Zero Disease

Angelo Barbato

ZERO DESEASE

Original title: Malattia zero

Translated by: Clarissa Cassels

Publisher: Tektime

ZERO DISEASE

The birth of the health collaborative model (Commons).

The birth of digital networks for health (Health Smart Grid Digital).

Author: Angelo Barbato MD angelo.barbato@gmail.com

Doctor of Hygiene and Preventive Medicine Specialist and Specializing in Cardiology. Expert in Public and Private Health. He has worked in the Health Management of Italian health organizations, military and civil covering clinical positions, Chief of Health Director of Public Hospital, Chief of Health Director in Local Health Authority, Chief of DATA Management and Chief of ICT Management. He is coordinator of the Technical Board "Disease Zero and Sustainable Health" of CETRI-TIRES Third Industrial Revolution European Society, inspired by the economic ideas of Jeremy Rifkin.

Index

Presentation 1

Contributions 3

Foreword by Angelo Consoli – The Health Communities 7

1. The wellness and health management in the ideological framework of Jeremy Rifkin 13

2. Historical evolution of healthcare assistance 27

2.1 From Hippocrates to the discovery of antibiotics 27

2.2. The healthcare systems: public (welfare state and Beveridge) and private (Bismark) 33

2.3 The metaphor of the pendulum 47

2.4 Donald Trump and “deregulation” even in health 51

2.5 A new model on the horizon: the Commons of health 53

3. The medicine initiative in the territory: prevention and chronicity 57

4. The acute ill and first aid 61

5. Prevention 67

5.1 Introduction 67

5.2 The determinants of health 71

5.3 The determinants of social and economic integration and social welfare 75

5.4 Lifestyles 79

5.5 Physical activity 81

5.6 The prevention of chronic degenerative diseases through nutrition 87

5.7 Cardiovascular and oncological risks 105

5.8 Psychiatric Risk 109

5.9 Genetic Risk 111

5.10 Dentistry risk and zero cavity 117

6. The paradigm of communication and doctor Google 123

7. New communication frontiers in health 129

7.1 Fitness bracelets and wearable devices 129

7.2 Telemedicine 135

8. Health care orientated by the patient 137

9. The democratization of health 145

10. The new community care in Italian public 151

11. Digital technology in surgery 171

12. The new paradigm in health care: the health Commons and crowdfunding 175

13. Goals and indicators of Zero Disease 181

14. From Rifkin’s 3 paradigms to Zero Disease 3 paradigms 187

Presentation

The book stems from the desire of the authors to disseminate tools and transformation of models in health care, inspired by Jeremy Rifkin’s theory 'Zero Marginal Cost'.

The ambitious attempt to make an accessible and usable participative model of health, illness and treatment, meets the need of the human being to recover the relationship with himself and with the world around him. The environmental, economic, social and technological should be geared towards preserving the human being and the environment he lives in. The inevitable repercussions on health will become increasingly avoidable using the new paradigm of communication, through conscientious choices and the essential support of the internet. The transition from a Hierarchical and Structured Medicine to a Capillary and Distributed one sees the human being involved in the role of being responsible for himself. The health-oriented community will be the arrival point, not only a start, and a social duty prior to being a fundamental right.

This probably represents a visionary shift which, in the words of our intellectual reference "It's Already Happening".

Contributions

Thank you to the following professionals for their contribution:

➔ Bruno Corda, MD

Doctor, Specialized in Emergency and First Aid Surgery, Hygiene and Preventive Medicine. Already a Family Doctor, Director of Prevention Department, Director of Public Hygiene and Health Service. President of the Italian Society of Hygiene- Lazio Section. Master Degree CORGESAN and EMMAS in Health Management. Technical Table “Zero Disease and Sustainable Health” of CETRI-TIRES - Third Industrial Revolution European Society, inspired by the economic ideas of Jeremy Rifkin. bruno_corda@alice.it

A special thanks to Bruno Corda for having introduced me to the studies of Jeremy Rifkin.

Angelo Barbato

➔ Angela Meggiolaro, MD

Specialized Doctor in the Department of Hygiene and Infectious Disease Department of Sapienza, University of Rome. Epidemiologic and Health Economy Field experience. Author of textbooks and Scientific Publications in the Field of Public Health and Medicine of the Territory. Technical Table “Zero Disease and Sustainable Health” of CETRI-TIRES - Third Industrial Revolution European Society, inspired by the economic ideas of Jeremy Rifkin. angela.meggiolaro@gmail.com

➔ Dr. Angelo Consoli

Director of the European Office of Jeremy Rifkin

President of CETRI-TIRES (Third Industrial Revolution European Society)

Co-Author with Livio de Santoli of the Manifesto-book “Zero Zone”.

