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3. Biosocial medicine: Biology, biography, and the tailored care of the patient

Author

Horwitz, Ralph I, Lobitz, Gabriella, Mawn, McKayla, Conroy, Allison Hayes, Cullen, Mark R, Sim, Ida, and Singer, Burton H

Subjects
Health Services and Systems, Health Sciences, Clinical Research, Patient Safety, Generic health relevance, Good Health and Well Being, Biosocial medicine, Precision medicine, Social epidemiology, Clinical medicine, Evidence based medicine, Public Health and Health Services, Epidemiology, Public health, Sociology
Abstract

Biosocial Medicine, with its emphasis on the full integration of the person's biology and biography, proposes a strategy for clinical research and the practice of medicine that is transformative for the care of individual patients. In this paper, we argue that Biology is one component of what makes a person unique, but it does not do so alone. Biography, the lived experience of the person, integrates with biology to create a unique signature for each individual and is the foundational concept on which Biosocial Medicine is based. Biosocial Medicine starts with the premise that the individual patient is the focus of clinical care, and that average results for "ideal" patients in population level research cannot substitute for the "real" patient for whom clinical decisions are needed. The paper begins with a description of the case-based method of clinical reasoning, considers the strengths and limitations of Randomized Controlled Trials and Evidence Based Medicine, reviews the increasing focus on precision medicine and then explores the neglected role of biography as part of a new approach to the tailored care of patients. After a review of the analytical challenges in Biosocial Medicine, the paper concludes by linking the physician's commitment to understanding the patient's biography as a critical element in developing trust with the patient.

Published
2021

5. Multivariate mixed membership modeling: Inferring domain-specific risk profiles

Author

Russo, Massimiliano, Singer, Burton H., and Dunson, David B.

Subjects
Statistics - Applications
Abstract

Characterizing the shared memberships of individuals in a classification scheme poses severe interpretability issues, even when using a moderate number of classes (say 4). Mixed membership models quantify this phenomenon, but they typically focus on goodness-of-fit more than on interpretable inference. To achieve a good numerical fit, these models may in fact require many extreme profiles, making the results difficult to interpret. We introduce a new class of multivariate mixed membership models that, when variables can be partitioned into subject-matter based domains, can provide a good fit to the data using fewer profiles than standard formulations. The proposed model explicitly accounts for the blocks of variables corresponding to the distinct domains along with a cross-domain correlation structure, which provides new information about shared membership of individuals in a complex classification scheme. We specify a multivariate logistic normal distribution for the membership vectors, which allows easy introduction of auxiliary information leveraging a latent multivariate logistic regression. A Bayesian approach to inference, relying on P\'olya gamma data augmentation, facilitates efficient posterior computation via Markov Chain Monte Carlo. We apply this methodology to a spatially explicit study of malaria risk over time on the Brazilian Amazon frontier.

Published
2019

15. Prosocial polio vaccination in Israel

Author

Wells, Chad R., Huppert, Amit, Fitzpatrick, Meagan C., Pandey, Abhishek, Velan, Baruch, Singer, Burton H., Bauch, Chris T., and Galvani, Alison P.

Published
2020

20. Ecological change increases malaria risk in the Brazilian Amazon.

Author

Arisco, Nicholas J., Peterka, Cassio, Diniz, Cesar, Singer, Burton H., and Castro, Marcia C.

Subjects
ECOSYSTEM dynamics, MALARIA, MALARIA prevention, DEFORESTATION, LOGGING
Abstract

