Richard A. Cash

Richard Alan Cash
Born June 9, 1941
Milwaukee, Wisconsin, USA
Residence Cambridge, Massachusetts, USA
Nationality USA/American
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
Alma mater

University of Wisconsin–Madison, BS (pre-med), 1963
New York University School of Medicine, MD (1966)

Johns Hopkins School of Hygiene and Public Health, Johns Hopkins University, MPH (1973)
Known for Developing oral rehydration therapy (ORT), infectious diseases, ethics of health research in the developing world, public health education
Notable awards The Prince Mahidol Award Medal, from His Royal Highness the King of Thailand (2006)

Richard Alan Cash, M.D., M.P.H. (born June 9, 1941) is an American global health researcher, public health physician, internist, and Prince Mahidol Award / Medal winner. He is a Senior Lecturer in International Health and Director of the Program on Ethical Issues in International Health in the Department of Global Health & Population of the Harvard T.H. Chan School of Public Health in Boston. Prior to joining HSPH full-time, he was a Senior Fellow at the Harvard Institute for International Development (previously HIID, now CID) and part-time at HSPH. He is gifted 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 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.[1] 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.[2][3][4] 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.

Cash continues to work with BRAC on a number of their health and education projects. After joining Harvard 30 years ago (at HIID and HSPH), he worked on a number of international programs that stressed implementation, training, and capacity building. In particular, the ADDR (Applied Diarrheal Disease Research project) provided over 150 grants to developing country scientists and led to over 300 publications in national and international journals. At HSPH, Cash has taught a wide variety of courses, including Introduction to International Health, the Epidemiology 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 Bangladesh for HSPH students.

At present, he has visiting faculty appointments at the Achutha Menon Centre for Health Sciences Studies in Trivandrum, Kerala, India (teaching in the MPH program for the past nine years) and at the James P. Grant School of Public Health of BRAC University in Dhaka, Bangladesh (a member of the international board of advisors and teaching in the MPH program for three years). Institution/capacity building in developing nations is very much part of his lifelong professional commitment and work.

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,[5] 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.[6]

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.[7]

Contributions to ethics

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.

Contributions to public health

Richard A. 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.

Cash has been a PI of the ADDR (Applied Diarrheal Disease Research) Project, which helped scientists in developing nations develop their research abilities by conducting their own research projects. Over 150 studies involving more than 350 investigators were funded in twelve countries in Latin America, Asia, and Africa, leading to over 275 research publications. Research priorities of the program focused on: acute respiratory infection and nutrition; behavioral studies of care takers and providers; diarrhea (prevention; persistent and evasive diarrhea); and foods and fluids. Numerous ADDR studies explored researcher training and translation (e.g. how researchers are trained and how research results are translated into policy and program implementation). The ARCH (Applied Research 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.

Accolades

Books and Publications

Dr. David Nalin has published over 120 peer-reviewed academic papers, spanning his work over 40 years. Some highlights include:

Oral maintenance therapy for cholera in adults. Nalin DR, Cash RA, Islam R, Molla M, Phillips RA. Lancet. 1968 Aug 17;2(7564):370-3. This paper in The Lancet is the original report of Dr. Nalin and colleagues’ work with ORT.

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.

Cash, R., Wikler, D., Saxena, A., Capron, A. Casebook on Ethical Issues in International Health Research, Geneva: World Health Organization, 2009, 2010.

Translated into five other languages, including Arabic, Chinese, English, French, Russian, and Spanish. ISBN 9789241547727; second edition forthcoming. ISBN 978 92 4 154772 7 (NLM classification: W 20.5).

Major professional service

Professional societies

Major professional service

Professional Societies (past and present)

Editorial boards

Timeline

Further reading

References

  1. ↑ Sandeep, K. "Worth his salt" in The Hindu, February 25, 2002
  2. ↑ Oral rehydration therapy: the simple solution for saving lives | The BMJ
  3. ↑ Woodward, Billy. "David Nalin-Over 50 Million Lives Saved." Scientists Greater Than Einstein. Fresno: Quill Driver Books, 2009.
  4. ↑ "UNICEF Proclaims His Discovery As Greatest Medical Breakthrough of 20th Century". Science Heroes.
  5. ↑ www.princemahidolaward.org
  6. ↑ http://www.ryt9.com/es/ryt9m/50430/ NOTE that the TEXT of the Mahidol Award ceremony of January 2007 notes that the Mahalanabis contribution is for the application of ORT.
  7. ↑ friesfoundation.org - This website is for sale! - friesfoundation Resources and Information
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