisciplinary degrees. Over the past 12 months, he has overseen structural and curriculum changes designed to keep pace with a changing world and ensure that SPH continues to graduate students who “are actually the doers in public health,” as Galea, whose long résumé includes a stint in Somalia with Doctors Without Borders, puts it.
In addition to tonight’s kickoff celebration for the SPH community at Boston’s Algonquin Club, the school is marking its anniversary with a symposia series, regional and global receptions around the country, a photo contest, and a gala dinner scheduled for November. The anniversary reflects a story of determination, creativity, and being a major force for change, from environmental threats to patients’ rights.
SPH was established in 1976 as a program within MED’s sociomedical sciences and community medicine department, with an initial class of 54 master of public health students and 20 nondegree students. Initially the school’s curriculum was practical rather than theoretical, with classes scheduled for only Tuesday, Wednesday, and Thursday evenings, so those with full-time jobs could attend. The first students were almost exclusively health professionals seeking to further their education. At the time, there were only two concentrations: Health Delivery Systems and Health Research and Evaluation.
“At first, the people we attracted were nurses, doctors, hospital administrators, and people who worked in public health,” says Leonard Glantz (CAS’70, LAW’73), an SPH professor emeritus of health law, bioethics, and human rights. “And most people in public health were not trained in public health; they were trained in sociology or political science or nursing.”
At the start “it was like a mom and pop operation,” recalls Theodore Colton, chair of the epidemiology and biostatistics department from 1980 to 1999. Trained at the Johns Hopkins School of Public Health, Colton arrived at BU just as the school was preparing for its first accreditation visit. He says the founding dean, Norman A. Scotch (CAS’51, GRS’52), was “a great gambler in terms of the idea of a school of public health.” Scotch had previously been head of MED’s sociomedical sciences program and is credited with guiding SPH through the accreditation process at a time when Boston’s only graduate school of public health was at Harvard. Today, the school bestows an annual teaching award in his name to an SPH faculty member who has made an “outstanding and sustained contribution to the education program.” Scotch died in 2014, at age 86.
SPH’s first graduating class, in 1979, was a small group of 46 master’s students, all part-time. Last year, the school awarded 1,078 degrees to students from 43 countries (the first international student was accepted in 1981), with master’s or doctoral degrees in epidemiology (the school’s first PhD program, started by Colton), biostatistics, environmental health, epidemiology, and health policy and management and master’s programs in global health, health law, bioethics, and human rights, maternal and child health, and social and behavioral sciences. The school also offers a PhD program in leadership, management, and policy, as well as dual degrees with other schools: MED, the School of Law, the School of Social Work, the College of Arts & Sciences, the Questrom School of Business, and Sargent College of Health & Rehabilitation Sciences.
Informing drunk-driving laws, patients’ rights, legal health proxies
Much of that growth is attributed to Robert Meenan (MED’72, Questrom’89), who served as dean for 21 years, stepping down in 2014. Under Meenan’s watch, the school expanded dramatically. He guided SPH’s move from MED to its current home in the Talbot Building, overseeing the renovation of the historic former hospital to house the school. “It was the first time all the SPH faculty were together in one building,” says Glantz.
As well, Meenan instituted a practicum requirement for master’s students. “Meenan was very businesslike,” says George Annas, a William Fairfield Warren Distinguished Professor, an SPH professor of health law, policy, and management, a MED professor, and a LAW professor, “but he always remembered that we’re an academic institution.”
SPH earned full accreditation from the Council on Education for Public Health in 1983, and graduated its first doctoral candidate in 1985. Today, as it continues to send public health professionals into the field, SPH is a research leader at the forefront of major studies, including the sweeping, historic Framingham Heart Study, the Black Women’s Health Study, and the New England Centenarian Study, as well as important studies on gun violence, and recently, on e-cigarettes. Faculty in six departments—biostatistics, community health sciences, environmental health, epidemiology, global health, and health law, policy and management—conduct research that contributes to public health policies around the world.
Those who associate the public health field only with preventing communicable diseases might be surprised to learn that it was SPH research that informed the nation’s drunk-driving laws and led to the institution of patients’ rights and the establishment of legal health proxies. As a profile in the January 2016 edition of the venerable medical journal The Lancet notes, “BU SPH brought attention to physical disability as a public health problem, contributed to the understanding of the effects of environmental toxins in conditions such as Gulf War syndrome, and was the catalyst for international reconsideration of the value and ethics of placebo-controlled trials.”
