We could do a lot to improve public health and reduce runaway medical expenses if we focussed more on preventing disease and less on medical fixes, says Gary Bennett. 

Bennett is a professor of psychology and neuroscience at Duke University. 

Transcript:

From Duke University, this is “Glad You Asked,” where we consider the question, “What should we be talking about this election season?”

"I’m Gary Bennett. I’m a professor of psychology and neuroscience at Duke. I think we should be talking about the idea that good policy is better than medicine. The problem that we have in the U.S. right now is that we have healthcare costs that are just spiraling completely out of control. And this is really unsustainable. 

And if you look at what we’re dying of, there are things like cardiovascular disease, cancer, diabetes. These are all mostly preventable conditions. And then the burden of those conditions falls disproportionately on the poor. And if you can’t get behind the moral imperative to fix that problem, then I think you have to get behind the economic one, which is, we just can’t afford it. 

The good news here is that if you look at these leading killers, you can seriously mitigate your risk by doing some extremely common sense, very simple things. Things like never smoking, losing weight, eating a healthy diet and being physically active. For those four conditions, we have good treatments. But they all require high levels of motivation. And we know that a lot of the American population just is not motivated to improve their obesity and their diet and their physical activity and their smoking rates. 

And that’s where good policy comes in. Because good policy can help to structure environments in a way that the default choice is always a healthy choice. So we really need to be thinking about the kinds of policies that can make our world a place where it’s easier to be healthier. In the area of physical activity, what would really help is for us to create neighborhoods that had greater street connectivity, to increase the number of sidewalks, to increase our bike lanes, to really make our physical environments conducive to physical activity. And that requires good public policy. It requires investments in our physical infrastructure.

In the area of obesity, we have good examples here in North Carolina of policies that are designed to make it easier for corner store operators to offer healthy fruits and vegetables. These are really important policies that can add meaningfully to the health of Americans."

You’ve been listening to “Glad You Asked.” To subscribe, visit bitly.com/gladyouaskeditunes. Again, that’s bitly.com/gladyouaskeditunes. 




Sidewalks Versus Surgery {Glad You Asked, Episode 23}

Our society gives the mentally ill short shrift, so much so that "we'll look back on it in 100 years' time as absolutely appalling," says Jane Costello. 

Severe mental illness burdens families, taxes the criminal justice and shortens lives. And we'll continue to pay those heavy prices until we take the issue seriously, Costello says. 

Costello is a professor in the psychiatry department at the Duke University School of Medicine and the Duke department of psychology and neuroscience an associate director of the Duke Center for Child and Family Policy.

Turning Our Backs on Mental Illness {Glad You Asked, Episode 30}

The United States has long been a magnet for scientists from all over the world. With both science and immigration under attack, Raphael Valdivia wonders if that legacy is at risk. 

"Glad You Asked" is a series of short commentaries by Duke experts on issues that deserve public attention. In Season 2, Duke experts share a question they would like to pose to our nation's new president -- and describe why that question matters.   

Valdivia is a professor of molecular genetics and microbiology in the Duke University School of Medicine and vice dean for basic science at Duke University.

Photo of the Noor lab at Duke University by Duke Photograpy.

Transcript:

From Duke University, this is “Glad You Asked.” A new administration in the White House means new issues on the table. So we wondered, if you could ask our new President one question, what would it be?

“My name is Raphael Valdivia. I’m a professor of molecular genetics and microbiology at the School of Medicine. I’m also the vice dean of basic sciences at Duke University. 

“President Trump, I am a scientist and an immigrant. And my question for you is, ‘Am I welcome here?’ 

“I was born and raised in Lima, Peru. I left there to attend college here. Once I got here, that’s when I discovered a passion for the sciences, for discovery, for knowledge. And it was very much a sense here in the United States that that was valued. To be curious, to be creative, to be an intellectual was never a dirty word. 

“And it is really in the last decade or so where that has become a problem. So the support for sciences, I’ve seen it erode at the beginning in the context of climate science. And certainly funding of the NIH, of NSF, of the EPA, of the USDA, of all these different government agencies
-- the erosion of that foundation just percolates to the entire system. 

