People
Richard Alan Cash, MD, MPH

Richard Alan Cash, MD, MPH

Burgess COMMENTARY

Peter Burgess

Richard Alan Cash, MD, MPH Born: 1941 Milwaukee, Wisconsin, USA Residence: Cambridge, Massachusetts, USA Citizenship: United States Nationality: USA/American Fields: global health,medicine in the developing world,population health, infectious diseases,Ethical Issues in Global Health Research [1],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 [2],BRAC University,SEATO,Pakistan-SEATO Cholera Research Laboratory (CRL) [3],Harvard School of Public Health,Harvard University

Known for Developing oral rehydration therapy (ORT), infectious diseases, ethics of health research in the developing world, public healtheducation

Notable awards: The Prince Mahidol Medal, from His Royal Highness the King of Thailand (2006)

Prof. Richard Alan Cash, MD, MPH (1941- ) is an American global health researcher, public health physician,internist, and Prince Mahidol Award / Medal [4] winner [5]. He is a Senior Lecturer in International Health [6] and Director of the Program on Ethical Issues in International Health in the Department of Global Health & Population [7] of the Harvard School of Public Health [8] in Boston. Prior to joining HSPH full-time, he was a Senior Fellow atthe Harvard Institute for International Development (previously HIID, now CID) and part-time at HSPH [8]. He isgifted at figuring out how to show others how to do much with very little.

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 [9] 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. 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 oral rehydration therapy (ORT) [* have been estimated to have saved over 50 million lives worldwide [10]. [11][12][13] 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) [14], which taught over 13 million mothers and caregivers how to prepare and use ORT in the home using the 'pinch and scoop' method.Cash continues to work with BRAC on a number of their health and education projects. After joining Harvard 30years ago (at HIID and HSPH), he worked on a number of international programs that stressed implementation,training, and capacity building. In particular, the ADDR [15] (Applied Diarrheal Disease Research project) providedover 150 grants to developing country scientists and led to over 300 publications in national and international journals. At HSPH, Dr. Cash has taught a wide variety of courses, including Introduction to International Health, theEpidemiology of Infectious Disease of Importance in Developing Countries, Ethical Issues in International Research,and Urban Health Care in Developing Countries. He also leads field-trip courses to Kerala, India, and Bangladeshfor HSPH students.At present, he has visiting faculty appointments at the Achutha Menon Centre for Health Sciences Studies inTrivandrum, Kerala, India (teaching in the MPH program for the past nine years) and at the James P. Grant School of Public Health [16] of BRAC University in Dhaka, Bangladesh (a member of the international board of advisors andteaching in the MPH program for three years). Institution/capacity building in developing nations is very much partof his lifelong professional commitment and work.It is estimated by WHO researchers that, each year, around 500 million packs of the oral rehydration solution areused in more than 60 developing countries, [17] saving over 60 million lives around the world. For demonstrating howinexpensive and simple-to-use oral rehydration therapy (ORT) could treat cholera and other diarrheal diseases, thenby promoting in the developing world customized applications of oral rehydration therapy - ORT - developed by Dr.Cash and Dr. David R. Nalin (at Merck in Vaccine Development from 1983 to 2002), Dr. Cash, Dr. David Nalin, andDr. Dilip Mahalanabis became joint recipients of the 2006 Prince Mahidol Award [18] in public health for 'exemplary contributions in the field of public health' and for their contributions 'to the application of the oralrehydration solution in the treatment of severe diarrhea worldwide, including Thailand. [19] On November 8, 2011, Dr. Cash was presented with the 2011 [www.friesfoundation.org James F. and Sarah T. FriesFoundation] Prize for Improving Health at the Centers for Disease Control and Prevention for his leadership in thedevelopment and dissemination of Oral Rehydration Therapy as a practical treatment for cholera and other diarrhealdiseases that has saved the lives of at least 60 million children worldwide. [20]

Ethics Contributions

Dr. Cash has lectured internationally and authored or co-authored a number of published papers on research ethicsand teaches a Harvard course and directs a summer intensive workshop on those issues. He won continued NIHfunding for a series of courses on research ethics in medical and health research done in resource-poor nations [1] thattouch on over a dozen issues listed on the public course's website [8] . The use of case method teaching has been acritical 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 [8] .

