I wasn’t so sure how to describe Treato. It’s really interesting – mixing semantic analysis, social media, medical records, and analysis – Treato is really the next level of how consumers research diseases.
The image to the right is one that came from searching for Lyme disease.
I am not sure how they assemble that graphic, but I guess it’s a mixture of curation (plainly telling the system the usual drugs) and seeing what folks report they took (by combing the web). [Aside: It seems to be just listing the most used drugs (and knowing how the disease is treated, it looks like that to me). I wonder if there’s enough data for them to actually rank the drugs based on favorable outcomes, too. Outcomes analytics is where my head is always at, these days.]
Treato says they identified “over 160,000 English language websites, containing user-generated-content about medications and symptoms.” And that they “have searched and mapped thousands of these sites and indexed over 1 billion posts, covering well over 11,000 drug brands.” And they “have organized and analyzed this vast amount of data to create statistically proven insights about every aspect of medication use” [from their About page.]
I am not sure if they do this, but I’d like to see Treato applying their engine to sites like Patients Like Me, or 23 and Me, where there is an even richer set of data connecting people, disease, and outcomes.
And I am not sure, but they say the throw in patient records from HMOs, which I guess must mean claims data (which one can buy). But it would be cool if they could also mine medical record notes as well. They have the tech to do it, it’s just a matter of pointing their analytics tools to a new source (hm, what about Practice Fusion?).
I’m always thinking of how to extract meaning from medical records. So, Treato blows my mind.
Do you know of any other consumer disease research tools as sophisticated as Treato?
Hm, I wonder if they have enough to model trends, `a la Google Flu Trends, and then predict out-breaks? And it would be cool if Treato published a Health of the Nation – sort of like a Google Zeitgeist – of what is searched for and trends in diseases. I don’t think I’ve seen anything like that. Perhaps the CDC has something like this? For sure Treato is sitting on meaningful data they could use for this report. What do you think?
When I was at SXSW, I spent most of my time at either Big Data or Healthcare sessions. The interesting thing is that the Big Data sessions always devolved to talking about healthcare and the healthcare sessions always spoke about Big Data.
One aspect of the fusion of big data and healthcare that kept coming up was personal health monitoring. And since SXSW I have spoken and listened to a few folks (@dpatil, @rodrigoATCG, @nagle5000, @syntheticzero, and Sanjiv Shah) exploring measurement, self-analysis, and health devices.
Back in 2004-05, I worked on a product called Lifeblog – it collected all your SMS, MMS, photos, and videos into a timeline on your PC. It was way advanced for its time, and pointed to a future where we would cache our life’s stream of data. Working on that set me off thinking of sensors, lifestreaming, visualization of personal data (one set of discussions around visualizing recorded mobile phone usage data involved a colleague who left Nokia to set up @futureful – yes Nokia dabbled in this space once), my vision for what was supposed to be Ovi, my interest in lifestream aggregation, and a dotted line all the way to me getting involved in Big Data and Healthcare and Life Sciences in my role at IBM.
So, what do I see today in terms of these personal health devices?
At HIMSS in February, a big healthcare IT event, there was a whole section promoted by Qualcomm that was about mobile health measurement devices, such as the Asthmopolis inhaler sensor, and many mobile cardiac monitors. Also, there is a strong move (disclaimer, IBM is a big promoter) of the Patient Centered Medical Home (PCMH), which calls for sensors to provide independence to the patient, care to be provided outside the clinic, and constant monitoring for adverse events.
Nike Fuel was all over SXSW, and FitBit is expanding their their product portfolio. IBM is involved in the (young-mom) activity monitor BodyMedia. And here’s an article of the VC behind the gamified (shudder) heart monitor, Basis. And 23andMe’s Linda Avey (@lindaavey) started up a company (with Mitsu Hideishi, @syntheticzero) called Curious, specifically to explore how to make personal health data available to the (non Quantified Self) masses.
And of course, I don’t need to go into the amazing things happening in the Quantified Self world. Here’s an exciting post of a recent meet up. Look at all the projects!
More recently (and what triggered this post) is the news (link via @erigentry) that FourSquare founder, Naveen Selvadurai, is getting into health monitoring. Nothing captures the attention more of investors than some successful entrepreneur entering a new field that most mainstream folks have not thought of.
Innovation from the outside
One thing that hit me is that whatever arises from the fusion of Big Data and personal health measurement, it will come from outside the healthcare industry. Part of that is because in the healthcare industry, they are thinking of hospitals, chronic conditions, FDA, reimbursements, privacy, and so forth. Too much baggage, I think.
