Translator: Abdul Ameti Reviewer: Helena Bedalli In the mid-90s CDC and Kaiser Permanente discovered an anomaly that dramatically increases risk for seven of the top 10 causes of death in the US. In large doses, it affects brain development, immune and hormonal system and also the way our DNA is read and transcribed.
People who are affected by this anomaly in very large doses have three times the risk of death from heart disease, lung cancer, and a 20-year volatility of life expectancy. In addition, doctors are not trained for daily examination and healing. The anomaly I am talking about is not something chemical. It is the trauma of childhood.
What trauma are we talking about? I’m not talking about failing the exam, or losing a basketball game. I’m talking about such harsh and penetrating threats which in the first sense of the word convey to us and change our physiology things like: abuse, negligence or growing up with a parent suffering from a mental illness or drug-dependent.
For a long time, I looked at these things the way I was trained to look: or as a social problem – referred to in social services or as a mental health problem – referred to medical services. Then something happened that made me reconsider my whole approach.
When I finished the internship, I wanted to go to a place where I felt needed a place where I could make a difference. And I went to work for the California Pacific Medical Center, one of the best private hospitals in Northern California, and together, we opened a clinic in Bayview-Hunters Point, one of the poorest and neglected neighborhoods in San Francisco.
Before we talk about this, was just a pediatrician all over Bayview to serve more than 10,000 children, so we got down to business, and gave great quality of treatment regardless of financial capabilities. It was something so beautiful.
We targeted typical health inequalities access to medication, vaccination rates, hospitalization rates for asthma, and broke all records. We felt very proud of ourselves. But then, I started noticing a worrying trend. Many children referred to me for “Concentration Disorders and Hyperactivity ”(ADHD) but in fact, when I did one deep historical and physical research what I found is that many of my patients I could not diagnose them with ADHD.
Many of the children I checked had experienced such severe trauma so much so that I felt something else was happening. Somehow, something important was escaping me. Before I started my internship, I completed my master’s degree in public health and one of the things to teach in public health school is that, if you are a doctor and sees 100 children drinking from the same well and 98 have diarrhea you can start and write recipes dose-by-dose antibiotics or go to the place and say, “What the hell is in this well?”
So I started reading everything that came my way about how exposure to disasters affects a child’s developing mind and body. And one day, my colleague came to my office and said: “Dr. Burke, have you seen that?”
In his hand was a copy of a study called “Study of Childhood Disaster Experiences” That day changed my internship at the clinic, and finally my career. Study about childhood disaster experiences it is something that everyone should know.
It was done by Dr. Vince Felitti in Kaiser and Dr. Bob Anda on CDC, and together they interviewed 17,500 adults about their experiences about what they called “child misfortune” (ACE) These included physical, emotional or sexual abuse; physical or emotional neglect; parental mental illness, drug addiction, imprisonment; parental separation or divorce; or domestic violence.
For each positive response, they received a point on the ACE score. What did they do then was the correlation of these ACE results against health consequences. What they found was surprising. Two things: Number one: ACEs are more common.
67 percent of the population had at least one ACE, and 12.6 percent, or 1 in 8 had four or more ACEs. The second thing they found was a “dose-response” relationship The higher the ACE score, the more severe the health consequences.
For a man with an ACE score of four or more risk of chronic obstructive pulmonary disease was 2 and a half times larger than in a man with an ACE zero score. For hepatitis, also 2 and a half times larger. For depression, 4 and a half times.
For suicide, 12 times. A man with an ACE score of seven or more there was three times more risk to life from lung cancer. and 3 and a half times the risk of ischemic heart disease. the number one killer in the US. Of course that makes sense.
Some people saw this data and said, “Look. If you had a difficult childhood, you are more likely to drink alcohol. and to smoke and do all those things that destroy health. This is not science. It’s just bad behavior. ” This is exactly where science intervenes.
Now we understand better than ever, how early disasters affect the development of the brain and body of children. Affects “nucleus accumbens” (from lat. Supported nucleus) the center of pleasures and rewards in the brain which is involved in drug addiction.
It inhibits the parafrontal cortex which is necessary for the control of impulses and executive functions a critical space for learning. In MRI scanners we notice measurable differences in amygdala, fear response center. So there are obvious neurological reasons why people are exposed to large doses of adversity are more likely to exhibit high-risk behaviors, and this is important to know.
