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Collective intelligence out-diagnoses even professionals
The Human Diagnosis Project project is building the world's "open medical intelligence" system.
- The Human Diagnosis Project can develop medical diagnoses with startling accuracy.
- The platform combines the knowledge of medical professionals and artifical intelligence.
- The goal of the project is to provide open, readily available high-level guidance and training to health care professionals across the globe.
The world-class Mayo Clinic is often the place patients go for a second opinion on a medical diagnosis. It's a good thing they do. According to a report issued by the clinic in 2017, 88 percent of them return home with either a completely different diagnosis or a significantly altered one. Only 12 percent receive confirmation of their doctors' original conclusions.
It's hard to overstate the life-and-death importance of medical misdiagnoses, and with all the artificial intelligence and data collection tools out there, you'd think there might be a way to improve on these statistics. This said, the goal of the Human Diagnosis project, or "Human Dx," (a triple pun their site explains) is to create the world's open medical intelligence system, a "collective intelligence" that can produce vastly improved diagnostic accuracy.
In early March, JAMA published the results of an experiment conducted by Human Dx in cooperation with Harvard, and the results were impressive. Where 54 individual human medical specialists correctly diagnosed 156 test cases 66.3 percent of the time, collective intelligence achieved an 85.5 percent accuracy rate. Nine medical professionals contributed to the collective intelligence conclusions.
Human Dx founder Jayanth Komarneni tells Big Think that, "We can get numbers in the 97th, 98th [percentile], and even — if we have sufficiently large numbers of participants — we can get to super intelligent results. That means that it outperforms 100 percent of individual participants."
About Human Dx
The Human Dx project is a partnership between the social, public, and private sectors — in the U.S., it's a 501 (c)(3) not-for-profit/public-benefit corporation. According to Komarneni, Human Dx's business model is as free of cost to users as possible while still generating enough income to be self-sustaining. There are now nearly 20,000 medical professionals in almost 80 countries contributing. Among Human Dx's partners are, as the company states: the American Medical Association, the Association of American Medical Colleges, American Board of Medical Specialties, and the American Board of Internal Medicine. They're also working in collaboration with researchers at Harvard, Johns Hopkins., University of California San Francisco, Berkeley, and MIT.
While diagnoses produced by Human Dx do bring together the opinions of multiple medical professionals, it's far from a simple voting system. It incorporates its own massive data set, machine learning, and artificial intelligence in addition to the input from medical professionals to develop its diagnoses. In designing their collective intelligence, says Komarneni, Human Dx had to first re-think the idea of open intelligence itself.
"We believe that open intelligence is the third form of open knowledge," he explains. The first was open source-protocols such as those on which the internet is based, as well as operating systems such as Linux. These protocols enabled the second form, open content: Wikipedia, data libraries, and so on. Open intelligence combines the first two: "And when you think about A.I. in the context of software," says Komarneni, "it really is code which is smartly delivering content to you based on what you put into the system."
The importance of open intelligence is that without it being available at low cost or free, the cost of A.I. is going to be so prohibitive that it'll "exacerbate, as opposed to close, income, health, and other disparities in society," warns Komarneni. Nowhere will the ramification be more serious than in health care, since "there is nothing we care more about than the well-being of the people we love and ourselves."
How Human Dx collective intelligence works
Collective intelligence in the Human Dx project is not unlike a panel of participants, when are referred to as "agents." Some of these are medical professionals, but they may also include the outputs of other systems. For example, Komarneni mentions that it's entirely possible IBM's Watson could be one of these agents, or even a data set from the National Institutes of Health.
Of course, individual agents, even the human participants, express themselves in their own ways — is a lump "blue" or "blueberry-colored," for example — not to mention that contributions from some agents such as A.I. or datasets may be in the form of raw data. Before any meaningful synthesis of all these opinions can be performed, the first step is to convert them all into a common language of some sort. Human Dx's AI uses natural language processing, text prediction, and medical ontologies to derive these translations as the process's first step.
Human Dx establishes the capability, or CQ ("clinical quotient"), of each agent. To do this they rank agents' skills using test cases with known diagnoses, including "some of the most wickedly complex cases," says Komarneni. This allows Human Dx to determine how accurate agents' diagnoses can be expected to be, and how heavily they should be weighted against other participants' contributions in solving the current case.
