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Richard Alan Cash | |
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![]() Richard A. Cash at 50 Years of ORT Celebration | |
Born | June 9, 1941 |
Nationality | American |
Alma mater | University of Wisconsin–Madison New York University School of Medicine Johns Hopkins University |
Known for | Developing oral rehydration therapy (ORT), infectious diseases, ethics of health research in the developing world, public health education |
Spouse | Stella Dupuis |
Awards | The Prince Mahidol Award Medal, from His Royal Highness the King of Thailand (2006) |
Scientific career | |
Fields | global health, medicine in the developing world, population health, infectious diseases, Ethical Issues in Global Health Research, development of individual and institution-based research capacity in developing nations, institution/capacity building in resource-poor nations, impediments and opportunities for global surveillance for infectious diseases, new and reemerging infectious diseases, role of research in the development of policy and program implementation |
Institutions | Johns Hopkins, Johns Hopkins Hospital, BRAC University, SEATO, Pakistan-SEATO Cholera Research Laboratory (CRL), Harvard T.H. Chan School of Public Health, Harvard University |
Richard Alan Cash (born June 9, 1941) is an American global health researcher, public health physician, and internist. He is a Senior Lecturer in International Health at the Harvard T.H. Chan School of Public Health in Boston. [1]
He is an alumnus of the University of Wisconsin–Madison (B.S., 1963). New York University School of Medicine (M.D., 1966), and Johns Hopkins School of Hygiene and Public Health (MPH, 1973). [1]
Cash began his international career over 40 years ago when he was assigned by NIAID of the NIH to the Pakistan-SEATO Cholera Research Laboratory (CRL) in Dhaka, East Pakistan (now the ICDDR,B in Dhaka, Bangladesh). While there, he and his colleagues developed and conducted the first clinical trials of oral rehydration therapy (ORT) in adult and pediatric cholera patients and patients with other infectious causes of diarrhea. [2] This technology matches the volume of fluid losses from dehydration patients with the volume they consume so that the fluid replacement packets greatly reduce or completely replace IV therapy (particularly where it is not feasible or unavailable), which was then the only current treatment for cholera. Discoveries in ORT have been estimated to have saved over 50 million lives worldwide. [3] [4] [5] World Health Organization (WHO) estimates are that at least 60 million children have been spared painful deaths because of ORT. They also conducted the first field trials of ORT, the first community-based trials of ORT, and the first use of amino acids (glycine) as an additional substrate. In the late 1970s, Cash worked with BRAC (presently the world's largest NGO in terms of programs and personnel) on their OTEP (Oral Therapy Extension Programme), which taught over 13 million mothers and caregivers how to prepare and use ORT in the home using the "pinch and scoop" method.
It is estimated by WHO researchers that, each year, around 500 million packs of the oral rehydration solution are used in more than 60 developing countries, [6] saving over 60 million lives around the world. For demonstrating how inexpensive and simple-to-use oral rehydration therapy (ORT) could treat cholera and other diarrheal diseases, then by promoting in the developing world customized applications of oral rehydration therapy (ORT) developed by Cash and David R. Nalin (at Merck in Vaccine Development from 1983 to 2002), Cash, David Nalin, and Dilip Mahalanabis became joint recipients of the 2006 Prince Mahidol Award in public health for "exemplary contributions in the field of public health" and for their contributions "to the application of the oral rehydration solution in the treatment of severe diarrhea worldwide, including Thailand. [7]
On November 8, 2011, Cash was presented with the 2011 James F. and Sarah T. Fries Foundation Prize for Improving Health at the Centers for Disease Control and Prevention for his leadership in the development and dissemination of Oral Rehydration Therapy as a practical treatment for cholera and other diarrheal diseases that has saved the lives of at least 60 million children worldwide. [8]
Cash has lectured internationally and authored or co-authored a number of published papers on research ethics and teaches a Harvard course and had long directed (until 2009) a summer intensive workshop on those issues. He won continued NIH funding for a series of courses on research ethics in medical and health research done in resource-poor nations that touch on over a dozen issues listed on the public course's website. The use of case method teaching has been a critical element of all his courses. Many of the currently-used ethics case studies, the course outlines, many readings, and other course materials are available on that site. After the breakup of the Soviet Union, Cash served (beginning in 2003) with the Russian Academy of Sciences project on development of bioethics capacity in the Commonwealth of Independent States.
