After abandoning my Fitbit device in January because using it didn’t see improvement in my weight (see previous post), I was wondering if I could still measure my risk to develop cardiovascular diseases and other preventable chronic diseases (diabetes e.g.). So, still sitting at my desk (something I do for more than 8 hours a day in theory – probably more in practice), I looked into the ways to monitor my risk for these diseases …
I recently read with interest Dr. Gammino’s post on how geospatial data and microplanning is helping the CDC and its partners to work towards the eradication of polio.
There Dr. Gammino describes the hurdles faced by healthcare workers in countries where census data is often missing, where political, seasonal and geographical variations are making these more difficult. The description of the different social structures in urban or rural areas was also interesting. But the post also highlights how “social mapping” and geographic information systems (GIS) are helping understanding where the population resides and helping reaching them (here for polio vaccination but this could be for other purposes: maternity care, child care, etc.).
In Uttar Pradesh, households supporting polio vaccination in blue, those opposing polio vaccination in red (from Waggs)
In this respect, modelling could help determine the best strategy to reach still unknown population, where settlers could move, where to concentrate efforts e.g. And a few papers actually address these issues. For instance, Rahmandad et al. studied the impact of network types (networks between individuals) on the dynamics of a polio outbreak. Or Tony Wragg reported the influence of information campaigns on polio eradication in India (one could use information as an infectious agent).
Now it would be interesting to see the two worlds collide: having these geotagged information feed a prediction model and reverting back predictions to healthcare workers in the field to inform them of potential areas to visit. This would have some implications for logistics and these efforts should also address privacy questions. But it would potentially help eradicating polio too.
The Open Knowledge Foundation (OKF) released the Open Data Index, along with details on how their methodology. The index contains 70 countries, with UK having the best score and Cyprus the worst score. In fact the first places are trusted by the UK, the USA and the Northern European countries (Denmark, Norway, Finland, Sweden).
And Belgium? Well, Belgium did not score very well: 265 / 1,000. The figure below shows its aggregated score (with green: yes, red: no, blue: unsure).
The issue with this graph is that you may first think it’s a kind of progress bar. For instance, in transport timetables, it seems Belgium reached 60% of a maximum. But the truth is that each bar represents the answer to a specific question. So the 9 questions are, from left to right:
Does the data exist?
Is it in digital form?
Is it publicly available?
Is it free of charge?
Is it online?
Is it machine readable (e.g. spreadsheet, not PDF)?
Is it available in bulk?
Is it open licensed?
Is it up-to-date?
With the notable exceptions of government spending and postcodes/zipcodes, nearly all Belgian data is available in a way or another. That’s already a start – but … None of them are available in bulk nor machine readable nor openly licenced and only few of them are up to date. Be sure to read the information bubbles on the right of the table if you are interested in more details.
The national statistics category leads to a page of tbe Belgian National Bank. And here is one improvement that the OKF could bring to this index: there should be a category about health data. For Belgium we are stuck with some financial data from the INAMI (in PDF, not at all useful as is) but otherwise we have to rely on specific databases or the WHO, the OECD or the World Bank. The painful point is that these supranational bodies often rely on statistics from states themselves – but Belgium doesn’t publish these data by itself!
If you are interested in the topic, three researchers from the Belgian Scientific Institute of Public Health published a study about health indicators in publicly available databases, 2 years ago [1]. Their conclusions were already that Belgium should improve on Belgian mortality and health status data. And the conclusion goes on about politically created issues for data collection, case definition, data presentation, etc.
I was recently in a developping country (Vietnam) where we try to improve data collection: without reliable data collection it is difficult to know what are the issues and to track potential improvements. In the end, this is also applicable in Belgium: we feel proud of our healthcare system ; but on the other hand it is difficult to find health-related data in an uniform way. It is therefore difficult to track trends or improvements.
The US FDArecently approved Proteus Digital Health Ingestion Event Marker (IEM). Basically, it’s a pill with some electronics attached (very tiny electronics: around 0.5mm in diameter for a total weigth of 5mg, see picture below). Once activated the pill transmit a signal and, coupled with a detector, you know when the pill got into your body.
When you think of it, it seems very interesting. The direct potential application (Proteus is only making the IEM, not the pill itself on which the IEM is attached) is to monitor when a patient actually take her/his pills. Or for the patient, just to remember if the pill was taken already or not (you can also use boxes with specific places for each day). Some people see here a plot against human health in general – maybe. But as I use to say: watch the use, don’t punish the tools. The IEM could of course be used to ensure patient’s compliance and increase the surveillance. But on the other end, the IEM could also help decide if a properly taken medication (from “Big Pharma” or from “natural products”) is indeed efficacious.
