I would first like to thank the organizers of
the Schiller Institute for inviting me to speak
on this theme, which I consider fascinating and
interesting.
I was a medical doctor for 15 years. I
worked at the Toulouse Medical Faculty in the
Neuropsychiatry department. After 15 years, I
completely changed my life, because I became an
assistant director of the CNES [French National
Space Studies Center] in charge of Space
Applications, Societal Applications, Patents,
Technology Transfers, etc.
I stopped working in that position on July
1, 2012, and am now retired. But I continue to
defend the advantages that satellites can bring
to citizens globally.
The theme of your conference is ``A new
paradigm for the survival of civilization.''
Paradigm is a word which, in French, can
correspond to a set of ideas, which often
allows us to come up with an original idea, and
I insist on the original word. As we shall see,
it is obligatory to carry through on these
ideas and to innovate. The word innovation has
guided me throughout my career as a doctor or
at the CNES, and you will understand why.
The ideas may be technological,
methodological, humanitarian, or humanist. But
in all cases, they are the product of basic
scientific research, as [the previous speaker]
Didier Schmitt mentioned, for space exploration
in the broad sense of the term. And this
scientific research leads systematically, or
95% of the time, to applied research, which
contributes to the well-being of the population
of a given country, continent, or all of
mankind.
My presentation is divided in four
parts.
Why should we innovate in the area that I
call ``health and satellites''? I will give you
two concrete examples. One on the environment,
and one which concerns 7.5% of the people in
this room, and I'll tell you why a bit later.
Then, I will give some conclusions and
recommendations on innovation.
Although I'm retired, I am a consultant
with the Institute of Space Medicine of
Toulouse, which was created when the European
Space Agency, the CNES, and the DLR [German
Aerospace Center] decided to participate in the
Hermes space shuttle project, which was then
dropped for political reasons.
The medical world is also changing
I think it's important that a world is
changing. I'm not referring to the conflicts
that were brought up in the preceding
interventions, but from what I see, as a simple
doctor serving the population, whatever the
country, the continent, or the language may be,
the world is changing in the medical domain,
because the populations are aging, be it in
Europe, in America, or in the Middle East. What
is the immediate consequence on public health?
Chronic diseases which used to affect only a
few, will see their incidence triple, if not
quadruple.
For example, a recent study given to the
Health Ministry found that if the government of
France--but it holds for all the governments in
the world--did nothing to fight obesity, 25% of
the population will be obese in less than 30
years. Obesity means many chronic diseases,
including diabetes. Already now, 7% of the
French people are diabetic; 6.2% of the
Germans; 5% of the Chinese--if you multiply 5%
by 1.3 billion, that's a lot of people. So, the
aging of the population is a factor of change.
Another factor in new social practices is
everything that has to do ``tele,'' such as
tele-work, and domotics. That means sitting at
home in an armchair and simply pressing a key
on the computer and everything is done
automatically. I don't do anything anymore, I
just take my siesta, eat, so I become
sedentary, which is the second relatively
important factor of change.
Unfortunately, because of the crisis in
Europe--in southern Europe, in particular--we
have less and less money. So we need what I
call pragmatic and practical approaches.
We also have technical and scientific
developments in information and communication
technologies, be it through land-based networks
or satellite networks, such as nanotechnologies
or bio-captors and bio-sensors. This will lead
to the emergence of new services, new trades,
new jobs. And medically speaking, in France,
Spain, Italy, and a number of other European
countries--I don't know about Germany--we have
a ``demedicalization,'' that is, fewer and
fewer doctors and nurses, which will be
problematic. So it is absolutely necessary to
include deliberations on public health among
these changes, and you will see what space can
contribute to that.
In terms of new technologies, which are
being developed and yield ever more positive
results, you have robotics, tele-surgery, and
medical imaging. When I was getting my
neurosurgery degree in 1970-71, if I had a
patient who was hemiplegic, and who had had a
stroke, I had no X-scanner, no MRI. How was I
supposed to make a diagnosis? It was a bit like
being a veterinarian.
