Disease Informatics: ICD11 at the doorstep

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Disease InformaticsICD-11 at the doorstep
Bill and Narayana

• By RP Deolankar
• Presentation for 4th Nutraceutical Summit, WTC,
  Mumbai, India
• Feb. 21-23, 2008

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WHO

• World Health Organization (WHO) provides a
  service which is designated as a Family of
  International Classifications (WHO-FIC)

10th version of ICD (ICD-10) has a Chapter
entitled Endocrine nutritional and metabolic
diseases
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ICD

• One of such service is International
  Classification of Diseases (ICD)
• Application of Statistics and Information Science
  to establish causes of morbidity

The activity is being described as a part of
Disease Informatics
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Disease Definition

• The ICD has become the international standard
  diagnostic classification for all general
  epidemiological and many health management
  purposes.
• In turn, ICD provided Diseases definitions

"Let your food be your medicine and your medicine
be your food" Hippocrates In short, most of the
diseases could be linked to food and lifestyle.
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ICD-10

• Endorsed by the Forty-third World Health Assembly
  (WHA) in May 1990
• Disease Definitions are quantal
• Domain of handpicked experts as described by
  media

Severity of the disease triggered by the virus
may be determined by the type of food had been
eaten by the subject.
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Scope for improvement

• Severity of Disease Diseases are quantitative
• Holistic approach Multiple morbidities interact
• Throwing open portal to Doctors, Health Workers,
  Educationists and Spiritualists

Dr. T. B. Ustun
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Scope for improvement in clinical research

• Multiple morbidity ? Multiple hypotheses
• Bayesian applications

• What can be done?
• As most of the functional foods serve as
  multiple remedy and also could reduce side
  effects of drugs, create task force for
  statistical methods in this area

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Objectives of the presentation

• Discuss How to use platform provided by
• ICD-11 for
• Defining the diseases with least error so that
  those are understood, prevented and reversed
• Identifying most of the targets to combat a
  cluster of diseases, understand spatial continuum
  through working on Disease Causal Chains and
• Designing a holistic solution to the disease
  problem

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Health of an individual

• Wellbeing Disease
• Loosing the wellbeing is proportionally gaining
  the disease

Wellbeing guards Good food Superb
lifestyle Complementary Nutraceuticals
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Medical check-up

• Revealing certain events in the health history of
  an individual
• Three aspects of Medical Check-up
• Attempt to hunt priors (Backend events)
• Understand present (Current event)
• Predict posteriors (Frontend events)

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Disease Causal Chain or Web

• Events linked together
• Chain could be reversed due to intervention
• Pruning the Frontends could stimulate branching
  in the chain

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Factors (Components)

• Drive events from backend to frontend
• Proxy, Overlapping, Independent, Mediators and
  Moderators
• Events could be modulated through altering
  factors

Prof. HC Kraemer
Factors are shown by arrows
Cause Effect Diagram
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Components working together

• It is not A B
• It is A B AB

Genes load the gun, the environment pulls the
trigger Prof. Kenneth Olden
Point to ponder Why certain probiotics reverse
viral diarrhea?
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Ancient Indian Model of Human Body Computer

• Human Somatic body Vitality Mind
  Intellect Bliss (Panchakosha)
• Intellect (Central Processing Unit) Self/ Ego
  (Software) Memory (Free space, Pen Drive/ Hard
  Disk) Mind/ senses (Program) Life history
  (Data)

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Human Microbial Organs

• Gut Associated, Vagina Associated, Skin
  Associated etc (Eco-organs)
• Being described as Human Microbiome

Prebiotics Probiotics Synbiotics
Prof. Stig Bengmark
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Clinical Research

• To understand the disease of an individual, one
  has to understand human and his body computer and
  his associated organs also

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ICD-10 classification

• Infectious and Parasitic Diseases
• Cancers
• Endocrine, nutritional or metabolic diseases etc.

