Transcriber: Petra Balíková Reviewer: Elisabeth Buffard
Today we're going to talk about a very powerful idea
that can transform the lives of children around the world.
It's an idea that's simple, that's easy to implement
and that costs little or nothing.
But it does require that we join together to accomplish it.
But even that's good news,
because we're living in a participation age.
We are not just consuming culture, we're creating it together.
When it comes to medicine, participatory medicine,
taking charge of our own health
is fundamental to transforming health care.
And participatory public health
enables us to tackle
the world's biggest health problems together.
We can't just rely on public institutions to get the job done,
as important as they are,
if we want to change huge things fast.
So today we're going to talk about a global, historic campaign
called TICC TOCC.
It's a participatory campaign.
But first, we have to set the stage.
There are a few things you need to know.
There are two atoms that are very common, very plentiful,
but they all too often do not end up
in the right place at the right time.
And the consequences for children's health,
for their developing brains, for the neurons in their developing brains
are immense.
The first of these is oxygen.
I can remember, when each of my own children were born,
this sense of joy and relief when I heard their first cry.
Their lungs were filled with air.
It's an instinctive thing in us parents to feel great when they cry
and not good when we don't hear anything.
The first minute of life is often called the golden minute,
because it's so important.
And the reason that it's called the golden minute,
is that there is a huge difference between babies who get enough oxygen
in that first minute after being born
and those who don't get enough.
In fact, the World Health Organization has estimated
that 29% of all newborn deaths around the planet
come from not getting enough oxygen at birth.
We call it birth asphyxia.
And that's just part of the problem.
There is a million kids who die every year from not getting enough oxygen.
There's another million or even more who get enough oxygen to survive,
but not enough to thrive,
and they're left with lifelong consequences
like cerebral palsy or epilepsy or learning disabilities
or a developmental delay.
And even that's not the whole story.
One in 10 newborns around the world -
in some places one in seven -
get suboptimal amounts of oxygen at birth.
In public health, there is this concept that's really useful,
called disability-adjusted life-years, or a related concept,
quality-adjusted life-years,
and very simply, it's a measure of health.
It's the number of years of health that are lost
because of disability or disease or death.
And when you look around the planet at loss of health in childhood,
far and away the number one cause of kids losing health
is not getting enough oxygen in the first minutes of life.
The stakes couldn't get any higher than this, for children's health.
So how do we solve it?
Well, one solution of course, would be
we could just get an oxygen canister in every village
and every room where a baby is born.
We could solve it, it's simple,
but not easy to implement and not inexpensive.
Especially when you talk about refilling the oxygen canisters,
this would get really tough.
Another solution would be just to get a simple bag and mask
into the rooms where babies are born.
It's a lot cheaper than an oxygen canister.
Just pushing room air into the baby's lungs
has enough oxygen to make a difference.
But again, it's not easy to implement.
Another solution would be to train childbirth attendants.
There's a really cool coalition called Helping Babies Breathe,
and they're dedicated to making the golden minute successful for babies.
And their goal is to have a trained, certified birth attendant
at every delivery in the world by 2015.
It's a great goal, an ambitious goal.
Support them.
But the idea we're talking about today
is simpler, easier to implement, cheaper, can make change faster
and makes all the other interventions more effective.
Now, the other atom that we need to consider today
represents a problem that's even more widespread
than not getting enough oxygen,
and that's not getting enough iron.
Iron is central to our lifeblood.
It's what allows our blood to carry oxygen to our brains and the other organs.
And when we don't have enough iron, we don't make enough red cells.
It's called iron deficiency anemia
and it's one of the world's biggest public health problems.
Iron deficiency anemia can cause poor gross motor development,
it can cause poor memory, it can cause fatigue,
it can cause you to get sick more often and have a harder time getting better.
But when it comes to iron deficiency,
iron deficiency anemia is just the tip of the iceberg.
Because a lot of people have normal red blood cells
but are still iron deficient enough to affect their intelligence,
perhaps forever.
Somewhere around two billion people on our planet
have lost intelligence because of iron deficiency.
It's a huge problem!
