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COPING WITH GLOBAL EMERGING DISEASES in the
NEW MILLENIUM
Arnauld Nicogossian,MD
The 6th NASA Seminar Series
“Emerging Diseases”
Topics for Discussion
• The last two Centuries• Summation of the 6th
Seminar series• What are we concerned
with today?• Technology• Error - Reduction• The Bright New
Millenium
The Last Two Centuries
1796
1816
1845
1897
1970
19671945
1950
1986
1990
1920
What has changed
• Cyber-health– E-records, internet connections,etc
• Complementary medicine– $10B market, reduced burden on health care
institutions
• Consumer attitudes and choices – enhancing the experience– meeting the needs– segment products and markets
FORCES AT WORK
• MEDICAL & TECHNOLOGICAL ADVANCES
• PROFESSIONAL OPPORTUNITIES
• COST OF CARE
• SOCIO-ECONOMIC GAPS
• PUBLIC ATTITUDES
• GLOBAL ECONOMY & HEALTH PRIORITIES
Public attitudes
• Internet• professional societies• news media and
entertainment• contact with nurses,
nutritionists, pharmacists, health advisers
• self monitoring
Result Driven Medicine
• Evidence and outcome base medicine
• Electronic patient record
• Virtual patient & (biocomputation)
• virtual drug trials
• Portability of medical information
• Portability in computing
LOW COST IS HIGH QUALITY: DO IT RIGHT THE FIRST TIME
Emerging Diseases
• Multiple Chemical Sensitivity
• Chronic diseases• Asthma and social
status• Food engineering &
allergies
• Chronic Fatigue & shift workers
• Stress• Depression
– violence
– suicide
– “La fin-du-siecle
Travel Medicine
• Health in extreme or esoteric environments– Cost
– communications
– accessibility
– epidemiology
• Standards of medical practice
• Professinal education
TRAVEL MEDICINE
• ENVIRONMENTAL EXPOSURES
• FOOD POISONING• REEMERGING
INFECTIONS• DISYNCHRONOSIS
ENVIRONMENTAL INJURIES
• CHEMICAL• PHYSICAL• WEATHER• RODENTS • MARINE LIFE• REPTILES• INSECTS• PLANTS
What are the Global Health Priorities?
• Famine
• Drinking Water
• Health and mental stresses due to regional wars and mass displacements
• Basic Sanitation and Hygiene
• Eradication of Poliomyelitis
BIOTHREAT
• ANTHRAX• PLAGUE• TULAREMIA• SALMONELLA• SMALLPOX• VIRUSES OR DNA
FRAGMENTS• BRUCELLOSIS• CHEMICALS
Bioterrorism
• Ease of Accomplishment– availability of culture agents– adequate growth capacity– preparation for delivery– release into populated areas
• Alternatives to active agents– toxins– chemicals
Human Interventions and Consequences
Case Studies
• West Nile Virus– outbreaks in late summer/ fall– Birds+mosquitos (human incidental)– Related to St.Louis Encephalitis– 1 enc. Case for 50 assymptomatic– 2.5 % of residual disease– Endemic in the Middle East (1977)
Human Interventions and Consequences
• Case Studies– DES or diethylstilbesterol administered in the
20th Century for : miscarriage prevention– In the off-springs produces increased risks for:
breast and clear cell CA
structural genital abnormalities- epididymal cysts
high risk pregnancies :ectopic, miscarriage, premature birth and infertility)
– Radiation effect and genomic instability
Technology Evolution
• Smart and Small• Mobile and dexterous• Aware• Communicative• Interconnected• Autonomous• Complex
Technology Evolution
• By 2030 – computing power of infinite proportions– software with specific intelligence– manufacturing processes replaced by intelligent
micro-nano manufacturing– mobile robots with dexterous manufacturing– robots with human senses and extended spectral
resolution
Technology Evolution
• By 2020– VR will replace our workstations– universal connection to Internet– robots will operate autonomously– we will not control all robotic operations– emergence of new and unexpected capacity
Technology and Health
• By 2010 Telemedicine will be routine
• By 2010 DNA Chips will begin to replace complex diagnostic labs
• By 2015 first hospital/clinic based robotic surgery
• By 2020 all medical records computerized and interconnected to medical care system
• By 2025 in body repair capability
Technology and Health
• By 2030 nursing homes will become absolete
• By 2030 microsensors will be embedded in all goods
• By 2035 medicine will be able to offer accurate prognosis
• By 2040 consumers will take greater responsibility for health and care
Technology and Health
• Longevity• Quality of life• Employment• Consumerism• Public Health Policy• What about medical
practice• Ethics
Medical Risk Management
Diagnosis
Treatment
Prognosis (63-20-17%)
Medical Risk Management
• Formula for Errors:
Good people + bad processes
• 1 million preventable errors = 120,000 deaths/year
• Safety critical errors happen at all levels of the system
• Error-free human performance is doomed to fail
Medical Risk Management
• Reliance on memory
• Attention span during a task
• Ease of information access
• Error detecting /blocking system”preclude forcing functions”
• Standardize repetitive tasks
• Communications and # of hand-offs
Medical Risk Managment
• Error Containment– Lessons learned– Statistical analysis– epidemiological/anthropological/cultural issues
• Error Reduction– Education/training– performance measurement of “high-
risk”processes
HEALTH & THE WORKPLACE
• CHOICES– family
– workplace
– environment
– education
– lifestyle
– longevity
– health
– safety
• A CONTINUUM
THE CHANGING PATTERN
a b
c d
e
gf
a- prenatal b- development c- healthy adult d- pre-clinical e- disease g- impairment f - disability
AGING
HEALTH
+
_
intervention
care
prevention
Short History of Medicine
• 2500 BC take these herbs for chest pain
• 1200 AD take this potion and pray
• 1600 AD take this potion & we do a phlebotomy
• 1800 AD take this tincture and rest
• 1900 AD By pass or Transplant surgery?
• 2000AD take this pill
• 2200 AD take these herbs