One Health: Extending Frontiers in the Art of Medicine by W. Jean Dodds DVM 832 The scientific era began centuries ago with the Scientific Revolution of 1543 and the teachings of Copernicus, Gallileo, Kepler, Newton, Harvey, Kuhn, Huygens and Shapin. They and other pioneers brought us to the early 1800s. At that time, the practice of homeopathy as founded by Samuel Hahnemann was widespread, and the first homeopathic medical school opened in 1832. In 1920, the last of these schools closed as homeopathic practice declined in favor of today’s allopathic medicine. Despite this change, however, homeopathy has devoted followers and is still practiced throughout the world. The Scientific Era of the 1900s began after that: 1940s – biomedical research is based on clinical observations and hypotheses are tested in laboratories 1960s –laboratory and applied clinical research becomes more molecular, including the first concept of gene therapy 1970s –molecular science and genetics become mainstream. Laboratory animal welfare and vaccine issues become recognized 1980-1990s –clinical and drug therapies evolve from this science; stem cells are cloned and the animals benefit too 1990 – evidence -based medicine becomes the key, and the first gene therapy success is achieved in the USA with ADA (adenosine deaminase) deficiency 2000s – present — human, dog and cat genomes are sequenced which launches more gene therapy studies, and stem cell therapy for people and pets becomes clinically available History of Integrative Medicine and Veterinary Medicine Integrative medicine is the term that applies to the combination of conventional Western medicine with alternative (complementary or adjunctive) medicine. This combination when applied to all sentient species equates to “One Health”. It evolved from the desire to improve patient care and reduce harm. It also reflects today’s bias towards allopathic medicine and the need to be judged by our peers. A more balanced approach would be to apply Evidence-Based Practice, which is the combination of evidence-based medicine and practice-based experience. This focuses on the patients and collaborative application of complementary alternative medicine therapies (termed “modalities”). These could include acupuncture, acupressure, chiropractic, Chinese and Western herbal therapy, massage therapy, nutrition and supplements, aroma therapy, and other means of healing. These alternative methods have been documented to be of benefit to human and animal patients for alleviating chronic pain, arthritis, infections and inflammation, bowel disorders, depression and anxiety, seizures, and even certain cancers. Education in the human and allied health care medical sciences includes these teachings today. The relevance of evidence-based practice becomes obvious when a particular effective therapy is novel and not yet widely known or accepted. It is the experience gained by those initiating these methods that needs to be applied to patient care even before the evidence of benefit is proven, otherwise the patient can be harmed and suffer. This is the judicious use of what is known as “current best evidence”. The Human-Animal Bond Emphasis on the interaction and co-dependency between humans and animals on our planet has developed into what is widely appreciated as the “human-animal bond”. As we share the earth, skies and waters with them, the lives and health of domesticated, companion, free-living and captive wildlife, aquatic species and birds have become intertwined in our very existence. This is a symbiotic relationship of mutual benefit and conservation — not only from the food and fiber animals, fowl and fish we use to sustain ourselves, but also for the love and companionship shared between us and the dogs, cats, horses, birds and exotic species that we call pets. Figure 1. Illustrating the human-animal bond of One-Health The Current ‘OMICs Era Scientific validity and efficacy studies have led to the ‘omics medical sciences we practice today: Genetics represents the DNA genomic “blueprint” of heredity Diet influences include: Epigenetics, DNA methylation and histones; Transcriptomics, RNA; Proteomics, proteins; and Metabolomics, metabolites generated Nutrigenomics is the emerging science that studies molecular relationships between nutrition and the response of the body’s genes in promoting health. Different diets alter the expression of one’s genes and the resulting production of proteins and metabolites, thus leading to individualized, functional nutrition. Specific nutrients affect the body responses in a way defined as that body’s “molecular dietary signature”. This is unique for each individual person or animal, unless you have an identical twin. Therefore, certain diet-regulated genes play a role in the onset, incidence, progression and/or severity of chronic disease. Dietary intervention and optimization can thus be used to prevent, mitigate, or even cure chronic disease. Nutrition, when combined with modest or moderate exercise, is the most important factor for maintaining human and animal health and longevity. Figure 2. The picture of optimal health Pharmacogenomics deals with the influence of genetic variation in the response of individual humans and animals to specific drugs. Genotype-specific therapy is used in some cases today to correlate the gene expression of an individual with the efficacy or toxicity of a drug. The aim of this approach is to develop a rational means to optimize therapy as related to a particular patient’s genotype. The would maximize drug efficacy with minimal adverse effects. What Does the Future Hold? Current developments are aimed at: Targeted gene therapy for genetic diseases Stem cell therapy to correct physical and clinical traits, disorders and mutations in embryos, fetuses, and fully developed individuals Nanotechnology which uses just minute atoms and molecules to study genetics, drug therapy, and other fields of science Cloud technology which involves precision data gathering and data mining of medical information on the internet cloud 3-D printing offers powerful design and modeling of body parts to allow for exact precision surgeries, dentistry, and even production of human and animal organs Self-health where internet and home diagnostics and monitoring are becoming available remotely, which includes virtual doctor visits for ourselves and our pets Selected Reading Duggal M, Menkes DB. Evidence-based medicine in practice. Int J Clin Pract 2011; 65(6): 639-644. Dodds WJ. Keynote Address: Celebrating 30 years of magic – extending frontiers in the art of medicine. Proc Am Hol Vet Med Assoc 2012, Birmingham, AL Sept 9, 2012. Palmquist RE. Perspective: Evidence-based practice: what is it ? J Am Hol Vet Med Assoc 2014; 35, Spring Issue: 7-10. Dodds WJ. Epigenetics: programing for health and longevity. J Am Hol Vet Med Assoc 2014; 37, Fall Issue: 16-22. About W. Jean Dodds DVM Veterinarian for more than 50 years, graduating when women were pioneers. Dedicated career to helping animals stay healthy, thrive and have long lives. Experienced and widely published in clinical and research fields of hematology, immunology, endocrinology, nutrition and animal welfare. Co-author of two popular books (The Canine Thyroid Epidemic and Canine Nutrigenomics).