I had hoped that payers would see the importance of tracking health outside the clinic, especially for incentives or rebates on paying for care. My thought now is that they will end up buying someone rather than building something.
Which leads me to my realization that folks outside the industry have none of that baggage, have oodles of experience in consumer web services and data visualization, and, perhaps most importantly, view these devices as curious toys that are begging to be played with in interesting and novel ways.
But the challenge is not to alienate the non-techies who are interested in keeping an eye on their health, but are not as driven as the usual QSer. QSers are the bleeding edge of all this. My brainwave here and excitement is how to being this to the rest of us, making the ideas of QS more mainstream.
“It is NOT about the data but how it inspires”
This quote is from Rodrigo Martinez (@rodrigoATCG) from the IDEO healthcare practice. It dovetails nicely with a comment from DJ Patil (@dpatil) that, “OK, so my super intelligent scale tells me I’m fat. But I can see that looking in the mirror.”
“Inspire” is what I’d expect from an IDEO designer, and that’s fine. But for me, it’s really about motivation – how to stay interested in my health, effect the changes that need to be done, and be proud of my accomplishments. I don’t think “gamification” (as in badges and levels) is the answer (and I find it a bit tacky). I think there are more positive ways to motivate people – competition, social pressure, monetary incentives (and of course, I’d love to see the health plans get involved – even perhaps mandating).
What behaviors are we trying to promote by making this data visible to people? And, more importantly for anything that tries to optimize a parameter, what should we measure? Obviously the parameters we measure should represent something we wish to modify (isn’t the whole point about modifying a behavior to maintain or improve health?).
What do you think? Next Monday, I’ll be in Minneapolis participating in a predictive analytics event. I’ll be part of an executive roundtable, a breakout session on predictive analytics, and a general audience talk on the Predictive Power of Big Data Analytics in Healthcare. One thing I will touch on is the fusion of Big Data and personal health monitoring (another reason for this post). I’m sure I’ll get a lot of feedback on this topic – the event host is a device manufacturer with some monitoring devices of their own.
I also wanted to point out that IBM, my employer, published last year an excellent report on “liberating the information seeker” and The Future of Connected Devices (download PDF). I highly suggest you read it if you’re interested in this space.
So, what do you think? Do you use any of these devices, even just a heart rate monitor while running? A pedometer? What do you think will be the way we bridge the intense measuring world of the quantified self to a user of a device who just needs a little help to stay healthy?
Of course, this post is about devices and personal health. I see some interesting opportunities with personal medical records. But that’s a different aspect of Big Data and healthcare and best left for a different post.
I’ll leave you with a video of a well-used healthcare monitoring example at IBM – the Data Baby. Read the case study too (PDF). Disclaimer, I am part of the team that sells the streaming analytics product used for this project.
Image from dpstyles™ (There’s a weird cognection behind this image: I searched for CC images of Nike Fuel on Flickr and came up with this one, which I thought was pretty cool. When I looked at the other images, I realized this was Dennis Crowley’s stream. This post was triggered by a the Selvadurai news item mentioned above. Weird.)
“That is my thesis; that’s why I think this matters. When I left the room at the SXSW “New Aesthetic” panel, this is what concerned me most. I left with the conviction that something profound had been touched. Touched, although not yet grasped.
In the article quoted above, Bruce Stirling, gives an overview of the field, ties it to other areas of aesthetics and technology and philosophy, and then nudges New Aesthetics on its way with paternal pat on the tusch, a request, and a “get to it.”
Thomas Friedman recently wrote about a discussion he had with Frank Fukyama on the two-volume opus Fukyama is working on “The Origins of Political Order.”
Of course, I hardly ever get political here, but this article resonated with me.
“Indeed, America today increasingly looks like the society that the political scientist Mancur Olson wrote about in his 1982 classic “The Rise and Decline of Nations.” He warned that when a country amasses too many highly focused special-interest lobbies — which have an inherent advantage over the broad majority, which is fixated on the well-being of the country as a whole — they can, like a multilimbed octopus, choke the life out of a political system, unless the majority truly mobilizes against them.”
I think it’s amazing how well our nation has stood the test of time, seeing it was basically invented by a bunch of rich white men over 200 years ago. But two things always pop back up in my head – perhaps the concept of nation is out-moded and democracy doesn’t seem to have the ability to reinvent itself as radically as it was created.
