NEVER SAY DIE 5 ways to save a life

An edited transcript of a panel discussion held on November 3, 2010 at the Writers Guild of America, West • THE NORMAN LEAR CENTER NEVER SAY DIE •

THE NORMAN LEAR CENTER HOLLYWOOD, HEALTH & SOCIETY

The Norman Lear Center is a nonpartisan research and public Hollywood, Health & Society (HH&S), a program of the Norman policy center that studies the social, political, economic and cultural Lear Center, provides entertainment industry professionals with impact of entertainment on the world. The Lear Center translates accurate and timely information for health storylines. Funded its findings into action through testimony, journalism, strategic by the Centers for Disease Control and Prevention, The Bill and research and innovative public outreach campaigns. On campus, Melinda Gates Foundation, The California Endowment and the from its base in the USC Annenberg School for Communication National Institutes of Health, HH&S recognizes the profound & Journalism, the Lear Center builds bridges between schools and impact that entertainment media have on individual knowledge disciplines whose faculty study aspects of entertainment, media and behavior. HH&S supplies writers and producers with accurate and culture. Beyond campus, it bridges the gap between the health information through individual consultations, tip sheets, entertainment industry and academia, and between them and the group briefings, a technical assistance hotline, panel discussions at public. Through scholarship and research; through its conferences, the Writers Guild of America, West, a quarterly newsletter and Web public events and publications; and in its attempts to illuminate and links to health information and public service announcements. The repair the world, the Lear Center works to be at the forefront of program also conducts extensive evaluations on the content and discussion and practice in the field. impact of TV health storylines.

For more information, please visit: For more information, please visit: www.learcenter.org. www.usc.edu/hhs.

NEVER SAY DIE: 5 WAYS TO SAVE A LIFE

Experts who work around the world saving lives by treating preventable illness and writers who have featured critical global health topics in their top-rated TV shows will offer their compelling stories.

A video of the program can be watched in its entirety online at: http://youtu.be/2gjNKdGxKPY

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NEAL BAER, MD, is a Harvard–trained physician, practicing pediatrician, and STEPHEN OSTROFF, MD, is the director of the Bureau of Epidemiology of award-winning television writer and producer. Since 2000 he has been the Show- the Pennsylvania Department of Health (PADOH), and also serves as the Acting runner and Executive Producer of the NBC series Law and Order: Special Vic- Physician General for the Commonwealth of Pennsylvania. Before these appoint- tims Unit. Before his tenure at Law and Order, he was Executive Producer of ments, he had a 21-year career with the U.S. Public Health Service (USPHS), most ER. Recently, his mentorship of a Mozambican HIV/AIDS orphan resulted in the of that time at the Centers for Disease Control and Prevention (CDC) in Atlanta. documentary film Home Is Where You Find It. He was also an adjunct profes- While at CDC, Dr. Ostroff was Assistant Surgeon General, USPHS, and Deputy sor (2001–2005) at the University of Southern California teaching in the area of Director of the National Center for Infectious Diseases (NCID), and was respon- health communications, health promotion and disease prevention, and sex education. He is also sible for coordination of outbreak investigations performed by NCID scientists and was engaged Co-Chair of Hollywood, Health & Society. in issues related to emerging infectious diseases. He currently is President of the Council of State and Territorial Epidemiologists, chairs the Public Health Committee of the American Society for RAJEEV VENKAYYA, MD, director of Global Health Vaccine Delivery, oversees Microbiology’s Public and Scientific Affairs Board, is a member of the Policy Committee for the late-stage development of health technologies and interventions as well as ef- Society of Healthcare Epidemiologists of America, is a member of CDC’s Healthcare Infection Con- forts to expand access to health solutions in the developing world. Previously, trol Practices Advisory Committee, and is the Secretary’s representative to the Pennsylvania State Venkayya served as special assistant to the U.S. president and senior director for Medical Board. He also chairs the Pennsylvania Department of Health Institutional Review Board. biodefense at the White House. One of his key responsibilities was development and implementation of the U.S. strategy for pandemic influenza. He served as an LAWRENCE KAPLOW is currently consulting producer on House. As a re- advisor to the director of the U.S. Centers for Disease Control and Prevention and sult he has enjoyed several Emmy Award nominations and a WGA Award for was one of 13 nonpartisan White House Fellows appointed by President Bush in Best Episodic Script. He attended University of Rochester for English and NYU’s 2002. Venkayya is a pulmonary and critical care physician and assistant professor of medicine at Graduate Program in Creative Writing, Fiction. He got his first script from Paul the University of California, San Francisco. Previously, he directed the high-risk asthma clinic and Haggis, a long story that begins with Marjorie David begging Stephen Nathan co-directed the Medical Intensive Care Unit at San Francisco General Hospital. He holds a medical and David Shore to hire him as a researcher at Family Law, because, as he said, “I degree from Northeastern Ohio Universities College of Medicine. can Google.” Despite that interview or perhaps because of it he has worked with Shore since. He has spoken at NYU and USC. Kaplow recently sold a drama pilot to CBS with Elaine PAUL D. BLUMENTHAL, MD, MPH is Professor of Obstetrics and Gynecol- Goldsmith Thomas. He’s an avid snow skier, a terrible surfer, an abomination, really, and likes cows. ogy at Stanford University School of Medicine. He directs the Section of Family Planning Services and Research at Stanford and also directs SPIRES, the Stanford SANDRA DE CASTRO BUFFINGTON, MPH, is the Director of Hollywood, Program for International Reproductive Education and Services, an initiative pro- Health & Society, a program of the USC Annenberg Norman Lear Center that viding technical assistance and training to family planning programs in 16 coun- leverages the power of the entertainment industry to improve the health and tries across Africa, Asia, and Central America. Dr. Blumenthal received his medical well-being of individuals and communities worldwide. The program provides re- degree from The University of Health Sciences/The Chicago Medical School in sources to leading scriptwriters and producers with the goal of improving the 1977 completed a residency in obstetrics and gynecology at Michael Reese Hos- accuracy of health-related storylines on top television programs. Funded by the pital and Medical Center in Chicago, followed by a Fellowship in Family Planning at UCLA in 1982. CDC, The California Endowment, The Bill & Melinda Gates Foundation, HRSA’s For over 20 years, Dr. Blumenthal has been an advisor to multiple international agencies such as Division of Transplantation, ONDCP and the NIH, the program recognizes the pro- JHPIEGO Corporation, IPAS, Family Health International, Gynuity Health Projects, and the World found impact that entertainment media has on individual knowledge and behavior. She is known Health Organization and has served as the special Advisor to Minister of Health and Family Planning for her award-winning work in global health and social transformation. She has nearly 30 years of the Republic of Madagascar. He currently serves as the Global Medical Director for Population of experience working in global health, entertainment education and emergence technologies; 20 Services International, and has served as Medical Director for both Plannned Parentood of Chicago years were spent working internationally, and five of those years were spent in residence overseas. and Maryland in the past. www.learcenter.org 3 • THE NORMAN LEAR CENTER NEVER SAY DIE •

preventable diseases, such as measles and polio; pregnancy- related illnesses and deaths caused by a whole host of preventable conditions; and other deadly illnesses like malaria, worms and NEVER SAY DIE: 5 WAYS TO SAVE A LIFE diarrheal disease.

