Tag Archives: patient
#434658 The Next Data-Driven Healthtech ...
Increasing your healthspan (i.e. making 100 years old the new 60) will depend to a large degree on artificial intelligence. And, as we saw in last week’s blog, healthcare AI systems are extremely data-hungry.
Fortunately, a slew of new sensors and data acquisition methods—including over 122 million wearables shipped in 2018—are bursting onto the scene to meet the massive demand for medical data.
From ubiquitous biosensors, to the mobile healthcare revolution, to the transformative power of the Health Nucleus, converging exponential technologies are fundamentally transforming our approach to healthcare.
In Part 4 of this blog series on Longevity & Vitality, I expand on how we’re acquiring the data to fuel today’s AI healthcare revolution.
In this blog, I’ll explore:
How the Health Nucleus is transforming “sick care” to healthcare
Sensors, wearables, and nanobots
The advent of mobile health
Let’s dive in.
Health Nucleus: Transforming ‘Sick Care’ to Healthcare
Much of today’s healthcare system is actually sick care. Most of us assume that we’re perfectly healthy, with nothing going on inside our bodies, until the day we travel to the hospital writhing in pain only to discover a serious or life-threatening condition.
Chances are that your ailment didn’t materialize that morning; rather, it’s been growing or developing for some time. You simply weren’t aware of it. At that point, once you’re diagnosed as “sick,” our medical system engages to take care of you.
What if, instead of this retrospective and reactive approach, you were constantly monitored, so that you could know the moment anything was out of whack?
Better yet, what if you more closely monitored those aspects of your body that your gene sequence predicted might cause you difficulty? Think: your heart, your kidneys, your breasts. Such a system becomes personalized, predictive, and possibly preventative.
This is the mission of the Health Nucleus platform built by Human Longevity, Inc. (HLI). While not continuous—that will come later, with the next generation of wearable and implantable sensors—the Health Nucleus was designed to ‘digitize’ you once per year to help you determine whether anything is going on inside your body that requires immediate attention.
The Health Nucleus visit provides you with the following tests during a half-day visit:
Whole genome sequencing (30x coverage)
Whole body (non-contrast) MRI
Brain magnetic resonance imaging/angiography (MRI/MRA)
CT (computed tomography) of the heart and lungs
Coronary artery calcium scoring
Electrocardiogram
Echocardiogram
Continuous cardiac monitoring
Clinical laboratory tests and metabolomics
In late 2018, HLI published the results of the first 1,190 clients through the Health Nucleus. The results were eye-opening—especially since these patients were all financially well-off, and already had access to the best doctors.
Following are the physiological and genomic findings in these clients who self-selected to undergo evaluation at HLI’s Health Nucleus.
Physiological Findings [TG]
Two percent had previously unknown tumors detected by MRI
2.5 percent had previously undetected aneurysms detected by MRI
Eight percent had cardiac arrhythmia found on cardiac rhythm monitoring, not previously known
Nine percent had moderate-severe coronary artery disease risk, not previously known
16 percent discovered previously unknown cardiac structure/function abnormalities
30 percent had elevated liver fat, not previously known
Genomic Findings [TG]
24 percent of clients uncovered a rare (unknown) genetic mutation found on WGS
63 percent of clients had a rare genetic mutation with a corresponding phenotypic finding
In summary, HLI’s published results found that 14.4 percent of clients had significant findings that are actionable, requiring immediate or near-term follow-up and intervention.
Long-term value findings were found in 40 percent of the clients we screened. Long-term clinical findings include discoveries that require medical attention or monitoring but are not immediately life-threatening.
The bottom line: most people truly don’t know their actual state of health. The ability to take a fully digital deep dive into your health status at least once per year will enable you to detect disease at stage zero or stage one, when it is most curable.
Sensors, Wearables, and Nanobots
Wearables, connected devices, and quantified self apps will allow us to continuously collect enormous amounts of useful health information.
Wearables like the Quanttus wristband and Vital Connect can transmit your electrocardiogram data, vital signs, posture, and stress levels anywhere on the planet.
In April 2017, we were proud to grant $2.5 million in prize money to the winning team in the Qualcomm Tricorder XPRIZE, Final Frontier Medical Devices.
Using a group of noninvasive sensors that collect data on vital signs, body chemistry, and biological functions, Final Frontier integrates this data in their powerful, AI-based DxtER diagnostic engine for rapid, high-precision assessments.
Their engine combines learnings from clinical emergency medicine and data analysis from actual patients.
