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Today we're going to talk about
a very powerful idea

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that can transform the lives of children
around the world.

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It's an idea that's simple,
that's easy to implement

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and that costs little or nothing.

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But it does require
that we join together to accomplish it.

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But even that's good news,

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because we're living
in a participation age.

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We are not just consuming culture,
we're creating it together.

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When it comes to medicine,
participatory medicine,

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taking charge of our own health

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is fundamental
to transforming health care.

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And participatory public health

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enables us to tackle

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the world's biggest
health problems together.

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We can't just rely on public institutions
to get the job done,

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as important as they are,

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if we want to change huge things fast.

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So today we're going to talk about
a global, historic campaign

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called TICC TOCC.

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It's a participatory campaign.

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But first, we have to set the stage.

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There are a few things you need to know.

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There are two atoms
that are very common, very plentiful,

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but they all too often do not end up

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in the right place at the right time.

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And the consequences
for children's health,

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for their developing brains,
for the neurons in their developing brains

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are immense.

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The first of these is oxygen.

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I can remember, when each
of my own children were born,

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this sense of joy and relief
when I heard their first cry.

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Their lungs were filled with air.

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It's an instinctive thing in us parents
to feel great when they cry

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and not good when we don't hear anything.

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The first minute of life
is often called the golden minute,

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because it's so important.

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And the reason that it's called
the golden minute,

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is that there is a huge difference
between babies who get enough oxygen

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in that first minute after being born

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and those who don't get enough.

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In fact, the World Health
Organization has estimated

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that 29% of all newborn deaths
around the planet

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come from not getting
enough oxygen at birth.

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We call it birth asphyxia.

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And that's just part of the problem.

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There is a million kids who die every year
from not getting enough oxygen.

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There's another million or even more
who get enough oxygen to survive,

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but not enough to thrive,

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and they're left
with lifelong consequences

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like cerebral palsy
or epilepsy or learning disabilities

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or a developmental delay.

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And even that's not the whole story.

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One in 10 newborns around the world -

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in some places one in seven -

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get suboptimal amounts of oxygen at birth.

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In public health, there is this concept
that's really useful,

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called disability-adjusted life-years,
or a related concept,

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quality-adjusted life-years,

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and very simply, it's a measure of health.

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It's the number of years
of health that are lost

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because of disability or disease or death.

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And when you look around the planet
at loss of health in childhood,

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far and away the number one cause
of kids losing health

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is not getting enough oxygen
in the first minutes of life.

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The stakes couldn't get any higher
than this, for children's health.

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So how do we solve it?

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Well, one solution of course, would be

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we could just get
an oxygen canister in every village

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and every room where a baby is born.

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We could solve it, it's simple,

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but not easy to implement
and not inexpensive.

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Especially when you talk about refilling
the oxygen canisters,

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this would get really tough.

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Another solution would be
just to get a simple bag and mask

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into the rooms where babies are born.

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It's a lot cheaper
than an oxygen canister.

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Just pushing room air
into the baby's lungs

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has enough oxygen to make a difference.

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But again, it's not easy to implement.

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Another solution would be to train
childbirth attendants.

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There's a really cool coalition called
Helping Babies Breathe,

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and they're dedicated to making
the golden minute successful for babies.

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And their goal is to have a trained,
certified birth attendant

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at every delivery in the world by 2015.

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It's a great goal, an ambitious goal.

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Support them.

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But the idea we're talking about today

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is simpler, easier to implement, cheaper,
can make change faster

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and makes all the other interventions
more effective.

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Now, the other atom
that we need to consider today

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represents a problem
that's even more widespread

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than not getting enough oxygen,

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and that's not getting enough iron.

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Iron is central to our lifeblood.

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It's what allows our blood to carry
oxygen to our brains and the other organs.

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And when we don't have enough iron,
we don't make enough red cells.

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It's called iron deficiency anemia

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and it's one of the world's
biggest public health problems.

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Iron deficiency anemia can cause
poor gross motor development,

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it can cause poor memory,
it can cause fatigue,

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it can cause you to get sick more often
and have a harder time getting better.

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But when it comes to iron deficiency,

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iron deficiency anemia
is just the tip of the iceberg.

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Because a lot of people
have normal red blood cells

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but are still iron deficient enough
to affect their intelligence,

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perhaps forever.

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Somewhere around two billion
people on our planet

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have lost intelligence
because of iron deficiency.

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It's a huge problem!

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The World Health Organization estimates

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that if we could just fix that one problem
in a developing nation,

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just fix iron deficiency,

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we would increase their productivity
about 20%, their GNP by 20%.

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Huge health and economic benefit.

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And it's not just developing nations.

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In the developed world,
in the United States where I come from,

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iron deficiency is still common.

