Cancer Burden Facing Asian Americans Partly Caused by Racism

Cancer Burden Facing Asian Americans Partly Caused by Racism

The Journal of the National Cancer Institute (JNCI) published a commentary today on the significant cancer disparities facing Asian Americans. The article is authored by seven researchers from across the country who participated in the U.S. Food and Drug Administration (FDA) Oncology Center of Excellence “Conversations on Cancer” held on July 29, 2021. The virtual “conversation,” the first by the FDA, focused on the unfair cancer burden impacting Asian Americans. The lead author of the commentary is Moon Chen, associate director for community outreach and engagement with the UC Davis Comprehensive Cancer Center.

In percentage terms, Asian Americans are the fastest-growing U.S. racial group for the past three censuses, yet data aggregation obscure distinctions within subgroups of the more than 24 million Asians living in the United States. The JNCI commentary illustrates the harmful impacts this is having on Asian American communities.

Chen said the neglect of Asian American cancer inequities stems from multiple factors. They include historical prejudices against Asian Americans and the myth of Asian Americans as the model healthy minority, compounded by language and cultural barriers as well as racism.

“Asian Americans are unique as the first U.S. population to experience cancer as the leading cause of death,” said Chen. “Bigotry against Asian Americans, pervasive since the 19th century, but especially during the COVID-19 pandemic, is only exacerbating the cancer disparities that are costing Asian Americans their lives.”

High rates of certain cancers in Asian Americans

The authors cite a disproportionate rate of certain cancers affecting Asian Americans including:

  • Cancers due to infectious origin such as the human papillomavirus (HPV). For example, Vietnamese American women experience the highest U.S rates of cervical cancer.
  • High rates of liver cancer caused by chronic hepatitis B virus (HBV) infection rates in Asian and Southeast Asian Americans, including Hmong Americans.
  • Nasopharyngeal cancers, occurring in the upper part of the throat behind the nose, affecting Chinese Americans at high rates.
  • Stomach cancers, which have the highest rates among Korean Americans.
  • Lung cancer among never-smokers that disproportionately affects Asian American women at a rate of more than twice that of non-Hispanic white women.

The authors note an “infinitesimal proportion” of the National Institutes of Health (NIH) budget funds Asian American research even though the population is experiencing the highest percentage increases of any U.S. racial population for the past three decades. Between 1992 and 2018, only 0.17% of the total budget of the NIH funded research on Asian Americans. A portfolio analysis of grants funded by the National Cancer Institute’s Division of Cancer Control and Population Sciences showed a very limited number of studies focused on Asian Americans, with none at the time addressing the causes of cancer.

Asian Americans are also underrepresented in clinical trials. According to the commentary, only 1% of clinical trials emphasize racial and ethnic minority participation as a primary focus. Only 5 such trials focus on Asian Americans as compared with 83 for African Americans and 32 for Hispanics.

“Classifying Black Americans and Hispanic Americans as underrepresented minorities in clinical trials is helpful, but it is regrettable that our national policy excludes designating Asian Americans as underrepresented minorities, as documented by data in this commentary,” said Chen. “There is a myth that Asian Americans don’t get cancer, but that is far from the truth.”

What needs to happen to equalize cancer inequities

To rectify inequities, the authors recommend a call to action:

  1. Disaggregate data for Asian American subgroups (Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippines, Thailand, and Vietnam). The commentary calls for a separate focus on Native Hawaiians and other Pacific Islanders.
  2. Assess the impact of lived experiences and historical trauma. The authors state that culturally competent oncology care is required to improve access to health insurance/health care. They assert it is also needed to address language and cultural barriers that prevent Asian Americans from getting the medical help they need.
  3. Listen to community voices. Rich diversity and unique experiences within Asian American communities are best understood and appreciated by listening to and partnering with patients and community advocates. Research must ensure community representation, buy-in and engagement.

“It is also important to focus on the impact of racism on cancer disparities and prioritize funding resources. Otherwise, we will not take the necessary steps forward for achieving health equity for Asian Americans,” Chen added.

The other authors on this commentary  include: Richard J. LeeRavi A. MadanVan Ta Park, Susan M. Shinagawa, Tracy SunScarlett L. Gomez.

