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Big data, personalized medicine, artificial intelligence. String these three buzzphrases together, and what do you have?
A system that may revolutionize the future of healthcare, by bringing sophisticated health data directly to patients for them to ponder, digest, and act upon—and potentially stop diseases in their tracks.
At Singularity University’s Exponential Medicine conference in San Diego this week, Dr. Ran Balicer, director of the Clalit Research Institute in Israel, painted a futuristic picture of how big data can merge with personalized healthcare into an app-based system in which the patient is in control.
Dr. Ran Balicer at Exponential Medicine
Picture this: instead of going to a physician with your ailments, your doctor calls you with some bad news: “Within six hours, you’re going to have a heart attack. So why don’t you come into the clinic and we can fix that.” Crisis averted.
Following the treatment, you’re at home monitoring your biomarkers, lab test results, and other health information through an app with a clean, beautiful user interface. Within the app, you can observe how various health-influencing life habits—smoking, drinking, insufficient sleep—influence your chance of future cardiovascular disease risks by toggling their levels up or down.
There’s more: you can also set a health goal within the app—for example, stop smoking—which automatically informs your physician. The app will then suggest pharmaceuticals to help you ditch the nicotine and automatically sends the prescription to your local drug store. You’ll also immediately find a list of nearby support groups that can help you reach your health goal.
With this hefty dose of AI, you’re in charge of your health—in fact, probably more so than under current healthcare systems.
Sound fantastical? In fact, this type of preemptive care is already being provided in some countries, including Israel, at a massive scale, said Balicer. By mining datasets with deep learning and other powerful AI tools, we can predict the future—and put it into the hands of patients.
The Israeli Advantage
In order to apply big data approaches to medicine, you first need a giant database.
Israel is ahead of the game in this regard. With decades of electronic health records aggregated within a central warehouse, Israel offers a wealth of health-related data on the scale of millions of people and billions of data points. The data is incredibly multiplex, covering lab tests, drugs, hospital admissions, medical procedures, and more.
One of Balicer’s early successes was an algorithm that predicts diabetes, which allowed the team to notify physicians to target their care. Clalit has also been busy digging into data that predicts winter pneumonia, osteoporosis, and a long list of other preventable diseases.
So far, Balicer’s predictive health system has only been tested on a pilot group of patients, but he is expecting to roll out the platform to all patients in the database in the next few months.
Truly Personalized Medicine
To Balicer, whatever a machine can do better, it should be welcomed to do. AI diagnosticians have already enjoyed plenty of successes—but their collaboration remains mostly with physicians, at a point in time when the patient is already ill.
A particularly powerful use of AI in medicine is to bring insights and trends directly to the patient, such that they can take control over their own health and medical care.
For example, take the problem of tailored drug dosing. Current drug doses are based on average results conducted during clinical trials—the dosing is not tailored for any specific patient’s genetic and health makeup. But what if a doctor had already seen millions of other patients similar to your case, and could generate dosing recommendations more relevant to you based on that particular group of patients?
Such personalized recommendations are beyond the ability of any single human doctor. But with the help of AI, which can quickly process massive datasets to find similarities, doctors may soon be able to prescribe individually-tailored medications.
Tailored treatment doesn’t stop there. Another issue with pharmaceuticals and treatment regimes is that they often come with side effects: potentially health-threatening reactions that may, or may not, happen to you based on your biometrics.
Back in 2017, the New England Journal of Medicine launched the SPRINT Data Analysis Challenge, which urged physicians and data analysts to identify novel clinical findings using shared clinical trial data.
Working with Dr. Noa Dagan at the Clalit Research Institute, Balicer and team developed an algorithm that recommends whether or not a patient receives a particularly intensive treatment regime for hypertension.
Rather than simply looking at one outcome—normalized blood pressure—the algorithm takes into account an individual’s specific characteristics, laying out the treatment’s predicted benefits and harms for a particular patient.
“We built thousands of models for each patient to comprehensively understand the impact of the treatment for the individual; for example, a reduced risk for stroke and cardiovascular-related deaths could be accompanied by an increase in serious renal failure,” said Balicer. “This approach allows a truly personalized balance—allowing patients and their physicians to ultimately decide if the risks of the treatment are worth the benefits.”
