{"id":400,"date":"2008-08-24T19:00:39","date_gmt":"2008-08-25T01:00:39","guid":{"rendered":"http:\/\/hunch.net\/?p=400"},"modified":"2008-08-24T19:00:39","modified_gmt":"2008-08-25T01:00:39","slug":"mass-customized-medicine-in-the-future","status":"publish","type":"post","link":"https:\/\/hunch.net\/?p=400","title":{"rendered":"Mass Customized Medicine in the Future?"},"content":{"rendered":"<p>This post is about a technology which could develop in the future.<\/p>\n<p>Right now, a new drug might be tested by finding patients with some diagnosis and giving or not giving them a drug according to a secret randomization.  The outcome is observed, and if the average outcome for those treated is measurably better than the average outcome for those not treated, the drug might become a standard treatment.<\/p>\n<p>Generalizing this, a filter <em>F<\/em> sorts people into two groups: those for treatment <em>A<\/em> and those not for treatment <em>B<\/em> based upon observations <em>x<\/em>.  To measure the outcome, you randomize between treatment and nontreatment of group <em>A<\/em> and measure the relative performance of the treatment.<\/p>\n<p>A problem often arises: in many cases the treated group does not do better than the nontreated group.  A basic question is: does this mean the treatment is bad?  With respect to the filter <em>F<\/em> it may mean that, but with respect to another filter <em>F&#8217;<\/em>, the treatment might be very effective.  For example, a drug might work great for people which have one blood type, but not so well for others.<\/p>\n<p>Finding <em>F&#8217;<\/em> is a situation where machine learning can help.  The setting is essentially isomorphic to <a href=\"http:\/\/www.conflate.net\/icml\/paper\/2008\/337\">this one<\/a>.  The basic import is that we can learn a rule <em>F&#8217;<\/em> for filters which are more strict than the original <em>F<\/em>.  This can be done on <em>past recorded data<\/em>, and if done properly we can even statistically prove that <em>F&#8217;<\/em> works, <em>without<\/em> another randomized trial.  All of the technology exists to do this now&#8212;the rest is a matter of education, inertia, and desire.<\/p>\n<p>Here&#8217;s what this future might look like:<\/p>\n<ol>\n<li>Doctors lose a bit of control.  Right now, the filters <em>F<\/em> are typically a diagnosis of one sort or another.  If machine learning is applied, the resulting learned <em>F&#8217;<\/em> may not be easily described as a particular well-known diagnosis.  Instead, a doctor might record many observations, and have many learned filters <em>F&#8217;<\/em> applied to suggest treatments.<\/li>\n<li>The &#8220;not understanding the details&#8221; problem is sometimes severe, so we can expect a renewed push for understandable machine learning rules.  Some tradeoff between understandability and predictive power seems to exist creating a tension: do you want a good treatment or do you want an understandable treatment?<\/li>\n<li>The more information fed into a learning algorithm, the greater it&#8217;s performance can be.  If we manage to reach a pointer in the future where <a href=\"http:\/\/en.wikipedia.org\/wiki\/Gattaca\">Gattaca style<\/a> near instantaneous genomic sequencing is available, feeding this into a learning algorithm is potentially very effective.  In general a constant pressure to measure more should be expected.  Given that we can learn from <em>past<\/em> data, going back and measuring additional characteristics of past patients may even be desirable.<\/li>\n<li>Since many treatments are commercial in the US, there will be a great deal of pressure to find a filter <em>F&#8217;<\/em> which appears good, and a company investing millions into the question is quite capable of overfitting so that <em>F&#8217;<\/em> is better than it appears.  Safe and sane ways to deal with this exist, as showcased by various machine learning challenges, such as the <a href=\"http:\/\/www.netflixprize.com\/\">Netflix challenge<\/a>.  To gain trust in such approaches, a trustable and trusted third party capable of this sort of testing must exist.  Or, more likely, it won&#8217;t exist, and so we&#8217;ll need a new trial to test any new <em>F&#8217;<\/em>.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>This post is about a technology which could develop in the future. Right now, a new drug might be tested by finding patients with some diagnosis and giving or not giving them a drug according to a secret randomization. The outcome is observed, and if the average outcome for those treated is measurably better than &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/hunch.net\/?p=400\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Mass Customized Medicine in the Future?&#8221;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[29],"tags":[],"class_list":["post-400","post","type-post","status-publish","format-standard","hentry","category-machine-learning"],"_links":{"self":[{"href":"https:\/\/hunch.net\/index.php?rest_route=\/wp\/v2\/posts\/400","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hunch.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hunch.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hunch.net\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/hunch.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=400"}],"version-history":[{"count":0,"href":"https:\/\/hunch.net\/index.php?rest_route=\/wp\/v2\/posts\/400\/revisions"}],"wp:attachment":[{"href":"https:\/\/hunch.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=400"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hunch.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=400"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hunch.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=400"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}