Transcript Disease Informatics: ICD

Bill and Narayana
Disease Informatics:
ICD-11 at the doorstep
By: RP Deolankar
Presentation for 4th Nutraceutical Summit, WTC,
Mumbai, India
Feb. 21-23, 2008
WHO
World Health Organization (WHO)
provides a service which is designated
as a Family of International
Classifications (WHO-FIC)
10th version of ICD (ICD-10) has
a Chapter entitled “Endocrine
nutritional and metabolic
diseases”
ICD
One of such service is International
Classification of Diseases (ICD)
Application of Statistics and
Information Science to establish
causes of morbidity
The activity is being described as a
part of “Disease Informatics”
Disease Definition
The ICD has become the
international standard diagnostic
classification for all general
epidemiological and many health
management purposes.
In turn, ICD provided Diseases
definitions
"Let your food be your medicine and your
medicine be your food" Hippocrates
In short, most of the diseases could be
linked to food and lifestyle.
ICD-10
Endorsed by the Forty-third World Health
Assembly (WHA) in May 1990
Disease Definitions are quantal
Domain of handpicked experts as described
by media
Severity of the disease triggered by
the virus may be determined by the
type of food had been eaten by the
subject.
Scope for improvement
Severity of Disease: Diseases are
quantitative
Holistic approach: Multiple
morbidities interact
Throwing open portal to Doctors,
Health Workers, Educationists
and Spiritualists
Dr. T. B. Ustun
Scope for improvement in
clinical research
 Multiple morbidity ►
Multiple hypotheses
 Bayesian applications
 What can be done?
As most of the
functional foods serve
as multiple remedy
and also could reduce
side effects of drugs,
create task force for
statistical methods in
this area
Objectives of the presentation
Discuss: How to use platform provided by
ICD-11 for
Defining the diseases with least error so
that those are understood, prevented and
reversed
Identifying most of the targets to combat
a cluster of diseases, understand spatial
continuum through working on Disease
Causal Chains and
Designing a holistic solution to the
disease problem
Health of an individual
= % Wellbeing + % Disease
Loosing the wellbeing is
proportionally gaining the disease
Wellbeing guards
Good food
Superb lifestyle
Complementary Nutraceuticals
Medical check-up
Revealing certain events in the health
history of an individual
Three aspects of Medical Check-up
Attempt to hunt priors (Backend
events)
Understand present (Current event)
Predict posteriors (Frontend events)
Disease Causal Chain or Web
Events linked together
Chain could be reversed due to
intervention
Pruning the Frontends could
stimulate branching in the chain
Event
Event
Event
Event
Factors (Components)
Drive events from backend to Prof. HC Kraemer
frontend
Proxy, Overlapping, Independent,
Mediators and Moderators
Events could be modulated through
altering factors
Factors are shown by arrows
Event
Event
Cause Effect Diagram
Components working together
It is not A + B
It is A + B + AB
Genes load the gun,
the environment pulls the trigger
Prof. Kenneth Olden
Point to ponder: Why certain probiotics reverse viral diarrhea?
Ancient Indian Model of
Human Body Computer
Human = Somatic body + Vitality +
Mind + Intellect + Bliss
(Panchakosha)
Intellect (Central Processing Unit) +
Self/ Ego (Software) + Memory (Free
space, Pen Drive/ Hard Disk) + Mind/
senses (Program) + Life history
(Data)
Human Microbial Organs
Gut Associated, Vagina Associated,
Skin Associated etc (Eco-organs)
Being described as Human
Microbiome
Prebiotics
Probiotics
Synbiotics
Prof. Stig Bengmark
Clinical Research
To understand the disease of an
individual, one has to understand
human and his body computer and
his associated organs also
ICD-10 classification
Infectious and Parasitic Diseases
Cancers
Endocrine, nutritional or
metabolic diseases etc.
