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Special Event

Millennium 2000: Diseases That May Come and Go

Aired January 1, 2000 - 1:13 p.m. ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

ANNOUNCER: Killing the killers: With new breakthroughs against infection and into our own DNA, there are diseases we will soon cure. Every major disease will have gene therapy as a treatment option and new ones we'll need to fear.

(BEGIN VIDEO CLIP)

DR. ANTHONY FAUCI, NATIONAL INSTITUTES OF HEALTH: You give it the terminology "super bug" when it has overcome man's attempt to suppress it.

(END VIDEO CLIP)

JONATHAN MANN, CNN ANCHOR: The last hundred years witnessed medical breakthroughs over diseases that would once mean certain death and untold misery.

NATALIE ALLEN, CNN ANCHOR: And the new century finds modern science on the cusp of revolutionary discoveries that could redefine the treatment of disease.

CNN medical correspondent Dr. Steve Salvatore reports the groundwork is already in place.

(BEGIN VIDEOTAPE)

DR. STEVE SALVATORE, CNN MEDICAL CORRESPONDENT (voice-over): It is perhaps the most massive scientific undertaking in history: to identify and map each and every one of the millions of genes that make up the blueprint to the human body.

The human genome project will help scientists understand exactly what makes each of us who we are. But most importantly, the genome will find the missing and damaged genes that can lead to diseases like muscular dystrophy, Lou Gehrig's, Alzheimer's disease and many cancers.

DR. FRANCIS COLLINS, DIRECTOR, HUMAN GENOME PROJECT: You're going to see a proliferation of discoveries about the genetic contributions to diabetes and heart disease and high blood pressure and schizophrenia and multiple sclerosis and on down the list.

The most immediate consequences will be diagnostics, where you and I can find out, if we wish to know that information, what our own individual risks are for future illness. Those will not be precise risks that say, oh, well, you're going to get this disease on your 45th birthday, but they will be relative risks. And they will be very useful for many of those circumstances where we have good ideas about how to reduce the risk if you know what disease specifically is lurking there in your DNA.

SALVATORE: Thousands of diseases that can damage the quality of life or cut life short have genetic components. Once those genes are identified, medicine will have made the first crucial step toward a cure.

DR. WILLIAM HASELTINE, CEO, HUMAN GENOME SCIENCES: Understanding human genes gives us a powerful set of new tools to address medical problems, either to create new chemical drugs to treat diseases or to use the genes and the substances they make, proteins, as medicine themselves.

DR. FRENCH ANDERSON, UNIVERSITY OF SOUTHERN CALIFORNIA: I think by 20 years from now, gene therapy will have revolutionized medicine. Every major disease will have gene therapy as a treatment option, and millions of lives will have been saved.

SALVATORE: In gene therapy, malfunctioning genes are replaced by healthy ones. The healthy genes are delivered into the cells of very various organs using a virus. The main challenge has been to find a virus that safely carries the healthy genes to the right cell. Sometimes the virus misses its target or creates side effects in the patient.

Researchers are still trying to determine what killed 18-year-old Jesse Gelsinger. Gelsinger, who had a rare liver disorder, died in September at the University of Pennsylvania, where he was participating in a gene therapy trial. That death placed a caution light on further trials, but researchers remain optimistic that gene therapy will save lives in the 21st century.

DR. FRANCIS COLLINS, DIRECTOR, HUMAN GENOME PROJECT: In the longer term, these gene discoveries will lead us to a whole new level in terms of drug development. And we will have therapies, both drug therapies and gene therapies, for diseases that we currently don't successfully treat.

SALVATORE: So does that mean we will someday look back on breast cancer or tasex (ph) the way we now look back on polio?

HASELTINE: I think that we are 10 to 20 years away from that happening. It will happen. We will get over our current difficulties, and we will have ways to change genetic destiny.

SALVATORE: But genetic diseases are only one category of disease. Experts say one of greatest threats to humanity in the 21st century will be an increased frequency and severity of infectious diseases and super bugs.

