Data Science in Medicine – Part I

Only a few years ago Health Care practitioners would methodically write down their clinical impressions during a face to face interview with patients and then pass the chart to a waiting nurse or aide that would proceed to the next stage. The piece of paper was the final trustworthy depositary for all the clinicians’ opinions and recommendations. Then the chart would eventually be shared with other professionals, technicians, administrators, payors’ functionaries, etc., and ultimately find its home in an archive.

The advent of Electronic Record-keeping has dramatically upended that quaint era and changed all the paradigms of care delivery for all the involved parties. As most practitioners sit in front of their terminals and type along the patients’ narrative, once the face to face clinical encounters are finished and the patients leave the medical office, a torrent of medical information also rushes out of the door with them too. Then it proceeds to feed several endpoints related to consulting offices, studies’ referrals, control and audit, pharmacies’ inboxes, administrative oversight, etc.

We are living in an era when every time we click on our computers or smartphones, every time we send any messages, every time we manifest any preferences in the social media, there is a quick sharing of information that escapes our control and becomes manipulated by total strangers as we have described in a previous article. However, this technological tsunami can become very useful for the smart medical researchers who can analyze and interpret  humongous amounts of data sets. Using ever changing algorithms and powerful computers, they can mine gold from it.

The classical tenets of medical research are changing dramatically as breakthroughs are achieved by biomedical researchers, mathematicians, computer programmers, statisticians and several others that contribute specific skills for the task at hand; together they can “read” from the enormous amount of data to find significant correlations between seemingly disconnected facts to swiftly inform practitioners. The biggest gains from Data Science have occurred in the field of genomics, thus enabling to tailor treatments to the patients’ unique characteristics in Oncology, Hematology, Cardiovascular diseases, Neurological diseases, Ophtalmological disorders, etc.

At present the first priority of the research community is to figure out multiple ways to share clinical, laboratory and technical data in real-time with their peers all over the country and beyond in order to use it to find innovative, revolutionary cures. The Observational Health Data Sciences Informatics program (OHDSI) has designed a data- sharing network of medical investigators of multiple institutions in twenty-five countries to study the medical records of almost 400 million (yes, million) people. The Department of Biomedical Informatics at the Columbia University Irving Medical Center (CUIMC) has the responsibility of coordinating this research; they are already actively mining the data and producing outstanding results in racial disparities of health care access and equity, cross-national differences, hidden side effects of drugs, etc. We will discuss many of them in future installments of our next blogging season.

What do you think? Please tell us.

Don’t leave me alone.

Superstitious artists – Charles Dickens

If you receive a knife as a gift, you must return that odd courtesy with another gift.

Charles Dickens was one of the most popular writers of his times and he received a trove of gifts from his admirers over the course of his career, including cutlery. In 1850 his novel David Copperfield, which he considered as his masterpiece, was published in England; William Brookes, the owner of the Sheffield tool company William Brookes and Sons, was miffed to learn that Dickens had used the name “Brooks of Sheffield” to ridicule his main character and wrote a letter to him. The author replied that: “it is one of those remarkable coincidences…I had no idea that I was taking a liberty with any existing firm, and why I added Sheffield to Brooks (of all the towns in England) I have no…knowledge. It came to my head as I wrote.”

Mr. Books was so satisfied with the writer’s courteous response to his concerns that he sent him a beautiful cutlery case in 1851. Alarmed at the prospect of being left out of that budding friendship, Dickens immediately prepared an autographed first copy of his book with a nice letter. That book will come to auction in London soon. For all his savvy knowledge of human character, Dickens respected old wives’ tales. Defiantly superstitious he always carried a navigational compass with him in order not to lose his way—artistic inspiration—with the contact of worldly distractions. To receive the inspirational influence of the muses, his bed always had to face North.

The author plied his trade in the beginning of the Victorian period that started with the coronation of Queen Victoria in 1837 and ended with her passing away in 1901. Despite all the purported social sophistication of Victorian middle and upper classes, they mostly believed in the mystical aspect of life and respected certain ingrained traditions at home. When a person died, all the mirrors of the place where the wake was being held had to be covered with a black cloth, lest the spirit became trapped in one of those gateways. All the clocks in the household were stopped to mark the mourning and to avoid bad luck for the survivors. The fear of opening an umbrella inside a home came from that era.

As many other writers, Dickens believed that the presence of a cat was necessary to maintain the inspiration in the artist’s residence. Mary Dickens, daughter of the author, said that initially cats were not allowed in the household because they had many birds. However, she received a white kitten called Willamina from a London friend and it instantly became a dear member of the family, developing a devotion for her father.