“For all of the school’s growth over the last four decades, I think what’s been remarkable is our ability to stay true to our core mission: producing top-tier scholarship that maintains a deep commitment to improving the health of populations, particularly vulnerable populations, locally and globally,” says Galea, who succeeded Meenan as dean. “We will continue to reshape our research and curriculum to meet new challenges, but we’ll never abandon an approach rooted in real-world education and practice. That’s what has distinguished us in the past, and that’s what will allow us to continue to grow.”
Annas, who, like Glantz, has a law degree, notes that at the time SPH was evolving, there was “an outbreak of hospital regulations, and the sense that there were people who needed to know about these things, none of which were taught in medical school.” In defining its mission, SPH had to “not be like Harvard; that was easy,” says Annas. “Harvard was a great international school of public health, but not one focused on local public health.”
“Our students tend to be idealistic, and they come to a place that supports their idealism, a place where they have role models and support systems,” says David Ozonoff, an SPH professor and chair emeritus of environmental health, who headed the department from 1977 until 2003 and directed SPH’s Superfund Research Program for 20 years.
Choosing to work in the trenches rather than climb the corporate ladder
A look at SPH’s earliest catalogues, which Colton has stashed in his office, show him along with Glantz, Annas, and Ozonoff as scruffy young academics with long hair and beards. “I went to medical school in the ’60s, when public health was a very low-status specialty,” says Ozonoff. “If you said you were going into public health, it meant you’d be in the South Bronx reading TB screens for the rest of your life.” But like so many of his peers at that time, Ozonoff was an anti-war and civil rights activist (he organized a group of physician draft resisters), and public health spoke to his values. SPH beckoned to students and faculty who were eager to work in the trenches rather than climb the corporate ladder.
Ozonoff was invited by Scotch to launch the environmental health program, and his first task was to establish a basic curriculum. “There was no department; it was called a section, and I taught everything. I also wanted to do research, so the question was, what’s going to be the nature of this department,” Ozonoff says. “The occupational part of this thing was closed off, because there was Harvard, which had very good occupational health program, and you don’t get in the same niche with a giant. What they weren’t doing was environmental and community stuff, so I said that we’re going to concentrate on working with communities that have their air and water contaminated by big business. That suited my politics perfectly. And we were the only ones doing that.”
It turned out, he says, that “there were a lot of top-notch, smart young people who wanted to do this, too, and could have gone anywhere, but they came to us because we had something the other places didn’t—the opportunity to make their life and their politics whole.”
The SPH website describes the school’s mission thus: “to improve the health of populations locally, nationally, and internationally, with a special focus on the disadvantaged, underserved, and vulnerable.” Through education and research, the school seeks to make a needed difference in the real world.
Today, the school is on the cusp of the “next leap forward,” says Glantz. “We have a new dean who’s a real public health visionary.” Galea, who has already effected change on many levels, has been commended by colleagues like Glantz and Annas for his decision to combine two departments last September—health law, bioethics, and human rights and health policy and management—to create the health law, policy, and management department. The new department, Galea says, will be at “the forefront of the global scholarly conversation about the role of laws, policies, and health systems in shaping the health of the public.”
“He believes in the social determinants of health,” Glantz says. “And that poverty matters,” adds Annas. And SPH continues to attract students who share these concerns. “What we’re most proud of is what our students do,” Glantz says. “We have graduates in state government, city government, federal government, and all over the world doing all sorts of important and interesting work. People don’t come to SPH in order to become rich or famous. They are people who are dedicated to communities, and we give them the skills to be effective.”
From Ozonoff: “It’s not a school for prima donnas.”
This BU Today story was written by Susan Seligson, Senior Writer for BU Today and Bostonia.
SPH professor concerned about virus, but also “prepared to be alarmed”
On February 1, 2016, Margaret Chan, director-general of the World Health Organization (WHO), declared Zika virus “a public health emergency of international concern.” Chan’s statement said the 2016 outbreak is an “extraordinary event” and a public health threat to the world.
For decades the virus, transmitted by the Aedes mosquito, affected mostly monkeys in equatorial Africa and Asia. In humans, Zika occasionally caused a mild, flu-like illness. A story in today’s New York Times also reported a case discovered in Texas earlier this week of Zika virus infection transmitted by sex, raising new concerns about how the virus is spread.
