The new frontier of medicine is precision.
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so
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since the beginning of the covet 19
pandemic
i have been heavily involved in its
management
both from a healthcare system
perspective and a scientific one
one of the member of the women’s brain
project
a non-profit which high co-founded went
already in february in china
and she acted as a source of scientific
information
for the scientists working at the
women’s brain project
once the first data became available
from the chinese population
it appeared that more men were
infected with the virus suffering from
major consequences and dying of it
this was for us a an extremely
important observation because what we do
we study the impact
that sex meaning our dna and gender
meaning our social constructs that we
all carry
have on diseases with a special focus on
brain
and mental diseases later on
more data became available worldwide and
it was confirmed
that in fact more men were
having severe symptoms of the
coronavirus infection
as compared to women and dying even of
it although
women were representing the majority of
the
working force in the healthcare system
at the front line
and scientific hypotheses are based on
the fact that the immune system
of women might be stronger in fighting
the virus
now is this true just for the
coronavirus
or not well actually medicine it is
embedded of these sex and gender
differences
but it seems that we need a pandemic
to get the world recognize it
now but if this is the case
our sex and gender differences
represented in the way we develop
medical solutions for humankind and the
answer is no
a report from last year
describing the number of people included
within
clinical trials for drugs approved by
fda between 2015
and 2017 showed that just 43
of the patients included were women and
this number included also
those indications reflecting disease or
condition
prevalent in women like menopause the
same report pointed to the fact that
only five percent of the patients
included were black
12 percent asian 78 majority
white you might agree with me that the
clinical development in our days
it is based on an average existent
persona
a default human which in fact
historically happened to be
predominantly white
and male now what does this mean for
medicine
well the situation it is not that
good in fact a report
from the general american office in 2001
pointed to the fact that out of 10 drugs
eight were withdrawn from the market
because had major side effects
on the female population mainly we know
that women
are not really included
in phase one and phase two of clinical
trials or underrepresented
and this results in drugs which shows in
this population often
a moderate efficacy and major side
effects
even more striking it is what happened
last year 2019
a drug for hiv to prevent
hiv has been approved but only for men
and the reason is that not even one
single woman was included in the
clinical trial design
this is unacceptable
so how can we solve this well
the future is going to bring us
precision medicine
precision medicine it is the opposite of
shallow medicine what i have described
to you before
to quote erictopol and it is based on
the use of
proteomics genomics metabolomics
information about our socioeconomic
status
about the race of the patient
the ethnicity of the patients the sex
and the gender of the patients
analyzed by artificial intelligence
which means
each of us in this room will have a
medical treatment tailored based on its
own specific needs
but why is this not yet a reality
well the simple answer is that medicine
and mainly artificial intelligence
interpreting medicine
it is biased and those biases
are intrinsic very often in a
non-conscious way in not only those who
are developing the algorithm
but mainly in the data set which is used
for this type
of algorithms it’s a known problem
and that in genomics for example big
data sets
reflect usually 80 kilos
relatively wealthy white men and as a
doctor
i would love to have this type of
patients all the time
but it does not reflect the overall
population
so
this has of course implication for
the way we do solutions and i give you
just an example
recently scientists
were developing and diagnostic tool
based on algorithm that was learning
from data set
and what they’ve realized is that if the
algorithm was trained mainly with
data from female the algorithm
wasn’t accurate enough in diagnosing
chest pathology in men
and the other way around pointing to the
fact that you need both sexes
to make a useful diagnostic
algorithm now this type of sex and
gender differences
are also embedded in brain
and mental diseases and
this is where one of the highest unmet
medical needs
in medicine persists i am a specialist
in alzheimer’s disease
i can tell i can tell you that even in
alzheimer we have sex and gender
differences women represent the majority
of the patients
women progress faster with the cognitive
decline
women have more brain atrophy and they
also represent the majority
of the caregiver task force managing
this condition
for their beloved ones what if we
outsource the solution
to algorithms what if we bring
type of precision medicine and precision
medicine relies on
digital biomarkers which means in this
case
you can download an application on your
mobile and while sitting on the coach of
your living room
you can take a test and this test is
going to assess your risk
of having eventually alzheimer’s disease
it can
tell you if your brain it is a normal
one
working properly if it has already
symptoms of
what is called mild cognitive impairment
the phase before
the full alzheimer’s disease becomes
manifested but now the interesting part
comes
what if we ask the algorithm if the
brain performing the test
it is a female brain or a male brain
and actually the answer is that yes the
algorithm can distinguish it
so based on certain type of classifier
it can tell
without the person taking the test it is
a female or a male one
so we need to use this type of
technology to analyze eventually how
diseases
are affecting men and women in a
different way
in what domains of our brain performance
this
has a meaning and implemented in the way
we do develop clinical trials to bring
the medicine of the future with us
now the solution it is precision
medicine which has in fact the potential
of transforming
basically the treatment of brain and
mental
diseases and to do that
will mean that we will reduce the cost
of the healthcare system we will have
better drugs they will act better they
will be tailored
for the person sitting here each of us
and this is
at the right time at the right moment
for the right medical condition
but for doing that we need to do in my
opinion four things mainly
the first one it is to educate to this
type of
differences educate the scientific
community
policy makers regulators drug developers
even the lay public and novel technology
designers
we need to be aware that there is a risk
of having algorithms which might be bias
and if this is the case we have to
mitigate this risk
and avoid that it get implemented and
perpetuated in the system
we need to activate always a strong
ethical discussion
for both clinical solutions
treatments but also for novel technology
design such as the solution that we are
designing
it is meant to benefit the overall
population
and finally we need to make artificial
intelligence which is
explainable we need to know why
artificial intelligence has taken that
decision
at that moment and finally we need to
make it also
reproducible which means the result has
to be reproduced in different parts of
the world
to be actually really true
so 2020 has been a
very very difficult year for science and
medicine
and we have seen that we still have a
lot of work
to do i think that out of this tragedy
we have the unique opportunity to
transform
health care system and medicine
to make it sustainable to make it
representative of the characteristic of
each of us
when we do design drugs when we do
design novel technology
when we try to find social solutions for
big problems as the pandemic in my
opinion
the precision medicine will become
a reality once the word differences
which divide each of us will be replaced
by the word characteristic
thank you