Will AI take diagnosis away from docs?
Volume 8, Issue 6 | July 19, 2023
In This Issue
Using wastewater and AI to halt the next pandemic
GAO reports on the “coulda” and “shoulda” of COVID-19 gov response
Alzheimer’s diagnostics take another step forward
New and Noteworthy
Using wastewater and AI to stop the next pandemic before it starts
Global wastewater surveillance could potentially have stopped the COVID pandemic in its tracks, says Samuel V. Scarpino, director of AI and Life Sciences at Northeastern University’s Institute for Experiential AI. The good news is that the basic infrastructure for that surveillance already exists, according to a recent Lancet paper on which Scarpino is a coauthor. But it needs consistent funding and better global coordination.
One roadblock to coordination: Some nations don’t want to share their wastewater data. Scarpino’s group is developing a model that gets around this problem by using federated learning, in which each participant uses their own dataset to independently train an algorithm without sharing data with one another. The resulting model would trigger an alarm whenever pathogen levels rise in a certain area - or when new pathogens show up.
AI can be used to identify those new pathogens, too - the Northeastern AI group is currently training neural networks to recognize when the mix of pathogens in the poopy soup has changed, which is an indicator that something new has arrived.
GAO COVID-19 report offers fixes; some were mandated a long time ago
The Government Accountability Office (GAO) has produced a broad-ranging report focused on what could (and should) have been done better in the government’s response to COVID. It focuses on multiple topics, from public health preparedness (diagnostic testing and medical countermeasures) to improper payments, fraud and funding distribution, COVID’s impact on the economy, and protecting vulnerable populations. Most of the report focused on financial issues, but we were interested in the public health recommendation to create a national biosurveillance network, including a country-wide wastewater testing program as a critical leading indicator.
The challenging news is that much of the reforms have not been put into place: The biosurveillance network was mandated by federal law 16 years ago but has yet to be established. According to the GAO website: “GAO has made 386 recommendations to executive branch agencies and 19 matters for congressional consideration to strengthen the transparency and accountability of the federal response to the pandemic. As of April 2023, the agencies had fully or partially addressed 47 percent of these recommendations and Congress had fully addressed two matters.”
Another step into the new era of Alzheimer’s diagnostics
Following up on our feature on Alzheimer’s diagnostics, we’re already seeing change in that sphere: The Alzheimer’s Association and the international committee of the National Institutes of Health’s National Institute on Aging have added blood-based biomarker tests to their new draft guidelines for Alzheimer’s diagnosis. The tests look for the following:
Amyloid-beta proteinopathy, based on plasma amyloid-beta 42/40 ratio
Tau proteinopathy, based on measurements of pTau-181 and pTau-217
Not surprisingly, there were caveats. The proposed guidelines noted that any test must not be used in isolation; it must be evaluated within a clinical context. More to come here as time progresses.
Food for Thought
Will “a machine-intelligent world” take over diagnosis from docs?
This week, Science published a special issue, “A machine-intelligent world,” beautifully synthesized in this week’s Ground Truths blog by Eric Topol. Among its wide range of topics were AI’s application in infectious disease and its impact on clinical diagnosis. Illustration from Science included below.
A policy perspective by professors from the University of Toronto’s Rotman School of Management points out that in the past, automation has enhanced the productivity of highly skilled workers (by taking over their routine tasks and allowing them to focus on more knowledge-based work) and empowered the less skilled (by augmenting their capabilities), at the expense of the middle. However, when it comes to medical diagnosis, that paradigm may shift.
Up to now, the authors note, “diagnostic expertise has been the cornerstone of a physician skillset.” AI has the potential to automate elements of this skillset, thereby empowering highly educated and trained medical staff who are not physicians (“pharmacists, nurse practitioners, physician assistants, and paramedics”).
Commentary: Whether AI will be more broadly used will depend on choices about how we allow AI to be used. For now, the vast majority of the 521 FDA-approved AI-enabled medical devices are imaging and cardiac-monitoring applications that look for needles in haystacks: clinically important signals embedded in very large electronic datasets. These electronic datasets and / or images are also tough for a person to read quickly and effectively - too easy to miss that needle. But this field is moving as fast as technology will allow - as the competitive innovation and the money to fund the best efforts are there. We believe that at least the analysis of medical data sets (for individual patients and for population-wide data) will change in the next 3-5 years. We also expect and will cheer when the delivery of that data changes to make it faster and more efficient. This will involve not only AI but “simple” algorithms that are customized by patient and provider. You might want everything in an online portal, while your friend wants it in a text and your neighbor wants it on paper.
We hope and expect diagnostic test results to be easier to understand, delivered more quickly, and in the form that each recipient wants or needs. A pipe dream? Hopefully not.
COVID deaths - and all excess deaths - are down
Preliminary data from the National Center for Health Statistics regarding COVID deaths in 2022 showed:
The COVID death rate declined 47% from 2021 to 2022
76% of deaths were caused by COVID
COVID was a contributing factor in 24% of deaths
The COVID death rate was highest among:
Persons 85 years old and older
Non-Hispanic American Indian and Alaska Native populations
Males
The CDC also published their data showing that roughly 80 people are dying from COVID per day (meaning that COVID either directly caused death or was a contributor). COVID was the fourth leading cause of death, down this year from number three, at 5.7% of overall deaths. And as Your Local Epidemiologist reported, excess deaths have finally reached and remained at pre-pandemic levels, starting at the beginning of 2023. (On a weekly basis, excess deaths happen when the number of deaths during a given week is higher than the average number of deaths we’d expect during that week.)
Quick Hits
The dogs continue to get good press! A recent meta-study covering 31,000 samples showed that trained sniffer dogs can detect COVID at least as effectively as antigen tests - and in some cases, more sensitively than PCR.
A recent report in Nature Communications documented “at least 109 independent spillovers” of the SARS-CoV-2 virus from humans to white-tailed deer, including Alpha, Gamma, Delta, and Omicron variants. These transmissions then led to 39 cases of deer-to-deer transmission and three cases in which the virus may have spilled back from deer to people.
If you have a hard time hearing conversations in loud restaurants, read this
Our diagnostics-related Public Service Announcement for the week: Hearing tests are important! If you’re at risk for dementia, uncorrected hearing loss makes your risk even worse.
Why? Three potential reasons:
The inner ear and the brain must work harder to hear and understand what it is hearing.
Hearing loss may create structural deficits on the brain, causing it to shrink faster.
If you can’t hear well, you might avoid social situations, which in itself increases your dementia risk.
So if you have risk factors for dementia and you find yourself asking the kids or grandkids to repeat themselves a lot, get a test. We understand that it’s a hassle, and hearing aids aren’t the hippest accessory, but it’s worth it.