Triviality
Infectious disease is not a
nutritional disease
Nutritional disease is not an
endocrine disease
One may have Infectious Disease
+ Nutritional Disease +
Endocrine disease
i.e. Multiple morbidities but not
the complex disease
Reality
Infection can happen due to
endocrine abnormality and
endocrine abnormality can
happen due to malnutrition
Some component may occur as
prior some component may occur
as posterior
(Keshan disease: Selenium
Deficiency + coxsackie virus B4)
What is neglected in ICD-10
Disease Causal Chain
Most of the traditionally
established remedies (TER) alter
disease causal chain
TER could alter some component
of a sufficient cause of the
disease
Disease definition might not
regard that component
Rothman and Greenland
Sufficient and component cause model
(Button is not sufficient cause to
switch on or switch off the bulb)
Sufficient causal mechanisms > 1
Three sufficient causes of disease.
To summarize the background
Diseases are complex
Needs group effort to understand
Needs modern tools of
information science to study
Yet can have simple solutions
ICD-11
 Membership is open
to all who are
willing to register
 Members can back
their suggestions
with appropriate
evidence
 Members can
participate in online
debate over
proposed changes
in disease definition
 What can be done?
Register as a
member, Form
Disease Informatics
Groups
Systematic reviews: Basis of
ICD-11
 Practice of
combining the
results of a number
of studies
(scientific, clinical
and public health)
that address a set
of related research
hypothesis
• What can be done?
Participate in
Cochrane
collaboration
What is Cochrane
Collaboration?
 It is a global
network of
dedicated
volunteers for
providing reliable
source of evidence
in health care.
Evidence is in the
form of Systematic
reviews based on
meta-analysis
 What can be done?
Register our
interest in
nutraceuticals and
functional foods,
form Cochrane
review group
Professor Archibald Leman Cochrane
Field testing of ICD-11
Draft version of
ICD-11 shall be
field tested
What can be done?
Participate in the
field testing
Standardization of terminology
ICD-11 website
shall provide
linkage for
standardization
of terminology
What can be done?
Find out
methodology so
that world
understands our
terminology
Examples of Indian terms
Simple term: Ama = Dysbiotics
(Products of dysbiosis)
Complex term: Vata = Body
constitution described as Low
density of the body +
Ectomorphy + More gaseous +
Less muscle + High body motility
+ Linear body shape etc
Traditional Knowledge Digital Library
should be made available to ICD-11
Confusion due to local dialect
Kanjika (Indian functional food,
also abbreviated as Kanji), a
probiotic food, is a lactic fermented
product where lactic fermentation
is the terminal step in food
processing and is prepared from
raw material of plant origin and
devoid of dairy product
Kanji is also used for porridge that
is confusing
Confusing terms (Continued)
Umbil is similar to kanjika but
contains lactic fermented milk as
an ingredient or cooked plant
material may be combined with
lactic fermented dairy product
Umbil is also used in place of
Kanjika by some people
Standard Terminology
MeSH, Medical Subject Headings of
NLM, NIH, USA
Based on UMLS (Unified Medical
Language System) Metathesaurus
Standardization of Data
Processing
 ICD-11 website
shall provide
linkage for
standardization of
Data Processing
 More and more
Bayesian
Approach would
appear in Disease
Informatics
 What can be
done?
Develop user
friendly software
Standardization of Research
 ICD-11 website
shall provide
linkage for
standardization of
research
 More and more
Good Practice
Protocols would be
asked for
 What can be done?
Develop standard
courses in Health
Research, Project
Management Software,
Infrastructure and
Equipment
Management, Store and
Inventory Management,
Archive Management,
Document Management
and GLP, GCP, GCLP,
GMP etc
Example of Disease Causal
Chain; …follows
Phytase (germinated grains) +
Calcium + Vitamin D + Sun Exposure
for Influenza prevention?
Sania in Sun
Calcium deficiency as the front-end
event due to Chelation by Phytic acid
Front end events of Reduced
availability of Calcium
Front end events
No deficiency in subjects taking
calcium sufficient diet
Sub-clinical deficiency in subjects
taking calcium deficient diets
Rickets in children where
component cause is calcium
deficiency
Osteomalacia / osteoporosis in
elderly where component cause is
calcium deficiency
Degradation of vitamin D in the
liver due to calcium deficiency
Backend event
Calcium deficiency
(reduced availability of
Calcium due to IP6)
Front end events of Degradation of
vitamin D in the liver
John M Pettifor. Nutritional rickets: deficiency of vitamin D, calcium,
or both? Am J Clin Nutr 2004; 80(suppl): 1725S–9S.
