public health and arsenic

I thought this was an interesting argument put forth by a guest lecturer in my pre-professional class the other day, who is a professor at the Mailman School of Public Health. He’s also a professor in the EAEE department (I know, because I sort his mail).

This fellow is pretty impressive, as we are expecting him to receive a Nobel Prize any moment now, especially for his paper “Preferential induction of necrosis in human breast cancer cells by a p53 peptide derived from the MDM2 binding site.” That basically translates to “I found a non-harmful peptide that can selectively kill cancer cells!”

In any case, he said, “If you want to cure diseases, become a doctor. If you want to prevent diseases from spreading in the first place, become a public health professional.”

This struck me, because it’s true that doctors only provide secondary prevention not necessarily removing the risk of disease (or arsenic-poisoning in Bangladesh, in this lecture’s case), but mitigating it. Arsenic can become methylated (made non-toxic), but the risk of exposure is still there.

The problem with Bangladesh was that, in the 60’s and 70’s, people discovered that the surface water was microbially contaminated and contributed to many diarrheal diseases. So UNICEF went in and installed about a million tube wells, only to find that many of them contained unsafe levels of arsenic (about 50 micrograms per liter—keep in mind that the “accepted” amount is 5-10) about two decades later. (This reminds me of CFCs, in the case that solving one problem leads to another, like global warming—bah, depressing!) Because arsenic is tasteless and colourless, people were not aware of the problem until the symptoms began appearing in the 90’s, the kicker being brownish spots on the palms of the hands, and later nasty-looking skin lesions. I figured that since people work mostly with their hands, there must be a huge productivity loss (if we’re going to be heartless and measure humanity in dollars) of about $42 million/year because of the disease burden of arsenic in drinking water. THIS is actually more than the previous problem of contaminated surface water, though we cannot really blame UNICEF.

I think that biggest challenge to public health is getting the people to respond to the findings. Professor Brandt-Rauf’s team figured out that deeper wells in Bangladesh were clean, while the shallower ones were contaminated, and they went around and marked every shallow well with a poison sign, and green-lighted every “good” well. The problem was that some of these wells are 6 feet apart from each other. After spending a day explaining the dangers of arsenic to a young mother, the team went on to discover that, by evening, the woman still went to draw water from the contaminated well. When confronted, she merely said, “that water tastes better.” Still, after hearing about public health professionals researching this problem and finding a safe short-term solution (use the deeper wells!) it begs the question:

Why aren’t public health professionals paid more than doctors? I have my theories, but I’m not quite sure. Maybe it’s one of those “don’t panic until it’s too late” and you’re already sick types of situations, or the mindset of “it can’t happen to me.”

I just get this feeling of being kicked in the stomach when people scorn me for wanting to go help people in poorer parts of Africa and Southeast Asia. “Isn’t there enough people here who need help?” they ask. “Why travel so far when there are homeless people on the streets of New York?” True and true. But you never hear of problems like arsenic or lead in drinking water in New York City. There are some places in the midwest that have arsenic problems, but not at 50 micrograms per liter! We have the groundwork of a healthy society already in place, at least tending to our basic needs (water and food). The point of making the whole sustainability argument is that it is possible to engineer these areas out of poverty—similar to “the goal of the philanthropist is to put himself out of work.” I mean, cheers to Adam Smith, who said it first and best: “Common years of sickness and mortality…cannot fail to diminish the produce of industry.” In order to promote any sort of societal progress, people must be healthy first.

I don’t know. It’s stuff like this that gets me out of bed every day, and plug and chug through my inane chemistry lectures, because I want to do something about it. Not necessarily public health, but engineering for a better planet. At the same time, it’s stuff like this that makes me want to hide under the covers, daunted by the massive scale of these problems.

Besides, we all know that Bangladesh is going to flood in about thirty years as a result of global warming, but that’s a whole other rant.

The role of a citizen-scientist

So I just got out of a panel discussion that SEBS (Scientists and Engineers for a Better Society) sponsored, of which I am a part of, and it was awesome.

