health

Pricing Lives: Guideposts for a Safer Society

Curated on October 31, 2018 by Stefaan Verhulst

Book by W. Kip Viscusi: “Like it or not, sometimes we need to put a monetary value on people’s lives. In the past, government agencies used the financial “cost of death” to monetize the mortality risks of regulatory policies, but this method vastly undervalued life. Pricing Lives tells the story of how the government came to adopt an altogether different approach–the value of a statistical life, or VSL—and persuasively shows how its more widespread use could create a safer and more equitable society for everyone.

In the 1980s, W. Kip Viscusi used the method to demonstrate that the benefits of requiring businesses to label hazardous chemicals immensely outweighed the costs. VSL is the risk-reward trade-off that people make about their health when considering risky job choices. With it, Viscusi calculated how much more money workers would demand to take on hazardous jobs, boosting calculated benefits by an order of magnitude. His current estimate of the value of a statistical life is $10 million. In this book, Viscusi provides a comprehensive look at all aspects of economic and policy efforts to price lives, including controversial topics such as whether older people’s lives are worth less and richer people’s lives are worth more. He explains why corporations need to abandon the misguided cost-of-death approach, how the courts can profit from increased application of VSL in assessing liability and setting damages, and how other countries consistently undervalue risks to life.

Pricing Lives proposes sensible economic guideposts to foster more protective policies and greater levels of safety in the United States and throughout the world….(More)”.

Positive deviance, big data, and development: A systematic literature review

Curated on October 31, 2018 by Stefaan Verhulst

Paper by Basma Albanna and Richard Heeks: “Positive deviance is a growing approach in international development that identifies those within a population who are outperforming their peers in some way, eg, children in low‐income families who are well nourished when those around them are not. Analysing and then disseminating the behaviours and other factors underpinning positive deviance are demonstrably effective in delivering development results.

However, positive deviance faces a number of challenges that are restricting its diffusion. In this paper, using a systematic literature review, we analyse the current state of positive deviance and the potential for big data to address the challenges facing positive deviance. From this, we evaluate the promise of “big data‐based positive deviance”: This would analyse typical sources of big data in developing countries—mobile phone records, social media, remote sensing data, etc—to identify both positive deviants and the factors underpinning their superior performance.

While big data cannot solve all the challenges facing positive deviance as a development tool, they could reduce time, cost, and effort; identify positive deviants in new or better ways; and enable positive deviance to break out of its current preoccupation with public health into domains such as agriculture, education, and urban planning. In turn, positive deviance could provide a new and systematic basis for extracting real‐world development impacts from big data…(More)”.

The biggest pandemic risk? Viral misinformation

Curated on October 24, 2018 by Stefaan Verhulst

Heidi J. Larson at Nature: “A hundred years ago this month, the death rate from the 1918 influenza was at its peak. An estimated 500 million people were infected over the course of the pandemic; between 50 million and 100 million died, around 3% of the global population at the time.

A century on, advances in vaccines have made massive outbreaks of flu — and measles, rubella, diphtheria and polio — rare. But people still discount their risks of disease. Few realize that flu and its complications caused an estimated 80,000 deaths in the United States alone this past winter, mainly in the elderly and infirm. Of the 183 children whose deaths were confirmed as flu-related, 80% had not been vaccinated that season, according to the US Centers for Disease Control and Prevention.

I predict that the next major outbreak — whether of a highly fatal strain of influenza or something else — will not be due to a lack of preventive technologies. Instead, emotional contagion, digitally enabled, could erode trust in vaccines so much as to render them moot. The deluge of conflicting information, misinformation and manipulated information on social media should be recognized as a global public-health threat.

So, what is to be done? The Vaccine Confidence Project, which I direct, works to detect early signals of rumours and scares about vaccines, and so to address them before they snowball. The international team comprises experts in anthropology, epidemiology, statistics, political science and more. We monitor news and social media, and we survey attitudes. We have also developed a Vaccine Confidence Index, similar to a consumer-confidence index, to track attitudes.

Emotions around vaccines are volatile, making vigilance and monitoring crucial for effective public outreach. In 2016, our project identified Europe as the region with the highest scepticism around vaccine safety (H. J. Larson et al. EBioMedicine 12, 295–301; 2016). The European Union commissioned us to re-run the survey this summer; results will be released this month. In the Philippines, confidence in vaccine safety dropped from 82% in 2015 to 21% in 2018 (H. J. Larson et al. Hum. Vaccines Immunother. https://doi.org/10.1080/21645515.2018.1522468; 2018), after legitimate concerns arose about new dengue vaccines. Immunization rates for established vaccines for tetanus, polio, tetanus and more also plummeted.

