Johns Hopkins Magazine - April 1996 Issue

In Short - Public Policy & International Affairs

Dale Keiger and Melissa Hendricks
Saying "Nyet" to Russian An all-time low for U. S. infant mortality why global warming could be infectious an era of ethical deception

Russian language field is "eating its young"

A Hopkins policy institute has found a striking decline in the enrollments of Russian language programs at American colleges and universities. The decline has been precipitous enough to cause the report's author to warn, "The Russian-language field in the U.S. is facing a severe crisis."

Richard D. Brecht, a senior fellow at Hopkins's National Foreign Language Center, wrote the report. He says that a 1994 survey of the country's 50 largest collegiate Russian programs found enrollment declines of between 30 to 50 percent since 1990. Those declines have caused programs to reduce the number of teaching assistantships, thus reducing the number of graduate students in Russian and Slavic studies. The field, Brecht says, "is eating its young."

Curiously, Brecht notes, the drop-off in student interest comes at the same time that both government and non-government agencies are "training more personnel in Russian than ever before, in response to an increase in current and anticipated needs."

In his report, Brecht says that from 1986 to 1990, a period when the Soviet Union appeared daily in the news, student enrollments increased by 30.7 percent. The decline began around 1991, when media coverage of Russia and the newly independent states of the former Soviet Union dropped off significantly, and what coverage there was tended to portray Russia in a negative light--as Brecht puts it, "more akin to a developing nation than a world power."

The center's director, David Maxwell, says, "We still see Russia as an area of tremendous strategic interest. On a more pragmatic note, it's an area of tremendous business opportunity. There's every reason to think that sometime in the next five or six years people will want to take Russian language courses again, and there won't be anyone to teach them. When an institution cuts out a program, it's almost impossible to get it back."

Total national enrollment in all language instruction has gradually increased, Maxwell notes. Over the last few years, the most dramatic increase has been in Spanish. Together, Spanish, French, and German account for more than 80 percent of all language students.

The National Foreign Language Center is a research center in Washington, D.C., that monitors foreign language education in the U.S. It tries to help formulate public policy that will improve language programs and enhance Americans' capacity to conduct international business and foreign relations. --DK

A surge in infectious diseases?

The earth is getting warmer and it may soon be getting germier. In the January 17 Journal of the American Medical Association, public health researcher Jonathan Patz (MPH '92) warns that global warming stands a very real chance of promoting a worldwide surge in infectious diseases, many of which are deadly and difficult to prevent. Malaria, dengue fever, yellow fever, viral encephalitis, schistosomiasis, and cholera are likely to increase.

According to one model included in the study and developed by the Netherlands National Institute of Public Health and Environmental Protection, even a relatively small increase in temperature will place 620 million more people at risk of malaria by the year 2050, and cause 1 million more malaria deaths.

"I think we should be concerned," says Patz, research associate in molecular microbiology and immunology at the School of Public Health. "This is potentially a very major public health problem."

The average global temperature will increase 2C by the year 2100, predicts the United Nations Intergovernmental Panel on Climate Change. This rise in temperature will contribute to the spread of disease in a number of ways both direct and indirect, says Patz, who is a member of the U.N. panel. Global warming widens the swath of the planet that is hospitable to disease-carrying insects such as mosquitoes (carriers of the malaria parasite, as well as the virus that causes dengue, or breakbone fever); blackflies (which spread river blindness); and tsetse flies (which transmit African trypanosomiasis, or sleeping sickness). Normally limited in scope by cold temperatures and frosts, these insects will cross latitudes and migrate to higher altitudes with warming temperatures, says Patz. Such an effect was seen in 1987 in Rwanda, when malaria spread to higher altitudes following a period of record high temperatures and rainfall.

Higher temperatures also increase infectiousness of many agents including the malaria parasite, Plasmodium falciparum. After a mosquito ingests Plasmodium as part of a blood meal, the parasite travels from the insect's gut to its salivary glands, where it can be released to infect another host when next the mosquito dines. The parasite's time of travel from gut to gland is called the incubation period. When the temperature is 20C, THE incubation period is about 25 days. But when the temperature is 25C, the incubation is about 11 days shorter.

