Fogarty’s brain disorder program trains researchers such as Congoloese neuroscientist Dr. Desire Tshala-Katumbay.
Scientists gathered at Kirschstein Auditorium recently to explore frontiers in neuroscience for global health and to mark the 10th anniversary of the Fogarty International Center’s brain disorders program, which is designed to focus attention and resources on this neglected area.
“There is no health without mental health,” observed Dr. Thomas Insel, NIMH director. He said it is “critical” this profound public health need is addressed as efforts are made to improve health care globally.
Yet an “unconscionable” gap exists between access to treatment for neurological conditions for people living in wealthy countries as compared to populations living in low-resource settings, said Dr. Steven Hyman of Massachusetts Institute of Technology and Harvard University. This brings “huge societal costs,” not only for patients but also for their caretakers and communities, he said. “It degrades human capital formation.”
Research is key to improving patient care and must be conducted in-country to be viable and effective, said Dr. Gwen Collman of NIEHS. With community engagement and involvement, she noted, “you can translate the results more quickly.”
Recognizing this research need, Fogarty launched its program called Brain Disorders in the Developing World: Research Across the Lifespan in 2003. With broad support across NIH, the initiative has provided at least $85 million to fund more than 150 projects that investigate conditions afflicting populations in low-resource countries. The disorders range from neurodevelopmental, such as autism, to neurodegenerative diseases, including Alzheimer’s, to neuropsychiatric, as in depression.
One grantee who collaborates with researchers on different continents is Dr. Richard Guerrant at the University of Virginia. His projects in Brazil and South Africa have shown how child malnutrition impairs cognition and can be prevented by low-cost interventions such as zinc supplements and reducing diarrhea. Research evidence such as this, Guerrant noted, are essential for “driving future policy decisions.”
Indeed, this is what happened in Barbados when researchers, starting in the 1960s, amassed records on malnutrition and child mortality. “We worked very hard with the government of Barbados to make malnutrition a reportable disease,” said Dr. Janina Galler of Harvard. The government adopted a comprehensive nutrition program to age 12 and malnutrition was eliminated by 1980.
“All children should have the chance to achieve their full potential,” said Dr. Alan Guttmacher, director of NICHD. He added this means protecting cognitive development not only prenatally and in the first months of life, but also “well beyond.”
Fogarty’s brain program covers disorders that strike at all ages, including adult onset neurodegenerative disorders and dementias. NIA director Dr. Richard Hodes noted about 15 percent of the world’s population will be over 65 in a few years. “The challenges are going to be absolutely enormous, in particular those posed by age-related diseases,” he said. To maximize progress, he urged researchers to share their data widely and in interpretable forms.
One new arena for brain researchers is HIV/AIDS, where antiretrovirals have dramatically extended patients’ lives. But little is known about the long-term neurological impact of either the virus or the drugs. Fogarty brain program projects include studies of cognition in children exposed to HIV at birth and the link between HIV and cerebral malaria.
More than 350 researchers attended Fogarty’s brain disorders conference to network and share discoveries.
NIH leaders discussed a number of significant accomplishments of the brain disorders program, which receives broad support across the institutes and centers.
Photos: Ernie Branson
The knowledge gleaned from global health research can bring insight into health everywhere, noted Dr. Story Landis, director of NINDS. She cited a Peruvian study of a tape worm disease transmitted from pigs to people and noted in one U.S. public hospital, a third of patients with epilepsy had eaten infected pork. “So it’s not just a developing country issue,” she said. “It’s also an issue in this country.”
Researchers seeking low-cost interventions in developing countries have produced novel, inexpensive approaches relevant for developed countries as well. Dr. Benjamin Warf, a current Fogarty grantee, in earlier research in Uganda devised a minimally invasive procedure for treating hydrocephalus. The procedure, now also adopted in the U.S., has greatly reduced the number of patients receiving brain shunts, which carry a higher infection risk.
In another example of two-way benefit, a study in Latin America compared treatment of traumatic brain injury using expensive high-tech equipment commonly used in the U.S. with its own practice of clinician monitoring and found no difference in patient outcome. “It has caused us to rethink our care and ask what really, truly is important,” said Dr. Randall Chesnut of the University of Washington. “By corroborating across borders, we can come to a better understanding of what we do.”
As well as producing science to expand knowledge about brain disorders and ways to diagnose, prevent and treat them, a key aspect of Fogarty’s brain program has been to provide significant training from more than 140 developing country researchers to expand capacity in their countries.
Chesnut’s traumatic brain injury project, for example, involves 13 intensive care units in Latin America where many former trainees are conducting their own research and training programs. With Fogarty brain program grants, “you’re making researchers as you’re doing research,” he said. “It’s a bit like building the bridge as you’re driving across it. We need to integrate the idea that research is not what you read in a journal, it’s what you do in the educational process and in the machinery of medicine.”
Links to the symposium webcast and more information about the program are available at http://bit.ly/braindisorders.