Supercourse Newsletter, May 6 2003
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Grant challenge write-up - Supercourse Newsletter
Dear Friends:
Yesterday we came across a fascinating project called the "Grand
Challenge" with is co sponsored by NIH and the Gates foundation.
The Bill & Melinda Gates Foundation is establishing the Grand Chal-
lenges in Global Health initiative a major new effort and partnership
with the National Institutes of Health (NIH) and the Foundation for
the National Institutes of Health (FNIH). This initiative will iden-
tify critical scientific challenges in global health and increase re-
search on diseases that cause millions of deaths in the developing
world each year.
No money will be awarded, but if grand challenge is identified, then
resources for funding of grants in this area will be provided. There
will be 10-15 grand challenges of global health identified.
We thought that we would submit the concept of telepreventive medi-
cine and the Supercourse for review as a grand challenge. It will be
submitted by us, the Supercourse Team, which includes you!!
We would appreciate if you could review the material below and send
comments to <ronlaporte@aol.com> . Thank you so much.
In a few days we will be sending to you the Golden Lecture.
Best Regards from:
Ron, Faina, Mita, Eugene, Bill Gates, Akira, Wendy, Soni, Abed,
Julia, Tomoko, Beatriz, Tom, Deb
mailto:super1+@pitt.edu
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GRAND CHALLENGE:
Telepreventive Medicine
Prevention Knowledge on Demand, Any time, Any Place, Any One
By the Supercourse Family of 9250 Global Faculty
Abstract: There has been a 30 year increase in life expectancy since
1900 which represents the greatest rate of increased seen in history.
It has been estimated that over 90% of the increase was due to pre-
vention. Prevention represents shared information about avoiding dis-
ease. If we could harness prevention with the IT revolution, we would
produce a global discipline of telepreventive medicine. Prevention
knowledge is the key to improved health. The global challenge will be
1) create a global health network bringing together all those engaged
in prevention, 2) establishing an Internet backbone to the monitoring
of disease as currently surveillance world wide is extremely incom-
plete, slow and inaccurate, 3) establishing a system of prevention
information on demand, where bridges between existing community in-
formation exchange systems link to the Internet, and 4) creating an
open source system to develop high quality scientific content about
prevention that can be then used at the local level. This telepreven-
tive medicine approach may be THE most important technology for the
continuous improvement of health and thus must be top priority for
the grand challenge of global health.
Overview: The Grand Challenge of Telepreventive Medicine
During the past millennium global life expectancy has risen from less
than 25 years of age at 1000 AD, to 35 years of age in the middle
ages, to 40 years of age in 1900. Over this period it took 1900 years
to achieve a 15 year increase in life expectancy. Since 1900 life ex-
pectancy world wide increased to over 70 years, an increase of 30
years in but 100 years. A similar pattern occurred for developed and
developing countries alike. As Wolfenson from the World Bank has
said, life expectancy has risen more in the past 40 years, than it
has in the past 4000. We are healthier now than we have ever been.
Most certainly there are enormous health problems and disparities but
world wide but the vast majority of the people are healthier than
their grand parents. The reason is prevention. It has been estimated
by the World Bank and others that 28 of the 30 year increase has due
to prevention.
Information Sharing is the primary component of prevention. Knowledge
about hygiene, nutrition, location of potable water, safe sex, con-
tainment of infections, smoking cessation, physical activity are all
information sharing. If we could harness the information revolution
for prevention, this could have a powerful effect on health. The
Economist pointed out that if the automobile industry progressed as
rapidly as Information Technology (IT), an automobile would travel at
150,000 km/hour, it would get 100,000 km/liter of gas, and cost US$
5.00. A health grand challenge is how to marry prevention with the IT
revolution.
Prevention is the exchange of information, the collection of data,
surveillance, transmission of information and communication with peo-
ple. Information is the infrastructure on which prevention is built,
but it is a rickety, antiquated and expensive infrastructure. There
needs to be a telepreventive medicine infrastructure, representing
cheap, low bandwidth systems, reaching large numbers of people to
prevent disease. As the Internet reaches <10% of the people world
wide, this system needs to interface with existing information ex-
change systems such as village elders, postal systems, religion in-
formation systems and even grandmothers to make available prevention
knowledge, anytime, any place and any where.
http://bmj.com/cgi/content/full/323/7314/694/b
The marriage of Prevention and IT are critical in this borderless
world. AIDs, SARS, Acid Rain, population growth, global obesity, the
decline of CHD, and global warming, are all part of international
health and wellness. There is a critical need for a global network of
prevention so that "mass customized" prevention will be available on
demand.
http://bmj.com/cgi/content/full/313/7069/1383/a
The Grand Challenge of Telepreventive Medicine consists of 4 compo-
nents:
1. Networking everyone in prevention world wide. As health is global,
should an outbreak of West Nile Fever occur in NYC, input from Egypt
would be most valuable. Similarly the rapid rise of Diabetes in the
Ivory Coast could gain by the experiences of diabetes control in
France. Monitoring the incidence of disease in Brazil may provide im-
portant insight into forthcoming disease in Argentina if the informa-
tion could be shared. This is indeed feasible as we have already cre-
ated a network on the Internet of 9750 faculty from 151 countries,
4000 of which are from developing countries.
