An Opinion – One Health “We are in it together”… physicians and veterinarians serving human and animal health worldwide By Bruce Kaplan, DVM* Known as the father of modern medicine and the father of Internal medicine, the great Canadian physician Sir William Osler, was a 19th and early 20th century practitioner of modern day “One Medicine-One Health” collaborative principles. One example: while teaching at the Montreal Veterinary College, Dr. Osler organized a significant study of parasites in the pork supply of Montreal with one of his most brilliant veterinary students, Albert W. Clement. The two concluded, correctly, that thorough cooking of pork was the best protection against humans contracting parasitic illnesses when ingesting this meat. Dr. Clement, a veterinarian, later became a President of the United States Veterinary Medical Association now the American Veterinary Medical Association or AVMA. (1, 2, 3) Schwabe coined “One Medicine” term and Crystallized the concept in the 20th century _____________________________________________________________________ A re-examination of historically valid references helps to verify that the American veterinarian, Calvin W. Schwabe, DVM, MPH, ScD originally coined the term “One Medicine” and represented it to designate the concept associated therewith (4, 5). Among other reference sources, Dr. Schwabe demonstrated how statements and actions taken by the great 19th century German physician Rudolf Virchow, MD, the father of cellular pathology, bolstered the case for Schwabe’s original “One Medicine concept” proposition (5). Dr. Virchow said, “between animal and human medicine there are no dividing lines--nor should there be.” A literature review of Dr. Osler’s writings (6, 7) plus two prominent biographies (2, 3) revealed no personal usage of the term “One Medicine”, but his alliance with veterinary medicine and veterinarians is historically unquestioned, at least during his early teaching and medical career in the 19th century. According to all available documented references, Dr. Osler would have supported Dr. Schwabe’s proposal having been strongly influenced by his teacher and pathology mentor Dr. Virchow (who most certainly would have concurred). Today, “One Medicine” is commonly referred to as “One Health” worldwide. This terminology change occurred during the first decade of the 21st century. Today’s 21st century “One Health” version (formerly called “One Medicine”) _____________________________________________________________ Drs. Virchow, Osler, and Schwabe probably would have greatly appreciated today’s 21st century American Medical Association (AMA) physician/internist President Cecil B. Wilson, MD, and his visionary Oslerian observations and conclusions. Virchow, Osler, and Schwabe were obviously endowed with the gifts of critical and creative thinking. The One Health concept is a product of their accepted wisdom. Dr. Wilson, a strong One Health supporter and advocate, commented in his January 28, 2011 AMA One Health blog http://alturl.com/j7svg, “We are in it together”. He went on to say “Physicians and veterinarians—as healers—have a lot in common, whether our patients walk on two legs or four. And our patients share a lot of diseases in common, whether they talk, bark, moo, oink, purr…or whinny. I was reminded of this when I participated on a panel last week in Orlando (January 17, 2011) with another physician and two veterinarians at the North American Veterinary Conference. We were talking about opportunities for interdisciplinary action in association with the “One Health Initiative,” which the AMA supports. … Here’s why it is important for this interaction: • Sixty percent of the nearly 1,500 infectious diseases now recognized in humans are caused by pathogens that have an animal vector [reservoir].• Three of every four newly emerging human infectious diseases originate in animals (zoonotic).• Many zoonotic diseases pose increasing threats to the human race (Ebola, Lassa fever and the Nipah, Hendra and Marburg viruses).• Pollution and environmental contamination affect human and animal health.• Many drugs and most medical devices are tested and refined in animals before use in humans.• Humans, animals and the environment also intersect at farms, slaughterhouses and processors.