Some, Many & All
By IRVING KENT LOH,
Chief Medical Officer and Co-founder of Infermedica
Irving Kent Loh MD FACC FAHA FCCP FACP is chief medical officer and co-founder of Infermedica, an artificial intelligence in healthcare company focused on clinical decision support. He is founder of the Ventura Heart Institute which has been focused on cardiovascular disease management of high risk disease, preventive strategies, and clinical research. He has been the principal investigator in over 160 clinical trials, and gave a TEDx talk on the rationale behind randomized clinical trials. He is an Adjunct Lecturer in the Department of Medicine at the Stanford School of Medicine, member of the AI4Health topic group on symptom assessment of the International Telecommunication Union of the World Health Organization. He chairs the Technology and Innovation Committee of the California Chapter of the American College of Cardiology, and recently organized and moderated the ‘Colloquium on Artificial intelligence, Technology, Innovation and the Future of Cardiology” at UC San Francisco Mission Bay Conference Center.
MD FACC FAHA FCCP FACP
There are three areas which will have impact on cardiovascular disease in the near and distant future. The first area will affect some, the second many, and the last all patients and providers.
A recent development has to do with risk reduction in high-risk cardiovascular disease patients. The pillars of secondary prevention pharmacologic interventions are antiplatelet drugs, beta-blockers, statins, inhibitors of the renin-angiotension-aldosterone system, and now a specific type of omega-3 fish oil which is a pure EPA (eicosapentaenoic acid) preparation, icosapent ethyl. The results of the REDUCE-IT trial involving 8200 mildly hypertriglyceridemic patients with cardiovascular disease and also patients with diabetes and two other cardiac risk factors experienced a 25% reduction in major cardiovascular events. Given the recent FDA assessment of benefit, it is likely that this agent will be added to the cardiac pharmacologic cocktail to reduce risk of further major adverse cardiac events in these populations of patients.
The second pending breakthrough will deal with tools for genetic modifications that may be permanent repairs for patients and their offspring. Many cardiovascular diseases are genetically based and consequently heritable. These include such lethal diseases as familial hypercholesterolemia, long QT syndrome, some forms of cardiomyopathies, and many others. Early experience with CRISPR-cas9 in humans have demonstrated that the technology works, though much research remains to be done to ensure no off-target effects and, critically, the ethics of such interventions.
Further advances in gene “prime editing” with even better targeting may enhance the probability that this revolutionary, albeit controversial, technology may see expanded clinical trials and validation. If successful, the commensurate impact on afflicted patients and their families will be difficult to underestimate.
The third area with the greatest impact on essentially all individuals will be the rapidly evolving application of artificial intelligence, machine learning, and deep learning to healthcare. Beyond the mundane administrative efficiencies where rudimentary applications are in current use, the impact on the Big Data that overwhelms the ability of humans to comprehend and derive useful and actionable information from the myriad sources of relevant healthcare data that impact not only the individual patient (precision medicine) but also much larger groups of patients (population health) will be profound. Relief of the drudgery that afflicts the bureaucracy of healthcare will improve the lives of healthcare providers at all levels and allow them to return to the actual care of patients, and thus reduce the burnout that is epidemic in physicians today.
These provider facing applications will cull through the firehose of data, collecting the key information with the greatest value to the problem at hand, which will be identified and the relevant science provided to the healthcare provider for action that will still be the domain of the human.
In the world I envision, artificial intelligence will assist, not replace, the well trained clinician, who will apply the information to the human condition with empathy and touch. The improved interface for patient facing applications will give individuals more control and understanding of their condition and provide patients the opportunity to have more control of their healthcare, including decision making.
In the world I envision, artificial intelligence will assist, not replace, the well trained clinician, who will apply the information to the human condition with empathy and touch.