FAUCI: There is always the threat of a new and emerging epidemic, and those of us in the public health field are always concerned about the capability of the influenza virus to emerge in a deadly fashion as it did in 1918, where it caused over 20 million deaths worldwide and up to 750,000 deaths in the United States.

SALVATORE: Since its discovery, 16.3 million people have died from AIDS. Although the spread of the disease has been stemmed in many parts of the world, it is decimating Africa. Sixty-nine percent of the 34 million people infected with HIV worldwide live in sub- Saharan Africa.

In the United States, 60 percent of hospital infection are caused by drug-resistant microbes, which kill 14,000 people each year.

FAUCI: A classic super bug is a multiple-drug-resistant staphlycoccus aureus. Another super bug is a multiple-drug resistant tuberculosis. Sol you give it the terminology "super bug" when it has overcome man's attempts to suppress it by what we usually suppress them with, namely anti-microbials.

SALVATORE: Over the past two decades, over 30 new and emerging infectious diseases have been identified in humans. Hantha (ph) virus, a virus spread by rodents, infected over 50 people, more than two-thirds died. Last summer, the West Nile virus mysteriously appeared in the U.S., where it had never been seen before. It was carried by birds from New York and spread to the southeastern United States.

Certainly the shrinking world has made it difficult to contain infectious disease. As human beings have become more mobile, millions of us traveling from continent to continent and shipping our livestock and food around the world, natural barriers that used to contain disease have become irrelevant, broken down by ships and airplanes. Disease travels, too.

FAUCI: The fact that we live in global community, where there's travel back and forth, where you can have someone be in Africa one day and be in the West Coast of the United States literally the next day, or in certain countries in Asia and go around the world, that means that any infection or any disease in any part of the world can be transmitted to another part of the world under any circumstances.

SALVATORE (on camera): So what hope do we have to contain or cure these kinds of diseases? Hospital infections could be dramatically reduced if hospital staff were more vigilant about hand washing. The CDC and NIH are currently working on new vaccines for AIDS and other infectious diseases, but hope may once again be found in genetics.

DR. PAUL MATSUDAIRA, WHITEHEAD INSTITUTE FOR BIOMEDICAL RESEARCH: If we know the sequenced of their genomes, then we'll have a basic blueprint of their genetic code. And from that blueprint, we'll be able to understand how that organism can live or cohabit in our body.

SALVATORE: The ultimate goal, of course, is to wipe out all diseases, to never again see a child struggle with muscular dystrophy or leukemia, a man in his 60s lose his mind to Alzheimer's disease, a teenager die randomly from mysterious bacteria or virus. The dawn of the 21st century find us closer to that goal than we could ever have imagined, but hope can brighten or dim depending on where you live. The quality of health care around the world varies wildly. As medical science advances, there is no doubt new cures and treatments will be discovered. The next challenge will be to distribute them to everyone who needs them.

Dr. Steve Salvatore, CNN, New York.

(END VIDEOTAPE)

MANN: We're going to pause briefly here, but when we come back, 21st century solutions: a conversation with experts from the World Health Organization, the Centers For Disease Control and human genome scientists about the breakthroughs that are happening and the ones that lie ahead.

Stay with us.

ANNOUNCER: In the last decade, more than 50 new viruses were identified.

(COMMERCIAL BREAK)

ANNOUNCER: In the Past 25 years, the average life expectancy has increased by nine years.

MANN: The human genome project that we've been talking about today holds out an amazing prospect. Science has found the instruction manual that explains every cell in our species. Doctors just don't understand it yet. But there is progress there, and there is progress of many kinds elsewhere, as well.

We're going to talk about that now with three guests. From Southampton, New York, William Haseltine, who appeared in our preceding report. He's founder and CEO of a company called Human Genome Sciences. Joining us from Geneva, Switzerland, Dr. David Heymann, executive director of the World Health Organization's communicable diseases cluster. And from here in Atlanta, Dr. Jeffrey Koplan, director of the Centers for Disease Control and Prevention, the CDC.

Doctors, we thank you all for being with us.

Let's start with you Dr. Heymann in Geneva, but I'm going to invite everyone who's here with us and Natalie here on the set with me to jump in if you have a thought or two. Doctor Heymann, where are the real medical miracles today? Where are the breakthroughs being effected? Where are the extraordinary cures that excite people like you?