➔ Francesca Mirabelli, MD Ph.D

Specialist in Cardiology

Ph.D in Biomedical technology in clinical medicine

Second level Master Degree in Imaging diagnostic cardiology

ASL Rome 1. francesca.mirabelli78@gmail.com

➔ Alessandro Anselmo, MD Ph.D

Specialist in General Surgery

Ph.D in Surgical pathophysiology

Ph.D in Organ Transplants

Second level Master Degree in Organ Transplants

Fellow of the European Board of Surgery

Medical Executive - UOC Transplant Surgery - PTV Foundation- Rome

➔ Antonio Magi, MD

Doctor Specialist in Radiology

Health Past-Director IV District ASL Rome A

➔ Dr. Roberto Del Gaudio

Personal Trainer Master 3° level federal FIPE CONI and Jurist

roberto.del.gaudio2@gmail.com

➔ Dr. Antonina Fazio

Biologist-Nutritionist Specialized in Clinical Pathology afazio2002@hotmail.com

➔ Dr. Eloisa Fioravanti

Degree in Arts and Dentistry fioravelo@gmail.com

Translated by Clarissa A. Cassels

Degree in European Studies at Maastricht University

Translator and interpreter, massage therapist and travel blogger on www.piglinaround.com

Foreword by Angelo Consoli – The Health Communities

The Third Industrial Revolution is not only a change from a centralized, top-down energy/economic model towards a distributive and interactive one.

The Third Industrial Revolution is also and mostly a paradigmatic shift for the human race.

An epical passage from an individualistic and utilitarian lifestyle to a biospheric and empathic one. In a society in which the marginal cost of production and distribution of goods and services is closer and closer to zero, where information, objects, ideas, services and people travel at infinitesimal costs compared to a hundred years ago, and in timeframes then unimaginable; the human genre is emerging from an economy of scarcity, entering a sustainable system of abundance. An economy in which its activity will no longer develop according to the canons and standards of the traditional market economy based on profit, but according to canons and standards of a social economy based on collaborative Commons.

Jeremy Rifkin lucidly describes Energy Commons as composed of millions of prosumers (both producers and consumers) able to generate almost all their green energy needs at a marginal cost close to nothing , the Commons of Logistics able to project, print and distribute goods and services at almost null marginal costs, and the Commons of Health, Education and Culture able to guarantee scholastic, health and cultural services of same condition; or Mobility Commons for the movement of humans in increasingly sustainable, efficient and economic ways.

The new generations are projected beyond the capitalist market and the centralized, hierarchical, closed, patriarchal, property-tied model towards a distributed model, which is collaborative, open, transparent, equal and empathic.

It is what Rifkin calls power on a lateral scale, or “Lateral Power”.

Today’s youth, linked together in a virtual sphere (by social networks through which information travels with abundance and freely) and in a physical space (thanks to low cost flights, unimaginable ten years ago, or faster and more efficient metropolitan transport lines), “are rapidly getting rid of the remaining ideological cultural and commercial ties that have long been separating the “mine” from the “yours”, in the frame of a capitalistic system characterized by relationships of private property, market exchanges and national borders. “Open Source” has become the mantra of a generation that sees power relations in a completely new way compared to their parents and grandparents who have lived in a world dominated by geopolitics.” (cit. Jeremy Rifkin, Society at Zero Marginal Cost, pag. 429-430)

In a new empathic civilization profoundly integrated in the biosphere community, all our natural resources will become shared patrimony and the way that they are used will become everyone’s business.Even the planning of urban spaces, be it industrial or rural, will not be an exception to this rule.

The construction of large industrial and infrastructure installation networks of the third millennium and the third industrial revolution cannot therefore continue to proceed according to the dissipative and unsustainable canons of the fossil era. Networks were built in disregard of the principles of efficiency, space optimization of urban and rural spaces were ravaged repeatedly and savagely for the construction of tens of thousands of power lines, pipelines, cable ducts, aqueducts, road infrastructure, electronic networks and lighting networks.

In the collaborative Commons idea, the internet of things offers new and unreleased possibilities of “doing more with less” (the principle of energetic efficiency affirmed by the European Union) taking advantage of the existing networks and enriching them with new functions, useful to expand the sharing economy and empathy among human beings.

The collaborative Commons is based on the idea that the thermodynamic laws cannot be ignored, minimized, avoided or violated. The first law of thermodynamics clearly tells us that nothing is destroyed but everything is transformed. Therefore, burning an object to close the waste cycle does not at all entail its elimination or freedom from it, but simply having changed its state, from solid to gas and making it even more dangerous not only for the environment but also for human health. All the energy of the second industrial revolution is based on the violation of the laws of thermodynamics. The combustion of a fuel to bring about propulsion or the turning of turbines is a thermodynamic folly with lethal consequences to human health. Changing the paradigm from the fossil cycle to the solar cycle, therefore entails activating a new, less harmful economy, consequently more in line with an illness prevention policy and closer to the objective of zero disease.

