IBM WATSON & AI — IS IT THE NEXT BIG THING?

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A Convention Center was booked for the event. This Convention center in Bangalore was chosen by the Heads of top 10 hospitals to host the gathering of medical experts, healthcare professionals, researchers, pharma company representatives, foreign delegates, government officials, patients and all the stalwarts of the healthcare sector. A special event of around 3000 people is organized where an important announcement needs to be made. The D-Day of the event was near. Dr. Raghu the head in charge was a bit apprehensive. The first Sunday of January 2019 was planned for the event.

Finally, the days passed by swiftly and the first Sunday of January 19′ knocked on the door. Dr. Raghu’s team comprised of doctors, researchers, pharmacist, and healthcare managers. Ms. Rachna was the event manager and Dr. Ranveer, deputy to Dr. Raghu co-ordinated her. The Convention Center glittered with diasporas of decorations, banners, standees, and what not. The invitees trickled slowly at the venue. The humming of people grew louder as the time of the inauguration neared. A whole lot of venue looked celestial. The Global head of a leading pharma company, Head of a top MNC dealing with data analytics, and a famous researcher were the chief guests. The podium was beaming with people. With the lighting of the traditional lamp, the convention was opened. The Chair of the event announced the list of events with the inauguration speech. The topic was –“Diabetes the silent killer – ways to track and control it.”

Dr. Raghu explained the purpose of gathering. Adjusting the mike, he cleared his throat before delivering the most awaited words –

“My friends, today we have gathered to discuss and share about one of the worlds’ most troublesome disease – Diabetes (also called as Diabetes Mellitus). To brush up with the types of diabetes– there are basically three types -Type 1, Type 2, and Gestational (found in pregnant females). In the last decade, the cases of people living with diabetes jumped almost 50 percent. Worldwide, it afflicts more than 422 million people. Diabetes is a leading cause of blindness, kidney failure, amputations, heart failure, and stroke. The global cost of diabetes is now 825 billion dollars per year, according to the largest ever study of diabetes levels across the world led by scientists from Imperial College London, and involved Harvard T.H. Chan School of Public Health, the World Health Organization, and nearly 500 researchers across the globe, incorporated data from 4.4 million adults in most of the world’s countries.*

Atlas-1

Reference- https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html

2 one

Reference- https://www.who.int/diabetes/global-report/WHD2016_Diabetes_Infographic_v2.pdf

From a father waking up at 3 am each night to check the glucose of his toddler with type 1 diabetes, to a brother bandaging the numb feet of his elderly sister with type 2 diabetes, caring for a gestational wife at the cost of office work, are few emotional sides of a diabetic patients’ family. Half of the people living with diabetes recently surveyed by the International Diabetes Federation (IDF) feel that their diagnosis has put a strain on their family. The cost of medication and ongoing care remains an issue in many parts of the world, despite almost 100 years passed since insulin – necessary for treating type 1 diabetes – was first used to treat the condition. 79% of adults with diabetes were living in low- and middle -income countries. The greatest numbers of people with diabetes are between 40 and 59 years of age. 1 in 2 diabetics remains undiagnosed. More than 21 million live births (1 in 7 births) were affected by diabetes during pregnancy in the past 5 years or so. 352 million more people are at risk of developing type 2 diabetes in near future. Diabetes is emerging a serious concern in India too. The number of people with diabetes in India increased from 26•0 million in 1990 to 65•0 million in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5•5% in 1990 to 7•7% in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala and Delhi, followed by Punjab, Goa, and Karnataka. The most important risk factor for diabetes in India was overweight. The cost involved in treating post–diabetic complications is huge** Taking a deep pause in between, “From here onwards, I pass on the mike to Dr. Ranveer, a renowned oncologist, who will explain the complications related to diabetes and why we have gathered here with more than 2000 diabetic patients, along with their families in today’s’ program. I welcome you, Dr.Ranveer.”