Google is developing a full range of internal and external sensors (e.g. smart contact lenses) that can monitor the wearer’s vitals, ranging from blood sugar levels to blood chemistry.
In September 2018, Apple announced its Series 4 Apple Watch, including an FDA-approved mobile, on-the-fly ECG. Granted its first FDA approval, Apple appears to be moving deeper into the sensing healthcare market.
Further, Apple is reportedly now developing sensors that can non-invasively monitor blood sugar levels in real time for diabetic treatment. IoT-connected sensors are also entering the world of prescription drugs.
Last year, the FDA approved the first sensor-embedded pill, Abilify MyCite. This new class of digital pills can now communicate medication data to a user-controlled app, to which doctors may be granted access for remote monitoring.
Perhaps what is most impressive about the next generation of wearables and implantables is the density of sensors, processing, networking, and battery capability that we can now cheaply and compactly integrate.
Take the second-generation OURA ring, for example, which focuses on sleep measurement and management.
The OURA ring looks like a slightly thick wedding band, yet contains an impressive array of sensors and capabilities, including:
Two infrared LED
One infrared sensor
Three temperature sensors
One accelerometer
A six-axis gyro
A curved battery with a seven-day life
The memory, processing, and transmission capability required to connect with your smartphone
Disrupting Medical Imaging Hardware
In 2018, we saw lab breakthroughs that will drive the cost of an ultrasound sensor to below $100, in a packaging smaller than most bandages, powered by a smartphone. Dramatically disrupting ultrasound is just the beginning.
Nanobots and Nanonetworks
While wearables have long been able to track and transmit our steps, heart rate, and other health data, smart nanobots and ingestible sensors will soon be able to monitor countless new parameters and even help diagnose disease.
Some of the most exciting breakthroughs in smart nanotechnology from the past year include:
Researchers from the École Polytechnique Fédérale de Lausanne (EPFL) and the Swiss Federal Institute of Technology in Zurich (ETH Zurich) demonstrated artificial microrobots that can swim and navigate through different fluids, independent of additional sensors, electronics, or power transmission.
Researchers at the University of Chicago proposed specific arrangements of DNA-based molecular logic gates to capture the information contained in the temporal portion of our cells’ communication mechanisms. Accessing the otherwise-lost time-dependent information of these cellular signals is akin to knowing the tune of a song, rather than solely the lyrics.
MIT researchers built micron-scale robots able to sense, record, and store information about their environment. These tiny robots, about 100 micrometers in diameter (approximately the size of a human egg cell), can also carry out pre-programmed computational tasks.
Engineers at University of California, San Diego developed ultrasound-powered nanorobots that swim efficiently through your blood, removing harmful bacteria and the toxins they produce.
But it doesn’t stop there.
As nanosensor and nanonetworking capabilities develop, these tiny bots may soon communicate with each other, enabling the targeted delivery of drugs and autonomous corrective action.
Mobile Health
The OURA ring and the Series 4 Apple Watch are just the tip of the spear when it comes to our future of mobile health. This field, predicted to become a $102 billion market by 2022, puts an on-demand virtual doctor in your back pocket.
Step aside, WebMD.
In true exponential technology fashion, mobile device penetration has increased dramatically, while image recognition error rates and sensor costs have sharply declined.
As a result, AI-powered medical chatbots are flooding the market; diagnostic apps can identify anything from a rash to diabetic retinopathy; and with the advent of global connectivity, mHealth platforms enable real-time health data collection, transmission, and remote diagnosis by medical professionals.
Already available to residents across North London, Babylon Health offers immediate medical advice through AI-powered chatbots and video consultations with doctors via its app.
Babylon now aims to build up its AI for advanced diagnostics and even prescription. Others, like Woebot, take on mental health, using cognitive behavioral therapy in communications over Facebook messenger with patients suffering from depression.
In addition to phone apps and add-ons that test for fertility or autism, the now-FDA-approved Clarius L7 Linear Array Ultrasound Scanner can connect directly to iOS and Android devices and perform wireless ultrasounds at a moment’s notice.
Next, Healthy.io, an Israeli startup, uses your smartphone and computer vision to analyze traditional urine test strips—all you need to do is take a few photos.
With mHealth platforms like ClickMedix, which connects remotely-located patients to medical providers through real-time health data collection and transmission, what’s to stop us from delivering needed treatments through drone delivery or robotic telesurgery?
Welcome to the age of smartphone-as-a-medical-device.