So, today, technologies are evolving;
information and communications technologies as
well. And all this opens perspectives for
consultations in remote locations, in
personalizing medical treatments, in coaching a
patient and in monitoring his health from his
home without having to be there.
What does that mean? Essentially, in 5 to
6, or 10 years, for at least those health-care
professionals who are interested in new ICTs
[information and communication technologies]
and transmissions, either land-based or by
satellite, the patient will go less frequently
to the hospital; instead, the hospital will
come to him. Because he [the health-care
professional] will have a certain number of
captors [data connectivity software] and tools,
a whole range of technological systems for
monitoring and making diagnostics.
I now come to satellites. Satellites are
like rockets, we have to admit it, and face the
fact. Satellites, just like rockets, usually
meet military needs at the outset. Fortunately,
there are people in the space agencies, be it
in the United States, Russia, Europe, France,
and the German DLR, who are relatively
humanist, and who try and find civil
applications for the first uses of satellites.
I remember the satcoms; the first
telecommunications satellite was called
``Asterix.'' This satellite had been
constructed secretly, on General de Gaulle's
orders, simply because a military man had
explained to de Gaulle that this satellite
would enable France to listen to and transmit
information very, very quickly, whereas we were
still in the era of Morse code--that was in
1966-67. That satellite foreshadowed the
Telecom 1A, Telecom 1B, etc.
Who developed positioning and navigation
satellites (GPS)? The Americans and the Defense
Department for the first Gulf War. That was the
first time a certain number of global
positioning systems came onto the market.
Today, the GPS market is enormous, and the
Galileo market will soon be.
The latest model, the Earth observation
satellite--which was built at the request of
the military so that different armies could spy
on each other--is used in various fields today,
such as agriculture, energy--we saw it this
morning in the detection of aquifers in the
desert--and tele-epidemiology. I'll give you
some examples.
Today, most satellites are built for
civilian use, be it observation, localization,
or telecommunications. The annual market for
services using civilian satellites, outside of
the military, is EU100 billion per year, broken
down as follows: 75% for telecommunication
services, so EU75 billion euros, of which 90%
is for TV platforms (CanalSat, Astra, Eutelsat,
etc.); 23% for GPS and Galileo (TomTom, banking
trade, precision architecture); the remaining
2% is for Earth observation.
How can these differences be explained? I
have an explanation, which I experienced
personally for some years at the CNES: When we
defined these satellites, they always
corresponded to social needs voiced by
potential users, farmers, urbanists, people who
were going to use them, and who understood why
the satellite would be advantageous for their
problems. But for Earth observation, it was the
DLR, the CNES, the ESA [European Space Agency]
which sent their engineers, who worked mainly
on imaging techniques, and once they were
developed, they put them on platforms, and we
ended up with satellites over our heads,
without really knowing what to do with them.
That is the sad reality of the GMES program
(European Earth Observation Program).
1997 was an important year for the CNES,
for my colleagues, because the minister in
charge of us was Mr. Claude Alle@aggre
[Education and Research Minister], who was
interested in a certain Mammoth* [footnote], as
my French colleagues will remember. He asked
the head of the CNES to answer the following
question: ``Can satellites be of help to public
health, yes or no? Submit a report in 6 to 9
months.''
So the president of the CNES asked me, as
the only medical doctor, to set up a task
force. I had two possibilities: I could either
set up a group called PUSH, i.e., with
engineers from the CNES, ESA, and the DLR with
which we collaborated, or take users, that is
representatives of doctors, surgeons, nurses,
patients. I chose the latter and those people
chose 4 themes, and today I will mention two of
them.
Teleconsultation and Tele-epidemiology
The first is what is called
teleconsultation in isolated, remote areas, the
second is tele-epidemiology. The other two,
education and home monitoring, only concern
transmission of data, or gathering and
transmitting automatic data.
Teleconsultation is what health care is
called in isolated areas. What can
communications satellites contribute to that?