A.I. joins the panel
At this point, the agents' inputs are synthesized to derive the most likely diagnosis, and this is combined in an A.I. model with all of the aggregated case data that's ever been captured by Human Dx — interactions in the "tens of millions" — including how "lots of other participants over many other cases have solved these cases." This A.I. model then joins the panel in arriving at the final diagnosis.
"And those [agents] combined," says Komarneni, "are how we can get to results that outperform the vast majority of individual participants."
The Harvard and Johns Hopkins studies
The Harvard study published in JAMA is the first public demonstration of the Human Dx system as a diagnostic tool. Working with an international cohort of medical students and professionals, the results were unquestionably amazing. There were 2069 users working 1572 cases — again, these were cases with known correct answers — from the Human Dx data set. About 60 percent of the participants were residents or fellows, 20 percent were attending physicians, and another 20 percent were medical students. In the study, as more medical professionals were added to the collective intelligence "panel," up to nine individuals, its accuracy consistently rose. Physicians who weren't specialists in their test-case areas achieved just a 62.5 percent accuracy score.
A previous study published in JAMA in January, and done in cooperation with Johns Hopkins, looked at Human Dx as an automatic platform for assessing the diagnostic abilities of health care professionals and students. That the scores of participants looking at 11,023 case simulations were consistent with their training level shows, in Komarneni words, "that we provided a valid, quantitative, scalable measure of medical reasoning." While he admits this doesn't sound like a big deal, it is, since it offers a far more accurate and scalable option to current multiple-choice assessments, which have been shown to correspond poorly to real-world diagnostic skills.
The future of health care and Human Dx
Komarneni says that there are basically only two ways to provide global universal health care, a pressing need since, "Almost half the world has no access to essential health services." One way, he says, would be to create a God-like A.I. system to provide health care to everyone, but, "We know that's not going to happen." God-like AI is just too hard, potentially requiring having to know everything about a patient from the tiniest details — say, the quantum behavior of electrons in mitochondria — to the huge, as in the kind of environment a patient lived in as a child.
In addition, Komarneni says, "In a world where data is locked up in many disparate silos, there isn't going to be a single collective agent. There's going to be a collective of many intelligent agents, both human and machine. The key is how do you integrate intelligence into larger buckets of intelligence than can solve the world's hardest problems."
This is where the Human Dx project, and the second approach, comes in. It actually has two components:
- The first is the expansion of existing medical professionals' diagnostic accuracy skills by providing them access to the Human Dx platform and its collective intelligence as a diagnostic tool.
- The second is helping to train new professionals, and Human Dx Training is already offering this on the Human Dx site.
For those concerned with privacy in a system such as Human Dx, Komarneni says it'll be a non-issue, explaining with an example. When two people converse, "We don't have access to the underlying data of each others' minds. We're agents that are interacting with each other to gain relevant and useful information from each other." Similarly, Human Dx's system of interacting agents doesn't require the exposure of patients' personal data. What's shared with Human Dx are the conclusions agents draw from that data, not the data itself. In the case of a dataset operating as an agent, the data would be anonymized.
Human Dx's interest in all this is developing a platform it hopes others find uses for. "We believe we're just building the enabling technology that many other stakeholders could use." As examples, Komarneni imagines, "The VA could implement their own version of this. Kaiser Permanente could implement their own version. Employers could contract with us or with their own insurers. You could even also have individual and group practices use Human Dx software to serve patients directly."
Human Dx is currently looking at ways to open up as much of the project for non-professionals as possible, and they've already made a start: On their home page is a diagnosis cloud — mouse over the various blue bubbles to see different conditions, and then click for further details. In addition, just beneath the cloud is a search field with which you can look up diseases and symptoms.
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
COVID-19 deepens U.S. health disparities<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
Astronomers spot an object heading into Earth orbit.
