Community-Centered Medicine

high tech/low tech

by Adam Law on November 22, 2015

Today the BBC Health Page on their website BBC Health page announces that the UK government in partnership with the Bill and Melinda Gates foundation are giving 1 billion dollars to the eradication of malaria and also to the improvement of biodefenses against the spread of virulent diseases like Ebola, SARS, MERS. At the end of the article there is the following quote: “A report published in the journal Nature earlier this year showed 663 million cases of malaria have been prevented in Africa as a result of concerted efforts to tackle the disease since 2000. Researchers from Oxford University attributed the reduction mostly to bed nets. The drug artemisinin and spraying homes with insecticide also played a part.” It is a reminder to us that with all the hubris about how technological developments in health care are going to solve these fundamental problems, it is low tech public health measures that often make the largest difference. However, I am certainly a great advocate of basic science as this can take care of the disease that public health measures fail to reach. Another recent BBC Health News article provides a glimmer of home in the attempt to understand and hence produce effective treatments against this parasite. And the development of vaccines using these insights may turn out to be the most cost effective measure against malaria. This is a “just in time” infusion of research cash as malaria is changing it’s geographic distribution owing to climate change – see for example Parham PE, Michael E. 2010
This reminds me of an endearing moment in my life in 1984 when I took off 6 weeks between a position as a senior house office in cardiology at the Brompton Hospital and starting a position as a registrar in general medicine and endocrinology at Northwick Park in London. I wanted to visit South East Asia and planned an itinerary to visit Thailand, Malaysia, Sumatra and Singapore. I was concerned about the reports of resistant malaria and taking into account my love of public health, went to the Youth Hostel Association and purchased a mosquito net. I visited Phuket and was staying in a small beach house – my first night not in hostels, hotels and houses of friends. I took out my mosquito net for the first time and figured out how to arrange this to keep out mosquitoes. I felt sanctimonious as I went to sleep that night feeling invincible against the insect world. I woke up the next morning covered in bed bug bites. From this I learned some humility and my vast amusement at my fate overcame the horrible itchiness as I left the area to go further on my travels. Once in New York City I neurotically inspected my hotel mattress for bed bugs only to find a cockroach the size of a small rodent in the sink. I discovered that shaving gel is an effective weapon against cockroaches – now I wonder if I should have kept her/him as a pet.


This article in the Lancet articulates well the importance of reducing short term green-house gas emissions. The now classic research by Shindell et al shows graphically the importance of black carbon and methane in meeting the less than 2 degree Celsius increase in global warming target.
Shindell figure
I think that we need to rapidly transition from using methane for re-powering coal fired plants, transportation, domestic uses and industrial applications. The health co-benefits of making this transition will go a long way to paying for the cost of directly transitioning to clean, renewable energy sources.

Lancet editorial.pdf


The interaction of Globalization, Climate Change and Human Health

by Adam Law April 7, 2013

          In this weeks edition of the New England Journal of Medicine Dr. Anthony McMichael, who is from the Australian National University, Canberra, reviews the ways in which globalization, climate change and human health interact. The final sentence of this brave piece of scholarship sums it up nicely: “For populations to […]

Read the full article →

Dr. Nirav Shah’s tough decision

by Adam Law April 3, 2013

I warmed to Dr. Nirav Shah when I heard him on an interview explain why he had recently decided to start practicing clinical medicine in a teaching context to keep in touch with his professional roots. He is a native of Buffalo NY, and received his medical training and MPH at Yale School of Medicine. […]

Read the full article →

Winter is on the wane – time to get a winter exercise plan!

by Adam Law March 31, 2013

There was a hard frost on the ground outside my home in Ithaca today. However, it has been a damp and chilly day, and there is no residual ice or snow. As I drive, I see more runners, cyclists, walkers out to enjoy Ithaca’s gray gym. As the spring arrives many of us will shake […]

Read the full article →