can unstructured data be good for your health?

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Can Unstructured Data Be Good For Your Health? Nabarun Dasgupta Chief Science Officer Epidemico, Inc. NBME Philadelphia July 13, 2015 Slides available @epidemico

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Can Unstructured Data Be Good For Your Health?

Nabarun Dasgupta

Chief Science Officer

Epidemico, Inc.

NBME Philadelphia

July 13, 2015

Slides available @epidemico

Traditional Disease Reporting

Public1

Healthcare Workers, Electronic Health Records2

Laboratories3

Ministries of Health4

World Bodies (WHO, EMA)5

Public1

Healthcare Workers, Electronic Health Records2

Laboratories3

Ministries of Health4

World Bodies (WHO, EMA)5

Digital Disease Detection

Public

Healthcare WorkersElectronic Health

Records

Laboratories

Ministries of Health World Bodies (WHO, EMA)

Digital disease detection picks up early signals

Traditional public health monitoring

Distribution of Disease

200,000+web sites

171public & private

sources

15languages

every hour, 24/7

Typhoid cases in Mufulira have

reached 2, 227 with health authorities

calling for increased efforts to prevent

new infections in Mupambe Township.

2, 227

#

Typhoid Mufulira

Mupambe Township

Natural language processingEACH POST IS ANALYZED FOR KEY INFORMATION

Case & death counts#

255species

300Diseases

40,000locations

Alerts are categorized using more than 19 million phrases

96% accuracy

Focus on Liberia

Satellite Mapping Of Interventions

Monrovia, Liberia

Brazil World Cup 2014Alerts from participating countries and hosting cities

19

In northern Nigeria, religious and political leaders, led by the chairman of the Supreme Council for Sharia in Nigeria, Datti Ahmed, boycotted the polio vaccine in 2003, claiming that the oral polio vaccine was contaminated with HIV and could also cause sterilisation in those vaccinated, fuelling widespread public distrust.

Monitoring Vaccine Sentiment

Black Markets

Sonrick Hansen et al. PLoS One. 2012

John Brownstein

32

SOCIAL

The WEB-RADR project is supported by the Innovative Medicines Initiative Joint Undertaking (IMI JU) under grant agreement n° 115632,resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013)and EFPIA companies’ in kind contribution.

Medicine Use

Negative Reaction

Suspected Problem

Require medical attention

Life threatening

Reported

Verified

Patients don't report bad reactions because they don't know they should.

We can amplify their voices by meeting patients where they are at and filtering out noise.

Patients are speakingShouldn’t we be listening?

Beyond informing the public about the

importance of adverse event

reporting, we can take steps to

encourage patients to report.

01 02 03Meet patients

where they’re

at

Protect their

privacy

Give them

easy-to-use

tools

Data flow for

detecting adverse

drug reactions in

social media data.

36

DATA PROCESSING

Acquire

Filter

CurateCausation

Describe

Collect social

media data

Detect

events,

translate

vernacular

Reduce

false

positives

Descriptive

statisticsSynthesis

of

information

SOCIAL

“posts with resemblance to adverse events”

Proto-AE

50 million posts that mention a medical product have been collected. The classifier has been trained with 360,000 manually coded posts.

38

AUTOMATED FILTERING

68%

Research-ready data available

daily.

PRECISION[+ predictive

value]

88%

RECALL[sensitivity]

Bayesian classifier

identifies posts with

resemblance to AEs

Dictionary translates

vernacular to

MedDRA

Multiple copies of posts

are consolidated and

PII removed

01

02

03

Vernacular-to-Regulatory Translation

39

Spelling VariationsCombined or invented wordsImplied phrasesInternet Vernacular Translation

lost their eyesight

seeing weird colorseeing weird colour

doublevision

couldn’t seedouble vision

blindgoogley eyed

blurry vision

changes in visioncross eyedseeing weird

vision changeblindness

cross visionvisual snow

googly eyedseeing double

making me eat like a mouseanorexic

lost appetite

#notevenhungryappetite is nonexistent

apetite surpressed

didn’t get hungry

dont want to eat

killed my apetite

miss feeling hungry

killed my appetitecan’t eatlost apetite

lost my appetiteno appetitey

lack of apetitestomach small

lost teh appetite

never hungrynever want to eat

cant eat

couldnt seecrosseyed

blurry

apetite surpressed

killed my apetitelost apetite

lack of apetite

lost teh appetite

Typos

seeing weird colorseeing weird colour

googley eyed

googly eyed

#notevenhungry

no appetitey

making me eat like a mouse

never want to eat

Visual impairment

MedDRA 10047571 Decreased appetite

MedDRA 10061428

making me eat like a mouseanorexic

lost appetite

#notevenhungryappetite is nonexistent

apetite surpressed

didn’t get hungry

dont want to eat

miss feeling hungry

killed my appetitecan’t eatlost apetite

lost my appetiteno appetitey

lack of apetitestomach small

lost teh appetite

never hungrynever want to eat

cant eat

lost their eyesight

seeing weird colorseeing weird colour

doublevision

couldn’t seedouble vision

blindgoogley eyed

blurry vision

changes in visioncross eyedseeing weird

vision changeblindness

cross visionvisual snow

googly eyedseeing double

couldnt seecrosseyed

blurry

killed my apetite

•Victoza® - liraglutide [rDNA origin] injection

•Diabetes indication

•UK, US, IN, CN, EU, JP, DE, DK, NL, IE, SE, FR, MY, SG

•Public Social Media (FB & Twitter)

