The meta-informational challenge of molecular data

The future of DNA sequencing

Where does DNA sequencing goes from here?. Nowadays, this is an appropriate question to pose.  The answer appears in an article in an interesting article in Nature.

Now, geneticists would like to have DNA sequences for everyone on Earth, and from every cell in every tissue at every developmental stage (including epigenetic modifications), in health and in disease. They would also like to get comprehensive gene-expression patterns by sequencing the complementary DNA copies of messenger RNA molecules.

In a mere 40 years, the central goal of putting molecular data about cells to practical use has changed from an informational challenge to a meta-informational one. Take clinical applications of genome-sequence data. It may soon be possible to use DNA sequencing routinely to analyse body fluids obtained for any clinical purpose. But only a vast amount of well-organized data about the multi-year medical histories of millions of people will provide the meta-information needed to establish when to ignore such data and when to act on them.

The uncertain cost of clinical trials

How much do clinical trials cost?

A research on seven top pharmaceutical companies has provided fresh data about costs of clinical trials:

For the trials in the data set, the median cost of conducting a study from protocol approval to final clinical trial report was US$3.4 million for phase I trials involving patients, $8.6 million for phase II trials and $21.4 million for phase III trials.

If you compare these data with the total drug costs (2.6 billion), you may ask yourself how all these costs are estimated. Maybe all this information is wrong and useless.

PS. Waiting for the new book on Theranos scandal

Pharma sales 2017

Kupka au Grand Palais

Why is it so difficult to implement policies?

Governance and the Law

If you want to know an updated approach to policy reforms, then you have to read the World Development Report 2017
The main messages:

• Successful reforms are not just about “best practice.” To be effective, policies must guarantee credible commitment, support coordination, and promote cooperation.
• Power asymmetries can undermine policy effectiveness. The unequal distribution of power in the policy arena can lead to exclusion, capture, and clientelism.
• Change is possible. Elites, citizens, and international actors can promote change by shifting incentives, reshaping preferences and beliefs, and enhancing the contestability of the decision making process.
• Three guiding principles for rethinking governance for development are:
• Think not only about the form of institutions, but also about their functions.
• Think not only about capacity building, but also about power asymmetries.
• Think not only about the rule of law, but also about the role of law

You'll understand that the key element of any reform goes beyond evidence on what works and consensus. It should be clearly designed following specific steps. I suggest you have a look at it.

El gran Guillem Roma amb Alessio Arena

Integrating genome and epigenome studies

The Key Role of Epigenetics in Human Disease Prevention and Mitigation

I've said it many times: beware of snake-oil sellers. Nowadays you may find it everywhere, specially on internet. You may get a genetic test for a disease that creates a false illusion of safety, or another that provides an unnecessary and avoidable concern. Only evidence based prescribed tests can be considered appropriate.
Therefore, if you want to confirm that genome is not enough, you have to check the review at NEJM on epigenetics. At the end of the article you'll find the explanation on why we do need integrated genome and epigenome association studies. You'll understand that cancer is fundamentally an epigenetic disease.
The current knowledge is changing quickly some conventional truths and "known unknowns" that we've had for years. This is good news for citizens, and bad news for snake-oil sellers if detected. Governments should help citizens on this screening effort, and protect citizens from fake medical information.

Practice makes perfect (2)

The Volume–Outcome Relationship Revisited: Practice Indeed Makes Perfect

Why is it so difficult to accept it? There is wide "evidence for the practice-makes-perfect hypothesis by showing that volume is a driving factor for quality". Unfortunately, the opportunities for the health system are still larger than it should be. There is a resistance in organizations, there is inertia, and all these drivers play a role. In planned health systems, there is no reason to be strict on it.
Just for those that are dubious, I would suggest a look at this article and to my former post.

Parov Stelar

The smart money in tech would not have made this mistake

It's about Theranos. You may find my previous posts in this link. Now SEC has confirmed that was a "massive fraud". That's it. If you want a good analysis check FT.
Microfluidics is not an easy prêt-à-porter technology. Many people knew it but Mrs Holmes has been selling it as snake-oil. And as usual in these cases, the end of the film is already written. She can't go to the lab for the next 10 years, a fine, and the company may be closed. All started with and article by Mathew Herper in WSJ. An innocent article with an innocent question that she couldn't answer. That's all. Silicon valley smart money would not have made this mistake.

Modigliani exhibition in Tate Gallery now

The miracle of bread and fish

According to the Gospels, a large crowd had gathered and was following Jesus. Jesus called his disciples to him and said:

"I have compassion for these people; they have already been with me three days and have nothing to eat. I do not want to send them away hungry, or they may collapse on the way."

His disciples answered:

"Where could we get enough bread in this remote place to feed such a crowd?"
"How many loaves do you have?" Jesus asked.
"Seven," they replied, "and a few small fish."
"Jesus told the crowd to sit down on the ground. Then he took the seven loaves and the fish, and when he had given thanks, he broke them and gave them to the disciples, and they in turn to the people. They all ate and were satisfied. Afterward the disciples picked up seven basketfuls of broken pieces that were left over. The number of those who ate was four thousand men, besides women and children. After Jesus had sent the crowd away, he got into the boat and went to the vicinity of Magadan (or Magdala)."

Now let's imagine one country and his health expenditure in 2007 and 2017, let's think about a figure, let's say 1,186€. This was the per capita expenditure in 2017. What was the per capita expenditure one decade earlier? 1€ less!!! It was 1,185€. This is a miracle, if you take inflation into account the reduction of expenditure is huge. Technology and ageing were not the drivers of expenditure growth because there was no growth!
Between 2017 and 2016 the growth was 5.9% in public expenditure. In private health insurance  expenditure it was 5,4%. That's it.
If you have to think about health expenditure miracles, have a look at Catalonia, it's incredible.
And it is so incredible that today our government is in exile, or in prison, or bail pending trial. Today the spanish police has entered in our government palace and has arrested one high official.
This is the rogue state where the majority wants to leave, and unfortunately we are alone, prosecuted and it's not possible to decide the new president. Europe forgets the attack on civil liberties. Shame.

Now