can unstructured data be good for your health?
TRANSCRIPT
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)
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
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.
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
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
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
45
MENTIONS & PROTO-AEs
6360
4098
29 411
TWITTERAll mentions
FACEBOOKAll mentions
TWITTERProto-AEs
FACEBOOKProto-AEs
01
02
03
04
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
United Kingdom Spontaneous Reports
United States Spontaneous Reports
(w/o multiplicate reduction)
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
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…
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
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/
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)
77
QUESTIONS?
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