NOTES

While machine learning may deliver clinical benefits, the work to understand mechanistic insights is key to not only predict but prevent and treat underlying conditions. We hope that all these innovations will serve couples trying to conceive and lower the cost barriers to reproductive technologies, but recognize that the real impact of the financing gold rush in this area is yet to be seen.

Notes on Engineering Health

In the late 1960’s, the idea to record patient information in electronic form rather than on paper emerged. The goal of the first EMR, presented by Lawrence “Larry” Weed, was to allow a third party to independently verify a diagnosis in order to improve patient outcomes. The first EMR was developed in 1972 by the Regenstrief Institute and was welcomed as a major advancement in healthcare / medical practice.

Notes on Engineering Health

Measuring the effects of climate change and pollution on health is hard but the consensus is that they are overwhelmingly negative. To understand the ramifications of a worsening climate crisis, it is useful to make a distinction between the impact on health and on healthcare delivery.

Notes on Engineering Health

The global COVID-19 pandemic caused an unprecedented number of challenges for our health systems during 2020. Many of these health challenges, however, have been persistent problems for years. For example, according to data released by the Center for Disease Control and Prevention (CDC), almost one-third of COVID-19 infections in the U.S. have affected black Americans though they represent only 13% of the U.S. population…

Notes on Engineering Health

2020 has been the year of airway inflammation. Everyone became an immunologist in record time with a specialization in infectious disease and a fellowship in lung damage. Words like cytokine (storms) and R0 have become common lingo in households. The difficulty of understanding and treating airway inflammation, however, was no stranger to the medical community, despite lengthy efforts to better understand targeted therapies to ameliorate its effects.

Notes on Engineering Health

Although the maxim “Let food be thy medicine, and let medicine be thy food” is generally agreed to be an apocryphal quote by Hippocrates, there are good reasons why it still resonates as an immutable truth. Looking at the healthcare industry from a standpoint of health—as we try to do at Digitalis—regularly brings us back to nutrition as a key pillar of a healthy life. In particular, our attention this month was attracted by a number of studies carefully looking at large datasets that highlight again the key importance of diet and nutrition.

Notes on Engineering Health

This month we are introducing a new section of the newsletter, First Five, a curated list of topics that we are working on along with a bit of commentary and links to some of the content (scientific papers, books, podcasts, video, etc.) that is motivating our work. Our hope is that this new format will add some additional openness about our unfinished work, and will further facilitate the free flow of ideas with our readers.

Notes on Engineering Health

While our understanding of fat metabolism has evolved considerably since the nineteen-thirties, blockbuster agents have yet to be developed to help curb the obesity epidemic. We focus on three areas of current interest in the search for control over fat metabolism.

Notes on Engineering Health

While a lot of research has been focused on understanding the genetic causes of disorders in the hope to fix problems at the gene level, a number of disorders cannot be solved using this method alone — whether because they are multigenic or of unknown genetic cause. As a response, a growing trend has been to characterize pathologies according to their metabolic phenotypes. New techniques have allowed clinicians and researchers to measure more accurately a wider array of metabolites and nutrients, shedding new light on biology and disease.

Notes on Engineering Health

The choreography of immune cells continues to be better understood, the reasons why we seem to be developing more allergies are being plumbed (from the hygiene hypothesis to the role of the microbiome), the way to treat symptoms are being advanced, but there is still a deep lack of understanding why some foods or common allergens are more prone to excite the immune system than others. Uncovering these differences will open the door to understanding the root causes of allergic reactions and engineer ways to modulate the immune response which is critical as the number of people worldwide with allergies is increasing.

Notes on Engineering Health

There are numerous studies correlating low levels of vitamin D in plasma to increased risk of varying health maladies. Cancer, autoimmune disorders, general innate immunity, hypertension/other cardiovascular events, diabetes types 1 and 2, neuropsychiatric function, pregnancy outcomes, and all-cause mortality have all been cited as conditions potentially mediated by a patient’s Vitamin D status.

Notes on Engineering Health

We cannot standby and avert our gaze from what is happening in the United States. The need for change, systemic and immediate, is as clear and inarguable in our health industry as it is in our political arena.

Notes on Engineering Health

From the 1950s when the double helix structure of DNA was unveiled to the CRISPR editors of the past few years, progress toward being able to engineer biology consistently and at high fidelity has been constant. Our ability to treat biology as an engineering discipline may even be reaching the point where it can be tasked with solving problems such as the current coronavirus pandemic.

Notes on Engineering Health

While there are many open questions about managing the current pandemic, there seems to be universal agreement that the best case solution is the creation of an effective vaccine to SARS-CoV-2, the coronavirus that causes COVID-19.

Notes on Engineering Health

As the current coronavirus crisis evolves, the key question will eventually shift from how we should we manage this pandemic to how can we be better prepared for the inevitable next one. What tools can we develop to make us more agile and effective when a virus strikes again?

Notes on Engineering Health

In these troubled days, it certainly can feel like we are approaching the end of civilization as we have known it. The Doomsday Clock has never been closer to midnight (currently just 100 seconds away) and the obvious level of unpreparedness of societies facing the ongoing coronavirus crisis has not done anything to reverse the somber ticker.

Notes on Engineering Health

The fact that the broad population can’t calculate or has poor instinct for statistics such as positive predictive value is one thing, but more serious concerns about public health and safety are raised when the main clinical actors in the medical profession are less than proficient in understanding basic statistical tools.

Notes on Engineering Health

The search for causal inference when randomized clinical trials are problematic (and even when they are not) has long been a goal of epidemiological research. Taking advantage of the rise of Genome Wide Association Studies (GWAS) and the wealth of data they have produced, epidemiologists have created a clever hack known as Mendelian randomization (“MR”) to untangle correlation from causation.

Notes on Engineering Health

Life expectancy is a metric for the average age of death in a population. In 1800, regardless of place of birth, a newborn could expect to live fewer than 35 years. By 1950, the global average for life expectancy was still only 46 years, but with a much broader distribution spanning from 68 years in the richest countries to only the low 30s in the poorest countries. Today, it ranges from 53 (in the Central African Republic) to 85 (in Japan), with a global average of 71 years.

Notes on Engineering Health

While it is a bit of a truism to say that we live in a time of rapid change, that does not make the fact of it any less challenging. In particular, change at the intersection of technology, social norms, and economics is forcing us to grapple with the meaning and practice of trust in unexpected ways.

Notes on Engineering Health

Recent research has shown that we cannot hide amongst the crowd. In fact, more than 60 percent of Americans with European ancestry are identifiable through their DNA, whether or not they have ever submitted a sample to be sequenced. This potential inability to remain genomically private stems from the fact that by early 2019 an estimated 26 million consumers had been sequenced by the four leading commercial consumer DNA companies.

Notes on Engineering Health

An approach to discovery—answers first, explanations later—accrues what is call intellectual debt. It’s possible to discover what works without knowing why it works, and then to put that insight to use immediately, assuming that the underlying mechanism will be figured out later. In some cases, we pay off this intellectual debt quickly. But, in others, we let it compound, relying, for decades, on knowledge that’s not fully known.

Notes on Engineering Health

Digitalis invests in solutions to complex problems in health. In doing so, we aspire to framing and tackling Hilbert-level open problems in fields relevant to our mission. This newsletter will periodically provide notes on our efforts in an attempt to “show our work.” We invite you to be in touch with your ideas about important problems and potential solutions. And we look forward to working with you to develop the best solutions at scale to deliver better health to all.

Notes on Engineering Health