“So there’s me as a scientist, but there’s also me as an immigrant. Many of the scientists in the United States actually were born abroad, and they came here really looking for opportunities and to tap onto this excitement about discovery and knowledge. The U.S. is the magnet, you know, we come here because we know the possibilities. We bought into the dream. 

“And I had never really felt until the last couple of years, especially after the election, that I would be judged by how I would look as opposed to what I can bring to the table. Now that I suddenly feel that I may not be welcome, for the first time in 30 years that I’ve been here, I have second guessed whether I made the right decision or not when I decided to come here to work, live and have a career in science.”

This is Glad You Asked. To subscribe, visit bitly.com/gladyouaskeditunes. That’s bitly.com/gladyouaskeditunes.

Is America Still a Beacon for Immigrant Scientists? {Glad You Asked, Season 2, Episode 3}

Cancer expert Kelly Marcom, MD, discusses the role that genetics and environmental exposure play in the role of understanding why a person develops cancer.

Dr. Marcom is a professor of medicine and member of the Duke Cancer Institute (DCI). He is part of a team of experts at DCI that offers genetic testing and counseling to people diagnosed with cancer, as well as people at risk of developing cancer.



Transcript
Lindsay Key: Welcome to HeadScratchers, a mini-cast from the Duke University School of Medicine. We ask Duke experts to help us understand the questions in science that have us scratching our heads. Today we're speaking with Dr. Kelly Marcom, an expert in genetics and cancer. 

Dr. Marcom, what are the factors that contribute to someone getting cancer?

Dr. Kelly Marcom: Well, it's a very complex question, and one that we continue to work on very hard. Cancer is not a very intuitive disease process. Unlike a lot of things that affect our bodies, you know, you get a heart attack, you block a blood vessel -- those things are fairly straightforward. But cancer -- cancer is something that we don't naturally have a good intuitive understanding for. And it always then, consequently, is a bit of a mystery to many people why they got it. 

Fundamentally, cancer is a genetic disorder, by which I mean that the underlying cause of the problem is damage to the genes in the cells. But that understanding of cancer is really something that's still relatively recent. Watson and Crick identified DNA in the 50s, and so that began the whole process of understanding DNA and what it does. And, while people had always made observations about inherited patterns of cancer within families, it wasn't necessarily evident what the basis of that was. 

Now, prior to that time, there was a great deal of emphasis on the infectious nature of cancer, as caused by viruses. You can imagine, if you see cancer being transmitted through a family from one generation to the next, you might naturally assume that it's an infection. And there was a good scientific rationale for that: clearly it had been shown that certain viruses were responsible for certain types of cancer -- the most classic and probably one of the most important being cervical cancer, caused by papillomavirus. 

And so that whole story really came together with understanding that cancer is developed because you get damage to the DNA that perpetuates the additional damage to the DNA, and propagates itself through the cancer cells, and leads then to unregulated growth. And figuring out how those viruses cause cancer was in damaging DNA, and damaging things in the cells in the cervix in the course of the virus growing. 

So if genetics are the basis of the cancer, what is the influence of environmental exposures? Most of the things that contribute from a lifestyle have to do with exposing your body to things that damage your DNA. Smoking is the biggest culprit. Too much sun -- that's going to cause DNA damage. All those lifestyle factors, they all have some exposure that increases that risk for DNA damage. 

Ultimately, when we understand why cancers develop, it first helps us understand how to treat it, but then also we use it to help us understand how to screen people for cancer, and then ultimately -- hopefully -- a better understanding about how to prevent it.

LK: Thanks for listening. This podcast was produced by the Duke University School of Medicine. Music by Blue Dot Sessions. Visit us online at headscratcherspodcast.duke.edu. You can also find us on all your favorite podcast players. Don't forget to hit the subscribe button! And if you like us, leave us a review
Medical Disclaimer & Terms of use at https://bit.ly/2LrjWdh

Headscratchers: What Factors Contribute to Someone Getting Cancer?

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Headscratchers: What Factors Contribute to Someone Getting Cancer?

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