Aaron S. Bernstein

Lungs in a Warming World: Climate Change and Respiratory Health

Climate change is a health threat no less consequential than cigarette smoking. Increased concentrations of greenhouse gases, and especially CO₂, in the earths atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, temperature variability, air pollution, forest fires, droughts, and floods, all of which put respiratory health at risk. These changes in climate and air quality substantially increase respiratory morbidity and mortality for patients with common chronic lung diseases such as asthma and COPD and other serious lung diseases. Physicians have a vital role in addressing climate change, just as they did with tobacco, by communicating how climate change is a serious, but remediable, hazard to their patients.

Special FeaturesLungs in a Warming World: Climate Change and Respiratory Health

Climate change is a health threat no less consequential than cigarette smoking. Increased concentrations of greenhouse gases, and especially CO₂, in the earths atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, temperature variability, air pollution, forest fires, droughts, and floods, all of which put respiratory health at risk. These changes in climate and air quality substantially increase respiratory morbidity and mortality for patients with common chronic lung diseases such as asthma and COPD and other serious lung diseases. Physicians have a vital role in addressing climate change, just as they did with tobacco, by communicating how climate change is a serious, but remediable, hazard to their patients.

Climate change and children's health.

Purpose of review To present the latest data that demonstrate how climate change affects childrens health and to identify the principal ways in which climate change puts childrens health at risk. Recent findings Data continue to emerge that further implicate climate change as contributing to health burdens in children. Climate models have become even more sophisticated and consistently forecast that greenhouse gas emissions will lead to higher mean temperatures that promote more intense storms and droughts, both of which have profound implications for child health. Recent climate models shed light upon the spread of vector-borne disease, including Lyme disease in North America and malaria in Africa. Modeling studies have found that conditions conducive to forest fires, which generate harmful air pollutants and damage agriculture, are likely to become more prevalent in this century due to the effects of greenhouse gases added to earths atmosphere. Summary Through many pathways, and in particular via placing additional stress upon the availability of food, clean air, and clean water and by potentially expanding the burden of disease from certain vector-borne diseases, climate change represents a major threat to child health. Pediatricians have already seen and will increasingly see the adverse health effects of climate change in their practices. Because of this, and many other reasons, pediatricians have a unique capacity to help resolve the climate change problem.

The coming health crisis: indirect health effects of global climate change.

Global climate change threatens the health of hundreds of millions of people. While much has been written about the direct impacts of climate change on health as a result of more severe storms, more intense heat stress, changes in the distribution of infectious disease, and reduced air quality, we are concerned that the indirect impacts of a disrupted climate system may be orders of magnitude more important in terms of the human suffering they cause. Because these indirect effects will result from changes in biophysical systems, which are inherently complex, there is significant uncertainty about their magnitude, timing, and location. However, the uncertainty that shrouds this issue should not be cause for complacency; rather it should serve as an organizing principle for adaptation to its ill effects.

Biological Diversity and Public Health

In the wake of a species extinction event unprecedented in human history, how the variety, distribution, and abundance of life on earth may influence health has gained credence as a worthy subject for research and study at schools of public health and for consideration among policy makers. This article reviews a few of the principal ways in which health depends on biodiversity, including the discovery of new medicines, biomedical research, the provision of food, and the distribution and spread of infections. It also examines how changes in biological diversity underlie much of the global burden of disease and how a more thorough understanding of life on earth and its relationships has the potential to greatly alleviate and prevent human suffering.

