GENED 1053: The Global Heart Disease Epidemic: Stopping What We Started

What are you willing to do for the health of others?

Gen Ed 1053 Syllabus File: Gen Ed 1053 FALL 2024 syllabus as of 21 Feb 2024.doc

GENED 1053

The Global Heart Disease Epidemic: Stopping What We Started

What would you do for the health of others?

Fall 2024

Note on 12 April 2024:

For rising sophomores, juniors and seniors: the class is full, except for the seats reserved for incoming first year students. If you really want/need to take the class in Fall 2024, send Rich an email and he'll let you know if a seat becomes available.

First year students will lottery for the remaining class spots in August, 2024.

The course will be offered one more time, in Fall of 2025, so there will be an opportunity for non-seniors to take it in 2025.

Description: Heart diseases have killed occasional humans since ancient times, but only in the past century have heart diseases become epidemic throughout the world. In the current century, heart diseases will be the leading global cause of death, and the majority of those heart disease deaths will actually occur in the developing world. The global epidemic of heart disease has been driven by many social, economic and technological events. Some of these events have been dramatically detrimental to human health, such as the accidental invention of the American cigarette by an enslaved person in North Carolina in the 19th Century—an invention that is projected to kill one billion people between 2000 and 2100. Other events, such as advances in public health and safety, have been beneficial by extending lifespan and preventing early death, but they have also allowed age-related heart diseases to explode. Technological advances have improved our economic productivity but also led to changes in our lifestyles that promote heart diseases—in fact, you’re probably sitting down while reading this, and that affects your risk for many diseases. In this course, we will consider the complex relationship of health and society by examining the epidemic in common heart diseases. We will explore how major lifestyle factors such as tobacco, alcohol, exercise, and diet affect health, and we will also consider how economics and politics powerfully influence health. We will also discuss the role of government and our obligations to each other, and to future generations. We will ask you to learn CPR so that you might someday save a life, and we’ll ask you if that is important to you. The easy part of this course will be learning how you and your loved ones can live healthier; the hard part will be thinking about what you can and should do for others. 

 

Enrollment: Limited to 75 students. This course will be a part of the coordinated, ranked-choice Gen Ed lottery. Please note that the course instructor does not make decisions about admittance; please see the Gen Ed website for more information on the lottery process.

 

Instructor:         

Richard T. Lee, M.D. (please call me: Rich)

Fairchild Building, Room 159

Email: Richard_Lee@harvard.edu

 

Teaching Fellows:      

Hannah Fandl, email: hannahfandl@fas.harvard.edu

Laura Ben Driss, email: laura_bendriss@fas.harvard.edu

Meghan Zimmer, email: mzimmer1@g.harvard.edu

 

Location:                     Harvard Hall Room 101 for lectures Monday and Wednesday

                                   

Time: Monday and Wednesday morning lectures at 9:00-10:15 AM, with a weekly Friday morning section. Friday morning sections will have two possible times that students will fix for the semester:

9:00-10:15 AM and 10:30-11:45 AM. Sections will be in either Fairchild 261 (two floors up from Fairchild lobby), Fairchild 361 (third floor of Fairchild), or Bauer 001 (ground floor)

Note: Class attendance is required, and class starts on time at 9AM. As attendance is required in all Gen Ed courses, Gen Ed courses are not eligible for course-wide simultaneous enrollment waivers. Students pursuing simultaneous enrollment in a Gen Ed course and a non-Gen Ed course must attend the Gen Ed course. If you don’t like waking up for a 9AM class, please don’t apply for the lottery, so that we have spots for students who want to attend.

Office Hours:               For Rich: before or after class on Mondays and Wednesdays, or Fridays 2-3PM at Fairchild 159. For Section Leaders: to be arranged

 

Course Grading:         

Class Participation and Attendance               10% total

Section Projects and Participation                 40% total

                                                              Attendance                                                                   10%

                                                                        Healthy Living Challenge                                        10%

                                                                        Pre-section quizzes/assignments                         10%

                                                                        CPR training/assignment                                        5%

                                                                        Thought experiment assignment                         5%

     Mid Term Exam                                              15% total

     Final Exam                                                      35% total

                                   

Note: Any material late by up to one week-20% deduction before grading. Any material late by 1-2 weeks-40% deduction before grading. Any material late by more than two weeks-no credit. If you miss the mid-term quiz without illness or pre-arrangement, you will be allowed to take a make-up with a 20% deduction before grading. Any grading disputes will be handled on a case-by-case basis by the course instructor and teaching team.

