ISPP 2015

Career Opportunities in Pharmacy
A smarter, more precise way to think about public health | Sue Desmond-Hellmann


OK, first, some introductions. My mom, Jennie, took this picture. That’s my dad, Frank, in the middle. And on his left, my sisters: Mary Catherine, Judith Ann,
Theresa Marie. John Patrick’s sitting on his lap
and Kevin Michael’s on his right. And in the pale-blue windbreaker, Susan Diane. Me. I loved growing up in a big family. And one of my favorite things
was picking names. But by the time child
number seven came along, we had nearly run out of middle names. It was a long deliberation before we finally settled
on Jennifer Bridget. Every parent in this audience knows the joy and excitement of picking a new baby’s name. And I was excited and thrilled to help my mom in that special
ceremonial moment. But it’s not like that everywhere. I travel a lot and I see a lot. But it took me by surprise to learn in an area of Ethiopia, parents delay picking the names
for their new babies by a month or more. Why delay? Why not take advantage
of this special ceremonial time? Well, they delay because they’re afraid. They’re afraid their baby will die. And this loss might be a little more
bearable without a name. A face without a name might help them feel just a little less attached. So here we are in one part of the world — a time of joy, excitement,
dreaming of the future of that child — while in another world, parents are filled with dread, not daring to dream
of a future for their child beyond a few precious weeks. How can that be? How can it be that 2.6 million babies die around the world before they’re even one month old? 2.6 million. That’s the population of Vancouver. And the shocking thing is: Why? In too many cases, we simply don’t know. Now, I remember recently seeing
an updated pie chart. And the pie chart was labeled, “Causes of death in children
under five worldwide.” And there was a pretty big section
of that pie chart, about 40 percent — 40 percent was labeled “neonatal.” Now, “neonatal” is not a cause of death. Neonatal is simply an adjective, an adjective that means that the child
is less than one month old. For me, “neonatal” said:
“We have no idea.” Now, I’m a scientist. I’m a doctor. I want to fix things. But you can’t fix
what you can’t define. So our first step in restoring
the dreams of those parents is to answer the question: Why are babies dying? So today, I want to talk
about a new approach, an approach that I feel will not only help us
know why babies are dying, but is beginning to completely transform the whole field of global health. It’s called “Precision Public Health.” For me, precision medicine comes
from a very special place. I trained as a cancer doctor,
an oncologist. I got into it because I wanted
to help people feel better. But too often my treatments
made them feel worse. I still remember young women
being driven to my clinic by their moms — adults, who had to be helped
into my exam room by their mothers. They were so weak from the treatment I had given them. But at the time, in those front lines
in the war on cancer, we had few tools. And the tools we did have
couldn’t differentiate between the cancer cells
that we wanted to hit hard and those healthy cells
that we wanted to preserve. And so the side effects that you’re
all very familiar with — hair loss, being sick to your stomach, having a suppressed immune system,
so infection was a constant threat — were always surrounding us. And then I moved
to the biotechnology industry. And I got to work on a new approach
for breast cancer patients that could do a better job
of telling the healthy cells from the unhealthy or cancer cells. It’s a drug called Herceptin. And what Herceptin allowed us to do is to precisely target
HER2-positive breast cancer, at the time, the scariest
form of breast cancer. And that precision let us
hit hard the cancer cells, while sparing and being more
gentle on the normal cells. A huge breakthrough. It felt like a miracle, so much so that today, we’re harnessing all those tools — big data, consumer monitoring,
gene sequencing and more — to tackle a broad variety of diseases. That’s allowing us to target individuals with the right remedies at the right time. Precision medicine
revolutionized cancer therapy. Everything changed. And I want everything to change again. So I’ve been asking myself: Why should we limit this smarter, more precise,
better way to tackle diseases to the rich world? Now, don’t misunderstand me — I’m not talking about bringing
expensive medicines like Herceptin to the developing world, although I’d actually kind of like that. What I am talking about is moving from this precise
