Good healthcare decisions depend on good data – whether you’re making federal health policy or treating a single patient.
But the data is often incomplete – particularly when it comes to defining a group that still makes up the majority of the U.S. population — a ‘non-Hispanic White’ person. That’s the primary reference category used in health data.
“Nobody questions who’s white, but they should,” said Jen’nan Read, a Duke sociologist and lead author of new research recently published in the journal Demography. “The white category contains diverse ethnic subgroups, but because we lump them all together, we miss important health vulnerabilities for millions of Americans.”
Read and co-author Fatima Fairfax, a Duke doctoral student in sociology, analyzed data from the 2000 to 2018 waves of the National Health Interview Survey to compare the health of white adults born in the U.S., Europe, the Middle East, and the Former Soviet Union.
Duke sociology professor Jen’nan Read and PhD student Fatima Fairfax
Separating groups collapsed into the white category, they found that foreign-born Whites have a smaller health advantage over U.S.-born whites than is commonly assumed, and immigrants from the Former Soviet Union are particularly disadvantaged. Those immigrants report worse health, including higher rates of high blood pressure, compared to U.S.-born whites as well as people from Europe and the Middle East.
These findings illustrate how global events, such as the wars in the Ukraine and Syria, have contributed to changes in the composition of white immigrants over time.
Understanding these changes – and the distinct experiences of white immigrant subgroups – is vital to understanding long-term patterns in health disparities within the broad white category, the authors argue.
“If we truly care about reducing health disparities in this country, we need to know where the disparities are. And they get hidden when people are lumped into broad categories,” Read said. “Ukrainian immigrants, for example, we see in the news what they’re leaving. Death, destruction, their kids may have gone years now without education. This has lifelong impacts on their wellbeing. The physical consequences from stress are enormous–we know stress increases all sorts of physical health problems. High blood pressure, cholesterol, the list goes on.”
And the science is clear. The more accurate the information healthcare providers have on their patients, the better the outcomes.
“We’re missing health patterns here,” Read said. “Our country is extremely diverse, and not talking about diversity doesn’t change that fact. Health inequality costs us a lot–it costs the healthcare system and society as a whole.”
“Health is arguably the most important indicator of how a society is doing, and paying more attention to diversity within broad categories will allow us to do better.”
Post by Eric Ferreri, Duke Marketing & Communications
A long time ago in a galaxy far, far away… Or should I say, January 23 at the Rubenstein Arts Center…? That is where biomedical engineer Nina Tandon showed us the almost magical, yet extremely precise, science of EpiBone–where personalized bones and cartilage are grown from stem cells.
Photo credit: Brown Girl Magazine
But first, it would be completely inappropriate of me to discuss Tandon’s revolutionary work without first sharing her stories from her childhood and adolescent years; that was one of the many aspects I admired about her talk–how much love Tandon shared for those who helped spark her passion for science.
First, there was her grandmother, Dadi Ma, who at a young age wanted to study math, but unfortunately, due to the time she grew up in, was pushed away from any STEM-related field. Tandon helped complete her Dadi Ma’s dreams to pursue a STEM education. And there were the late nights in the research library with her mother; Tandon told us how she would often use her class as a group to “test how people’s memories worked, and test our (Tandon’s) classmate’s depth perception.” Then, Tandon met Dr. Maria Musarella, who helped identify her brother’s retinitis pigmentosa. And while no cure for it at the time, Dr. Musareli told Tandon how there was a team at MIT working on it–to which Tandon thought, “Maybe I’ll join that team one day.”
Little did young Nina Tandon know just what she would do one day.
After going to school for electrical engineering, Tandon found herself working at a Bell Labs spin-off, where she learned one of the most important lessons of her life: One’s choice of job should always be “content secondary, people primary.” However, because of the new suburban area she found herself in post-9/11, Tandon felt isolated. But within this time of solace, she was able to connect the similarities between genes and data: “The axon conduction in a nerve–that’s a lot like those same equations that govern the transatlantic cable… cell membranes are 20 times higher capacitance than the best capacitors that we could build with our human hands.”
Through these observations, Tandon was able to conclude that “our bodies are the most exquisite technology we have ever been familiarized with.”
Photo credit: London College of Osteopathy
So she decided to apply to the team at MIT that Dr. Musarella had told her about years before, in which she was accepted and then joined. It was a full circle moment; Tandon was seeing herself living the dreams of the girl who would conduct experiments on her elementary school class. It should have been perfect, right?
“And I had made a mistake… I made a mistake.” She had not chosen people first and content secondary. However, as Tandon noted many times throughout her talk, it is her failures that showed her what it was she needed to do in order to succeed.
I found this aspect of the talk truly inspiring. Usually, when an extremely accomplished person talks to an eager room, they spend most of their time highlighting what they have done correctly. But here Tandon was, taking her time telling us all of the ways in which she had failed. And how those were the moments that led to her largest lessons learned. Although I can’t speak for everyone in that room, as a college student myself, there was a comfort in seeing such a successful, powerful, and kind woman telling us that we will fail… And showing us that that is the beauty in success.