And while these health problems are still prevalent, there is Sandra de Castro Buffington: Good evening, everyone. Thank progress being made in the fight against them. The health you all for being here with us tonight. My name is Sandra de Castro problems we’re discussing tonight are preventable with low-cost Buffington, and I’m Director of Hollywood, Health & Society, a solutions that work. program at the USC Annenberg Norman Lear Center. As many of you know, Hollywood, Health & Society works We are so pleased to bring together this extraordinary group of with television writers to help them obtain accurate medical experts for our panel, “Never Say Die: 5 Simple Ways to Safe a information from experts for their scripts. The Bill and Melinda Life.” Gates Foundation supports us in helping writers get accurate global health information, in particular. The global health community has many tools at hand to prevent disease and to save lives. Storytelling is one of the most powerful And this evening, I am delighted to introduce our keynote speaker, tools of all. Tonight we will hear real stories of real people and the Dr. Rajeev Venkayya, the Director of Global Health Vaccine Delivery Writers are ways in which public health experts save millions of lives around at the Bill and Melinda Gates Foundation. taking on topics the world. with global reach Dr. Venkayya is a We’ll also hear from TV writers who tell compelling global health pulmonary and critical care and exploring stories and connect powerfully with millions of viewers. But these physician. At the Gates the ways writers are not simply entertaining their viewers. Often, they’re Foundation, he oversees different cultures teaching them something in the process. In fact, these shows can late-stage development and countries transform our society as a whole, and it always takes a deeply of Foundation-funded interact with one committed and visionary writer to bring a health storyline to life. technologies and public health interventions. He another. Positive storylines have enormous power. The storytellers create also oversees efforts to Sandra de Castro Buffington our collective future and invent what happens in our culture, and help expand access to today there is a growing trend in entertainment to look beyond our affected health solutions borders overseas for information and stories. Writers are taking on to the most disadvantaged topics with global reach and exploring the ways different cultures populations in the and countries interact with one another. developing world.

Today’s pressing global health concerns make for truly compelling Previously, Dr. Venkayya storylines on TV and in films, and these topics include vaccine- Sandra de Castro Buffington served as Special Assistant

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to U.S. President George W. and then talk about the opportunity. Many people in this room Bush and Senior Director represent an important part of the opportunity. for Biodefense at the White House Homeland I’m going to get to that good stuff in a moment, but let me first Security Council. One of talk about how we think about the problem. his key responsibilities was developing and The Gates Foundation was started about 10 years ago, and we implementing the U.S. have three different programs of work within our organization. strategy for pandemic influenza. One is called U.S. Programs, which is principally focused on education here in the U.S. — better secondary school education, Dr. Venkayya played preparing kids for college, and making sure that those kids can a significant role succeed once they arrive in college. in developing U.S. government policies in We have a Global Development Program that looks principally at Dr. Rajeev Venkayya biosecurity, biosurveillance, agricultural productivity in poorer countries, as well as financial public health and medical preparedness, as well as the National services for the poor. Biodefense Strategy. He also served as a Special Advisor to the Director of the U.S. Centers for Disease Control and Prevention. Then we have the Global Health Program, which is the largest program in the Gates Foundation, accounting for about half of Tonight, he will speak to us about vaccines, some of the simplest, our grants every year. We make about $3.5 billion in grants every most effective ways to save lives around the world. year and about half of those are in Global Health.

Please join me in welcoming Dr. Rajeev Venkayya. Now, within Global Health, there are a lot of things that we could be working on. There are infectious diseases, there’s cancer, there’s Dr. Rajeev Venkayya: Thank you, Sandra, and thank all of depression, there’s trauma. It’s a very, very long list of problems you for taking an evening to learn a little bit about some of that affect populations in developing countries much more than the issues like rotavirus and diarrhea, that confront the world’s they do here in the U.S. poorer populations, as well as ways that we can tell that story more effectively to spur people to take action and to put people in Bill and Melinda made a decision a long time ago that they were power who will use the levers of power to take action themselves going to be very focused. And, in fact, the Global Health Program here in the U.S. focuses principally on the three big diseases that affect the poor around the world — HIV, tuberculosis and malaria — and then the I work for the Gates Foundation, which spends a lot of time trying most significant killers of mothers and children, and those really to think about how to have health impact. I thought what I would for children are infectious diseases, communicable diseases. do is begin by telling you a little bit about what the Foundation does – talk about some of the big problems that we’re tackling I’m going to talk a little bit about communicable diseases because

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there is really a good new story as of today, but there is a greater too. Every single person in this room, I’m confident, has had news story ahead of us. Let me paint a picture for you of what the an episode of diarrhea in their life. In fact, you’ve probably had situation is around the world. several. Many of you have had pneumonia, or you at least know somebody who has had pneumonia at some point. Every year, about eight million kids under the age of five die of preventable diseases or conditions. Of those eight million children, Having pneumonia in this country, as difficult as it can be to deal about four million of them — about 40 percent of them — die with, is not that bad overall. You can call your doctor. She or he before their first month of life is complete and about half of them can call in a prescription for you over the phone if they think it’s within the first day. mild. Otherwise, you go to urgent care or the emergency room, and they’ll give you an antibiotic and send you home. If you’re Every year, There are many countries in this world where if you go to villages, sick enough, they’ll admit you to the hospital and give you IV mothers and fathers won’t name their children until they get past antibiotics. And if you’re really sick, they’ll give you oxygen, they’ll about eight the first 30 days of life because it’s viewed as potentially bad luck put you in the intensive care unit and watch you. And if you get million kids and because in so many cases children don’t make it that long. even sicker, they’ll put you on a mechanical ventilator with about under the age six different nurses and respiratory therapists and other health of five die of Think about how traumatic it is to lose a child for someone in this workers coming in to check on you every moment of every day country. It’s no different for parents who are living anywhere else and night. You get no sleep in an ICU because there’s so many preventable in the world. Eight million children die every year. people watching you. diseases or conditions. If you look at the breakdown of the conditions that cause Now, change your zip code. You’re a child who is five years old, Dr. Rajeev Venkayya those children to die, about 30 percent of them are due to two and you develop a cough and some wheezing and breathlessness, conditions. One is pneumonia, an infectious disease that affects a shortness of breath. There are very few things in this world that the lungs, and the second is diarrhea. are worse than not feeling like you can get enough air from breath to breathe. Think about people who have asthma. Seven to 10 These two conditions are not just killers; they also happen to be percent of you have asthma, so you have a sense for what I’m preventable, which makes it an even more difficult story to bear. talking about. You realize that these deaths don’t have to happen and, frankly, the majority of all the other deaths don’t have to happen either. You have this condition, but your parents can’t afford to take you But these are extraordinarily preventable because we have vaccines to a provider, certainly not a physician. And most of the places that that are now available to tackle the most significant pathogens we’re talking about and doing this work, there are no physicians. that cause pneumonia and diarrhea in children. So the best you’re going to get is a chemical seller, a drug retailer, who probably doesn’t have any medical training, who probably When I’m traveling and go to hospitals and clinics, I do a little zip has no idea what is going to work and what’s not going to work, code game in my head. I am a pulmonary critical care physician, so and no idea how to assess the illness. You may get just one or two I have done my training in nice hospitals with intensive care units pills of an antibiotic that may or may not have an effect on the and nice emergency rooms. I have my experience in dealing with pathogen that’s causing your infection. But even if they do give illness in adults and children. You all have your own experience, you the right antibiotic, if they only give you one or two doses, it’s