targeting for individuals to tackle public health problems in populations. Now, OK, I know probably
you’re thinking, “She’s crazy. You can’t do that. That’s too ambitious.” But here’s the thing: we’re already doing this in a limited way, and it’s already starting
to make a big difference. So here’s what’s happening. Now, I told you I trained
as a cancer doctor. But like many, many doctors
who trained in San Francisco in the ’80s, I also trained as an AIDS doctor. It was a terrible time. AIDS was a death sentence. All my patients died. Now, things are better, but HIV/AIDS remains
a terrible global challenge. Worldwide, about 17 million women
are living with HIV. We know that when these women
become pregnant, they can transfer the virus to their baby. We also know in the absence of therapy, half those babies will not survive
until the age of two. But we know that antiretroviral therapy
can virtually guarantee that she will not transmit
the virus to the baby. So what do we do? Well, a one-size-fits-all approach,
kind of like that blast of chemo, would mean we test and treat
every pregnant woman in the world. That would do the job. But it’s just not practical. So instead, we target those areas
where HIV rates are the highest. We know in certain countries
in sub-Saharan Africa we can test and treat pregnant women
where rates are highest. This precision approach
to a public health problem has cut by nearly half HIV transmission from mothers to baby in the last five years. (Applause) Screening pregnant women
in certain areas in the developing world is a powerful example of how precision public health
can change things on a big scale. So … How do we do that? We can do that because we know. We know who to target, what to target, where to target and how to target. And that, for me, are the important
elements of precision public health: who, what, where and how. But let’s go back
to the 2.6 million babies who die before they’re one month old. Here’s the problem: we just don’t know. It may seem unbelievable, but the way we figure out
the causes of infant mortality in those countries
with the highest infant mortality is a conversation with mom. A health worker asks a mom
who has just lost her child, “Was the baby vomiting?
Did they have a fever?” And that conversation may take place as long as three months
after the baby has died. Now, put yourself
in the shoes of that mom. It’s a heartbreaking,
excruciating conversation. And even worse — it’s not that helpful, because we might know
there was a fever or vomiting, but we don’t know why. So in the absence of knowing
that knowledge, we cannot prevent that mom, that family, or other families in that community from suffering the same tragedy. But what if we applied
a precision public health approach? Let’s say, for example, we find out in certain areas of Africa that babies are dying
because of a bacterial infection transferred from the mother to the baby, known as Group B streptococcus. In the absence of treatment,
mom has a seven times higher chance that her next baby will die. Once we define the problem,
we can prevent that death with something as cheap
and safe as penicillin. We can do that because then we’ll know. And that’s the point: once we know, we can bring
the right interventions to the right population
in the right places to save lives. With this approach,
and with these interventions and others like them, I have no doubt that a precision public health approach can help our world achieve
our 15-year goal. And that would translate
into a million babies’ lives saved every single year. One million babies every single year. And why would we stop there? A much more powerful approach
to public health — imagine what might be possible. Why couldn’t we more effectively
tackle malnutrition? Why wouldn’t we prevent
cervical cancer in women? And why not eradicate malaria? (Applause) Yes, clap for that! (Applause) So, you know, I live
in two different worlds, one world populated by scientists, and another world populated
by public health professionals. The promise of precision public health is to bring these two worlds together. But you know, we all live in two worlds: the rich world and the poor world. And what I’m most excited about
about precision public health is bridging these two worlds. Every day in the rich world, we’re bringing incredible
talent and tools — everything at our disposal — to precisely target diseases
in ways I never imagined would be possible. Surely, we can tap into
that kind of talent and tools to stop babies dying in the poor world. If we did, then every parent would have
the confidence to name their child
the moment that child is born, daring to dream that that child’s life
will be measured in decades, not days. Thank you. (Applause)