So, to make an extremely long story short, Tandon then proceeded to join Robert Langer’s lab at MIT for five years, studying “how electrical signals could coax stem cells into becoming tissue,” work in a management consulting job at McKinsey & Company to learn more about entrepreneurship, and then attend Columbia for her EMBA and PhD (at the same time!). Phew, that’s a lot.
In 2014, Tandon co-founded EpiBone, in which she and her team began working in a candy factory-converted lab in Harlem. By starting with CT scans, EpiBone can make a “perfect puzzle piece-shaped biome material scaffold and a perfect puzzle piece bioreactor.” In other words, “an environment that simulated the natural conditions for tissue development.” Within two to four weeks, Tandon and her team can grow any cartilage, bone, and joints needed throughout the body.
Photo credit: EpiBone
Since starting her company, EpiBone has been able to grow jaw bones for six patients, which “fit perfectly and were integrated within four to six months.” This is just the beginning. EpiBone’s technology could change how we view medicine and treatment–giving patients a promise of more active lives instead of just a prescription of pain medicines.
However, as much of a miracle as this is, Tandon had to move her business’s location because of the restraining process of clinical trials within the United States, where the limited funding cannot match the necessary costs of clinical trials. Now in Abu Dhabi, Tandon has found a home for her and her family to live happily while also being in a place where she feels like EpiBone is finally starting to see a future where it can be implemented into medicine and used in patients.
Photo credit: EpiBone
Ending her talk, Tandon noted how she has learned to count her blessings, even in times when she felt like her work was not being appreciated for what it was. “It’s a shortcut for me because I’ve studied biology to be grateful… Oh my god, my heart just beat five times–that’s like a million miracles.”
Tandon has shown us that true success is not viewed from the top of the mountain, looking down at all that you have climbed, but instead, learning to appreciate and find joy in the trek to the top. I thank her, on behalf of all of the people at Duke and all who she will help in the future, for her revolutionary work in science and her honest words of inspiration.
In an increasingly polarizing world, the discussion surrounding human rights remains at the forefront of all that we do as a society. People are becoming more aware, as, these days, violations are displayed right before our eyes. With a click of a button or a swipe of the thumb, people are able to see travesties occurring throughout all parts of the world. Developments in technology help us remain knowledgeable about such issues, but what about the offenses that we don’t see—the silent killers that we chalk up to poor fate, to chance? What about the violations in which we ourselves play a major role? These are urgent questions that researchers at the Duke School of Medicine are working to answer, with a specific focus on the deadly impacts of climate change.
In times of crisis, the most disadvantaged communities bear the greatest burden. The researchers recognize that climate change is no different and have strategized ways to reverse these effects. They presented their research in a recent talk, titled Climate Change and Human Health: Creating a Strategic Plan for Duke’s School of Medicine. Associate Professor and lung disease expert Dr. Robert Tighe led the conversation.
A photo of Dr. Robert Tighe. Courtesy of Duke’s Department of Medicine Website.
While presenting his research, Tighe identified a major shift in sea surface temperature trends, noting that the trend has deviated greatly from the statistical norm. Although the reasons behind this shift are not fully understood, it is believed to have serious implications, as excess heat poses risks to human health. According to the Centers for Disease Control, increasing temperatures and carbon dioxide have the potential to impact water quality, air pollution, allergens, and severe weather conditions. These conditions, in turn, bring forth respiratory allergies, cholera, malnutrition, and cardiovascular disease, to name a few. Tighe’s research goes beyond the general effects of these issues; it delves into how they disproportionately impact the most vulnerable members of society: children, the elderly, low-income communities, and communities of color.
A chart containing information about the most vulnerable parts of population to the effects of climate change. Courtesy of Biological Science.
On a local scale, Tighe highlights that many in these vulnerable positions often lack access to the healthcare necessary to mitigate these impacts. For instance, low-income citizens are often unable to afford the costs associated with repairing the physical damage climate change inflicts on their homes, leaving them exposed to pollutants and the effects of environmental toxins. The elderly also find themselves in similarly precarious scenarios, as many of these situations require evacuation—something not always feasible for those in fragile health. Consequently, they too are left exposed to pollutants and dietary challenges exacerbated by climate change.
On a global scale, these issues heavily impact countries in vulnerable positions. The United States, China, India, the European Union, and Russia are among the largest contributors to carbon emissions. However, the consequences of this burden fall disproportionately on countries like Bangladesh, Haiti, Mozambique, small island nations, and others. Due to their geographic locations, climate change brings far more than just hotter days—it brings devastating hurricanes, tsunamis, cyclones, and widespread malnutrition. The limited financial resources in these nations make rebuilding and mitigating these impacts extraordinarily challenging, especially as many climate effects are recurring. This disparity is particularly frustrating, as these countries contribute only a fraction of the world’s carbon emissions.
