The One Health Discussion series continued this year with
Peter Rabinowitz, MD, MPH who is an Associate Professor in the Department of
Environmental and Occupational Health Science and the Department of Global
Health at the University of Washington, where he directs the Human Animal
Medicine Project. http://deohs.washington.edu/hamp/ He completed a Family Medicine residency at UC San Francisco and a fellowship in
General Preventive Medicine/Occupational and Environmental Medicine at the Yale
School of Medicine.
The Human Animal Medicine Project explores the linkages
between human, animal, and environmental health including zoonotic infectious
disease at the human-animal interface, animals as ‘sentinels’ of environmental
health hazards, and clinical collaboration between human health care providers
and veterinarians in a species-spanning approach. A goal of the Project is to
serve as an incubator and organizer of research, training, and clinical
activities at the University of Washington related to the
human-animal-ecosystem interface.
Dr. Rabinowitz began the discussion by providing a working
definition: “One Health (formerly called One Medicine) is dedicated to
improving the lives of all species—human and animal—through the integration of
human medicine, veterinary medicine and environmental science.” He provided a history of One Health through
examples from Virchow, Osler, and Schwabe.
Dr. Rabinowitz emphasized the emerging and reemerging
infections from vector-borne or zoonotic means.
He explained the intensification of agriculture, resulting in large
farms of pigs and chickens, with chickens reaching numbers into the 20 billion.
He also noted how deforestation and changing water resources are changing the
global environment. He emphasized how 50% of US households have pets, with most
pets being in households with children.
It was noted how the concept of ‘One Health’ has gained
endorsements from the WHO, CDC, USDA, OIE, FAO, AMA, AVMA, CPHA, NCCID, and the
Gates Foundation. It spans the concepts
of individual health, population health, and ecosystem health encompassing
Zoonotic infections along with Comparative Medicine/Translational Medicine.
He endorsed the book “Zoobiquity: The Astonishing Connection
Between Human and Animal Health” by Barbara Natterson-Horowitz and Kathryn
Bowers.
Dr. Rabinowitz noted the disparity of One Health Programs, which are more prevalent in Veterinary schools than Medical schools.
Several case presentations were made. The first involved a dog with a mass in his spinal column and its owner with non-specific
gastrointestinal symptoms that progressed to altered mental status and fever of
unknown origin. A discussion ensued from
all fields as to the differential and appropriate course of care. Quite quickly, a differential of Rocky Mountain
Spotted Fever was offered and a review of the pathophysiology was covered. In the case example, the Veterinarian received the
diagnosis from the CDC through pathology and conveyed the information to the
Physician resulting in the corrected treatment and resolution of symptoms. A
discussion followed as to how the case could have been handled more efficiently
and effectively. Most discussion focused
on developing a better monitoring infrastructure and communication network.
A second case was presented involving a pregnant woman with
cats exhibiting anorexia, dehydration, ataxia, tremor, and hypersalivation for
3 weeks which was ineffectively treated with an H2 blocker for reflux. The cats
where admitted to a veterinary hospital where they were found to be anemic with
lead levels that was lethal to one of the cats even after chelation therapy. The pregnant woman was instructed to
follow-up with her own doctor and was found to have a lead level of 40mcg/dL.
It turned out that she was stripping old paint with a blowtorch while preparing
her house for the baby. A discussion
ensued as to how animals can act as sentinels and how the case could have been
handled differently. The conversation focused
on better avenues of communication.
There was an emphasis on barriers to One Health including
the following: Professional Segregation,
‘Us vs Them’ attitude, need for evidence, training structure, time needed for
paradigm shifts, and location. There
should be a shift from an ‘Us vs Them’ mentality to a ‘Shared Risk’ viewpoint.
The cases were reviewed with this vantage point with a
postulated shared electronic medical record that would be able to alert an MD
for a possible differential prompting a quicker diagnosis and treatment with
cost savings.
New Competencies for Human Health were suggested including:
- Understanding of shared environmental risks
- Including veterinarians in health care
- Ability to interpret comparative medical information
- Awareness of the role of zoonotic infection in both acute and chronic disease; including smoldering infection
- Awareness of the relevance of a shared microbiome
There was emphasis on developing evidence for clinical
relevance of animal disease events to humans through retrospective review of
veterinary medical charts. The example
of feline asthma was given as sentinels of air quality.
The session concluded with reference back to the Human
Animal Medicine Project and the Zoobiquity conference in Seattle. http://zoobiquity.com/events/upcoming-events/
Post authored by Johann Hsu, MD
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