By SAURABH JHA, MD
This is the part two of a three-part series. Catch up on Part One here.
Preetham Srinivas, the head of the
chest radiograph project in Qure.ai, summoned Bhargava Reddy, Manoj Tadepalli, and
Tarun Raj to the meeting room.
“Get ready for an all-nighter, boys,”
Qure’s scientists began investigating
the algorithm’s mysteriously high performance on chest radiographs from a new
hospital. To recap, the algorithm had an area under the receiver operating
characteristic curve (AUC) of 1 – that’s 100 % on multiple-choice question
“Someone leaked the paper to AI,”
“It’s an engineering college joke,”
explained Bhargava. “It means that you saw the questions before the exam. It
happens sometimes in India when rich people buy the exam papers.”
Just because you know the questions
doesn’t mean you know the answers. And AI wasn’t rich enough to buy the AUC.
The four lads were school friends from
Andhra Pradesh. They had all studied computer science at the Indian Institute
of Technology (IIT), a freaky improbability given that only hundred out of a
million aspiring youths are selected to this most coveted discipline in India’s
most coveted institute. They had revised for exams together, pulling
all-nighters – in working together, they worked harder and made work more fun.
By SAURABH JHA, MD
No one knows who gave Rahul Roy
tuberculosis. Roy’s charmed life as a successful trader involved traveling in his
Mercedes C class between his apartment on the plush Nepean Sea Road in South
Mumbai and offices in Bombay Stock Exchange. He cared little for Mumbai’s weather.
He seldom rolled down his car windows – his ambient atmosphere, optimized for
his comfort, rarely changed.
Historically TB, or
“consumption” as it was known, was a Bohemian malady; the chronic suffering produced
a rhapsody which produced fine art. TB was fashionable in Victorian Britain, in
part, because consumption, like aristocracy, was thought to be hereditary. Even
after Robert Koch discovered that the cause of TB was a rod-shaped bacterium –
Mycobacterium Tuberculosis (MTB), TB had a special status denied to its immoral
peer, Syphilis, and unaesthetic cousin, leprosy.
TB became egalitarian in the early twentieth
century but retained an aristocratic noblesse oblige. George Orwell may have
contracted TB when he voluntarily lived with miners in crowded squalor to
understand poverty. Unlike Orwell, Roy had no pretentions of solidarity with
poor people. For Roy, there was nothing heroic about getting TB. He was
embarrassed not because of TB’s infectivity; TB sanitariums are a thing of the
past. TB signaled social class decline. He believed rickshawallahs, not
traders, got TB.
When The White House announced their Precision Medicine Initiative last year, they referred to precision medicine as “a new era of medicine,” signaling a shift in focus from a “one-size-fits-all-approach” to individualized care based on the specific characteristics that distinguish one patient from another. While there continues to be immense excitement about its game-changing impact in terms of early diagnoses and targeting specific treatment options, the advancements in technology, which underlie this approach, may not always yield the best medical results. In some cases, low cost approaches, based on sound clinical judgment, are still the better option.
For example, tuberculosis (TB) is an infectious disease that continues to pose global burden with 9.6 million new cases and 1.5 million deaths reported in 2014 alone. The large toll is partly due to lack of effective treatments (particularly for drug-resistant cases) but also due to delays in diagnosis. One might think that precision medicine technology leading to improved diagnosis would be effective at minimizing the related death toll but we shouldn’t automatically assume that. It turns out that sometimes the latest technological advancements can be so sensitive that we detect organisms that are not causing disease.
When Florida voters elected Rick Scott back in 2010 they may have thought they were getting a health care expert. After all, his claim to fame was building the largest for-profit hospital company. Boy were they wrong.
The list of Scott’s public health missteps are vast–such as trying to gag doctors from discussing guns with patients, taking credit for refusing to perform abortions at his old company, trying to shut down a monitoring database that would keep pain pill addicts from getting more prescriptions, and pushing the sale of the state’s public hospitals to buyout funds to raise money to close the deficit.
But this latest one may be the most tragic. In March Governor Scott moved to close A.G. Holley hospital, a small 100-bed safety net institution specializing in tuberculosis. The Palm Beach County public hospital had operated for 60 years. Closing it saved only $5.4 million, which is what its costs were last year. Scott justified the closure saying that TB cases had dropped by 10% in recent years.