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not going to be enough. If you ever have a question as to whether vaccines are useful, take If you get sicker, you go to a hospital. But there aren’t many people a trip to a developing country and see what happens when you to take care of you — certainly no doctor, possibly no nurse, don’t have access to vaccines. Children die because they never had certainly no antibiotics that you can give intravenously. If you go to access to the tool that we take for granted here in the U.S. the intensive care unit, it’s really a different room with a different bed but none of the other things that I talked about. Some people would say, “Well, why do you need to use a vaccine that might be expensive?” When I say expensive, this is 15 So you die a death of breathlessness. This is the picture in U.S. dollars for two or three doses of one of these vaccines for developing countries. I could tell you story after story of the zip rotavirus. “Why do you want to use a vaccine? Why do you want code game. I walk into a neonatal “ICU” and see a child that to go through all that trouble and expense? Why don’t you just Children die was born six hours ago, breathing 80 times a minute, not getting give clean water to all children?” because they never enough air, with no oxygen in sight, no heat lamp in sight because had access to the there is no power and who’s dead by morning. I would love to make sure that every child in this world had access tool that we take to clean water. Nothing would be better in terms of making sure for granted here in So these are the kinds of things that are happening every day, that we eliminated diarrhea as a significant cause of childhood every hour, around the world, and what’s remarkable is that illness. the U.S. people don’t know about them. People in this country don’t really Dr. Rajeev Venkayya spend a lot of time thinking about these things. The problem is that you can’t snap your fingers and get clean water to children around the globe. This is something that The good news is that we have tremendous opportunities to takes years and, more importantly, a lot of money and political change that picture. Just a few years ago, the number of children commitment. The reality is it’s not going to happen overnight. under the age of five who were dying every year of preventable We need to make those investments. But every day that goes by causes was 10 million. Now we’re down to 8 million. And we think without clean water in developing countries, 1,500 children die of we can drive that number much, much lower by implementing a rotavirus gastroenteritis. number of tools. The most important and cost effective of which are those vaccines I talked about against the things that cause That’s what we’re up against. The answer is don’t do one or the pneumonia and diarrhea. other; the answer is do both and do both as quickly as you can.

These are vaccines that if you have children, your kids certainly There are some great success stories. I talked about the drop in got, and any child born in the last 10 years would’ve gotten. They the number of preventable deaths in children under the age of tackle these agents that cause pneumonia and diarrhea. We take five. Another great success story in the vaccine game is smallpox. them for granted. In fact, we are so complacent in this country Smallpox hasn’t been on this globe for 30 years. Smallpox was about vaccines that a lot of people think that we should just get the first infectious disease that we eradicated from the face of the rid of them because we haven’t seen a lot of vaccine-preventable earth. It’s a horrible illness. About 30 percent of the people who diseases in this country in so long that they’re not even on our are infected with the smallpox virus died when it was an epidemic. radar.

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We no longer have to deal with that in this country. It’s a race to see what the next human disease we’re going to eradicate. My hope is that it’s polio. We have taken the number of cases of polio around the world down by 99 percent over the past 20 years. Only four countries haven’t gotten rid of the polio virus — Nigeria, India, Pakistan, and Afghanistan. And because of the political commitment and resources in India and because of the Dr. Rajeev Venkayya political will of the traditional and religious leaders and the political speaks to the audience leadership in Nigeria, we are seeing spectacular progress on polio at the Writers Guild of America, West in India and Nigeria. talk about a television show tonight, so bear with me.

Nigeria’s cases of polio have gone down 98 percent since last year. An example of a show that really drew me in because of its In India, the cases were down by 90 percent since last year. So complexity, because it really dove in and exposed you to all the the scoreboard is looking really good to take two of those four messiness and showed that these problems don’t have black and countries off the polio map very soon. That’s a disease that’s very white answers — it’s not House, it’s not ER, it’s not Scrubs — it’s close to eradication. actually Battlestar Galactica. It’s not the first Battlestar, which left me with permanent scars from my childhood. It is the new Guinea Worm is about to be eradicated as well. And there are a Battlestar, which is no longer running, but if you’ve seen it, you handful of others that are very close. Nobody knows about these know that the people on that show are like real people. They have things in this country. A few people do, but not a lot of people, flaws. They actually, with a couple of notable exceptions, look like and herein lies the opportunity. people in your neighborhood. These are people you might meet on the street. We have in this room individuals who can touch the lives of many people around this country and even around the globe. I love the fact that they took on issues around religion and redemption and substance abuse and conflict because all of those When I first went into medicine, it was to have an impact on themes tied back to things that I was seeing day to day in real life. people’s lives, and the reason I went from my clinical world to the They didn’t shy away from those things. policy environment in Washington, D.C., was because I wanted to expand my reach to touch more lives. One way to do that is So 80 percent of the reason that I kept watching Battlestar was through policy change. Then, when I went from D.C. to Seattle for those reasons. And the other 20 percent, if you want to know, to my current job was because I wanted to continue to have an is because of Tricia Helfer and Grace Park. That has nothing to do impact on a large scale. with writing, so I’m not going to talk about it here.

People who write stories can have exactly that kind of impact if This can be good for business. If you draw in viewers and actually you tell the story effectively. Some people say it’s not good for respect them enough to show them the complexity of these business, that this kind of thing is not terribly compelling. But I problems, they will become loyal viewers. Sci-Fi can come up with actually dispute that, and I would point to an example. I had to 10 terrible series, but I’ll still have a good image of Sci-Fi because

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Mine was in India when I was a child. I was born in the States, but we would visit India every two or three years. I would take time off from school and I’d go to see my family in Andhre Pradesh, and we would always have to transit through Bombay, now Mumbai. There are two airports in Mumbai. There’s the international terminal and then there’s the domestic terminal, so you had to

Dr. Rajeev Venkayya speaks hop in a cab or a bus and go from one to the other. to the audience at the Writers Guild of America, West During that ride, every time the bus stopped or the taxi stopped, countless kids would run up and bang on the window. They of what they did with Battlestar. were just like kids who lived in my zip code except they lived in a different place with access to very different things, or lack of You can touch the lives of people around the country and put access to those same things. It’s the same children you saw in the these issues into their mind. You can have them think about slums in Slumdog Millionaire – children who have very very little. these problems and elect people who care about those problems and want to do something about them. We need leaders in this Comparing my life to theirs had a pivotal impact. Everybody has country who are willing to invest in HIV, tuberculosis, malaria, a story like that. But in some cases, those stories are things that maternal, newborn, child health. they saw on television or saw in the movies that changed their life.

