[Reblog] Will Getting More Granular Help Doctors Make Better Decisions?

From the 8 February 2015 post at The Health Care Blog

Will Getting More Granular Help Doctors Make Better Decisions?

Excerpt (longish post)

But, there are many things that data will never do well.  For certain things, physician heuristics may lead to better decisions than any predictive model.

Heuristics are shortcuts, based on experience and training that allow doctors to solve problems quickly.  They are pattern maps that physicians are trained to recognize. But, heuristics have a reputation for leading to imperfect answers: Wikipedia notes that heuristics lead to solutions that “(are) not guaranteed to be optimal, but good enough for a given set of goals…. (they) ease the cognitive load of making a decision.”  Humans use them because we simply can’t process information in sequential binary fashion the way computers do.

It would be a mistake to call heuristics a sad substitute for big data.  Some cognitive scientists have made the argument, and I think they’re right, that heuristics aren’t simply a shortcut for coming to good-enough answers. For the right kinds of problems, heuristically generated answers are often better than the those generated by computers.

How can this be?

I often think of the following cartoon in Randall Munroe’s superb recent book, What If? Serious Scientific Answers to Absurd Hypothetical Questions.  In trying to compare human and computer thinking, he rightly notes that each excels at different things.  In this cartoon, for example, humans can quickly determine what they thought happened.  Most people can tell you that the kid knocked over the vase and the cat is checking it out, without going through millions of alternate scenarios.  Monroe notes that most computers would struggle to quickly come to the same conclusion.

So, from the perspective of an emergency doctor, here are the three leading problems with the applied use of complex analytics in the clinical setting:

• 1. The garbage in, garbage out problem.  In short, humans regularly obfuscate their medical stories and misattribute causality. You need humans to guide the patient narrative and ignore red herrings.

• 2. If we want to be able to diagnose, screen and manage an ER full of runny-nosed kids with fevers, we simply can’t afford the time it takes for computers to sequentially process millions of data points. The challenge is at one simple and nuanced: allowing 99% of uncomplicated colds to go home while catching the one case of meningitis. It’s not something that a computer does well: it’s a question of balancing sensitivity (finding all true cases of meningitis among a sea of colds) and specificity (excluding meningitis correctly) and doctors seem to do better than computers when hundreds of cases need to be seen a day.

• 3. There is a problem with excess information, where too much data actually opacifies the answer you’re looking for. Statisticians call this “overfitting” the data. What they mean is that as you add more and more data points to an equation or regression model, the variability of random error around each point gets factored in as well, creating “noise”. The more variables, the more noise.

The paradox is that ignoring information often leads to simpler and ultimately better decisions.

…

Related articles

• It takes more than great algorithms to make personalization work
• Sanjay Bakshi: Daniel Kahneman vs Gary Klein

[News article] New ‘smart bandages’ for burn victims and others

From the February 2015 Science 360 news article

TODAY’S VIDEO New ‘smart bandages’ for burn victims and others

http://c.brightcove.com/services/viewer/federated_f9?isVid=1&isUI=1

Some bandages are embedded with medicine to treat wounds, but researchers at Harvard University and Brigham and Women’s Hospital have something much more sophisticated in mind for the future of chronic wound care. With support from the National Science Foundation, engineer Ali Khademhosseini and a multidisciplinary team are bringing together advances in sensors, biomaterials, tissue engineering, microsystems technology and microelectronics to create “smart bandages” for wounds that require ongoing care, such as burns, diabetic ulcers and bed sores. The new devices, known collectively as flexible bioelectronics, will do much more than deliver medicine. They will be able to monitor all the vital signs of the healing process, such as oxygen levels and temperature, and make adjustments when needed, as well as communicate the information to health professionals who are off-site. To fulfill the critical need for flexibility, the team is testing new materials, such as a hydrogel that would cover a wound with just the right amount of stretch to be comfortable.

