coping with global emerging diseases in the new millenium arnauld nicogossian,md the 6th nasa...

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