Cash explored contrasts within and between nations in health research ethics as a PI (Principal Investigator) of a training grant from the National Institutes of Health on "Ethical Issues in International Health Research" at HSPH. For eleven years, as Director of the Program on Ethical Issues in International Health Research and in line with his deep commitment to capacity building in growing nations, he has conducted training workshops based on this research in at HSPH, and in 18 nations in South America, Africa, India, and the Middle East, covering issues of informed consent, confidentiality, conflict of interest, investigator responsibilities to study populations, research in resource poor environments, and the development of ethical review committees. He has also overseen the training of 20 Fellows from Asia, and he has conducted over 30 workshops on research ethics in 12 nations.
Richard Cash is interviewed intermittently (often in remote meetings) to comment on the legacy of work he has done in the Middle East, India, and Himalayas. [9] [10]
Dr. Richard A. Cash has published over 120 peer-reviewed academic papers, spanning his work over 50 years. Some highlights include:
Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea lasting a few days. Vomiting and muscle cramps may also occur. Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance. This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish. Symptoms start two hours to five days after exposure.
Gastroenteritis, also known as infectious diarrhea or simply as gastro, is an inflammation of the gastrointestinal tract including the stomach and intestine. Symptoms may include diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydration may also occur. This typically lasts less than two weeks. Although it is not related to influenza, in the U.S. it is sometimes called the "stomach flu".
BRAC is an international development Organisation based in Bangladesh. In order to receive foreign donations, BRAC was subsequently registered under the NGO Affairs Bureau of the Government of Bangladesh. BRAC is the largest non-governmental development Organisation in the world, in terms of number of employees as of September 2016. Established by Sir Fazle Hasan Abed in 1972 after the independence of Bangladesh, BRAC is present in all 64 districts of Bangladesh as well as 16 other countries in Asia, Africa, and the Americas.
Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydration therapy can also be given by a nasogastric tube. Therapy should routinely include the use of zinc supplements. Use of oral rehydration therapy has been estimated to decrease the risk of death from diarrhea by up to 93%.
Albany Medical College (AMC) is a private medical school in Albany, New York. It was founded in 1839 by Alden March and James H. Armsby and is one of the oldest medical schools in the nation. The college is part of the Albany Medical Center, which includes the Albany Medical Center Hospital. Along with Albany College of Pharmacy, Albany Law School, the Dudley Observatory, and Union College, it is one of the constituent entities of Union University.
ICDDR,B is an international health research organisation located in Dhaka, Bangladesh. Dedicated to saving lives through research and treatment, ICDDR,B addresses some of the most critical health concerns facing the world today, ranging from improving neonatal survival to HIV/AIDS. In collaboration with academic and research institutions over the world, ICDDR,B conducts research, training and extension activities, as well as programme-based activities, to develop and share knowledge for global lifesaving solutions.
Dilip Mahalanabis was an Indian paediatrician known for pioneering the use of oral rehydration therapy to treat diarrhoeal diseases. Mahalanabis had begun researching oral rehydration therapy in 1966 as a research investigator for the Johns Hopkins University International Center for Medical Research and Training in Calcutta, India. During the Bangladeshi war for independence, he led the effort by the Johns Hopkins Center that demonstrated the dramatic life-saving effectiveness of oral rehydration therapy when cholera broke out in 1971 among refugees from East Bengal who had sought asylum in West Bengal. The simple, inexpensive Oral Rehydration Solution (ORS) gained acceptance, and was later hailed as one of the most important medical advances of the 20th century.
Daniel Isaac Wikler is an American public health educator, philosopher, and medical ethicist. He is currently the Mary B. Saltonstall Professor of Population Ethics and Professor of Ethics and Population Health in the Department of Global Health and Population of the Harvard T.H. Chan School of Public Health in Boston. He is Director and a core faculty member in the Harvard Program in Ethics and Health (PEH). His current research interests are ethical issues in population and international health, including the allocation of health resources, health research involving human subjects, organ transplant ethics, and ethical dilemmas arising in public health practice, and he teaches several courses each year. He is a fellow of the Hastings Center, an independent bioethics research institution.