Then something changed. In 2007, Zika started popping up in the Pacific islands, and in 2015, scientists detected the virus in the Americas, where it is now “spreading explosively,” according to WHO. Most alarming, says Chan, is the possible connection between Zika and microcephaly—babies born with small heads and neurological deficits—and also Zika’s possible link to other neurological syndromes like Guillain-Barré.
BU Today spoke to Donald Thea, a School of Public Health professor of global health and director of the Center for Global Health & Development, about Zika, asking what we know and what we still need to learn.
BU Today: This virus was discovered in 1947, but only recently has it become an international concern. When did you realize that it might be something bigger or different?
Thea: It was the reports of microcephaly that were coming out of northeast Brazil that concerned everybody. Our Brazilian colleagues noticed that there was a sharp increase in that area. And because it seemed to be concurrent with the outbreak of this virus, they put two and two together and assumed that there was a connection. However, a firm epidemiologic connection is yet to be established.
That was in October 2015?
Yes. Preceding that, there had been reports of increases in microcephaly in an outbreak that occurred in French Polynesia in 2013. And that was the first place that in retrospect we saw this disease begin to emerge. Prior to that, there had never really been any reports of microcephaly or Guillain-Barré syndrome that I’m aware of.
The microcephaly numbers in Brazil are really high.
I think we have to be a little bit careful about those numbers. The latest numbers seem to indicate that there are about 4,000 cases of microcephaly reported from Brazil. But microcephaly is a syndrome; it’s not a disease, and there are variations in how you define it. It is characterized by a small cranium, a small brain, and poor brain growth. Now, there’s normal variation in head size. So people have gone back and reassessed the first 700 cases out of the 4,000. And they have declassified as microcephaly or found other causes for about 400 of those cases. Those numbers are approximate, but it’s really quite interesting. In Brazil, they’re beginning to question the numbers. A 26-fold increase in microcephaly in one year seems to be very, very high. And the term that they’ve used is “almost not credible.”
Still, it appears that there’s a big increase in microcephaly. Is there something else that might be causing it?
So that’s part of what we have to be careful about. Microcephaly is quite a rare condition, but we do know that there are a number of other infections that cause it. Making the diagnosis of Zika can be tricky, also. It’s not particularly easy to do. You get infected, you become symptomatic, you have virus in your blood, and that virus in your blood lasts for about a week, during which time you can diagnose it with laboratory tests. But because this virus is of the same family as dengue, chikungunya, West Nile, there are cross-reactions.
What’s a cross-reaction?
When you’re infected with a virus, your body mounts an antibody response to that virus. Say you had dengue in the past, and I give you a Zika test—your Zika test may be a false positive, because your body still carries antibodies to dengue that caused the Zika test to be positive. So we have to be very careful about the tests that we use, when we use them, and how we apply them to populations. This is garden-variety disease outbreak surveillance, but it has to be done properly for us to get a really sound idea of what is the actual incidence of Zika in the population.
Is the WHO response excessive, since we know so little? Is it a result of the widespread criticism of its slow response to Ebola?
I think our experience with Ebola was very sobering. And if, in fact, this relationship between Zika virus infection and microcephaly exists, these are potentially devastating effects on children, on the next generation. And if there is widespread transmission, affecting newborn children, it’s obviously a very, very serious problem and a deeply emotional problem. But as George Annas’, Sandro Galea’s, and my opinion piece in the Boston Globe indicates, we do think that the WHO may have acted prematurely in calling this an international public health emergency.
What other central nervous system problems might be connected to Zika?
There appears to be evidence of central nervous system calcification on ultrasounds of some of the children. There also appears to be diminished natural brain formations. Gyri and sulci are the normal curves and indentations in the brain, and they seem to be different or less in some of these children. But again, we are absolutely at the very beginning of investigating this disease and its effects and cannot yet conclude that these changes are due to infection with Zika.
The vast majority of people who get Zika are asymptomatic, which is also a little bit worrisome. Of people who get infected, 80percent have no symptoms; 20 percent have the typical syndrome, which is very, very mild. And prior to some of the reports of Guillain-Barré, which need to be confirmed, it’s essentially a very benign illness, not typically requiring hospitalization. So these more profound effects are obviously very worrying.
And those other central nervous system effects have not been verified?
Is Zika spread only through mosquitoes? I’ve heard rumors of one case spread through sex.
Yes. There was a researcher in Senegal, and he came back to the United States and apparently infected his wife, who had never left the country.
So what do we do about single isolated reports like that?
