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