Talk to me: How AI can diagnose disease

The collision of health care and technology.

Jan 12, 2022 View in browser   By Ben Leonard The Big Idea EXPRESSING A DISEASE: Want to know whether you have Covid-19 or even Alzheimer's? Artificial intelligence might soon have an answer just by listening to your voice. Leading researchers are developing technology that sorts through evidence of so-called vocal biomarkers to hone in on medical conditions that might not be detectable during routine office visits or exams. "This line might seem to have been lifted from a Star Trek script," said Bertalan Meskó, director of the Medical Futurist Institute. "But we are close to having such conversations with our computers." The technology works by picking up subtle voice characteristics the human ear can't detect. Then, it uses artificial intelligence to sift through the noise for potential signs of disease. Machine learning algorithms can, for example, distinguish speech impairment patterns associated with mild Parkinson's disease. That could lead to more cost-effective ways of monitoring neurological conditions, though it's unclear whether speech alone can characterize the full severity over time. LM Otero/AP Photo But voice data can be messy — muddled by background noise and other disruptions — and there's often too little data for robust analysis, experts say. That's so far kept the technology from becoming a standard feature in clinics and doctors' offices. Patient privacy around how voice data could be sold or used for nefarious purposes is also a concern. "These tools are intrinsically unnerving. That's the nature of innovation," said John Nosta, founder of NostaLab and a health tech expert. "We have to pass through the domain of wonder and fear." It's been deployed largely in research settings to help detect Covid-19, Alzheimer's and even coronary artery disease — as well as Parkinson's. The greatest potential is thought to be the ability to diagnose neuromuscular conditions that affect the upper-respiratory tract, said Rita Singh, a long-time Carnegie Mellon researcher on the technology. Experts say that, if successful, vocal biomarkers could catch serious conditions earlier and improve patient outcomes while saving money. It could also make the screening process faster. Researchers project the technology will be used in some form in a widespread fashion by decade's end. Top researcher Thomas Quatieri of MIT's Lincoln Laboratory said that using voice for screening is likely "at least" a few years away, while use for diagnosis could take longer. A lot will hinge on accessing robust enough voice data. A key is working with health institutions to getting patient voice samples paired with their diagnosis, said David Liu, CEO of Sonde Health, which is deploying the tech to detect symptoms of respiratory and mental health conditions. For the technology to be able to scale, data will need to be collected in the background, Liu said. Sonde is working with chipmaker Qualcomm to optimize its technology with its processors in cellphones, saying it could pick up voice signals passively and potentially detect signs of depression in patients at home, for example. That's where privacy concerns arise. "I'm not sure if it is possible to solve those issues," Mesko said. "The real question … is how much of our privacy we are willing to give up in exchange for a chance for a longer and healthier life." Welcome back to Future Pulse, where we explore the convergence of health care and technology. Share your news and feedback: @dariustahir, @ali_lev, @abettel, @samsabin923, @_BenLeonard_. Tweet of the Week rebecca mix @mixbecca "why, in 2022, the third year into a pandemic, are insurance companies denying coverage for telehealth appointments and making patients go into offices instead?? how does this make sense at all???" Around the World WHO: TOO EARLY TO TREAT COVID AS ENDEMIC: The World Health Organization told governments this week it's too early to predict that the Covid-19 pandemic will burn itself out, adding that more than half of people in Europe would catch the disease over the next two months. POLITICO's Sarah-Taïssir Bencharif writes the intervention by the global health body came after Spanish Prime Minister Pedro Sánchez signaled a policy shift away from counting cases and quarantining and toward a risk-based approach typical of managing outbreaks of diseases like influenza, which seeks to protect the most vulnerable. Now was not the time to conclude the pandemic will fade out, the WHO said, with the coronavirus as capable as ever of evolving and posing a new threat. "In terms of endemicity, we're still a way off," Catherine Smallwood, WHO Europe's senior emergency officer, said at a briefing. Spain plans to shift to a so-called sentinel surveillance system, Sánchez said, with cases reported by a sample of hospitals and doctors used to estimate disease prevalence and direct public health measures, such as vaccination