In one of my novels, I have a character, who is in politics and policy, examine the whole idea and genesis of “nation”. She then discusses democracy and says:
“And the irony is that these are democracies, meaning that they are supposed to listen to the public and follow the will of the public. Yet in reality, the system is so complex that it can’t bootstrap a new system, molt into something different.
“Have you ever seen a democracy revamp itself? No, it can’t generate the necessary discontinuity of the same order that was needed to bring itself into existence.”
Part of me thinks we’re screwed if we can’t get ourselves out of this mess and that this is the worst the US government has been ever. But then the other part of me tries to think back to previous governments, congresses, and presidents and wonder if the immediacy of the stupidity and inanity of Washington DC has always been the same. Only nostalgia makes us forget.
Sigh.
Friedman’s article starts asking if we America needs an Arab Spring. And Fukuyama has some strong suggestions for change. Friedman concludes:
“I know what you’re thinking: “That will never happen.” And do you know what I’m thinking? “Then we will never be a great country again, no matter who is elected.” We can’t be great as long as we remain a vetocracy rather than a democracy. Our deformed political system — with a Congress that’s become a forum for legalized bribery — is now truly holding us back.”
I guess I’ve always been the inactive cynic. And, perhaps, I represent a large majority of the bourgeoisie of America. What’s it going to take to get me moving, if already I know the problem and just sit on my ass, like most of us.
Note: The article got hundreds comments and I saw good ones. Sigh. If only we had better tools to follow the comments as well. Of course, I’ve ranted about this before (here in 2009 and here in 2008).
“Researchers have documented repeated evolution in other organisms, but the sticklebacks are unique because the freshwater transition has occurred so many times. “Sticklebacks have been a phenomenal system for understanding rapid evolution,” says evolutionary biologist Erica Bree Rosenblum of the University of California, Berkeley, who wasn’t involved in the study. “This paper shows that repeated evolution can occur by ‘reusing’ the same genetic mechanisms over and over again.””
This quote is from a review in Science of a Nature paper where stickleback fish genomes were sequenced and compared. The catch is, the stickleback fish used to be a sea fish until glaciers melted 10,000 years ago and left many stranded in freshwater lakes and streams.
What then happened is that the freshwater sticklebacks all had to evolve to survive in the freshwater.
Independently.
What is interesting, is that it’s clear that all of these fish evolved the same adaptations. And now there is genetic evidence that most of these independent changes were in the same places of the genome in each of these freshwater fish.
While this has been seen in other organisms, the stickleback provide an experiment where this has happened multiple times, showing “repeated evolution can occur by ‘reusing’ the same genetic mechanisms over and over again.”
Adjacent possibles I am not surprised.
I picked up a term from futurist Paul Saffo, “adjacent possible” (I use it a lot to point out interesting things in evolution). Applied to evolution, it means an organism can really only sample the possible mutation paths that are adjacent to its current make-up. An organism cannot evolve from bacteria to bird in one move, much like “you can’t get there from here” in one move. In both cases, each step must be an adjacent possible step.
In this case, all the sticklebacks had similar adjacent possible ways to adjust to freshwater living. So they were constrained by their genome. But also, the environment exerted similar pressures, so the adjacent possible were further constrained.
The sticklebacks all had to make the same choices, with the same starting material, to adapt to the same environment.
“The main difference from eukaryotes is that prokaryotic reproduction is independent of DNA acquisition and recombination. Instead, DNA is obtained from fragmented chromosomes obtained via parasexual means (that is, without reproduction). These mechanisms of DNA exchange are not restricted to gene exchange within species, and therefore traits can and do come from highly divergent organisms. For example, imagine that acacia trees could exchange DNA with lions and that the resulting new tree developed “limbs” that allowed them to attack grazing giraffes. This is in a sense what prokaryotes do all the time.”
I am fascinated by horizontal gene transfer, whereby microbes from different species share genetic information. Species, as we all learn, are defined by not being able to exchange genetic information and produce fertile offspring.
Of course, microbes flaunt this rule.
The prevalence of gene transfer, where bacteria of different species exchange genetic information, blurs the boundaries between “species”. I remember listening to Penny Chisholm talk to Ira Flatow about Parachlorococcus and redefining what we call a species of microbes, which she called “genomic variants.”