Conclusion
With these DIY data collection and diagnostic tools, we save on transportation costs (time and money), and time bottlenecks.
No longer will you need to wait for your urine or blood results to go through the current information chain: samples will be sent to the lab, analyzed by a technician, results interpreted by your doctor, and only then relayed to you.
Just like the “sage-on-the-stage” issue with today’s education system, healthcare has a “doctor-on-the-dais” problem. Current medical procedures are too complicated and expensive for a layperson to perform and analyze on their own.
The coming abundance of healthcare data promises to transform how we approach healthcare, putting the power of exponential technologies in the patient’s hands and revolutionizing how we live.
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Posted in Human Robots
#434637 AI Is Rapidly Augmenting Healthcare and ...
When it comes to the future of healthcare, perhaps the only technology more powerful than CRISPR is artificial intelligence.
Over the past five years, healthcare AI startups around the globe raised over $4.3 billion across 576 deals, topping all other industries in AI deal activity.
During this same period, the FDA has given 70 AI healthcare tools and devices ‘fast-tracked approval’ because of their ability to save both lives and money.
The pace of AI-augmented healthcare innovation is only accelerating.
In Part 3 of this blog series on longevity and vitality, I cover the different ways in which AI is augmenting our healthcare system, enabling us to live longer and healthier lives.
In this blog, I’ll expand on:
Machine learning and drug design
Artificial intelligence and big data in medicine
Healthcare, AI & China
Let’s dive in.
Machine Learning in Drug Design
What if AI systems, specifically neural networks, could predict the design of novel molecules (i.e. medicines) capable of targeting and curing any disease?
Imagine leveraging cutting-edge artificial intelligence to accomplish with 50 people what the pharmaceutical industry can barely do with an army of 5,000.
And what if these molecules, accurately engineered by AIs, always worked? Such a feat would revolutionize our $1.3 trillion global pharmaceutical industry, which currently holds a dismal record of 1 in 10 target drugs ever reaching human trials.
It’s no wonder that drug development is massively expensive and slow. It takes over 10 years to bring a new drug to market, with costs ranging from $2.5 billion to $12 billion.
This inefficient, slow-to-innovate, and risk-averse industry is a sitting duck for disruption in the years ahead.
One of the hottest startups in digital drug discovery today is Insilico Medicine. Leveraging AI in its end-to-end drug discovery pipeline, Insilico Medicine aims to extend healthy longevity through drug discovery and aging research.
Their comprehensive drug discovery engine uses millions of samples and multiple data types to discover signatures of disease, identify the most promising protein targets, and generate perfect molecules for these targets. These molecules either already exist or can be generated de novo with the desired set of parameters.
In late 2018, Insilico’s CEO Dr. Alex Zhavoronkov announced the groundbreaking result of generating novel molecules for a challenging protein target with an unprecedented hit rate in under 46 days. This included both synthesis of the molecules and experimental validation in a biological test system—an impressive feat made possible by converging exponential technologies.
Underpinning Insilico’s drug discovery pipeline is a novel machine learning technique called Generative Adversarial Networks (GANs), used in combination with deep reinforcement learning.
Generating novel molecular structures for diseases both with and without known targets, Insilico is now pursuing drug discovery in aging, cancer, fibrosis, Parkinson’s disease, Alzheimer’s disease, ALS, diabetes, and many others. Once rolled out, the implications will be profound.
Dr. Zhavoronkov’s ultimate goal is to develop a fully-automated Health-as-a-Service (HaaS) and Longevity-as-a-Service (LaaS) engine.
Once plugged into the services of companies from Alibaba to Alphabet, such an engine would enable personalized solutions for online users, helping them prevent diseases and maintain optimal health.
Insilico, alongside other companies tackling AI-powered drug discovery, truly represents the application of the 6 D’s. What was once a prohibitively expensive and human-intensive process is now rapidly becoming digitized, dematerialized, demonetized and, perhaps most importantly, democratized.
Companies like Insilico can now do with a fraction of the cost and personnel what the pharmaceutical industry can barely accomplish with thousands of employees and a hefty bill to foot.
As I discussed in my blog on ‘The Next Hundred-Billion-Dollar Opportunity,’ Google’s DeepMind has now turned its neural networks to healthcare, entering the digitized drug discovery arena.
In 2017, DeepMind achieved a phenomenal feat by matching the fidelity of medical experts in correctly diagnosing over 50 eye disorders.