A map of the global climate risks. Courtesy of the New York Times.
This is precisely what Tighe’s work aims to address. He is working to connect the science on climate change effects, researched by those in the School of Medicine, with that of the Nicholas School of the Environment. Referring to this as an interdisciplinary issue, Tighe believes that the place to begin is within the community. He emphasizes the importance of starting with the people of Durham: What do they need? How can we best help them? How does this affect our own backyard? He stresses the importance of outreach, educating the community on how climate has long-term impacts on their health. Tighe also underscores the need to view this as an opportunity to combine diverse strengths to address the crisis from every angle.
In the face of a climate crisis that goes beyond borders and affects the most vulnerable among us, Tighe’s and his fellow researchers’ work is a call to action. By fostering collaboration between scientific fields and engaging directly with local communities, he develops an approach that is both comprehensive and compassionate. His work reminds us that addressing climate change isn’t just a scientific or political issue—it’s a deeply human one, demanding a united effort for the wellbeing of all under the sun.
On every third Thursday of the month, Devil’s Krafthouse is host to Research on Tap: a series that gives Duke researchers, from undergraduates to postdoctoral fellows, the opportunity to present their work in a casual setting. It may seem odd for the procedures of academia to make their way into a space for socialization and entertainment, but this situation allows individuals to practice speaking publicly to a general audience under a short time limit–good conditions for developing their “research elevator pitch.” These were the pitches on October 17:
As it’s name suggests, Cv is a bacterium violet in color. Photo courtesy of Dr. Edward Miao and Dr. Carissa Harvest.
Jacqueline Trujillo, a Ph.D. student in the Department of Molecular Genetics and Microbiology, who is part of Dr. Edward Miao’s lab, presented her research on immune cell response to the bacterium Chromobacterium violaceum (Cv). Being an environmental pathogen, Cv usually resides in the soil of tropical and subtropical areas. While disease in humans is rare, the mortality rate is high in immunocompromised individuals.
“The Miao Lab was initially studying pyroptosis, a form of cell death that occurs during infection, when they discovered Cv-induced granulomas,” Trujillo said. Granulomas are specialized structures that are formed to contain and eradicate pathogens, but they can range in the arrangement and type of cells they consist of; one induced by tuberculosis infection, for example, would include adaptive immune cells like T and B cells. However, when the pathogen inducing them is Cv, only innate immune cells are present: neutrophils in the inner cluster and inflammatory macrophages in the outer cluster. When Cv is detected, neutrophils are the first to flock to the site of infection in a “toxic swarm.” The neutrophils themselves are typically able to effectively kill microbes even before granuloma formation. “These are one of the most toxic defending cell types in the immune system,” Trujillo said.
Despite this, the lab observed something unusual: these neutrophils failed to kill off the Cv bacteria, which continued to replicate despite the swarm. The lab ultimately saw Cv eliminated by the innate granulomas within about 21 days, but the ability to survive the neutrophils is what Trujillo now aims to understand. Such a feat from an environmental bacterium comes as a surprise, being “something more characteristic of the causative agent [Yersinia] of the bubonic plague,” Trujillo said. A comparison between the proteins CopH and YopH, virulence effectors in Cv and Yersiniarespectively, reveals lots of similarities between the two. Trujillo hypothesizes that CopH is part of the secret to how Cv disarms the immune system’s defenses.
The role of virulence effectors is generally “aid[ing] in survival, invasion, and suppressing immune responses.” Through needle-like structures, bacteria inject these proteins into a host cell. A cell responds to this in two main ways. It dies–initiating pyroptosis to prevent the pathogen from replicating inside the cell. Second, it signals for help by making chemical messengers called inflammatory cytokines. Investigating the first response is what led the Miao Lab to Cv-induced granulomas.
Now, the lab is interested in understanding the regulatory signals that form the granuloma–and the role that inflammatory cytokines might play, if any. In addition to testing her hypothesis on CopH, Trujillo intends to determine if neutrophils respond to Cv’s initial survival by producing the cytokine IL-18, thus recruiting immune cells to the infection site. This would help the Miao Lab confirm their idea that the neutrophils’ failure to clear Cv is what prompts the process of granuloma formation.
With much still unknown in the area of granuloma biology, Cv provides an “excellent model for studying immune cell biology and characterizing bacterial virulence effectors,” Trujillo said.
Though it happens that many Research On Tap speakers are in the sciences, the program isn’t discipline-specific. Our second researcher of the evening, Sungil Kim, studies a far different field from Jacqueline.
Photo courtesy of Hong Chung.
As a Ph.D. student in Finance at the Fuqua School of Business, Kim is looking at the effects of a growing trend in recent years: private equity (PE) firms acquiring healthcare companies. His focus is on what’s known as the “buy-and-build”, as this business strategy is often used by such firms entering the healthcare sector. The scenario typically looks like this: a private equity firm first acquires a large existing company, called the platform company or “first deal.” They’ll then acquire several smaller companies, or “add-on deals,” in order to expand the platform company’s operations.