First of all, what do we mean by isolated
areas? These are remote areas geographically:
the depths of the Amazon, the middle of the
desert, the hinterland of Nice, which is very
isolated because to get an emergency
ultrasound, you need to wait between seven
hours and twelve days! And that's only 100 km
from Nice. Or French Guyana, which has about
250,000 inhabitants, of whom 122,000 live some
two hours by helicopter away from the nearest
hospital. The same is true of the Brazilian
Amazon. These are geographically isolated
areas.
Areas can also become isolated because of
a natural or industrial catastrophe. I
experienced that myself in Toulouse when the
AZF fertilizer plant blew up, killing 33 people
and wounding 37,000, which meant that many
hospitalizations in two days. One whole
district of Toulouse was razed. We are
surprised there were not more deaths. During
the first two days, the only way doctors could
communicate with one another, and rescue
workers could communicate with the hospitals,
and so on, was by satellite. So, that was
considered an isolated area. In the event of an
earthquake, a tsunami or even a coup d'etat,
the first things that go are the land-based
telecommunications systems. With
telecommunication or positioning satellites,
things work out well.
(By the way, that is why Hugo Chavez
managed to escape seven or eight years ago,
when he was kidnapped by the CIA and the
Spanish police: he had a GPS system in his
pocket, a gift from his wife, so he could be
locateed very quickly.)
Other isolated sites are ships, planes,
and civilian or military expeditions. An Airbus
380, for example, or certain charter company
planes, have 1,052 passengers. During a 15-hour
non-stop flight, a medical problem will always
come up, which the flight attendants can't
solve. And the doctors can't solve it either,
because when a doctor hears the question: ``Is
there a doctor on board?,'' at least in France,
he pretends not to hear, or he goes to hide in
the restroom and doesn't come out, for
liability reasons. Because on the question of
medical liability onboard a plane, the French
stupidly copy-catted the Americans.
And then, as I mentioned for Nice, there
is a lack of medical and paramedical
professionals in geographically remote areas,
and sometimes in metropolitan areas.
Let's look at some health-care tools that
were developed thanks to space. This one was
developed with funds granted by [the previous
speaker] Didier Schmitt. It is an ultrasound
system, with a probe placed on the stomach of a
patient, or elsewhere on the patient's anatomy,
and it's moved remotely by a ``joystick''
located 100, 1,000, or 15,000 km away, or just
in the room next door. This is remote
``tele-ultrasound.'' These tools exist already.
In France, three small and medium-sized
companies were created to produce this kind of
instrument.
This is another product. It's just a van
with a satellite antenna on top, which can
transmit images and data, and relatively heavy
files from wherever the van is located, toward
the hospitals. These are emergency tools,
because when a natural catastrophe occurs, the
first things that are disrupted or disappear
are telecommunications, and the tools deployed
by the French Civil Protection Services
(emergency preparedness). Here you see
containers that were used in Haiti two years
ago in January. It's a small tool, which has
been further miniaturized today, which has a
computer, electrocardiographic systems,
measurement of arterial pressure, and these
medical parameters are collected and
transmitted automatically to the hospital.
The DIABSAT project comes from the words
``diabetes'' and ``satellite.'' In France, in
Spain, in Italy, in many European countries,
there is an increasing number of diabetics. 80%
of them don't know they have it, and they only
realize it when a complication comes up. Four
complications are very serious: The patient can
become blind, can have a heart attack or a
stroke, can lose the use of his kidneys, and
can lose all sensation in the lower limbs.
To get an appointment with an
opthalmologist, a neurologist, a cardiologist,
or a nephrologist, is a real obstacle course.
To see an opthalmologist in Paris, you have to
wait at least 6 months, in Toulouse, between 12
and 15 months. So, what did we do? We put all
the examinations corresponding to these four
specialists in this van. It's not driven by a
doctor, but by a nurse, and it travels around
rural areas. We began a study three years ago,
and it ended with a cohort of 2,000 patients.
Since then, all the structures responsible for
public health care on the regional level in
France have ordered between 1 and 3 such vans
for their regions.
