conventional classification of diseases

8/14/2019 Conventional Classification of Diseases

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Conventional Classification of diseases

Let us see conventionally how the diseases are classified:

Infectious diseasesGenetic diseases

Nutritional diseases

Endocrine diseases

Mind diseases etc.


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Examples of Snags in Disease Classification

Infectious Disease is not a Nutritional Disease

Nutritional Disease is not an Endocrine DiseaseEach disease is being attributed to one cause etc

This creates lot of problems


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Reality

It is seen sometimes that

Certain hormones reverse viral encephalitisLet us hypothesize that

Viral encephalitis is due to endocrine problem

+ viral infection


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Viral Encephalitis hypothesis

At least one of the factor creating endocrine problem

(genetic, drug, malnutrition, stress, improper lifestyle etc)+

One of the viral infection (West Nile virus or Japanese

Encephalitis Virus or Herpes Simplex Virus or

Chandipura Virus or Measles or Mumps or Chicken pox

or Rubella or Cytomegalovirus or HIV etc)


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Solution to the disease

If endocrine disorder precedes viral infection then

Rectifying endocrine disorder would preventencephalitis due to all viruses,

Hypothetical solution could be preventing stress,

fortified foods, sunbath or eating hypoglycaemic foods

Simple solution but complicated research

Normal Delivery


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Alternative approach

Several vaccines to prevent viral encephalitis

And for each viral vaccineScientists may perform several studies

Yet results could be disappointing

Simple research but complicated solution

Caesarian


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Prevention is better than cure

Certain diseases make patient vulnerable

Preventing the disease through vaccine for aspecific disease

Means

Preventing the specific disease

As well as

Preventing several front-end events


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Metabolic imprinting and programming

Prenatal and early postnatal development

can affect susceptibility to various adult-

onset chronic diseases

http://history.enotes.com/food-encyclopedia/metabolic-

imprinting-programming

Prenatal preventive steps to avoid adult disease


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Hunt for panacea

It is one of the objective of

Disease Informatics


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Priors and posteriors

Health policy can not be full-proof

Unless Priors and Posteriors

Are estimated

Appropriate Health policy document

can not be prepared unless

Disease Informatics shapes well


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Disease denominator

Quite a low incidence rate of a particular disease is

result of the big denominator


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Why big denominator?

The disease causative agent is not considered as a

component.

It is assumed that it is the whole story

Diseases are really complex

http://www.wordinfo.info/words/index/info/view_unit/1/?letter=B&spage=3


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Component SufficientComponent to which

Population exposed is

Part of sufficient causal mechanism

Button is not sufficient cause to switch on or switch off the light.

Prof. Kenneth Rothman
http://images.google.co.in/imgres?imgurl=http://www.egms.de/figures/journals/mibe/2005-1/mibe000016.f2.png&imgrefurl=http://www.egms.de/egms/servlet/Figure%3Fid%3Dmibe000016%26figure%3Df2%26vol%3D2005-1&h=600&w=400&sz=421&hl=en&start=4&tbnid=ZT05IdP3BJ2IdM:&tb


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Sufficient causal mechanisms.> 1

Sufficient causal mechanisms could be more than 1

Component investigated may not share all mechanisms

Three sufficient causes of disease.

By Kenneth J. Rothman and Sander Greenland

Prof. Sander Greenland
http://images.google.co.in/imgres?imgurl=http://www.ph.ucla.edu/EPI/faculty/greenland/SG2003cropped.jpg&imgrefurl=http://www.ph.ucla.edu/EPI/faculty/greenland/greenlandphoto.html&h=353&w=336&sz=30&hl=en&start=1&tbnid=3m_7cgMd04T2hM:&tbnh=121&tbnw=115&prev=/ima


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Encephalitis associated with viruses(Bulb lights)

Occurs in those individuals

Who are predisposed (wiring iscompleted)

And one of the several viruses (button)

Triggers the disease (Switch on the bulb)

No wiring no switching on of bulb


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Why newer viruses emerge?

Examine priorsViruses can not emerge outside the host

Antioxidant deficiency in host could lead to emergence of

new viruses

http://www.jacn.org/cgi/content/abstract/20/suppl_5/384S

Dr. Melinda Beck
http://www.unchealthcare.org/site/lfs_unch_portraits/613.jpg


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Disease Definition

The disease definitions require set of

intersection of some factors (component causes)

as denominators to

make the definition complete


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What is seen in viral encephalitis?

Most of the encephalitic diseases attributed to virusesHave low incidence because

Virus is not enough to cause the disease

But it may be required

InSouth Africa a large outbreak of west Nile affected an

estimated 18 000 peopleof all ages, yet only one case of

encephalitis was reported.

http://bmj.bmjjournals.com/cgi/content/full/326/7394/865


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Component and sufficient causes

Which component causes come together (?)

To make sufficient causal mechanism for disease (?)

This is the challenge in Spatial Epidemiology and

For the Disease Informatics Groups


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Requirement of team effort

Define complex diseases thereby

Identifying all the targets to combat disease andDesign a holistic solution


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Disease features

The disease as it is understood today has

Shared + Variable features


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Conventional disease definition

The universally shared features as against spatiality are

generally considered for diseases definition, howeverthe most optimum solutions are spatiality dependent

shared by local people than universal


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Communicable diseases

In case of communicable diseases

The conventional approaches to have thedefinition of disease in 3 phases

Suspected, Probable and Confirmed and

Arriving at a single cause (!!!)