•Jan 1, 2014 to March 9, 2015

•English language only

•Compare to US, UK and Canada health authorities data

42

• DESCRIPTIVE METHODS

43

OVERALL RESULTS

10,433

Total number

of public

mentions in

Facebook or

Twitter.

ACQUIRE

368

Total number

of Proto-

AEs. 3.5% of

mentions are

Proto-AEs.

FILTER

158

False

positives

removed by

manual

curation

30%

CURATE

699

Drug-event

pairs at the

MedDRA

preferred

term level

DESCRIBE

Victoza only

44

Descriptive Analysis

45

MENTIONS & PROTO-AEs

6360

4098

29 411

TWITTERAll mentions

FACEBOOKAll mentions

TWITTERProto-AEs

FACEBOOKProto-AEs

01

02

03

04

46

COMPARISON SOCIAL & SPONTANEOUS

47

SOCIAL MEDIA PREFERRED TERMS (>2)

48

QUANTIFYING EVENTS

49

IN THEIR OWN WORDS

Typical

Proto-AEs

& Patient

Benefits

@user I just restarted taking victoza which made me so sick to my stomach till my body got used to it.

Aside from the nausea (worse today) and occasional bouts of hypoglycemia (better today), four days on Victoza and down 5.3 lbs! Amazing!

Twitter, May 3, 2014

Facebook, December 9, 2014

50

IN THEIR OWN WORDS

Product

Quality

Issues

Anyone else having issues with plugger jamming on their flex pen of victoza? The only difference I see is the new needles . I had to stick myself 4 times today to get almost a full dose. Frustration. Doesn't seem related to where I am into pen, first dose, midway , last. Third pen this has happened on in a row

Facebook, December 9, 2014

51

IN THEIR OWN WORDS

Diversion &

Re-Sale

I have 2 boxes of victoza insulin pens if interested inbox for more information

Facebook, February 3, 2015

Please, if anybody is on Victoza for diabetes or insulin resistance < i ordered too much stock and it is non returnable being a fridge item > please pop in at [redacted] pharmacy .....will organise a good price to compensate for my blunder.

Facebook, February 27, 2015

52

IN THEIR OWN WORDS

Product

Pricing

Just bought 4 Victoza pens from my pharmacy (CVS). $800 out of pocket. Uggg. :(

Facebook, February 6, 2015

53

IN THEIR OWN WORDS

Off-label

Use

Had my first injection of Victoza. So if it doesn't kill me from one of side effects my sugar should stabilize. One side effect is puzzling. "For type 2 Diabetics only. Not intended for type 1 diabetics". I'm the poster child for type 1 Diabetics.

Facebook, February 6, 2015

54

7.7%Posts with HSI

“I've been on Victoza for a total of 17 days now for pre-diabetes. After the 5th day the nausea hit and it's horrible. I'm afraid to eat anything and the smell of fried foods kill me. I started on 0.6 for 7 days and now I'm up to 1.2.....when does it get better? My Dr recommended that I go back to 0.6 for a couple weeks to see if it helps. I feel nauseous, bloated, stomach hurts, dizzy at times......I have lost weight (which for me is a good thing ) but it's not good enough to keep feeling so horrible. Anyone have any suggestions for the nausea and bloatng?”

Facebook, January 23, 2015

HEALTH SYSTEM INTERACTION

0

1

2

3

4

5

2 4 2 1

The EMA’s list of Important Medical Events (IME) can be used to identify posts of greatest medical consequence

55

IMPORTANT MEDICAL EVENTS

2.0%Posts with IME

2

23

21

158

Twitter

United Kingdom Spontaneous Reports

United States Spontaneous Reports

(w/o multiplicate reduction)

Facebook

56

REPORTING BURDEN PER MONTH

10Canada Spontaneous Reports

Twitter & Facebook: Jan ‘14 – Mar ’15MHRA Drug Analysis Print: Jun ‘09 – Mar ‘15

FDA FAERS: Oct ‘12 – Mar ‘14 Health Canada: Aug ‘10 – Dec ‘14

SOCIAL

demo.medwatcher.org

58

CLINICAL TRIAL DISCUSSION

I saw some discussion about the clinical trial for ####### but don't think I've seen my question asked before. I started the trial a little over three months ago and have seen zero improvement...