Public Health Contributions

Dr. Richard A. Cash explored contrasts within and between nations in health research ethics as a PI (PrincipalInvestigator) of a training grant from the National Institutes of Health on 'Ethical Issues in International HealthResearch' at HSPH. For eleven years, as Director of the Program on Ethical Issues in International Health Research [21] and in line with his deep commitment to capacity building in growing nations, he has conducted trainingworkshops based on this research in at HSPH [21] , and in 18 nations in South America, Africa, India, and the MiddleEast, covering issues of informed consent, confidentiality, conflict of interest, investigator responsibilities to studypopulations, research in resource poor environments, and the development of ethical review committees. He has alsooverseen the training of 20 Fellows from Asia, and he has conducted over 30 workshops on research ethics in 12 nations.

Dr. Cash has been a PI of the ADDR (Applied Diarrheal Disease Research) Project, which helped scientists indeveloping nations develop their research abilities by conducting their own research projects. Over 150 studiesinvolving more than 350 investigators were funded in twelve countries in Latin America, Asia, and Africa, leading toover 275 research publications. Research priorities of the program focused on: acute respiratory infection andnutrition; behavioral studies of care takers and providers; diarrhea (prevention; persistent and evasive diarrhea); andfoods and fluids. Numerous ADDR studies explored researcher training and translation (e.g. how researchers aretrained and how research results are translated into policy and program implementation). [The ARCH (AppliedResearch for Child Health) Project replaced the ADDR Project and expanded its work further into roles of development activities on the reemergence of previously-controlled infectious diseases and the emergence of newly-described infectious diseases. Awards, Honors, Distinctions €€1994 - Special Citation - 25th Anniversary of the development of Oral Rehydration Therapy (ORT)ICDDRB/Government of Bangladesh€2006 - 2006 Prince Mahidol Award, received in January 2007 in Bangkok [5] €€2007 - Samuel Bereson Award for Distinguished Alumni, New York University School of Medicine€€2008 - Distinguished Alumni Award, New York University€2011 - 2011 Fries Prize for Improving Health [22] at the US Centers for Disease Control

Major Professional Service

€1995-1996 - President, Child Health Foundation [23] , Columbia,

MD€1993-1997 - Board Member, Child Health Foundation [23], Columbia, MD €1982-1984 - Chair, International Health Section, American Public Health Association Professional Societies (past and present) €Global Health Council [24]

€American Academy for the Advancement of Science [25]

€Royal Society of Tropical Medicine and Hygiene [26]

€International Epidemiological Association [27]

€Society for Epidemiological Research [28]

€National Council for Internatiional Health [29]

€€International Health Society€Massachusetts Medical Society [30] €€American Public Health Association

Editorial Boards €1997 € present - Member, Editorial Board, Archives of Medical Research€1987 € present - Member, Editorial Board, Community Health Education

Major Research Interests €1. Ethical Issues in Global Health Research [1] €€2. Development of individual and institution-based research capacity in developing countries€€3. Impediments and opportunities for global surveillance for infectious diseases€€4. New and reemerging infectious diseases€€5. The role of research in the development of policy and program implementation

