“If you’re not going to ban them … ”

Past efforts to make a “safer” cigarette, attorney Scott D. Ballin told the audience at a seminar at the Institution for Social and Policy Studies, may have increased the risks to smokers. Ballin, a former vice president for public policy at the National Heart Association, said low-tar and low-nicotine cigarettes offered smokers a false sense of security. “People were compensating by smoking twice as much and inhaling more deeply,” he said at the May gathering. “I don’t think it is politically or economically feasible for tobacco products to be banned in this society. The real question we have to struggle with is, if you’re not going to ban them, what do you do with them?”

Ballin called for making cigarettes safer by removing carcinogens and other toxins known to cause disease. “Risk reduction can be an effective strategy,” he said, “but it has to be done based on science and with a regulatory mechanism, such as [that provided by] the FDA, in place. What we have done with other products regulated by the fda should now be applied to tobacco.”

“If not you, who? If not now, when?”

Phill Wilson, the keynote speaker at this year’s AIDS Science Day, got the most applause when he exhorted his audience to do more to help community groups in New Haven.

“People from places like Yale and Harvard and Princeton are the people who run the world,” Wilson said, speaking at the School of Public Health in April. “Use your privilege to make a difference.”

Wilson, the founder of the African American AIDS Policy and Training Institute, said AIDS takes thousands of lives a day, yet the international community has not offered a response commensurate with the epidemic. Action must be local as well as global, he said.

“There is something wrong with institutions like Yale that exist in poor communities like this,” he said, “if they don’t use their resources, their influence, their talent to strengthen the infrastructure of the organizations that live and die in their shadow. Community programs in New Haven should never have a shortage of evaluators, organizational-development folks, grant writers, researchers, website designers, policy analysts. … If not you, who? If not now, when?”

Drawing on native culture in medical practice

For Melvina McCabe, M.D., the diversity of cultures found in the United States is a double-edged sword, a source of both richness and ugliness. “The richness of our culture is a gift that many do not appreciate. The ugliness is racism, intolerance and the belief that our culture, and therefore who we are, is better than any other,” said McCabe, an associate professor at the University of New Mexico School of Medicine. At a Humanities in Medicine lecture in April McCabe described her own journey through three cultures; the Navajo way of her family, the Christian teachings of the boarding school where she received her early education and the ethos of the medical world.

From her Navajo origins she has maintained the belief that wellness comes from a harmony with one’s self and all living things. “In no other place but health care is a flexible, open-minded approach so paramount,” she said. “It is here that we are trained to heal people, but truly heal them and take into account not only the physical aspects of a person, but also their desires, their culture and their ideas of health, wellness and illness.”

Making the case for better newborn screening

During a visit to the School of Medicine in August, U.S. Sen. Christopher Dodd couldn’t resist showing his audience a picture of his daughter, then just a few weeks away from her first birthday. But there was a point the doting father wanted to make about her birth at a hospital in Virginia. “At no stage were we ever advised of the importance of newborn screening,” he said at Pediatrics grand rounds.

Dodd’s daughter was born healthy, but newborn screening for genetic defects can mean the difference between life and death. Congenital metabolic defects that can be detected by screening can cause mental retardation and sudden death. Physicians check for eight disorders in Connecticut, and recent legislation will expand screening in January to cover two additional metabolic disorders. Access to screening varies, however, from state to state.

Dodd has proposed federal legislation that would provide funding to expand the scope of screening. “Parents must know what their state requires and their options to receive supplemental screening if they so desire,” Dodd said. He came to Yale at the invitation of Scott A. Rivkees, M.D., associate professor of pediatrics, who testified on the topic in June before a U.S. Senate committee.