Hemendra Nath Chatterjee was an Indian scientist from West Bengal known for the earliest publication of a formula for Orally Rehydrated Saline (ORS) for diarrhea management in 1952. Although his results were published in The Lancet, they didn't receive much recognition from Western scientists until later. Some argue this was for cultural reasons as his treatment protocol included traditional medicine, and also because the scientific underpinnings of ORS weren't well understood. However, some argue he shouldn't be given credit for its invention at all, as some of his results contradict the results of modern studies, and argue his success was likely due to using only mildly ill patients.
The Pollin Prize for Pediatric Research was an annual award given to physicians who contributed important advances to the field of pediatrics, and was the only existing international pediatric award. The prize was created in 2002 by Irene and Abe Pollin, and funded by the Linda and Kenneth Pollin Foundation. It was administered by the NewYork-Presbyterian Hospital, and as of 2003, Dr. Rudolph Leibel was chairman of the selection panel.
Robert Kellogg Crane was an American biochemist best known for his discovery of sodium–glucose cotransport.
David R. Nalin is an American physiologist, and Pollin Prize for Pediatric Research and Prince Mahidol Award, a.k.a. Mahidol Medal winner. Nalin had the key insight that oral rehydration therapy (ORT) would work if the volume of solution patients drank matched the volume of their fluid losses, and that this would drastically reduce or completely replace the only current treatment for cholera, intravenous therapy. Nalin led the trials that first demonstrated ORT works, both in cholera patients, and more significantly, also in other dehydrating diarrhea illnesses. Nalin's discoveries have been estimated to have saved over 50 million lives worldwide.
Robert Allan Phillips MD was a research scientist whose research contributed to a transformation in the treatment of cholera.
The management of dehydration typically involves the use of oral rehydration solution (ORS). Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt added per liter. Clean plain water can also be one of several fluids given. There are commercial solutions such as Pedialyte, and relief agencies such as UNICEF widely distribute packets of salts and sugar. The World Health Organization (WHO) describes a homemade ORS with one liter water with one teaspoon salt and six teaspoons sugar added. The WHO; however, does not generally recommend homemade solutions as how to make them is easily forgotten. Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness. Both agree that drinks with too much sugar or salt can make dehydration worse.
Norbert Hirschhorn is an Austrian-born American public health physician. He was one of the inventors and developers of the life-saving method called oral rehydration therapy for adults and children suffering fluid loss from cholera and other infectious diarrheal illnesses. It is estimated that his work has saved around 50 million people suffering from dehydration.
Matlab was an upazila of the Chandpur District of the Chittagong Division, Bangladesh. In 2000, the administrative area was subdivided into Matlab Dakshin Upazila and Matlab Uttar Upazila.
DripDrop is an oral rehydration solution company, based in Oakland, CA. Eduardo Dolhun founded the company in 2008 and began manufacturing in 2010. In practice, DripDrop ORS is used as a part of oral rehydration therapy.
John Briscoe was a South African-born environmental engineer who was Visiting Professor of the Practice of Environmental Health in the Department of Environmental Health at Harvard School of Public Health. He was known as "Mr. Water" to environmental economists. At Harvard, Briscoe also held appointments at the Harvard School of Engineering and Applied Sciences (SEAS) as Gordon McKay Professor of the Practice of Environmental Engineering, and at the Harvard Kennedy School. His career focused on efforts on the developing world to successfully manage and preserve water as a precious resource. In early 2014, he received the Stockholm Water Prize - the “Nobel Prize of Water" - for "unparalleled contributions to global and local management of water - contributions covering vast thematic, geographic, and institutional environments-that have improved the lives and livelihoods of millions of people worldwide.”
Stanley G. Schultz was an American physician and scientist whose work led to the development of oral rehydration therapy. He held the Fondren Family Chair in Cellular Signaling and the H. Wayne Hightower Distinguished Professorship in the Medical Sciences at the University of Texas Health Science Center at Houston (UTHealth) before becoming the center's medical school dean.
The child survival revolution was an effort started by UNICEF to reduce child mortality in the developing world. The effort lasted from 1982 to the 1990s, and generally coincides with James P. Grant's tenure as executive director of UNICEF (1980–1995). The child survival revolution included various programs and conferences, including the World Summit for Children in 1990.