The quote above is from a review of an article in Science that examines speciation in marine bacteria. It discusses how the investigators found prevalent horizontal gene transfer. But the cool thing, as I understand it, was that many of the same genes were being captured by bacteria in the same ecological niche.
In short, the environment is selecting for horizontally transferred genes to be conserved. These genes are not transmitted through organisms in the same species, but all of the bacteria are being selected to keep these transferred genes. In short, many of the genes from a population do not have a common ancestor (as in, cells dividing and propagating genes that way).
Even cooler, an analogue has been seen in prokaryotes, in a sense. Darwin’s finches all share genetic information through the usual repeated back-crossing between species, but ” the characters defining their ecological niche appear to be maintained through selection.”
So I guess we are talking about genomic variants, but not necessarily variants with the same ancestor – the ecological niche selects for that genomic variant, which has a collection of genes from the mother cell (ancestor) and from other cells (horizontal gene transfer)
“In conclusion, a time window exists that enables the artificial colonization of GF mice by a single oral dose of caecal content, which may modify the future immune phenotype of the host. Moreover, delayed microbial colonization of the gut causes permanent changes in the immune system.”
Ok. So there’s mounting evidence that rapid colonization of the gut of neonates is important to immune development. Next step is to translate that into real medical therapies. There are immune and gut diseases that afflict newborns (also, in many cases, newborns are bombarded by antibiotics at this crucial time) – what have we learned to make them healthier and also ensure that their immune system develops properly?
“Finally, the text still requires context. As publishers spin up their digital and print-on-demand backlists, more and more is published with less and less context. These efforts amount to land-grabs and rights-squatting, without adding value. Works without TOCs, indexes, author bios, footnotes. Placing work in context is one of publishers’ primary tasks, stretching out to commissioning introductions, assembling background material, supporting biographies and critical studies. Design belongs here too: good book design, appropriate book design, as important now as it has ever been.
“Velocity, depth, breadth. These are the dimensions we can add to books, that are the gifts of a digital age, not gimmicks, glossy presentation and media-catching stunts.”
What I like about James Bridle is that he’s in love with books and is able to bridge the bits and atoms worlds, translating and informing in both directions.
Obsession
One thing about me I don’t talk about much: I have an obsession with writing. And not the kind that you’ve read from me – websites, blogs, and the like. I’ve been actually writing stories, sketching narratives, jotting down snippets on and off for 30 years.
Of course, I’ve been writing online for almost 20 of those years. And, while James (in the article quoted above) does not think that is publishing, I do. Of a sort. On the level of bulletins and pamphlets of old.
At the same time, I absolutely agree with him that it’s not Publishing, capital P.
“P”ublishing
I am of the camp that thinks there’s a need for editors and publishers who, as James says above, provide context. Partly there’s the culling the chaff and bad writing, pointing out what’s valuable and well-written, no different than how we tend towards online publications that eloquently point us to what’s interesting and worth our attention.
But, James points out further that Publishers wrap text in a rich layer of context to enhance the text. So true. So necessary.
My books-in-waiting
I have posted some of my short stories here (see Narratives tab above), but have never felt complete (I have two novels and a few dozen short stories). A large part of me wants to see the stories in print, in a physical book (meh, Kindle?), for folks to flip through, fondle, read without having to know me. Yeah, good old-fashioned traditional Publishing.
Services like LuLu emboldened me to head down the path of just publishing it myself, but I know in my bones that I want an experienced editor to read my book, make it better (this is what editors do), and give it to a Publisher who can give it a design, context, audience access, and have it rub elbows with other books. No I am not looking for fame or fortune, just that I publish a wholesome book that I will be proud of.
I’ve known this all these years, and every time I put my novel or short stories into a book format (and go through the contortions of endless editing, layouts, design decisions), I am reminded that the mechanics and business of Publishing is not going away any time soon. [UPDATE: No sooner had I posted this I saw a tweet that pointed to this article “Publishing is no longer a job or an industry — it’s a button” which takes another tack to say Publishing is dead and Publishing is necessary – well, parts are dead and other parts are necessary. Basically, the same thing James says and I comment on.]
It’s hard work.
And LuLu knows that – check out all the Publishing services they offer á la carte.
Another hat-tip to James, I recently made a travel guide for my wife – travel guide, tips, language guide, photos, some fun things, and so forth. I cleaned up and formatted the text, added photos, laid it out, added a TOC (an index would have killed me), personalized it a bit. LuLu was just my printer. And it was great to not really have to worry about the copyrights. Only thing, it cost more to ship it than to print it (I shipped it fast – couldn’t wait to see it). Ugh. Atoms still have to be moved.