Since private equity firms buy businesses with the eventual goal of selling them at a profit, their primary focus is increasing efficiency to reduce costs. On one hand, these buyouts might be seen as beneficial for languishing businesses in need of operation enhancements. But within the healthcare sector, many worry the resultant cost-cutting will lead to declining standards of care for patients.
Kim set out to investigate if operational improvements are sustainable across multiple acquisitions within the buy-and-build framework. The simple answer? No.
Kim confirmed that, on average, private equity firms improve the operational performance of hospitals without hurting quality, “a finding that agrees with some of the previous literature.” Yet, one only needs to take a closer look into the sequence of deals to uncover a different, more complicated story.
To arrive at his answer, Kim considered three main factors–operational efficiency, profitability and quality–in both the platform company and add-on companies. Platforms, or first acquisitions, did see success in performance, but this came with what appears to be a trade-off, as the first two factors increased while quality went down. As in, quality of healthcare. From one of Kim’s graphs, it was apparent that occurrences of four of the six health outcomes measured, including mortality and remission of heart failure, increased in such first deal situations.
Meanwhile, results for the add-ons changed little before and after the buyout, meaning that the initial success from the platform didn’t carry over to later acquisitions, even as reduced costs did. A potential reason for this inability to replicate success, Kim explained, is that these cost savings may come from reducing the number of patients and services, instead of truly improving the efficiency of operations.
In contrast to academic journals that display research that’s been in the works for years, Research on Tap brings us closer to working papers in their ongoing, exploratory stages. While it’s difficult to draw wider conclusions from Kim’s findings just yet, and important to remember the specific first deal context of this study, research like his helps us further understand the issues facing improvement of our healthcare system and where private equity plays a role.
If you’re interested in learning something new and free Krafthouse bites, swing by and attend a session–the next one occurs on November 21, 2024 at 5 p.m. The program welcomes prospective speakers to place themselves on the waitlist for a spot.
Dr. John Bartlett, Professor of Medicine and Global Health Researcher
In your retirement, would you ever hold four Zoom calls every week with colleagues?
To be fair, Dr. John Bartlett is not technically retired. He is employed by Duke at the 20% level and continues to serve as a Professor of Medicine. However, his busy schedule, which also includes 2-3 months in Tanzania every year and writing grants to support research education efforts, in no way resembles the glorified picture of retirement many of us imagine!
Fellow freshmen, we may be in for the long haul.
Before I dive into my interview with Dr. Bartlett, I must acknowledge the incredible enthusiasm he showed in response to my invitation to an interview. Even as cable lines are down in western North Carolina, where he resides, due to the impact of Hurricane Helene, he still offered to keep our original interview time and made himself fully accessible to my questions. I extend my sincere gratitude to Dr. Bartlett for his time, and it is only just for me to relay his thoughts to our readers at large.
For students unfamiliar with Dr. Bartlett’s background or professional experiences, he has been a Duke faculty member since the 1980s, serving as both a physician in infectious diseases and internal medicine and a professor. His lengthy career traversed continents, having become deeply involved in international HIV/AIDS research and treatment since the 2000 World AIDS conference held in Durban, South Africa.
“As I traveled to South Africa, I witnessed the profound disparities between clinical outcomes for patients in the U.S., who were thriving, and [those in] the continent most severely impacted by HIV, where no treatment was available,” said Dr. Bartlett, recalling his transition to international work. “We reckoned that [the] concept of research with service could be applicable with an African partner,” he added, which led him to spend two-thirds of the next decade in Tanzania, focusing on this new partnership.
Picture of the Kilimanjaro Christian Medical Centre, where Dr. Bartlett conducted most of his research and education efforts in Tanzania
Captivated by Dr. Bartlett’s unique experiences, I inquired why he became involved in Tanzania, a country halfway across the globe. To my surprise, it turned out that in the early 2000s, faculty and students at Duke held a strong inclination towards advancing global health research. At the same time, researchers also sought to expand the scope of their activities overseas. Dr. Bartlett shared what was perhaps the most important reason last: “I have to credit my wife, a social worker, who was also quite committed to international work.”
I learned much about global health throughout the interview. When Dr. Bartlett shared statistics showing 100% effectiveness of certain HIV/AIDS treatments currently offered in lower-income countries, I was stunned. From no access to treatment a few decades ago to successful management of the disease today, there has been remarkable and swift progress that is saving millions of lives. Of course, there are still barriers to treatment including cultural norms, “ubiquitous” stigma, lack of testing resources, and cost. However, the global health field is advancing every day, with newfound knowledge regarding protective factors against HIV transmission helping to further lower mortality rates.