So we have an example of something using
satellite techniques to collect and transmit
data, between 12 and 18 o'clock toward the
Toulouse hospital, which is highly beneficial.
The cost of the four exams [to the
patient?--nbs], including paying off the van
and the nurse's salary, is EU105 euros. Four
specialist exams for EU105 euros, and no need
to travel--knowing that one of the reasons for
the ``hole'' in the French public medical
insurance system is the cost of the patients'
medical travel.
DIABSAT is a van with five types of tests:
the eye fundus, artery pressure, sensibility
[in the lower limbs], foot ulcer risk, and
kidney function. This is not screening for
diabetes, but of diabetic complications, which
is different. The entire population should be
screened for diabetes.
What were the results? It began in October
2010 and ends in December 2012. By June 2011,
we had 1,000 cases, and more than 3,500 tests.
What is extremely interesting, is that about
240 cases led to an emergency hospitalization.
That means the person was becoming blind, had
severe kidney failure, had an angina pectoris,
an artery was getting clogged up, had a hole in
the foot which wouldn't heal. So this was
extremely beneficial, and responds to a
relatively important need in the population.
Here are the pathological results:
- retinopathy: 19%,
- nephropathy:
- micro-albuminuria 27%,
- lower limbs arteriopathy: 21%,
- neuropathy lower limbs: 15%,
- foot ulcer risk: 17%.
and the costs:
- investment ( van, medical devices,
satellite communications: 124000 [euro],
- functioning (over 12 months, full-time
nurse): 145000 [euro].
The other example I want to give concerns
what I call ``mosquitology,'' a Catalan
speciality. This concerns all the diseases
related to flying vectors, such as mosquitoes
or birds.
You should know that there are 3.5 billion
people on the planet who are in the ``risk
population'' group as regards four diseases:
haemorrhagic coughing and fevers, malaria (2
million deaths per year, half of them
children), meningitis, and cholera. These four
diseases are called ``environment dependent,''
which means they are related to environmental
changes in the relevant country, mainly
climatological changes, and whatever has to do
with water: rainfall, hydrometry, temperature,
are factors promoting the emergence of mosquito
populations.
This morning, a speaker mentioned
irrigation projects in Egypt between the Suez
Canal and the Sinai [Hussein?--add reference].
Well, two years after these projects were
carried out, the Rift Valley Fever emerged, a
fever which is imported by bovines, camels, and
sheep, and it came from Mauritania via Sudan
into Egypt.
Through a change in the environment,
mosquitoes were able to transmit this disease
from animals to man. Until Easter Sunday of
last year, there was only one Department in
France at risk for mosquito-related diseases.
Now, the journal {L'Officiel}, at the request
of the Health Ministry, has published the names
of four other Departments. At first, it was
only the Alpes Maritimes, but the Var, the
Vaucluse, and the Bouches du Rho@afne were
added, so it's in the entire southeast of
France where we're beginning to see the
premises for what could become, in 7 to 10, or
maybe 20 years, a subtropical climate, with the
multiplication of vectors favoring these kinds
of diseases.
The population is growing, and 50% of the
population is exposed to diseases associated
with climatological changes, so we see the
reemergence of a series of pathologies with
relatively acute epidemics. Such reemergences,
for all diseases, provoke 4 to 5 million
deaths, of which half are children, which is
quite high. Animal mortality is 10 to 15
million per year. This is only the data for
malaria. So the climate change impact is great.
We set up an unusual methodology in
tele-epidemiology. We associate a certain
number of data gathered from the ground--in a
given department, city, region, or
country--with data observed from Earth
observation satellites, this time on the scale
of the country or the continent, in terms of
vegetation, rainfall, humidity. And then we
combine the data, we put them in a ``pressure
cooker,'' and a mathematical modelling comes
out, which allows us to establish risk maps. So
we can say: ``Dear Ministers of Tourism and
Agriculture in Senegal, between the month of
February and May 2013, the probability of a
Rift Valley Fever epidemic, or of malaria
between Dakar and Tambacounda, will be about
80%. So, please set up mosquito eradication
means.''