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The latest estimate
in the United States is that kids today,

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who are 0-5 years old, in the US,

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together have lost 9 million IQ points
from not getting enough iron.

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That's in the US!

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At a staggering price tag

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of about a 100 billion dollars
for those kids

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in lifetime lost earnings

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because of their decreased intelligence.

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So if we were to spend billions of dollars

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to fix iron deficiency,

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it'd be a good investment.

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And one way to deal with the problem
would be to manufacture

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and package and distribute
iron supplements all over the world.

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And there's people doing that,
it's a great idea.

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Tens of millions of kids have been helped,
but it hasn't solved the problem.

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Another idea would be
to distribute iron supplements

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to pregnant women around the world:

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there are fewer of them, it would help
the moms, the babies, great idea.

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I support a group called
Vitamin Angels that's doing that.

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I've traveled with them to villages
that had never seen a doctor before

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and seen the impact of getting iron
and other micronutrients to them.

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It's very cost-effective, it's very cool.

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Another way of solving the iron problem

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would be to fortify
all of our infant formula

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and all of our infant cereals with iron.

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And that's the leading
solution in the West.

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But there's something kind of off kilter
about that solution.

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And here is the clue.

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Among the highest-risk kids in the world,
for iron deficiency,

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are the babies
who are exclusively breastfed

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for longer than 6 months.

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And to me, I found that really
counterintuitive,

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because breast milk, human milk
is the perfect food for human babies.

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Why would those be the ones at risk?

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I mean, it's what's got
the right nutrients.

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Here it is:

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breast milk is "low" in vitamin D.

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Because presumably, historically,
babies got vitamin D from the sun.

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Today, they spend
most of their lives indoors.

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And breast milk is "low" in iron

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presumably because historically,
they got it a different way.

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And not from boxed cereal
and infant formula.

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So I want to tell you an idea now

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that I want you to remember
for the rest of your lives.

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It's time to get to the solution here.

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I want to ring a bell
that can't be unrung,

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to change your perception.

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And here is the idea:

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at the moment a baby is born,

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anywhere on the planet,

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a third of their blood
is outside their body.

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The circulation that's been nourishing
them through all of development,

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a third of it is still outside their body
at the moment of birth.

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And for all of human history,
for as long as we have been humans,

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until very recently,

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what happened was this beautiful thing:

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the baby would emerge,

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and then you would see the umbilical cord
would start pulsing, pumping,

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pushing blood into the baby.

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And the baby would get
about 30% more blood

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during the 90 seconds or so longer
than we currently allow the blood to flow.

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What does this 30% extra blood do?

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Well, first of all, they're basically
getting iron supplements,

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without the packaging,
without the manufacture,

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without distribution.

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They're getting iron-rich blood,
enough iron to last them for months,

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and largely eliminate iron deficiency
anemia in kids without cost.

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They're not just getting iron though,
they also getting oxygen!

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Before a baby is born,

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they get all of their oxygen
through the umbilical cord.

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And in that golden minute
after they're born,

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all the circulation is changing around
and the lungs are starting to open up,

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they're still getting oxygen
through the cord.

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During that golden minute
while the lungs are getting set up,

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oxygen is coming through.

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And it's not just oxygen.

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They get red blood cells,

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the only cells in the body
that can carry oxygen.

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They get 30% more blood volume,

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60% more red blood cells,

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in that extra 90 seconds.

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It's red cell rich blood.

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It's a packed red blood cell transfusion.

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You know, recently,
Lance Armstrong has made the news,

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even though he never tested positive
for drugs in his blood.

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But allegedly, his wins
in the Tour de France came in part

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because he was infusing himself
with his own red blood cells.

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And that's a technique we know works.

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When you get extra red blood cells,
you got extra strength, extra endurance

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and it's been the state
of nature for newborns

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since the beginning of human history,

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to get this pack of red blood cells.

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And it's not just red blood cells.

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It's even richer in white
blood cells, comparatively.

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You know, I said that lack of oxygen
is the biggest cause of loss of health.

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But the most immediate cause
of newborn death is infections.

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32% of all newborn deaths
is from infections.

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The umbilical cord blood is rich
in white blood cells to fight infections

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and antibodies that mom has created.

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Perhaps the most important thing

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is that that umbilical cord blood
is packed with stem cells,

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these cells with genetic potential
to prevent and repair

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damage throughout the body.

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You'll be learning more
about stem cells later today,

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but just one example.

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We've learned just in recent years
that muscular dystrophy,

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that we used to think was primarily
damage to the muscles, isn't.

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It is primarily damage to the stem cells
that repair muscle damage.

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Babies, throughout most of history,
had gotten cutting-edge medical treatment,

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an autologous stem-cell transplant
at birth, as a course of nature.

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But, in 1913 an idea took hold in the West

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and spread around the globe.