Discussing Duke’s global health efforts at large, Dr. Barlett was quick to point out the diversity of current projects around the world. “I would refer you to the website for the latest list of countries because I can’t keep up with the continuing growth!” Upon a quick search, this sentiment makes sense: Duke works in more than 40 countries and there are more than 100 active projects. “I am especially proud to see that [the institute’s work] is not limited to a single geographic region or a single topic”, Dr. Bartlett added, reflecting how projects “run the gammit from infectious diseases to non-communicable diseases to cancer to mental health to health systems strengthening.”
By this point in the article, maybe some engineer readers are yearning for a message pertaining to their academic interests. Don’t worry, Dr. Bartlett talked about your importance in global health work during the conversation too! “There are quite a few BME professors who work with students to develop practical, low-cost solutions to common global health problems,” he said. From rapid diagnostic tests to laparoscopes, the BME department has played a crucial role in the Global Health Institute’s efforts. And these engineering projects are still active: for students desiring to involve themselves in this work, Dr. Bartlett recommends reaching out to Dr. Ann Saterbak, a Biomedical Engineering professor who coordinates many opportunities.
Before I conclude, I would like to share a quote from Dr. Kathy Andolsek, professor of family medicine, discussing the character, expertise, and work of Dr. Bartlett:
“He was a dedicated researcher and clinician and an early pioneer in HIV/AIDS. [As a] primary doc, I [worked] with him to get my patients into his clinical trials… so we ‘shared’ many patients. He was inspirational to students and a great listener.”
Thank you, Dr. Bartlett, for your tireless work on HIV/AIDS treatment around the world. As an educator, researcher, and clinician, you have contributed much to the betterment of health outcomes for patients. Your commitment towards this noble cause and desire to help Tanzanian counterparts become independent in their research encourage all of us, medical students and non-medical students alike, to persistently pursue goals we believe in.
When we think about global interconnectedness we often focus on varied cultures, but we tend to forget about innumerable systemic dynamics that could enrich our understanding of the world. The senior presentations given by students in International Comparative Studies to mark the end of the term shared their mission to understand the world better through research.
The exploration of language ideologies in Mauritius, the complex yet fascinating web of transitional justice, the contentious aspects of medical missions in global health, and the intersection between superficiality and urban dynamics in Los Angeles all demonstrated understanding the unseen world at play.
Language and Identity in Mauritius
Katy Turner’s research into the Mauritian education system sheds light on the complex interplay between language and colonial histories. Even though one could argue colonialism is a tale of the past, Turner’s research proved otherwise. In Mauritius, where the creole language — formed by enslaved individuals and now a mother tongue — meets societal resistance, the educational emphasis remains on English and French. Turner’s exploration raises critical questions: How do Mauritian primary school teachers perceive the role of Mauritian Creole, especially given its contentious status? How has the colonial past shaped these perceptions?
Her findings reveal a conflicted landscape. While some view the Mauritian Creole as a relic of the past, advocating for a future aligned with English, others see it as vital for a holistic educational experience. Its colloquial use in classrooms helps connect students with their history, and according to her observation, students didn’t mind its use over English and French, but their parents very much did. They preferred English and French over their own local language. This put me in a daze. Afterall, being Pakistani born and raised, this wasn’t a surprise: English is the language of the rich, and Urdu is the language of the poor. These complex linguistic preferences of these countries highlight how colonized some developing countries are till today.
In Mauritius, the narratives of slaves, parents and educational policies often discourage this practice. This ‘hidden curriculum‘ suggests a deep-seated struggle with identity and linguistic heritage, hinting at a broader dialogue about language as a carrier of culture and history. This colonial hangover is one we need to fight to connect with what our culture really means.
The Anti-Politics of Memory in Transitional Justice
GraceEndrud delves into the “anti-politics” of memory, examining how transitional justice often morphs into a universal narrative that may overlook local truths. Her focus on the International Center for Transitional Justice (ICTJ) illuminates the challenges of defining justice in varied contexts — ranging from criminal justice to truth commissions. The ICTJ’s extensive work is reflected in their archival collections spanning several decades. Grace sat in the library searching through archives for days, and went to great lengths (like analyzing the order they were in) to show their global influence also reveals tensions, such as in Iraq where document manipulation was used to sway electoral outcomes.
Blindfolded suspected militants, with possible links to al-Qaeda, are seen at Iraqi police headquarters in Diyala province, north of Baghdad December 5, 2011. Police forces arrested 30 suspected militants during a raid in Diyala province, a police source said. REUTERS/Stringer
This research was inspired by James Ferguson’s analysis in “The Anti-Politics Machine.” It suggested that transitional justice can sometimes strip away the political layers that are essential for understanding and addressing the root causes of injustice.
Reassessing Medical Missions Through a Decolonial Lens
Catherine Purnell’s investigation into medical missions driven by evangelical Christian beliefs poses questions about the possibility of decolonizing global health. The narrative that divides the world into those who help and those who need help is deeply entrenched in the ethos of many medical missions. Purnell’s interviews with medical missionaries reveal an underlying intention to provide care in remote areas, which often includes building schools and water systems alongside healthcare.