 

Note: Weekly sections will be covering group discussions, overview of weekly lectures, and key reading material. Grading for the section component will include section attendance, and participation. Exams will cover the lectures as well as key reading material which will also be covered in sections. At least 15% of the exams will be from the reading material. The Final Exam will cover the entire course.

 

Note: Students may take up to one Gen Ed course pass-fail with instructor permission. We will consider requests to take the course pass-fail. In order to satisfactorily pass the course, any student taking the course pass-fail must attend section each week and complete all assignments, including assessments and the final exam.

           

Collaboration is encouraged for Section Projects. Exams are not collaborative, with no electronic device aids. Any material submitted to meet course requirements is expected to be student’s own work. Students are directed to Harvard Guide to Using Sources at the beginning of their first term, and in the required first-year writing course, Expository Writing 20. Undergraduates are urged to take great care in distinguishing their own ideas and thoughts from information and analysis derived from printed and electronic sources. Please note this link to the Harvard Guide for Using Sources

 

We expect that all work students submit for this course will be their own. We specifically prohibit the use of ChatGPT or any other generative artificial intelligence (AI) tools at all stages of the work process, including preliminary ones. Violations of this policy will be considered academic misconduct. We draw your attention to the fact that different classes at Harvard could implement different AI policies, and it is the student’s responsibility to conform to expectations for each course. 

 

Students approved for accommodations should contact the teaching staff by the end of the second week to discuss elements of the course that may be inaccessible and develop a plan together on how their accommodations will be implemented, based on their letter from Disability Access Office. Here is the link to the DAO

 

You cannot enroll in this class if you have previously taken SCRB 175.

 

Lecture            Date                            Topic

 

1                      9/4 (W)                       The heart and major heart diseases

 

Section 1: 9/6 (F): Introduction, ice breaker, overview of course content and contact information

 

 

2                      9/9 (M)                        Life on earth, Evolution and Evolutionary Mismatch

 

3                      9/11 (W)                      Epidemiologic Transitions in history and modern times

 

Section 2: 9/13 (F): How to read and interpret a scientific study

Discussion of Required Readings:

• “Overview of Cardiovascular Disease” under Module 1
• “Atherosclerosis across 4000 years” under Module 1
• “Humans Evolving” under Module 2
• “Typhoid Mary” under Module 3

Assignment: Pre-section quiz due on Canvas for assigned readings

 

 

4                      9/16 (M)                      Smoking and how Americans invented the addictive cigarette

 

5                      9/18 (W)                      Sugar and Triangular Trade

 

 

Section 3: 9/20 (F): Introduction to the Healthy Living Challenge and readings review

We begin a two-week module on healthy living as it relates to the prevention of cardiovascular diseases. Section 3 is devoted to reviewing some guidelines on healthy living and how to design a Healthy Living Challenge. In the following week, we will ask that students collect and report data on a particular lifestyle topic to provide a “baseline” for the average Harvard student. In Section 4, you will choose and present your own proposed Healthy Living Challenge.

Discussion of Required Readings:

• “Proctor Excerpts” under Module 4
• “Swedish Twins and Smoking” under Module 4
• “AHA 2021 Dietary Guidelines” under Module 5

Assignment: Pre-section quiz due on Canvas for assigned readings

 

6                      9/23 (M)                      Obesity and exporting disease

 

7                      9/25 (W)                      Diabetes and the diabetic complications

 

Section 4: 9/27 (F): Your Healthy Living Challenge design

This week, students will present their Healthy Living Challenge design in 3-5 minutes and receive peer feedback before the challenge starts. In the following week, students will track their progress through data collection.

Discussion of Required Readings:

• “NEJM Obesity Myths” under Module 6
• “7 ways to jumpstart healthy change in your life” under Module 6
• “Discovery of Insulin” under Module 7
• “How Elizabeth Hughes survived starvation” under Module 7

Assignment: Prepare a 3-5 minute presentation on your Healthy Living Challenge Design

 

 

8                      9/30 (M)                      Epidemiology and how to study diseases in people

 

9                      10/2 (W)                      Human Research: History and Ethics

 

Section 5: 10/4 (F): Question-Based Review of Lectures and Readings Thus Far

Discussion of Required Readings:

• “Randomized Trials” under Module 8
• “Review on Medical Ethics” under Module 9

Assignment: Pre-section quiz due on Canvas AND Submit two review questions to Canvas

 

 

10                    10/7 (M)                      Hypertension and Salt Consumption

 

11                    10/9 (W)                      Alcohol—have a little, but how little, and why?