DR. DAVID HEYMANN, WORLD HEALTH ORGANIZATION: Well, the cures and the tools necessary to prevent infectious disease are with us today. What we have to do is muster the political will and also the financial support to use these tools better to use these tools better to stop the infectious diseases which are occurring worldwide. MANN: Jeffrey Koplan, the point is well taken. Money matters. But it's also a question of science and of scientific success. Where are the big successes now?

DR. JEFFREY KOPLAN, DIRECTOR, CENTERS FOR DISEASE CONTROL: I think we're seeing one right now around the world in our efforts for polio eradication. Dr. Heymann and his organization are leading the way in this. But we expect by the end of next year to have eliminate polio as a scourge around the world. This involves both the scientific know-how to do it, which we have, the public health will, and, as Dr. Heymann said, the political will to get it done.

MANN: Why don't we go now to Southampton. Dr. Haseltine, you're working on a whole new kind of drugs. Are we about to see a whole new kind of medical care because of them?

HASELTINE: Yes, we were. And in answer to your first question, 1999 has been a breakthrough year for medicine. We've seen an unprecedented explosion in our knowledge of infectious diseases at their most intimate level, the level of their complete gene sequence. We have a very accurate blueprint of human genes, and that knowledge is now seeping through our universities, our pharmaceutical companies, the biotechnology companies, and we are witnessing a true revolution in the making.

That's not underestimate the importance of distribution of current medical practice throughout the world. We're in great need of the World Health Organization's surveillance and the CDC and -- distributing what we now know. We can make a much healthier world just on what we know today, but the future is even more exciting.

MANN: I'm struck by what you're telling us, Dr. Haseltine, because we've been talking about gene research for an hour now, and you sound like the most optimistic voice that we're hearing from.

HASELTINE: Well, I'm extremely optimistic based on the knowledge that we have. We have actually taken some of these breakthroughs and have them in patients, humans beings being treated right now with some of these genomic breakthroughs. We're trying to restructure and re- grow blood vessels in the human heart to make coronary bypass surgery irrelevant, we're trying to heal the skin of patients with these chronic wounds that don't heal, we're trying to shield the body from the devastating effects of chemotherapy. Those are things that are happening today. And we also hope very soon to be introducing new drugs to stimulate the immune system to help fight off some of those infections that are resistant to antibiotics.

So I'm extremely optimistic about the near-term as well as the long-term future, as long as we have the right medical infrastructure not only in the developed world but in the developing word as well.

ALLEN: Quick follow-up on that point, the future Dr. Haseltine -- this is Natalie. You have said in the past, and I quote, "Death is a series of preventable diseases." That said, and with this research and your optimism, let's talk about life expectancy. In the next 100 years, where could that go? HASELTINE: Well first of all, let's start with the last hundred years. In developed worlds, life expectancy has just about doubled. We're now living, on average, twice as long as people born in the last century. And I think the next century can add another 50 or 60 years to the average life-span. So the average person can live a full, natural life-span of 100 to 120.

And I think eventually we can do better than that. But for now, I think we can keep our sight on bringing everybody's longevity up to those of us who can live the longest, which is about 120 years.

MANN: Let's go to Geneva, because once again I'm struck by the different voices that we're hearing -- one doctor who says that technology and research is really going to change everything, and other voices that say technology really isn't the answer. Is there nothing on the research front, is there nothing that gene research, Dr. Heymann, offers the kind of people and the kind of diseases that the WHO is seeing?

HEYMANN: Well, I'll come back to what I said earlier. We do have the drugs and we do have the vaccines today to get rid of the majority of infectious diseases. Infectious diseases today are very unequally distributed in the world.

If you look in low-income countries, you'll see that of all the deaths that occur in those countries, 45 percent are still due to infectious deceases. If you look at the population which is economically productive, those people under the age of 46 years of age, you'll find that of those dying, 48 percent die of infectious diseases, and 90 percent of those deaths are due to six infectious diseases: tuberculosis, malaria, diarrheal diseases, pneumonia, measles and AIDS, diseases for which we have vaccines or good drugs or preventive measures. So we must better use those tools and get rid of infectious disease deaths today.

