Magnificent at times: Jeremiah Mead & advances in respiratory research

In the famous joke by Woody Allen, two Jewish women are commenting on the food at a resort in the Catskill Mountains. One says, "The food is terrible here." The other responds sadly, "And the portions are so small!"

I often feel that my comments on healthcare are similar: It's so bad. And there's way too little of it! Yet sometimes I realize that our healthcare is also magnificent at times, and life-saving – as in the healthy birth of my son, 19 years ago.

My wife started labor nine weeks prematurely. Doctors were able to stop the labor from progressing, and gave my son the drug beta dimethasone to speed the maturation of his lungs. In a fetus' development in the third trimester, the walls of the lungs initially stick together, and can’t inflate with air, until a chemical surfactant is released. At that point, the lungs can inflate and deflate appropriately, readying the baby to breathe upon birth.

If a baby is born prematurely, before the surfactant changes the lungs in this way, respiratory distress syndrome can result, often fatally. In the past, this caused the deaths of 50,000 premature babies each year.

My wife got the drug in time, and it somehow made its way to Neil's lungs, triggering the release of the surfactant, before he was born a few days later. He didn't get RDS, and he didn't need a ventilator. He has long been in excellent health, and he's bigger and more muscular than me now.

Dr. Jeremiah Mead was the scientist who discovered the role of the surfactant, and opened the way for a series of discoveries that now make RDS much less frequent. I learned this only in reading his obituary; he died at age 88 in mid-August.

In a colleague's words, "his major contribution is that he set the agenda in respiratory mechanics, and posed the questions that everyone else picked up."

Read another NICU story.

Thanks to Emma Stickgold for the source article in the Boston Globe of August 18.

We have become the ones: The passing of Sen. Edward Kennedy

Poverty is the biggest risk factor for poor health: poor people live shorter lives, with more disease and disabilities, than the rest of us. So for those who are passionate about improving public health, the loss of Teddy Kennedy is a particularly great setback.

He was influential in passing the State Children's Health Insurance Program (SCHIP) and the Americans with Disabilities Act, and raising the minimum wage, to name only three examples of laws that brought about big public health gains.

His compassion, tenacity, and joy, and his record of achievement, make him my hero.

With his passing, as Caroline Kennedy Schlossberg said in her eulogy, "we have become the ones who have to do all the things he would have done -- for us, for each other and for our country."

Read a blog post from last year aboutTeddy Kennedy’s final year.

Using himself as an example: Plaintiff Howard Engle's Progeny

Dr. Howard Engle passed away on July 22 at age 89, from chronic obstructive pulmonary disease. He had smoked multiple packs of cigarettes a day since college. Though he tried many times to quit, he never succeeded, and continued to smoke until his death.

His medical specialty had been pediatric neurology, and he frequently worked with cerebral palsy patients. He preached to his patients about the dangers of smoking, using himself as an example. "He wanted to teach people, especially kids, that smoking is not a good habit," said his son David.

Among his patients in the 1980s were the children of two medical malpractice lawyers, Stanley and Susan Rosenblatt. In 1991, the Rosenblatts brought a class-action suit against tobacco companies on behalf of flight attendants who had inhaled secondhand smoke, winning a settlement that cost the companies $300 million. Dr. Engle took a keen interest in the case.

Because he was a smoker with emphysema who wished to publicize the addictive nature of smoking, he agreed to become the lead plaintiff in a second class action suit, filed by the Rosenblatts in 1994. In 2000, the plaintiffs received the largest punitive award ever decided by a jury, for $145 billion. An appeals court voided the award as excessive and said the class of plaintiffs was too disparate. Later, the Florida Supreme Court let that ruling stand, though it allowed individuals to bring suit. Thousands of individuals have done so, and courts are now beginning to decide their cases – which are known as the Engle Progeny.

Advice: Use your standing and your personal network to fight for public health. Sometimes you have to sue the B*ST*RDS.

Read a very different ">class action lawsuit story.

Thanks to Bruce Weber for the source obituary in the Boston Globe of July 25.