programs. Meanwhile, U.K. Prime Minister Boris Johnson is under pressure from lawmakers in his ruling Conservative Party to lift restrictions now that the country's record-breaking wave of Omicron infection appears to be peaking, Washington Watch FDA DEVICE OVERHAUL PLAN ADVANCES: A long-anticipated plan to overhaul how the Food and Drug Administration regulates medical device quality was sent this week to the White House Office of Management and Budget for review, reports AgencyIQ, POLITICO's regulatory insight platform for the FDA. The rule has been in development since at least 2018. It seeks to harmonize the FDA's Quality System Regulation, or QSR, with an international standard known as ISO 13485:2016 that's recognized by most major global regulators. The FDA wants to make it easier and efficient for companies to comply with a single global standard. But key issues need to be resolved, including how much effort it will take for companies — particularly smaller, U.S.-based companies — to comply with the new requirements and for how long. CDC DATA COLLECTION IN THE SPOTLIGHT: The Centers for Disease Control's pandemic data collection was a hot topic during a Senate health committee hearing on the Biden administration's Omicron response Tuesday, when lawmakers like Sen. Maggie Hassan (D-N.H.) questioned why the agency's tallies on vaccination rates are still spotty and inaccurate. CDC Director Rochelle Walensky said her agency continues to rely on state immunization registries, adding that when people don't bring their vaccine card to their booster shot appointment, the shot is marked down as their first dose instead of their third. Walensky couldn't say when the issue will be resolved, but she noted the agency is working with every state to "reconcile" data gaps. Data trickles up from underfunded state and local health departments — many of which still operate on manual data entry, fax machines and other outdated technologies. The problem extends beyond vaccination rates to challenges tracking new variants, collecting information on racial disparities and more — forcing the government to turn to international data to make domestic policy decisions as the pandemic drags on. Finance PHARMA R&D RETURNS SOAR: Falling drug development costs last year helped manufacturers reap the highest returns on investment since analysts began tracking the metric more than a decade ago, according to a new report from Deloitte. Average drug development costs dropped from $2.4 billion in 2020 to $2 billion in 2021, according to the report. As development costs dipped, projected return on investment grew to 7.0 percent in 2021 from 2.7 percent in 2020. The jump in returns represents a rebound after several years of forecasted declines in return on investment in the sector. Elise Amendola/AP Photo Neil Lesser, a principal at Deloitte and a leader in its life sciences research and development work, said the returns grew largely because of the higher number of late-stage treatments in development during the Covid-19 pandemic, which brought many vaccines, antivirals and therapeutics into the pipeline. Covid-19 also increased the push to accelerate development via streamlining protocols and data collection as well as enhanced collaboration with regulators. "It's not shortcuts; it's efficiencies. It was ingenuity sparked by the emergency of the time," Lesser said. "Whether those practices can be scaled to the rest of the portfolio, we'll look to future years … to see that." Postscript JUSTICE FOR INVESTORS, NOT PATIENTS: Theranos founder Elizabeth Holmes has been found guilty of defrauding investors. But what about the patients who used the company's blood-testing technology and were led to believe they had cancer, changed their heart meds or thought they were diagnosed with autoimmune diseases or food allergies? Legal considerations led the government to emphasize how Holmes's misrepresentations defrauded investors like the DeVos and Murdoch families out of millions. But it's left some in the health tech world questioning whether patients will ever be made whole for emotional distress or financial costs they incurred. Nic Coury/AP Photo "It's a bit outrageous that the law allows people to rip off patients versus investors," said Christine Lemke, the co-founder of startup Evidation Health. Tyler Shultz, one of the prominent whistleblowers who informed investigative reporter John Carreyrou's work unmasking Theranos, said on Carreyrou's podcast that the fallout was a bit "disappointing." Whistleblowers "put our necks on the line not to save Betsy DeVos' $100 million but to save patients from potentially getting bad medical results," he said. What We're Clicking The Wall Street Journal surveys the field of anti-aging therapeutics. The New York Times looks at the surge of Covid-test misinformation. And STAT examines how telehealth companies are trying to cut costs.   Follow us

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