Publications (Partial List) €€Chowdhury AMR and Cash RA. A Simple Solution: Teaching Millions to Treat Diarrhoea at Home. UniversityPress Ltd., Dhaka, 1996.€€Keusch GT and Cash RA. A Vaccine Against Rotavirus: When is Too Much Too Much? [Editorial]. New Eng.J.Med. 337(17):1228-29, 1997.€€Chowdhury S. and Cash RA (ed). Implementing Women's Health Programs in the Community: The BangladeshExperience. BRAC Publications, Dhaka, 1998.€€Cash RA and Narasimhan V. Impediments to Global Surveillance of Infectious Diseases: Economic and SocialConsequences of Open Reporting. J. Soc. Int. Devel., 1999.€€Chen L, Evans T, and Cash RA, 'Global Health as a Public Good', in Global Public Goods: InternationalCooperation in the 21st Century, Oxford University Press, New York, 1999.€€Oral or nasogastric maintenance therapy in pediatric cholera patients. Nalin DR, Cash RA.€€J Pediatr. 1971 Feb;78(2):355-8. - This paper describes the use of ORT in pediatric patients.€Oral maintenance therapy for cholera in adults. Nalin DR, Cash RA, Islam R, Molla M, Phillips RA. Lancet. 1968Aug 17;2(7564):370-3. This paper in Lancet is the original report of work by Dr. Cash and colleagues • work withORT.

Other Publications about ORT

€€Oral therapy for diarrheal diseases. Nalin DR. J Diarrhoeal Dis Res. 1987 Dec;5(4):283-92. This paper providesan overview of how ORT can be used for dehydration resulting from diarrheal diseases, not only cholera.€Worth his salt. Sandeep K. The Hindu. 2002 Feb 25. Popular press article celebrating Dr. Cash's visit toThiruvananthapuram, Kerala, India, site of the Achutha Menon Centre for Health Science Studies. Global Research Projects

€Ethics in Health Research in China: Capacity Development - China [31]

€International Fellowship in Health Research Ethics [32]

Timeline

€€1941 - Richard A. Cash born in Milwaukee, Wisconsin€€1959-1962 - University of Wisconsin (Madison), BA (pre-med), 1959 [accelerated; 3-year degree]€€1962-1966 - New York University School of Medicine, MD (1966)€€1966 (Fall) - Rheumatic Disease Unit, Northern General Hospital, Edinburgh, Scotland€€1966-1967 - Intern (Medical Internship), Bellevue Hospital, New York, New York €€1960s - Work as a young clinician interest in global health at the Pakistan-SEATO Cholera Research Laboratory(CRL) in Dhaka€€1967 - Richard Cash co-discovers that oral therapy can rehydrate cholera patients. Collaborates with Dr. DavidNalin to develop trial protocol to confirm discovery success.€1967-1970 - Senior Assistant Surgeon General, US Public Health Research Fellow, Cholera Research Laboratory,National Institute of Allergy and Infectious Diseases of the National Institutes of Health assigned to CRL, Dhaka,Bangladesh.€€1970-1971 - Junior Assistant Resident, Department of Medicine, University of Maryland Hospital, Baltimore,MD€€1971-1973 - Fellow in Infectious Diseases, Department of Medicine, University of Maryland Hospital, Baltimore,MD€€1972-1973 - Johns Hopkins School of Hygiene and Public Health, MPH (1973)€€1973-1976 - Assistant Professor, University of Maryland - Department of Medicine€€1975-1976 - Assistant Professor, University of Maryland - Department of Social and Preventive Medicine€1975 - The World Health Organization (WHO) and the United Nations Children • s Fund (UNICEF) agreed topromote a single, orally administered solution of oral rehydration salts to prevent dehydration caused by diarrhea.€€1976 - Lecturer, Department of International Health, Johns Hopkins School of Hygiene and Public Health€€1977-2000 - Fellow, Harvard Institute for International Development, Cambridge, MA€€1979-1989 - Lecturer, Department of Tropical Public Health, Harvard School of Public Health, Boston, MA€€1981-1990 - Director, Office of International Health, Harvard School of Public Health, Boston, MA€€1990-2000 - Co-director, Health Office, Harvard Institute for International Development, Cambridge, MA* 1998- NIH Grant to develop ethics course in healthcare research among vulnerable populations in resource poor areasof the developing world.€€1990-2002 - Lecturer on International Health, Department of Population and International Health, Harvard Schoolof Public Health, Boston, MA€€1994 - Special Citation - 25th Anniversary of the development of Oral Rehydration Therapy (ORT)ICDDRB/Government of Bangladesh€1998 € present - Visiting Professor, Achutha Menon Centre, Sree Chitra Tirunal Institute for Medical Sciences andTechnology, Thiruvananthapuram, Kerala, India€€1998-2001 - Principal Investigator, Ethical Issues in International Health Research, Harvard School of PublicHealth, Boston, MA€€1999 - First 'Ethical Issues in International Health Research' course offered at HSPH.€€2000-2006 - Principal Investigator, International Fellows Program in Ethical Issues in International HealthResearch, Harvard School of Public Health, Boston, MA€2001 € present - Director, Program on Ethical Issues in International Health Research, Harvard School of PublicHealth, Boston, MA€2002-2008 - International Fellowship in Health Research Ethics [32] (September 19, 2002 - December 31, 2008) -sponsored by NIH/FIC€€2002-2008 - Senior Lecturer on International Health, Department of Population and International Health(department name change in mid-2008), Harvard School of Public Health, Boston, MA