We have found that it is useful to categorize misinformation into several levels….(More).

Wearable device data and AI can reduce health care costs and paperwork

Curated on October 23, 2018 by Stefaan Verhulst

Darrell West at Brookings: “Though digital technology has transformed nearly every corner of the economy in recent years, the health care industry seems stubbornly immune to these trends. That may soon change if more wearable devices record medical information that physicians can use to diagnose and treat illnesses at earlier stages. Last month, Apple announced that an FDA-approved electrocardiograph (EKG) will be included in the latest generation Apple Watch to check the heart’s electrical activity for signs of arrhythmia. However, the availability of this data does not guarantee that health care providers are currently equipped to process all of it. To cope with growing amounts of medical data from wearable devices, health care providers may need to adopt artificial intelligence that can identify data trends and spot any deviations that indicate illness. Greater medical data, accompanied by artificial intelligence to analyze it, could expand the capabilities of human health care providers and offer better outcomes at lower costs for patients….

By 2016, American health care spending had already ballooned to 17.9 percent of GDP. The rise in spending saw a parallel rise in health care employment. Patients still need doctors, nurses, and health aides to administer care, yet these health care professionals might not yet be able to make sense of the massive quantities of data coming from wearable devices. Doctors already spend much of their time filling out paperwork, which leaves less time to interact with patients. The opportunity may arise for artificial intelligence to analyze the coming flood of data from wearable devices. Tracking small changes as they happen could make a large difference in diagnosis and treatment: AI could detect abnormal heartbeat, respiration, or other signs that indicate worsening health. Catching symptoms before they worsen may be key to improving health outcomes and lowering costs….(More)”.

Many Around the World Are Disengaged From Politics

Curated on October 18, 2018 by Stefaan Verhulst

Richard Wike and Alexandra Castillo at Pew Research Center: “An engaged citizenry is often considered a sign of a healthy democracy. High levels of political and civic participation increase the likelihood that the voices of ordinary citizens will be heard in important debates, and they confer a degree of legitimacy on democratic institutions. However, in many nations around the world, much of the public is disengaged from politics.

To better understand public attitudes toward civic engagement, Pew Research Center conducted face-to-face surveys in 14 nations encompassing a wide range of political systems. The study, conducted in collaboration with the Center for Strategic and International Studies (CSIS) as part of their International Consortium on Closing Civic Space (iCon), includes countries from Africa, Latin America, Europe, the Middle East and Southeast Asia. Because it does not represent every region, the study cannot reflect the globe as a whole. But with 14,875 participants across such a wide variety of countries, it remains a useful snapshot of key, cross-national patterns in civic life.

The survey finds that, aside from voting, relatively few people take part in other forms of political and civic participation. Still, some types of engagement are more common among young people, those with more education, those on the political left and social network users. And certain issues – especially health care, poverty and education – are more likely than others to inspire political action. Here are eight key takeaways from the survey, which was conducted from May 20 to Aug. 12, 2018, via face-to-face interviews.

Most people vote, but other forms of participation are much less common. Across the 14 nations polled, a median of 78% say they have voted at least once in the past. Another 9% say they might vote in the future, while 7% say they would never vote.

With at least 9-in-10 reporting they have voted in the past, participation is highest in three of the four countries with compulsory voting (Brazil, Argentina and Greece). Voting is similarly high in both Indonesia (91%) and the Philippines (91%), two countries that do not have compulsory voting laws.

The lowest percentage is found in Tunisia (62%), which has only held two national elections since the Jasmine Revolution overthrew long-serving President Zine El Abidine Ben Ali in 2011 and spurred the Arab Spring protests across the Middle East.

Attending a political campaign event or speech is the second most common type of participation among those surveyed – a median of 33% have done this at least once. Fewer people report participating in volunteer organizations (a median of 27%), posting comments on political issues online (17%), participating in an organized protest (14%) or donating money to a social or political organization (12%)….(More)”.

DNA databases are too white. This man aims to fix that.