Dr. Ranveer, a senior oncologist (a branch that specializes in cancer diagnosis and treatment), eagerly stepped towards the stationed electronic mike. Being a top oncologist and researcher made him an eye candy of all the major research companies and healthcare institutions globally. He greeted everyone and gave a brief introduction while taking out his notepad and keeping it on the front desk,

“Friends, 2013 was a turning point for diabetes and NCDs (Non communicable diseases), with WHO adopting the overarching goal of a 25% reduction in premature mortality from NCDs by 2025 and the nine voluntary targets on NCDs – including a 0% increase in diabetes and obesity prevalence and 80% access to essential medicines and devices by 2025. At the end of that year, IDF created the Parliamentarians for Diabetes Global Network (PDGN), an initiative aimed at increasing political attention to diabetes and the exchange of best practices between policymakers from different countries. A silent killer, this disease is already taking its toll in terms of mortality and morbidity. What happens in this disease? All the cells in your body need sugar to work normally. Sugar gets into the cells with the help of a hormone called insulin; this hormone works like a coded key which is decoded by the cells and allowed entry for its functioning. If there is not enough insulin or if your body stops responding to insulin, sugar builds up in the blood. This is what happens to people with diabetes. High blood sugar levels can lead to problems if untreated. People with Type 1 diabetes don’t produce insulin. You can think of it as not having a proper hormonal key. People with Type 2 diabetes don’t respond to insulin as well as they should and later in the disease often don’t make enough insulin. You can think of this as having a malfunctioned key. Gestational diabetes is high blood sugar that develops during pregnancy and usually disappears after giving birth. It can occur at any stage of pregnancy but is more common in the second half. I am stressing more on Type 2 diabetics because out all the diabetes cases, around 90% share is taken by them. That’s because type 2 develops gradually, and you may not realize that you have high blood glucose for quite some time. Over time, high blood glucose can cause serious damage. Friends, if you don’t work hard to keep your blood glucose level under control, there are short and long-term complications to contend with. Short-term complications of type 2 diabetes are hypoglycemia (very low blood glucose if you’re taking insulin) and hyperosmolar hyperglycemic nonketotic syndrome (HHNS), which is very high blood glucose and a rare condition with increase in thirst and urination but one should be aware of.”

Taking a sip of water, Dr. Ranveer continued, “Long term complications are more problematic. These complications develop over many years and they all relate to how blood glucose levels can affect blood vessels. Over time, high blood glucose can damage the body’s blood vessels, both tiny and large. Damage to your tiny blood vessels causes microvascular complications; damage to your large vessels causes macrovascular complications. Microvascular Complications involve – Eye, Kidney, and Nerve Disease. You have small blood vessels that can be damaged by consistently high blood glucose over time. Damaged blood vessels don’t deliver blood as well as they should, so that leads to other problems, specifically with the eyes, kidneys, and nerves. Eyes: Blood glucose levels out of range for a long period of time can cause cataracts and/or retinopathy in the eyes. Both can cause loss of vision. Kidneys: If untreated, kidney disease (also called diabetic nephropathy) leads to impaired kidney function, Uncontrolled (or poorly controlled) diabetes can cause the kidneys to fail and require dialysis; they’ll be unable to clean the blood properly. Heart and blood vessel disease: Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure. Nerves: Nerve damage caused by diabetes is also known as diabetic neuropathy. The tiny blood vessels “feed” your nerves, so if the blood vessels are damaged, then the nerves will eventually be damaged as well.

Complications-3

Reference- http://www.medsci.org/v11p1185.htm

In type 2 diabetes, some people will already show signs of nerve damage when they’re diagnosed. This is an instance where getting the blood glucose level under control can prevent further damage. But we are more concerned with an increase in cancer predisposition of diabetic patients. Research suggests that a diagnosis of diabetes places a person at an increased risk of various types of cancer. Diabetes — type 1 and type 2 — put people at risk of developing specific types of cancers. We want to target that and catch hold of it early. Thatswhy, we are here on a mission. We want to catch hold of this menace quite early. We want to keep track of this disease in our patients with the help of big data boom along with modern day AI, Analytical tools like Watson Analytics. How can Dr. Watson help us in early diagnosis so that intervention can be done faster?

Our mission here today is to announce that a — Cohort study (longitudinal) of Type 2 diabetics will be undertaken for 3 years (that may extend to phase-II). We have randomly chosen 2000 patients in the age group of 25-45 diagnosed with Type 2 diabetes (A1C levels above 7 and below 9) from the 10 hospitals of Bangalore. If someone migrates in between or any untoward thing happens, we will randomly pick the patient from our secondary replacements. Experts from the field of AI (artificial intelligence) and analytics (Watson Analytics) will collaborate with us. We have Dr. Siddharth of IBM Watson Cognos Analytics with us to explain how the AI can aid us in the study, explain to the patients gathered here how to contribute in the study, and how important is the study in terms of improving patients lives and decreasing financial burden from the healthcare budgets.”

