“One medicine, one health”

Posted by Tara C. Smith on March 21, 2008
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If one over-arching theme came out of this conference, it was the concept noted in the title: “one medicine, one health.” In one of the early lectures, a speaker polled the audience to find out how many attending were veterinarians, and how many worked in human health. The room was divided pretty evenly, which attests to the importance of animals in the emergence of new diseases in humans. Regular readers, of course, will know that these diseases that cross species boundaries–zoonoses–make a large proportion of the emerging diseases we see (~75% by several estimates). Early Monday morning, Dr. Thomas Monath spoke about the intersection of human and animal health–the “one medicine, one health” concept that

Monath asserted that what we need is more simultaneous study of zoonoses in both humans and the animals they may have either originated from, or spread to. A hundred or so years ago, this view was much more common, with the boundaries between human and animal medicine blurred. However, so much specialization has occurred throughout the past century that even practitioners of each discipline (human versus animal medicine) don’t necessarily have all the expertise even to treat everything in their own chosen species, much less pay attention to others. Monath (and many others) have argued for more integration between those in the animal and human health worlds. One needn’t not know everything, but should strive to be aware of what’s happening in species other than those in one’s particular area of study.

To promote this, both the American Medical Association (AMA) and the American Veterinary Medicine Association (AVMA) have endorsed the “One health” resolution, pledging support and assistance to battle emerging diseases at the interface of their professions.

What do they hope to gain from this resolution?

-A broader scope of both human and veterinary medical education

-Integration of veterinary medicine and human health campaigns

-Increased knowledge of infectious and chronic disease in all species, and

-Integrated research

This type of collaborative research that crosses boundaries has already been demonstrated to work, and not only for infectious disease:

For example, medical, veterinary and wildlife disease experts coordinated operations during the West Nile virus outbreak; Ebola outbreaks in animals typically preface human outbreaks; sick cats were a warning about high mercury content in fish; and lead poisoning in dogs alerted doctors to dangers in lead paint to children.

As one who works primarily in human health, but from the aspect of investigating our animal friends as well as Homo sapiens, I’m in staunch agreement.

Next up, how Google fits into emerging infectious diseases…

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  1. #1 Ron
    March 21, 2008

    This is a refreshing take on emerging diseases. You mention ‘wildlife’ in one quote but I wonder if the real implications are clear. We need to take a truly ecological view. For example, with respect to say avian influenza, we need to look at the general vulnerable population and not just focus on poultry and people. Wild birds in the region are just as much a part of our ‘flock’ as the chickens in the chicken house. We need to manage the metapopulation as a whole. This should make us question such orthodox ideas as massive culling or ‘biosecure’ enclosures that attempt to isolate subpopulations from the general metapopulation. These efforts are bound to fail and exert a high cost. Consider the damage done to biodiversity in domestic foul due to culling and other useless rules. This is just one example of where we need to completely rethink our approach and “one medicine, one health…” is a great step forward. Congratulations to all involved in this new approach.

  2. #2 Ron
    March 21, 2008

    that would be “domestic fowl”

  3. #3 Kausik Datta
    March 23, 2008

    That is how it should work. But it doesn’t. I attended an informal lecture by the veterinarian of Bronx Zoo in New York, the woman who had first drawn attention to the West Nile Virus outbreak, through meticulous and painstaking detective work. Initially she had a tough time getting any help whatsoever from either the State Health officials or the CDC. She established the cause of the avian deaths as WNV after seeking and getting substantial help from the US Military Research.

    Similarly, in the C. gattii outbreak in Vancouver Island in British Columbia in 2000, several types of animals, along with human beings were affected. Mainly through the efforts of a few concerned individuals, there was an unprecedented collaboration between physicians and veterinarians that helped identify a lot of sentinel veterinary cases. That outbreak has spread into the Pacific Northwest, but any kind of concerted collaboration between veterinarians, researchers and physicians is still lacking in the US.

    The only way in which this lofty resolution can work is if there is a sea change in attitudes and preconceived notions. It has to be through the concerted, co-ordinated efforts of both types of professionals, who look after the health and well-being of both animals and humans.

  4. #4 Mountain Man
    March 23, 2008

    “One Medicine, One Health”

    What kinda Orwellian double-speak is this? Does it mean anything of value to anyone?

    “One Doctor, One Enema”

    “One Pap Smear, One Co-Payment”

    This is all junk promulgated by mind-numb robotic morons — albeit with advanced degrees.

  5. #5 boomer0127
    March 23, 2008

    It seems that only if the bottom line ($$) is affected, there is no desire to link the 3 groups you mentioned together before something bad happens. Afterwards, I guess public outcry can get things moving (WNV human deaths), but by then, bad things have already happened.

    I think the sea change has to be from the top – but congress isn’t going to mandate money for problems that don’t exist until after they’ve been burned a few times. The resource labs are supposed to be the place for information and assistance, but educating physicians where to look for information can be difficult, especially for diseases that are rare or are not reportable.

    It is easy to retrospectively examine a situation (WNV) and make changes that would have increased the detection of the virus. But what about the next virus? What if there was a zoonotic infection in texas that was slowly spreading north? Maybe something bat-borne like Hendra – how long would it take before we figured out what is was and how many “what if’s” would be listed once it go under control? Of course this is just an example.

    We spend so much money on anti-terror and blocking illegal immigration, but the next big danger could very well be from an illegally imported animal harboring a nasty virus. My cynical view on the country’s view on science is that we won’t be prepared for it.

  6. #6 John Shuey
    March 24, 2008

    Alas, Mountain Man, to appreciate the meaning and importance of the title one would have to read and understand the post.

  7. #7 boomer0127
    March 24, 2008

    This new approach sounds great, but how does this hookup between vets, physicians and researchers take place? I thought this was the job of the MD/PhD doing translational research at an institution with a vet school or a large animal facility?

    I agree that zoonoses are likely to be a major cause of major future disease, but I guess i am cynical about any preparedness in advance of disease. Look at global warming/climate change now. We can’t get our heads out of our butts to even decide if we should do anything about it. Is congress going to appropriate money for an infectious agent that might never come? If anything, the threat of bioterrorism should have sparked a mandate for this sort of communication for the benefit of the people.

    Sadly, we are a reactionary population. Congress only acts when they have been burned. This open communication sounds great, but it will take an event with very bad consequences to make it policy.

  8. #8 Patchouli
    March 27, 2008

    Recent years have seen tremendous growth in alternative medicine techniques like Acupuncture, Ayurvedic Healing, Crystal healing, Reflexology and Therapeutic Touch.

  9. #9 Joe
    July 10, 2009

    Alas, Mountain Man, to appreciate the meaning and importance of the title one would have to read and understand the post.