And just a year later, DeepMind announced a new deep learning tool called AlphaFold. By predicting the elusive ways in which various proteins fold on the basis of their amino acid sequences, AlphaFold may soon have a tremendous impact in aiding drug discovery and fighting some of today’s most intractable diseases.
Artificial Intelligence and Data Crunching
AI is especially powerful in analyzing massive quantities of data to uncover patterns and insights that can save lives. Take WAVE, for instance. Every year, over 400,000 patients die prematurely in US hospitals as a result of heart attack or respiratory failure.
Yet these patients don’t die without leaving plenty of clues. Given information overload, however, human physicians and nurses alone have no way of processing and analyzing all necessary data in time to save these patients’ lives.
Enter WAVE, an algorithm that can process enough data to offer a six-hour early warning of patient deterioration.
Just last year, the FDA approved WAVE as an AI-based predictive patient surveillance system to predict and thereby prevent sudden death.
Another highly valuable yet difficult-to-parse mountain of medical data comprises the 2.5 million medical papers published each year.
For some time, it has become physically impossible for a human physician to read—let alone remember—all of the relevant published data.
To counter this compounding conundrum, Johnson & Johnson is teaching IBM Watson to read and understand scientific papers that detail clinical trial outcomes.
Enriching Watson’s data sources, Apple is also partnering with IBM to provide access to health data from mobile apps.
One such Watson system contains 40 million documents, ingesting an average of 27,000 new documents per day, and providing insights for thousands of users.
After only one year, Watson’s successful diagnosis rate of lung cancer has reached 90 percent, compared to the 50 percent success rate of human doctors.
But what about the vast amount of unstructured medical patient data that populates today’s ancient medical system? This includes medical notes, prescriptions, audio interview transcripts, and pathology and radiology reports.
In late 2018, Amazon announced a new HIPAA-eligible machine learning service that digests and parses unstructured data into categories, such as patient diagnoses, treatments, dosages, symptoms and signs.
Taha Kass-Hout, Amazon’s senior leader in health care and artificial intelligence, told the Wall Street Journal that internal tests demonstrated that the software even performs as well as or better than other published efforts.
On the heels of this announcement, Amazon confirmed it was teaming up with the Fred Hutchinson Cancer Research Center to evaluate “millions of clinical notes to extract and index medical conditions.”
Having already driven extraordinary algorithmic success rates in other fields, data is the healthcare industry’s goldmine for future innovation.
Healthcare, AI & China
In 2017, the Chinese government published its ambitious national plan to become a global leader in AI research by 2030, with healthcare listed as one of four core research areas during the first wave of the plan.
Just a year earlier, China began centralizing healthcare data, tackling a major roadblock to developing longevity and healthcare technologies (particularly AI systems): scattered, dispersed, and unlabeled patient data.
Backed by the Chinese government, China’s largest tech companies—particularly Tencent—have now made strong entrances into healthcare.
Just recently, Tencent participated in a $154 million megaround for China-based healthcare AI unicorn iCarbonX.
Hoping to develop a complete digital representation of your biological self, iCarbonX has acquired numerous US personalized medicine startups.
Considering Tencent’s own Miying healthcare AI platform—aimed at assisting healthcare institutions in AI-driven cancer diagnostics—Tencent is quickly expanding into the drug discovery space, participating in two multimillion-dollar, US-based AI drug discovery deals just this year.
China’s biggest, second-order move into the healthtech space comes through Tencent’s WeChat. In the course of a mere few years, already 60 percent of the 38,000 medical institutions registered on WeChat allow patients to digitally book appointments through Tencent’s mobile platform. At the same time, 2,000 Chinese hospitals accept WeChat payments.
Tencent has additionally partnered with the U.K.’s Babylon Health, a virtual healthcare assistant startup whose app now allows Chinese WeChat users to message their symptoms and receive immediate medical feedback.
Similarly, Alibaba’s healthtech focus started in 2016 when it released its cloud-based AI medical platform, ET Medical Brain, to augment healthcare processes through everything from diagnostics to intelligent scheduling.
Conclusion
As Nvidia CEO Jensen Huang has stated, “Software ate the world, but AI is going to eat software.” Extrapolating this statement to a more immediate implication, AI will first eat healthcare, resulting in dramatic acceleration of longevity research and an amplification of the human healthspan.
Next week, I’ll continue to explore this concept of AI systems in healthcare.
Particularly, I’ll expand on how we’re acquiring and using the data for these doctor-augmenting AI systems: from ubiquitous biosensors, to the mobile healthcare revolution, and finally, to the transformative power of the health nucleus.
