The first Pollin Prize for Pediatric Research was presented at Columbia Presbyterian Medical Center on Nov. 15 to four clinician-scientists for developing oral rehydration therapy, a water-based solution of glucose and salt that treats infectious diarrhea. The Lancet called the therapy "the most important medical discovery of the 20th century."
The researchers, Dr. Norbert Hirschhorn, consultant, Yale/World Health Organization Collaborating Center on Health Promotion Policy and Research at Yale University School of Medicine; Dr. Dilip Mahalanabis, director, Society for Applied Studies, Calcutta, India; Dr. David Nalin, former director, Vaccine Scientific Affairs, Merck Vaccine Division; and Dr. Nathaniel F. Pierce, professor of international health and disease prevention control, Johns Hopkins Bloomberg School of Hygiene and Public Health, developed the solution to treat severely dehydrated children in former East Pakistan (now Bangladesh) and India in the 1960s and early 1970s. The solution replaces the essential fluids and electrolytes lost by patients stricken with potentially fatal diarrhea caused by cholera and other gastrointestinal infections. Health workers and family members administer the fluid orally.
Since the adoption of the inexpensive and easily applied intervention, the worldwide mortality rate for children with acute infectious diarrhea has decreased from 5 million to about 1.3 million deaths each year. An estimated 40 million patients have been saved in the past 30 years by the treatment's implementation.
Until the discovery of oral rehydration and maintenance therapy, the only efficient means of rehydrating a child or adult with serious dehydration was to provide fluids intravenously. For the vast majority of people in the developing world, cholera or severe diarrheal illness was often a death sentence due to the cost and inaccessibility of intravenous therapy.
The award, which will be given annually, was created by Irene and Abe Pollin and their family, who are from Chevy Chase, Md., and funded by the Linda and Kenneth Pollin Foundation. The foundation honors two Pollin children who died of congenital heart disease. The prize is administered by NewYork-Presbyterian Hospital and coordinated by Dr. Rudolph L. Leibel, professor of pediatrics and medicine at P&S, who is chairman of the panel that selects the prize recipients.
The prize consists of a $100,000 award and a $100,000 fellowship stipend assigned by the recipients to a young investigator working in an area related to that of the recipients.
Some patients with major depression being released from inpatient facilities are not being adequately treated with antidepressants and are at increased risk of suicidal behavior, according to findings from P&S and New York State Psychiatric Institute researchers.
Led by Dr. Maria Oquendo, associate clinical professor of psychiatry, the researchers tried to determine if antidepressant treatment led to fewer suicide attempts in 136 hospitalized patients two years after their release for depression from two East Coast hospitals. The researchers found that patients who were depressed after discharge were at an increased risk of attempting suicide. They also found that not enough patients received antidepressants to analyze whether the drugs could prevent suicide.
Major depression with its devastating symptoms of sadness, sleep and appetite disturbance, difficulty concentrating, hopelessness, and suicidal thoughts is known to be a risk factor for suicide attempts. By alleviating depression, antidepressants may reduce the risk.
The researchers say their study provides the first concrete evidence that recurrence of major depression during a two-year period after admission for depression is directly linked to suicidal acts in persons at risk. Suicide attempt risk was seven times greater in people who suffered from depression after discharge. In agreement with research by others, prior suicide attempts were also strong risk factors for future suicide attempts. The risk increased by 30 percent with each suicide attempt the patient made before the study.
The investigators also found that patients after discharge received inadequate antidepressant treatment. Eighteen received no medication, while the average dose and duration were too low for the others. The under treatment could be due to several factors, including patient non-compliance and lack of insurance.
Because so few patients received adequate treatment, the investigators could not determine if antidepressants reduce the risk of suicide attempts. They are collecting more data to try to answer the question. The study findings were published in the October American Journal of Psychiatry.
Ethicists and others complain that when physicians and researchers gain informed consent from their research subjects, the consent is not truly informed. Patients also may feel pressured, ethicists say, to comply to participate in research, concerned that their care is contingent upon taking part in a study.
Now with the help of a new grant from the National Institutes of Health that began in September, the University hopes to change the way potential participants learn about the benefits and risks of taking part in a research study. The $250,000, one-year grant includes funding to develop a multimedia program that would be available to potential research participants and the local community.
The program will explain what research is, the importance of human participants, what informed consent means, what should be considered before taking part, and the rights of the participants. Spanish and English materials will be available in public areas and homes, which will allow potential participants to review the material on their own timetable and discuss the matter with trusted family members. Another part of the grant expands the use of administrative computer programs used by Columbia Institutional Review Boards to affiliated institutions, helping them better manage their human subjects review.
A group led by Dr. Richard Sohn, director of the Office of Grants and Contracts at Health Sciences, and Beth Israel, executive director of the Office of Projects and Grants at Morningside, met in November at an initial planning meeting to come up with innovative ideas about transforming the informed consent process.
During the meeting, the participants said a video would likely be the most effective way to deliver their message, but decided to first investigate what other schools and research institutions have produced. Participants also stressed the need to include community members in the planning process.
Dr. Sohn says informed consent sometimes may be obtained from participants at the last minute in a clinical setting where they may not feel comfortable and the only people available to answer questions are trying to gain the patient's consent and have a conflict of interest. "The multimedia program is something that will be very exciting and useful," Dr. Sohn says.