Here is the approach applied to RVF, for
example, in Senegal. This is a raw image of a
SPOT observation satellite. After processing
these data, together with ground data,
veterinarian data, customs and traditions,
etc., we establish this map. The darkest zones
are the ones where one should definitely not
go; the red ones are very risky; and in the
yellow zones, one can move, as long as he has
good anti-mosquito protection. These maps can
be drawn up every three days, and are provided
to the agencies which request them.
The same holds for urban malaria. Today,
we are able, in a city like Dakar, and in other
cities of sub-equatorial Africa, to determine
where mosquitoes, or female anopheles, are
going to predominate and where the risk places
are. These maps are also given to the
Senegalese Tourist Office once a week. The same
thing is true for Burkina Faso as regards
malaria in rural areas.
This type of approach took seven years.
When I went to see the head of the SPOT
program, I told him I thought doctors would be
interested in studying Earth observation images
for pathologies. I thought he was going to kill
me or fire me from the CNES, because he really
thought I was crazy, or eccentric. It took us
seven years to show that the idea was valid
and, today, there are some 22 networks set up
in South America, Africa and, Asia. Four
companies, small and medium-sized enterprises
of 7 to 10 people each, were created to process
this type of images. So, it's already a reality
which will amplify in the coming years.
In conclusion, I would say that the use of
satellites to help medicine, in detecting
epidemics, or in the lack of medical care in
remote sites, has become reality. It's a good
response to the recommendations of the World
Health Organization, in particular, as concerns
the environment and climate change.
In terms of expanding, we have to transfer
all this know-how to all the regions of France,
as well as to other countries and continents,
without becoming obsessed with the price. In
fact, the price of telecommunications via
satellite is no longer $15 per 10 secondsm as
it was with Inmarsat seven or eight years ago.
Today, it's at EU0.5, if we use Globalstar or
rather Thuraya. We have to integrate these
tools and these approaches into our health-care
systems and adapt them to the needs of the
patients. They are the ones, together with the
doctors, who decide, not the engineers, and
certainly not the space agencies.
The conclusion of the conclusion? To
establish a new paradigm in terms of space and
societal research, we have to innovate. That is
the key word in health care. And to innovate is
not easy, when you're conservative. We have to
change; we have to want to change. To change a
procedure, an approach, a mentality. We have to
make it understood, as you have discussed it
here today, that Iran is in a very difficult
situation, because some 5 or 6 people want it
to be that way, or heads of state want it so,
for reasons that are not really clear.
Then, we need a ``user'' approach. The
engineers, the satellite producers, the
polytechnicians, and administrative elites in
government cabinets should not be deciding; the
users--farmers, diabetics,
psychiatrists--should, and that has not yet
sunk into our mentalities. We need an
integrated approach. As I mentioned, all of
this exists already, we just need to integrate
everything.
We have something really extraordinary, in
Germany and France; it's Airbus program. Part
of it is produced in England, another part in
Germany, another in Spain, and the integration
is shared between two sites, Hamburg and
Toulouse, and those two cities have had
extraordinary economic development. So we
should not forget the integrative approach, but
we should avoid reinventing what already
exists. We need revolutionary ideas. The more
revolutionary the idea is, the better it will
work. We need to have revolutionary ideas, and
not be afraid to voice them.
I come back to the specialist of mammoths
I mentioned before. This specialist, and I knew
his cabinet very, very well, used to come up
with about 10 ideas per day. One per month was
acted upon, but that's already very good.
One also has to be authentic and honest.
You don't ask for money in order to satisfy the
shareholders, but to implement this or that
innovation.
If we look at all these data in terms of
space applications, I could add to health care
and security, and other areas such as resources
(agriculture, water, energy), and
transportation on land, sea, and in the air.
For space techniques applied to health care, as
of last July, 47 small and medium-sized
companies had been created in France, with
1,250 people, and a turnover of nearly EU1
billion per year. When we use satellites for
civil and human purposes, we can do very
beautiful things.
Thank you for your attention.