The Oncology Center of Excellence at the FDA sponsored Conversations on Cancer: Advancing Equity in Asian American and Pacific Islander Communities: Racism and Injustice, which was the virtual panel discussion upon which the commentary is based. The work was supported by the National Institute on Aging (R24AG063718) and the National Cancer Institute (P30CA093373).

Handle with Care

“Sticks and stones may break my bones,” the familiar children’s rhyme goes. But if you are a nurse suffering from osteoporosis (porous bones), such routine on-the-job activities as lifting patients or carrying heavy medical equipment could put you at risk for a serious fracture of the hip, spine or wrist.

Osteoporosis is a metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue. It is often called the “silent disease,” because victims have no symptoms of how fragile their bones have become until a fracture occurs. According to the National Institutes of Health (NIH)’s Osteoporosis and Related Bone Diseases National Resource Center, osteoporosis is a major public health threat for 25 million Americans. Two key factors put today’s aging RN population at especially high risk: 80% of osteoporosis victims are women, and the risk increases after menopause.

Asian nurses, in particular, have strong reason to be concerned about developing this serious disease. The National Asian Women’s Health Organization (NAWHO) estimates that more than one-fifth of Asian American women currently suffer from osteoporosis. The NIH notes that Caucasian and Asian women are more predisposed to the condition than black or Hispanic women, due largely to differences in bone mass and density.

“Asian nurses typically have a shorter body stature than Caucasian nurses,” adds Alice Chan, RN, a Sacramento, Calif.-based public health nurse who serves on the national advisory board for NAWHO’s Living Healthy osteoporosis education program. “Even when a hospital bed is adjusted to the lowest level, there is still potential for us to strain our backs when leaning over to lift heavy patients. In many cases, hospitals’ physical standards do not accommodate nurses whose height is less than five foot two.”

But even though Asian nurses are at the top of the risk ladder, osteoporosis doesn’t discriminate. African-American and Hispanic nurses are threatened by the disease as well.

“All women are at risk,” maintains Dr. Felicia Cosman, associate professor of medicine at Columbia University and clinical director of the National Osteoporosis Foundation. “Even African-American women, who seem to have the lowest risk of all the racial and ethnic groups, have a one-in-eight chance of suffering a significant fracture due to osteoporosis, compared to one-in-two for a Caucasian or Asian woman. That’s still a fairly high risk, and it may increase substantially with age.”

Boning Up on Osteoporosis Prevention

Although a number of medications are available for treating osteoporosis, the disease has no cure—making prevention the best defense. The NIH offers these recommendations for keeping bones strong:



  • Eat a balanced diet rich in calcium. According to Cosman, 1,200 milligrams of calcium daily is advisable.


  • Exercise regularly, especially weight-bearing activities. Chan recommends swimming for 20-30 minutes a day.


  • Don’t smoke. “Too many nurses are still smoking,” Cosman cautions.


  • Limit alcohol and caffeine intake. “Many nurses drink a lot of cola and coffee at work,” Chan observes, “because nursing can be exhausting and we feel like we need a boost to keep us energized. But caffeine, like alcohol, is one of those agents that contributes to lower bone density.”

Women who have a family history of osteoporosis or are otherwise at high risk should see their physician for a bone density test in order to determine a further course of action. “When your periods start to become very irregular, that’s the time to get a bone density test—and push for it if your doctor says no,” advises Cosman. “Not everyone needs a bone density test at menopause, but if you have any of the clinical risk factors, you should strongly consider getting the test. If the results reveal that you fall into or close to the osteoporosis range, you will probably need to be treated with some medication.”

More information about osteoporosis risk factors and treatment, targeted to specific racial and ethnic minority groups, can be found online at

Taking Precautions at Work

If you are a nurse who has been diagnosed with osteoporosis, it doesn’t necessarily mean you’ll have to give up your physically strenuous career. But what will you have to do differently on the job to reduce your risk of suffering a debilitating fracture or other bone injury? Chan and Cosman have these suggestions:


  • “Generally, we recommend not lifting heavy things, such as patients,” says Cosman. “I would also really stress the use of good body mechanics in the workplace—e.g., taking most of the force in your legs rather than your back and no lifting while leaning forward.” She suggests consulting a physical therapist for more specific recommendations.