Another direct application is the correct identification of pills before consumption. There are a lot of websites that will help us correctly identify pills found outside boxes at home (see here for instance). If you activate the IEM on a pill, the signal emitted can directly tell you which medication it is. Provided the signal emitted contains an unique signature.
And there I have some questions … Kit Yee Au-Yeung and her colleagues published an abstract (PDF) at Wireless Health 2010 about the technology. The detailed paper explains well some aspects of the IEM like the way the battery actually uses the patient’s body fluids to power a redox reaction (very simple – hence clever to use it here). But the paper doesn’t say the distance at which the signal can be recorded nor how this signal is encoded.
How far can you measure the signal from this IEM? The paper states that the “communication process remains entirely within the body; it is unnoticed by and not detectable beyond the patient consumer“. It goes into several measures during the reported clinical studies but does not mention how far the signal can be measured. In my opinion, the IEM signal cannot be detected from very far for various reasons: the statement copied above, the output of this type of redox reaction and size of substrate used and the way they define their scheduling adherence. In this definition, a “sensor-enabled medication was considered taken “on-time” when ingested within ± 1 hour and ± 2 hours of the specified time“. Since the IEM is activated as soon as in contact with body fluids and the sensor/detector is placed approximately next to the stomach, I guess the sensor only detects the IEM signal when the IEM actually reaches the stomach. I wonder if one would place the sensor just below the throat, will the time-to-detection be shortened?
How is the signal encoded? The paper reports an identification accuracy of 100%, meaning all detected sensors were correctly identified. It also reports a sensitivity of 97.7%, meaning the study did not detect the negative controls in 97.7% of cases of ingested negative controls. Good. Now what happens if you ingest several different medications at the same time? They will most probably reach the stomach at the same time too and their respective signals will be detected at the same time. The paper says that the sensor/detector “interprets the information from the edible sensor, identifies it as unique“. How? We don’t know. From previous experiment I know it is feasible to encode a somehow unique signal in 5mm of electronics. Up to how many different signals can be encoded (and decoded, given a weak signal)? This will give the maximum number of e-pills you can ingest at the same time.
Although the FDA only approved it for placebo pills so far, it is a very interesting first step towards the control/cure of chronic diseases, sometimes requiring to follow a long-term medication plan. Although the pill is kind of passive and the whole system (*) only measures when a pill is actually ingested, more active e-pills will come to market, for instance only releasing one of their drugs when receiving a signal or delivering a dose adapted to the environment in which they are. Later on you can imagine e-pills acting like Proteus (sic!) in the Fantastic Voyage …
(*) the whole system involves a wearable sensor/detector/patch as well as a “social” application on smartphone. The sensor was already approved by the FDA a long time ago (under the name of “Raisin Personal Monitor”). From the official screenshot the app also reports activity (including sleep), heart beat, blood pressure, etc. (as many other apps around now). Could be cool to try this!
Although numbers seem correct (references are at the bottom), although they intelligently re-use the presentation of some well-known tobacco companies, there is one thing that I don’t like that much: like this sentence, the figure is very, very long. You have to scroll many pages in order to see everything. It may look like a story but it is not presented as such (I mean: there are no clear marks of different steps in the story, except the three “chapters”). On the right is the complete figure in exactly 800 pixels of height – can you read something? GOOD.is solved this issue by using a Flash player that allows the viewer to woom in/out and go to different sections of the figure (see here for instance).
Now, about smoking … Smokers do what they want with their health. Of course, I criticise the physical dependency, the effects on social security and indirectly on everyone’s capacity to react to other health issues. And of course I hope that people could stop smoking. But in my opinion the most disgusting thing about tobacco is secondhand smoking (aka. passive smoking): the inhalation of smoke by persons other than the active smoker. This passive smoking is especially harmful in young children. The CDC estimated that it is responsible for an estimated 150,000–300,000 new cases of bronchitis and pneumonia annually, as well as approximately 7,500–15,000 hospitalizations annually in the United States – both in children below 18 months. And in adults, passive smoking increase the risk of heart disease and lung cancer by 20-30%. Without doing anything – just inhaling smoke from your neighbour.
So it was a very nice idea from them to draw people’s attention to these health issues. It could have been better if the figure would have been more “readable” IMHO.
