Uncertain Health in an Insecure World – 85

“Auspicious Beginnings“

In Ancient Rome, priests called augurs studied the flight and feeding patterns of birds to prophesize the future. The word auspicious is derived from Latin, auspex, meaning “bird seeker.” The plural, auspices, is often used to refer to “kindly patronage and guidance.”

Precision medicine (PM) enjoyed an auspicious beginning.

In an April 24, 2015 TEDxSantaClara talk, “Collaboration is the New Competition,” David Haussler (University of California Santa Cruz Genomics Institute director, above) describes how he guided Jim Kent (below), then a UCSCgrad student, to write “killer” computer code to sequence of the first human genome. In June 2000, Kent used a cluster of one hundred work stations, each no more powerful than a modern cell phone, to crack The Human Genome.

Their research was prescient – an example of radical collaboration.

Celera, founded by Craig Venter, quickly scaled up commercial genome sequencing. Celera is now a subsidiary of business giant, Quest Diagnostics.

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Next generation sequencing (NGS) transformed genomic analyses.

Successful genome alignment and variant calling takes intense computing efforts. Single nucleotide polymorphism (SNP) and insertion and deletion (indel) mutation variant calling methods identify genome positions with polymorphisms relative to a reference file. Variant calling yields insights into nucleoside-level organismal differences between human and microbial genomes. But variant calling is a multistep bioinformatics process with a number of potential sources of error.

Converting millions of gene sequencing reads per sample into meaningful data is hardly trivial.

A conscious human brain can fire 38 thousand trillion synaptic messages per second!

The world’s most powerful supercomputer, IBM’s BlueGene, can manage about 0.002% of that. But human beings have come to rely on supercomputers to make sense of the world. In November 2015, Intel placed its fastest 8-teraflop (8x10¹² floating-point operations per second) Knight’s Landing silicon chip into desktop PC’s. Soon, handheld devices will put supercomputer performance into the palms of teenagers.

In 2011, it took supercomputers approximately 10 days to sequence a human genome. Since then, bioinformatics experts have been tackling how to shift from local site computing power to Cloud data sharing. In 2013, many institutional and national data repositories like the U.S. Veterans Administration Million Veteran Program (below, left) contained such numerous genomes that would take one institution months to sequence them. 

The cost per genome being sequenced (above, right) began to dramatically drop in 2008, paradoxically increasing the number of institutional genome data silos. Contemporaneously, the clinical care of children with genetic diseases included more genomic data embedded in electronic health records (EHR). Exomes are now sequenced clinically to determine the metabolic fate of certain drugs, such as expensive Elelyso™ enzyme replacement therapy for children with Gaucher’s Disease.

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Bioinformatics is facing down the data sharing bottleneck.

In the research funnel (below), one’s proximity to a bottleneck determines how one approaches the problem. 

In 2015, Stanford bioinformatics researchers began "nitty gritty" work with Google to query the NIH database of Genotypes and Phenotypes (dbGaP) in the Cloud with BigQuery™, dramatically reducing the time required to do a single data query for 30 million annotated variants to mere seconds (below). 

With this advance, by applying Dremel technology (Apache Drill™, below), the era of open source genomic data mining began.

The recent convergence of open source Cloud computing and gene sequencing scalability set the stage for the February 2016 Obama Administration’s Precision Medicine Initiative.

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The last bottleneck is personal health information (PHI) privacy.

The press is full of shocking privacy breech stories involving healthcare insurance databases and EHR’s. Data sharing security concerns related to PHI privacy have resulted in increased regulatory hurdles, reducing data access and preventing research collaborations that could lead to real PM progress. 

In the end, the type of privacy required in the PM data sharing milieu boils down to math. At the 2006 Proceedings of the Association of Computing Machinery on Privacy, Stanford’s Philippe Golle showed that with an individual’s birth date and 5-digit zip code, there is a 63.3% probability that a U.S. person’s identity can be determined without any requirement for gender being known.

According to Stanford’s Somalee Datta (below... and yes… it auto-corrects to 'Data'), points-of-view on data privacy differ for patients (“My Health”), companies (“My Business”) and researchers (“My Research”).

Patients want better healthcare for their children, themselves, their extended families and community, and may be willing to accept the unknown risk and longer term implications of genomic data loss.

Businesses seek the value proposition associated with better healthcare for patients, but risk large scale hacking, malicious ransomware, bad press and loss of consumer trust.

Researchers’ end game is effective data use for new discoveries that improve health, and they are willing to tolerate complex data use agreements and/or negotiated service agreements for data access.

In order for bioinformatics to relieve this last bottleneck – timely data sharing with secure privacy protection – patients need transparency regarding the use of their data (informed consent), businesses require secure platforms that allow granular monitoring of data activity (like financial systems currently utilize), and researchers want workflow oriented bioinformatics suites that allow for flexible research plans (open access). 

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PM sits squarely at the interface between genomics big data and immense computing power.

 How thinking humans grapple with this complex interface will define the usefulness of genomics data to the future practice of PM.

If PM’s future is to augur well, bioinformaticians must get more patients’ big data into the hands of more genomics researchers who work on more powerful open-source analytic platforms.

The precogs in the Square clearly see how the “kindly patronage and guidance” of patients, businesses and researchers produced PM's auspicious beginning.

But we worry that PM could crash to Earth if regulators fail to properly read the chicken entrails.