  • Take special care to avoid falls. “Even though hospitals take great pains to prevent this, I have seen incidents where nurses did slip and fall at work—it’s a hazard that can occur in a workplace where you’re often in a hurry,” Chan points out. “Even if you’ve only spilled a few drops of medicine or IV fluid on the floor, there’s always a chance you could slip on it.”


  • Above all, Chan emphasizes, don’t be afraid to ask for help if an activity proves too physically challenging. “Sometimes in an emergency, it’s easy to think only about the patient and forget about yourself,” she says. “But if the height or weight of the patient creates a situation you can’t handle physically, always ask for help. Sometimes even two nurses may not be able to lift a patient who weighs close to 300 pounds; you might have to wait for a third or fourth person to help you.” 
Providing Culturally Competent Mental Health Care to Asian Americans and Pacific Islanders

Providing Culturally Competent Mental Health Care to Asian Americans and Pacific Islanders

When Asian and Pacific Islander (API) patients visit medical facilities complaining of physical problems, they usually receive physical treatments. However, Shih-Yu (Sylvia) Lee, PhD, RNC, a postdoctoral fellow at Emory University in Atlanta, knows that asking these patients a few extra questions may mean the difference between curing a minor physical ailment and treating a major mental illness.

“[API patients] tend to express their feelings through physical complaints like a headache or upset stomach,” she explains. This practice is known in psychiatry as somatization.

ShihYu (Sylvia) Lee, PhD, RNCShihYu (Sylvia) Lee, PhD, RNC

Research suggests that health care providers’ failure to look at non-physical causes of ailments in Asian Americans and Pacific Islanders, combined with other cultural and linguistic barriers, may mean that this population is receiving inadequate mental health care. Lee encourages nurses to actively help eliminate these barriers by adopting a culturally competent approach to assessing API patients’ symptoms. Cultural sensitivity to these patients’ unique mental health needs is also a must for communicating treatment options to API individuals, who represent the fastest-growing minority population in the United States.

According to A Provider’s Handbook on Culturally Competent Care: Asian and Pacific Islander Population, 2nd Edition, published by Kaiser Permanente, little is known about the frequency of mental disorders in APIs. Because they represent a relatively small number of patients admitted to psychiatric hospitals compared with other racial and ethnic groups, this has led to the misconception that Asian Americans simply have fewer mental health problems than other Americans.

Gayle Tang, MSN, RNGayle Tang, MSN, RN

However, the research data that is available contradicts this stereotype. The Centers for Disease Control and Prevention’s National Center for Health Statistics reports that API males and females between the ages of 15-24 consistently have the highest suicide rate of all ethnic groups in that age range. Elderly Asian Americans exhibit more instances of dementia than the general population, according to the National Asian American Pacific Islander Mental Health Association (NAAPIMHA). The association also reports higher than average suicide rates among some elderly Asian groups.

Many immigrants from Southeast Asian countries, particularly those from Vietnam, Laos and Cambodia, have survived traumatic refugee experiences. According to NAAPIMHA, 40% of these refugees suffer from depression, 35% from anxiety and 14% from post-traumatic stress disorder. And a study cited in Kaiser Permanente’s Provider’s Handbook reveals that while API patients are less likely to be admitted to psychiatric hospitals than their Caucasian counterparts, those who are admitted have a longer median length of stay than white patients.

These disturbing statistics suggest that Asian Americans and Pacific Islanders may not be receiving adequate mental health care early on and that by the time they do obtain treatment, their problems are more severe and harder to treat.

Behavior, Culture and Language

While mental illness is not an easy topic for most Americans to discuss, there is an especially strong stigma in the Asian American culture that discourages potential patients from seeking mental health services. “We tend to suppress our feelings,” says Lee, who is from Taiwan. “What happens in the family stays in the family.”

This is where the somatization comes in. Instead of seeking a mental health referral, many API patients will choose to see their primary care physician about a physical problem. Even if primary care providers are aware that their patient’s physical complaints may have an underlying emotional cause, lack of familiarity with Asian cultural norms can make it difficult for providers to determine whether a particular behavior is a common practice or a cause for concern.