(*) Unfortunately for them, “Online Nursing Programs” sounds like a website that will just ask for your credit card number although they publish nice infographics – like this other one about sanitation. The About page that doesn’t say who they are add to these doubts.
It all started with a strong statement in the LA Times:
If early humans had been vegans we might all still be living in caves.
It says nothing and everything at the same time … Not eating meat would have stopped our “evolution” from early humans? Not eating meat would make us dumber? Or does it have something else to do? It does.
The original article on PLoS ONE is in fact a study about the impact of carnivory on human development and evolution. And the method used is a model of weaning in Mammals (thus no intelligence test per se). Psouni and her colleagues showed that:
Brain mass is a better fundamental predictor of time to weaning than is female body mass (figure 2);
Limb biomechanics is a predictor of time to weaning (figure 3);
Dietary profile is a predictor of time to weaning (figure 4) and that
Time to weaning in humans is quantitatively predictable from a carnivorous diet (figure 5).
So eating meat made human women wean more rapidly than if we stayed vegetarian. Their model suggests that “the contribution of carnivory was to shorten the duration of lactation and suckling despite the overall prolongation of development associated with increased adult brain mass”. Nothing about intelligence thus.
However this paper came to my knowledge after OAD published a (quite long) infographics about the dangers of red meat (not meat in general). On the presentation-side, I’m not sure such long vertical banner is powerful enough: after some time you are tired to scroll down. On the content-side, it’s a well-known fact that red meat comes with a lot of healthy risks. On top of that, the infographics focuses a lot on the USA, one of the countries where the consumption of red meat is high. This reminded me a TV programme from Jamie Oliver where he showed how meat is processed in the USA …
It’s “good” to be reminded of all this only once you’ve come back from there …
Key messages? Always read the original paper (even diagonally it’s better than general press) and know what you eat!
Edited on May 12, 2013 to remove the link to the original infographics (as it was not present anymore).
Indeed: 2011 was the International Year of Chemistry (IYC). But why IUPAC and UNESCO dedicated a year to that basic science? It was for two reasons: one looking at the past and one looking at the future.
Looking at the past, 2011 was the 100th anniversary of Marie Curie‘s Nobel Prize in Chemistry for her discovery of the elements radium and polonium. She was the first woman to be awarded a Nobel Prize. And her discovery was very important for both the science in itself and its applications to health. Radium’s radioactivity seemed to contradict the principle of the conservation of energy. The discovery of radium allowed other great names in chemistry and physics like Rutherford to study the atom and radioactivity decay. In medicine, the radioactivity of radium allowed the development of radiation therapies, used to control or kill malignant cells in cancer treatment.
But 2011 was also the 100th anniversary of the first Solvay conference which subject was “Radiation and the Quanta”. Marie Curie was obviously present, along with Henri Poincaré, Max Planck, Ernest Rutherford and Albert Einstein among others. It was held at the Hotel Metropole, in Brussels (yes, in Belgium 🙂 ). Solvay conferences in physics and chemistry still continue now.
1911 Solvay conference
So IUPAC and UNESCO wanted to commemorate the achievements of chemistry and its contributions to the well-being of humankind in general. And 2011 was full of activities all over the world (there was probably one near your place and there are still plenty of activities prepared for 2012!).
One of these activities was the creation of a team of young people/scientists who debated and introduced their ideas and expectations from life sciences and chemistry, industry and governments to build a better world in 2050. I am grateful to my company to have chosen me to represent it in this “Young Leader” team: it really was a great experience!
Every member of the team came from different horizons (Europe, Asia, America, Africa) with different backgrounds all related in a way or another to chemistry (but it’s true that we were mostly chemists and engineers). We started by the simple statement that “chemistry is everywhere and for everyone“. It’s quite obvious but if we are often reminded of the negative impacts of chemical products and chemical reactions, chemistry also enabled billions of applications and made possible to feed more people, give them shelters and potentially a better health. It’s not roses all the way ; mankind has lots of efforts and progress to make. But if you think of the computer you are using to read this post, for instance: it’s working thanks to thousands of chemical compounds and chemical reactions. And on top of that, chemistry is also a natural process (well, first, it’s a natural process). When you eat your breakfast, when you listen to a lecture, when you attend a meeting, when you practice some sport, when you meet friends, when you sleep, you are full of chemical reactions, using thousand different chemical elements.
