medicine World That Brings the diac surgeons who provide services in less technically advanced areas of the world. The same group of physicians goes every year to Ho Chi Minh City to work in the Cho Ray Hospital. It is a 1,700-bed facility, with two patients to a bed—a place with more need than resources. The hospital treats 10,000 patients a day; many sleep in the lobby waiting to get an appointment to see a physician. The issues are all complex. And the need is great. There are patients who need heart valve surgery or have acute myocardial infarction but can’t afford to pay for treatment. The heart team that includes Dr. Lee spends a week at a time working to help people who don’t have the ability or technology to help themselves. In turn, Dr. Lee has learned a few things as well: “You see how little you can get away with—sometimes you are forced to be creative and inventive because of the lack of technology.” He places great importance on initiatives of this type in academics. “Especially here,” says Dr. Lee, “teaching gives us a way to give back. To arrange to do this and bring teams to the world stage—there is a lot to be gained.” pollution problem before hosting the 2008 Summer Olympics. The study, funded by a grant from the National Institutes of Health (NIH), continued until 2009 and was published in 2012. “Their goal was to temporarily clean up the air to protect the athletes,” says Dr. Kipen. A percentage of factories were going to be closed temporarily, particularly those that were burning coal. Vehicles were also restricted to use inside the city only every other day. After the Olympics, these pollution measures were going to be lifted, allowing the businesses and vehicles to go back to the way they had operated before. It was the perfect opportunity to measure the beforeand-after effects of pollution on the body. Dr. Kipen explains the pollution-disease connection this way: “There is lots of epidemiology that links the quality of the air we breathe with increased risk of heart attacks— not just day to day but hour to hour.” For this study, measurements were taken in three different time periods—before the restrictions were initiated, while they were in force, and, finally, after the restrictions were lifted. The panel study was performed through a partnership with the Peking University First Hospital, where 128 medical students were recruited to give samples of their blood, breath, and urine six times—twice during each of the three periods. “We were not measuring clinical events, because these were healthy individuals. What we were looking at were biological markers that we think are involved in how heart and lung disease develops,” says Dr. Kipen. The study found that during the second time period—when pollution had been restricted—all the adverse biomarkers from breath and blood decreased, especially for inflammation and coagulation. And in urine samples, pollution-damaged DNA attributed to oxidized stress showed the same thing. What was most interesting, Dr. Kipen says, was that in the last time period, after the measures to reduce pollution were lifted, a JOHN EMERSON C l o s e r Global research that finds relatable, Practical answers H “Teaching gives us a way to give back. To arrange to do this and bring teams to the world stage—there is a lot to be gained,” says Leonard Y. Lee, MD ’92 (facing page) associate professor and interim chair, Department of Surgery and chief, division of cardiothoracic surgery at Robert Wood Johnson Medical School, directs the Mission to Vietnam through the organization Hearts Around the World. 32 Robert Wood Johnson I MEDICINE ow do air pollution in Beijing and pesticide exposure in Bangkok relate to the health of the rest of the world? Faculty members from the Environmental and Occupational Health Sciences Institute (EOHSI) can give you a personal perspective. Howard Kipen, MD, MPH, professor of environmental and occupational medicine and acting associate director, EOHSI, and Nancy Fiedler, PhD, professor of environmental and occupational medicine, were involved in research initiatives pursuing answers about the effects of pollution and pesticides. Dr. Kipen’s research took place between 2005 and 2009, mostly when Beijing was mandated to work on its overwhelming air