Richard A. Cash6€2003-2005 - Ethics in Health Research in China: Capacity Development [31] (September 30, 2003 - August 31,2005) - sponsored by NIH/NHLBI€2003 € present - Member, International Advisory Committee, James P. Grant School of Public Health, BRACUniversity, Dhaka, Bangladesh€2004 - Began working at HSPH on Ethical Issues in Global Health Research summer intensive course with Dr.Daniel I. Wikler, previously Senior Bioethicist at WHO.€2005 - Visiting Professor, James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh€2007 - Dr. Cash received the Mahidol Medal from His Royal Highness the King of Thailand, presented at aceremony at the Chakri Throne Hall in Bangkok, Thailand [5] .€€2007 - Samuel Bereson Award for Distinguished Alumni, New York University School of Medicine€2008 - Distinguished Alumni Award, New York University€2008 € present - Senior Lecturer on International Health, Department of Global Health and Population (departmentname change in mid-2008), Harvard School of Public Health, Boston, MA€2011 - Awarded the 2011 Fries Prize for Improving Health [22] at the US Centers for Disease Control for hisdevelopment of Oral Rehydration Therapy External links €'Cholera: A Not-So-Simple Solution' [33] €HSPH Faculty Profile [6] €Ethical Issues in Global Health Research summer intensive course at HSPH [21] €Link to ScienceHeroes.com [10] €Link to Dr. Cash • s biography as recipient of the Prince Mahidol Award [5] €Against the Odds € Making a difference in global health € A Simple Solution [34] €Woodward, Billy. 'David Nalin-Over 50 Million Lives Saved.' Scientists Greater Than Einstein. Fresno: QuillDriver Books, 2009 [35] €Google Scholar Search for Publications by Dr. Richard Alan Cash [36] €Google Search for Online Mentions of Dr. Richard Alan Cash [37] Related Reading €Scientists Greater than Einstein: The Biggest Lifesavers of the Twentieth Century [38] (Hardcover) by BillyWoodward [39] (Author, Fresno: Quill Driver Books, 2009€The Lessons of Oral Rehydration Therapy: The co-discoverer of a simple solution to a global killer passes all hehas learned to public health's next generation [40] , Karin Kiewra [41] , Harvard Public Health Review [42] , 2007. References [1]http:/ /www. HSPH.Harvard.edu/ bioethics/ [2]http:/ /www. hopkinsmedicine. org/the_johns_hopkins_hospital/ index. html[3]http:/ /www. icddrb.org/images/8thascon_briefhistory. pdf [4]http:/ /www. princeaward.mahidol.ac.th/ prince-award. html[5]http:/ /www. princemahidolaward. org/laureate-bio. en.php?type=ind&id=2006-11-22%2006:29:42[6]http:/ /www. hsph. harvard. edu/ faculty/richard-cash/ [7]http:/ /www. hsph. harvard. edu/ departments/ global-health-and-population/ [8]http:/ /www. hsph. harvard. edu[9]http:/ /www. icddrb.org[10]http:/ /www. scienceheroes.com/ index. php?option=com_content&view=article&id=65&Itemid=113[11]http:/ /www. bmj. com/ cgi/ content/ full/334/suppl_1/ s14?view=long&pmid=17204754[12][12]Woodward, Billy. 