It has been my privilege to serve as one of the historical consultants to Pox and the City, a digital role-playing game for the history of medicine.The game lets players learn about the conquest of smallpox (once known as the “speckled monster”). It was developed with funding from the National Endowment for the Humanities.

Pox and the City just completed beta-testing and got some great reviews from high school students. I interviewed the creator of this project, medical historian Lisa Rosner, who is a professor of historical studies at Richard Stockton College.

What made you want to teach history of medicine through a digital role playing game?

Games have emerged as an exciting art form for presenting humanities content. Hollywood merged medical history with entertainment back in 1936, with The Story of Louis Pasteur, the first film to turn a vaccination experiment into a cliffhanger. We hope that our game will be as successful in combining real historical material with new media.

In back-to-back rulings this week, a federal judge decided that two children with end-stage cystic fibrosis—10-year-old Sarah Murnaghan on Wednesdayay and 11-year-old Javier Acosta on Thursday—should be eligible for a lung transplant from the adult donor list, rather than the under-12 list from which they are unlikely to receive new lungs in time. There are too few pediatric transplant donors to meet the demand. The transplants, if successful—if appropriate adult donors are found—would offer them new leases on their still very young lives.

Earlier this week Sarah's parents had appealed directly to U.S. Health and Human Services Secretary Kathleen Sebelius to make an exception for her. When Sebelius refused to intervene, the Murnaghans took their case to court; after U.S. District Court Judge Michael Baylson ruled in their favor, Javier's mother did the same and got a matching decision within hours. The rulings will be revisited at a June 14^th hearing. Until then, Sarah and Javier, both at Children's Hospital of Philadelphia, are eligible for lungs from the adult  transplant waiting list, increasing the chances that they may receive the life-saving operation.

Bioethicist Arthur Caplan, director of the division of medical ethics at NYU Langone Medical Center, said he is concerned about fairness. "It is not clear why everyone now waiting at the bottom of any transplant list would not seek relief in federal court," Caplan told NBC news Wednesday, before Javier's mother filed. "Unless the judge has reason to think the lung distribution rules are simply a product of age discrimination and nothing more—which seems highly unlikely—then this becomes a troubling instance of non-doctors deciding who is the best candidate to receive a lung or other scarce medical resource."

It is those scarce resources that need our attention.

Let’s have a brief conversation about climate change.

How is climate change related to health?

Here is some of what the World Health Organization has to say: “Climate change affects the social and environmental determinants of health—clean air, safe drinking water, sufficient food and secure shelter.” Global warming leads to excess deaths, and many major killers—diarrheal diseases, malnutrition, and malaria among them—are sensitive to climate and expected to worsen as it changes.

Fine. But what about health conditions I’m more likely to encounter right here? Is climate change going to affect my health?

Today’s piece, the fourth in our ongoing race and health series, is by Janet Golden, a historian of medicine and public health. She writes about the teaching of race and health, and connections between past and present.

- Michael Yudell

As a medical historian, I find the subject of race and health to be both the easiest and the hardest to present to my students. It’s easy because there is so much data to analyze, from W.E.B. DuBois’ Philadelphia Negro (1899) to more recent work from the National Institute on Minority Health and Health Disparities. This agency, which is part of the National Institutes of Health, has been around in one form or another since 1990, and today has the mission of leading “scientific research to improve minority health and eliminate health disparities.” That is the challenge.

Economic disparities and racism are the foundation of a significant portion of health disparities. They are linked to factors like living in neighborhoods filled with environmental hazards such illegal lead smelters and in homes with lead-based paint, not to mention the cockroaches that have been linked to asthma. Poverty is tied to the lack of access to good food, good jobs, good education, and good health services. Neighborhoods matter. Health is not an individual issue; it is a collective concern.

The infant mortality rate, an index of national well being used around the world, shows how far we have come since 1900, when the death rate for infants was 100 out of every 1000 live births. And a look at the infant mortality rate today shows we have a long way to go. As pediatrician and historian Jeffrey Brosco has demonstrated, “deaths among African-American infants have remained double the national average” for more than a century.

That’s the crux of our nation’s problem and of the problem in my classroom. We aren’t talking about something that can’t be substantially remedied; we are talking about a situation that reflects the ongoing problem of race and inequality.

A United Nations worker was gunned down by extremists near Peshawar, Pakistan, while delivering vaccines Tuesday in the village of Kaggawala. The World Health Organization, which runs the Global Polio Eradication Initiative for the U.N., then announced that it was temporarily suspending the program in Pakistan.

