Conventional Classification of diseasesLet us see conventionally how the diseases are classified:Infectious diseasesGenetic diseasesNutritional diseasesEndocrine diseasesMind diseases etc.

Examples of Snags in Disease ClassificationInfectious Disease is not a Nutritional DiseaseNutritional Disease is not an Endocrine DiseaseEach disease is being attributed to one cause etcThis creates lot of problems

RealityIt is seen sometimes that Certain hormones reverse viral encephalitisLet us hypothesize that Viral encephalitis is due to endocrine problem + viral infection

Viral Encephalitis hypothesisAt 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)

Solution to the diseaseIf endocrine disorder precedes viral infection then Rectifying endocrine disorder would prevent encephalitis due to all viruses,Hypothetical solution could be preventing stress, fortified foods, sunbath or eating hypoglycaemic foodsSimple solution but complicated research

Normal Delivery

Alternative approachSeveral vaccines to prevent viral encephalitisAnd for each viral vaccine Scientists may perform several studiesYet results could be disappointingSimple research but complicated solution

Caesarian

Prevention is better than cure

Certain diseases make patient vulnerable

Preventing the disease through vaccine for a specific diseaseMeansPreventing the specific diseaseAs well asPreventing several front-end events

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

Hunt for panacea

It is one of the objective ofDisease Informatics

Priors and posteriors

Health policy can not be full-proofUnless Priors and PosteriorsAre estimated

Appropriate Health policy document can not be prepared unlessDisease Informatics shapes well

Disease denominatorQuite a low incidence rate of a particular disease is result of the big denominator

Why big denominator?The disease causative agent is not considered as a component.It is assumed that it is the whole storyDiseases are really complex

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

Component Sufficient Component 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

Sufficient causal mechanisms.> 1Sufficient causal mechanisms could be more than 1Component investigated may not share all mechanisms

Three sufficient causes of disease.

By Kenneth J. Rothman and Sander Greenland

Prof. Sander Greenland

Encephalitis associated with viruses (Bulb lights)Occurs in those individualsWho are predisposed (wiring is completed) And one of the several viruses (button) Triggers the disease (Switch on the bulb)

No wiring no switching on of bulb

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

Disease DefinitionThe disease definitions require set ofintersection of some factors (component causes)as denominators tomake the definition complete

What is seen in viral encephalitis?

Most of the encephalitic diseases attributed to viruses Have low incidence becauseVirus is not enough to cause the diseaseBut it may be required

In South Africa a large outbreak of west Nile affected an estimated 18 000 people of all ages, yet only one case of encephalitis was reported.

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

Component and sufficient causesWhich component causes come together (?)To make sufficient causal mechanism for disease (?)This is the challenge in Spatial Epidemiology and For the Disease Informatics Groups

Requirement of team effortDefine complex diseases thereby Identifying all the targets to combat disease and Design a holistic solution

Disease featuresThe disease as it is understood today has Shared + Variable features

Conventional disease definitionThe universally shared features as against spatiality are generally considered for diseases definition, howeverthe most optimum solutions are spatiality dependentshared by local people than universal

Communicable diseasesIn case of communicable diseasesThe conventional approaches to have the definition of disease in 3 phasesSuspected, Probable and Confirmed and Arriving at a single cause (!!!)

Why modern approach?Conventional approach has Yet to generate feasible solutions for Most of the real life health problems

Rigid Disease Definitions

One cause- one effect

It is like expecting honesty from an individualWho has undergone a forced marriage

Where lies the solution?Considering simultaneously The non-communicable components of the disease Could really change this picture and Help in designing the health strategy

Multiple morbiditiesSufficient cause approach could be fruitfully used if role of multiple morbidities in the outcome is precisely recognized

Components working togetherIt is not A + BIt is A + B + AB

An interaction can override any main effects When there is an interaction along with main effects, we must reexamine the main effects to see if they are really worth paying attention to.

Famous statistician Keppel quoted by M. Plonsky

Statistical interaction is a property of which linear model the researcher selects, not a property of the population, risk factors, or outcome.

Factors working together

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

Defining the diseasesThe purposes of defining the diseases are To understand exactly what those are So that those are prevented or reversed

The basis of Disease InformaticsTo operate on the fact that “Most outcomes — whether disease or death — are caused by A chain or web consisting of many component causes”This has been denoted as Disease Causal Chain (DiCC)

Modern EpidemiologyEpidemiologists Rothman and Greenland emphasize that the"One cause − one effect" understanding is A simplistic misbelief

Baseline for Disease Informatics“Existence of chain or web consisting of many component causes” Connotes lot of information and Could be difficult to handle manuallyHere goes the role of information scientists

GurusDrs. 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

After identifying several causes of an infant death and having realized that prevention of any cause could have saved the infant, Abhay and Rani Bang started working to solve the riddle.

Approach

GadchiroliThe Gadchiroli approach could be fruitfully used if Role of multiple morbidities as pointed out by Drs. Bangs and their colleagues in the outcome is precisely recognized

www.indianngos.com/districts/gadchiroli.htm

Dr. Rani Bangwww.ashoka.org

Bayesian again

To tackle the problem of Multiple morbiditiesMultiple hypotheses are required

Alternatively,Disease Complex needs to be definedRather than several simple diseases

Disease burdenBurden of several diseases rely on Certain backend events of Disease Causal Chain

Backend vs. Frontend measuresFrontend event measures are like Pruning the branches of disease tree while Backend event measures uproot the tree

Disease Causal ChainsThe Disease Causal Chains should be studied as A spatial epidemiological problem for All the diseases together Present in the locality.

Solving problem of Disease Complex

Disease Causal Chain

It could be developed as powerful techniqueTo handle disease complex

Target identificationDisease Causal Chain displays Several targets to solve health problemAnd not just the one

Antiviral InvestigationHTS antiviral assays on New Chemical EntitiesThese assays does not nullify The traditionally established utility of certain formulations

What is neglected?The ability of Traditionally established remedy to alter

Disease Causal Chain

Dr. Raghunath A Mashelkar

Who suffers?Patients are deprived of Several nutraceuticals and functional foods or Lifestyle modalities capable of Preventing or reversing the viral disease

Dr. V Prakash

Side effects

Patients of viral diseases are subjected to Consuming drugs having Tremendous side effects

Nutraceuticals and functional foodsHave lesser side effects

Disease InformaticsIt is the application of Information Science in Defining the diseases with least error, Identifying most of the targets to Combat a cluster of diseases (Disease Causal Chain) and Designing a holistic solution (Health strategy) to the problemDepending the severity of the disease

Disease informatics for setting up Disease definition, 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

Thank you

This presentation is dedicated to Dr. Ulhas V Wagh