 

Section 6: 10/11 (F) Practice Quiz

Required Readings: NO READINGS

Assignment: Answer two student review questions on Canvas AND Submit Healthy Living Challenge Report

 

 

                        10/14 (M)                   Holiday, Indigenous Peoples Day

 

12                    10/16 (W)                   Cholesterol—eat all you want, maybe

 

Section 7: 10/18 (F): Mid-term Review

• Discussion of Required Readings:
• “2020 JACC Salt HTN Review” under Module 10
• “1053 Lancet risk of alcohol” under Module 11
• “Vallee scientificamerican alcohol” under module 11
• “Eggs” under Module 12
•  

Assignment: NO ASSIGNMENT

 

 

 

13                    10/21 (M)                    Mid-term exam in class

 

14                    10/23 (W)                    Added sugars and why you should not drink calories

Section 8: 10/25 (F): Course Readings

• Discussion of Required Readings:
• “How Big Tobacco Hooked Children on Sugary Drinks” under Module 14
• “SSBs-2022 review” under Module 14

Assignment: Pre-section quiz due on Canvas for assigned readings

 

 

15                    10/28 (M)                    Trans fats—a Nobel Prize, tastes great but kills you

 

16                    10/30 (W)                     Exercise—Why and how much?

 

11/1 (F):  CPR Training

If the Healthy Living Challenge was about what actions you could take for your own cardiovascular health, this is about what you can do for the cardiovascular health of others. Do we have an obligation to others when it comes to their cardiovascular health? If such an obligation exists, on what grounds can we justify it? Students will take CPR training this week and read Chiara Cordelli’s “Prospective Duties and the Demands of Beneficence” (2018) for next section. You may elect to opt-out of CPR training, but we will then ask you to write an essay about why you chose that.

Required Readings: NO READINGS

Assignment: NO ASSIGNMENT

Logistics: Sections will not meet this week, and the time and location of CPR trainings are to be determined at a later date.

 

 

 

17                    11/4 (M)                      Vitamins make expensive urine or prevent disease 

 

18                    11/6 (W)                     Genetics and heart diseases

 

Section 9: 11/8 (F): CPR - Reflections & Thoughts; The relative roles of genetics and environment in cardiovascular disease

Discussion of Required Readings:

• “Brownwell NEJM” under Module 15
• “Bassuk scientificamerican” under Module 16
• “History of Self-Experimentation” under Module 17
• “Genetics of Heart Diseases” under Module 18

Assignment: Pre-section quiz due on canvas AND CPR follow-up assignment due on canvas

 

 

                        11/11 (M)                   Holiday, Veterans Day

 

19                    11/13 (W)                    Air quality and heart disease—should you care?

 

Section 10: 11/15 (F): Instructions for Final Exam & Effective Public Communication

In this section, students will consider two thought experiments and practice communicating complex concepts in the science of cardiovascular medicine to the lay public.

Discussion of Required Readings:

• “Volkswagon and deaths” under Module 19

Assignment: On canvas, prepare and submit three talking points for an assigned Course Module for each thought experiment. Additionally, select one primary research paper from the literature, and summarize the paper’s most important point(s) in 1-3 sentences using only plain language. And add one talking point to your argument for Thought Experiment 2.

 

Thought experiment 1:

You have just finished taking the GENED 1053 course while a student at Harvard College. The course exposed you to heart diseases and their risk factors. You were taken through the basic epidemiology, molecular mechanisms, and physiology underlying the diseases and their risk factors. After the semester, you went home to spend time with your family. When you get home, your family asks how the semester went for you. During conversation, your family asks you to explain what you learned. How would you explain the concepts you have learned to your family? Assume that your family members know nothing about basic epidemiology, molecular mechanism, and physiology underlying the diseases and their risk factors. 

 

Thought experiment 2: 

During your conversation with your family, you got to know that most of your family members live in a way that puts them at risk of cardiovascular diseases. So, you decided to educate them on certain lifestyle modifications they can reduce their risk. However, your family members are libertarians who take their individual right to live the way they want seriously and detest impositions on that freedom. Explain the concept of 'prevention' to your libertarian family members. How you would go about communicating lifestyle modifications to them, so as not to sound offensive and authoritarian?    

 

 

20                    11/18 (M)                    Thinking through a case of heart failure with a patient

 

21                    11/20 (W)                    Aging and an age-induced heart disease: atrial fibrillation

 

                        11/22 (F)                     No Section Meeting

 

22                    11/25 (M)                    Racial disparities in health care is a public health issue

 

                        11/27 (W)                   Thanksgiving break starts – No Class

 

                        11/29 (F)                     Thanksgiving break - No Section

 

23                    12/2 (M)                      Covid, pandemics, and being prepared for future challenges

 

24                    12/4 (W)                     A conversation with you: What should we do for others?

 

 

Final Exam: TBD – Exam period is 12/11 (W) – 12/20 (F)