The attack was not the first against the U.N's anti-polio program. In December of 2012, nine polio eradication workers were killed there, threatening progress against the crippling and deadly disease. Violence has also flared against vaccine workers in Nigeria which, along with Pakistan and Afghanistan, is one of the only three countries on earth where the disease is still endemic.

This upsurge in violence against U.N. polio vaccine workers was triggered, in part, by the CIA’s fake hepatitis B vaccination campaign run as part of the hunt for Osama bin Laden in 2011 (vaccine workers were sent to Bin Laden’s compound to try to collect DNA samples). Some Pakistanis have come to believe that vaccination is an American plot to sterilize them or to spy on them.

Nonetheless, the Global Polio Eradication Initiative has made great progress in eradicating polio from the planet. Since 1988, annual cases of polio have decreased by more than 99% worldwide. To eliminate polio from the three remaining countries, and to prevent its resurgence in places like India, which reported its last case of polio in 2011, the program administered polio vaccines in 2012 to 448 million people in 48 countries.

In a Psych. 101 class many years ago, I remember learning that some mental disorders were more common among people born in winter and spring. The reason was unclear. I pretty much forgot about this interesting factoid until reading about a recent study that found evidence of a link between some mental illness and the seasons: the flu.

The new study, published online this month in the journal JAMA Psychiatry, found that in utero exposure to maternal influenza was associated with a four-fold increase in the likelihood of developing bipolar disorder. The disorder, once known as manic depression, causes dramatic shifts in mood and energy, and can inhibit the ability to carry out day-to-day tasks. It affects an estimated 2.6 percent of American adults each year.

The research analyzed data from the Child Health and Development Studies, a large cohort of 19,044 people born in Alameda County, Calif., between 1956 and 1966. All of the study participants’ mothers were members of the Kaiser Permanente insurance plan when they gave birth—providing the researchers with fairly comprehensive data on maternal health and information on whether or not they had the flu while pregnant.

To test the hypothesis that in utero exposure to maternal influenza is associated with developing bipolar disorder as an adult, the researchers first had to identify all members of the Child Health and Development Study who developed the disorder after childhood. To do this, they reviewed Kaiser’s medical database and records from Alameda County Behavioral Health Care Services, and sent questionnaires to all study participants and their mothers. After all possible cases were identified, a structured clinical interview was conducted with each person to independently confirm bipolar disorder. There were 92 cases of the disorder.

Today we have another important and interesting contribution to our ongoing series on race and health in Philadelphia. Oni Richards-Waritay, executive director of the African Family Health Organization (AFAHO) discusses how cultural and linguistic barriers can lead to poor health outcomes.

-- Michael Yudell

Research indicates that the health of immigrants to the United States worsens the longer they are here. For example, many members of Philadelphia’s African and Caribbean immigrant and refugee community are healthier than other residents upon arrival in the U.S. But their health deteriorates the longer they stay here.

We continue our series on race and health in Philadelphia today, joined by Cynthia Figueroa, president and CEO of Congreso de Latinos Unidos, who shares her expert insight into the state of health in Philadelphia’s Latino community.

- Michael Yudell

Health disparities are differences in health outcomes as a result of demographic, social, or environmental attributes. In the Latino community, cultural and linguistic barriers can compound disparities and lead to unfavorable and unhealthy outcomes. Poverty also exacerbates health issues, creating inequities in health-care access and treatment. At  Congreso de Latinos Unidos, a multiservice non-profit organization that focuses on well-being of Philadelphia’s Latino community, we see the impact of disparities in health every day.

For example, the 19133 zip code, where the majority of Congreso’s clients reside, had the highest percentage of people in poverty (56.4%) in 2011–nearly double the citywide rate (28.4%), which itself was the highest recorded in Philadelphia in years.  

Almost 50% of children have not received all the recommended vaccines at some point before their second birthday, according to a study of 300,000 children that was recently published in JAMA Pediatrics. While some cases of skipped vaccines may be due to missed opportunities or difficulty accessing healthcare services, one in eight children in this study were undervaccinated due to parental choice to either delay or refuse vaccinations.

Here are some questions I hear about alternative vaccine schedules:

Why do parents veer from the recommended vaccination schedule?

Parents ask their pediatricians to delay giving one or several vaccines for a variety of reasons. The current routine immunization schedule includes 24 vaccines before age 2 years and up to six vaccines at one time. It is difficult for parents to see their infant or young child receive multiple injections in one sitting, and it causes many to wonder if exposure to so many vaccines at the same time might overwhelm a child’s immune system-- particularly for an infant.