MANN: While we hear about these very serious threats and these terrible diseases, authorities in the United States can take pride in the fact that many of these diseases were in the U.S. and were essentially cured.

Weren't they, Dr. Koplan?

KOPLAN: We have gained 40 years of live over the course of the century. But if we were sitting around now in 1900, and we were saying, what are our big targets? What are our big challenges? What do we need to do? We would have not guessed many of things that have come up over the century that we have had do deal with, and that have ended up being health problems. In 1900, we would have named infectious diseases, workplace hazards, safe pregnancies and childbirth, and we've done a terrific job at controlling those in the United States over the these years, amongst other things.

But some of the things we wouldn't have anticipated were the tremendous toll that tobacco would have taken on our health, the role of automobiles, and collisions and injuries and deaths from those over the century. We wouldn't have considered dental health to be something to concern ourselves with. And so, we can't be so smart now as to say we're going anticipate all of the things that are going to come up, because many of them of are of our own making. And so human behavior plays a huge role in our health, in our dealings with disease and our avoiding and preventing disease.

The 40 years we've gained over the 20th century have largely been because of our efforts on prevention, not our efforts on cure.

MANN: We're going to ask our three doctors to stay with us. We have to stop for a moment.

But when we come back: when disease turns doctors into detectives, emerging illnesses.

Stay with us.

(COMMERCIAL BREAK)

ALLEN: Thirty new infectious diseases have emerged in the last couple decades alone. Just one of them, AIDS, has changed lives in just about every country on every continent.

MANN: How many more are out there? Joining us once again, our three guests. Let's go to Geneva and Doctor Heymann to start with.

Dr. Heymann, is there another AIDS, is there another ebola out there?

HEYMANN: Certainly we have to be on the lookout for new infectious diseases. These diseases are with us. Many of them are in animals, and they somehow manage to breech that barrier between animals and humans, and fact, humans and others are with us, in humans themselves. But you don't yet see their output as we did with AIDS. AIDS came along. It was in humans for a very long period of time before we even knew that it had infected them and was going to cause the huge epidemic that it does throughout the world. So infectious diseases are with us now. We have to be on the lookout. We talked about influenza as well. Keeping surveillance over these diseases so we can see when they will occur, and we can stop them before they spread too rapidly.

MANN: Jeffrey Koplan, in Atlanta, are there specific things that you're looking at, specific trouble areas on the globe, specific maladies that are emerging?

KOPLAN: Well, as you've indicated, we've had a wide range of new infectious disease public health issues, almost one a year for 30 years, over 30, and we'll have more to come. We feel that careful monitoring, what we call surveillance, looking for new diseases as they crop up anywhere in the world affects us anywhere else in the world.

The boundaries that we live in are no longer the counties that we're in or the neighboring cities, but there as far away as different continents. That's due to shipping, due to air transport, due to travel -- by people coming here and our people going elsewhere -- misuse of antibiotics. All these things create a fertile home for new infectious agents. But by careful tracking and monitoring both at CDC, at WHO, in other countries, we can get a better handle on when these organisms appear and what they're doing.

MANN: Let me ask you more about that, because there's so much disease detective work built into the kind of work that you and your staff are doing. How do you spot a new disease? How do you track it? How do you know how to fight it?

KOPLAN: Well, we have some wonderful new techniques, as well as the traditional ones. The traditional ones are what we call "shoe leather epidemiology," getting people out there, investigating new cases, determining whether they're different, seeing if they're clusters. There are several cases look like the same disease, and then having laboratory confirmation.

But we've got some of the new biomedical, some genetic techniques that are improving our capability to identify. One case of a disease that occurs in Albuquerque, another case that occurs in Atlanta and a third case that occurs in Maine. And tie them all together to see whether there's a common source for these.

In the last few years, just in the United States, we have identified many new outbreaks that we wouldn't have been able to 10 or 15 years ago because of these new techniques.