39 thoughts on “A smarter, more precise way to think about public health | Sue Desmond-Hellmann

  1. This woman has inspired me really… A thing so simple yet so ignored. Keep on these good talks ted-ed, you're one of the best YouTube channels.

  2. I like this but… I couldn't help thinking "yeah, the world isn't overpopulated enough, we need to save more babies".

  3. She's the typical naive (intelligent in her subject) scientist who fails to see that curing diseases, infections, etc. will stop or at least slow down natural selection in countries were people have 5-7 babies (poor dumb people breeding, dumb because they can't afford the baby but still have it, because they won't accept condoms etc. for cultural reasons and mistrust), thus leading to huge overpopulation, economy crisis, mass unemployment and hunger. A baby that isn't born / doesn't survive won't have to live this agony and hunger, better for it if it didn't live at all.
    I really hate those naive scientist who want to cure everything because they want to save lives without knowing they're dooming them and in the end us all. She has a good heart, but she's incredibly stupid in some ways.

  4. It might be worth mentioning that Herceptin costs $4,500 per month or $54,000 per year. Often taken with Perjeta which costs $5,400 per month or $71,000 per year. Together, $115,000.

  5. The only aspect of this talk that I felt was extraordinary, was the lengths she went to EXCLUDE men.

    blah…

    misandric fluff.

  6. This approach suggested by her is already used in primary health care in Brazil. It really works. And the most important: it's free and accessible to all moms and children

    Sorry if I wrote something wrong. I'm Brazilian and don't have much fluency on english

  7. So… this talk could have been summed up as "try to figure out what the problem is and fix it". I see NOTHING new in this at all.

  8. Boycott the TED cult.

    There's a bunch of creeps and psychotics are running the show (nothing to do with the speakers).

  9. Public Health shouldn't be a forefront of a nation. I live in Canada, and we have a very limited bureaucratic nightmare of heavily unionized healthcare. MRI's cost 300% more than they do in South Korea (using this example from personal experience). In the Canadian healthcare, I had to wait a year to see a doctor after begging and pleading with a local clinic to let me get checked out by someone that knows what they are talking about.

    Fair warning to everyone, our system isn't free. I paid over $600k in taxes for this nightmare of a system, and it killed my father and aunt. Ready to atlas shrug to a nation that allows me to have options….

  10. But…post-infant-death mother-interviews is the way they are trying to find out what is killing the babies, and her "alternative approach" starts where that knowledge is already collected… It doesn't make any sense, it just sounds nice.

  11. Keep doing it Doc! Amazing work! This sure is a complex science problem. Some of these ppl commenting here are just to narrow to understand the factors here.

  12. gene sequencing. sigh whatever. I don't fucking care anymore. stay away from my genes. I have generations of a very ancient genetic make up. I would never tamper with that. even though I am schizophrenic.

  13. Wanna know what the leading cause of neonatal deaths are? Its the lack of using contraceptives. Stop having babies if you cant provide for them

  14. Aren't the most common reason for infant mortality in the first month of life premature birth and lethal genetic conditions, with the latter being more common in small communities where people marry cousins?

  15. Stop trying to lobby or fix issues for people that are themselves uniterested in solving such issues. Mother not naming a child is supposed to mean something? I would not bring a baby into the world without knowing that I can offer the best there is to them. We are overpopulating this planet and handing our own issues to future generations instead of putting a halt on this. Why?

  16. Wow. This is genius. Giving healthcare to sick people, not to everyone? Genius! Why didn't anyone think of that?

    Now that we've figured out we don't need to test everyone in the world for AIDS, I'm sure the drug companies, NGO's, and governments will step up and finally allocate funds to smartly and precisely wiping out AIDS and malaria in no time!

    AIDS: Solved
    Malaria: Solved
    Cancer: Solved
    Aging: Solved

    Now, let's go find a smart and precise way to solve other problems. Crime? War? Famine? Financial crises?

    Wait… What? You're telling me we haven't cured AIDS and Malaria because its victims have no money, and thus no one cares about them? No! Surely, the only reason white people haven't fixed Africa by now is that we haven't been smart and precise. Surely!

  17. is medicine still for profit? i last heard IT IS! who what where how is it ever going to be a HUMAN RIGHT…medical health care

  18. Boy she sent my heart plummeting at the 2 minute mark. Thank you Sue Desmond-Hellmann for putting this data in the context of my humanity.

  19. Propose it in public health and you get applause. Propose it in law enforcement and you get riots. Either way profiling boils down to using your limited resources in the most efficient way.

  20. I'm sorry but why she taking credit for something that the public health field has been doing for YEARS like yes you're a Doctor and thanks for spreading awareness but public health researchers are extremely intelligent biostaticians/epidemiologists that don't need practicing M.D.'s acting like they're the ones saving everyone's lives. They're there to apply public health to their individual patients unless they chose a career in public health (which is not fee-for-service) so none of them do. HUG YOUR LOCAL EPIDEMIOLOGIST.

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