We spend less than 1 percent of the U.S. government budget on I made decisions in my career to do things that would have an these problems. People think we spend 20 percent of our budget impact. You have the opportunity to do exactly the same, and I on these problems, that we’re giving the money away. People think hope that tonight’s event will convince you of how important it that we are just shoving the money out the door. We’re giving is to bring these concepts in to the work that you do. So I look money away to China, but that’s a different problem. I’m talking forward to our conversation later. Thanks. about giving money away in foreign aid. The reality is that we’re putting very, very little money into this. But even that little amount Sandra de Castro Buffington: Thank you, Dr. Venkayya for your of money is doing some amazing things. Foreign assistance in this inspiring talk and for all the extraordinary work you do. country has had a dramatic impact on HIV, a dramatic impact on malaria and increasingly tuberculosis, and soon maternal, newborn Next, I’d like to introduce our distinguished panelists. and child health. First, we’re thrilled to be joined by Dr. Paul Blumenthal. I worked If you change the way a person thinks about the problem, then with Paul at Johns Hopkins University in International Reproductive you can help them recommit themselves to doing something Health for many years, so welcome. He is now Professor of about it. Every single person you meet who works in global health Obstetrics and Gynecology at Stanford University School of will have at least one story they can point to that shows why they Medicine. He also directs the section of Family Planning Services chose this career path. and Research at Stanford, as well as SPIRES, the Stanford Program for International Reproduction Education and Services. SPIRES

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provides training to family planning programs in 16 countries across Africa, Asia, and Central America. His wife, Lynne Gaffikin, who’s sitting here in front, is a distinguished epidemiologist and a dear friend, and she actually studies the transmission of human disease to chimpanzees. It’s kind of a backwards approach, Lynn. They have lived in Kenya and Madagascar and have worked all over the world. (From left) Dr. Rajeev Venkayya, Sandra de Castro Buffington and Dr. And, next, I am very pleased to introduce Dr. Stephen Ostroff. Neal Baer Dr. Ostroff is the Director of the Bureau of Epidemiology at the documentary film, Mozambique. The film has screened in 38 film Pennsylvania Department of Health and also serves as the acting festivals in six countries so far. Physician General for the Commonwealth of Pennsylvania. Neal also brings his commitment to global health issues to Law & Before these appointments, he had a 21-year career with the US Order: SVU, and later tonight, we’ll show you a clip of an episode Public Health Service, spending most of that time at the CDC in which examines conflicting viewpoints about vaccinating children Atlanta. And while at CDC, Dr. Ostroff was Assistant Surgeon for measles. General of the US Public Health Service and Deputy Director of the National Center for Infectious Diseases. There, he was responsible And last, but definitely not least, I’d like to introduce Larry Kaplow, for coordinating outbreak investigations and was also engaged in Consulting Producer for the hit Fox show House. Larry attended issues related to emerging infectious diseases. University of Rochester for English and NYU’s graduate program in Creative Writing. For his work on House, he’s received several Tonight, we are also joined by some top-notch writers and Emmy award nominations and a WGA award for the best episodic producers. script.

First, I’d like to present Dr. Neal Baer. Neal is a Harvard-trained Also, Kaplow recently sold a drama pilot to CBS. Congratulations, pediatrician, Co-Chair of the Hollywood Health and Society Larry. He’ll speak with us tonight about his upcoming House Advisory Board, and Executive Producer of Law & Order: Special episode called “A Pox on Our House.” In the show, a medical Victims Unit on NBC. He was formerly Executive Producer of the impossibility becomes reality as the threat of a smallpox outbreak award-winning hit series ER. affects House and the rest of the Princeton Plainsboro Hospital. The show airs on November 15th, but we’re getting a sneak Neal has a personal commitment to global health and social justice. preview tonight. For years, he has given cameras to kids and HIV-positive women in Africa to empower them to tell their own stories. So please join me in welcoming all of our distinguished panelists.

Neal mentored a young man from Mozambique, Alcides Soares, And now I’ll turn this over to our Moderator and Panelist, Dr. Neal one of 500,000 Mozambiquan children who have lost their Baer. parents to AIDS. Neal worked with Alcides to help him make a

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Dr. Neal Baer: Thanks, Sandra, and thank you, Dr. Venkayya, for 210 million a year. Some 30 to 50 percent of these unintended your keynote address. It raises really important issues that all of us pregnancies will contribute heavily to maternal mortality, and one writers need to think about in addressing global issues. And we’ll of the simplest ways to reduce maternal mortality is to provide be talking about that tonight from various perspectives — from people with family planning. physicians who are in the field and doing research in these areas and from two of us who are writers, who are attempting to write We have lots of methods. We have lots of different venues through about these issues. Then we’ll hear from each person. I’ll ask a which we can provide them. But if you look at how many women question or two, and then we’ll turn it over to you all at the end die from pregnancy-related causes every year, it turns out that it’s to ask some questions. equivalent to about three 747s going down every day. That works out to be about one woman dying from a pregnancy-related cause We’re going to begin with Dr. Paul Blumenthal, who is an expert every minute. A huge number of women suffer and often in places on family planning, which is, believe it or not, a very easy way to — like in villages, in maternity cottages, in their homes — where prevent many, many different kinds of medical problems around much of this could be prevented by prenatal care, institutional the world. It’s something that we don’t often hear much about deliveries and family planning. these days, but it’s very critical. So Dr. Blumenthal, please present to us. Having women deliver at an institution can address the very top cause of maternal death — postpartum hemorrhage. Dr. Paul Blumenthal: Thanks very much. It’s always a little unnerving when you’re called an expert. In my world, an expert I want to introduce you tonight to the concept of unmet need. is someone from out of town with slides. But no slides tonight. Worldwide, women have an unmet need for contraception existing somewhere between 18 and 30 percent of a given population. I’m really pleased to be able to talk with you about family planning What do we mean by unmet need? We mean women who have Some 30 to 50 — and we can put family planning and contraception together. expressed a desire to get contraception but can’t afford it or can’t percent of... One is the technique and one is the program. access it. unintended It’s interesting that when Rajeev was talking about vaccine The three words that I probably want to leave with you in terms pregnancies will programs, family planning is also a real one-world program, just of the contraceptive agenda are access, convenience, and contribute heavily like talking about vaccines. Making a vaccine is one thing. A effectiveness. Those three principles really define what we are to maternal vaccination program is a different thing, getting the vaccine out often not doing very well, especially in access and convenience. mortality. there. One of the important aspects about family planning, whether it’s Dr. Paul Blumenthal You could argue that family planning methods like contraceptives in the United States or abroad, is women don’t often have access are, in essence, vaccines. They’re not given by injections, but what to a place where they can get family planning. they really do is prevent the thing you want to prevent. They prevent an unintended pregnancy. In the United States, this is often insurance related. Women can’t access a method of family planning because they don’t Worldwide, unintended pregnancies exist at the level of about have insurance and there aren’t enough venues anymore where