ALLEN: Dr. Haseltine, I'm curious, you struck such an optimistic tone. Listening to Dr. Heymann and Dr. Koplan about -- and certainly, you know, so many unknowns that are in our future. Are you confident that your work and that of researchers can stay ahead of the game?

HASELTINE: I think we can stay ahead of the game, and even with AIDS. I was involved in that from 1981 on, and we identified the disease quickly, understood its transmission, were able to make some very major efforts to contain the spread in the United States. And were those methods applied globally, we would have contained the AIDS epidemic. It's a matter of behavior at this point more than it is science.

But I'd like to make another point, and that is, I believe we can stay ahead of infectious threats that come from outside, from different environments, into our population. But the next frontier is the body that turns on itself, the aging body, the body that has hidden genetic defects that are manifest later. That's our next frontier. That's where we're going to get our next 40 years of life. So we'll live from 80, instead of dying at 80, to 120, because those aren't the extrinsic diseases. Those are the intrinsic diseases, and that's what the human genome project, that's what this new medicine is going to be about, extending this frontier of the threats that come from within, allowing ourselves to regenerate and repair ourselves from within, based on knowledge of how we're made and how we build ourselves.

MANN: Dr. Haseltine, you make it sound almost like the human body is going to be impervious someday soon. Is that really likely? HASELTINE: It never will be impervious. But we will be able to rebuild, regenerate and repair what is damaged by injury, what is diseased or what is even worn by time. And we'll do so by creating a new pharmacopia, a new set of drugs that are based on the instructions that allow us to build our bodies, maintain our bodies and repair our bodies. So although we can never be confident that there won't be threats from all sorts of environmental sources, we can track those, we must track those, we must stay vigilant. But there is this brand new frontier of curing intrinsic as well as extrinsic diseases.

MANN: Doctors Koplan and Heymann, let me ask you your thoughts on what we've been hearing. Does this sound like science fiction to you? Or is this the way the future is really going to unfold? KOPLAN: I think one thing we have to pay some attention to is quality of life. Dr. Haseltine has well indicated that we're likely to be able to expand our longevity, as we have in the past, whether it's 90 or 100, 110 or 120, I think we have to ask, how are people going to be spending that time, if they're uncomfortable, if they're inactive, if their quality of life is poor? Don't give me those extra years.

I think what we need to be paying a lot of attention to, is we will have an increasingly aging population in this country and the Western world, even in parts of developing world, and we're going to have to confront, how do we maximize people's potential during years, keeping them both disease-free and pain-free and active, living fruitful lives?

MANN: The assumption in all of this is that the tools that have worked in the past are going to work in the future.

Dr. Heymann, let me ask you: We've been using a lot of antibiotics, most of us take too many of them, and now they are not as useful as they once were. Do we all face the future of new diseases being fought with old tools that won't work?

HEYMANN: Well, the biggest danger today is the fact that our tools are losing their effectiveness. As you say, antibiotics are no longer as effective as they once wore.

And what we are seeing is windows of opportunity closing. Windows where once we could treat infections with very inexpensive drugs are now closing because the drugs are too expensive.

Take the example of gonorrhea, in Africa. Gonorrhea is a simple sexually-transmitted disease, which in the '60s it could easily be treated with antibiotics such as penicillin and tetracycline, very inexpensive antibiotics. Today we can no longer treat gonorrhea anywhere in the world with penicillin and tetracycline. We must go to what we call second- and third-generation antibiotics, which are expensive.

In Africa, governments are not willing to commit to these drugs. Gonorrhea remains untreated, and as a result it is increasing. And we now know that gonorrhea is actually driving the HIV epidemic. People who are infected with Gonorrhea transmit or become infected with HIV much easier than those people who don't have gonorrhea.

So we see a window of opportunity of treating gonorrhea cheaply closing.

MANN: Doctors, I am going to ask you once again to pause for a moment. Our conversation will continue. We will be talking about the changing world, and its challenge to your health. Stay with us.

ANNOUNCER: Ninety percent of infectious disease deaths are caused by just six diseases: pneumonia, tuberculosis, diarrheal diseases, malaria, measles, and HIV/AIDS.