The Third Industrial Revolution is creating healthier and cleaner societies, an agriculture without pesticides or genetically modified organisms (GMO), a distributed industry instead of one centralized on very reduced emissions. On the contrary, continuing with the vertical logic will inevitably produce health pollution as an effect of soil, water and waste landfills contamination and the poisoning of air by incinerators.

However, with his new book, Rifkin causes us to reflect , he also covers the correlations between environment and health, he illuminates us on how the doctor/patient relation is changing in the dynamic of a new community of distributed health. Rifkin reaches this considerable result described also as the “Commons of Health”.

Why not imagine, in fact, beyond the Commons of Information, the Commons of Energy, also the Commons of Health? “A Commons in which modern technologies of distributed and interactive information permit Dr Gille Frydman, founder of ACOR (Association of Cancer Online resources) to develop a model of participative medicine in which different subjects converge in a sole Commons. Patients, researchers, doctors, financers, producers of medical equipment, therapists, pharmaceutical companies and health professionals, would all be committed in collaborating to improve the care of the patient” (Rifkin, Society at Zero Marginal Cost, page 343).

This is not a remote or an unrealistic hypothesis. “Patientslikeme”, a social network of over 200,000 e-patients already fights 1,800 diseases. An important achievement they have obtained has been exposing the scandal of lithium-based pharmaceuticals used for Amyotrophic Lateral Sclerosis. A study based on information received online showed how these drugs were totally uninfluential in the treatment against ALS. Such an example shows how the “open source” approach in medical research can produce important results, as opposed to competitive research, through which data remains trapped under a vertical, limited and secretive system.

In medicine, more than in any other sector, it becomes increasingly fundamental to dispose of “big data” with adequate algorithms, following the crowdsourcing model in order to identify sanitary models at low marginal costs and yet with very high efficiency. In the chapter “Everyone is a doctor” of his latest book, Jeremy Rifkin reminds us that, nowadays, the Internet counts with hundreds of health Open Source Commons. Rifkin consequently highlights that “everything suggests that their number will increase significantly in the coming years, when in various countries the electronic storage of health data will make health care support services more fluid and efficient... The big data, that will therefore be made possible to generate in the United States as in all other countries, will form a pool of information that, if properly exploited by open source Commons oriented health by patients, may, subject to appropriate safeguards on confidentiality, revolutionize the health sector” (Rifkin, Ibidem, page 348) .

Hence, the message launched from the collective of sensitive and intelligent doctors interpreting Rifkinian thought, among whom are Dr. Angela Meggiolaro, Dr Bruno Corda and Dr Angelo Barbato, completes the vision of a society of zero emissions, waste, kilometres and of a zero marginal cost economy.

The “Zero” vision expressed in the book-manifesto Zero Zone, written by professor Livio de Santoli and myself, thanks to the contribution of Angelo Barbato, has permitted us to trigger the spread of awareness around the Zero Disease concept. This occurs in a scenery in which the internet of things and the Third Industrial Revolution bring the centre of health care precisely onto the territory, calling for the necessity to increase prevention as a “Pillar” of the distributive model of health in medicine in the zone.

The new vision highlights that the traditional model based in the hospital has become ineffective for the treatment of chronic diseases which are increasingly diffused due to the lifestyles and occupations imposed since the Second Industrial Revolution, and which can be reduced by enhancing the prevention pillar. Telemedicine, home care, fight against chronic diseases, doctor’s actions on the territory’s schools and public administrations and especially the adoption of proactive methods by the citizen-patients, will increasingly revolutionize how we deal with health, moving the focus from the institution to the area.

This new health model of the third Industrial Revolution will revolutionize the current paradigms of health care, reaching extraordinary and very rapid results, mainly through prevention. The new care model is the heart of the book ‘Zero Disease’. The realization of such a possible future depends entirely on us, starting from public administrations and health care enterprises. Notwithstanding citizens and their propulsive aggregating force which lead increasingly rapidly towards a biospheric, empathic, collaborative and sustainable lifestyle, where Community becomes Zero Zone.

Angelo Consoli

Director of the European Office of Jeremy Rifkin

President of CETRI-TIRES (Third Industrial Revolution European Society)

Co-Author with Livio de Santoli of the Manifesto-book “Zero Zone”.

1. The wellness and health management in the ideological framework of Jeremy Rifkin

Bruno Corda Angelo Barbato

Jeremy Rifkin is one of the world’s most recognized economists who in his recent work1 2 has stressed the progressive rise of a new economic system, gradually alternating and replacing capitalism. The engine of this transformation is the digital revolution, allowing the internet of things. Telecommunications’ Internet of things (or, more properly, the Internet of Things or IoT), is a neologism referring to the extension of Internet to the world of objects and concrete places3 . The internet of things is made up of a network between the energy internet, the communication internet and the logistics internet4 . Rifkin summarizes his economic thinking in three basic paradigms (energy, communications and logistics), stating that in the evolutionary change of these archetypes, man becomes the star of a new industrial revolution.