As for indirect effects, global warming is expected to increase sea surface temperature, which will promote red tides (a source of seafood poisoning) and algal blooms (which may be a reservoir for cholera). Global warming models also predict that the sea level will rise one-half inch in the next 100 years, says Patz. Rising tides will force approximately 100 million people from their homes. Many will flock to cities, where overcrowding will contribute to the spread of disease.

The United States will not be exempt from these emerging diseases. Global warming is expected to bring warm, wet winters and prolonged hot, dry summers to more northerly regions of the U.S. These climatic conditions will usher in widespread mosquito-borne encephalitis, such as St. Louis encephalitis, which is currently confined to southern regions of the United States.

Patz says he does not intend for the report to be a cause for alarm. Rather, "we should recognize an opportunity for prevention." He would like to see improved mosquito control programs, more extensive monitoring of emerging infectious diseases, and more policies that integrate public health and environmental concerns.

Since the industrial revolution, the environment's carbon dioxide levels have climbed 29 percent, largely as a result of the burning of fossil fuels, according to the U.N. panel, says Patz. Atmospheric C2 and other "greenhouse gases" trap Earth's radiant heat yet allow sunlight to penetrate. Thus, the planet warms. "There is a growing international consensus among climatologists that global warming is real," says Patz. "Very few climatologists will say it is not." --MH

Ethical lapses in human testing

The federal Advisory Committee on Human Radiation Experiments, chaired by Ruth Faden, professor of health policy and management at the School of Public Health, recently issued its final report. The report capped an 18-month investigation by the committee into allegations that from 1944 until 1974, federal researchers exposed test subjects to ionizing radiation without their informed consent.

The investigation showed that some of the allegations were true--patients, including children, were not informed that they were being used as radiation test subjects. With some of the children, the radiation levels used would be unacceptable by modern standards due to the risk of thyroid cancer.

Says Faden, "We came across very graphic examples of where the government misled people, and as best as we could establish, the motivation could not be laid at the feet of clear national security concerns." She says the committe found numerous cases in which the U.S. government maintained secrecy for fear of litigation or bad publicity.

The committee's recommendations included:

The committee's investigation included 20 public hearings, testimony from more than 200 people, and review of a half-million documents, some of which turned up in people's garages. Hopkins was the only institution with two representatives on the committee. Philip Russell, professor of international health, also served.

The committee also interviewed 1,900 patients about contemporary research practices. It found that while current rules meant to protect human subjects have significantly improved, serious problems remain. Faden notes, for example, that some consent forms present overly optimistic characterizations of the research's possible benefits to seriously ill patients. Such forms do not adequately explain the likelihood of pain, inconvenience, or extra expense for the patients. Some use incomprehensible technical jargon.

Writing last October in The Chronicle of Higher Education, Faden said, "Hope is a delicate and precious commodity for people with life-threatening illnesses. For physicians, finding the balance between honesty and support of that hope is often difficult. Feeding hope at the expense of candor is one thing; exploiting the desperation of patients who lives hang in the balance is another."

Written by Melissa Hendricks and Dale Keiger.

A drop in infant mortality

There's encouraging news on the population front: infant mortality rates in the United States dropped slightly between 1993 and 1994, from 8.3 per 1,000 births, to 7.9--the lowest rate ever reported in this country. That's according to "The Annual Summary of Vital Statistics," a report prepared by Public Health researchers Bernard Guyer and Donna Strobino, together with colleagues from the National Center for Health Statistics.

Most of the improvement came in infants under 28 days old, the researchers found, and is due to improved availability of neonatal intensive care, effective treatment of upper respiratory distress syndrome, and fewer deaths from sudden infant death syndrome. Unfortunately, a gap still remains between mortality rates of black infants and white infants, a serious problem that will need future research, Guyer says.

The overall number of U.S. births in 1994 also declined, by 1 percent, falling below 4 million for the first time in five years. The researchers expect this fall-off to continue, so that by 2050, children under 18 will represent just 24 percent of the U.S. population (as compared to 28 percent today).

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