Ecological change in the Brazilian Amazon is closely linked to human mobility and health. Mining, agriculture, logging, and other activities alter highly diverse ecological and demographic contexts and subsequent exposure to diseases such as malaria. Studies that have attempted to quantify the impact of deforestation on malaria in the Brazilian Amazon have produced conflicting results. However, they varied in methodology and data sources. Most importantly, all studies used annual data, neglecting the subannual seasonal dynamics of malaria. Here, we fill the knowledge gap on the subannual relationship between ecological change in the Brazilian Amazon and malaria transmission. Using the highest spatiotemporal resolution available, we estimated the effect of deforestation on malaria cases between 2003 and 2022 using a stratified Bayesian spatiotemporal hierarchical zero-inflated Poisson model fitted with the Integrated Nested Laplace Approximation. The model was also stratified by state. We found that a 1% increase in 1-mo lagged deforestation increased malaria cases in a given month and municipality by 6.3% [95% credible interval (Crl): 6.2, 6.5%]. Based on an interaction term included in the model, the effect of deforestation on malaria was even larger in areas with higher forest cover. We found that the coefficients for deforestation and mobility were highly variable when stratified by state. Our results provide detailed evidence that, on average, deforestation increases malaria transmission, but that the relationship is not spatiotemporally uniform. These results have implications for stratifying malaria control interventions based on ecological dynamics to help Brazil achieve its goal of malaria elimination by 2035. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Estimating the lives that could be saved by expanded access to weight-loss drugs.

Author

Pandey, Abhishek, Yang Ye, Wells, Chad R., Singer, Burton H., and Galvani, Alison P.

Subjects
DRUG accessibility, GASTRIC inhibitory polypeptide, TYPE 2 diabetes, HEALTH services accessibility, BODY mass index
Abstract

Obesity is a major public health crisis in the United States (US) affecting 42% of the population, exacerbating a spectrum of other diseases and contributing significantly to morbidity and mortality overall. Recent advances in pharmaceutical interventions, particularly glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide, liraglutide) and dual gastric inhibitory polypeptide and GLP-1 receptor agonists (e.g., tirzepatide), have shown remarkable efficacy in weight-loss. However, limited access to these medications due to high costs and insurance coverage issues restricts their utility in mitigating the obesity epidemic. We quantify the annual mortality burden directly attributable to limited access to these medications in the US. By integrating hazard ratios of mortality across body mass index categories with current obesity prevalence data, combined with healthcare access, willingness to take the medication, and observed adherence to and efficacy of the medications, we estimate the impact of making these medications accessible to all those eligible. Specifically, we project that with expanded access, over 42,000 deaths could be averted annually, including more than 11,000 deaths among people with type 2 diabetes. These findings underscore the urgent need to address barriers to access and highlight the transformative public health impact that could be achieved by expanding access to these novel treatments. [ABSTRACT FROM AUTHOR]

Published
2024
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26. Falling down the biological rabbit hole: Epstein-Barr virus, biography, and multiple sclerosis

Author

Horwitz, Ralph I., Hayes-Conroy, Allison, Singer, Burton H., Cullen, Mark R., Badal, Kimberly, and Sim, Ida

Subjects
Complications and side effects, Risk factors, Demographic aspects, Health aspects, Military personnel -- Health aspects, Epstein-Barr virus diseases -- Complications and side effects -- Demographic aspects, Multiple sclerosis -- Risk factors -- Demographic aspects
Abstract

Introduction A recent research report in Science by Bjornevik et al. tested the hypothesis that multiple sclerosis (MS) is caused by Epstein-Barr virus (EBV) in a cohort of more than [...]

Published
2022
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29. Projection de la demande de lits de soins intensifs durant l'epidemie de COVID-19 au Canada

Author

Shoukat, Affan, Wells, Chad R., Langley, Joanne M., Singer, Burton H., Galvani, Alison P., and Moghadas, Seyed M.

Subjects
Care and treatment, Supply and demand, Equipment and supplies, Forecasts and trends, Market trend/market analysis, Hospital beds -- Supply and demand, Coronaviruses, Intensive care units -- Equipment and supplies, Medical care quality -- Forecasts and trends, COVID-19 -- Care and treatment
Abstract