The Importance of Biodiversity to Medicine

IN THE PAST 12 MONTHS ALONE, MORE THAN 1000 NEW species were identified. Some were found in Earth’s most remote locations, such as the Weddell Sea off Antarctica or central Australia’s Simpson Desert, where 3 species of carnivorous sponges and a new microbat species were found, respectively. In addition, nearly 100 previously unknown species of bacteria were found to be inhabiting human epidermis. When it comes to biodiversity—a term that describes the variety of life on the planet—the more scientists look, the more they find. But these discoveries represent far more than just novelty. In them can be found a major engine of advancement for medicine and biomedical research and a new lens with which to look on human health and disease. A Canadian scientific expedition to Easter Island in 1964 provides an example of how biodiversity can benefit medicine. In a remarkable stroke of luck, the scientists brought home a scoop of soil containing Streptomyces hygroscopicus, the bacterial source of sirolimus, a drug that has revolutionized the treatment of solid organ transplant rejection. Sirolimus and its derivatives have also shown promise in the treatment of brain, lung, endometrial, and kidney tumors and as a coating for arterial stents to prevent restenosis. Serendipity of this sort has arisen not only in exotic places but also in familiar ones. For example, Chromobacterium violaceum was cultured from the Pine Barrens of New Jersey, leading to the discovery of aztreonam, a principal antibiotic used in the treatment of gram-negative infections. Science has routinely appropriated microbial compounds for human use, ranging from old stalwarts such as penicillin, aminoglycosides, and tetracyclines to the new lipopeptides (eg, daptomycin) and antifungals (eg, caspofungin). But the reliance on natural products in drug development extends far beyond antimicrobial applications. Studies involving snakes, sea squirts, sponges, and snails have led to the discovery of angiotensin-converting enzyme inhibitors, trabectedin (a new treatment for soft tissue sarcomas), the antivirals azidothymidine and acyclovir, and ziconotide, respectively. Despite enormous investment into synthetic drug development, about half of the 100 most prescribed medications in the United States and about half of the new drugs approved by the Food and Drug Administration in the past 25 years derive directly or indirectly from nature (TABLE). Natural products compose a superb resource for drug discovery because they have evolved, in some cases during millions of years, to exploit fundamental biological pathways often shared by humans. In addition, the random aspect of the evolutionary process gives rise to products with unforeseen, and perhaps unforeseeable, biological actions, allowing for the development of pharmaceuticals with novel mechanisms of action. For example, paclitaxel (discovered in the bark of the Pacific yew tree), a mainstay of chemotherapy for a variety of cancers, was the first drug shown to inhibit microtubule breakdown during mitosis. The ability of nature to devise novel approaches to biological challenges has proven especially valuable to biomedical research. To survive in the extremely hot water of Yellowstone Park’s Mushroom Spring, the bacterium Thermus aquaticus has enzymes that remain functional at high temperature. One of its heat-stable enzymes, DNA polymerase, was instrumental in the development of the polymerase chain reaction, for which the Nobel Prize was awarded in 1993. Another Nobel Prize was awarded in 2006 for a discovery involving a common flower. Intending to produce more intensely colored petals, researchers introduced extra copies of a pigment gene into petunias. The resulting flowers were, against expectation, partially or totally white. The molecular basis for this effect was found to be RNA interference, a fundamental biological mechanism for inhibiting gene expression that has great potential to treat neurodegenerative disease, cancer, infection, and other medical conditions. A number of scientific breakthroughs have come from studies involving some of the 100 000 or more venomous peptides produced by sea snails of the genus Conus. These slow-moving predators, which live on or near coral reefs (among the most endangered habitats on earth), subdue fish with a precise chemical assault directed at their prey’s nervous system, leading to rapid paralysis. Peptides isolated from Conus species bind many molecular targets, including ion

Add ecology to the pre-medical curriculum.

In their Letter “Competencies: A cure for pre-med curriculum” (11 November 2011, p. [760][1]), W. A. Anderson and colleagues endorse a proposed shift in pre-medical education toward core competencies. We believe that the specific competencies proposed by the Association of American Medical

The Materiality of Human Capital to Corporate Financial Performance

Institutional investors have become increasingly interested in analyzing long-term investment risks and rewards posed by environmental, social and governance (ESG) factors. A growing body of data and analytical tools has been developed to assist in the task, but the focus has largely been on environmental and governance matters. This paper helps fill in the gap on social factors, specifically those involving how companies manage workplace relationships, a topic often referred to broadly as human capital or human resource (HR) management. We examine both a wide range of HR policies and separately those that relate directly to employee training.Our survey of the literature on human capital found 92 empirical studies that examined the relationship between HR polices and financial outcomes such as return on equity, return on investment and profit margins. We conclude that there is sufficient evidence of human capital materiality to financial performance to warrant inclusion in standard investment analysis. However, we also find that doing so remains a challenge for a number of reasons. These range from the fact that companies do not provide investors with comparable data to a lack of consensus over which combinations of policies have the most impact on financial outcomes.

Climate Change and the Crystal Ball of Vector-Borne Disease Forecasts

For decades, researchers have endeavored to better predict the incidence of vector-borne disease on a planet with a changing climate. Methods, though imperfect, have advanced considerably and led to the tantalizing prospect of forecasting the emergence of diseases such as malaria and dengue in new locations. This paper presents some of these recent advances and considers them in the context of their prospective aim: to prevent harm from vector-borne disease.