Provided by the National Science Foundation
Runtime: 3:08

[Report] Women and Girls at Risk of Female Genital Mutilation/Cutting in the United States

English: updated prevalence of FGM in Africa (Photo credit: Wikipedia)

From the February 2015 Population Reference Bureau report

The Population Reference Bureau (PRB) data included in this data brief are preliminary. A new Centers for Disease Control and Prevention (CDC) report on female genital mutilation/cutting in the United States also will be released soon, providing additional information on women and girls at risk.

(February 2015) Female genital mutilation/cutting (FGM/C), involving partial or total removal of the external genitals of girls and women for religious, cultural, or other nonmedical reasons, has devastating immediate and long-term health and social effects, especially related to childbirth. This type of violence against women violates women’s human rights. There are more than 3 million girls, the majority in sub-Saharan Africa, who are at risk of cutting/mutilation each year. In Djibouti, Guinea, and Somalia, nine in 10 girls ages 15 to 19 have been subjected to FGM/C. Some countries in Africa have recently outlawed the practice, including Guinea-Bissau, but progress in eliminating the harmful traditional practice has been slow.1 Although FGM/C is most prevalent in sub-Saharan Africa, global migration patterns have increased the risk of FGM/C among women and girls living in developed countries, including the United States.

Increasingly, policymakers, NGOs, and community leaders are speaking out against this harmful traditional practice. As more information becomes available about the practice, it is clear that FGM/C needs to be unmasked and challenged around the world.

The U.S. Congress passed a law in 1996 making it illegal to perform FGM/C and 23 states have laws against the practice.2 Despite decades of work in the United States and globally to prevent FGM/C, it remains a significant harmful tradition for millions of girls and women. In the last few years, renewed efforts to protect girls from undergoing this procedure globally and in immigrant populations have resulted in policy successes. In Great Britain and in other European countries, a groundswell of attention has focused on eradicating the practice among the large immigrant populations of girls and women who have been cut or are at risk of being cut. Moreover, in 2012 the 67th session of the UN General Assembly passed a resolution urging states to condemn all harmful practices that affect women and girls, especially FGM/C. The UN resolution was a significant step toward ending the practice around the world.

In the United States, efforts to stop families from sending their daughters to their home countries to be cut led to a 2013 law making it illegal to knowingly transport a girl out of the United States for the purpose of cutting. FGM/C has gained attention in the United States in part because of the rising number of immigrants from countries where FGM/C is prevalent, especially sub-Saharan Africa. Between 2000 and 2013, the foreign-born population from Africa more than doubled, from 881,000 to 1.8 million.3

The Risk of FGM/C in the United States

In 2013, there were up to 507,000 U.S. women and girls who had undergone FGM/C or were at risk of the procedure, according to PRB’s preliminary data analysis. This figure is more than twice the number of women and girls estimated to be at risk in 2000 (228,000).4 The rapid increase in women and girls at risk reflects an increase in immigration to the United States, rather than an increase in the share of women and girls at risk of being cut. The estimated U.S. population at risk of FGM/C is calculated by applying country- and age-specific FGM/C prevalence rates to the number of U.S. women and girls with ties to those countries. A detailed description of PRB’s methods to estimate women and girls at risk of FGM/C is available.

[Reblog] False Positives and Real Dollars: Why $88 won’t effectively screen for lung cancer

 

On a related note, during Peace Corps training in Nashville (1979) I came down with a bad cough, often coughing for 5-10 minutes at a time. Don’t think the rainy weather and me going around with an umbrella or raincoat helped. Anyways, was sent to an area doctor and after a few tests, told me and the Peace Corps staff not to be concerned. Just a dormant fungus (and I do live a bit north of the Ohio River Valley). Anyways, after a few days in Monrovia, Liberia (6 am temps of about 85), I stopped coughing.

PS We were boarded in motels. One late night was awakened by a few young men  in the group coughing loudly and giggling outside my window. Chalk it up now to some late night drinking and the men still being, well, young.