We had Dr. Gavin Schmidt from NASA, who is a British fellow in charge of realclimate.org, and he had a couple of very interesting observations: scientists seem separated from society, not necessarily because they are socially awkward, but because they have this weird relationship in the idea that scientists have values tied to their work. If they make their values known to the public, they’re accused of having an agenda; iff they do not make their values known and try to disclose only the facts, they are accused of having a hidden agenda (which is in some cases, worse). His other main point was that most people do not understand how science progresses—most of the time, two scientists will agree on 99% of the research; it’s the 1% dispute that causes the public to go, “this entire thing is bogus, how do we know what’s right?” Yet science is discovered through that 1% of tugging back and forth, and somehow, arguments and experiments later, we have a possible theory.

Professor Holmes is a biomedical engineering professor here at Columbia, in charge of the ethics class.  His views mostly come from medical science, as that is his background, speaking mostly from the perspective of doctors. One of the most obvious ways science gets a hand in society is through medicine. The problem with politics in the medical community is that most of the decisions are made by people who are not properly educated in science and are easily swayed by lobbyists who “show up at the game.” Most doctors, he says, whine about new legislation after it’s been passed into law, but why weren’t they there in the first place to present their point of view? That is the real problem of science and politics, is that decisions are not made by those most knowledgeable; the scientists view any time spent outside of their lab as “time wasted,” yet all they do is kvetch when there are new policies against them. Quite obviously, the people who show up are usually the ones who win the game.

The third panelist was Cornelia Dean, former Science Editor of the New York Times. She’s now writing a book on how scientific facts can be manipulated to suit an agenda. We had great representation in our panelists—there was Holmes for the biology side (medicine and evolution), Schmidt with the environmental aspect (climate change, global warming) and Cornelia Dean, an expert in navigating and understanding political incentives via science. She mentioned probability in thinking, and how the American people respect scientists so much only because most of them don’t really know the details about it. She also strongly condemned science education—how science teachers don’t even have science degrees anymore, but education degrees with a couple of classes in science.

There was a Q&A among the audience members and the panelists themselves. All three of them discussed scientists’ responsibilities and obligations to their field—it’s not enough to just publish some works in some scholarly journals in a language nobody can really understand (Cornelia Dean recounted a great joke she’d heard—if Paul Revere was a scientist, he would have marched through Lexington saying “A progress of British soldiers has been observed!”) in order to get grant money. People spend billions of tax dollars on scientific research, but for what? We should hold these scientists accountable. We should expect the scientists to tell us what they’re doing and why it’s significant, even though 99.9% of what they do in the lab will not turn out to be the next penicillin. There was a general consensus in the room that scientists should take a more active role in society so they can a) stop whining about terrible legislation, b) bring new relevance to their work. Get people educated and interested. Cornelia Dean mentions that when she writes science articles, she’s not sure what the public knows or remembers. If she were a sports writer, she wouldn’t need to explain third base or a touchback every time she wrote an article. Sports writers would assume that their audience already knows what these terms mean, which makes it easier to the news. The problem with science is that there are so many “sports” and so many “rules”, it’s like watching a soap opera that puts on an episode once a year.

There was also mention about true information and credible scholarly articles versus the majority of “bad” scientific information on the internet. Most of the time, the public cannot tell the difference between what’s “real” and what’s “some dude at Berkley ranting about genetically grown vegetables without sources or citations” (that was by Holmes, by the way).

The panel went magnificently, in my opinion. It could have gone on all night—two hours passed and I didn’t even notice.

I love these seminars / lecture-type things. So far I’ve learned about Making Globalization Work (the problem with globalization is that it widens the gap between the rich countries and the poor countries, but a way to make it work is for the rich countries to ‘help out’ the poor countries — duh), network neutrality (certain information highways being held or promoting one brand or product? no way!), women in sustainable development (women play a huge role in this, most of the issues in Africa and Southeast Asia result from the extra time and effort women must face as a result of being the traditional caretaker. A big part of this is also infant mortality rates and deaths from childbirth), and linguistics and politics (the idea of language polarizing a society is at large, think about Rwanda, then think about Papua New Guinea that has like 3000 languages. The political dynamic is fascinating!)