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COPING WITH GLOBAL EMERGING DISEASES in the NEW MILLENIUM

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

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COPING WITH GLOBAL EMERGING DISEASES in the NEW MILLENIUM

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  1. COPING WITH GLOBAL EMERGING DISEASES in the NEW MILLENIUM Arnauld Nicogossian,MD The 6th NASA Seminar Series “Emerging Diseases”

  2. 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

  3. The Last Two Centuries 1920 1945 1967 1796 1970 1816 1845 1950 1986 1897 1990

  4. 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

  5. FORCES AT WORK • MEDICAL & TECHNOLOGICAL ADVANCES • PROFESSIONAL OPPORTUNITIES • COST OF CARE • SOCIO-ECONOMIC GAPS • PUBLIC ATTITUDES • GLOBAL ECONOMY & HEALTH PRIORITIES

  6. Public attitudes • Internet • professional societies • news media and entertainment • contact with nurses, nutritionists, pharmacists, health advisers • self monitoring

  7. Evidence and outcome base medicine Electronic patient record Virtual patient & (biocomputation) virtual drug trials Portability of medical information Portability in computing Result Driven Medicine LOW COST IS HIGH QUALITY: DO IT RIGHT THE FIRST TIME

  8. Multiple Chemical Sensitivity Chronic diseases Asthma and social status Food engineering & allergies Chronic Fatigue & shift workers Stress Depression violence suicide “La fin-du-siecle Emerging Diseases

  9. Travel Medicine • Health in extreme or esoteric environments • Cost • communications • accessibility • epidemiology • Standards of medical practice • Professinal education

  10. TRAVEL MEDICINE • ENVIRONMENTAL EXPOSURES • FOOD POISONING • REEMERGING INFECTIONS • DISYNCHRONOSIS

  11. ENVIRONMENTAL INJURIES • CHEMICAL • PHYSICAL • WEATHER • RODENTS • MARINE LIFE • REPTILES • INSECTS • PLANTS

  12. 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

  13. BIOTHREAT • ANTHRAX • PLAGUE • TULAREMIA • SALMONELLA • SMALLPOX • VIRUSES OR DNA FRAGMENTS • BRUCELLOSIS • CHEMICALS

  14. Bioterrorism • Ease of Accomplishment • availability of culture agents • adequate growth capacity • preparation for delivery • release into populated areas • Alternatives to active agents • toxins • chemicals

  15. 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)

  16. 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

  17. Technology Evolution • Smart and Small • Mobile and dexterous • Aware • Communicative • Interconnected • Autonomous • Complex

  18. 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

  19. 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

  20. 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

  21. 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

  22. Technology and Health • Longevity • Quality of life • Employment • Consumerism • Public Health Policy • What about medical practice • Ethics

  23. Medical Risk Management Diagnosis Treatment Prognosis (63-20-17%)

  24. 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

  25. 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

  26. Medical Risk Managment • Error Containment • Lessons learned • Statistical analysis • epidemiological/anthropological/cultural issues • Error Reduction • Education/training • performance measurement of “high-risk”processes

  27. CHOICES family workplace environment education lifestyle longevity health safety A CONTINUUM HEALTH & THE WORKPLACE

  28. THE CHANGING PATTERN a- prenatal b- development c- healthy adult d- pre-clinical e- disease g- impairment f - disability + prevention a b H E A L T H c d intervention e care f _ g AGING

  29. 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

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