2. Improving monitoring and forecasting of diseases: "The Answer my
friend is blowin in the wind" http://www.pitt.edu/~rlaporte/ref4.html
Honda sold 9.25 million motorcycles last year, and McDonalds now has
sold 99 Billion hamburgers. Companies would go broke if they could
not monitor global, regional and local product sales. The size of
these companies pall in comparison to the 1,000 Trillion dollar
health business, yet our systems of monitoring new cases of disease
are almost non-existent. The US discovered a down turn of CHD 15
years after it occurred, and SARS illustrated how difficult it was to
monitor a new disease. There is almost no monitoring of the incidence
of non-communicable diseases. For infectious diseases the systems
miss 10-90% of the cases. Without accurate monitoring of incidence we
know little about our successes and failures for prevention, iatro-
genic threats, and new threats.
We argued that with that the networking of global scientists and sta-
tistical technology such as capture-recapture could establish a Tele-
surveillance system for all diseases. An ideal model is the weather
bureau. Why cannot we discuss about the today's health in eastern
Russia, and then drill down to Moscow, and to your neighborhood? It
is indeed feasible with weather, and it should also be with health.
Specific challenges would be the establishment of the technical and
statistical tools at the local level to assure accuracy in "counting"
diseases to feed nationally and globally.
3. Prevention Information on Demand: Any Time, Any Place, Any Body
There is an enormous amount of information on the Web and elsewhere
about prevention. Little of this information trickles down to the
people who need most. We need to establish systems as above where a
large amount of global surveillance data are collected, and analyzed
by "high end" systems through Internet2. These systems communicate
however with only 1000s of people, we need to reach billions for pre-
vention. There needs to be Prevention systems that bridge the band-
width spectrum. At the lowest end of bandwidth are neighbors talking
with neighbors, verbal autopsies, this information needs to be fed up
the chain of bandwidth to Supercomputers for analysis and forecast-
ing, and rapidly sent back for community and person decision making
about health. Many people have talked about connecting everyone in
the last mile. The reality is that this is that it is unlikely to
ever occur, as less than 10% of the people are connected, in the year
2020, this may rise to 12%. Instead of trying to connect everyone,
there needs to be technology to interface the Internet with existing
channels of information sharing, this includes information sharing in
the community by elders, through religion with clerics, priests and
rabbis, local governments and schools as well as families. There
needs to be the technology to "Mass Customize" the prevention mes-
sages so that different communities of users can easily make the
knowledge "actionable". The conduit to do this is the local public
health official who is in the global network, thus pushing the infor-
mation through this conduit. The scientific and technological chal-
lenge is how to create the local interfaces and mass customization of
the prevention message.
4. Content: We need good scientific content to push through a Global
Health Network. We have taken one approach, that of the Supercourse
(www.pitt.edu/~super1) This is an open source system of PowerPoint
lectures on demand. It has been constructed by 9450 faculty from 151
countries and currently has 1300 lectures. We are reaching across the
digital divide with 39 mirrored servers (e.g. in Mongolia, the Sudan
and Malaysia), we distributed 10,000 CDs which are then re-copied,
and are building Prevention PowerPoint comic books for global distri-
bution. Systems like this of global sharing of content are feasible.
We have a Muslim network (300 members), a Former Soviet Union network
(300 people), and Pakistani network (510 scientists)
Impact: Much of the mission presented concerning the Grand Challenges
talked about Malaria, Aids and TB. Clearly these are major scourges
with Malaria and Aids killing 2-3 million each and TB one million. If
we could eliminate all 3, this would eliminate about 10% of the
deaths in the world each year, a remarkable total.
However, the effect of improving prevention knowledge may be far
greater, and much less costly. "The most urgent task before us is to
get medical and health knowledge to those most in need of that knowl-
edge. Of the approximately 50 million people who were dying each year
in the late 1980's, fully two thirds could have been saved through
application of that knowledge." Grant J. Med Educ 994;28(suppl 1):11
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