For example, Lee says, in Chinese, Japanese and Korean cultures, women who have given birth take the post-partum healing period so seriously that they often remain at home on bed rest for up to a month after delivering their baby. Even if the newborn needs to be placed in the NICU, the mother might send other family members to visit the baby, while she continues to rest. If she were to visit the baby, her family may request a wheelchair for her to help conserve her energy. Nurses who are not familiar with this cultural practice may be unnecessarily alarmed that the mother is showing signs of post-partum depression.

If a nurse does have a concern about a patient’s behavior, Lee’s advice is to simply ask for more information. “You really need to talk to a family member,” she emphasizes.

Linda S. Beeber, PhD, APRN, BC, a professor of nursing at the University of North Carolina at Chapel Hill, agrees that nurses should look at each patient individually, even if they are Asian American nurses who share the patient’s ethnic background and are familiar with the culture. This is because familiarity could lead to labeling and making assumptions. “It could perpetuate biases. It is a step away from stereotyping,” says Beeber, who has studied depression in Korean, Chinese, Taiwanese and Native Hawaiian graduate students. “It does not take into account the powerful process of acculturation.”

In addition to barriers caused by cultural differences, there are often obvious language barriers that can prevent Asians and Pacific Islanders from receiving adequate mental health treatment. “New immigrants might not be able to speak English well,” says Lee.

Maggie LuoMaggie Luo

According to the Kaiser Permanente Provider’s Handbook, about 38% of Asian Americans do not speak English fluently. The same holds true for a very large proportion of APIs over 65 years of age. And unlike most Hispanic subgroups, who all speak Spanish, API subgroups encompass a wide range of different languages, from Chinese, Japanese and Vietnamese to Tagalog, Hindi and Hmong.

While nurses are not expected to provide interpretive services, patients will rely on nurses to find well-trained translators to help communicate with them. Lee advises nurses to get to know the network of translators in their geographic area and to only recommend the professionals who have proper training. “In addition to linguistic training, they need to know the medical terms,” she says, citing an instance where a patient misunderstood a diagnosis because one of the medical terms was not communicated effectively.

Gayle Tang, MSN, RN, director of national linguistic and cultural programs at Kaiser Permanente in San Francisco, believes that linguistic competence is an important component of a health care facility’s ability to provide culturally competent care. This goes beyond simply providing translation services, she adds. “Language and culture are interchangeable,” Tang argues. “[If you can’t] speak the right words, in the right tones and with the right expressions, you’re not linguistically competent.”

Communication for Compliance

Once it has been determined that an Asian American or Pacific Islander patient is in need of mental health care, the next challenge for the nurse to overcome is often recommending treatment in a way that encourages the patient to complete his or her therapy successfully. Typically, a care provider would gather data on the symptoms of the problem, determine the cause, recommend a treatment and assume that the patient accepts the counsel.

However, an API patient might have a different explanation for the problem, based on his/her cultural beliefs. According to Tang, some patients may feel that their problem is primarily a spiritual one, or is a consequence of past behavior. If the recommended therapy does not address what the patient believes is causing the problem, the patient may choose to forego treatment.

Tang recommends using one of two culturally sensitive communication methods to increase the chances of successful treatment: the Kleinman model or the LEARN model. These methods can help nurses determine their patient’s level of acculturation and minimize the use of broad cultural stereotypes and prejudicial biases.

The Kleinman model, developed by noted psychiatrist Arthur Kleinman, is a general tool for cross-cultural communication. According to Tang, this model involves asking patients a series of questions about their complaint. “[It helps] assess a patient’s beliefs about their condition,” she says.

What do you call your problem? What name does it have? Why has it happened to you? Why now? are examples of questions Tang may ask. She would also ask patients what they believe will help make the problem go away. Using this model helps nurses understand whether or not they are seeing an issue in the same way their patient sees it.

The LEARN model, published in 1983 by E.A. Berlin and W.C. Fowkes, Jr., is geared toward letting the patient lead the discussion of his/her symptoms. It is an acronym for listen, explain, acknowledge, recommend and negotiate.

“It is an easy-to-remember model that reminds nurses to not only explain a situation but to also take time to understand how their patient sees a problem,” says Tang. “The nurse will listen to how the patient sees their own problem, then the nurse will explain his or her own perception of the problem. At that point the nurse acknowledges the differences and similarities between the two viewpoints while being nonjudgmental. The nurse would then recommend treatment or behavior change and then try to negotiate the best way to get the patient to follow through.”