This is already personalized medicine at its finest. But Balicer didn’t stop there.
We are not the sum of our biologics and medical stats, he said. A truly personalized approach needs to take a patient’s needs and goals and the sacrifices and tradeoffs they’re willing to make into account, rather than having the physician make decisions for them.
Balicer’s preventative system adds this layer of complexity by giving weights to different outcomes based on patients’ input of their own health goals. Rather than blindly following big data, the system holistically integrates the patient’s opinion to make recommendations.
Balicer’s system is just one example of how AI can truly transform personalized health care. The next big challenge is to work with physicians to further optimize these systems, in a way that doctors can easily integrate them into their workflow and embrace the technology.
“Health systems will not be replaced by algorithms, rest assured,” concluded Balicer, “but health systems that don’t use algorithms will be replaced by those that do.”
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A research team at the University of Washington has trained an artificial intelligence system to spot obesity—all the way from space. The system used a convolutional neural network (CNN) to analyze 150,000 satellite images and look for correlations between the physical makeup of a neighborhood and the prevalence of obesity.
The team’s results, presented in JAMA Network Open, showed that features of a given neighborhood could explain close to two-thirds (64.8 percent) of the variance in obesity. Researchers found that analyzing satellite data could help increase understanding of the link between peoples’ environment and obesity prevalence. The next step would be to make corresponding structural changes in the way neighborhoods are built to encourage physical activity and better health.
Training AI to Spot Obesity
Convolutional neural networks (CNNs) are particularly adept at image analysis, object recognition, and identifying special hierarchies in large datasets.
Prior to analyzing 150,000 high-resolution satellite images of Bellevue, Seattle, Tacoma, Los Angeles, Memphis, and San Antonio, the researchers trained the CNN on 1.2 million images from the ImageNet database. The categorizations were correlated with obesity prevalence estimates for the six urban areas from census tracts gathered by the 500 Cities project.
The system was able to identify the presence of certain features that increased likelihood of obesity in a given area. Some of these features included tightly–packed houses, being close to roadways, and living in neighborhoods with a lack of greenery.
Visualization of features identified by the convolutional neural network (CNN) model. The images on the left column are satellite images taken from Google Static Maps API (application programming interface). Images in the middle and right columns are activation maps taken from the second convolutional layer of VGG-CNN-F network after forward pass of the respective satellite images through the network. From Google Static Maps API, DigitalGlobe, US Geological Survey (accessed July 2017). Credit: JAMA Network Open
Your Surroundings Are Key
In their discussion of the findings, the researchers stressed that there are limitations to the conclusions that can be drawn from the AI’s results. For example, socio-economic factors like income likely play a major role for obesity prevalence in a given geographic area.
However, the study concluded that the AI-powered analysis showed the prevalence of specific man-made features in neighborhoods consistently correlating with obesity prevalence and not necessarily correlating with socioeconomic status.
The system’s success rates varied between studied cities, with Memphis being the highest (73.3 percent) and Seattle being the lowest (55.8 percent).
AI Takes To the Sky
Around a third of the US population is categorized as obese. Obesity is linked to a number of health-related issues, and the AI-generated results could potentially help improve city planning and better target campaigns to limit obesity.
The study is one of the latest of a growing list that uses AI to analyze images and extrapolate insights.
A team at Stanford University has used a CNN to predict poverty via satellite imagery, assisting governments and NGOs to better target their efforts. A combination of the public Automatic Identification System for shipping, satellite imagery, and Google’s AI has proven able to identify illegal fishing activity. Researchers have even been able to use AI and Google Street View to predict what party a given city will vote for, based on what cars are parked on the streets.
In each case, the AI systems have been able to look at volumes of data about our world and surroundings that are beyond the capabilities of humans and extrapolate new insights. If one were to moralize about the good and bad sides of AI (new opportunities vs. potential job losses, for example) it could seem that it comes down to what we ask AI systems to look at—and what questions we ask of them.
Image Credit: Ocean Biology Processing Group at NASA’s Goddard Space Flight Center Continue reading