Richard A. Cash
Encyclopedia
Prof. Richard Alan Cash, MD, MPH (1941- ) is an American
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 global health
Global health
Global health is the health of populations in a global context and transcends the perspectives and concerns of individual nations. Health problems that transcend national borders or have a global political and economic impact, are often emphasized...

 researcher, public health physician, internist, and Prince Mahidol 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 School of Public Health in Boston. Prior to joining HSPH full-time, he was a Senior Fellow at the Harvard Institute for International Development
Harvard Institute for International Development
The Harvard Institute for International Development was a think-tank dedicated to helping nations join the global economy, operating between 1974 and 2000...

 (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
Dhaka
Dhaka is the capital of Bangladesh and the principal city of Dhaka Division. Dhaka is a megacity and one of the major cities of South Asia. Located on the banks of the Buriganga River, Dhaka, along with its metropolitan area, had a population of over 15 million in 2010, making it the largest city...

, East Pakistan (now the ICDDR,B in Dhaka
Dhaka
Dhaka is the capital of Bangladesh and the principal city of Dhaka Division. Dhaka is a megacity and one of the major cities of South Asia. Located on the banks of the Buriganga River, Dhaka, along with its metropolitan area, had a population of over 15 million in 2010, making it the largest city...

, Bangladesh
Bangladesh
Bangladesh , officially the People's Republic of Bangladesh is a sovereign state located in South Asia. It is bordered by India on all sides except for a small border with Burma to the far southeast and by the Bay of Bengal to the south...

). While there, he and his colleagues developed and conducted the first clinical trials of oral rehydration therapy
Oral rehydration therapy
Oral rehydration therapy is a simple treatment for dehydration associated with diarrhoea, particularly gastroenteritis or gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth...

 (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
Oral rehydration therapy
Oral rehydration therapy is a simple treatment for dehydration associated with diarrhoea, particularly gastroenteritis or gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth...

 (ORT) [* have been estimated to have saved over 50 million lives worldwide. World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 (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
Glycine
Glycine is an organic compound with the formula NH2CH2COOH. Having a hydrogen substituent as its 'side chain', glycine is the smallest of the 20 amino acids commonly found in proteins. Its codons are GGU, GGC, GGA, GGG cf. the genetic code.Glycine is a colourless, sweet-tasting crystalline solid...

) 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, Dr. 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
Kerala
or Keralam is an Indian state located on the Malabar coast of south-west India. It was created on 1 November 1956 by the States Reorganisation Act by combining various Malayalam speaking regions....

, India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

, and Bangladesh
Bangladesh
Bangladesh , officially the People's Republic of Bangladesh is a sovereign state located in South Asia. It is bordered by India on all sides except for a small border with Burma to the far southeast and by the Bay of Bengal to the south...

 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
BRAC University
BRAC University is a private university in Dhaka, Bangladesh. The university was established by BRAC in 2001 under the Private University Act 1992. BRAC University had its first convocation in January 2006...

 in Dhaka
Dhaka
Dhaka is the capital of Bangladesh and the principal city of Dhaka Division. Dhaka is a megacity and one of the major cities of South Asia. Located on the banks of the Buriganga River, Dhaka, along with its metropolitan area, had a population of over 15 million in 2010, making it the largest city...

, Bangladesh
Bangladesh
Bangladesh , officially the People's Republic of Bangladesh is a sovereign state located in South Asia. It is bordered by India on all sides except for a small border with Burma to the far southeast and by the Bay of Bengal to the south...

 (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 life-long 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, saving over 60 million lives around the world. For demonstrating how inexpensive and simple-to-use oral rehydration therapy (ORT)
Oral rehydration therapy
Oral rehydration therapy is a simple treatment for dehydration associated with diarrhoea, particularly gastroenteritis or gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth...

 could treat cholera and other diarrheal diseases, then by 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
David Nalin
David R. Nalin is an American physiologist, and Pollin Prize for Pediatric Research and Mahidol Medal winner. Nalin had the key insight that Oral rehydration therapy would work if the volume of solution patients drank matched the volume of their fluid losses, and that this would drastically...

, and Dr. Dilip Mahalanabis
Dilip Mahalanabis
Dilip Mahalanabis is an India biologist. He was the director of International Centre for Diarrhoeal Disease Research, Bangladesh Dilip Mahalanabis (born November 12th, 1934) is an India biologist. He was the director of International Centre for Diarrhoeal Disease Research, Bangladesh Dilip...

 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.

