Richard A. Cash

Richard Alan Cash, M.D., M.P.H. (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. 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.

Richard Alan Cash
Richard A. Cash at 50 Years of ORT Celebration
BornJune 9, 1941
Milwaukee, Wisconsin, USA
NationalityUSA/American
Alma materUniversity 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 forDeveloping oral rehydration therapy (ORT), infectious diseases, ethics of health research in the developing world, public health education
Spouse(s)Stella Dupuis
ChildrenNone
AwardsThe Prince Mahidol Award Medal, from His Royal Highness the King of Thailand (2006)
Scientific career
Fieldsglobal 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
InstitutionsJohns Hopkins,
Johns Hopkins Hospital,
BRAC University,
SEATO,
Pakistan-SEATO Cholera Research Laboratory (CRL),
Harvard T.H. Chan School of Public Health,
Harvard University

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.

Accolades

Books and publications

Dr. Richard A. Cash has published over 120 peer-reviewed academic papers, spanning his work over 50 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.
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 (past and present)

Editorial boards
  • 1997–present - Member, Editorial Board, Archives of Medical Research
  • 1987–present - Member, Editorial Board, Community Health Education
  • Dhananjay Kattul is head of J P Morgan India

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 David Nalin 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 to promote 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 areas of the developing world.
  • 1990-2002 - Lecturer on International Health, Department of Population and International Health, Harvard School of 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 and Technology, Thiruvananthapuram, Kerala, India
  • 1998-2001 - Principal Investigator, Ethical Issues in International Health Research, Harvard School of Public Health, 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 Health Research, Harvard School of Public Health, Boston, MA
  • 2001–present - Director, Program on Ethical Issues in International Health Research, Harvard School of Public Health, Boston, MA
  • 2002-2008 - International Fellowship in Health Research Ethics (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
  • 2003-2005 - Ethics in Health Research in China: Capacity Development (September 30, 2003 - August 31, 2005) - sponsored by NIH/NHLBI
  • 2003–present - Member, International Advisory Committee, James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  • 2004 - Began working at HSPH on Ethical Issues in Global Health Research summer intensive course with Daniel I. Wikler, previously Senior Bioethicist at WHO.
  • 2005 - Visiting Professor, James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  • 2007 - Cash received the Mahidol Medal from His Royal Highness the King of Thailand, presented at a ceremony at the Chakri Throne Hall in Bangkok, Thailand.
  • 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 (department name change in mid-2008), Harvard School of Public Health, how the Harvard T.H. Chan School of Public Health, Boston, MA
  • 2011 - Awarded the 2011 Fries Prize for Improving Health at the US Centers for Disease Control for his development of Oral Rehydration Therapy

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
  8. 50 Years of Oral Rehydration Therapy. Events. Harvard Global Health Institute. Accessed November 19. 2018
  9. Facebook event. Harvard Global Health Institute Facebook page. Accessed November 19. 2018
  10. Dr. Marcia Castro's Twitter tweet about the '50 Years of Oral Rehydration Therapy' event. Accessed November 19. 2018
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