The World Health Organization estimates
that if we could just fix that one problem in a developing nation,
just fix iron deficiency,
we would increase their productivity about 20%, their GNP by 20%.
Huge health and economic benefit.
And it's not just developing nations.
In the developed world, in the United States where I come from,
iron deficiency is still common.
The latest estimate in the United States is that kids today,
who are 0-5 years old, in the US,
together have lost 9 million IQ points from not getting enough iron.
That's in the US!
At a staggering price tag
of about a 100 billion dollars for those kids
in lifetime lost earnings
because of their decreased intelligence.
So if we were to spend billions of dollars
to fix iron deficiency,
it'd be a good investment.
And one way to deal with the problem would be to manufacture
and package and distribute iron supplements all over the world.
And there's people doing that, it's a great idea.
Tens of millions of kids have been helped, but it hasn't solved the problem.
Another idea would be to distribute iron supplements
to pregnant women around the world:
there are fewer of them, it would help the moms, the babies, great idea.
I support a group called Vitamin Angels that's doing that.
I've traveled with them to villages that had never seen a doctor before
and seen the impact of getting iron and other micronutrients to them.
It's very cost-effective, it's very cool.
Another way of solving the iron problem
would be to fortify all of our infant formula
and all of our infant cereals with iron.
And that's the leading solution in the West.
But there's something kind of off kilter about that solution.
And here is the clue.
Among the highest-risk kids in the world, for iron deficiency,
are the babies who are exclusively breastfed
for longer than 6 months.
And to me, I found that really counterintuitive,
because breast milk, human milk is the perfect food for human babies.
Why would those be the ones at risk?
I mean, it's what's got the right nutrients.
Here it is:
breast milk is "low" in vitamin D.
Because presumably, historically, babies got vitamin D from the sun.
Today, they spend most of their lives indoors.
And breast milk is "low" in iron
presumably because historically, they got it a different way.
And not from boxed cereal and infant formula.
So I want to tell you an idea now
that I want you to remember for the rest of your lives.
It's time to get to the solution here.
I want to ring a bell that can't be unrung,
to change your perception.
And here is the idea:
at the moment a baby is born,
anywhere on the planet,
a third of their blood is outside their body.
The circulation that's been nourishing them through all of development,
a third of it is still outside their body at the moment of birth.
And for all of human history, for as long as we have been humans,
until very recently,
what happened was this beautiful thing:
the baby would emerge,
and then you would see the umbilical cord would start pulsing, pumping,
pushing blood into the baby.
And the baby would get about 30% more blood
during the 90 seconds or so longer than we currently allow the blood to flow.
What does this 30% extra blood do?
Well, first of all, they're basically getting iron supplements,
without the packaging, without the manufacture,
without distribution.
They're getting iron-rich blood, enough iron to last them for months,
and largely eliminate iron deficiency anemia in kids without cost.
They're not just getting iron though, they also getting oxygen!
Before a baby is born,
they get all of their oxygen through the umbilical cord.
And in that golden minute after they're born,
all the circulation is changing around and the lungs are starting to open up,
they're still getting oxygen through the cord.
During that golden minute while the lungs are getting set up,
oxygen is coming through.
And it's not just oxygen.
They get red blood cells,
the only cells in the body that can carry oxygen.
They get 30% more blood volume,
60% more red blood cells,
in that extra 90 seconds.
It's red cell rich blood.
It's a packed red blood cell transfusion.
You know, recently, Lance Armstrong has made the news,
even though he never tested positive for drugs in his blood.
But allegedly, his wins in the Tour de France came in part
because he was infusing himself with his own red blood cells.
And that's a technique we know works.
When you get extra red blood cells, you got extra strength, extra endurance
and it's been the state of nature for newborns
since the beginning of human history,
to get this pack of red blood cells.
And it's not just red blood cells.
It's even richer in white blood cells, comparatively.
You know, I said that lack of oxygen is the biggest cause of loss of health.
But the most immediate cause of newborn death is infections.
32% of all newborn deaths is from infections.
The umbilical cord blood is rich in white blood cells to fight infections
and antibodies that mom has created.