As AI and other exponential technologies increase our healthspan by 30 to 40 years, how will you leverage these same exponential technologies to take on your moonshots and live out your massively transformative purpose?
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Posted in Human Robots
#434534 To Extend Our Longevity, First We Must ...
Healthcare today is reactive, retrospective, bureaucratic, and expensive. It’s sick care, not healthcare.
But that is radically changing at an exponential rate.
Through this multi-part blog series on longevity, I’ll take a deep dive into aging, longevity, and healthcare technologies that are working together to dramatically extend the human lifespan, disrupting the $3 trillion healthcare system in the process.
I’ll begin the series by explaining the nine hallmarks of aging, as explained in this journal article. Next, I’ll break down the emerging technologies and initiatives working to combat these nine hallmarks. Finally, I’ll explore the transformative implications of dramatically extending the human health span.
In this blog I’ll cover:
Why the healthcare system is broken
Why, despite this, we live in the healthiest time in human history
The nine mechanisms of aging
Let’s dive in.
The System is Broken—Here’s the Data:
Doctors spend $210 billion per year on procedures that aren’t based on patient need, but fear of liability.
Americans spend, on average, $8,915 per person on healthcare—more than any other country on Earth.
Prescription drugs cost around 50 percent more in the US than in other industrialized countries.
At current rates, by 2025, nearly 25 percent of the US GDP will be spent on healthcare.
It takes 12 years and $359 million, on average, to take a new drug from the lab to a patient.
Only 5 in 5,000 of these new drugs proceed to human testing. From there, only 1 of those 5 is actually approved for human use.
And Yet, We Live in the Healthiest Time in Human History
Consider these insights, which I adapted from Max Roser’s excellent database Our World in Data:
Right now, the countries with the lowest life expectancy in the world still have higher life expectancies than the countries with the highest life expectancy did in 1800.
In 1841, a 5-year-old had a life expectancy of 55 years. Today, a 5-year-old can expect to live 82 years—an increase of 27 years.
We’re seeing a dramatic increase in healthspan. In 1845, a newborn would expect to live to 40 years old. For a 70-year-old, that number became 79. Now, people of all ages can expect to live to be 81 to 86 years old.
100 years ago, 1 of 3 children would die before the age of 5. As of 2015, the child mortality rate fell to just 4.3 percent.
The cancer mortality rate has declined 27 percent over the past 25 years.
Figure: Around the globe, life expectancy has doubled since the 1800s. | Image from Life Expectancy by Max Roser – Our World in Data / CC BY SA
Figure: A dramatic reduction in child mortality in 1800 vs. in 2015. | Image from Child Mortality by Max Roser – Our World in Data / CC BY SA
The 9 Mechanisms of Aging
*This section was adapted from CB INSIGHTS: The Future Of Aging.
Longevity, healthcare, and aging are intimately linked.
With better healthcare, we can better treat some of the leading causes of death, impacting how long we live.
By investigating how to treat diseases, we’ll inevitably better understand what causes these diseases in the first place, which directly correlates to why we age.
Following are the nine hallmarks of aging. I’ll share examples of health and longevity technologies addressing each of these later in this blog series.
Genomic instability: As we age, the environment and normal cellular processes cause damage to our genes. Activities like flying at high altitude, for example, expose us to increased radiation or free radicals. This damage compounds over the course of life and is known to accelerate aging.
Telomere attrition: Each strand of DNA in the body (known as chromosomes) is capped by telomeres. These short snippets of DNA repeated thousands of times are designed to protect the bulk of the chromosome. Telomeres shorten as our DNA replicates; if a telomere reaches a certain critical shortness, a cell will stop dividing, resulting in increased incidence of disease.
Epigenetic alterations: Over time, environmental factors will change how genes are expressed, i.e., how certain sequences of DNA are read and the instruction set implemented.
Loss of proteostasis: Over time, different proteins in our body will no longer fold and function as they are supposed to, resulting in diseases ranging from cancer to neurological disorders.
Deregulated nutrient-sensing: Nutrient levels in the body can influence various metabolic pathways. Among the affected parts of these pathways are proteins like IGF-1, mTOR, sirtuins, and AMPK. Changing levels of these proteins’ pathways has implications on longevity.
Mitochondrial dysfunction: Mitochondria (our cellular power plants) begin to decline in performance as we age. Decreased performance results in excess fatigue and other symptoms of chronic illnesses associated with aging.