Amidst clapping Dr. Siddharth, a senior leader of the Healthcare Analytics team reaches the mike,
“Good morning friends! Today, I am glad to be among you. Without taking more time, I will explain the relevance of this study. I must say that Dr. Ranveer has wonderfully explained about the crippling power of the disease. Today, we have gathered to explain that this study, where patients (cohorts) who already have Type 2 diabetes will be monitored for certain risk factors (list given in table 1) on a daily basis. A simple list of questions in a survey form will be sent to each participating patient every night. The answers need to be given in either yes/ no/ not sure. This survey is connected to a database center where they will be processed. Apart from this, every six months from the start of study, patients will need to take tests like — BMI (weight), BP, FS/PP levels, some nerve tests (to check numbness & tingling in their hands or feet) A1C findings, ketone levels in urine/blood, microalbumin (a protein in your urine), IL-1alpha(that plays a central role in the regulation of inflammatory responses to infections), LDL levels (low density lipoproteins), androgen levels in females(for PCOs), Vit D/K levels, certain cancer marker genes (e.g. for colorectal cancer marker Carcinoembryonic antigen or CEA is used). It’s not to create panic as many tests patients already undertake but on a more regular and organized way to aid in early diagnosis of precancerous conditions associated with diabetes. On the basis of the analysis of survey data and index findings — the most risk factors will be scored and an alert will be sent to the respective patients for changes in their routine. IBM Watson Analytics is an intelligent, self-service data analysis and visualization application for discovering patterns and insights in your data. The two data findings will collaborate and a comprehensive analysis like —drivers of disease based on the risk factors, top 100-200 very high-risk patients, a progression of disease status, predisposition to a precancerous condition from investigations and scoring, will be traced out through AI. An alert will be sent to the most risk patients for changes in certain routine habit. If anyone is found with abnormal marker levels then a thorough medical history followed by a physical exam, other lab tests, imaging tests will be conducted.

A beauty of a well-run cohort study is the multiple outcomes that can be considered. A group well characterized and followed over a long period of time provides much useful information, and added to our understanding of the roles of obesity, lipids, hypertension, etc. in diabetes as well as contributing an algorithm for predicting increased risk for the precancerous condition. Just to touch upon the word ‘Algorithms’ —they are instructions for solving a problem or completing a task. Here in the study, the data will be processed further to get recipes for risk factors based on certain index scores that can be adaptive and applied to a larger population. Complex algorithms will soon help clinicians make incredibly accurate determinations about our health from large amounts of information, premised on largely unexplainable correlations in that data. Policy makers need to take urgent action to prepare health and social security systems to mitigate the effects of diabetes.”

ASSESSMENT OF RISK FACTORS

5 one

guardian_tu3790

Reference- https://www.thespikeapp.com/

Table 1: Example of ‘Daily survey’ questions
Sr. no Factors
YES (1) No (2) Not sure (3)
1. Late Rise in the morning
2. Nicotine intake
3. Light exercise
4. Heavy exercise
5 Yoga/pilates/dance
6. Breakfast taken
7. Walking some distance for office
8. Maximum time sitting
9. Any conflict in the workplace
10. Lunch taken
11. Fatty diet/Junk food consumed
12. Conc. Juices
13. Walking some distance back to home
14. Evening snacks
15. Alcoholic beverages
16. Smoking more than 2 cigarettes
17. Dinner taken
18. Late dinner
19. Night walking post dinner
20. Late sleep
21.# Any other thing to be discussed

#Patient will be asked to make note of the health-related important things done out of the routine stuff

Table 2: Example of Indices for 6 monthly assessment
Sr.No Investigation Date Value
1. BMI
2. BP
3. FS
4. PP
5. Insulin levels
6. A1C
7. IL-alpha
8. Ketone level
9. LDL levels
10. Androgen levels
11. VIT D/K
12. Cancer Markers (type)

After the speech, the area was live with clapping. The list of programs ended well. It seems that Watson Analytics and AI’s future is bright in the coming years.

(Names and plot in the blog are figments of imagination. Wherever genuine facts and figures are used, due mention of the reference source is given. The IBM Watson Analytics part is based on the authors’ experience of using it. Any resemblance to living or dead is purely coincidental.)

References-

https://www.ncbi.nlm.nih.gov/pubmed/29496507

*https://www.hsph.harvard.edu/news/press-releases/diabetes-cost-825-billion-a-year/

http://www.spiegel.de/international/world/playing-doctor-with-watson-medical-applications-expose-current-limits-of-ai-a-1221543.html

**https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30387-5/fulltext

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