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family planning methods can be provided free of charge. The fourth aspect of an over-the-counter medication is that you So they go without. In the should be able to recognize dangerous side effects when you’re United States, our unintended having them. pregnancy rate is about 50 percent. About 50 percent of So ask yourself, why isn’t the pill over the counter? It’s largely all pregnancies in the United political. I was a history major in college and really thought I would States are unintended. go into medicine because it was one of the few things that was apolitical, but it shows you what I knew. In other countries where the system is different, this is One of the interesting things about family planning, and this considerably lower. Especially probably applies to all of us who deal in the world of public health, in Western Europe, it’s about is that there’s a real difference in approach between what we do 5 to 10 percent. But in our Dr. Paul Blumenthal in public health environments and what happens in the clinical country, we haven’t done a very good job, and a lot of that is environment. access. Larry Kaplow and I were talking a little bit about House just before Another issue is convenience. For far too long, family planning has the event began. The beauty of House is the elegance of the been over-medicalized. The methods that we have today are safe diagnosis. Everything is about what’s wrong with this patient and and effective. But we can’t we get them to people without hoops how are we going to diagnose it. to jump through. Public health is all about the intervention. It’s not about the Let me just give you one example. Why isn’t the birth control pill diagnosis. We don’t test women for fertility if we want to give over the counter? Anybody know? them a method of family planning because we assume that they’re fertile and the intervention — all the benefit is with the For a pill to be over-the-counter, there are only four things it needs intervention, not with the diagnosis. It would defeat our purpose to be. It has to have easy-to-read and easy-to-follow instructions. to prove that someone was fertile in order to give them a method A person has to be able to identify her own contraindications. of family planning. For example, why shouldn’t you take this medication? So in the case of birth control pills, the only thing is risk for stroke. Most So in public health, in general, the same is true and definitely women can probably figure out when they’re having a stroke. And true for vaccines. The public health approach is all about the taking the pill — one pill every day — that’s a pretty easy-to-follow intervention and not necessarily about the diagnosis. instruction. Many countries not only have access issues but also have supply The other thing is there should not be any potential for abuse. You issues. Most countries don’t have enough stock of birth control that you can kill yourself with aspirin, but you cannot kill yourself pills. What happens is that a woman may come to a clinic, request with birth control pills. And they’re not addictive. birth control pills and only be given a month’s supply.

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This has led to a real revitalization, a real resurgence, in interest in There seems to be tremendous interest in this one area. In the four what we call long-acting, reversible contraceptive methods. These years prior to our beginning the project, two IUDs were inserted. are typified by the IUD, which some of you remember from the In the month after we provided the training, eight were inserted, past, and the subdermal implant. which may not be big numbers, it’s not in the millions, but it’s a ...we will insert start. an IUD at We’ve had women who have helped themselves to our diaphragm the same time samples in the clinic even though they have a hole in them and The other method that has become very popular is the contraceptive won’t work, because they need something. implant. It’s like a large-bore IV. It’s a needle, and inside this needle the woman is is a little implant that’s about the size of a matchstick. I don’t know having a baby. I brought with me a sample of one of the IUDs that is available if you can see it, but there’s a sample of it. It’s very flexible and It’s one-stop in the United States and worldwide. This is an IUD that is actually bendable. This IUD lasts for five to seven years. shopping. Baby loaded with a progestin. It’s one of the two hormones that is out, placenta commonly in birth control pills, and it comes in a very handy-dandy You can really insert this injection at a bus stop. But this lasts for inserter. three to four years. The effectiveness is very high. out, IUD in, no

second baby. This kind of healthcare is mostly provided by nurses in developing So the three principles that we try to employ — access, Dr. Paul Blumenthal countries. They carry all the water, if you will, and they do most of convenience, effectiveness – are there. We make sure that people the heavy lifting in healthcare. can avail themselves to them, and in so doing, we can have real impact in reducing maternal mortality because of unintended But this is a very simple device. Once it’s inside the uterus, it’s pregnancies, especially in areas where unmet need is high. forgettable. It is what we call a forgettable contraceptive because once it’s in, there’s nothing for the woman to remember. Looking at the men in this room, I want you to know that there are approximately 720 billion sperm released into the world every Something that’s very new for us in the family planning world is minute. And so we have our work cut out for us. that we will insert an IUD at the same time the woman is having a baby. It’s one-stop shopping. Baby out, placenta out, IUD in, no Unfortunately, male contraceptives have not kept pace with what second baby. Especially for rural women in developing countries, we’re able to offer women. There’s a lot of work still being done this could really be a game changer because the provider is there, in the world of male contraception, but we’re just not there yet. the woman is there. No accessories are necessary. You don’t even And like any other vaccine, if we could vaccinate the men with a need a light. You don’t need a speculum. method, well, we could even prevent pregnancies on both sides of the gender equation. In Uganda, we have a project way out in rural Uganda where the gorillas live. These women have a really hard time getting to a Thank you very much. I look forward to your questions later. clinic. They’re way out there. But there is a hospital that women can go to, reside in a dormitory prior to the delivery, and then at Dr. Neal Baer: You’re not done yet. You gave us a lot of facts. You the time of the delivery we’re now offering them postpartum IUDs. said 50 percent of pregnancies in the United States are unplanned

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ninth child in rural Uganda. This IUD is offered to her postpartum. The look on her face once she had received the method and knows she is going home with protection against unintended pregnancy that would probably last her for the remainder of her reproductive years — it was almost a transcendent expression of thanks.

By the way, in developing countries, the IUD that we pay for here for $750 costs $0.64. So this is immensely cost effective. And the gratitude that women feel when getting a family planning method that allows them to take care of their family, allows them to be Dr. Paul Blumenthal speaks to the audience at the Writers productive in the workplace, is worth all the effort we put into it. Guild of America, West

and there are issues of access, convenience, over medicalization, Dr. Neal Baer: We need to write a show about family planning etcetera. Let’s say I’m writing for my show, Law & Order: SVU, or for Law & Order: SVU because the facts are interesting. But you’ve just tied them to the emotion — the teenage girl turning away a comedy like Modern Family or even a soap opera like Days of ...there are Our Lives, tell me a story that you’ve really seen, something that and not knowing what to do. Certainly speaks volumes to all the would move me to write about it and integrate some of the facts writers here. Thank you. about 2.5 to 3 into my story. million kids Dr. Paul Blumenthal: Pleasure. in Africa who Dr. Paul Blumenthal: First of all, did you know that I’ve been have HIV/ watching Days of Our Lives since 1965? Dr. Neal Baer: You’ve heard a lot of facts so far: 210 million unwanted pregnancies; 8 million children die every year. There are AIDS. Of

Let me give you a high and a low, if I can. 20 million AIDS orphans in Africa. According to the United Nations, those, about there are about 2.5 to 3 million kids in Africa who have HIV/AIDS. 350,000 As an obstetrician/gynecologist, there’s nothing that’s a bigger Of those, about 350,000 are actually receiving treatment. You are actually probably didn’t know that. Only about 10 percent. high, even in my advanced age, than delivering a wanted baby to receiving parents who are welcoming it into the world. There’s nothing that treatment. gives us a bigger high than that clinically. What do you think when I tell you those numbers? Nothing went through your mind, nothing, because we can’t hold those Dr. Neal Baer

One of the biggest lows is delivering a baby of a teenager or numbers in our head. I don’t know what that means: 20 million someone who had not planned on that pregnancy and who as AIDS orphans. soon as the baby is born looks away, doesn’t know what to do. That’s really an impetus for us to provide better family planning. I could walk you through it and say that if you were flying on an airplane into Los Angeles Basin at night and you saw all the

Recently, when we have instituted the postpartum family planning twinkling lights and you multiplied that by about five times, then methods, one of the vignettes is of a woman who’s delivering her that would be the number of AIDS orphans in Africa. Then you start to get a picture. We’re so number oriented in our lives, but

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those numbers really don’t hold much meaning for us.

What does hold meaning for us but stories. In the early 1990s in the United States, there was a measles epidemic and over 120 kids died. Even 120 kids is a number hard to imagine.

I would contend that if you tell a story about one person, you often will never forget that story because it’s moving, it’s emotional. You can connect with it in ways that you can’t with the numbers. So we’re going to see a clip from my show, SVU, about vaccinations. to strike out.