Cellular senescence: As cells age, they stop dividing and cannot be removed from the body. They build up and typically cause increased inflammation.
Stem cell exhaustion: As we age, our supply of stem cells begins to diminish as much as 100 to 10,000-fold in different tissues and organs. In addition, stem cells undergo genetic mutations, which reduce their quality and effectiveness at renovating and repairing the body.
Altered intercellular communication: The communication mechanisms that cells use are disrupted as cells age, resulting in decreased ability to transmit information between cells.
Conclusion
Over the past 200 years, we have seen an abundance of healthcare technologies enable a massive lifespan boom.
Now, exponential technologies like artificial intelligence, 3D printing and sensors, as well as tremendous advancements in genomics, stem cell research, chemistry, and many other fields, are beginning to tackle the fundamental issues of why we age.
In the next blog in this series, we will dive into how genome sequencing and editing, along with new classes of drugs, are augmenting our biology to further extend our healthy lives.
What will you be able to achieve with an extra 30 to 50 healthy years (or longer) in your lifespan? Personally, I’m excited for a near-infinite lifespan to take on moonshots.
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Posted in Human Robots
#434508 The Top Biotech and Medicine Advances to ...
2018 was bonkers for science.
From a woman who gave birth using a transplanted uterus, to the infamous CRISPR baby scandal, to forensics adopting consumer-based genealogy test kits to track down criminals, last year was a factory churning out scientific “whoa” stories with consequences for years to come.
With CRISPR still in the headlines, Britain ready to bid Europe au revoir, and multiple scientific endeavors taking off, 2019 is shaping up to be just as tumultuous.
Here are the science and health stories that may blow up in the new year. But first, a note of caveat: predicting the future is tough. Forecasting is the lovechild between statistics and (a good deal of) intuition, and entire disciplines have been dedicated to the endeavor. But January is the perfect time to gaze into the crystal ball for wisps of insight into the year to come. Last year we predicted the widespread approval of gene therapy products—on the most part, we nailed it. This year we’re hedging our bets with multiple predictions.
Gene Drives Used in the Wild
The concept of gene drives scares many, for good reason. Gene drives are a step up in severity (and consequences) from CRISPR and other gene-editing tools. Even with germline editing, in which the sperm, egg, or embryos are altered, gene editing affects just one genetic line—one family—at least at the beginning, before they reproduce with the general population.
Gene drives, on the other hand, have the power to wipe out entire species.
In a nutshell, they’re little bits of DNA code that help a gene transfer from parent to child with almost 100 percent perfect probability. The “half of your DNA comes from dad, the other comes from mom” dogma? Gene drives smash that to bits.
In other words, the only time one would consider using a gene drive is to change the genetic makeup of an entire population. It sounds like the plot of a supervillain movie, but scientists have been toying around with the idea of deploying the technology—first in mosquitoes, then (potentially) in rodents.
By releasing just a handful of mutant mosquitoes that carry gene drives for infertility, for example, scientists could potentially wipe out entire populations that carry infectious scourges like malaria, dengue, or Zika. The technology is so potent—and dangerous—the US Defense Advances Research Projects Agency is shelling out $65 million to suss out how to deploy, control, counter, or even reverse the effects of tampering with ecology.
Last year, the U.N. gave a cautious go-ahead for the technology to be deployed in the wild in limited terms. Now, the first release of a genetically modified mosquito is set for testing in Burkina Faso in Africa—the first-ever field experiment involving gene drives.
The experiment will only release mosquitoes in the Anopheles genus, which are the main culprits transferring disease. As a first step, over 10,000 male mosquitoes are set for release into the wild. These dudes are genetically sterile but do not cause infertility, and will help scientists examine how they survive and disperse as a preparation for deploying gene-drive-carrying mosquitoes.
Hot on the project’s heels, the nonprofit consortium Target Malaria, backed by the Bill and Melinda Gates foundation, is engineering a gene drive called Mosq that will spread infertility across the population or kill out all female insects. Their attempt to hack the rules of inheritance—and save millions in the process—is slated for 2024.
A Universal Flu Vaccine
People often brush off flu as a mere annoyance, but the infection kills hundreds of thousands each year based on the CDC’s statistical estimates.
The flu virus is actually as difficult of a nemesis as HIV—it mutates at an extremely rapid rate, making effective vaccines almost impossible to engineer on time. Scientists currently use data to forecast the strains that will likely explode into an epidemic and urge the public to vaccinate against those predictions. That’s partly why, on average, flu vaccines only have a success rate of roughly 50 percent—not much better than a coin toss.