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Why modern approach?

Conventional approach has

Yet to generate feasible solutions forMost of the real life health problems


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Rigid Disease Definitions

One cause- one effect

It is like expecting honesty from an

individual

Who has undergone a forcedmarriage


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Where lies the solution?

Considering simultaneously

The non-communicable components of the disease

Could really change this picture andHelp in designing the health strategy


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Multiple morbidities

Sufficient cause approach could be

fruitfully used if role of multiplemorbidities in the outcome is

precisely recognized


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Components working together

It is not A + B

It is A + B + AB


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An interaction can override any main effects

When there is an interaction along with main

effects, we must reexamine the main effects to seeif they are really worth paying attention to.

Famous statistician Keppel quoted by M. Plonsky


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Statistical interaction isa property of

which linear model the researcher

selects, nota property of the population,

risk factors, or outcome.

Factors working together

http://ajp.psychiatryonline.org/cgi/content/full/158/6/848


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Defining the diseases

The purposes of defining the

diseases are

To understand exactly what thoseare

So that those are prevented orreversed


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The basis of Disease Informatics

To operate on the fact thatMost outcomes whether

disease or death are caused by

A chain or web consisting of

many component causes

This has been denoted as DiseaseCausal Chain (DiCC)


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Modern EpidemiologyEpidemiologists Rothman and

Greenland emphasize that the

"One cause one effect"

understanding is

A simplistic misbelief


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Baseline for Disease InformaticsExistence of chain or web consisting

of many component causes

Connotes lot of information andCould be difficult to handle manually

Here goes the role of informationscientists


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Gurus

Drs. Abhay and Rani Bang and their colleagues have

Successfully provided solutions to several health problems

By performing on multiple morbidities

Dr. Abhay Bang of Gadchiroli
http://images.google.com/imgres?imgurl=http://www.expresshealthcaremgmt.com/20041015/2004101501.jpg&imgrefurl=http://www.expresshealthcaremgmt.com/20041015/conversation01.shtml&h=76&w=75&sz=3&hl=en&start=11&tbnid=2PK6bNmKk9wryM:&tbnh=72&tbnw=71&prev=/images%3F


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After identifying several causes of

an infant death and having realizedthat prevention of any cause could

have saved the infant, Abhay and

Rani Bang started working to solvethe riddle.

Approach


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Bayesian again

To tackle the problem of Multiple

morbidities

Multiple hypotheses are required

Alternatively,

Disease Complex needs to be defined

Rather than several simple diseases


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Disease burdenBurden of several diseases

rely onCertain backend events of

Disease Causal Chain


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Backend vs. Frontend measures

Frontend event measures are like

Pruning the branches of disease tree whileBackend event measures uproot the tree


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Disease Causal Chains

The Disease Causal Chains shouldbe studied as

A spatial epidemiologicalproblem for

All the diseases together

Present in the locality.


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Solving problem of Disease Complex


It could be developed as powerful techniqueTo handle disease complex


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Target identificationDisease Causal Chain displays

Several targets to solve healthproblem

And not just the one


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Antiviral InvestigationHTS antiviral assays on New

Chemical Entities

These assays does not nullify

The traditionally established

utility of certain formulations


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What is neglected?

The ability of

Traditionally established remedy to alter


Dr. Raghunath A Mashelkar

Wh ff ?
http://images.google.com/imgres?imgurl=http://www.mitpune.com/wpc/images/2.jpg&imgrefurl=http://www.mitpune.com/wpc/promoters.html&h=149&w=119&sz=13&hl=en&start=11&tbnid=_Jll1B1mFbqSkM:&tbnh=95&tbnw=76&prev=/images%3Fq%3Draghunath%2Bmashelkar%26svnum%3D10%26hl


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Who suffers?

Patients are deprived of

Several nutraceuticals and functional foods or

Lifestyle modalities capable ofPreventing or reversing the viral disease

Dr. V Prakash
http://images.google.com/imgres?imgurl=http://www.biospectrumindia.com/images/content/2005/dec/BioTalk-V-Parkash02.gif&imgrefurl=http://www.biospectrumindia.com/content/bioFocus/10512071.asp&h=156&w=142&sz=11&hl=en&start=5&tbnid=ENYgmhAbz6vs_M:&tbnh=97&tbnw=88


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Side effects

Patients of viral diseases are subjected

to

Consuming drugs havingTremendous side effects

Nutraceuticals and functional foodsHave lesser side effects


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Disease Informatics

It is the application of InformationScience in

Defining the diseases with least error,

Identifying most of the targets toCombat a cluster of diseases

(Disease Causal Chain) and

Designing a holistic solution(Health strategy) to the problem

Depending the severity of the disease

R f


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Disease informatics for setting up Diseasedefinition, drawing Disease Causal Chain /

Web, marking Risk Events, Backend and

Frontend Events, and Health Problem

Solutions

Reference

http://bmj.bmjjournals.com/cgi/eletters/331/7516/566#134452


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Thank you

This presentation is dedicated to

Dr. Ulhas V Wagh

conventional classification of diseases

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