What do you think? Please tell us.

Don’t leave me alone.

Cannabis is authorized for medical use in France

On October 25, 2019, the members of France’s Assemblée Nationale (its legislative branch of government), during their consideration of the 2020 national budget authorized, with only a public vote of “hands up”, the medical use of Cannabis for an initial trial period of two years. The amendment was based on a report prepared by the researcher Olivier Learn, from the LREM, and then submitted for approval to the Agence du Medicament (ANSM), the French regulatory agency for drugs.

The therapeutic forms of Cannabis were only approved for those patients that are in what they dubbed as an “impasse thérapeutique” with clinical variants of Epilepsy that are resistant to traditional treatments, neuropathic pain after amputations, secondary effects of the chemotherapy and the involuntary muscular contractions of Multiple Sclerosis. The Cannabis will be provided in liquid or inhalator presentations by physicians that will be especially trained with stringent regulatory protocols by the government. Even thought its recreational use is still prohibited, this is a previous step in that direction.

During the past few years the elected officials of the European countries have been pressured by their peers in Holland, which is the only EU nation that has decriminalized the personal use of Cannabis. The small progressive country has been swarmed by busloads of eager buyers of pot for multiple reasons, including medical and recreational ones. The Dutch authorities claim that they can control what goes on in front of the counters but not in the back of them as the industry has been taken over by criminal gangs. If the other members of the European Community start to legalize and control the use of Cannabis, then the Dutch authorities could count on pan-European enforcement.

Even though it has not been legally approved yet in Macedonia—a small European country tucked between Serbia and Greece—its northern territory—with plenty of sunshine and little rain—has thousands of square kilometers with marijuana plants. A report of France Internationale (RFI) on the issue stated that many investors are already courting the Macedonian authorities to distribute their stocked tons of harvested pot. This schizophrenic negation of the reality by authorities of the European Community (EU) is reminiscent of what happens in the USA. A confused/confusing message.

Only the strict federal regulation and control of Cannabis will pave the way for the needed scientific research and protection of consumers in both the USA and the EU.

What do you think? Please tell us.

Don’t leave me alone.

“Celebrating” the World Aids Day

Dear readers and fellow bloggers:

Good morning and Happy Sunday to you all. Today many civic organisations, Public Health institutions. Health Care advocacy groups, Non-Profit organisations and the common citizenry all over the planet are “celebrating” the World Aids Day. We started our clinical training when this terrible disease had not been properly identified but it was already decimating entire communities, especially Gays, Minorities and the Poor. It was a time when also someone we knew personally had the misfortune of getting this diagnosis, which was equivalent to a death sentence at the time. We still shudder remembering all the wasted youth that we saw wither away in the clinical wards, in spite of all our professional efforts to save them. It was extremely frustrating for all health care practitioners.

Fortunately we have now many excellent pharmaceutical treatments and preventive schedules for this infection, which has saved countless people and afforded them a good quality of life even though they carry a chronic disease. The sustained promotion of safety measures for safe sex has dramatically curtailed its incidence in the population. However, it is still an ongoing epidemic, which has not been completely eradicated yet. In modern societies, four large segments of the population are bearing its brunt now:

a- Young people between 16 and 20 years of age

b- Women older than 65 years old

c – Intravenous drug abusers in the developed societies

d – The vulnerable population tier of under-developed societies

The first group of people were born long after the 80s and 90s when the disease ravaged our societies and the basic Public Health measures to prevent its spread were enacted; the lack of a dramatic narrative has desensitized them to the need to protect themselves. The second group has been largely victimized by men who have not used the proper protection in the sexual interactions with partners . The third group is still exposed to the dangerous sharing of needles and the concomitant infections of syphilis and gonorrhea. The last group suffer the consequences of economic inequality and unfair access to health care services in poor societies, including the good availability of retro-viral agents.

We must continue our medical, sanitary and institutional efforts to combat this life-threatening disease and we should participate in all the civic-minded initiatives. In our next blogging season starting in March 2020, we will write a series of articles about it, thus providing our little grain of sand to the humongous dune of necessary containment. Thank you very much for suggesting the critical topics that we should be discussing, which shakes us from the inevitable torpor that may grip us after these half-won battles. AIDS is still a major Public Health threat for all societies, rich and poor, of planet Earth. Any major natural or made-made catastrophe can re-awaken that dormant monster that could potentially overwhelm all the firewalls erected to contain it over so many years.

Nobody is free from any of its tragic effects. Nobody.

What do you think? Please tell us.

Don’t leave me alone.