Tired of relying on educated guesses, scientists have been chipping away at a universal flu vaccine that targets all strains—perhaps even those we haven’t yet identified. Often referred to as the “holy grail” in epidemiology, these vaccines try to alert our immune systems to parts of a flu virus that are least variable from strain to strain.
Last November, a first universal flu vaccine developed by BiondVax entered Phase 3 clinical trials, which means it’s already been proven safe and effective in a small numbers and is now being tested in a broader population. The vaccine doesn’t rely on dead viruses, which is a common technique. Rather, it uses a small chain of amino acids—the chemical components that make up proteins—to stimulate the immune system into high alert.
With the government pouring $160 million into the research and several other universal candidates entering clinical trials, universal flu vaccines may finally experience a breakthrough this year.
In-Body Gene Editing Shows Further Promise
CRISPR and other gene editing tools headed the news last year, including both downers suggesting we already have immunity to the technology and hopeful news of it getting ready for treating inherited muscle-wasting diseases.
But what wasn’t widely broadcasted was the in-body gene editing experiments that have been rolling out with gusto. Last September, Sangamo Therapeutics in Richmond, California revealed that they had injected gene-editing enzymes into a patient in an effort to correct a genetic deficit that prevents him from breaking down complex sugars.
The effort is markedly different than the better-known CAR-T therapy, which extracts cells from the body for genetic engineering before returning them to the hosts. Rather, Sangamo’s treatment directly injects viruses carrying the edited genes into the body. So far, the procedure looks to be safe, though at the time of reporting it was too early to determine effectiveness.
This year the company hopes to finally answer whether it really worked.
If successful, it means that devastating genetic disorders could potentially be treated with just a few injections. With a gamut of new and more precise CRISPR and other gene-editing tools in the works, the list of treatable inherited diseases is likely to grow. And with the CRISPR baby scandal potentially dampening efforts at germline editing via regulations, in-body gene editing will likely receive more attention if Sangamo’s results return positive.
Neuralink and Other Brain-Machine Interfaces
Neuralink is the stuff of sci fi: tiny implanted particles into the brain could link up your biological wetware with silicon hardware and the internet.
But that’s exactly what Elon Musk’s company, founded in 2016, seeks to develop: brain-machine interfaces that could tinker with your neural circuits in an effort to treat diseases or even enhance your abilities.
Last November, Musk broke his silence on the secretive company, suggesting that he may announce something “interesting” in a few months, that’s “better than anyone thinks is possible.”
Musk’s aspiration for achieving symbiosis with artificial intelligence isn’t the driving force for all brain-machine interfaces (BMIs). In the clinics, the main push is to rehabilitate patients—those who suffer from paralysis, memory loss, or other nerve damage.
2019 may be the year that BMIs and neuromodulators cut the cord in the clinics. These devices may finally work autonomously within a malfunctioning brain, applying electrical stimulation only when necessary to reduce side effects without requiring external monitoring. Or they could allow scientists to control brains with light without needing bulky optical fibers.
Cutting the cord is just the first step to fine-tuning neurological treatments—or enhancements—to the tune of your own brain, and 2019 will keep on bringing the music.
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Posted in Human Robots
#434151 Life-or-Death Algorithms: The Black Box ...
When it comes to applications for machine learning, few can be more widely hyped than medicine. This is hardly surprising: it’s a huge industry that generates a phenomenal amount of data and revenue, where technological advances can improve or save the lives of millions of people. Hardly a week passes without a study that suggests algorithms will soon be better than experts at detecting pneumonia, or Alzheimer’s—diseases in complex organs ranging from the eye to the heart.
The problems of overcrowded hospitals and overworked medical staff plague public healthcare systems like Britain’s NHS and lead to rising costs for private healthcare systems. Here, again, algorithms offer a tantalizing solution. How many of those doctor’s visits really need to happen? How many could be replaced by an interaction with an intelligent chatbot—especially if it can be combined with portable diagnostic tests, utilizing the latest in biotechnology? That way, unnecessary visits could be reduced, and patients could be diagnosed and referred to specialists more quickly without waiting for an initial consultation.
As ever with artificial intelligence algorithms, the aim is not to replace doctors, but to give them tools to reduce the mundane or repetitive parts of the job. With an AI that can examine thousands of scans in a minute, the “dull drudgery” is left to machines, and the doctors are freed to concentrate on the parts of the job that require more complex, subtle, experience-based judgement of the best treatments and the needs of the patient.