Minimoons<p>Scientists have confirmed just two prior minimoons. One was <a href="https://en.wikipedia.org/wiki/2006_RH120" target="_blank">2006 RH120</a>, which orbited us from September 2006 to June 2007. The other was <a href="https://en.wikipedia.org/wiki/2020_CD3" target="_blank">2020 CD3</a>, which got stuck in the 2015–2016 timeframe, and is believed to gotten away in May 2020.</p><p>2020 SO, the new kid on the block, is expected to arrive in October 2020 and pop out of orbit in May 2021.</p><div id="37962" class="rm-shortcode" data-rm-shortcode-id="f4c0fc8a2cba6536ea4cd960ebed3e6e"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1307729521869611008" data-partner="rebelmouse"><div style="margin:1em 0">Asteroid 2020 SO may get captured by Earth from Oct 2020 - May 2021. Current nominal trajectory shows shows capture… https://t.co/F5utxRvN6Z</div> — Tony Dunn (@Tony Dunn)<a href="https://twitter.com/tony873004/statuses/1307729521869611008">1600621989.0</a></blockquote></div>
Identifying 2020 SO<p>The first clue 2020 SO isn't your ordinary asteroid is its exceptionally low velocity. It's traveling much more slowly that a typical asteroid — their <a href="https://www.lpi.usra.edu/exploration/training/illustrations/craterMechanics/" target="_blank">average rate of travel</a> <a href="https://www.lpi.usra.edu/exploration/training/illustrations/craterMechanics/" target="_blank" rel="noopener noreferrer"></a>is 18 kilometers (58,000 feet) per second. Even <a href="https://en.wikipedia.org/wiki/Moon_rock" target="_blank">moon rocks</a> sent careening into Earth orbit by impacts on the lunar surface outpace pokey 2020 SO.</p><p>For another thing, 2020 SO has an orbital path very similar to Earth's, lasting about one Earth year. It's also just slightly less circular than our own orbit, from which it's barely tilted off-axis.</p><p>So, what is it? <a href="https://cneos.jpl.nasa.gov/ca/" target="_blank">NASA estimates</a> that the object has dimensions very reminiscent of a discarded Centaur rocket stage from the <a href="https://en.wikipedia.org/wiki/Surveyor_2" target="_blank" rel="noopener noreferrer">Surveyor 2 mission</a> that landed an unmanned craft on the moon. Back in the day, rocket stages were jettisoned as craft were aimed toward their desired position. This stuff, if released high enough, remains in space. It appears that this Centaur rocket, launched in September 1966, is now making its way back homeward, at least for a little bit.</p><p>When 2020 SO arrives at its closest point in December, the rocket is expected to be about 50,000 kilometers from Earth. Its next closest approach is much further: 220,000 kilometers, in February 2021.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQzMDk3NC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyODg1MTQ1MX0.HGknDwqp0GmeuczKY_AS7vrPG7KMFUc_XO95tNoI2xo/img.jpg?width=980" id="e5cda" class="rm-shortcode" data-rm-shortcode-id="85eb1f790d8c3ee5b261f7ba13eaa5e1" data-rm-shortcode-name="rebelmouse-image" alt="Centaur rocket stage" />
Centaur rocket stage
What we may be able to learn<p>Earthly space programs being as young as they are, scientists would love to know what's happened to our rocket during a half century in space.</p><p>While 2020 SO won't get close enough to drop into our atmosphere, its slow progress has scientists hopeful that they'll still get some kind of a decent look at it.</p><p>Spectroscopy may be able to reveal what the rocket's surface is like now — has any of its paint survived, for example? Of course, being out in space, it's likely to have been hit by lots of dust and micrometeorites, so the current state of its surfaces is also of interest. Experts are curious to know how reflective the rocket is at this point, valuable information that can help planners of future long-term missions anticipate how well a craft out in space for extended periods will remain able to reflect sunlight.</p>
Shannon Lee shares lessons from her father in her new book, "Be Water, My Friend: The Teachings of Bruce Lee."
- Bruce Lee would have turned 80 years old on November 27, 2020. The legendary actor and martial artist's daughter, Shannon Lee, shares some of his wisdom and his philosophy on self help in a new book titled "Be Water, My Friend: The Teachings of Bruce Lee."
- In this video, Shannon shares a story of the fight that led to her father beginning a deeper philosophical journey, and how that informed his unique expression of martial arts called Jeet Kune Do.
- One lesson passed down from Bruce Lee was his use and placement of physical symbols as a way to help "cement for yourself this new way of being, or this new lesson you've learned." By working on ourselves (with the right tools), we can develop the skills necessary to rise and conquer new challenges.
How to deal with "epistemic exhaustion."