It’s time for biopharma to embrace public health

This piece first appeared in the Timmerman Report.

Some years ago when I was working for a large biopharma, I heard a story. It seems a senior scientific executive had visited and given a seminar in which he described the company’s portfolio of drugs for type 2 diabetes. The company was projecting great uptake and profits. A member of our site raised his hand and said, “But if people just ate less and exercised a little more, they could prevent type 2 diabetes and the market would disappear.”

The answer: “Yeah, but they won’t.”

Harsh! But that executive was right. The Institute for Health Metrics and Evaluation (IHME) recently published a paper in JAMA describing how much different health conditions contribute to private and public health spending in the US. Number one? Diabetes. Following that were heart disease and chronic pain. These are chronic lifestyle diseases with big environmental and behavioral components, and the data make me wonder if there’s an opportunity here for the industry to zig and do some things that, in the long run, may make drug development more sustainable.

I think it’s time for biopharma to get involved in public health. Continue reading

Big Data and Public Health: An interview with Dr. Willem van Panhuis about Project Tycho, digitizing disease records, and new ways of doing research in public health

All opinions of the interviewer are my own and do not necessarily reflect those of Novo Nordisk.

One of the huge and perhaps still underappreciated aspects of the internet age is the digitization of information. While the invention of the printing press made the copying of information easy, quick and accurate, print still relied on books and other printed materials that were moved from place to place to spread information. Today digitization of information, cheap (almost free) storage, and the pervasiveness of the internet have vastly reduced barriers to use, transmission and analysis of information.

In an earlier post I described the project by researchers at the University of Pittsburgh that digitized US disease reports over the past 120+ years, creating a computable and freely available database of disease incidence in the US (Project Tycho, http://www.tycho.pitt.edu/) This incredible resource is there for anyone to download and use for research ranging from studies of vaccine efficacy to the building of epidemiological models to making regional public health analyses and comparisons.

Their work fascinates me both for what it said about vaccines and also for its connection to larger issues like Big Data in Public Health. I contacted the lead researcher on the project, Dr. Willem G. van Panhuis and he very kindly consented to an interview. What follows is our conversation about his work and the implications of this approach for Public Health research.

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Dr. Willem van Panhuis. Image credit: Brian Cohen, 2013

Kyle Serikawa: Making this effort to digitize the disease records over the past ~120 years sounds like a pretty colossal undertaking. What inspired you and your colleagues to undertake this work?

Dr. Willem van Panhuis: One of the main goals of our center is to make computational models of how diseases spread and are transmitted. We’re inspired by the idea that by making computational models we can help decision makers with their policy choices. For example, in pandemics, we believe computational models will help decision makers to test their assumptions, to see how making different decisions will have different impacts.

So this led us to the thinking behind the current work. We believe that having better and more complete data will lead to better models and better decisions. Therefore, we needed better data.

On top of this, each model needs to be disease specific because each disease acts differently in how it spreads and what effects it has. In contrast, however, the basic data collection process that goes into creating the model for each disease is actually pretty similar across diseases. There is contacting those with the records of disease prevalence and its spread over time, collecting the data and then making the data ready for analysis. There’s considerable effort in that last part, especially as Health Departments often do not have the capacity to spend a lot of time and effort on responding to data requests by scientists.

The challenges are similar–we go through the same process every time we want to model a disease–so when we learned that a great source of much of the disease data in the public domain is in the form of these weekly surveillance reports published in MMWR and precursor journals, we had the idea: if we digitize the data once for all the diseases that would provide a useful resource for everybody.

We can make models for ourselves, but we can also allow others to do the same without duplication of effort. Continue reading

Big Data provide yet more Big Proof of the power of vaccines

All opinions are my own and do not necessarily reflect those of Novo Nordisk.

Time for another screed about the anti-vaccination movement.

Well, not about them per se, but rather about another study that demonstrates how much of a positive difference vaccines have made in the US. The article, from researchers at the University of Pittsburgh and Johns Hopkins University, describes what I can only imagine to be a Herculean effort to digitize disease reporting records from 1888 to 2011 (article behind a paywall, unfortunately).  Turns out there are publications that have been collecting weekly reports of disease incidence across US cities for over a century.  I have not been able to access the methods, but I can’t shake the image of hordes of undergraduates hunched over yellowed clippings and blurry photocopies of 19th century tables, laboriously entering numbers one by one into a really extensive excel spreadsheet.

All told, 87,950,807 individual cases were entered into their database, including location, time, and diseases.  Not fun, however it was done. Continue reading

Hanging with the herd, for the immunity of it all

All opinions are my own and do not necessarily reflect those of Novo Nordisk.

When I hear about events such as the recent outbreak of measles among a small group in Texas, I am reminded of how complex, complicated and difficult public health efforts can be. In the US, for example, there are conflicting imperatives:  the rights of people to practice their beliefs versus the right of the community to be protected against preventable health threats.  This particular situation involved members of a church congregation, many of whom had not gotten vaccinated for measles due to worries about a link between autism and the Measles-Mumps-Rubella (MMR) vaccine.  While no scientific evidence has been found to support any such link, many had chosen not to be vaccinated “just in case.”

One day I hope to write about the link between the phenomenon of science denial and personal identity (one perspective can be seen here), but for now I just want to point out how this event and a recent publication by the Centers for Disease Control (CDC) on rotavirus vaccines demonstrate nicely the concept of herd immunity (article behind paywall, but writeup here).  There are different usage patterns for the term, so I’ll say up front I am using “herd immunity” to describe not just the proportion of individuals within a population who are immunized to a given pathogen but also the indirect effects for non-immunized individuals.  The term was first used in a publication in 1923, by Topley and Wilson, in the context of how to describe the host side of their studies in bacterial infection among mice.  The concept later gained mathematical underpinnings, including formulas describing how the different ratios of vaccinated to nonvaccinated individuals defines the degree of herd immunity depending upon how infectious a disease agent is. Continue reading

Internet access is a public (and private) health issue

All opinions are my own and do not necessarily reflect those of Novo Nordisk.

If the Founding Fathers had lived today, they would surely have included internet access as one of our inalienable rights.  No, scratch that, because if they had lived today they would have used Google Docs to crowdsource the Declaration and the result would probably have been much more generic and middle of the road than it actually is.  Also, the Declaration would also have been limited it to about 500 words so readers wouldn’t get bored and surf somewhere else, and it would have had embedded GIFs. Preferably animated.

Still, the ability to access the internet and everything that comes with that is, if not a right, an incredible advantage.  So I was stunned when I read in the Seattle Times the other day that a significant fraction of people in the US–about twenty percent–have little to no internet connection, although those numbers have recently begun to creep up, presumably due to smartphone uptake.   But of course, being a good Seattlelite with a liberal bent, my next reaction was to say, well, let’s not rush to judgement or conclusions.  Maybe those people just don’t want the internet.  Not that there’s anything wrong with that…

Except the article goes on to say that while seniors generally did not feel they were missing anything, the majority of other respondents did feel they were missing something important and were being left behind because of their limited access.  So it’s not a life decision; it’s a question of cost, access and education. Continue reading