Thursday, May 26, 2016

Something that Probably Never Happened

I read, a lot, the following quote attributed to the U.S. Surgeon General William Stewart from a speech in 1967:
“The time has come to close the book on infectious diseases. We have basically wiped out infection in the United States.” 
The quote is often used in the context of how naive Dr. William Stewart - and the scientific community consensus at the time - was about the ubiquity and tenacity of infectious diseases.  The supposed motivation for the quote was the rise in use and effectiveness of antibiotics, which essentially "closed the book" on disease.  We have the cure!

Looking back from 2016, we see how ridiculous Dr. Stewarts' quote is.  Antibiotic resistance is now a global looming threat.  HIV/AIDS entered the U.S. a year before Dr. Stewart's supposed speech but t wouldn't be discovered for another 15 years.  And innumerable other infectious diseases have been discovered in the intervening years, including Ebola virus, norovirus, and Legonella pneumophila to name a very few.

So it is obvious that Dr. Stewarts' quote is ridiculous.  But what's less obvious is that Dr. Stewart probably never said it.  Bradford Spellberg discusses his failure to ever find a primary source for the quote in a 2008 comment in Clinical Infectious Diseases.  Perhaps its time to "close the book" on maligning Dr. Stewart.  Spellberg gives plenty of other examples of prestigious scientists who incorrectly assumed the age of infection was over - let's use them instead.

Wednesday, May 4, 2016

The Proposed Aggregate Exposure Pathway Concept

The cover for Environmental Science and Technology this week is about the Aggregate Exposure Pathway (AEP) concept, a proposal by  Justin Teeguarden at the Pacific Northwest National Laboratory (USA) and colleagues to organize exposure data from the pollutant source to the target site of action.  The proposal is framed around chemical exposures, and feeds in to the already established Adverse Outcome Pathway (AOP) concept from toxicology.  The goal of the AEP is to create a framework that contributes to the evolution of exposure data from an observational science to a predictive science.

How is this relevant to pipes and potties?  In the nutrition and water, sanitation, and hygiene sectors, we're seeing increasing interest in monitoring exposures to both chemicals and microorganisms.  The latter often includes assessments of exposures to both fecal contamination in general and to specific pathogens.  These exposure and risk assessments benefit substantially from advances in the chemical exposure models.

Which WASH interventions matter most for improving child growth?

In March I had the opportunity to join a panel of researchers at the WHO to discuss strategies for improving child growth and nutrition in urban India.  Throughout the 2-day workshop many references were made to the WASH Benefits and SHINE studies, which are ongoing randomized controlled trials of water, sanitation, hygiene and nutrition interventions in Kenya, Bangladesh and Zimbabwe. 

At the WHO workshop most WASH researchers agreed that handwashing is effective and cheapaccess to toilets significantly reduces stunting in young children, and water delivered close to the home is a foundation of health and well-being. But it's difficult to say conclusively which interventions matter most for child growth without knowing the results of SHINE and WASH-B. 

Some early indications of the SHINE trial's progress were published last December, and rumor has it the much anticipated findings of WASH-Benefits will be shared this year at the ASTMH Annual Meeting.  Even so, a new joint publication by the WHO, UNICEF and USAID makes a strong case for integrating WASH interventions into nutrition programs to improve health outcomes for some of the world’s most vulnerable populations.