(video playing) I don’t think it’s impossible, but it does take some effort. We’ve gotten a lot of ideas today about how we could integrate these Dr. Neal Baer: As a pediatrician living in Los Angeles, where stories. I could start already thinking about a woman who has many actors go to pediatricians who don’t vaccinate, it was a very immigrated from Uganda and she’s had eight kids and she’s interesting episode to do. You can imagine that we got a lot of pregnant. That’ll be on Law & Order: SVU in March. I’m very e-mails about it. fortunate to have the opportunity to do that, but the challenge for all of us as writers is to broaden our perspective. What compelled me to do that show was the fact that we’re now in this place where every opinion is valid. A scientific fact becomes As a pediatrician, obviously, I’m interested in these issues, so it as valid as one’s own belief is valid, and we start to head down a colors the kind of work I do. But you don’t have to be a doctor, as real slippery slope because everything is okay. Larry will tell you in a minute, to write for a medical series.

It is incumbent on us as writers to put out stories that challenge So with that, I’m going to move on. beliefs and show various sides. We tried to raise the question, It is incumbent what is a parent’s responsibility to one’s own child, versus, what is Sandra de Castro Buffington: So where do you get your a parent’s responsibility to the community of children? on us as writers inspiration for these kind of obscure stories? to put out In doing stories like this, sometimes it is tough to figure out how stories that Dr. Neal Baer: The measles I wouldn’t say is obscure, but we’re to integrate a storyline that is possibly about global health or really lucky because I always ask as part of my deal that we have a challenge beliefs communicable diseases when your show is not really a medical full-time researcher, so we research, research, research, research, and show show, like Grey’s Anatomy or House. But it is possible to do it research, and get as much information as possible. because these are really stories about our lives. various sides. Dr. Neal Baer When we did this story, we did talk with Hollywood Health & Society There is a misconception that the American audience isn’t to get accurate information so that we’re not putting out things interested in global health because it’s not about them. As long as that are not true. Everything we said about the measles epidemic that false viewpoint pervades, it’s going to be difficult for writers

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in England and people not getting vaccinated The second is that I have been a tremendous admirer of the work is true, according to that’s done by Hollywood, Health & Society right from its inception the Centers for Disease when I was at CDC. As a front-line public health practitioner, I Control and Prevention, don’t think that you all really realize as writers the impact and but you have to believe power of the work that you do, particularly when you weave in somebody. some of these very effective public health stories into your shows.

We don’t rip from It’s extraordinary to me how many people will say that they saw the headlines. We get something in House or they saw something in Neal’s show or inspired by the gestalt they remember this storyline on General Hospital or whatever it of society. We look at happened to be. When the stories are done really well, you do a areas, particularly in tremendous service to all of those folks out there who need this health, where there type of information. So I never mind coming out here to be able are challenges, where to participate and be with you. people don’t agree. Dr. Stephen Ostroff I have the unenviable task of having to talk about three different We’ve done a number of shows about abortion and access to things. There are all of these wonderful props over there here, and abortion, and I guess the best answer is we start with a question. so I would suggest that after the presentations, you go over and When the look at these wonderful things because it puts some of this into Should teens be allowed to have abortions without telling their stories are parents? Should a young woman be allowed to get contraception perspective. over the counter? Is torture ever justified? Does a woman from a done really culture that performs female genital mutilation have the right to The three things that I was asked to talk about were bed nets, oral well, you do continue to do that in this culture? rehydration solution, and deworming. a tremendous service to all We ask questions that don’t have easy answers, and that’s the I’m going to start my comments with a quote, which feeds off of of those folks secret for our show. It takes us down a story trail that we hope what Neal was just saying: “One death is a tragedy, but a million explores the nuances that contribute to what seems like a simple deaths is a statistic.” out there who question that has no easy answers. need this type of It’s really a wonderful quote, and believe it or not, it’s by Joseph information. Dr. Steven Ostroff? Stalin. Who would’ve guessed that Joseph Stalin would’ve said Dr. Stephen Ostroff something like that? I have tried to figure out what he was Dr. Stephen Ostroff: Thanks very much. It’s really a pleasure to referencing, and I can’t tell whether he was referencing all of be here for several reasons. One of them is that coming from the the deaths that occurred in World War II in the Soviet Union or East Coast, we had our first frost yesterday so it’s wonderful to whether it was all of the deaths that he was responsible for as a be out here in beautiful sunny warm Southern California. I didn’t dictator in the 1940s and the 1950s. quite think it was going to be this warm.

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But when you hear a quote like that, it puts things into perspective. Very often, those of us in public health tend to focus on these Worms is a massive problem, and it’s hard to put it into context. quirky onesies and twosies that happens. I’m guilty of that But there are probably about a billion people around the world because we’ve had a whole series of them that we’ve expended a who are infected with worms. phenomenal amount of time and effort on. The island that I lived on, a place called Pohnpei, we had the big We had a case, for instance, of Lassa Fever earlier this year. Lassa boys. One was ascaris, which is the round worm. It can grow to be Fever is one of these hemorrhagic fevers — the Ebola mode from the size of a pencil in terms of diameter and can be feet long. We somebody who went over to Liberia. We recently had a couple of had trichuris, which is another bad one. We had hookworms. We cases of infant botulism that we think was from a homeopathic had all of them on this island. ...back behind teething capsule, that both of them had been exposed to at the same time. I was the internist, so I was taking care of the adults, and I saw these onesies and some of the most amazing worm infections. You just couldn’t twosies, there These are the onesies and twosies, but it makes you realize that believe some of the things that we would see. These worms get is this tsunami back behind these onesies and twosies, there is this tsunami of to be so big, and they get to be so convoluted that they would of illness that illness that goes on day-in and day-out throughout the developing basically block off the entire intestinal tract. In a typical month, goes on day-in world. That’s where you can really have an impact in some of your we would see eight, 10, 12 cases of something called “worm public health interventions, the things that are being done by the pancreatitis” because what would happen is that the worm would and day-out Bill and Melinda Gates Foundation. actually block the bile duct and cause all of this stuff to back up, throughout and these people would get these horrible illnesses. the developing Of these three different topics, the one that is the least recognized world. and the one that’s nearest and dearest to my heart is deworming. So anybody that got admitted to the hospital on my ward got dewormed. And the worms that would come out of them would Dr. Stephen Ostroff Many of you may remember the television program Northern Exposure. The premise of Northern Exposure was that you had be shocking. this guy from New York who ended up working in a clinic in rural Alaska because he was doing his scholarship payback from I realize you all just had dinner, so it’s difficult to talk about it. medical school. When somebody would die on my ward — and it didn’t really happen all that commonly because in that society if you told the I was “Southern Exposure.” When it came time for my scholarship family that somebody was going to die, they would take them payback from medical school, I got assigned to a little tiny island home and they wouldn’t die in the hospital — after they died, the in Micronesia and the Western Pacific, and I spent two years worms would crawl out of every place. And so you’d see them there working as the doctor. This place was 4,000 miles west of coming out of their nose and coming out of their mouth, and it Honolulu, it was really out there. When I got there, they told me, was just so amazing to me to see what these worms did. “You know, everyone here has worms.” I’m the big doc from a prestigious place in America, so I said, “How can that possibly be And part of the reason that it was such a problem on this island is the case?” You know what? They were right because everyone kava. A lot of folks have heard of kava. Kava is a common drink in there had worms. Fiji. In the island that I was on, Micronesia, we had the equivalent