But as the world is facing important challenges like overpopulation, energy depletion, pollution, etc. or simply because people want to make their lives better it’s also true that chemistry is our future and will play a role in tackling these issues. But instead of depicting a sad, pessimistic view of these issues and just enumerating technical solution chemistry is or will be designing, the team decided to work on a vision for 2050 and ways towards this vision:
By 2050 we must all have access to healthy, safe and fulfilled lives in symbiosis with our planet
With concrete examples of existing or budding chemical technologies and solutions allowed by the development of chemistry, we wrote three concrete stories of people who would have made a change in the future. Most megatrends were debated, lots of research was done to find scientific evidences of change or application. Better water distribution and usage, smarter housing, increased yields for locally produced food, more efficient energy production and storage mechanisms were among the topics we discussed. Health was also present as education, biotechnologies (like new delivery and detection methods), collaborations and policies also play a key role, with chemistry as a pervasive partner.
A milestone for the group was the Closing Ceremony of the IYC that was held in Brussels, on December 1st, 2011. We had to transmit that vision, the way we think it can be achieved to students and members of the chemistry community. It was a great pleasure to see the high level of interest and, for most of them, of passion the young students have towards Chemistry. Their questions, their curiosity about the future, their questioning of the implementation of our vision as well and their thirst of knowledge were amazing. It was also very, very interesting to listen to Ada Yonath’s talk about ribosomes but also science, curiosity and her passion. Professor Jean-Luc Brédas, Francqui Prize in 1997, also gave a very interesting talk about new and more efficient energy sources. Finally, the debate, the round table between main actors in the world of chemistry, the ideas, comments, discussions that followed were all very instructive and enlightening.
Fortunately this is not the end. All these ideas and discussions will definitely feed discussions and our efforts to maintain a platform for chemistry and its ways to help for a better future. We already started with a Facebook group. Central science created special topics about IYC activities. Nature created an IYC website with dozens of articles about everything from research to careers. And I hope to be able to write again about other initiative and, of course, about the fulfillment of our vision in 2050 (or even before!).
Photo credits: Marie Curie, from Scientific American by Wyoming_Jackrabbit (CC-by-nc-sa on Flickr). The photo of the Solvay conference was taken by Benjamin Couprie and from wikipedia. Photos of the YL group and the closing ceremony are from Vivian Hertz.
The Economist: non-communicable diseases account for the majority of deaths worldwide
I have nothing to add about the chart on the left (except I don’t think stacked bars are really useful to visually distinguish between quantities ; ok, I added something). My first reaction to the chart on the right was: these countries in the lower middle income group should really do something to tackle non communicable diseases: they represent more than the double amount of deaths than the total number of deaths in other income groups. Even for communicable diseases, they should do something: from the chart, it seems to be a bit less than 10m deaths from communicable diseases, i.e. approximately the same amount as the total number of deaths in other income groups too!
Just for you information (and because I also had to recall which countries were in that lower middle income group), here are some countries in the various groups (*):
Low income group: Afghanistan, Bangladesh, Ethiopia, North Korea, Nepal, Somalia, Togo, a.o.
Lower middle income group: Angola, Bolivia, Congo, Georgia, India, Iraq, Morocco, Pakistan, Sudan, Ukraine, Vietnam, a.o.
Upper middle income group: Algeria, Brazil, China, Cuba, Libya, Malaysia, Russian Federation, Serbia, South Africa, Thailand, a.o.
High income group: E.U. countries, Japan, Singapore, Switzerland, USA, a.o.
(*) Technically it follows the way the World bank classifies countries: economies are divided according to 2010 GNI per capita, calculated using the World Bank Atlas method. The groups are: low income, $1,005 or less; lower middle income, $1,006 – $3,975; upper middle income, $3,976 – $12,275; and high income, $12,276 or more.
Then you realize that if you just take the absolute number of deaths and compare these group of countries (as it’s done in the chart on the left), you don’t compare exactly on the same basis. What if some groups have more countries or lower/higher population? What if the total surface of countries in one group are much higher (lower) than in other groups? Idem for the population density, etc.
Fortunately, the WHO has a parameter one can use in order to objectivize a little bit this issue: the “Age-standardized mortality rate by cause (per 100 000 population)”. If you plot this parameter in the same way as above, you obtain this chart:
Age-standardized mortality rate by cause (per 100 000 population) per income group
From this you can now say that low income countries should really do something about NCDs but also communicable diseases, etc.