Curated on October 17, 2018 by Stefaan Verhulst

Interview of Carlos D. Bustamante by David Rotman: “In the 15 years since the Human Genome Project first exposed our DNA blueprint, vast amounts of genetic data have been collected from millions of people in many different parts of the world. Carlos D. Bustamante’s job is to search that genetic data for clues to everything from ancient history and human migration patterns to the reasons people with different ancestries are so varied in their response to common diseases.

Bustamante’s career has roughly spanned the period since the Human Genome Project was completed. A professor of genetics and biomedical data science at Stanford and 2010 winner of a MacArthur genius award, he has helped to tease out the complex genetic variation across different populations. These variants mean that the causes of diseases can vary greatly between groups. Part of the motivation for Bustamante, who was born in Venezuela and moved to the US when he was seven, is to use those insights to lessen the medical disparities that still plague us.

But while it’s an area ripe with potential for improving medicine, it’s also fraught with controversies over how to interpret genetic differences between human populations. In an era still obsessed with race and ethnicity—and marred by the frequent misuse of science in defining the characteristics of different groups—Bustamante remains undaunted in searching for the nuanced genetic differences that these groups display.

Perhaps his optimism is due to his personality—few sentences go by without a “fantastic” or “extraordinarily exciting.” But it is also his recognition as a population geneticist of the incredible opportunity that understanding differences in human genomes presents for improving health and fighting disease.

David Rotman, MIT Technology Review’s editor at large, discussed with Bustamante why it’s so important to include more people in genetic studies and understand the genetics of different populations.

How good are we at making sure that the genomic data we’re collecting is inclusive?

I’m optimistic, but it’s not there yet.

In our 2011 paper, the statistic we had was that more than 96% of participants in genome-wide association studies were of European descent. In the follow-up in 2016, the number went from 96% to around 80%. So that’s getting better. Unfortunately, or perhaps fortunately, a lot of that is due to the entry of China into genetics. A lot of that was due to large-scale studies in Chinese and East Asian populations. Hispanics, for example, make up less than 1% of genome-wide association studies. So we need to do better. Ultimately, we want precision medicine to benefit everybody.

Aside from a fairness issue, why is diversity in genomic data important? What do we miss without it?

First of all, it has nothing to do with political correctness. It has everything to do with human biology and the fact that human populations and the great diaspora of human migrations have left their mark on the human genome. The genetic underpinnings of health and disease have shared components across human populations and things that are unique to different populations….(More)”.

Governing artificial intelligence: ethical, legal, and technical opportunities and challenges

Curated on October 15, 2018July 19, 2019 by Stefaan Verhulst

Introduction to the Special Issue of the Philosophical Transactions of the Royal Society by Sandra Wachter, Brent Mittelstadt, Luciano Floridi and Corinne Cath: “Artificial intelligence (AI) increasingly permeates every aspect of our society, from the critical, like urban infrastructure, law enforcement, banking, healthcare and humanitarian aid, to the mundane like dating. AI, including embodied AI in robotics and techniques like machine learning, can improve economic, social welfare and the exercise of human rights. Owing to the proliferation of AI in high-risk areas, the pressure is mounting to design and govern AI to be accountable, fair and transparent. How can this be achieved and through which frameworks? This is one of the central questions addressed in this special issue, in which eight authors present in-depth analyses of the ethical, legal-regulatory and technical challenges posed by developing governance regimes for AI systems. It also gives a brief overview of recent developments in AI governance, how much of the agenda for defining AI regulation, ethical frameworks and technical approaches is set, as well as providing some concrete suggestions to further the debate on AI governance…(More)”.

A Doctor’s Prescription: Data May Finally Be Good for Your Health

Curated on October 9, 2018 by Stefaan Verhulst

Interview by Art Kleiner: “In 2015, Robert Wachter published The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, a skeptical account of digitization in hospitals. Despite the promise offered by the digital transformation of healthcare, electronic health records had not delivered better care and greater efficiency. The cumbersome design, legacy procedures, and resistance from staff were frustrating everyone — administrators, nurses, consultants, and patients. Costs continued to rise, and preventable medical mistakes were not spotted. One patient at Wachter’s own hospital, one of the nation’s finest, was given 39 times the correct dose of antibiotics by an automated system that nobody questioned. The teenager survived, but it was clear that there needed to be a new approach to the management and use of data.

