Wednesday, October 22, 2014

THE CONVERSATION: Airport screening isn’t about stopping Ebola – it’s about controlling borders


by Philip Alcabes, Professor of Public Health at Adelphi University


In 1728, the Holy Roman Emperor Charles VI ordered that a 1,200-mile fortified chain of guard posts along the entire eastern boundary of his lands be made into a permanent Pestkordon. Travelers and their goods could be inspected and detained there, and quarantined when desired.

Ostensibly, this was to prevent plague from entering his empire from the lands of the Turks and Slavs to the east. But plague had already left western Europe before the cordon was built. Charles knew that border checks serve economic and political purposes far more effectively than they prevent disease.

In the face of today’s Ebola outbreak, the clamor for travel bans, airport screening and border closings is a reminder that sanitary cordons continue to appeal – and for the same reason: fear of disease is easily exploited to achieve political ends.

On October 8, the US Centers for Disease Control and Prevention announced enhanced screening for Ebola at five US airports where a high volume of passengers from West Africa land, beginning with JFK. Six Canadian airports will begin “targeted temperature screening”, the Public Health Agency of Canada said, as will Heathrow and Gatwick airports in England. All of that is in addition to the screening measures already implemented at the airports in West Africa, where the outbreak is centered. As of October 13, some say that’s not enough and want to ban flights from the African outbreak zone.

Two aspects of this new Pestkordon are troubling.

First, there’s the striking contrast between the modern world we claim to live in and the world we make when we are in the throes of plague hysteria. We laugh at the notion of borders when it comes to Facebook and rue the government of China for enforcing them when it comes to internet availability for its citizens. But when faced with danger – or, more to the point, when a minor threat evokes fear – we want to shut the borders.

Second, shutting borders or establishing sanitary cordons is worrisome because it is antiquated thinking. Germs have always been travelers. Witness cholera, AIDS, SARS, the 2009 H1N1 flu or just each winter’s garden-variety flu. They are all transoceanic. That germs can now travel faster than ever makes them just like everything else in the world.
Successful sanitary cordons were usually defenses that shut disease into a community, not out. The English village of Eyam was said to have kept the Great Plague of 1665 from spreading to other parts of Derbyshire, for instance, by shutting itself off once some village residents fell sick. In 1900, San Francisco was partially successful at corralling plague inside its Chinatown for some weeks.

But cordons more often appear to work only because the danger is over - as with Charles VI’s border. They may be of limited effectiveness locally. In the bigger picture, they may be closing the barn door after the horse has bolted, as with this August’s cordon in Liberia and Sierra Leone. Sanitary cordons are constructed along political boundaries instead of the more pertinent geography of a virus’s spread. And, as CDC official Martin Cetron has asserted, travel is a “humanitarian bridge” to move personnel and supplies to affected areas.

The new Pestkordon won’t be effective. SARS taught us that back in 2003 when at least 35 million travelers or would-be passengers were screened with temperature sensors, but not one case of SARS was detected. Fever is too common and SARS was too rare, especially among people fit enough to travel. The costs, both monetarily and in terms of restricting the movement of necessary aid or supplies, can be great. Screening for a virus can play up to the old atavisms about foreignness and danger, and – in the case of Ebola – race.
The world has also changed. The majority of the global population lives in cities, meaning some three billion human beings are within about 24 hours’ travel of most of the world’s other human beings. Goods are constantly in transit from one country to another. In today’s world, borders are permeable and the conceptual space they circumscribe – “the West” or “our homeland” is at best fluid.

That border control is often about something other than protecting the public is perfectly evident in what CNN is calling the “Ebolification of immigration reform”. Republican senatorial candidate Scott Brown and Senator Rand Paul are citing Ebola as a reason to close the US border – with Mexico. These men know quite well that a West African virus isn’t going to be common among Central Americans. Still, they can look for votes by demanding border closing. Painting the US as vulnerable and claiming that dark-skinned people are bringing us their germs remains, it seems, a popular move. Indeed, in the past few days we’ve seen both Democrats and Republicans use the “getting tough on Ebola” strategy, presumably as a way to win votes.

The Ebola outbreak will end, although there will likely be more cases in the US and many, many more in West Africa before it does. The West needs to help affected countries contain the epidemic and treat the infected. But, the wealthy world also needs to maintain funding and enthusiasm for undramatic but indispensable measures, like contact tracing, that can halt the spread of an outbreak in its early days. Long-term solutions, like establishing permanent public health infrastructure and programming to deal with illness as it arises, are also critical.

The question is whether we can summon the resolve to create and implement sound public health measures both at home and in Africa so as to limit the outbreak’s effects – or if Ebola’s victims are going to be turned into straw men serving the aims of those who capitalize on Americans’ fears.

Reprinted from theconversation.com

Monday, October 20, 2014

Where Do Chinese-American Women with Cancer Turn when Conventional Medicine Falls Short?

by Bonnie Eissner

Prayer and exercise had the highest perceived effectiveness.

 

In treating cancer, fire is generally used to fight fire. Common medical interventions—chemotherapy, radiation and surgery—can cause as much discomfort as the disease itself. Many cancer patients understandably pursue other avenues to healing—herbs, acupuncture, meditation, prayer, diet, etc. Yet, according to Shan Liu, Ph.D., and Yiyuan Sun, D.N.Sc., assistant professors at the College of Nursing and Public Health, few studies agree on the prevalence or effectiveness of these so-called complementary and alternative medicines or CAMs. And in most large studies, the patterns among minorities, such as first-generation Chinese immigrant women, are impossible to tease out.