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to kava. It was called sakau. Sakau is made from the roots of the through a community and you treat everybody for worms. It’s pepper plant, and what you do is you take the roots of the pepper been very well demonstrated that if you do this on a routine plant, you pound it with water, and then you sieve it through a basis in parts of Africa and parts of Asia and parts of the Pacific hibiscus leaf. And when you do that, it makes it mildly narcotic. and parts of Latin America, you will have taller kids, you’ll have It’s a very common thing that people drink throughout the Pacific. stronger kids, you’ll have better educated kids, and you will deal with a lot of problems with anemia. Unfortunately, the roots of the pepper plant are loaded with the eggs of these worms. So people who drank this stuff would infect It’s really one of these remarkable interventions, and it’s a very themselves over and over with these worms. And epidemiologically, simple cost-effective intervention. I would urge all of you to go it was a remarkable phenomenon. look at these horrible worms on display here because hundreds of Oral rehydration millions of people around the world have these in their bodies and solution is The other interesting aspect of this is that the most common cause are shedding these things every single day. essentially a of admissions to my medical ward was chronic pulmonary disease, chronic emphysema and bronchitis. And I couldn’t figure out why The second issue that I’m going to touch upon is oral rehydration combination of so many young people had this, and it was because of the worms, solution. Of course, again after dinner, it has to do with diarrheal water with salt amazingly. disease. As Rajeev mentioned, diarrheal disease is one of the major and sugar. It’s killers around the world, particularly in kids under the age of five. very effective After you ingest the eggs of the worm, they bore through the intestines and then they transit through your lungs. When they For a long time, there was a belief that when you had severe in certain transit through your lungs, they set up this inflammatory response, diarrheal disease that you had to use IV rehydration. IV rehydration diseases, and in and these people get these horrible episodes of bronchitis and is very difficult to do in developing countries. And it’s also very particular, for exacerbations of their emphysema. And then what happens is you dangerous because you don’t really have good equipment and cholera. swallow. You cough them up. You swallow them. They go back you could potentially transmit things like HIV and all kinds of Dr. Stephen Ostroff into your intestinal tract and that’s where they become adults. infections from the catheter itself.

This is a phenomenon that reproduces itself over and over again I still do a fair amount of work overseas, and particularly in South all throughout the tropical parts of the world. The biggest problem Asia. I’ve had the wonderful opportunity to interact with a great that’s associated with worms is actually in children. They’re place in Bangladesh. For those of us in public health, we always generally not killers, but they do several things. One of them is refer to it as ICDDRB, which stands for the International Center for they sap your nutrition. Everybody knows the tapeworm story. So Diarrheal Disease Research in Bangladesh. kids who have very high worm burdens have very stunted growth. They produce anemia, and they also affect their ability to learn. ICDDRB are the folks that did the most to develop, implement and And it’s been very well demonstrated that kids who have excess study the impact and efficacy of oral rehydration solution. I know worm burdens do more poorly in school. that the Bill and Melinda Gates Foundation gave them an award a number of years ago for this. One of the very simple interventions that make a huge difference is to have these mass deworming campaigns. You basically go Oral rehydration solution is essentially a combination of water

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mortality. One of the things that they’re doing is pumping in lots of oral rehydration solution because if properly managed, you can get that mortality down to 1 percent. That’s the impact that a simple intervention can have.

The third one that I’m going to talk about briefly is bed nets. Bed nets are another really remarkable story. We have an example of a bed net over there on display, and it’s probably the one that An audience member asks a has gotten the most notoriety in recent years. There are lots of question. folks in Hollywood who have gotten heavily behind the issue of with salt and sugar. It’s very effective in certain diseases, and in insecticide-impregnated bed nets. We call them ITNs, insecticide- particular, for cholera. treated nets.

There are two types of diarrhea. There is diarrhea that is the result This is a phenomenon where you can take a disease like malaria of a toxin. And there is diarrhea that occurs because the bug itself and you can have a phenomenal impact in affecting the likelihood invades the intestinal lining. ...if you place that there will be both malaria cases and deaths related to the child or malaria, particularly in pregnant women and young children. It’s There are also two types of toxin-mediated diarrhea. One is when a combination of the net itself and the insecticide that’s placed place the the toxin affects the cells that line the gastrointestinal tract. And inside the net. family inside the other is when it doesn’t. And cholera surprisingly is one of the net, the these diseases where the toxin doesn’t really affect the cells itself. We know that if you place the child or place the family inside the efficacy of a bed net, the efficacy of a bed net in terms of reducing the incidence of The toxin produces a syndrome where the lining of your intestinal malaria is between 20 and 60 percent. It’s the gift that keeps on net in terms tract secretes huge amounts of fluid. But it doesn’t affect the giving because even if you don’t stay within the net, the insecticide of reducing ability of the gastrointestinal tract to absorb fluid. So if you can itself has an impact outside of the net. And not only within that the incidence put it through the top faster than it comes out the other end, it house but it will reduce the mosquito populations within that of malaria makes a huge difference. And that’s essentially the basis for oral community. So even if you don’t sleep under the net, the efficacy rehydration solution. is between of this intervention in terms of reducing malaria is between 10 and 15 percent and up to 30 to 40 percent. 20 and 60 It remarkably brought down mortality from cholera, which at the percent. beginning was about 70 percent, now down to 40 percent. When It’s really a remarkable and harmless intervention. It’s an easy thing Dr. Stephen Ostroff properly implemented, can be less than 1 percent. to do. Unfortunately, they’re not necessarily cheap. They’re about $10, which is beyond what many countries have the availability Many of you are probably watching the current situation in Haiti, to spend. So these campaigns, many of which are coordinated with the emergence of cholera. There has now been close to by donor agencies like Bill and Melinda Gates Foundation, to 5,000 cases of cholera. It’s three or four hundred deaths related to purchase and distribute bed nets has had a phenomenal impact that, and if you do the calculations, that’s about a 7 or 8 percent on the incidence of malaria around the world.

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So we shall move on to Larry. Sharon Stone and American Idol have gotten behind bed Larry Kaplow: The stories that I write come from personal nets, and it’s a solid, easy emotion, and then I spin them out. While you were talking, I got intervention. You can use a a text from my son Jake. And typically I write about him a lot, and single bed net for three to I was missing him. I missed him and it was during the day, and I five years. It doesn’t have to wanted to spend time with him. I couldn’t figure out if that was an be replaced. It’s really quite acceptable thing, an acceptable missing? Like what is acceptable remarkable. in missing somebody? Like how much can you miss somebody?