High Stakes
But, as ever with AI algorithms, there are risks involved with relying on them—even for tasks that are considered mundane. The problems of black-box algorithms that make inexplicable decisions are bad enough when you’re trying to understand why that automated hiring chatbot was unimpressed by your job interview performance. In a healthcare context, where the decisions made could mean life or death, the consequences of algorithmic failure could be grave.
A new paper in Science Translational Medicine, by Nicholson Price, explores some of the promises and pitfalls of using these algorithms in the data-rich medical environment.
Neural networks excel at churning through vast quantities of training data and making connections, absorbing the underlying patterns or logic for the system in hidden layers of linear algebra; whether it’s detecting skin cancer from photographs or learning to write in pseudo-Shakespearean script. They are terrible, however, at explaining the underlying logic behind the relationships that they’ve found: there is often little more than a string of numbers, the statistical “weights” between the layers. They struggle to distinguish between correlation and causation.
This raises interesting dilemmas for healthcare providers. The dream of big data in medicine is to feed a neural network on “huge troves of health data, finding complex, implicit relationships and making individualized assessments for patients.” What if, inevitably, such an algorithm proves to be unreasonably effective at diagnosing a medical condition or prescribing a treatment, but you have no scientific understanding of how this link actually works?
Too Many Threads to Unravel?
The statistical models that underlie such neural networks often assume that variables are independent of each other, but in a complex, interacting system like the human body, this is not always the case.
In some ways, this is a familiar concept in medical science—there are many phenomena and links which have been observed for decades but are still poorly understood on a biological level. Paracetamol is one of the most commonly-prescribed painkillers, but there’s still robust debate about how it actually works. Medical practitioners may be keen to deploy whatever tool is most effective, regardless of whether it’s based on a deeper scientific understanding. Fans of the Copenhagen interpretation of quantum mechanics might spin this as “Shut up and medicate!”
But as in that field, there’s a debate to be had about whether this approach risks losing sight of a deeper understanding that will ultimately prove more fruitful—for example, for drug discovery.
Away from the philosophical weeds, there are more practical problems: if you don’t understand how a black-box medical algorithm is operating, how should you approach the issues of clinical trials and regulation?
Price points out that, in the US, the “21st-Century Cures Act” allows the FDA to regulate any algorithm that analyzes images, or doesn’t allow a provider to review the basis for its conclusions: this could completely exclude “black-box” algorithms of the kind described above from use.
Transparency about how the algorithm functions—the data it looks at, and the thresholds for drawing conclusions or providing medical advice—may be required, but could also conflict with the profit motive and the desire for secrecy in healthcare startups.
One solution might be to screen algorithms that can’t explain themselves, or don’t rely on well-understood medical science, from use before they enter the healthcare market. But this could prevent people from reaping the benefits that they can provide.
Evaluating Algorithms
New healthcare algorithms will be unable to do what physicists did with quantum mechanics, and point to a track record of success, because they will not have been deployed in the field. And, as Price notes, many algorithms will improve as they’re deployed in the field for a greater amount of time, and can harvest and learn from the performance data that’s actually used. So how can we choose between the most promising approaches?
Creating a standardized clinical trial and validation system that’s equally valid across algorithms that function in different ways, or use different input or training data, will be a difficult task. Clinical trials that rely on small sample sizes, such as for algorithms that attempt to personalize treatment to individuals, will also prove difficult. With a small sample size and little scientific understanding, it’s hard to tell whether the algorithm succeeded or failed because it’s bad at its job or by chance.
Add learning into the mix and the picture gets more complex. “Perhaps more importantly, to the extent that an ideal black-box algorithm is plastic and frequently updated, the clinical trial validation model breaks down further, because the model depends on a static product subject to stable validation.” As Price describes, the current system for testing and validation of medical products needs some adaptation to deal with this new software before it can successfully test and validate the new algorithms.
Striking a Balance
The story in healthcare reflects the AI story in so many other fields, and the complexities involved perhaps illustrate why even an illustrious company like IBM appears to be struggling to turn its famed Watson AI into a viable product in the healthcare space.
A balance must be struck, both in our rush to exploit big data and the eerie power of neural networks, and to automate thinking. We must be aware of the biases and flaws of this approach to problem-solving: to realize that it is not a foolproof panacea.
But we also need to embrace these technologies where they can be a useful complement to the skills, insights, and deeper understanding that humans can provide. Much like a neural network, our industries need to train themselves to enhance this cooperation in the future.
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