Front end events of Vitamin D deficiency
(Avitaminosis D syndrome, I)
D: Finally, a vitamin makes the grade.
Several new studies suggest that the
so-called sunshine vitamin (because it’s
produced in skin exposed to sunlight)
may protect against cancer. One study
showed that as blood levels of vitamin D
go up, women’s breast cancer risk goes
down. Another found that fairly large
amounts of vitamin D lowered the risk
for pancreatic cancer by about 40%.
The Top 10 health stories of 2006, from
the Harvard Health Letter
Founder faculty member of the
Department of Endocrinology,
Metabolism & Diabetes at the
AIIMS, INDIA
Dr.Narayana Kochupillai
"Based on our clinical experience and
limited studies, we believe vitamin D
deficiency is widespread in northern India,"
http://www.bmj.com/cgi/content/full/326
/7379/12/b?etoc
Front end events of Vitamin D
deficiency
(Avitaminosis D syndrome, II)
Front end events
Backend event
Vitamin D
Autoimmune
deficiency
diseases
Type 1 diabetes
Heart Disease
Osteoporosis
The UV Advantage: The Medical Breakthrough
That Shows How to Harness the Power of the
Sun for Your Health by Michael F. Holick. I
Books /Marvel, New York
Prof. Michael Holick
Boston University
Front-end events of Vitamin D
deficiency
(Avitaminosis D syndrome, III)
Front-end event
Back-end event
Epidemic Influenza Vitamin D
(Driving factors to deficiency
be investigated)
Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF,
Giovannucci E. Epidemic influenza and vitamin D. Epidemiol Infect. 2006
Dec;134(6):1129-40
Aloia JF, Li-Ng M. Re: epidemic influenza and vitamin D. Epidemiol Infect. 2007
Oct;135(7):1095-6; author reply 1097-8.
Epidemic influenza and vitamin D.
Epidemiol Infect. 2006
Dec;134(6):1129-40
1.
2.
3.
4.
5.
6.
7.
8.
Cannell JJ, Atascadero State Hospital, CA
Vieth R, Mount Sinai Hospital, Canada
Umhau JC, NIH
Holick MF, Boston University
Grant WB, SUNARC, CA
Madronich S, National Center for Atmospheric Research, CO
Garland CF, University of California San Diego
Giovannucci E., Harvard School of Public Health, Boston
All authors are from different institutes
Disease definition challenged
Author’s remark in the conclusion section:
Is influenza infection a sign of vitamin D
deficiency as much as Pneumocystis carinii
pneumonia is a sign of AIDS?
J. J. Cannell
Nutraceutical for Influenza
Prevention on the basis of
the DiCC
Calcium Irrigated, UV
Irradiated Mushrooms
Rich in Calcium
Rich in Vitamin D
Rich in Protein
Useful in lead detoxification
Indian Government Institute
National Centre for Disease Informatics
and Research at Bangalore, India
Multi-disciplinary
Multi-centric
Surveillance
Healthcare: Eleventh Five Year Plan (2007-2012) by Ministry
of Health and Family Welfare, Government of India, New Delhi
Proposed Title-adjuncts for Nutraceutical Journals
Disease Path Speed Breakers
Causal Chain Quenchers
Sufficient Cause Crackers
Reversal of Disease Chronicle
Simple Solutions to Disease Clusters
Back-End Targets for Nutraceuticals
Disease Informatics for Nutraceutical Development
Learn more about DiCC
Disease Informatics: Phytates driving from the back-end
to Influenza, Encephalitis, Hepatitis, Anemia at the front-end
Supercourse : Epidemiology, the Internet and Global Health,
Lecture no. 30331
Disease informatics for setting up Disease definition, drawing
Disease Causal Chain / Web, marking Risk Events, Backend and
Frontend Events, and Health Problem Solutions
Rajendra P Deolankar BMJ.COM, 30 May 2006
Read the Basics of Disease
Informatics
DIG for Disease Informatics Group.
Part I Part II
Disease Informatics: Host factors
simplified
Supercourse : Epidemiology, the
Internet and Global Health,
Lecture no. 25371, 25381 and 28921