However, the real challenge lies in shifting these missions from a model of evangelical humanitarianism to one of genuine decolonization. According to her, true decolonized care would prioritize giving autonomy back to local communities and focusing on solidarity rather than charity. Purnell’s findings suggest a fundamental conflict between the traditional goals of medical missions and the emerging needs of decolonial, equitable healthcare practices.
The Multicultural Dynamics of Urban Spaces
Jess Blumenthal’s exploration into the complex narratives of multiculturalism in Los Angeles offers a fascinating lens through which to view urban dynamics and identity. Starting with the historic intersections in neighborhoods like Little Tokyo/Bronzeville, Jess examines the fluid and often contentious shifts in community compositions and their cultural implications. Originally a Japanese neighborhood, Bronzeville became predominantly African American during World War II when Japanese residents were interned. Such shifts underscore the impermanence and adaptability of urban ethnic landscapes.
Jess connects these historical and cultural narratives to broader literary works like “Tropic of Orange” and Octavia Butler’s “Parable of the Sower.” These works critique the superficiality of multiculturalism, suggesting a more interconnected and deeply woven fabric of society that transcends simplistic understandings of diversity. Jess uses these stories to highlight a poignant metaphor: just as characters in Butler’s work envision a destiny among the stars, our own societal evolution might be seen as an ongoing journey towards a more genuinely integrated multiculturalism.
Conclusion
Together, these presentations accentuated the complexities of cultural identity, memory politics, and health equity in a globalized world. They challenge us to think critically about how languages shape national identity, how justice processes can reflect deeper truths without falling into the traps of depoliticization, and how global health initiatives might genuinely respect and uplift the communities they intend to serve. As our world becomes increasingly interconnected, these discussions are crucial for fostering a more just and equitable global society.
If your community relied on COVID-19 rapid tests to reopen safely during the first year of the pandemic, there’s a good chance Rajiv Shah had something to do with it. Not just for his ambition but also for his audacity to transform the nature of our response to pandemics: Rajiv Shah, the president of the Rockefeller Foundation, played a crucial role in scaling up diagnostic testing for COVID-19.
He’s also the man who tackled Ebola with the Obama Administration. Back then, Shah and his team embarked on a “big bet” to deploy 2,500 troops to fight the disease, not on the battlefield, but on the frontlines of human health. Much like the name of his 2023 book “Big Bets,” he embarked on a journey to change the world.
In a Jan. 31 talk hosted by the Duke Global Health Institute, Shah discussed his “big bet mindset” when it comes to tackling public health challenges.
Bet #1 Diagnostic Testing at Scale
For starters, what’s a big bet?
“It’s a big bet you take on the community to help young people get opportunities. Often, when we think of charitable endeavors, we imagine that doing a little bit is beneficial because it makes us feel good. In contrast, a big endeavor means taking on something significant and engaging in the hard work necessary. It’s about going beyond just doing the best we can; this isn’t merely a charitable endeavor, it’s a strategic approach to ensure national security.” Shah explained.
Keeping true to his word, the goal was clear: administer 30 million tests per week to preempt the need for lockdowns and enable a safer, faster return to normalcy. This was not just a health initiative; it was a socio-economic strategy aimed at averting total disaster. He took a big bet, and the numbers spoke for themselves. The Rockefeller Foundation played a pivotal role in assisting schools with their reopening strategies during the pandemic. This support included the establishment of collaborative networks, the development of resources and guidelines, and the provision of expert recommendations. Now do you get why this man probably saved your life? It’s because he did!
Bet #2 A Memo for Bill Gates
It wasn’t all that easy for him though. He had his haters (don’t we all?). Perhaps the difference was, his hater was Bill Gates. But he successfully proved Gates wrong too. Thankfully, Gates and Shah are more like besties than anything now. Despite the initial dismissal of his ideas as “the stupidest thing,” Shah’s persistence and innovative thinking paved the way for a groundbreaking bond structure to fund vaccinations, ultimately saving millions of children’s lives. Shah and Gates – two greats in one room – inevitability led to the production of something good: The Vaccine Alliance. This meeting set the stage for a three-year roadmap focused on a bond structure to fund vaccinations. This initiative ultimately contributed to saving 16 million children’s lives.
The Final Bet: The Power of Experimentation.
I’ll be honest, I was intimidated walking into this room. I was in my Duke hoodie, not expecting fancy foods, and coat checks (good news: this meant they recorded his speech and uploaded it on YouTube. Check it out!).