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Triviality

• Infectious disease is not a nutritional disease
• Nutritional disease is not an endocrine disease
• One may have Infectious Disease Nutritional
  Disease Endocrine disease
• i.e. Multiple morbidities but not the complex
  disease

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Reality

• Infection can happen due to endocrine abnormality
  and endocrine abnormality can happen due to
  malnutrition
• Some component may occur as prior some component
  may occur as posterior
• (Keshan disease Selenium Deficiency coxsackie
  virus B4)

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What is neglected in ICD-10

• Disease Causal Chain
• Most of the traditionally established remedies
  (TER) alter disease causal chain
• TER could alter some component of a sufficient
  cause of the disease
• Disease definition might not regard that component

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Rothman and Greenland

• Sufficient and component cause model
• (Button is not sufficient cause to switch on or
  switch off the bulb)
• Sufficient causal mechanisms gt 1

Three sufficient causes of disease.
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To summarize the background

• Diseases are complex
• Needs group effort to understand
• Needs modern tools of information science to
  study
• Yet can have simple solutions

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ICD-11

• Membership is open to all who are willing to
  register
• Members can back their suggestions with
  appropriate evidence
• Members can participate in online debate over
  proposed changes in disease definition

• What can be done?
• Register as a member, Form Disease Informatics
  Groups

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Systematic reviews Basis of ICD-11

• What can be done?
• Participate in Cochrane collaboration

• Practice of combining the results of a number of
  studies (scientific, clinical and public health)
  that address a set of related research hypothesis

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What is Cochrane Collaboration?

• It is a global network of dedicated volunteers
  for providing reliable source of evidence in
  health care. Evidence is in the form of
  Systematic reviews based on meta-analysis

• What can be done?
• Register our interest in nutraceuticals and
  functional foods, form Cochrane review group

Professor Archibald Leman Cochrane
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Field testing of ICD-11

• Draft version of ICD-11 shall be field tested

• What can be done?
• Participate in the field testing

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Standardization of terminology

• ICD-11 website shall provide linkage for
  standardization of terminology

• What can be done?
• Find out methodology so that world understands
  our terminology

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Examples of Indian terms

• Simple term Ama Dysbiotics (Products of
  dysbiosis)
• Complex term Vata Body constitution described
  as Low density of the body Ectomorphy More
  gaseous Less muscle High body motility
  Linear body shape etc

Traditional Knowledge Digital Library should be
made available to ICD-11
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Confusion due to local dialect

• Kanjika (Indian functional food, also abbreviated
  as Kanji), a probiotic food, is a lactic
  fermented product where lactic fermentation is
  the terminal step in food processing and is
  prepared from raw material of plant origin and
  devoid of dairy product
• Kanji is also used for porridge that is confusing

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Confusing terms (Continued)

• Umbil is similar to kanjika but contains lactic
  fermented milk as an ingredient or cooked plant
  material may be combined with lactic fermented
  dairy product
• Umbil is also used in place of Kanjika by some
  people

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Standard Terminology
MeSH, Medical Subject Headings of NLM, NIH,
USA Based on UMLS (Unified Medical Language
System) Metathesaurus
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Standardization of Data Processing

• ICD-11 website shall provide linkage for
  standardization of Data Processing
• More and more Bayesian Approach would appear in
  Disease Informatics

• What can be done?
• Develop user friendly software

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Standardization of Research

• ICD-11 website shall provide linkage for
  standardization of research
• More and more Good Practice Protocols would be
  asked for

• What can be done?
• Develop standard courses in Health Research,
  Project Management Software, Infrastructure and
  Equipment Management, Store and Inventory
  Management, Archive Management, Document
  Management and GLP, GCP, GCLP, GMP etc