(COMMERCIAL BREAK)

MANN: We have been talking with three experts about the new diseases, the new cures, the new problems that they all involve. And we went to break just as I think Dr. Haseltine wanted to make a comment about super bugs and about antibiotics -- Doctor.

HASELTINE: There are a couple of things I would like to say about the use of antimicrobial drugs. The first is, the explosion in our knowledge of how these drugs are put together -- their genomes, their genes -- has led to a revolution in approaches to new antibiotics and vaccines. And I think we are on the very cusp of a major explosion in the number of new antibiotics and new effective vaccines that wipe out whole strains, not particular -- whole groups of bacteria, not just individuals.

But there's another point I would like to make. The 1990s have seen a medical transformation that is basically gone unheralded. And that is the advent of potent new anti-viral drugs. As early as the first part of the '90s, the only recipe for a disease, a viral disease, was chicken soup, bed rest and water. Today we have anti- herpes drugs, anti-age drugs, even anti-flu drugs and soon anti-cold medications. We have seen an explosion of a new class of drugs to kill viruses, and that was really unprecedented.

If you would have asked people even 15 years ago, could we have an armum imperium of new drugs to kill viruses, they would have said no. But today we are getting them and it is just the beginning. I believe we will see a tremendous explosion in the next 10 years in new anti-viral drugs. So I'm optimistic about our ability to keep one step ahead of both our viral and our microbial foes as long as we're careful.

And that's what you heard from the CDC, that's what you hear from WHO. And we have to be careful about how we introduce these compounds into our environment. We have the knowledge, we have the tools, but we have got to use them wisely.

MANN: Let's go to Dr. Koplan of the CDC, in fact.

The pharmacy is getting bigger, doctors are becoming more expert, we might be even becoming more careful in the way we live. But is the world getting to be a more dangerous place, a place that's friendlier to disease, because of human populations moving the way they do? Our food moves over vast distance, travel is changing the planet, the environment is changing the planet. Is the world itself getting more friendly to disease and less friendly to us?

KOPLAN: I don't think the world has changed much in its friendliness or unfriendliness to the population. Much of our impact with disease has to do with how we behave, not how the world treats us. And that's true how we manage the environment, what we put into our bodies, how we treat ourselves and how we act.

I think some of the biggest challenges we are dealing with in the next couple of decades involve issues of nutrition, obesity and physical activity, continued problems with tobacco and other drugs. Problems of child development and how we approach children, and how we nurture them and care for them.

Many of these are not infectious issues, and most of them don't require technological fixes. We have a lot of things we need to learn about these. How we deal violence. All of theses are major public health problems, challenges, for us, and we need to confront them in the next few years.

ALLEN: And how do you think, Dr. Koplan, people are doing for the most part? We have been hearing in the past decade or so, the past two decades, that exercise, nutrition, what you put into your bodies matters so much. But here in the United States we're seeing obesity is such a severe problem.

KOPLAN: Obesity is in epidemic proportions in the United States. Not all over the country, not in every group, but it is a large problem for young people, for older people, for more educated, for less educated. And it is a simple equation: If we take in more calories than we burn off, we are going to put on weight, and that's what we are doing.

This -- a variety of reasons we can postulate for this, but I think we have got to come to grips with this seriously. And it's a health issue. In the past I think we thought of it as a cosmetic or an aesthetic issue. It is really a health issue. Excess weight relates to diabetes, to heart disease, to osteoporosis, to gall bladder disease. And if we want to avoid those things and prevent them, we need to do something about these excess calories.

ALLEN: Do you think doctors are doing a good enough job incorporating lifestyle into their chats with their patients?

KOPLAN: I think doctors are trying. And there's a real change from when I first trained to when we see doctors now who raise these issues about tobacco, stress, about diet, about physical activity. But profound changes in our society won't be made until all of our citizenry recognizes this is something that they want to change. And we've seen it, so when people say, well you can't change human behavior around health, that is not true. We have seen profound changes around -- for health in human behavior in the 20th century.

