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