 Yoga

Dr. Liu and Dr. Sun are working to change this status quo and have already completed a pilot study of CAM use and perceived effectiveness among Chinese- American cancer survivors in Queens and Brooklyn , New York. Dr. Liu and Dr. Sun surveyed 97 Chinese-American women on their use of CAMs while being treated for cancer and found that the more symptoms the women experienced, the more likely they were to use CAMs. The most popular CAM was exercise, such as walking, followed by the herb lingzhi, vitamins and spiritual or faith therapy—i.e., prayer. Of these, prayer and exercise had the highest perceived effectiveness.


Dr. Liu and Dr. Sun’s study showed a greater prevalence of CAM usage among this segment—87 percent—compared with other U.S. studies but lower rates than studies conducted in China, which have shown rates of 97 to 100 percent.

Traditional Chinese philosophies—i.e., how you live makes you healthy or unhealthy—may be behind the higher use of CAMs in this population, according to Dr. Liu and Dr. Sun. They also say that knowing what questions to ask is crucial. For example, lingzhi—which is less well-known in the West—can potentially interact with chemotherapy or radiation therapy.
 
This piece appeared in the Erudition 2014 edition.

Monday, October 13, 2014

Nazis, Psychopaths and Morals

by Bonnie Eissner 

Picture this. You’re in Nazi Germany hiding with your baby and the members of your town. Your baby starts crying. If your baby keeps crying, the Nazis are going to kill everyone. What is the moral choice?

If you’re struggling with the answer, you’re not alone, says Elsa Ermer, Ph.D., an assistant professor at the Gordon F. Derner Institute of Advanced Psychological Studies. In her research into social cognition, Dr. Ermer has found that most people are slow to respond to this question and similar ones that test moral reasoning. Most of us have two decision-making systems—an emotional one that in this case tells us not to harm others and a rational one that tells us it’s better to save more lives. “People feel that conflict and then it takes them a while to decide what’s right,” Dr. Ermer says.

Brain Scans


Brain scans reveal that people with higher psychopathy scores have less gray matter (brain tissue that correlates with abilities and intelligence) in the regions colored blue. The color bar shows the scale of the effect. Areas that are more green are the regions where psychopaths showed greater differences from controls.


Dr. Ermer and Kent Kiehl, Ph.D., a professor at The University of New Mexico, have been asking incarcerated psychopaths how they would act in the Nazi scenario. Dr. Ermer and Dr. Kiehl bring a functional magnetic resonance imaging (fMRI) scanner to prisons to analyze psychopaths’ brain activity while they respond. In general, psychopaths choose to sacrifice the baby to save the town, and they decide much more quickly. Their “emotional system is either damaged, not working or just working at a lower level so it’s that rational calculus that’s taking over,” Dr. Ermer says.

Prior fMRI research on psychopaths has revealed that they have less tissue in their paralimbic cortex—part of the brain where emotions are processed. People with psychopathy also show reduced activity in these areas when making moral decisions.

The moral reasoning experiments are part of a series of studies that Dr. Ermer and Dr. Kiehl are undertaking with the ultimate goal of understanding how best to treat psychopathy. While psychopaths constitute just 1 percent of the general population, they represent 15 to 20 percent of the prison population.
 
This piece appeared in the Erudition 2014 edition.

Friday, October 10, 2014

CHI Summer Scholar Lecture Series Kicks off October 22nd!



The Center for Health Innovation cordially invites you to meet our faculty and hear about their current work in our CHI Scholar series. Adelphi University faculty are actively engaged in improving the health and health care of our families and our communities. Light refreshments will be served.  Please join us!
  
Wednesday October 22, 2014
1-2 pm, Ruth S. Harley University Center, Room 211
Professor Tonya Samuel: "Finding a Place for GIS in Community Health Assessments"
Professor Thomas Virgona: "The Deployment of Geographic Information Systems into Healthcare Informatics Research"

Tonya Samuel, EdD, MSPH
Dr. Samuel is an Assistant Professor in the College of Nursing and Public Health. She has over 15 years of experience in health education and research that spans academic, public and non-profit sectors.   From Dr. Samuel's field experience in violence, diabetes and hypertension prevention; tuberculosis and tobacco control, she is able to make students aware of the realities of public health and has published papers in community-engaged research. Dr. Samuel holds an EdD in health and behavioral studies and MSPH in epidemiology.

Thomas Virgona, Ph.D.
Research Interests
• Disaster Recovery
• Information Security
• Health Care Informatics
Dr. Virgona an Assistant Professor aand Director of the Healthcare Informatics Graduate Program at Adelphi University. Prior to joining Adelphi, he was an Associate Professor at Central Connecticut State University [School of Business].  Dr. Virgona was an employee of CitiGroup on Wall Street from 1990 - 2009. As a Vice President in the technology group, some of my responsibilities included Technology Information Security Officer, Software Quality Manager, Export Licensing and Project Management.

Dr. Virgona has published a number of articles in refereed journals, including “Towards an Epistemological Definition of the Research Front of Information and Society,”  and “Graduate Nursing Student Self-Assessment: Fundamental Technology Skills,” both of which were published in 2013.  In addition, he published a book in 2008 entitled, September 11, 2001: A Study of the Human Aspects of Disaster Recovery Efforts for Wall Street Financial Services Firms, which was followed 10 years post-9/11 by the article entitled, “September 11, 2001 In Retrospect: A decade on, what business continuity and information security lessons have we learners?”