Micro customization

Recent news (1) that a gastric resident delivery mechanism can deliver reliable, sustainable doses of agents for the long term is important. Innovation in chemical agents has moved ahead of mechanisms that would deliver them at the right time, in the optimum dose, by the best route and to the most receptive site. The ability to optimally deliver the agent is likely more important than the agent itself. In the absence of such delivery mechanisms, manufacturers have stuck to the original blue print - mass manufacturing of pills in a singular dose that shows the best therapeutic index in the population. Personalized medicine, thus, has remained elusive and more importantly, outside the business models of manufacturers.

It may be changing. Ironically, providers have moved ahead of other participants in the healthcare value chain, in the implementation of personalized medicine. Recent advancements in Artificial Intelligence and the availability of abundant data have better  positioned the providers to understand, treat and manage patients, individual by individual. If delivery mechanisms improve and become individually customizable, we can rapidly move into the next level of personalized medicine. Here, we can envision devices that can measure, decide and disburse micro doses to assure optimum delivery and complete compliance. Intelligent devices could be just round the corner, taking advantage of IoT. With embedded intelligence on board, such devices can not only operate as initially primed but also self learn and adjust over time. A couple of decades from now, medical professionals will likely view the current regime to be completely archaic.

More generally, any business that is driven by scale, a blind adherence to singular specifications, will have great difficulty to survive in the future. Technology is readily available, not just for mass customization but rather for individual intervention. This is a regime change that will affect every industry and every business. Getting ahead of this rapid transformation is a necessary condition for success.

(1) A gastric resident drug delivery system for prolonged gram-level dosing of tuberculosis treatment. Verma et al. http://stm.sciencemag.org/content/11/483/eaau6267

Type 2 Debate

A recent article (1) brings the current diagnostic and treatment regimens for those who are deemed to be at risk for progressing into Type 2 Diabetes, into question. The arguments are fair and the conflicts are clear. But what the article misses is the risk/return trade-off for the wretched condition. The total cost of diabetes related cost in the US alone is fast approaching $0.5 Trillion. With India and China running fast to the precipice, happily feeding on Western food, we do have a significant issue to deal with.

So, there are two important questions. First, do we have a reasonable idea of the risk of incidence and progression? Age old heuristics such as fasting blood sugar has been shown to be utterly useless.The current golden metric, A1c, is likely equally flawed. The answer to this question appears to be an emphatic no. And second, are the people in charge of prescribing the thresholds for diagnosis and prevention influenced by factors outside science. Unfortunately, the answer to this is likely yes.

Medicine has always shunned data and analytics in making decisions. This has set them so far behind, the US spends close to 20% of its GDP for worse outcomes. And aging regulators, still using century old statistical measurements to make decisions, makes this worse. The manufacturers, bloated with conventional statisticians, ever ready to prove what the regulators seek, are progressing backward in time. So, it is not surprising that we have ended up in a confusing muddle regarding a disease state that affects close 20% of the world population.

Now, what? It is easy to show statistics that claims only 2% of the pre-diabetics progress into diabetes. Since we are unclear as to the "precise," demarcation between pre and post diabetes, a more relevant question is what the total cost is on the system. A few thousand years ago, humans invented agriculture - and it clearly had an impact on their health. Meat eating humans for millennia, moved to stuff their bodies are not designed to process. In the last hundred years, they had too much to eat and that will certainly create problems not only for their organs, efficiently designed for very little food but also their infrastructure, designed for a slim body. Half the world's population now exceed the parameters of original designs.

Medicine has to embrace modern technology. Doctors should not be simply following rules put down blindly, regulators have to open their windows and realize that the "p-value," is a dead construct and manufacturers need to understand that their job is not a constrained optimization based on what the regulators think.

It is time for the industry to move on.


(1) https://www.sciencemag.org/news/2019/03/war-prediabetes-could-be-boon-pharma-it-good-medicine

Health

News (1) that a group of scientists is attempting to build up a health system in Madagascar from scratch, driven by data, analytics, and pure heart is welcome news. Health, a non-tradable asset, has kept modern humans bottled up. Electing dumb leaders has taken them further behind. The economics of health is a complex question and till scientists and medical professionals take it on, we will swirl around in political ignorance and impasse.

Humans did not have to worry about health until recently. Their able bodies were eaten by cats or crushed by heavier animals much before any required intervention against single cell organisms or auto-immune diseases. It is different now. They are living way past the design horizon. To make matters worse, they have been carrying unwanted weight, putting unexpected levels of stress on their joints. Their organs have been failing because of overuse and their infrastructure is crumbling, not able to hold them up. Modern medicine has acted as a band-aid to prolong life but it has not contributed to maximizing the utility of the individual or society.

A big part of this issue has to do with the inadequacies of systems that apparently intelligent people designed. When there are no markets, incompetence rises. When incentives are misaligned, humans behave as they are expected to, maximizing short term returns. And, humans have a tendency to gang up on the weak and the weary as they learned through the eons of evolution. It is a perfect storm - incompetence, ignorance and non-market designs - that could sink humanity.

It is time to step out. Experiment, revolutionize and let information and technology guide future actions.

(1) http://science.sciencemag.org/content/363/6430/918

Reducing software by hardware

New transistor designs (1) may help surpass the daunting constraints faced by contemporary software as we move toward solving highly specialized problems. The dominance of software over general computing architecture may be coming to an end. Until architectures can practically incorporate quantum computing, there is an impasse. And, quantum tunneling has brought conventional transistor designs to an asymptotic and predictable lethargy.

It is time to return to customized hardware for specialized problems. This will require more engineers again and less programmers and mathematicians. Educational institutions, grand masters at following the latest trends, while they teach the students "strategy," are incompetent in understanding what tomorrow will bring. And, that will certainly dampen innovation in the required direction.

However, this could be a short term phenomenon. Either of the two directions, squeezing more out of Silicon or finding better materials, may yield interesting designs that may allow a return to software in the future. The latter has much more potential but is also more risky. That would mean that the giants of the industry will shy away from it as they try to tie the quarterly numbers for the shareholders. And some of them may realize that the "cloud," is not a solution, just a sojourn.

The hardware regime is beginning again. We have to give electrons a more direct way to shuttle for efficient computing. Anything less will tie us down to the status-quo.

(1) http://advances.sciencemag.org/content/5/2/eaau7378