I think that probably they fall into the category of “biological curiosity.” And even if we did find it in semen, the timing of transmission is probably relatively short. And therefore sustaining an epidemic through sexual transmission in a population would be nowhere near being akin to HIV. But then again, as we’ve seen with Ebola, Zika also could also be sheltered in the testes and remain in the semen for some time.
So right now the mosquitoes are the big worry?
Yes, Aedes aegypti and Aedes albopictus.
Aedes aegypti is the worst mosquito ever. It spreads everything, doesn’t it?
Well, for sheer devastation, Anopheles, which carries malaria, is worse. But Aedes is a particularly difficult mosquito because unlike Anopheles, which breeds in clean water, Aedes seems to have an affinity for dirty water. So it tends to breed in small pools of dirty water like you would find in tires in the backyard during the rainy season, or plates, or pots, of any kind. And so urban transmission is more prevalent with diseases of Aedes than is rural transmission.
What measures are being taken now to prevent transmission ? Are people just spraying for the mosquitoes? Are they spraying DEET all over themselves? A pregnant woman can’t spray DEET on herself, can she?
Well, you may have to. Brazil has mobilized 220,000 army recruits who are fanning out over, I think, the urban and peri-urban area of Rio, where the 2016 Olympics are going to be, spraying with insecticides to try to bring the mosquitoes under control. But basically, we have no vaccine; we have no treatment. The only thing we can do to protect ourselves is to wear protective clothing or apply insect repellent, or remove ourselves from areas where the mosquito tends to be active—go behind screen doors, in air-conditioned rooms.
This sounds like a real problem for pregnant women in Brazil.
Potentially it is. And the recommendation by the authorities there to simply not get pregnant is very problematic, because there are all sorts of issues related to the availability of family planning services. Birth control pills and other products can be difficult to obtain, even if you have a highly motivated population.
How is the virus spreading to other countries? Are the mosquitoes piggybacking on people and getting on airplanes?
No, the more important factor is the transfer of the reservoir of the virus. So people who have the virus in their bloodstream travel to an area that does not have Zika, get bit by a mosquito, and then it goes on to bite other people. That is how it starts out.
Do we have these mosquitoes in Boston?
We really don’t have Aedes aegypti in Boston. We certainly don’t have it during the winter, during the fall, during the early spring. However, we do have Aedes albopictus, which is also known as the Asian tiger mosquito. It’s much hardier than Aedes aegypti and has been able to sustain colder temperatures.
It seems like every day, the world map has bigger splotches of Zika on it.
But we have to be really careful, because that could be an artifact in the same way that the microcephaly could be an artifact. It may well be that there had been lots of Zika in these areas, we just never looked for it. It’s not a common test. It’s not a highly available test. It’s a disease presentation that mimics others, looks like dengue, looks like chikungunya. So it may well be that there’s lots of Zika out there that we just never knew about.
So you’re saying a lot of research needs to happen really quickly. How?
Funds need to be mobilized, and national and international bodies like the Pan American Health Organization and the World Health Organization really need to step up and convene expert panels so we can get the best and most current information available on the table for everybody to see. We need to get the best minds together to plan out in a structured and rational way how to study this disease.
Do you see that starting to happen?
Yes. I mean, the health system and the public health research community in South and Central America are quite sophisticated, and there’s obviously a lot of concern. They’re beginning to do some of these epidemiologic studies. There’s a Phase 1 candidate vaccine that hopefully will be tested sometime during this calendar year. So there’s a lot of effort and energy being mobilized. But we will need more.
We touched on Ebola and you said that situation was sobering. But are there things that happened there, lessons learned, that might be applied now?
I think one of the lessons that we learned in West Africa was that it’s important to react quickly. And I think one of the other lessons that we learned is that it’s really important to have global surveillance, and it’s really important to build local capacity to do the kind of surveillance you need to get the earliest warning of these disease outbreaks.
Some experts are saying they’re concerned about Zika, but the WHO’s Chan says it’s alarming. Are you concerned or alarmed?
I’m concerned, but prepared to be alarmed. I’m prepared to be alarmed when there’s new data.
What would be the step down from concerned? Do you think it’s going to drop to “relaxed”?
I don’t think so. When it comes to the kinds of effects that may be linked to this, I don’t think anybody’s ever going to feel relaxed, unless we show conclusively that these devastating effects are not due to Zika. But we should never relax regarding the global nature of infectious diseases. There’s always a new one just around the corner.