Encouragement is a good way to successfully negotiate a treatment plan. “Find out what the patient is doing to help himself,” Beeber suggests. Even if a nurse has to advise a patient to stop using his current remedy in favor of a more medically effective option, the nurse can still use negotiation techniques to encourage the patient to try the recommended treatment.

For example, if a patient is treating her ailment with a traditional remedy such as a blend of herbal plants, Tang recommends saying something along the lines of: “We would like you to stop taking the herbal remedy for two weeks [and use the medicine that the doctor prescribed for you], just to make sure we know what is working and what is not working.” The patient is probably more likely to take the prescribed medicine if this approach is used–as opposed to the nurse saying, “That’s not going to work. There’s no scientific basis for [the herbal remedy].”

Even if patients accept a specific treatment regimen, they may not know how to follow it once they get home. “Ask for a return demonstration to help ensure that the information was communicated successfully,” says Tang.

Patient Advocacy

If an API patient needs to be referred to an outpatient or inpatient psychiatric care facility, it is once again important for the nurse to be a strong encourager. “[Patients] need assurance that this is the right thing to do,” says Maggie Luo, program coordinator for the Chinese American Mental Health Outreach Project (CAMHOP) in New Jersey. This may mean encouraging family members to encourage the patient. Luo suggests that nurses identify the relative who may have the most influence in the family and try to win that person’s support for the referral.

She also recommends using the term “mental health consumer” instead of “mentally ill” when referring to patients. This simple title change may help reduce the level of stigma associated with the referral.

Being a patient advocate also means proactively locating other supportive health care providers. “Try to help patients find a physician who knows about their culture,” says Lee. “You could actively make the referral for the patient, or you could just follow up with the other physician.”

Tang agrees that nurses should take a proactive approach to making sure the patient’s cultural and linguistic needs are met. “Every single nurse needs to make sure the system is in place,” she urges. “Make sure there are no gaps. Take that extra step. Make sure the interpreter is pre-scheduled for the next visit and the referral is made.”



Talking to Korean Parents about the HPV Vaccine

Nurses who care for the children of ethnic minority families often need to assess the parent or guardian’s perceptions of cultural and/or social topics to avoid misunderstandings. It’s an essential part of providing culturally competent care and has become a standard nursing practice. As a public health nurse in Fort Lee, New Jersey, where 20% of the population is Korean, I meet my community’s diverse cultural context daily.

During one of my clinic days, I suggested to a Korean mother, who I’ll call Mrs. K, that her 16-year-old daughter should receive the human papillomavirus (HPV) vaccine. I explained that HPV is responsible for most cervical cancers. Mrs. K wanted to know how the disease was transmitted, and I told her—by sexual contact. Mrs. K quickly responded, “What are you trying to say? My daughter does not have sex,” and I knew by her tone she was upset and offended.

According to the Centers for Disease Control, HPV is the most common sexually transmitted infection (STI) in the United States, with approximately 20 million people currently infected and six million new cases each year.1 As HPV is the cause of almost all cases of cervical cancer, it is considered one of the most preventable cancers in women. Currently two vaccines are in the market to prevent HPV: Gardasil® (Merck & Co., Whitehouse Station, New Jersey) and Cervarix® (GlaxoSmithKline, Brentfold, Middlesex, United Kingdom). These vaccines are licensed to be given to females between the ages of nine and 26 years old. However, to maximize the effectiveness of the HPV vaccines, it is important to vaccinate prior to the first sexual experience.2 

Despite living in a society infused with sexuality, the topic is still considered taboo with my patients, who are predominately Korean. I often encounter Korean parents like Mrs. K who have different perspectives and strong opinions regarding sexuality and communicating with their adolescent children. Korean parents tend to assume full responsibility for their children’s behavior and outcomes, and most are heavily involved in their child’s life, from going through daily routines to deciding on a college to even finding a spouse. Because the parents have that level of influence, it can be devastating to acknowledge that their child would partake in premarital sex.3 The Korean culture follows the ancient Chinese philosophy of Confucianism as well as Christianity, which highly regards family values and sexual innocence until marriage. Additionally, parental and adolescent sexual communication is rarely displayed in Korean families as they discourage premarital sex and it is not an open topic of discussion. Premarital sex among adolescents is stigmatized, unacceptable behavior, according to the cultural norms.4

Having been raised by first-generation Korean parents, I understand these ideas well. My parents still change the television channel when people kiss, and I can sense their discomfort when they see such things.