At the heart of Shah’s philosophy is a belief in the power of experimentation and innovation. His call to “keep experimenting” embodies the spirit of resilience and creativity that is essential for tackling the world’s most daunting health challenges. Being amidst well-suited individuals while donned in a hoodie wasn’t an experiment in the scientific sense, but it was an experience that highlighted the contrast between expectations and reality, comfort zones and the unfamiliar. It served as a metaphor for the broader experiments we’re all a part of—those that push us beyond our boundaries, challenge our preconceptions, and ultimately lead to growth.
His book was called ‘Big Bets’ because the editors thought it was catchy. They were right. But this title doesn’t just grab our attention—it invites us into a world where daring to dream big and taking calculated risks can lead to monumental changes in public health and beyond.
On June 5, 1981, the Centers for Disease Control and Prevention reported the first cases of a mysterious disease afflicting young, otherwise healthy men in a tiny suburb of Los Angeles, California. The disease, now known as AIDS, would go on to infect 85.6 millionpeople around the world, sparking an epidemic that persists to this day.
Pictured from left to right: Dr. James Curran and Dr. Kevin M. De Cock
The Origin of the Epidemic
The first cases of AIDS were reported by Dr. Michael Gottlieb, a young immunologist from UCLA. His groundbreaking findings, published in the CDC’s Morbidity and Mortality Weekly Report, described “previously healthy gay men from Los Angeles, San Francisco, and New York, who presented with rare opportunistic infections,” said De Cock. These infections, known as PCP (Pneumocystis carinii pneumonia) and KS (Kaposi’s sarcoma), were extremely rare. Upon observation, Gottlieb identified a startling commonality among the cases: they were all sexually active gay men.
These findings “didn’t fit into any organizational unit at the CDC,” so a multispecialty task force was formed. Led by Curran, it recruited experts in STIs, parasitology, virology, cancer, and more.
Tracking the Epidemic
At the start of the epidemic, cases were phoned into the CDC by individual doctors. But this quickly became inadequate. The epidemic was growing fast, and CDC phone lines could not keep up. “The CDC, therefore, developed a surveillance case definition for the syndrome,” De Cock explained. “Cases meeting this definition were reported through health departments to the CDC.”
“I think we were able with the case definition for surveillance, to take advantage of the fact that all of these conditions were very serious and so unusual that the physician would say ‘I’ve never seen anything like it,’…,” Curran said. “The other conditions were far less specific and far less useful for tracking the disease.”
In October 1981, these tracking protocols helped identify AIDS as a sexually transmitted disease. A national case-control study found that sexual activity was a leading risk factor, and a cluster of cases in 10 US cities linked via sexual contact was discovered. “People just didn’t want to believe it,” Curran said. “They wanted to believe that it wasn’t something transmissible.”
Expanding Epidemic
Over the next year, the epidemic expanded to include injection drug users, heterosexual partners of bisexual men, people of Haitian descent, and infants. But perhaps most surprising was the transmission occurring through blood transfusion. In December 1982, a case of AIDS-like illness was reported in a 20-month-old infant after receiving blood from a donor who later developed the virus.
“Until that December report of the infant, the mainstream media had actually paid very little attention to AIDS. But that suddenly changed,” said De Cock. “While AIDS was seen as a problem of marginalized groups… it was easy to ignore. But anyone might need a blood transfusion.”
In the following years, rumors surrounding transmission and contact sparked nationwide panic. Fear of contracting the disease caused AIDS patients to lose their jobs and housing. Although the CDC provided up-to-date information on the nature of the virus, quelling public fear was extremely difficult. “AIDS proved that you can’t separate prevention and treatment,” Curran explained.
Modern AIDS Era
As we get close… to 100 million HIV infections since the epidemic began- have we done as well as we should have?”
Dr. Kevin M. De Cock
In 1991, researchers successfully identified HIV (Human immunodeficiency virus) as the underlying cause of AIDS. Since then, scientific understanding of the disease has greatly improved. “Our success has made AIDS more normal, which has robbed the disease of some of its mystique,” De Cock expressed. However, there is still no known cure for AIDS. The disease is a lifelong battle that wreaks havoc on the people it infects.
Source: Our World in Data
De Cock and Curran’s contributions to the AIDS epidemic fundamentally shaped our understanding of the virus. Their work shines a light on the importance of frontline research and support. Their book, entitled ‘Dispatches from the AIDS Pandemic: A Public Health Story,’ is available to read here.
Note: Each year, we partner with Dr. Amy Sheck’s students at the North Carolina School of Science and Math to profile some unsung heroes of the Duke research community. This is the sixth of eight posts.
In the complex world of scientific exploration, definitive answers often prove elusive, and each discovery brings with it a nuanced understanding that propels us forward. Dr. Dana Kristine Pasquale’s journey in public health serves as a testament to the intricate combination of exploration and redirection that have shaped her into the seasoned scientist she is today.
Pasquale said her scientific path has been “…a nonlinear journey, that’s been a series of over-corrections. As I’ve gone from one thing to another, that hasn’t turned out to be what I expected.”
Dana Pasquale Ph.D.