'David Nalin-Over 50 Million Lives Saved.' Scientists Greater Than Einstein. Fresno: Quill Driver Books, 2009.[13]http:/ /www. scienceheroes.com/ index. php?option=com_content&view=article&id=65&Itemid=113 Richard A. Cash7 [14]http:/ /books. google. com/ books?id=gY0iovWA8voC&pg=PA15&lpg=PA15& dq=%22Oral+Therapy%22+ OTEP&source=bl&ots=tMv8K5HIoa&sig=6tKJHTee8HiI_D0MAJck5xXhnp4& hl=en&ei=B_7NSvnOD9LjlAfdyYyJAw& sa=X& oi=book_result&ct=result&resnum=6#v=onepage&q=%22Oral%20Therapy%22%20OTEP& f=false[15]http:/ /www. questia. com/ googleScholar.qst;jsessionid=KTBZQhn2460y8K9PnVvM1jb3KFYQlWjZdkG9g1RJp4XCPsXbZSHh!-383115674!1267170845?docId=5009383972[16]http:/ /sph. bracu.ac.bd/ [17]http:/ /www. princemahidolaward. org/laureate-bio. en.php?type=ind&id=2006-11-22%2006:29:42[18]http:/ /www. princemahidolaward. org/index. en.php[19]http:/ /www. ryt9.com/ es/ryt9m/50430/ NOTE that the TEXT of the Mahidol Award ceremony of January 2007 notes that theMahalanabis contribution is for the application of ORT.[20]http:/ /www. friesfoundation. org/prizerecip. html[21]http:/ /www. hsph. harvard. edu/ bioethics/ [22]http:/ /www. friesfoundation. org/prizerecip. html[23]http:/ /www. childhealthfoundation. org[24]http:/ /www. globalhealth. org[25]http:/ /www. AAAS. org[26]http:/ /www. rstmh.org[27]http:/ /www. dundee.ac.uk/iea[28]http:/ /www. epiresearch.org[29]http:/ /www.[30]http:/ /www. MassMed. org[31]https://webapps. sph. harvard. edu/ cfdocs/worldmap/ view-project. cfm?ID=216[32]https://webapps. sph. harvard. edu/ cfdocs/worldmap/ view-project. cfm?ID=215[33]http:/ /www. hsph. harvard. edu/ review/ summer_solution. shtml[34]http:/ /apps. nlm. nih.gov/againsttheodds/ exhibit/ community_health/simple_solution.cfm[35]http:/ /www. bmj.com/ cgi/ content/ full/334/suppl_1/ s14?view=long&pmid=17204754[36]http:/ /scholar.google. com/ scholar?q=%22Richard+A+Cash%22&hl=en&btnG=Search[37]http:/ /www. google. com/ search?q=%22Richard+ A. + Cash%22+ Harvard& ie=utf-8& oe=utf-8&aq=t&rls=org.mozilla:en-US:official& client=firefox-a[38]http:/ /www. amazon. com/ dp/1884956874[39]http:/ /www. eruditor. com/ books/item/ 9781884956874. html.en[40]http:/ /www. hsph. harvard. edu/ review/ winter07/ ort.html[41]https://www. facebook.com/ people/ Karin-Kiewra/ 1416643992[42]http:/ /www. HSPH.Harvard.edu Article Sources and Contributors Richard A. Cash Source : http://en.wikipedia.org/w/index.php?oldid=501662525 Contributors : Aymatth2, Johnpacklambert, Khazar2, Mandarax, MaynardClark, 1 anonymous edits License Creative Commons Attribution-Share Alike 3.0 Unported //creativecommons.org/licenses/by-sa/3.0/