…I am due for another appointment tomorrow and am still feeling intense frustration over the lack of improvement…I've been sorely tempted to give up and try something else…

59Illustration: Curt Merlo, The Village Voice

60

61

62

StreetRx.com

StreetRx (streetrx.com) is a collection of databases, websites, and citizen reports enabling real-time collection, organization, and display of street price data on diverted pharmaceutical controlled substances. Based on principles of crowdsourcing for public health surveillance, the site allows users to anonymously submit prices they paid or heard were paid for diverted prescription drugs.

External Referrals

Find Addiction TreatmentSAMSA, ADIN, DroguesInfoService.fr, L’ANAPAA, DBDD

Overdose PreventionMedication safety sites, HRC, naloxone

Safe Storage, Disposal &

TakebackFDA, Health Products Stewardship AssociationSafe Pain Management &

AdvocacyCanadian Pain Coalition, PainAustralia.org, RBK StuttgartHarm ReductionHRC, EuroHRN

Public health, pain patient advocacy, proper disposal

Cross-Validation of Black Market Prices

66Dasgupta et al. Journal of Medical Internet Research. 2013

Dasgupta et al. Journal of Medical Internet Research. 2013

68

Can the Black Market Discriminate between ADFs?Do different deterrence strategies and platforms result in discernible street price differences?

STEP 1

STEP 3

STEP 2

STEP 4

USA Data in USDNov 1, 2010 through Mar 31, 2015Solid oral formulations Compare 14 ADF to unprotected street price per milligram, within active ingredient

Geometric means and 95% CIN = 49,995

Non-parametric Wilcoxan rank-sum (Mann-Whitney) tests

(Partial-) Antagonists: Subutex vs. SuboxoneProdrugs: morphine vs. codeine; Vyvanse vs. amphetamines

Phyical barriers: Zohydro vs. Hysingla ER vs. IR hydrocodone; OxyContin OP vs. OC;Opana ER reformulation vs original; Xartemis XR vs. IR oxycodone;

Exalgo vs. IR hydromorphone; Concerta vs. Ritalin LA vs. methylphenidate, Nucynta ER vs. IR tapentadol

Not enough data to evaluate yet:Embeda,Targin(iq), Oxytrex, Oxecta, Quillivant XR, Talwin NX, Amrix

Percent Discount for ADF VersionsPutative abuse-deterrent formulation versus unprotected formulations with same active ingredient, using statistical comparison that is less influenced by outliers.

4% 36%

45%

54%

7% 22%

25%

42%

55%

Physical Barrier Prodrug(Partial-)Antagonist

Conc

erta

Exal

go

Opa

na E

R

Oxy

Conti

n O

P

Zohy

dro

Vyva

nse

code

ine

Subo

xone

tabl

et

Xart

emis

XR

p<.01

z -38

p<.01

z -38

p<.01

z -3.0

p<.01

z -3.7

p=.78

z 0.3

p<.01

z -8.6

p<.01

z -13

p=.34

z -0.9

p=.24

z -1.2

TBD

?

OROSOROSINTAC INTAC PolyOx

29%

Rita

lin L

A

p<.01

z -3.9

SODAS

24%

Nuc

ynta

ER

p=.10

z -1.6

INTAC

29%

Hys

ingl

a ER

p=0.46

z -0.7

INTAC INTAC

Physician/Patient forum

Safety concerns over drug products are frequently raised in some physician or patient forums

Doctor ordered an IV with 40mg Omeprazole mixed with 5% Glucose solution. The solution turned black after mixing the two…

- AI AI YI: http://www.iiyi.com/med/

Weibo

Worm found in Amoxicillin capsule packaged in blister package

Weibo

Consumer purchased extremely cheap ointment sold under brand name Bactroban but were not manufactured by GSK.

GSK’s Bactroban

74

Food safety signals from Twitter related to Target

Booz Allen Hamilton and Client proprietary and business confidential

Pet food

Supply chain analysis

In compliance Pending actions

Imports and exports

Critical vulnerability

FROM: Imagined Food Co.LtdADDRESS: 188 Imagined Lane, Boston, MA, 02116CONTACT: Alpha M. Bravo, (617) 893-xxxxMAIN SERVICE: Processed meat, bacon, etc.

TO: Madeup Logistics Co.LtdADDRESS: 61 Foodstuff Rd, Newton, MA, 02459CONTACT: Charlie N. Delta, (617) 112-xxxxMAIN SERVICE: Cold chain logistics

TRANSPORTATION METHOD: Truck (cold chain equipped)

TRANSPORATION DISTANCE: 5.1 miles

FOOD CATEGORY: Processed meat

AVERAGE VOLUME OF TRANSACTION: 10 ton/day

RISK SCORE FOR CONTAMINATION: 1.0 (1-10 Scale)

76Source: https://blog.fitbit.com/heart-racing-moments-from-the-big-game/

77

QUESTIONS?

epidemico.com

@epidemico

demo.medwatcher.org

@med_watcher

HealthMap.org

[email protected]