Depuis l'identification en decembre 2019 du coronavirus du syndrome respiratoire aigu severe 2 (SRAS-CoV-2) en Chine, on a repertorie plus de 850 000 cas confirmes de maladie a coronavirus 2019 [...], CONTEXTE : La hausse des cas de maladie a coronavirus 2019 (COVID-19) au Canada peut creer une forte demande de soins hospitaliers et de soins intensifs. Nous avons evalue la mesure dans laquelle l'isolement volontaire des personnes presentant des symptomes legers retarde le sommet epidemique et reduit la demande de soins dans chaque province canadienne. METHODES : Nous avons concu un modele de calcul et fait des simulations de la propagation de la COVID-19 dans chaque province. A partir des estimations des caracteristiques de la COVID19, nous avons evalue la demande de lits d'hopital et de lits de soins intensifs en l'absence d'isolement volontaire en supposant une moyenne de 2,5 cas secondaires, et avons compare des scenarios en faisant varier le taux d'isolement volontaire des cas legers 24 heures apres l'apparition des symptomes. RESULTATS : En l'absence d'isolement volontaire, l'epidemie atteindrait son sommet dans la premiere moitie de juin, et il faudrait en moyenne 569 jours-lits de soins intensifs par 10 000 habitants. Avec un taux d'isolement volontaire de 20 %, l'atteinte du sommet serait repoussee de 2 a 4 semaines, et la demande de lits diminuerait de 23,5 %; avec un taux de 40 %, le sommet serait repousse de 2 a 4 semaines supplementaires, et la demande de lits connaitrait une baisse de 53,6 %. En fixant le taux d'occupation actuel des lits de soins intensifs a plus de 80 % et le taux d'isolement volontaire a 40 %, la demande de lits demeure superieure au nombre de lits disponibles. INTERPRETATION : Au sommet de l'epidemie de COVID-19 au Canada, la demande de lits de soins intensifs excedera le nombre total de lits disponibles, meme avec un taux d'isolement volontaire de 40 %. Nos resultats montrent que la situation sera difficile pour le systeme de sante et que l'isolement volontaire pourrait reduire la demande de soins hospitaliers et de soins intensifs.

Published
2020
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30. Projecting demand for critical care beds during COVID-19 outbreaks in Canada

Author

Shoukat, Affan, Wells, Chad R., Langley, Joanne M., Singer, Burton H., Galvani, Alison P., and Moghadas, Seyed M.

Subjects
EPUB (Standard) -- Comparative analysis, Evaluation, Models, Comparative analysis, Health aspects, Hospital patients -- Models -- Health aspects -- Comparative analysis, Coronaviruses -- Health aspects -- Comparative analysis -- Models, COVID-19 -- Models -- Comparative analysis -- Health aspects
Abstract

Since the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 in China, coronavirus disease 2019 (COVID-19) has caused more than 850000 confirmed cases across 180 countries, [...], BACKGROUND: Increasing numbers of coronavirus disease 2019 (COVID-19) cases in Canada may create substantial demand for hospital admission and critical care. We evaluated the extent to which self-isolation of mildly ill people delays the peak of outbreaks and reduces the need for this care in each Canadian province. METHODS: We developed a computational model and simulated scenarios for COVID-19 outbreaks within each province. Using estimates of COVID-19 characteristics, we projected the hospital and intensive care unit (ICU) bed requirements without self-isolation, assuming an average number of 2.5 secondary cases, and compared scenarios in which different proportions of mildly ill people practised self-isolation 24 hours after symptom onset. RESULTS: Without self-isolation, the peak of outbreaks would occur in the first half of June, and an average of 569 ICU bed days per 10 000 population would be needed. When 20% of cases practised self-isolation, the peak was delayed by 2-4 weeks, and ICU bed requirement was reduced by 23.5% compared with no self-isolation. Increasing self-isolation to 40% reduced ICU use by 53.6% and delayed the peak of infection by an additional 2-4 weeks. Assuming current ICU bed occupancy rates above 80% and self-isolation of 40%, demand would still exceed available (unoccupied) ICU bed capacity. INTERPRETATION: At the peak of COVID19 outbreaks, the need for ICU beds will exceed the total number of ICU beds even with self-isolation at 40%. Our results show the coming challenge for the health care system in Canada and the potential role of self-isolation in reducing demand for hospital-based and ICU care.

Published
2020
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