In recent decades, the United States has seen a dramatic increase in opioid prescribing for chronic pain. That growth has been associated with increasing misuse of these medications, leading to alarming increases in unintentional opioid overdose deaths.
In a perspective in this week’s New England Journal of Medicine, Daniel Alford, MD, MPH, associate professor of medicine and assistant dean of Continuing Medical Education and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program at Boston University School of Medicine (BUSM), recommends that prescriber education is the best approach to addressing the prescription opioid-misuse epidemic, allowing for individualized care on the basis of a patient’s needs after a careful benefit–risk assessment.
According to Alford, a key problem is that clinician education around pain management and safe opioid prescribing has been lacking. As opposed to blunt regulatory solutions that decrease access to opioids in an indiscriminant way, education is a more finely tuned approach that can empower clinicians to make appropriate, well-informed treatment decisions for every patient at each clinical encounter. “Education has the potential to both reduce overprescribing and ensure that patients in need retain access to opioids,” explained Alford, who is also medical director of Boston Medical Center’s Office-based Opioid Treatment (OBOT) program.
Alford points out clinicians have limited tools at their disposal to help patients with severe chronic pain and the reimbursement system favors the use of medications alone, despite evidence supporting multimodal pain management. Moreover, whereas clinicians can use objective measures to guide their management of other chronic diseases, here they must rely solely on the patient’s (or family’s) reports of benefits (such as improved function) and harms (such as loss of control).
Alford believes voluntary prescriber education may be insufficient to address this problem and that mandatory education may be required. “If so, it will be important to link mandated education to medical licensure to avoid having clinicians opt out — since that could lead to reduced treatment access, as well as burnout among the clinicians who opt in,” he added.
Alford believes that the medical profession is compassionate enough and bright enough to learn how to prescribe opioids, when they are indicated, in ways that maximize benefit and minimize harm. “Though managing chronic pain is complicated and time consuming and carries risk, we owe it to our patients to ensure access to comprehensive pain management, including the medically appropriate use of opioids.”
Leading expert on health consequences of mass trauma, conflict
Sandro Galea, dean of the School of Public Health, has been appointed Boston University’s Robert A. Knox Professor. The professorship supports a BU faculty member who demonstrates excellence in scholarship, research, and teaching, as well as impact on society.
“Professor Galea’s energetic leadership and foundational research in the health of urban populations are sparking important new conversations and producing tangible results in communities across the globe,” says Jean Morrison, University provost and chief academic officer. “His work exemplifies the impactful, multidisciplinary approach at the core of this distinguished professorship.”
Galea says he is honored by the professorship. “I am thrilled that this professorship joins other endowed professorships held by scholars who are part of our school community,” he says.
Galea’s current research interests focus on the social production of health in urban populations. He examines the causes of brain disorders, particularly common mood-anxiety disorders and substance abuse. He is also a leading expert on the health consequences of mass trauma and conflict, and has studied the health impacts of the September 11 attacks, Hurricane Katrina, conflicts in sub-Saharan Africa, and combat in Iraq and Afghanistan. His most recent book, Population Health Science, coauthored with Katherine Keyes, is forthcoming from Oxford University Press.
His work has been supported by the National Institutes of Health, the Centers for Disease Control and Prevention, and several foundations, including the Robert Wood Johnson Foundation, which gave him a 2006 Investigator Award in Health Policy Research. He is an elected member of the National Academy of Medicine and of the American Epidemiological Society.
The second faculty member to receive the professorship, Galea is also the second from SPH. The previous Robert A. Knox Professor was Jonathon Simon, former director of the BU Center for Global Health & Development.
The Robert A. Knox Professorship was established through a 2012 $2.5 million gift from the Robert and Jeanne Knox Foundation, a philanthropic entity cofounded by Robert Knox (CAS’74, Questrom’75), chair of the BU Board of Trustees, and his wife, Jeanne, who heads the BU Parents Leadership Council.
This BU Today story was written by Michelle Samuels.
BU Medical Campus students, faculty and staff are invited to join the Department of Public Safety and their partners from the Boston University Police and Boston Police departments at a town meeting. Learn about the collaborative work being performed by our public safety, police and emergency preparedness representatives.
There will be a panel discussion moderated by Connie Packard, the Executive Director of Support Services, and plenty of time for you to ask questions and give feedback regarding safety and security in and around the medical campus neighborhood. Your BU ID will be required to attend. There will be handouts with valuable information provided at the end of the session.
- Wednesday, Jan. 27
- 3:30-5 p.m.
- Keefer Auditorium