Wachter has for decades considered the delivery of healthcare through a lens focused on patient safety and quality. In 1996, he coauthored a paper in the New England Journal of Medicine that coined the term hospitalist in describing and promoting a new way of managing patients in hospitals: having one doctor — the hospitalist — “own” the patient journey from admission to discharge. The primary goal was to improve outcomes and save lives. Wachter argued it would also reduce costs and increase efficiency, making the business case for better healthcare. And he was right. Today there are more than 50,000 hospitalists, and it took just two years from the article’s publication to have the first data proving his point. In 2016, Wachter was named chair of the Department of Medicine at the University of California, San Francisco (UCSF), where he has worked since 1990.

Today, Wachter is, to paraphrase the title of a recent talk, less grumpy than he used to be about health tech. The hope part of his book’s title has materialized in some areas faster than he predicted. AI’s advances in imaging are already helping the detection of cancers become more accurate. As data collection has become better systematized, big technology firms such as Google, Amazon, and Apple are entering (in Google’s case, reentering) the field and having more success focusing their problem-solving skills on healthcare issues. In his San Francisco office, Wachter sat down with strategy+businessto discuss why the healthcare system may finally be about to change….

Systems for Fresh Thinking

S+B: The changes you appreciate seem to have less to do with technological design and more to do with people getting used to the new systems, building their own variations, and making them work.
WACHTER: The original electronic health record was just a platform play to get the data in digital form. It didn’t do anything particularly helpful in terms of helping the physicians make better decisions or helping to connect one kind of doctor with another kind of doctor. But it was a start.

I remember that when we were starting to develop our electronic health record at UCSF, 12 or 13 years ago, I hired a physician who is now in charge of our health computer system. I said to him, “We don’t have our electronic health record in yet, but I’m pretty sure we will in seven or eight years. What will your job be when that’s done?” I actually thought once the system was fully implemented, we’d be done with the need to innovate and evolve in health IT. That, of course, was asinine.

S+B: That’s like saying to an auto mechanic, “What will your job be when we have automatic transmissions?”
WACHTER: Right, but even more so, because many of us saw electronic health records as the be-all and end-all of digitally facilitated medicine. But putting in the electronic health record is just step one of 10. Then you need to start connecting all the pieces, and then you add analytics that make sense of the data and make predictions. Then you build tools and apps to fit into the workflow and change the way you work.

One of my biggest epiphanies was this: When you digitize, in any industry, nobody is clever enough to actually change anything. All they know how to do is digitize the old practice. You only start seeing real progress when smart people come in, begin using the new system, and say, “Why the hell do we do it that way?” And then you start thinking freshly about the work. That’s when you have a chance to reimagine the work in a digital environment…(More)”.

Can the UN Include Indigenous Peoples in its Development Goals?: There’s An App For That

Curated on October 9, 2018 by Stefaan Verhulst

Article by Jacquelyn Kovarik at NACA: “…Last year, during a high-level event of the General Assembly, a coalition of states along with the European Union and the International Labour Organization announced a new technology for monitoring the rights of Indigenous people. The proposal was a web application called “Indigenous Navigator,” designed to enable native peoples to monitor their rights from within their communities. The project is extremely seductive: why rely on the General Assembly to represent Indigenous peoples when they can represent themselves—remotely and via cutting-edge data-collecting technology? Could an app be the answer to over a decade of failed attempts to include Indigenous peoples in the international body?

The web application, which officially launched in 11 countries early this year, is comprised of four “community-based monitoring tools” that are designed to bridge the gap between Indigenous rights implementation and the United Nations goals. The toolbox, which is available open-access to anyone with internet, consists of: a set of two impressively comprehensive surveys designed to collect data on Indigenous rights at a community and national level; a comparative matrix that illustrates the links between the UN Declaration on Indigenous Rights and the UN development goals; an index designed to quickly compare Indigenous realities across communities, regions, or states; and a set of indicators designed to measure the realization of Indigenous rights in communities or states. The surveys are divided by sections based on the UN Declaration on the Rights of Indigenous Peoples, and include such categories as cultural integrity, land rights, access to justice, health, cross-border contacts, freedom of expression and media, education, and economic and social development. The surveys also include tips for methodological administration. For example, in questions about poverty rates in the community, a tip provided reads: “Most people/communities have their own criteria for defining who are poor and who are not poor. Here you are asked to estimate how many of the men of your people/community are considered poor, according to your own criteria for poverty.” It then suggests that it may be helpful to first discuss what are the perceived characteristics of a poor person within the community, before answering the question….(More)”.