On another note, my husband quit smoking back in the 80’s after about 25 years of smoking. He had a lung X-ray and a dark spot on the lungs was noticed. He had quit smoking the month before. So now I’m wondering…cancer or fungus? He has not had any firm diagnosis of cancer since.

Beschreibung: Konventionelles Röntgenbild des Thorax (der Lunge) mit rundlicher Verdichtung in der linken Lunge Quelle: selbst erstellt –Benutzer:Lange123 17:18, 11. Nov. 2004 (CEST) (Photo credit: Wikipedia)

From the 9 February 2015 article By MATT HAWKINS, MD at The Health Care Blog

…Histoplasma capsulatum is a fungus endemic to the Ohio and Mississippi River Valleys.  It is everywhere.  You get it by breathing.  Prior studies suggest that >80% of those living in these regions have contracted the fungus.  The majority of people with histo don’t get sick.  But – they get lung nodules.  Lots of them.  The nodules are benign but often indistinguishable on imaging from “early” lung cancer.

The entrepreneurial owners of the pictured urgent care center likely know this.  They also know that Medicare and other carriers have limited coverage (reasonably so) to patients between the ages of 55 and 74 with at least a 30 pack year history of smoking.  If patients have quit smoking, they must have quit within 15 years to be eligible for coverage.  At first glance, it may seem like offering cheap, $88 screening for Americans ineligible for lung cancer screening coverage, or those eligible citizens too busy to get a physician order for a screening exam, is a good deed.  But, $88 is just the tip of the iceberg.  Additional screening exams and subsequent procedures/biopsies will all incur additional costs.

Our collective fear of malignancy, the unfortunately high frequency of lung cancer, and the promise of low dose CT screening for this disease will drive people outside of the NLST’s strict inclusion criteria into these low-cost, high-volume CT-scanning conveyor belts to “catch the cancer early.”

And what will they find in the Ohio River Valley?

Lots and lots of lung nodules.

…

The markedly increased propensity of patients in this region to have pulmonary nodules is likely to lead to an increased number of image-guided and open surgical biopsies (when the image-guided biopsy provides insufficient tissue for analysis).  More invasive procedures will naturally lead to more cost-inducing complications (such as pneumothorax and pulmonary hemorrhage) and, in some instances, death.

….

 

 

 

Related articles

• Finally Medicare Agrees To Pay For Smokers’ Lung Cancer Screening
• Histoplasmosis / Spelunker’s Lung / Caver’s Disease
• Can I interrupt your repeating a Medicare press release to talk about cost-effectiveness?
• 13 lung cancers caught by $99 screening program at Mercy Health Saint Mary’s
• Medicare Will Pay For Lung Cancer Screenings

[News article] Could a wireless pacemaker let hackers take control of your heart?

From the 9 February 2015 Science article

Medical devices don’t get regular security updates, like smart phones and computers, because changes to their software could require recertification by regulators like the U.S. Food and Drug Administration (FDA). And FDA has focused on reliability, user safety, and ease of use—not on protecting against malicious attacks. In a Safety Communication in 2013, the agency said that it “is not aware of any patient injuries or deaths associated with these incidents nor do we have any indication that any specific devices or systems in clinical use have been purposely targeted at this time.” FDA does say that it “expects medical device manufacturers to take appropriate steps” to protect devices. Manufacturers are starting to wake up to the issue and are employing security experts to tighten up their systems. But unless such steps become compulsory, it may take a fatal attack on a prominent person for the security gap to be closed.

For more on privacy and to take a quiz on your own privacy IQ, see “The end of privacy” special section in this week’s issue of  Science.

Related articles

• Problem FDA inspection findings in trials seldom reflected in medical literature
• U.S. FDA Commissioner Margaret Hamburg to step down
• FDA Grants Priority Review for Janssen’s Three-Month Schizophrenia Treatment
• High Profile Breast Cancer Drug Now FDA-Approved
• Under Hamburg, FDA Cozied Up to Industries It Regulates, Protected Corporations More Than Patients
• Ignyta’s (RXDX) Entrectinib Granted FDA Orphan Drug Designation