True governance and the value of health diplomacy
WASHINGTON, D.C., USA: I was recently in Washington, D.C., to hear a National Institutes of Health lecturer speak about the direction and future of global public health. When planning my weekend sightseeing, I wanted to include both classical architecture and structures with new vision. With that in mind, my first stop was a historic Smithsonian building and next was the ultra modern Newseum (www.newseum.org).
The Smithsonian American Art Museum Renwick Gallery (www.americanart.si.edu) offers visitors either a meditative experience or an inspirational one. There are enormous, otherworldly sculptures that bring you through the world population explosion or the aftermath of the Japanese tsunami. Other works, quite simply, display something as routine as a pleasant family picnic.
Founded with William Wilson Corcoran’s art collection in 1859, the gallery was labeled the American Louvre. It closed during the Civil War to house military records and uniforms. Fortunately, it’s been renovated several times since and continues as a part of the Smithsonian.
The building was slated for demolition in 1963 until stopped by Jacqueline Kennedy. In this instance, you could say the first lady was a conscientious objector.
I had the good fortune to visit the sleek Newseum on Pennsylvania Avenue during its cherry blossom festival. It was a lively evening, a fundraiser with cocktails and music. The Newseum, which opened in 2008, has positioned itself to “promote, explain and defend free expression and the five freedoms of the First Amendment: religion, speech, press, assembly and petition.”
It’s not every day that you go to a party with an on-the-spot Haiku bar. You walk up, reveal a little about yourself, and voilá! After my cleverly crafted poem was delivered, a distinguished gentleman nearby introduced himself. “Hello, I’m Mr. Old Sage* from the Washington Post.” The flower child in me wanted to gush and ask, “Do you know Carl Bernstein?” I could tell I was standing next to greatness. He leaned in and asked, “Who is it you write for?” I boldly said, “A newspaper you never heard of.” He bellowed, “You wanna bet?” “The Dental Tribune,” I responded. He thought for a moment and replied, “All the news that’s fit to spit?” There was a collective moan and laugh. I paused and said, “OK, give it your best shot. I’ve heard it all before. In fact, I’ve come to expectorate these kinds of comments.” More groaning. We bonded. “So tell me, Patricia, to floss or not to floss? That is the question.” He spoke how I assume most pilots speak. Short, concise sentences — perhaps hoping to get straight to the facts. “Didn’t you see the #Flossgate diorama up on the second floor?”
“Actually,” I responded, “that’s yesterday’s news, and yes please: Do floss.”
He quickly moved on: “So what’s the latest dental hygiene buzz? Whatya working on?” I took another sip of my cherry-blossom martini and said, “Bleach.”
“Teeth whitening?” he asked. ‘‘No,” I said, “the kind that brightens clothes and that we once often used to disinfect dental-unit lines.”
You could have heard a pin drop. It was as if I had just said, “Senator, have you stopped beating your wife?”
“Yes,” I continued: “Bleach. For decades, dental offices ran bleach through their water lines as a disinfectant. The EPA recently tried to nix that.”
‘‘Because of the fish in the streams?” somebody chimed in. “Indirectly, yes,” I said. “It’s not the bleach itself the regulators fear, it’s the mercury accumulating in our separators. Dental offices use a collector attached to their outflow water pipes to trap amalgam debris. The powers-that-be decided that if amalgam is exposed to bleach, its mercury will release in liquid form and escape the separator, discharging into public waterworks.”
“So where’s the news?” asked Mr. Old Sage.
“I think that requirement in the regulation is overkill,” I explained. “The smarter reason to avoid bleach is the fact that, over time, it pits tubing and corrodes couplings. But to contend that enough bleach is somehow going to sit on the amalgam to release its mercury as liquid is a stretch. Volumes of water go through our water pipes into the basement. It all leads to the same separator. The EPA wants to ban bleach and any use of oxidizing substances in drains, cuspidors or lines.”
The Washington Post reporter was entertained enough by his Japanese hors d’oeuvres with mini umbrellas to allow me to continue my rant.
“There is already a peer-reviewed study verifying the safety of bleaching trays. If we use the EPA’s logic, then the bleaching gel on our trays will somehow be changing the mercury in our dental fillings back to a dangerous liquid state. One of the ways a bleaching tray works, is by not allowing any air or water to touch the teeth during the process — creating an even more concentrated scenario than within a water line.
“Dental practices use bleach during root-canal procedures and provide in-office bleaching. All that stuff gets vacuumed off the patient and goes down the tubes. I suspect most offices are going to have to fill out a federal compliance certificate just the way they did after their separator was attached. It just creates more paperwork and impossible compliance.”
“So you don’t believe in government oversight?” Mr. Sage asked.