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And idea was this:

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as soon as baby emerges,
to clamp the cord,

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to surgically clamp it.

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To cut off, to choke off
the supply of oxygen,

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to cut off the flow of blood,

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to lock out the white blood cells,

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to lock out the antibodies

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and to take that umbilical cord,
stem cell treasure

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and throw it in the trash.

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Which, I think, is one of leading reasons
that we have chronic illnesses

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rising in kids today.

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Thankfully, many kids have
sufficient reserves

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to be able to handle that loss.

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But many don't.

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That leads us to the TICC TOCC campaign.

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Very simple idea:
Transitioning Immediate Cord Clamping

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To Optimal Cord Clamping.

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It's not a business,
it's not even a non-profit,

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it's a shared idea.

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Waiting an extra 90 seconds or so,
till the cord stops pulsing,

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the way we have throughout
almost all of human history.

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This is a powerful participatory idea,

252
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and one that's really easy to spread.

253
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Far easier to spread than it is
to spread supplements,

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or equipment, or antibiotics,

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and certainly than stem cell transplants.

256
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It's something that I'm convinced
that we can do.

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And why am I convinced we can do it?

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Because we've done it before.

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Back in 1913, when the idea
of clamping quickly spread,

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that was foreign,

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but it spread across the globe,

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even in the places no physician
had ever been,

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because the 20th century saw
what had been unprecedented advances

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in travel and in communications.

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It was airplanes and telephones
that let it spread.

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But today?

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Today, we have the internet.

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Today, we have mobile technology.

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Today, we have YouTube.

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Today things can spread
Gangnam Style around the globe

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faster than you can imagine.

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On Facebook, there are a billion people

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and on average, we're only
4.74 degrees of separation,

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we can reach everywhere.

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Twitter's even closer,
3.43 degrees of separation.

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And I've been in the most remote villages.

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They have no electricity, no toilets,
but people have cell phones.

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This is something we can do.

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Bang!

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We can take networked bits
and get the atoms we need

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to the developing neurons
and they'll unleash genetic potential.

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The TICC TOCC movement has a motto.

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It's a common phrase: "first do no harm."

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I hope you'll never hear it
the same way again.

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Because the first intervention
of the 21st century medicine,

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the first thing that we do for a baby,

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is surgical clamps and severing
that has no evidence base.

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00:16:31,992 --> 00:16:34,286
There is no credible evidence of benefit.

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00:16:34,310 --> 00:16:36,325
There is solid evidence, though,

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that it depletes iron stores,

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00:16:38,317 --> 00:16:40,135
that it decreases oxygen,

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that it diminishes
oxygen-carrying capacity,

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that it deters our abilities
to fight infections

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00:16:48,150 --> 00:16:49,492
and that it deprives babies

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of some of the most unique
and important cells in their body.

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If you look up, there is big scientific
evidence showing the safety and benefit

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of doing it the way
nature has always done it.

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00:17:00,221 --> 00:17:03,038
It's often called delayed
cord clamping in the literature.

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00:17:03,062 --> 00:17:04,264
I object to the term -

300
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it's not late, it's optimal cord clamping.

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It's on time.

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So how do we participate in this together?

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How does a TICC TOCC campaign work?

304
00:17:13,233 --> 00:17:14,868
And it couldn't be easier.

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To participate, it's only two things.

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First, request optimal cord clamping
for your loved ones.

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And second, share this simple idea
with your networks.

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Your social networks, online and off.

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Preferably as loud and as far as you can.

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But just request it and share it.

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And that's it!

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We can change the world.

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00:17:40,867 --> 00:17:44,803
It's not just humans who have done this
through all of human history, by the way.

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Primates too have umbilical cords,
and they instinctively wait.

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None of them will sever the cord
before it stops pulsing.

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00:17:50,723 --> 00:17:52,212
And it's not just primates.

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Mammals, throughout the world,
have umbilical cords.

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00:17:55,024 --> 00:17:56,913
And they instinctively wait.

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00:17:56,937 --> 00:18:00,469
None of them will actively sever the cord,

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they'll wait.

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00:18:01,888 --> 00:18:03,038
Today,

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TICC TOCC,

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00:18:05,192 --> 00:18:10,072
more than a quarter
of a million babies will be born.

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For most of them,

325
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it'll be clamped immediately
and thrown in the trash.

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00:18:15,734 --> 00:18:18,549
This intervention works
for kids born by C-section,

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or vaginally, born on time or early,

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00:18:20,752 --> 00:18:23,860
whether you want to bank
the cord blood stem cells or not.

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00:18:24,316 --> 00:18:25,551
We can change it.

330
00:18:27,025 --> 00:18:28,501
Let's do it.

331
00:18:29,374 --> 00:18:30,559
Thanks very much!

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00:18:30,583 --> 00:18:36,525
(Applause)