The Devil is in the Details

Please take a few minutes to watch this YouTube video. I was sent this link by Nadav Lankin, who is a brilliant developer working at 4net, a company that specializes in cloud computing and big data. I want to formally thank Nadav for this link and many others that he sends me. Nadav is also developing the whole area of Lean Startups in Jerusalem. “Lean Startups” is an established work method brought from the US, that helps startups become successful much faster. Just Google “Lean Startups” – it will be worth your time. In general, everything Nadav sends me is valuable and incredibly informative and I am very lucky to have him as a friend.

Mr. Ellie Goldratt is the creator of the video I linked to above. It has nothing obvious to do with medicine. It is however a brilliant analysis of a business scenario, where the conclusions have universal significance. One of the conclusions of Mr. Goldratt, is that too many companies think locally. When such companies are faced with a difficult period of time for their business, they tend to react instinctively rather than intelligently – based on available data. In the scenario that Mr. Goldratt discusses, a proper analysis of available business data saves a company from making a tremendous error of firing a large part of its staff.

The key message of this video is that data is out there and should be used as much is possible to make critical decisions. More so, the data that you or your company generates is only one piece of the puzzle. Mr. Goldratt emphasizes that you must think globally and consider the entire ecosystem that you or your company are part of.

Let’s now try to apply this to a medical scenario. Actually, even in medical school, future doctors are taught epidemiology. One of the basic principles of epidemiology is to think globally, when faced with a new disease or other medical condition. There is a principle in medicine that if one patient has a disease, you treat it and send the patient home. If two patients have the same disease, you can still call it a coincidence (after a proper evaluation and extensive history). But if three patients have the same disease, you treat it but keep the patients until you have evaluated their families, friends and communities, in order to make sure that this is not the first presentation of an epidemic. All of this is extremely pertinent today given the worldwide risk that the virus Ebola is presenting to all of us. There are other potential epidemics that have recently made the news like Polio and Measles. So, staying on top of the epidemiology of these diseases is critical to worldwide health.

I personally remember seeing my first case of Measles, here in Israel. I had never seen Measles during my studies in Canada. I had only seen a picture of a patient with Measles in my infectious disease textbook. But when I saw that patient with Measles in my clinic, he literally looked like a copy of the picture in my textbook. Considering the rarity of Measles since the introduction of the Measles vaccine, even one case was already very concerning. And, as things turned out, there was an outbreak of Measles in one community in Israel, primarily due to the community’s poor vaccination rate. This became a major story and concern for the Israeli ministry of health, and thankfully, it was handled professionally and effectively.

If we follow Mr. Goldratt’s approach, these cases of Measles needed to be carefully analyzed in order to know how to best deal with them. The ministry of health could have (made a mistake and) easily declared that Measles had returned to the Israeli population and spent many millions of dollars on re-vaccinating the whole population. Instead, the Measles patients’ environments were studied and the first case of Measles in Israel was identified. This first case (which is also called the “index case” and which was the origin of all of the other Measles cases in Israel), actually came from Britain. The young man, who brought the Measles infection to Israel, was part of a community back in Britain that was also experiencing a Measles outbreak. By assessing the index case and making sure to follow up on any contacts with the index case (and any contacts with the contacts of the index case), it was possible to isolate just those patients who needed attention (rather than blindly treating the whole country).

This actually is a perfect example of why ministries of health around the world need to publish their data about disease frequencies. This data, of course, should not have any identifying information in it. But it should be sufficiently detailed so that one can quickly [using a computer] track a disease as it moves across the world.

Eventually, it will be standard practice for every country to publish as much medical data as possible, and make it available via the web. Then, big data analysis tools will run regularly scheduled analyses to identify new trends in any disease. So, if there is suddenly an upswing in the number of heart attacks in France, this information would immediately be available to the local ministry of health and to the global medical community. And it might very well be that the origin of this upswing has nothing to do with France.

We are living in a magical time when we can access and analyze data in a way that was not possible even a few years ago. Hopefully soon, it will be the responsibility of every professional medical community to be sharing as much data as possible. Also, every doctor should eventually be versed in, at least, a basic knowledge of statistics and big data analysis. When every doctor is thinking globally rather than locally, there will be a significant improvement in the world’s quality of medical care.

Anyone who has a new idea related to collecting medical data, sharing this data and analyzing this data, should immediately explore the possibility of turning this new idea into an application that the world can benefit from. And there is nothing wrong with charging a reasonable fee for such an application.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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