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Demystifying Medicine One Month at a Time

Category: doctor heroes (page 2 of 2)

The Science of Medicine

Last week I told you of my admiration for Dr. Mona Hanna-Attisha, the Michigan pediatrician and epidemiologist whose strong research and advocacy was able to finally bring a shining light to the problem of lead in the water supply of Flint.

Continuing with a theme, I now bring you the story of Dr. Adriana Melo of Campina Grande, Brazil.

03-zika-doctor-adriana-melo.w245.h368Dr. Melo is an OB-GYN who subspecializes in Maternal-Fetal Medicine (MFM), the branch of obstetrics that deals with high-risk pregnancies.

She lives and works in northeast Brazil, which is less populous and more economically challenged than the southern, more well-known parts of the country (including Rio de Janeiro and Sao Paulo).

Dr. Melo noted an uptick in the number of fetuses with small heads on ultrasound — which is the main tool used by MFM doctors to diagnose babies in utero.

How much of an uptick? A rough look at the statistics shows ONE HUNDRED times the ‘normal’ rate of babies born with microcephaly, the medical name for the condition.

Dr. Melo had a suspicion that the mothers giving birth to these babies all had a common trait: they’d all told her that they’d had the characteristic rash associated with the mosquito-borne Zika virus.

When she tested the mothers for evidence of the Zika virus in their blood, the tests were negative. Not deterred, she convinced public health authorities to test the amniotic fluid of mothers carrying microcephalic fetuses. And indeed a strong correlation was found between exposure to Zika and microcephaly.

It’s this story of a doctor in a somewhat out-of-the-way place using her clinical insight to ‘prove’ a correlation which I find inspiring.

Dr. Melo could have been content to merely diagnose and treat these poor mothers and babies, perhaps simply ‘reporting up’ her findings on the increase in microcephaly. Instead, she decided to push against the inertia of daily medical practice because what she was seeing really bothered her — and as a mother of young children herself, she felt the urge to get to the bottom of the new trend.

If you follow health news, you no doubt have heard a lot about the Zika virus in the last few weeks, including warnings from both the CDC and the World Health Organization. As is often the case with warnings from these organizations, a certain amount of panic ensues — such as women in Latin America feeling that they’re being told not to get pregnant, for example.

I want to make it very clear that though there is a STONG ASSOCIATION between the rise in cases of Zika in the tropics of the Western Hemisphere and a concurrent rise in babies born with microcephaly, we must remember: Correlation does not equal causation. The public health agencies issuing travel and birth control warnings, while sounding dire, are making best guesses for us all to minimize our chances of harm. But drowned out in the response is the fact that we don’t yet know for certain that Zika is the cause of microcephaly. That work is ongoing.

For example, many experts think something else may be the cause — perhaps the use of dangerous pesticides in Brazil (that are banned elsewhere). That also sounds plausible since pesticides are used to “control the mosquito vector.” It’s entirely possible that microcephaly is occurring because of a chemical effect.

For now, we must wait and hope that science can show us the true cause of the uptick in microcephaly.

I also think it’s important to remind ourselves of two things about Zika virus: We’ve known about it since the 1940s, when it was discovered in Africa — so though if feels new, it’s really not. Secondly, at least for non-pregnant people, it only appears to cause mild flu-like symptoms and be a self-limited illness (not more than a few days at most).

My advice: Better to save your anxiety for the never-ending Presidential race.

A New Hero

I have a new hero. Her name is Mona Hanna-Attisha, MD, MPH.

monahannaattishaDr. Hanna-Attisha is a pediatrician in Flint, Michigan. She grew up in a suburb of Detroit. She graduated from the University of Michigan before attending medical school at Michigan State University. During her clinical years (the 3rd and 4th years of medical school), she spent many months at Hurley Medical Center in Flint, which serves as a clinical training site for MSU medical students (far from the flagship campus — something I can relate to).

As you may know from recent news, Flint has had some problems — especially due to an overabundance of lead in its drinking water.

For cost-saving reasons, the city of Flint switched the source of its drinking water from the Detroit system to the Flint River in April 2014. Almost immediately residents of the town began noticing the water looked, smelled, and tasted different. It took nearly a year and half for both state and federal officials to acknowledge that there was too much lead in the Flint water — repeatedly questioning the evidence that it was so.

That’s where our new hero comes in.

Dr. Hanna-Attisha directs a pediatric residency training program at Hurley. There are 190 pediatric residency training programs in the United States, training in total about 2600 pediatricians every year.

I can relate to this part of her job — my most recent role was directing an Internal Medicine residency. Though the medical issues are different (kids vs. adults), residency program directors have three essential jobs: recruiting medical school graduates, charting the learning curriculum, and making sure the program stays accredited.

Program Directors become role models for trainees. We try to inspire and motivate residents, offering career and life advice during what is a demanding three year training curriclum.

On top of clearly being good at this role for her residents (7 per class for a total of 20 or so residents), Dr. Hanna-Attisha uses her MPH training to do science — in this particular case epidemiology.

She combed through records at her medical center and discovered that lead levels measured in children’s blood in Flint (as part of routine pediatric care) had on average nearly doubled since the time of the water source switch. Though her claims were at first disputed by state officials, Dr. Hanna-Attisha kept at it, talking to parents, hospital leadership, and advocating with state and federal officials.

In the end, the simple elegance of her team’s science got the message across. The story has now received national attention, including the declaration of a federally-recognized ‘State of Emergency’ in Flint over its water supply.

I was researching Dr. Hanna-Attisha, and came across this TED-like talk she gave at a Michigan State College of Medicine event in 2014. It predates the Flint water story, but it shows her to be a dedicated public servant — not only committed to her trainees and her patients, but beyond that to questioning the very core of what makes people unhealthy: the social determinants of health.

Take a look and let me know what you think.

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