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Example of Disease Causal Chain follows
Phytase (germinated grains) Calcium Vitamin D
Sun Exposure for Influenza prevention?
Sania in Sun
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Calcium deficiency as the front-end event due to
Chelation by Phytic acid
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Front end events of Reduced availability of
Calcium
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Front end events of Degradation of vitamin D in
the liver
John M Pettifor. Nutritional rickets deficiency
of vitamin D, calcium, or both? Am J Clin Nutr
2004 80(suppl) 1725S9S.
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Front end events of Vitamin D deficiency
(Avitaminosis D syndrome, I)
D Finally, a vitamin makes the grade. Several
new studies suggest that the so-called sunshine
vitamin (because its produced in skin exposed to
sunlight) may protect against cancer. One study
showed that as blood levels of vitamin D go up,
womens breast cancer risk goes down. Another
found that fairly large amounts of vitamin D
lowered the risk for pancreatic cancer by about
40. The Top 10 health stories of 2006, from
the Harvard Health Letter
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Founder faculty member of the Department of
Endocrinology, Metabolism Diabetes at the
AIIMS, INDIA
Dr.Narayana Kochupillai
"Based on our clinical experience and limited
studies, we believe vitamin D deficiency is
widespread in northern India," http//www.bmj.com
/cgi/content/full/326/7379/12/b?etoc
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Front end events of Vitamin D deficiency
(Avitaminosis D syndrome, II)
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The UV Advantage The Medical Breakthrough That
Shows How to Harness the Power of the Sun for
Your Health by Michael F. Holick. I Books
/Marvel, New York
Prof. Michael Holick Boston University
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Front-end events of Vitamin D deficiency (Avitamin
osis D syndrome, III)
Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant
WB, Madronich S, Garland CF, Giovannucci E.
Epidemic influenza and vitamin D. Epidemiol
Infect. 2006 Dec134(6)1129-40 Aloia JF, Li-Ng
M. Re epidemic influenza and vitamin D.
Epidemiol Infect. 2007 Oct135(7)1095-6 author
reply 1097-8.
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Epidemic influenza and vitamin D. Epidemiol
Infect. 2006 Dec134(6)1129-40 1. Cannell JJ,
Atascadero State Hospital, CA 2. Vieth R, Mount
Sinai Hospital, Canada 3. Umhau JC, NIH 4. Holick
MF, Boston University 5. Grant WB, SUNARC, CA 6.
Madronich S, National Center for Atmospheric
Research, CO 7. Garland CF, University of
California San Diego 8. Giovannucci E., Harvard
School of Public Health, Boston All authors are
from different institutes
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Disease definition challenged Authors remark in
the conclusion section Is influenza infection a
sign of vitamin D deficiency as much as
Pneumocystis carinii pneumonia is a sign of AIDS?
J. J. Cannell
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Nutraceutical for Influenza Prevention on the
basis of the DiCC

• Calcium Irrigated, UV Irradiated Mushrooms
• Rich in Calcium
• Rich in Vitamin D
• Rich in Protein
• Useful in lead detoxification

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Indian Government Institute National Centre for
Disease Informatics and Research at Bangalore,
India

• Multi-disciplinary
• Multi-centric
• Surveillance

Healthcare Eleventh Five Year Plan (2007-2012)
by Ministry of Health and Family Welfare,
Government of India, New Delhi
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Proposed Title-adjuncts for Nutraceutical
Journals Disease Path Speed Breakers Causal
Chain Quenchers Sufficient Cause
Crackers Reversal of Disease Chronicle Simple
Solutions to Disease Clusters Back-End Targets
for Nutraceuticals Disease Informatics for
Nutraceutical Development
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Learn more about DiCC
Disease Informatics Phytates driving from the
back-end to Influenza, Encephalitis, Hepatitis,
Anemia at the front-end
Supercourse Epidemiology, the Internet and
Global Health, Lecture
no. 30331
Disease informatics for setting up Disease
definition, drawing Disease Causal Chain / Web,
marking Risk Events, Backend and Frontend Events,
and Health Problem Solutions Rajendra P
Deolankar BMJ.COM, 30 May 2006
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Read the Basics of Disease Informatics

• DIG for Disease Informatics Group. Part I Part
  II
• Disease Informatics Host factors simplified
• Supercourse Epidemiology, the Internet and
  Global Health,
• Lecture no. 25371, 25381 and 28921

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Thank you