After speaking with many patients regarding HPV and the vaccine, the parents have expressed concern about the possibility of the vaccine encouraging an increase in risky sexual behaviors. Concerned Women for America (CWFA) says, “Giving the vaccine to young girls before they are sexually active provides them with a false sense of security, possibly leading to risky sexual behavior that would not have occurred had the threat of cervical cancer been present.” 5 When these statements are made to the general public, nurses struggle with the realities of HPV and cervical cancer. Parents will continue to show reluctance in having their elementary- or middle-school-aged daughters vaccinated against STIs. As educators and patient advocates, nurses can emphasize how the HPV vaccines prevent cervical cancer rather than the details of sexual behaviors.

A number of my patients’ parents have expressed an interest in obtaining more information about the HPV vaccination so that they can make informed decisions. The Centers for Disease Control and Prevention (CDC) has information about HPV, cervical cancer, and the vaccines in multiple languages, including Korean. These customized information campaigns target specific ethnic groups to help raise awareness. Providing these printable educational materials from the CDC made it much easier for me to present the necessary information to the parents without offending them. Although I may have offended Mrs. K initially, she returned with her daughter to get the HPV vaccine series after reading the information in Korean. Korean parents may not be entirely confident about talking to their children about sex, but the parents should still be educated about when and how to talk to their children about sexual issues. Sex will become less of a taboo by simply accepting it as a part of life and talking about it openly in a family setting.


  1. Markowitz, L. E. et al, Quadrivalent human papillomavirus vaccine: Recommendations of the advisory committee on immunization practices (ACIP), 2007. MMWR Morbidity and Mortality Weekly Report 56, 1-24.
  2. Saslow, D. et al, “American Cancer Society guidelines for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors,” 2007. CA: A Cancer Journal for Clinicians, 57, 7-28.
  3. McGill, B. (2003, March 14). “Changing attitude toward sex threatens South Korean.” Growing promiscuity, lack of education may lead to increase in AIDS, experts say. The San Francisco Gate. Last modified on March 14, 2003
  4. Cha, E. S., Kim, K. H., & Doswell, W. M. (2007). Influence of the parent-adolescent relationship on condom use among South Korean male college students. Nursing and Health Sciences, 9, 277-283.
  5. Concerned Women for America. (2007). “The truth behind the HPV vaccine: Here’s what you need to know.” Last modified on June 2008

OMH, CDC Take Action to Fight Hepatitis B in Asian Americans

The federal Office of Minority Health (OMH) calls it one of the most serious but frequently neglected minority health disparities in the United States: Asian Americans, Native Hawaiians and other Pacific Islanders (APIs) have the highest rates of chronic hepatitis B and liver cancer caused by hepatitis B of all racial and ethnic groups. The Centers for Disease Control and Prevention (CDC) estimates that as many as two million people in this country are living with chronic hepatitis B, and over half of them are APIs.

The OMH and CDC aren’t just talking about this problem, they’re taking major steps to address it. The two agencies have teamed up to launch a national initiative aimed at closing the gap of chronic hepatitis B virus (HBV) disparities in API communities. In December 2008, the agencies published a report, based on the recommendations of a National Task Force on Hepatitis B Expert Panel convened by OMH, outlining an aggressive action agenda to reduce and eventually eliminate Asian Americans’ disproportionately high rates of this deadly disease.

The report, Goals and Strategies to Address Chronic Hepatitis B in Asian American, Native Hawaiian and Other Pacific Islander Populations, calls for increasing HBV education, public awareness, screening, early detection, immunizations and research, as well as improving access to care and treatment. Specific strategies include, among others, improving HBV-related public health prevention infrastructure and providing culturally competent HBV training for health care professionals.

“The fight against hepatitis B and associated liver cancer is critical to protect the health of Asian Americans and Pacific Islanders, who bear the brunt of the disease burden,” says John Ward, MD, director of the CDC’s division of viral hepatitis. “With a new strategic plan developed directly in partnership with communities most affected, we now have a clear roadmap to move forward in recognizing hepatitis B prevention as a national priority and protecting Asian Americans from the ravages of the disease.”