It was once a large rectangular container used by a computer company to ship products. Now, the container, as large as a railway coach, is a clinic that may well define the future of healthcare in India.
The clinic, in Lakhimpur Kheri, Uttar Pradesh, opened last week, an initiative of the CSIR-Institute of Genomics and Integrative Biology (IGIB) and Hewlett-Packard India. The man in charge of the project, Anurag Agrawal, a doctor and asthma researcher, is convinced the solution for India’s abysmal doctor-patient ratio and its befuddling mix of Ayurveda and Western medicine, lies in something that will at once be familiar to quantitative analysts on Wall Street or, closer home, on Dalal Street— the collective intelligence of dumb data.
And so, when villagers troop into the makeshift clinic for a review, a machine automatically collects blood samples and an unmanned terminal shoots and zooms a cardiogram into a cloud server, and the diagnosis follows.
India, which has less than one doctor for every 1,700 people—the US has one for every 390, Japan, one for every 500, and China, one for every 950, according to the World Health Organization—has experimented with a variety of ways to deal with the problem. It has used nurses and paramedics at rural primary healthcare centres who screen coughs and colds and prescribe over-the-counter medication, and it has used urban pharmacists, who frequently don the prescriptorial white coats, to do the same. Now, Dr. Agarwal believes centres such as the one in Lakhimpur Kheri could work as effective, medical intermediaries in the future.
That’s not a radical thought in a country where e-health became a buzz word long before e-commerce, although it can be argued that better connectivity and the cloud (still relatively new) may mean its time has finally come.
Meanwhile, Agrawal is even more enthused by the possibility of collecting copious amounts of data from centres such as the one at Lakhimpur Kheri—pulse readings, blood pressure and glucose levels, and anything else he can lay his hands on.
Such data is gold, he explains.
“More than public health, it is about creating massive data sets that will give us a sense of what’s going to happen in terms of recognizing diseases in their early stages,” said Agrawal.
And such analysis can throw light on hitherto unexplained phenomena, he adds.
Drawing on his own as-yet unpublished work, Agrawal offers the example of impulse oscillometry (breath measurement) readings.
The impulse oscillometry reading of an asthmatic looks no different from that of a normal person between attacks. Yet, “when we biopsy their lungs, there is something distinctly different, and so my students and I used a set of Fourier transforms to reinterpret these impulse oscillometry data”.
Fourier transforms are a staple of mathematical modelling and simply allow better interpretation and understanding of functions. Frequency signals, for instance, make more sense when their individual frequencies are separated.
“You do that, and by trial and error, we can see newer patterns emerge. Patterns that distinguish readings between asthmatics and regular people and that reveal massive differences in the way their lungs function,” he added.
Agrawal is now modifying these findings so as to be able to detect early signs of chronic obstructive pulmonary disease (COPD), globally among the top three causes of death in smokers.
And he isn’t the only one captivated by the power of data.
Ashutosh Pande, an engineer who’s spent most of his professional life designing GPS applications entirely unconnected to the world of medicine, was captivated enough by the lure of raw medical data (and its potential) to quit his job and launch his own company, Arogya Mobile Health Pvt. Ltd. Arogya has just begun preliminary trials in Uttarakhand to collect and scan assorted health parameters in the hope that they throw up patterns.
As part of his plan that essentially aims to marry the ubiquity of mobile phones with India’s burgeoning paranoia over “lifestyle diseases”, primary school-educated health workers registered with the government will collect weight, temperature, blood pressure and electrocardiogram readings from roughly 50,000 villagers in 50 villages. The Bluetooth-enabled devices will send the information to the cloud and a pre-programmed algorithm will instantly determine whether someone needs to go see a doctor.
“So, in return for Rs.20 monthly fee, subscribers to the service will know if their sugar, or blood pressure levels are normal or need clinical investigation,” said Pande.
Pande hopes that the data Arogya gets will throw up patterns after his research partners at the Indian Institute of Technology (IIT), Delhi, sift through them to extricate meaningful prognoses.
“We are already in talks with drug companies, who may find such data useful but, immediately, I think it will be of greater use for government health missions or for family health surveys where you want to be absolutely sure that the data you collect is accurate... Just subscriptions are not going to be a viable stream of revenue.”
Such data could also help the cause of Ayurveda, according to Agrawal.
In the last month, he has set up two more centres in Haryana and Andhra Pradesh and based on the tomes of readings envisions a kind of space-age future for Ayurveda, another project that he’s involved with at IGIB.
While both systems of medicine rely on heavy clinical investigation that sees their doctors extensively quiz patients, Ayurveda, with its personalized, encyclopaedic classification schemes presumes disease to be the result of an imbalance of a person’s constitution with his or her environment rather than--as Western medicine presupposes--an ailment being caused due to the presence of germs or other organisms.
“So while we do accept that a bacterium is responsible for tuberculosis and we know that every third person in India is a latent carrier, why is it that a third of this country isn’t sick with tuberculosis?” said Bhavana Prasher, an Ayurveda doctor involved with IGIB’s research.
While explanations of “immunity” and “genetics” may be more in keeping with the accepted explanations of modern medicine, Agrawal holds that rational explanations can only emerge from more observation—as random as the size of ears, the length of fingers and thyroxin levels—processed through the mindless efficiency of artificially intelligent algorithms.
He cites numerous, reputable research papers that claim to positively predict the chances of heart attacks and performance on the stock market to the ratio of finger lengths, or the digit ratio as it’s called.
“It was just interesting data until scientists discovered that these ratios depend on the expression of a category of genes called Hox genes, that regulate the expression of testosterone,” he said. “Testosterone and heart attacks and aggression are better known, so there, you now have a scientific explanation.”
M.S. Valiathan, a veteran cardiothoracic surgeon, isn’t convinced that masses of data will necessarily reveal treasures. Valiathan has also written two books on Ayurveda and exegeses on Charaka and Sushruta, the two most famous physicians and surgeons in Indian history.
He said that while there was an “intoxicating” quantity of new information available at the level of genes on why certain Ayurvedic formulations and prescriptions work, it hasn’t yet translated into new cures or improved medical therapies.
“I don’t know whether that will happen because both of these diseases approach treatment and well-being in different ways,” he said. “You could have better explanations, but finding newer treatments, or thinking through the possible causes of diseases requires greater, more sophisticated human understanding.”
Prasher doesn’t expect a syncretic third system of medicine to emerge but sees the wall between eastern and western forms crumbling, at least a little.
“As a practitioner for over 15 years, there is much scientific finesse in the method and knowledge of Ayurveda. Better understanding will lead to better conceptual concordance,” she added.