So these are really simple things So the point of this is that when I spun it out, it became a father/ that make a difference around son story about having to say goodbye to a son and what that the world every single day. would feel like. Of course it’s nothing that I would ever want to Larry Kaplow feel and it scared the living daylights out of me. That’s why I wrote Dr. Neal Baer: Thank you. So how much does it cost to deworm about it, because it was scary. a child and treat them for a year? So in year seven of House, which I’d love to take credit for, but I’m Dr. Stephen Ostroff: For ascaris and for trichuris, the deworming just one of 12 writers — David Shore created the show and there is really cheap. The medication is called Vermox. It’s easy to are a bunch of executive producers and staff that helped craft administer. It has virtually no side effects. On the island that I these stories. And even in year one, smallpox was kind of like this lived on, you could put it on the front counter in the store and let big softball just hanging out there begging to be hit. people just take it because it has really no down side. So with Hollywood, Health & Society, we got in touch with the It’s not the cost of the medication itself. It’s the cost of the campaign CDC and had a lot of conversations, and I got a bunch of doctors to get the pills into all of these kids’ mouths. What they usually try in headlocks and said, “How do I make this happen?” We made to do is piggyback on some other activity like polio immunization it work for this episode. days or something like that. And if you don’t have to deal with a lot of the administrative issues, you’re talking pennies. It’s very Dr. Neal Baer: So when is this on, November…? cheap.

Dr. Neal Baer: Our challenge then is to figure out how to tell a story about that because I would venture to say that most of us didn’t know —- especially the points you raised about raising IQ and a child’s general health for pennies. It’s something that certainly isn’t talked about, particularly these days when $150 million was spent on a gubernatorial campaign. (From left): Dr. Paul Blumenthal, Dr. Stephen Ostroff and Larry Kaplow

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population as having irrational views, you’re not going to make Larry Kaplow: 15th. any progress. To them, these are not irrational views. They’re just different views. And they may not be your own views, but the Dr. Neal Baer: 15th. All right. So TIVO it unless you’re watching longer you ignore those differences, it works to your detriment. it on the air, which probably only a certain percentage do. Thank you very much, and we have a few minutes for questions from Once that was understood, we started to truly engage religious anyone. Yes? and traditional leaders in Nigeria. There was a real sea change in the willingness of the population to be a part of this. Audience member: My question is for Dr. Venkayya and for the writers. There are many other examples that you could talk about. Certainly there are religious issues around things like family planning and, to How much does religion and religious fanaticism affect what some degree, immunization and population stabilization. We, at you’re able to do, how you’re able to make changes? the Foundation, are willing to take on some of these issues if it’s important enough, but we don’t go looking for a fight, if you will. For Neal and Larry, can you take that on as unrestrictedly as you would like to in order to tell these stories given our current climate? Dr. Neal Baer: We do. Any time there’s an alternative point of view, there’s a story. So the trick becomes, how do you humanize Dr. Rajeev Venkayya: I won’t go too close to the term fanaticism. someone who is a fanatic? That person’s a human being, perhaps Let’s just say religious beliefs. In our world, religious beliefs are with a family or whatever it is. How do you make the audience sometimes at odds with public health goals. A good example of empathize with that person, see that point of view, and then let this is in Nigeria. There, the polio campaign suffered a great setback them fight for 42 minutes? when some of the religious leaders told their congregations that this was an effort to sterilize mothers. So they basically shut down Dr. Paul Blumenthal: It’s actually surprising that while religious the campaigns. And we saw a resurgence in polio as a result of leaders can create barriers for family planning, women themselves those efforts. will go to great lengths to get them.

One of the lessons learned is that you really need to put yourself in In my experience, it depends on how enfranchised women feel in the shoes of the people whom you’re working with. If you see the society. What they have to live for really, and what has become their ideal family size. They will transcend often what their religious leaders are telling them in order to protect their family and create a better life for themselves.

Even within the Catholic church, there are sects that take a very practical approach to family planning. One of the urban legends of family planning — and I saw this in the Philippines – where, Audience members for a while, sterilization was very popular. Sterilization was a very looking at the samples on heavily accessed method of family planning. You ask, ”why?” One display.

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of the doctors with whom I was working said, “You only sinned that gets their buy-in and once.” So you get sterilized, you’ve sinned, you ask for absolution, reduces barriers. you’re forgiven, and that’s it. But with birth control pills, it’s every day, and it never stops. In this particular case, it was the Jesuits Dr. Stephen Ostroff: While who were taking this practical approach. They were saying, “Well, we think of this as an issue you know, there’s a way out of this.” People often don’t know that happens overseas, how close the church came to actually approving contraception. Pennsylvania has a very large population of individuals who There’s a really great Australian TV show out there — I don’t know we refer to as the “plain folks.” if any of you have seen it — called Brides of Christ. That’s the term that gets used for the Amish populations I found this in the video store and it had a very lascivious looking and the Pennsylvania Dutch cover. But it tells the story of a convent school. The sisters were populations, many of whom Audience members looking at the preparing for what they thought was inevitably going to be the samples on display. very much disdain medical decision of the Vatican Council to approve contraception because interventions and vaccinations, it was natural. Birth control pills are natural. They’re hormones, in particular. They are some of and you have a period just like every month. The Vatican Council our best customers in terms of disease outbreaks, unfortunately, actually ruled this way. Pope Paul VI, John the 23rd, having died, and we see the entire array of serious illness because they do overruled it. Just like what the FDA did to emergency contraception not avail themselves of some of these appropriate public health In our several years ago. interventions. experience, religious In our experience, religious leaders can often create a barrier. We just had an outbreak in suburban Philadelphia of measles at a leaders can Like Rajeev was saying, if you get to them you can often reason college I had no idea was even there. It’s a very small college run by with them. A very good example of this was the cervical cancer a religion that I had never heard of, called The New Church. They often create a vaccine in the United States. A lot of fundamentalists were raising are relatively opposed to vaccination, and there was a student from barrier. the specter of promiscuity — that this vaccine was going to make overseas who had been doing missionary work in Zambia, and he Dr. Paul Bluementhal teenagers promiscuous. was starting college there as a freshman. He took the grand tour through five different flights to get from Zambia to Philadelphia Some of the reproductive health groups went to these religious and spent two days at freshman orientation, developed a rash, leaders and said, “You know, we’re talking about cervical cancer, and was diagnosed with measles. the second-largest killer of women in developing countries and the number-one cancer killer of women in developing countries. Is Because so many of these individuals weren’t vaccinated, it was that a risk you want to take?” a mess. We ended up having to place in quarantine a substantial proportion of their freshman class for 21 days. What a miserable They actually backed down and did not interfere at all when the way to start college because of measles. vaccine was approved. The vaccine has made great inroads into adolescent health programs. So that’s an example of an approach It’s an issue for us even here in the United States.

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...it’s about Dr. Neal Baer: Thank you. As Larry said, it gives us grist for telling the various really interesting stories. In that measles episode, or in another perspectives episode about AIDS deniers, we had a kid whose family was very that can enrich religious and wouldn’t let him great treatment. He had different the discussion points of view. because we’re at So when you have these conflicts, the network has been very this place where supportive as long as you don’t demonize anybody but tell the we don’t have story. I’m not talking about balance per se. But it’s about the various conversations perspectives that can enrich the discussion because we’re at this about these place where we don’t have conversations about these things.

things. We’re going to wrap it up. We really appreciate your coming, and Dr. Neal Baer we hope we’ve inspired you to think about some of the really easy ways one child or hundreds of millions can be saved. So thank you for coming tonight.

Sandra de Castro Buffington: If you haven’t seen it yet, feel free to stop by and see the wormies, squirmies, and contraceptive methods, uterus, and things like that over there on the table.

For the writers out there, please know that you can call on Hollywood, Health & Society any time you’re doing a health storyline. We’ll be happy to help.

And I want to extend a warm thank you to all of tonight’s speakers. Thanks so much.

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