I couldn’t resist: “Usually I support it, but this seems like an odd detail — a pipe dream even,” I said, prompting a few more groans from our little group.
My soliloquy was interrupted by the arrival of Taiko drummers and a geisha wanabee. We all went back to our tiny food and pink drinks, and another news-of-the-day topic soon replaced my focus on bleach.
The news of the world, much of which is negative, is available to us 24/7. A shining ray of hope piercing through this barrage of calamitous information is an annual symposium on global health. The weekend I was in D.C., bright young scholars exchanged ideas with seasoned veterans from the public-health field. Representatives from the NIH, many humanitarian NGOs and approximately 25 universities from outside the U.S. were in attendance. An equal number of prestigious American universities were represented.
The Consortium of Universities for Global Health (www.cugh.org) was hosted by Johns Hopkins University and Makerere University of Uganda. The theme for this year’s symposium was “Healthy People, Healthy Ecosystems: Implementation, Leadership and Sustainability in Global Health.”
The joy of a public-health symposium is that it enables health-care workers to see they are a part of something greater than themselves. When we work alone in small rooms, we can lose track of the big picture. Listening to experts discuss positive progress on a global scale warms the heart. It’s not all 100 percent good news, but it’s encouraging to know some of our smartest minds are working together toward sensible solutions.
Among the health issues covered by the CUGH speakers were:
- Communicable disease: What’s around the corner and how to stop it? What will our patients fear next year? Rapid responses to new outbreaks of Ebola or Zika worldwide will ultimately lower risks to the U.S. In 2016, the U.S. president signed a little-known executive order to aid in our protection. The Global Health Security Agenda (GHSA) is a multi-faceted, multi-country initiative intended to accelerate partner countries’ capabilities to prevent, detect and respond to infectious disease threats. The threat of infectious disease can be naturally occurring or a deliberate terrorist attack.
- Environmental projections: Pollution-related diseases are a massive growing problem worldwide. Respiratory illness affects oral health. Global warming widens the footprint of mosquito-borne diseases. (The Zika virus stays active in blood and saliva for a week.) Climate change has been linked to a rise in type 2 diabetes.
- Pharmacology fraud: Fake medicines and devices threaten global health. Organized crime is involved in online sales of substandard medicines. The recent seizure of thousands of fake dental drills by Interpol comes to mind.
- Women and children: Can I have a “Booya!” for the people attempting to eradicate early childhood caries? Topics ranged from prenatal care to violence against women. Rapid delivery of modern birth control became a highly important component of the CDC’s response to the Zika outbreak in Puerto Rico.
- Empowering women to take leadership roles in the global health arena: Take politics out of wellness and get beyond statistics. There were discussions on how societies actually work. What if the world was run by sociologists rather than economists? Just as truth is the cornerstone of good journalism, it is crucial to public health policies.
- Drug-resistant micro organisms: We scrub, we spray but what else lurks? Pharmaceutical research is needed to develop new antibiotics, vaccines and insecticides.
When I was a child, my church collected for the starving children of Biafra. Millions died from starvation and disease. Which came first, the political unrest or the public-health crisis? Biafra no longer exists. We’d be hard pressed to find it on a map. Public health has worldwide macroeconomic and diplomatic consequences.
When countries are put under economic sanctions, how do you limit the hurt on their public-health institutions and health-care providers? How do you exchange new information and deliver improved medical devices? Infectious disease ignores national borders.
All of these issues were discussed during this weekend symposium. It has become even more important for global health-care practitioners to collaborate — helping many to make public health progress through back channels.
Social media is a double-edged sword. It can be a form of networking, but it can also pull you into a negative vortex. Your Facebook feed can reinforce your beliefs with confirmations from friends holding similar beliefs. But we can step outside our comfort zones and become advocates for public health. Volunteer, write, vote, attend meetings, protest. Small steps can lead us to a better and safer planet. One of my favorite expressions is: If you’re not at the table, you’re on the menu. (Is this from The Lion King?)
Global governments may come and go, but there are enough of us who care about the arts, the environment, the humanities, diplomacy, peacekeeping, science — in short, civilization itself.
If the annual CUGH symposium taught me anything, it is that level heads will continue to prevail.
*Notes: The author reveals that her encounter with a Washington reporter is fake news. However, the EPA restrictions on bleach in dental water lines did temporarily take effect on Jan. 15, only to be suspended days later as part of a larger Trump administration regulatory moratorium that withdrew the encompassing “Dental Effluent Guidelines” containing the oxidizing-line-cleaner restriction (“no pH lower than 6 or greater than 8”). In broad summary, the back-under-review effluent guidelines give practices three years to meet standards limiting discharge of mercury into publicly owned water-treatment works — primarily by requiring amalgam separators (already required by many states and municipalities and used now by 40 percent of practices the rules would affect).