Anchored in her formative years in a study abroad experience in Angola, Africa during undergraduate studies, Pasquale’s exposure to clinical challenges left an indelible mark. She keenly observed the cyclic nature of treating infections by shadowing a local physician.
“We would treat the same people from month to month for the same kinds of infections,” she recalled.
Things like economic and social barriers weren’t as stark there – everyone was at the same level, and there was no true impact that she could make investigating them. This realization sparked a profound understanding that perhaps a structural, community-focused intervention could holistically address healthcare needs – water, sanitation, etc. It set the course for her future research endeavors.
Upon returning to the U.S., she orchestrated a deliberate shift in her academic trajectory, choosing to immerse herself in medical anthropology at the University of North Carolina-Chapel Hill. Her mission was clear: to unravel how local communities conceptualize health. Engaging with mothers and child health interventionists, she delved into health behavior, yet found herself grappling with persistent frustrations.
“I found [health behavior] frustrating because there were still a lot of structural issues that made things impossible,” she says. “And even when you think you’re removing some of the barriers, you’re not removing the most important ones.”
Rather than being a roadblock, this frustration became a catalyst for Pasquale, propelling her toward the realms of epidemiology and sociology. Here, the exploration of macro and structural factors aligned seamlessly with her vision for sustainable public health, providing the missing pieces to the intricate puzzle she was trying to solve. She didn’t expect to end up here until her mentor suggested going back to school for it.
As principal investigator of Duke’s RDS2 COVID-19 Research and Data Services project during the early months of the pandemic, Pasquale navigated the challenges associated with transitioning contact-tracing efforts online. Despite hurdles in data collection due to the project’s reliance on human interaction and testing, the outcome was an innovative online platform, minimizing interaction and invasiveness. This accomplishment beautifully intertwines with her ongoing work on scalable strategies to enhance efficiency in public health activities during epidemics.
“We had a lot of younger people say that they would prefer to enter their contacts online rather than talk to someone… something that could be a companion to public health, not subverting contact-tracing, which is an essential public health activity.”
Pasquale’s expansive portfolio extends to an HIV Network Analysis for contact tracing and intelligent testing allocation. Presently, she is immersed in a project addressing bacterial hospital infections among patients and hospital personnel, a testament to her unwavering commitment to tackling critical health challenges from various angles.
When queried about her approach to mentoring and teaching, Pasquale imparts a valuable piece of wisdom from her mentor: “If you’re not completely embarrassed by the first work you ever presented at a conference, then you haven’t come far enough.”
Her belief in the transformative power of mistakes and the non-linear trajectory in science resonates in her guidance to students, encouraging them to not only accept but embrace the inherent twists and turns in their scientific journeys. As they navigate their scientific journeys, she advocates for the importance of learning and growing from each experience, fostering resilience and adaptability in the ever-evolving landscape of scientific exploration.
Guest Post by Ashika Kamjula, North Carolina School of Math and Science, Class of 2024
Note: Each year, we partner with Dr. Amy Sheck’s students at the North Carolina School of Science and Math to profile some unsung heroes of the Duke research community. This is the fifth of eight posts.
Meet Dr. Oyindamola Adefisayo – Oyinda to her friends – a Postdoctoral Research Fellow at Duke. She’s exploring bacterial factors in host-pathogen interactions using mice.
During our interview, parallels in our journeys became clear. Even as a high school senior, I could strongly identify with Dr. Adefisayo’s work and share similar passions. I envisioned myself evolving into an inspiring scientist just like her and felt a strong connection with my aspirations as a high school senior.
Originally from Lagos, Nigeria, Dr. Adefisayo came to the U.S. via the African Leadership Academy in Johannesburg. Like me, she left home at 16 for a two-year residential program for teenagers. It was filled with passionate and driven students like I’m with at NCSSM. Oyinda earned her B.A. in Biology at Clark University, specializing in the genetic basis of wing and eye development in the fruitfly Drosophila melanogaster.
Her Ph.D. at Memorial Sloan Kettering in New York City focused on Immunology and Microbial Pathogenesis. She studied mycobacteria, examining DNA damage response pathways, antibiotic resistance, and mutagenesis. The work connected with her knowledge of Nigeria’s high tuberculosis burden as she sought practical applications. She found that a delay in the machinery of DNA copying itself triggered a damage repair pathway called PafBC.
Beyond the lab, Oyinda’s passion for ballroom dancing reflects her belief that science is an art, since there’s so much creativity and artistic sense that goes into being a scientist. This resonated with me too. I use painting as an outlet during my research on environmental stressors and antibiotics at NCSSM.
I was inspired by Dr. Adefisayo’s beliefs and passions. She continues her scientific career by delving deeper into protocol development, data analysis, and global knowledge-sharing. Her goal is to learn from bacterial and host genetics and contribute to simplifying and expediting life science research for professionals worldwide.
Guest post by Emily Alam, North Carolina School of Math and Science, Class of 2024.