MANN: Let me ask the same question of Dr. Heymann in Geneva. Are we seeing that around the world? HEYMANN: We are seeing that people are changing their lifestyles. We have seen it in HIV infection throughout the world, where people are changing their sexual behavior. We see countries such as Uganda in Africa, or Thailand in Asia, where the population has taken to heart the messages of AIDS prevention, and are actually preventing it. And we are seeing the same with -- beginning movements in anti-smoking, and in different types of diseases that are related to lifestyle throughout the world.

So yes, these changes are occurring, but it is much more difficult to get the message through in some societies, where communication is not as good as in industrialized countries.

MANN: OK, we have to take a break once again.

But when we come back, the price of medical progress. Only some people can pay.

Stay with us.

ANNOUNCER: Infectious diseases are now the world's biggest killer of children and young adults, accounting for 13 million deaths a year.

(COMMERCIAL BREAK)

ALLEN: We have just a few minutes left on this topic for a quick on something else that tends to make sick people better, and it's money.

MANN: That's right.

Let's go to Southampton and William Haseltine.

Doctor, as we've been talking we've been hearing about this extraordinary research into relatively obscure diseases and the crying need for help on diseases that are striking hundreds of thousand of people around the world. Is the money spent on gene technology taking money away from solving bigger problems that affect more people?

HASELTINE: I'd like to make two points. The first is relevant to our earlier discussion about environment and better health. It's true that by exercise and eating right we can live longer, but eventually there's an within: ourselves. The new frontier, the gene- based research, will address that enemy within, things you cannot change with exercise or diet, predispositions for cancer and other disease.

Now to your second question, the question about health, I believe this new gene research is broadly applicable not only to advanced countries where we can do marvelous things with our technology, but to create new, simple, powerful, effective means to eradicate disease. After all, it was the intensive research that went into smallpox vaccines and eventually polio vaccines in the Western countries that are leading to an effective vaccine that can eradicate polio everywhere in the world. That, I think, is the best model. Advances made in the advanced countries can be reduced to simple formula to treat and cure diseases everywhere. And there are many diseases, as the point was made earlier in the discussion, that we can treat today, we can wipe out, if the infrastructure in the developed world were there. We have tools, and we're developing tools in our area of the world that can have a powerful transforming effect throughout the world.

MANN: Let's stay in Atlanta and go to Jeffrey Koplan at the Centers for Disease Control.

Is that what's going to happen? Are these tools going to be available cheaply and effectively in places like Africa and the poor nations of Asia?

KOPLAN: Not unless many of us demand it. My fear is that lots of the energy and investment will be in extending that life span from 80 years to 120 from those who have the wealth and are able to pay for it. I think those of us in public health are particularly concerned about people who don't survive childhood, who die during their pregnancies in many parts of the world, including the United States. We have populations here, minority, some ethnic groups, who do not share in the longevity and the health that the rest of us have.

So unless there is the political will that Dr. Heymann mentioned at the very earliest part of this discussion to direct resources, to direct attentions toward these killers and towards populations that need these preventative measure and cures, I'm skeptical that they'll occur without that will power. And being in public health...

MANN: Dr. Heymann, let's go to you for a final thought. Are you skeptical or optimistic, like these two doctors?

HEYMANN: I'm very optimistic that the world will pull together and will face the infectious disease crisis as they're facing all other crises. But it's very important that the money go into infectious disease, not only treatment and prevention but research.

Presently, if you look at the research dollars spent both publicly and privately in the world, less than two percent of that research dollar goes to the six major infectious disease killers. So we need to shift the balance of research a bit, using this post- genomic agenda to develop better drugs. And at the same time, as Dr. Koplan has said, we have to continue to gain the political will and the desire to stop the infectious diseases, which are among the poorest of the poor in both industrialized and developing countries.

MANN: On that thought, Dr. David Heymann of the World Health Organization, Jeffrey Koplan of the CDC here in Atlanta and William Haseltine of Genome Science, we thank you all for being with us.

ALLEN: Thank you, and happy New Year's.

For two hours now, we've been talking about your health and the future. Up next, we're going to turn a corner and have some fun with some other things about our future. New inventions for the next millennium.

Stay with us.

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