The first industrial revolution (about 1760-1870) was an economic transformation process or industrialization of society in which the agricultural and craft-trade systems became modernized and industrialized. Characterized by the generalized use of power-driven machines and of new, inanimate energy sources (such as fossil fuels - steam engines), the scheme was favored by a strong component of technological innovation. This was additionally accompanied by the phenomena of growth, economic development and profound socio-cultural and even political changes. This first industrial revolution began in the textile (cotton), metallurgical (iron) and mining (hard coal) industries.

The insurgence of the second industrial revolution (about 1870-1970) is conventionally set to 1870 with the introduction of electricity, chemicals and oil.

The third industrial revolution (1970) refers to the effects of mass introduction into industry of electronics, telecommunications and informatics5 .

In recent years a new generation of scholars and specialists have began to realize that the management and centralized control of commerce is giving way to peer production and horizontal distribution. The scale of property exchange on the market is becoming less important than access to goods and services on the network. Additionally, conscience is rising around the social capital as true economic value rather than the market capital.

The main result will be a more equitable society based on sharing and cooperation between citizens and a sustainable economic model, particularly from an environmental point of view.

The new paradigm will lead to a progressive market decline as we know it today, parallel to the development of a sharing economy based on the cooperation of the consumer who meanwhile also becomes producer (prosumer). This is the first new economic system to make its appearance since the birth of capitalism and socialism at the beginning of the 1800. A free economy is emerging, a mix between capitalism and collaboration. In 2050 Jeremy Rifkin predicts that capitalism will still exist, but it won’t be the sole economic system. Young people today collaborate with all sorts of things, produce and share their videos, their music, their news.

Online training courses are open and free, all this with marginal costs equal to zero. In fact, when producing a video, the marginal cost to distribute it to a billion people is virtually zero.

We're starting to see a new economic system in which there aren’t only producers and consumers, owners and workers but also prosumers; millions of people who access the Internet platforms of things and are able to produce, consume and share any virtual service: news, knowledge, music, video. We are bypassing the great twentieth-century organizations at almost zero marginal cost: free of charge, in abundance and outside the market. This is a revolution.

What will happen to Multinationals?

Many of the big and vertical ones of the twentieth-century have already been destroyed, as has happened, is occurring and will continue to take place in the music and video industry, in editorials and in television.

At the same time, thousands of other new companies have emerged in the economy of sharing. Not just Google, Facebook and Twitter, but thousands of profit and nonprofit companies that are building the sharing economy, thereby enabling young people to share what they create.

It 'a very destructive process to the market economy as we know it today, but it is only the beginning of a revolution towards the democratization of economic life.

Germany is leading this revolution, and even small countries like Denmark and Costa Rica are doing well. Germany is ahead in the internet of energy with 27% of the energy produced by sun and wind. It will be over 35% by 2020 and 100% by 2040. The costs of technologies for energy production are significantly reducing as has happened in the computer industry. A solar watt costed $ 150 in 1970, now it’s charged 64 cents and it will drop to 35 within 18 months. Once Germany has paid off the investment expenses, the marginal cost of energy produced will be close to zero. The sun and the wind do not send any bill to be paid to the Germans. It's free. Germany is heading towards an energy system at zero marginal cost that will make the economy more productive and efficient in the world, hugely benefitting its businesses and families.

China, too, has begun to change its energy policy with investments starting at 82 billion dollars in 2015 to digitize the electric grid smart. Millions of Chinese will be able to produce solar and wind energy in their home and share it in the national electricity grid.

In electrical engineering and telecommunications, a smart grid (intelligent network) is the combination of an information network and an electrical distribution network in a manner allowing to manage the power grid “smartly”.

Precisely the "intelligent" characteristic must be highlighted under various aspects or features as the efficient distribution of electrical energy for its more rational use, minimizing any overloads and variations in voltage around its nominal value6 .

Digital smart grid is a concept which, carried from the power supply, will be increasingly developed in the computer network connections. This has implications not only for Wi-Fi, broadband and big data. It is needed to move towards the trend of digitizing the three major paradigms of the economy: energy, communications and logistics (including transport systems).

There are no longer virtual or natural boundaries facing the great global problems such as population growth, food resources, over-exploitation of land resources, pollution of the planet and consequently uncontrolled problems at the limit of survival , of space and of the biosphere’s balance. These represent problems towards which consciousness is growing, issues we can no longer postpone, or worse, ignore.