• Monitoring animal health has led to the discovery that environmental contaminants, such as lead or mercury, can be unhealthy for humans. We are in it (this world) together, whether man or animal. And sharing information and science through collaboration between the medical and veterinary medical professions benefits us all.” The movement to promote and eventually implement this One Health concept for expeditiously protecting and saving lives has expanded exponentially in the U.S. and internationally. While it is not a new idea—having been around and actively championed by visionary historic health leaders in the 19th, 20th and especially the first decade of this 21st century—the majority of practicing physicians, veterinarians and the general public are still unaware of this health care tool. A tool that, when utilized in the past, expedited many documented health advances. Examples occurred and are happening in public health (infectious diseases) and high profile clinical human and animal health conditions like cancer, heart disease, orthopedics and others: · The Ebola virus, a horrible hemorrhagic fever disease transmitted to humans by an animal source, and mentioned by Dr. Wilson was discovered and named jointly by eminent virologists, a physician, Dr. Karl Johnson and a veterinarian, Dr. Fred Murphy at the U.S. Centers for Disease Control and Prevention (CDC) in 1976. · The coronary artery stent commonly used in people having heart attacks was invented in the 1990s by an Australian trained veterinarian/physician, Dr. Gary Roubin, now a prominent practicing physician interventional cardiologist in New York, a veterinarian pathologist (who performed the pathology on pigs that was sent to FDA in order to get the stent approved for human use), Dr. Peter Anderson currently at the University of Alabama Birmingham School of Medicine and others. Dr. Anderson holds the patent for the idea of having a Taxol (paclitaxel) drug coating on the stent to help prevent restenosis. · Orthopedic surgeons at the University of Missouri, veterinarian, Dr. James Cook and physician, Dr. Sonny Bal, for these past 8 years of the 21st century, have worked collaboratively with comparative medical research on efforts to create hip and knee replacements without using commonplace biomechanical metal and plastic materials. The technique being developed by Dr. Cook for dogs initially, involves use of laboratory grown tissue (cartilage) that can be molded into replicas of joints that require replacement. Drs. Bal and Cook are concomitantly developing a process whereby a similar process can be adapted for humans (think osteoarthritis therapy for dogs and humans). Dr. Cook is director of the Comparative Orthopaedic Laboratory at the MU School of Veterinary Medicine. This is merely the tip of the potential One Health iceberg, past and present! People need only read the history of this concept and realize that implementation on a grand scale would likely help curtail research duplications and expenditures while fast forwarding discoveries in a sea change for all of us who are “in it together”. *Dr. Bruce Kaplan is a retired veterinarian who lives in Sarasota, FL (USA). He helps operate the One Health Initiative website www.onehealthinitiative.com as contents manager in association with Laura H. Kahn, MD, MPH, MPP, Thomas P. Monath, MD, and Jack Woodall, PhD and is Contributing Editor for the Florida Department of Health, Division of Environmental Health’s quarterly online One Health Newsletter http://www.onehealthinitiative.com/newsletter.php . Dr.Kaplan has practiced small animal veterinary medicine for over 23 years and held positions in public health with the U.S. Centers for Disease Control and Prevention as an epidemiologist and the U.S. Department of Agricultures Food Safety and Inspection Service Office of Public Health and Science in Washington, DC. References: 1. Kahn LH, Kaplan B, Steele JH. Confronting zoonoses through closer collaboration between medicine and veterinary medicine (as ‘One Medicine’) Veterinaria Italiana 2007; 43: 5-19. http://www.izs.it/vet_italiana/2007/43_1/5_19.pdf ; and the One Health Initiative Autonomous pro bono team. 2. Bliss, Michael. William Osler, A Life in Medicine. Oxford University Press, 1999. 3. “The Life of Sir William Osler” by Harvey Cushing, 1925 Ed. (Courtesy Chris Lyons, MA, Dip. Ed, MLIS, Osler Library of the History of Medicine, McGill University) 4. Schwabe, C. Veterinary medicine and human health, 3rd ed. Baltimore: Williams and Wilkins: 1984. 5. U.S. Centers for Disease Control and Prevention (CDC), EID Journal, “One Medicine” for Animal and Human Health, Volume 10, Number 12–December 2004. http://www.cdc.gov/ncidod/eid/vol10no12/about_cover.htm. 6. Personal Communication: Chris Lyons, MA, Dip. Ed, MLIS, Associate Librarian, Osler Library of the History of Medicine, McGill University (March 17, 2011). 7. The Evolution of Modern Medicine A series of Lectures delivered at Yale in April, 1913 by William Osler: “immediately turned into the Yale University Press for publication.” One Health Opinions and Comments are welcomed by the One Health Initiative website. Please submit to firstname.lastname@example.org for consideration.