On November 8, 2011, Dr. Cash was presented with the 2011 [www.friesfoundation.org James F. and Sarah T. Fries Foundation] Prize for Improving Health at the Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...

 for his leadership in the development and dissemination of Oral Rehydration Therapy
Oral rehydration therapy
Oral rehydration therapy is a simple treatment for dehydration associated with diarrhoea, particularly gastroenteritis or gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth...

 as a practical treatment for cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...

 and other diarrheal diseases that has saved the lives of at least 60 million children worldwide.

Ethics Contributions

Dr. Cash has lectured internationally and authored or co-authored a number of published papers on research ethics and teaches a Harvard course and directs 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.

Public Health Contributions

Dr. 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.

Dr. 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.

Awards, Honors, Distinctions


Major Professional Service

  • 1995-1996 - President, Child Health Foundation, Columbia, MD
  • 1993-1997 - Board Member, Child Health Foundation, Columbia, MD
  • 1982-1984 - Chair, International Health Section, American Public Health Association
    American Public Health Association
    The American Public Health Association is Washington, D.C.-based professional organization for public health professionals in the United States. Founded in 1872 by Dr. Stephen Smith, APHA has more than 30,000 members worldwide...


Professional Societies (past and present)


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
  • 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. University Press 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 Bangladesh Experience. BRAC Publications, Dhaka, 1998.
  • Cash RA and Narasimhan V. Impediments to Global Surveillance of Infectious Diseases: Economic and Social Consequences 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: International Cooperation 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. 1968 Aug 17;2(7564):370-3. This paper in Lancet is the original report of work by Dr. Cash and colleagues’ work with ORT.

Other Publications about ORT

  • Oral therapy for diarrheal diseases. Nalin DR. J Diarrhoeal Dis Res. 1987 Dec;5(4):283-92. This paper provides an overview of how ORT can be used for dehydration resulting from diarrheal diseases, not only cholera.
  • Worth his salt. Sandeep K. The Hindu
    The Hindu
    The Hindu is an Indian English-language daily newspaper founded and continuously published in Chennai since 1878. According to the Audit Bureau of Circulations, it has a circulation of 1.46 million copies as of December 2009. The enterprise employed over 1,600 workers and gross income reached $40...

    . 2002 Feb 25. Popular press article celebrating Dr. Cash's visit to Thiruvananthapuram
    Thiruvananthapuram
    Thiruvananthapuram , formerly known as Trivandrum, is the capital of the Indian state of Kerala and the headquarters of the Thiruvananthapuram District. It is located on the west coast of India near the extreme south of the mainland...

    , Kerala
    Kerala
    or Keralam is an Indian state located on the Malabar coast of south-west India. It was created on 1 November 1956 by the States Reorganisation Act by combining various Malayalam speaking regions....

    , India
    India
    India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

    , site of the Achutha Menon Centre for Health Science Studies.

Global Research Projects


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. 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
    National Institutes of Health
    The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...

     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
    World Health Organization
    The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

     (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 Dr. Daniel I. Wikler
    Dan Wikler
    Daniel I. Wikler is currently in the of the Harvard School of Public Health in Boston. He is a core faculty member in the . His current research interests are ethical issues in population and international health, including , health research involving human subjects, organ transplant ethics,...

    , previously Senior Bioethicist at WHO.
  • 2005 - Visiting Professor, James P. Grant School of Public Health, BRAC University
    BRAC University
    BRAC University is a private university in Dhaka, Bangladesh. The university was established by BRAC in 2001 under the Private University Act 1992. BRAC University had its first convocation in January 2006...

    , Dhaka
    Dhaka
    Dhaka is the capital of Bangladesh and the principal city of Dhaka Division. Dhaka is a megacity and one of the major cities of South Asia. Located on the banks of the Buriganga River, Dhaka, along with its metropolitan area, had a population of over 15 million in 2010, making it the largest city...

    , Bangladesh
    Bangladesh
    Bangladesh , officially the People's Republic of Bangladesh is a sovereign state located in South Asia. It is bordered by India on all sides except for a small border with Burma to the far southeast and by the Bay of Bengal to the south...

  • 2007 - Dr. 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
    New York University
    New York University is a private, nonsectarian research university based in New York City. NYU's main campus is situated in the Greenwich Village section of Manhattan...

  • 2008–present - Senior Lecturer on International Health, Department of Global Health and Population (department name change in mid-2008), Harvard 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
    Oral rehydration therapy
    Oral rehydration therapy is a simple treatment for dehydration associated with diarrhoea, particularly gastroenteritis or gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth...


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