Journey of Alan R. Fleischman: from Neonatologist to Patients’ Rights Advocate
by Mariangels de Planell Saguer
In November 2011, Columbia Master of Science in Bioethics program organized a seminar presented by Dr. Alan R. Fleischman entitled “A Bioethical Journey from Clinical and Research Ethics to Policy and Public Health.” Dr. Fleischman is senior vice-president and medical director of the March of Dimes Foundation, as well as Clinical Professor of Pediatrics and Clinical Professor of Epidemiology and Population Health at the Albert Einstein College of Medicine in New York. Dr. Fleischman has published and lectured extensively in the field of neonatal and fetal physiology with a research focus on nutrition. He has been a pioneer in the field of bioethics, emphasizing the rights of individual patients and the responsibilities of health care professionals and organizations.
At the March of Dimes Foundation, he found the perfect environment to pursue this goal. March of Dimes is a nonprofit organization supporting pregnancy and baby health by preventing birth defects, premature labor and infant mortality. During his presentation, Dr. Fleischman used different examples to illustrate the March of Dimes’ work. In particular, he mentioned the prematurity campaign in which the Foundation focused its effort on enhancing awareness and supporting research about the root causes of preterm birth. Preterm birth—birth before 37 weeks gestation—is a serious and costly health problem, and is the leading cause of death in the first month of life in the United States (US). More than 540,000 babies —one out of every eight— are born prematurely each year in the US, and the rate has increased more than 20 percent in nearly 20 years. One reason for the constant rise of preterm births is the increase in twins, triplets, and other multiple births from reproductive technologies. In addition to the increased risks associated with multiple births, studies have also suggested that even infants born singly, but conceived with ovulation stimulation, are at increased risk for preterm delivery in comparison to naturally conceived single births. Babies who survive preterm labor face serious risk of lifelong health problems such as mental retardation, developmental delays, cerebral palsy, blindness, hearing loss, and other chronic conditions including asthma. Even infants born just few weeks sooner have a greater risk of respiratory distress syndrome, feeding difficulties, temperature instability (hypothermia), jaundice and delayed brain development. According to the Institute of Medicine, preterm birth costs the nation more than $26 billion annually.
March of Dimes is also investing a great deal of effort in its campaign to reduce the number of birth defects of brain and spine known as neural tube defects (NTDs), which include spinal bifida and anencephaly. NTDs are the most common birth defects, affecting approximately 3,000 pregnancies each year in the US. The development of the neural tube occurs very early in pregnancy, normally within twenty-eight days after conception. Because more than half of all pregnancies in the US are unplanned, NTDs develop well before most women know that they are pregnant. Studies in the early 1990s showed that up to 70% of NTDs could be prevented if around the time of conception and in early pregnancy women consumed 400 micrograms of folic acid per day. An example of successful public health intervention based on access to information occurred in 1998. The Food and Drug Administration (FDA) mandated the fortification of enriched cereal-grains such as bread and pasta to decrease the rate of NTDs. However, despite this success, March of Dimes research demonstrated that there were racial/ethnic disparities in the incidence of NTDs. For example, Hispanic women have higher rates of NTDs when compared with non-Hispanic women. One of the contributing factors, pointed out by Dr. Fleischman, is that a common ingredient used by Latin American population is corn masa flour, which is used to make products such as tamales and tortillas. For this reason, Dr. Fleischman proposed adding folic acid to corn masa flour to lower the rate of NTDs among Hispanic women, and March of Dimes is now pursuing this approval from the FDA.
The professional trajectory of Alan R. Fleischman is inspiring for all students that have the aspiration to make a difference in the public health policy arena. During his seminar, Dr. Fleischman stressed the importance of writing as a means of creating awareness of healthcare-related issues among professionals and the general public. Writing is “a good way to make people talk and think about injustices and discuss possible solutions,” he added. Dr. Fleischman has been using this tool throughout his professional career in the field of clinical and research ethics. His work has resulted in over 150 publications in peer-reviewed journals and book chapters, and he is the co-author of the book Pediatric Ethics: From Principles to Practice. He mentioned that the last step to completing his professional journey would be to make changes in high-level policies, improving disparities in public health, and formulating innovative laws that protect patients and increase access to medical information. He concluded his seminar with a golden piece of advice: “become successful in your area of interest and then people will listen.”
Published in RightsNews
Volume 30, no. 2, February, 2012.
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