Reprinted (Text only) from One Health Newsletter Fall Issue
The One Health Initiative through a 50-Year Lens
Robert E. Dedmon, MD, MPH, FACP, FACOEM
‘There are no passengers on spaceship Earth. We are all crew.’
- Marshall Mcluhan
The ‘50-year lens’ refers to my 50-plus years in medicine following graduation from medical school (Indiana U., 1956). Both veterinary and human medicine have undergone landmark transformation- from hi-touch to hi-tech, with many advances but some losses. Both physicians and veterinarians have increasingly specialized, but at a price. We physicians have lost some of our compassion and the ability to use a stethoscope or perform an adequate physical examination. Veterinary practice has become compartmentalized, with many graduates opting for ‘small-animal-only’ practice and a variety of specialties. I have also witnessed the erosion of physician professional values and integrity in research related in part to the financial/time pressures on professionals (the Medical-Industrial Complex-Relman NEJM 1980;303:963-970).
Yet, in spite of this dour perspective, other sea-changes are occurring that brighten our hope of improving the health of both humans and other animals on our planet. First is the recognition of the need for change in the way health professionals are educated. The old lecture/apprenticeship, ‘ see one-do one-teach one’ approach has been overturned by the advent of information technology (Medline October, 1971 http://www.nlm.nih.gov/news/medline_35th_birthday.html ) and the need for collaborative practice (One model is a hospital physician/nurse/pharmacist team). Last year’s lecture notes are out!
Second, 2010 marks the centennial of the Flexner report on medical education with a call to radically transform medical education ( Irby et al, Academic Medicine Feb 2010; 85(2):220-227). As a current example, the Medical College of Wisconsin has a medical scientist-MD-PhD track, one of the original distance-learning Masters in Public Health (MPH) degrees offered to applicants with professional or undergraduate degrees, as well as several other advanced degree , community-public health outreach, collaborative, and translational research programs (http://www.mcw.edu/FileLibrary/Groups/publicaffairs/publications/2010_Facts.pdf).
I received my MPH from MCW in 1991, and am most grateful for that opportunity.
The new medical school format is described as:
‘An integrated curriculum aims to bring students beyond mere fact and concept acquisition to a level of scientific fluency, using a common language of medical science, with which they can begin to think creatively about medical problems.’
Veterinary medical colleges have also been advancing/revising their curricula. Notable are those that offer MPH and PhD degrees in collaboration with other disciplines, in addition to the traditional DVM/VMD degrees. An AVMA report lists 16 veterinary colleges which offer MPH joint degrees in public health. (http://www.avma.org/onehealth/appendix_e.asp). All this requires a revised approach to faculty development as well. Who will train these 21st Century teachers and ensure a diverse faculty devoted to new thinking and practice? It means that a lot of us ‘old-dogs’ (I am 79, 80 in January) will have to learn new tricks. More importantly, we will have to learn from our students and younger faculty.
As an example, in 1956 when I graduated there were no defibrillators, MRI/CT, or practical electronic medical record systems. Now I use Skype, and I have a Netbook, laptop, Desktop, 3-in-one printer/scanner/fax, iPod, Kindle, and a Blackberry. To bridge this gargantuan gap, I went to night school at our local technical college, and took a lot of ‘lessons’ from our grandkids!
Third, our planet is undergoing radical change due to environmental encroachment such as depletion of our rain forests and increasing competition for space among plants, humans, and other animals (Dedmon, www.asianbiomed.org June 2008;4(3):497-498). International travel arrivals have approached the 1 billion mark ( http://en.wikipedia.org/wiki/Tourism), and many travelers have undertaken ecotourism/adventure travel excursions, with attendant health risks.
Fourth, students travel widely for educational and experiential reasons. When I was in medical school, international clerkships weren’t even mentioned. When I was an internal medicine resident, I spent a year in London in a metabolic research environment (Profs. Max Rosenheim and Charles Dent), but this was a safe environment. Now students from most medical schools have international opportunities due to international collaborations, as well as church groups who provide charity medical care in needy areas.
Fifth, we have seen the burgeoning increase in zoonotic diseases (e.g. SARS, West Nile Virus, Dengue, and Q fever, along with re-emerging macacine herpes virus-1 (monkey-B virus). See www.cdc.gov/eid for other examples). Rabies continues to cause ~55,000 deaths annually and requires ongoing diligence in the U.S., as indicated by a recent imported rabies death in Virginia-ex India (www.cdc.gov/mmwr , Oct 1, 2010;59(38):1236-1238). We have gradually come to understand the interdependence of animal and human health. Veterinary colleges and organizations have taken the lead in the One Health initiative as an important educational/practice concept for multiple disciplines. The American Medical Association has also expressed support for these efforts through a champion for this cause, Ronald M. Davis MD, AMA Past President, deceased 2008. Also, a recent text on human and animal health edited by a physician and a veterinarian with chapter authors from multiple disciplines underscores the importance of the One Health collaboration to the survival of ‘Planet Earth’. (Rabinowitz PM & Conti LA. (ed). Human-Animal Medicine. Saunders/Elsevier 2010).
One Health has entered the lexicon of a broader audience. I first learned about the concept during a rabies seminar at Kansas State University in September of 2009. Dr Michael Cates, director of the KSU MPH program described the work of the One Health Commission (www.onehealthcomission.org) and I had the opportunity to discuss this further with faculty and students. I subsequently wrote a short piece for Asian Biomedicine (referenced above) based on that experience.
Another major development ensued at a recent rabies seminar held in Boston with students and faculty from Tufts participating. It was very encouraging to hear these bright young students talk about One Health and their community service in vaccinating pet dogs of the elderly against rabies in housing complexes in the area.
The most encouraging activity in which I have participated occurred on
September 28, 2010-the fourth World Rabies Day recognized by the AVMA, OIE, CDC, WHO, WSPA, and a variety of other organizations. This was a webinar with participants from 34 countries describing successes and ongoing challenges to rabies education and prevention. Notable among the presenters was Jack Woodall, PhD of the One Health Initiative (www.onehealthinitiative.com). The entire series is freely available online: http://www.worldrabiesday.org/EN/Events/wrd-webinar.html.
In summary, the increased erosion of available space needed for all animals and plants to survive has resulted in newly emerging health problems for humans and other species. To address new demands, veterinary and human medicine, nursing (DNP degree), pharmacy (PharmD degree), and other disciplines are all moving forward with new ideas and programs. Thus One Health is a paradigm which serves the needs of all and encourages a spirit of collaboration and scientific inquiry for the common good. Stay tuned! Welcome to the ‘Crew’!
Dr. Dedmon is Clinical Professor Population Health-Public Health at the Medical college of Wisconsin in Milwaukee and a member of the Editorial Advisory Board, Asian Biomedicine, Chulalongkorn University, Bangkok.