“Exposure to microbes during early childhood is associated with protection from immune-mediated diseases such as inflammatory bowel disease (IBD) and asthma. Here, we show that, in germ-free (GF) mice, invariant natural killer T (iNKT) cells accumulate in the colonic lamina propria and lung, resulting in increased morbidity in models of IBD and allergic asthma compared to specific pathogen-free (SPF) mice. This was associated with increased intestinal and pulmonary expression of the chemokine ligand CXCL16, which was associated with increased mucosal iNKT cells. Colonization of neonatal—but not adult—GF mice with a conventional microbiota protected the animals from mucosal iNKT accumulation and related pathology. These results indicate that age-sensitive contact with commensal microbes is critical for establishing mucosal iNKT cell tolerance to later environmental exposures.”
There have been a good series of papers and studies into the “hygiene hypothesis” – that exposure to microbes early in life are actually important for the proper evolution of the immune system. This paper is one more example of that – these researchers were able to show what happened to the immune cells in the but of mice that never acquire bacteria, acquire bacteria only as adults, or acquire bacteria as pups.
I sometimes think of the 1850s-1990s as the Pasteurian Age – we were controlling bacteria to create a sterile world based on germ theory, aseptic techniques, public policies, and, of course, antibiotics. Alas, in the past 20 years, we’ve come to the realizations that we’ve reached (to joke a bit here) “peak antibiotics”, and that the only bugs to survive our clean homes and hospitals and antibiotics were Superbugs.
Now, in the past 5-10 years, I feel we are entering a post-Pasteurian Age, where we are gaining a deeper respect for the bacteria and fungi that share our world (and bodies) and that we are slowly thinking of how we can balance the sterile world we want and the microbe-filled world we need.
Great time to be a practical microbiologist, don’t you think?
“The results also showed that (i) consumption of an FMP containing five bacterial strains was not associated with a statistically significant change in the proportional representation of resident community members within and between individuals; (ii) the appearance and disappearance of strains comprising the FMP consortium did not exhibit familial patterns in the fecal microbiota; and (iii) B. animalis subsp. lactis CNCM I-2494 was the most prominent assayed member of the consortium represented in the microbiota during the 7-week period of FMP The results also showed that (i) consumption of an FMP containing five bacterial strains was not associated with a statistically significant change in the proportional representation of resident community members within and between individuals; (ii) the appearance and disappearance of strains comprising the FMP consortium did not exhibit familial patterns in the fecal microbiota; and (iii) B. animalis subsp. lactis CNCM I-2494 was the most prominent assayed member of the consortium represented in the microbiota during the 7-week period of FMP consumption. Analyses of the fecal gene repertoire over the course of the 16 weeks of the experiment indicated that (i) variations in the functional features of the (fecal) microbiome were less than the variations in bacterial species composition; (ii) there was no significant difference in the degree of similarity in representation of KEGG orthology group functions for a given co-twin at each time point compared to the degree of similarity that existed between co-twins, whereas individual and twin pair microbiomes were significantly more similar to one another than those from unrelated individuals; and (iii) there were no statistically significant changes in the representation of these functions when the FMP strain consortium was being consumed.”
This is a seminal paper in probiotic research. I have seen a ton of papers on this subject, but none were as thorough as this one. The one concern I had was that there was no control for the FMP (fermented milk product) matrix (I don’t know what to call it, but the fermented milk without the bacteria). I still think there might be a positive effect on the gut microbiome from that matrix.
But, these folks saw similar effects in humans who ate FMP and the mice who had only the bacteria that were found in the FMP, effectively showing what the effect of just the bacteria have on the microbiome.
Still, I’m curious to settle once and for all if there is any beneficial effect of the FMP matrix. My main thought here is that 1) we know that the lactose digesting bacteria help in the stomach (as seen in folks with lactose intolerance), but 2) only one bacterial species from the FMP really seems to make it all the way through the gut. Perhaps the matrix helps the microbiome or signals the microbiome to do something? In this study, it was suggested that the bacteria alone are activating specific microbiome metabolic pathway.
Fascinating stuff. Will need to dig into it more. And I just saw that there are some videos of the authors. Should be interesting.
I wasn’t so sure how to describe Treato. It’s really interesting – mixing semantic analysis, social media, medical records, and analysis – Treato is really the next level of how consumers research diseases.