Presented like this, the number of deaths due to injuries and communicable diseases (per 100,000 pop.) decreases if the income of the country increases. In other word, more income you have, relatively less risk you have to die from injuries or communicable diseases. That explains why 1 death under a fallen wall is reported as a big sad news in Belgium while 60 deaths in a bus crash are not even reported in the news in India.
Another striking conclusion is that in low income countries there is approximately the same number of deaths (per 100,000 pop.) due to NCDs and due to communicable diseases (+/- 20%). We are all aware of tuberculosis, malaria, AIDS/HIV, etc. in less rich countries but it seems NCDs are an equally important issue.
But the most frightful conclusion from these numbers is that there is approximately the same number of deaths (per 100,000 pop.) due to NCDs in all income groups (674 ± 75) except the high income one. In other words, irrespective of you location or your income (except high income), you have the same chances to be affected by a non communicable disease. And irrespective on your income (and this time, even for high income countries), you have more chances to die from a non communicable disease than a communicable disease.
Last week, United Nations gathered in New York, USA, to talk about prevention and control of non-communicable diseases (NCDs). Non-communicable diseases are non-infectious, of long duration and generally progressing slowly. Due to the fact they are not infectious, there is no pathogen to target and there is no transmission medium to fight. Due to their long duration and slow progression, one usually notices NCDs when it’s too late and eradicating NCDs is less spectacular than other (not less important) infectious diseases. However WHO measured that NCDs represents more than 60% of all deaths in the world. For the occasion, WHO released an introductory video that summarize the issue.
So there are 4 main non-communicable diseases:
Cardiovascular diseases
Diabetes (both of them represent 70% of deaths by NCDs)
Cancers (~ 20% of deaths by NCDs)
Chronic respiratory diseases (~ 10% of deaths by NCDs)
NCDs are not directly in the UN Millenium Development Goals but I already mentioned they represent 4 of the top 5 killers in the USA. Two of them are also in the top 5 killers worldwide. If the Millenium Goals succeed, non-communicable diseases will be the next big issue in health.
Although NCDs were considered as a disease limited to high income countries (with infectious diseases affecting low income countries), this is not really the case anymore. For instance, the map of male deaths due to cardiovascular diseases and diabetes in 2008 shows an approximately uniform rate in high income countries with some higher rates in low income countries (especially on the African continent).
WHO World : Cardiovascular diseases and diabetes, death rates per 100 000 population, age standardized: Males, 2008
If nothing is done, the incidence of NCDs will increase. On top of being a health issue, a matter of life and death, it will also become an economical problem as the costs of treatment as well as the indirect costs will also dramatically increase (increase per case treated and increase due to the number of cases treated).
Incident cases and cost of diagnosed diabetes per 1,000 people (adapted from Boyle et al. 2010 and Alternative Futures Diabetes 2025)
If you are looking for more figures about the cost of non-communicable diseases, here are two detailed reports recently published:
In a nutshell, non-communicable diseases are everywhere and the future doesn’t look happy. However …
However risk factors are identified and many of them are related to our own lifestyle:
Physical inactivity
Unhealthy diet
Tobacco use
Harmful use of alcohol
To end on a positive note, all these risk factors can be easily controlled and for a limited additional cost. For instance, governments can protect people from tobacco (taxes as well as bans on tobacco advertising, promotion and sponsorship, …) and alcohol (access restriction, bans on advertising, …) as well as promote public awareness about diet and physical activity. Companies can also promote healthy diet and physical activities to their employees. On top of that, the food industry can also include relevant actions in their corporate social responsibility policies. Finally on a personal level, we can increase our physical activity, increase fruit and vegetable intake, reduce our use of tobacco and alcohol, etc. Simple, cheap actions ; huge interesting consequences.
I just read that orange agent is used in Brazil to clear the Amazon. I am not judging people who may be forced by their living conditions to do this (although I doubt people who did this are poor since they sprayed it by plane). It may be the cheapest way to clear a forest to use the land for pasture (although I doubt buying chemical and spraying it by plane is cheap). But …
Because that’s the second stupid thing they are making: cows, horses, goats, sheep, etc. that will graze there will also be contaminated. In the worst case (for them), their meat will immediately be unfit for human. In the worst case (for everybody), the meat will be sold to people outside contaminated zones and these people will also be contaminated …
I will not be surprised if I read news about baby malformations in the coming years in Brazil. And I’m wondering why Monsanto is still selling orange agent anywhere in the world. Is money so important compared to human health?
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