Perhaps the most important thing
is that that umbilical cord blood is packed with stem cells,
these cells with genetic potential to prevent and repair
damage throughout the body.
You'll be learning more about stem cells later today,
but just one example.
We've learned just in recent years that muscular dystrophy,
that we used to think was primarily damage to the muscles, isn't.
It is primarily damage to the stem cells that repair muscle damage.
Babies, throughout most of history, had gotten cutting-edge medical treatment,
an autologous stem-cell transplant at birth, as a course of nature.
But, in 1913 an idea took hold in the West
and spread around the globe.
And idea was this:
as soon as baby emerges, to clamp the cord,
to surgically clamp it.
To cut off, to choke off the supply of oxygen,
to cut off the flow of blood,
to lock out the white blood cells,
to lock out the antibodies
and to take that umbilical cord, stem cell treasure
and throw it in the trash.
Which, I think, is one of leading reasons that we have chronic illnesses
rising in kids today.
Thankfully, many kids have sufficient reserves
to be able to handle that loss.
But many don't.
That leads us to the TICC TOCC campaign.
Very simple idea: Transitioning Immediate Cord Clamping
To Optimal Cord Clamping.
It's not a business, it's not even a non-profit,
it's a shared idea.
Waiting an extra 90 seconds or so, till the cord stops pulsing,
the way we have throughout almost all of human history.
This is a powerful participatory idea,
and one that's really easy to spread.
Far easier to spread than it is to spread supplements,
or equipment, or antibiotics,
and certainly than stem cell transplants.
It's something that I'm convinced that we can do.
And why am I convinced we can do it?
Because we've done it before.
Back in 1913, when the idea of clamping quickly spread,
that was foreign,
but it spread across the globe,
even in the places no physician had ever been,
because the 20th century saw what had been unprecedented advances
in travel and in communications.
It was airplanes and telephones that let it spread.
But today?
Today, we have the internet.
Today, we have mobile technology.
Today, we have YouTube.
Today things can spread Gangnam Style around the globe
faster than you can imagine.
On Facebook, there are a billion people
and on average, we're only 4.74 degrees of separation,
we can reach everywhere.
Twitter's even closer, 3.43 degrees of separation.
And I've been in the most remote villages.
They have no electricity, no toilets, but people have cell phones.
This is something we can do.
Bang!
We can take networked bits and get the atoms we need
to the developing neurons and they'll unleash genetic potential.
The TICC TOCC movement has a motto.
It's a common phrase: "first do no harm."
I hope you'll never hear it the same way again.
Because the first intervention of the 21st century medicine,
the first thing that we do for a baby,
is surgical clamps and severing that has no evidence base.
There is no credible evidence of benefit.
There is solid evidence, though,
that it depletes iron stores,
that it decreases oxygen,
that it diminishes oxygen-carrying capacity,
that it deters our abilities to fight infections
and that it deprives babies
of some of the most unique and important cells in their body.
If you look up, there is big scientific evidence showing the safety and benefit
of doing it the way nature has always done it.
It's often called delayed cord clamping in the literature.
I object to the term -
it's not late, it's optimal cord clamping.
It's on time.
So how do we participate in this together?
How does a TICC TOCC campaign work?
And it couldn't be easier.
To participate, it's only two things.
First, request optimal cord clamping for your loved ones.
And second, share this simple idea with your networks.
Your social networks, online and off.
Preferably as loud and as far as you can.
But just request it and share it.
And that's it!
We can change the world.
It's not just humans who have done this through all of human history, by the way.
Primates too have umbilical cords, and they instinctively wait.
None of them will sever the cord before it stops pulsing.
And it's not just primates.
Mammals, throughout the world, have umbilical cords.
And they instinctively wait.
None of them will actively sever the cord,
they'll wait.
Today,
TICC TOCC,
more than a quarter of a million babies will be born.
For most of them,
it'll be clamped immediately and thrown in the trash.
This intervention works for kids born by C-section,
or vaginally, born on time or early,
whether you want to bank the cord blood stem cells or not.
We can change it.
Let's do it.
Thanks very much!
(Applause)