But it turns out that although they do not exhibit high-risk behaviors, individuals are more likely to develop heart disease or cancer. The reason has to do with the hypothalamic-pituitary-adrenal axis, which is the brain and body reaction system, who oversees the reaction called “fighting or running”.
How does this work? So imagine you are walking in the woods and see a bear. Immediately your hypothalamus sends a signal to your pituitary gland which signals the adrenaline gland that says: “Release the stress hormones! Adrenaline! Cortisol!” And so your heart starts beating, Your eyelashes expand, the airways open, and you are ready to either fight him or run away from the bear.
And that’s great, if you are in the woods and there is a bear. (Laughter) But the problem is, what happens when the bear comes home every night, and this system is constantly activated and passes from being appropriated, or life-saving at detrimental health pressure.
Children are especially sensitive to repetitive stressful activity because their brain and body is developing. Large doses of disasters not only affect structure and function of the brain but adversely affect the development of the immune system, development of the hormonal system, even the way our DNA is read and transcribed. So for me this information threw out my old training window, because when we understand the mechanism of a disease, when we know not only which roads are interrupted, but like us as doctors, to use science for prevention and recovery.
This is what we do. So in San Francisco, we set up a Youth Welfare Center, for the prevention, examination and treatment of the impact of ACE and toxic stress. We just started with routine examination of each of our children, in their physical activities because I know that if my patient has 4 in the ACE result is 2 and a half times more likely to develop hepatitis or lung disease is 4 and a half times more likely to get depressed, and 12 times more attempted suicide, than my patient with zero ACE.
I know this when he (the patient) is in my examination room. For patients with a positive test, we have a very disciplinary team working to reduce disaster doses and treats symptoms using the best ways to include home visits, coordination of care, mental health care, nutrition holistic interventions, and yes, we also give them medication if needed.
But we also educate parents about the impact of ACE and toxic stress in the same way that it would take to cover electrical outlets or lead poisoning, and we expand the care of our asthmatics and diabetics in a way that justifies that you may need tougher treatment taking into account hormonal and immune changes.
So the other thing that happens when you understand this science, is desire to shout with fingers in ear because this is not just a child issue in Bayview. I immediately thought that anyone who would find out about this, we would have daily examinations, treatments with multidisciplinary teams and would be a competition for the most effective clinical protocols of healing.
But no. This did not happen. And it was a very good lesson for me. What I thought was just the best medical practice, i understand it to be a whole move. In the words of Dr. Robert Block, former President of the American Academy of Pediatrics, “Childhood Disasters are the only two most unaddressed threats to public health which our nation is facing today.
” And for many people this is a terrible prospect. The extent and extent of this problem seems so extensive that it seems futile to think about how we could approach them. But for me, that’s where the hope lies, because when we have the right system, when we are clear that this is a public health crisis, then we can start using the right tools to find solutions.
From nicotine and lead poisoning to HIV / AIDS The U.S. actually has a strong past in addressing of public health problems, but to repeat these successes with ACE and toxic stress, we will need determination and commitment, and when I see what the reaction of our nation has been so far, I ask myself, “Why haven’t we taken this more seriously?”
You know, at first I thought we marginalized this issue because it doesn’t apply to us. This is an issue for those children in those neighborhoods. Which is weird, because the data doesn’t prove it. The original ACE study was performed on a population which was 70 percent white race, 70 percent, with high school.
But then, the more I talked to people, I began to think that I might have understood it backwards. If I were to ask how many people in this room have grown up with a family member who has suffered from mental illness I bet some of you would raise your hands.
And if I were to ask how many people have had one parent who probably drank too much, or who believed that he who loves you beats you I bet some more hands would be raised. Even in this room, this is an issue that affects many of us, and I am beginning to believe that we are marginalizing this issue precisely because it applies to us as well.
Maybe it’s better to look elsewhere because we don’t want to see it. We would rather stay sick. Thankfully, scientific achievements, and, to be fair, economic reality makes this option less likely every day and more. The science is clear: Early disasters dramatically affect life expectancy.
Today, we are beginning to understand how to stop the transition from early facts in premature death, and 30 years earlier, child with high ACE score, and whose behavioral symptoms are invisible whose asthma management is not related and continuing to develop high blood pressure, and early heart disease or cancer, will be just as abnormal as a 6-month HIV / AIDS mortality.
People will look at this situation and say, “What the hell happened there?” This is curable. That could be. The only thing that matters most is that we need it today the courage to look this problem in the eye and to say that this is true and is for all of us. I believe we are the movement. Thank you. (Applause)
