# Presentation: 361954

## 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

- 1967

- 1945

- 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

*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

*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

- g

- f

-  a- prenatal
-  b- development
-  c- healthy adult
-  d- pre-clinical
-  e- disease
-  g- impairment
-  f - disability

- AGING

- H
- E
- A
- L
- T
- H

- +

**_**

- 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