[HN Gopher] Deep Nose may one day be the best diagnostician in m...
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Deep Nose may one day be the best diagnostician in medicine
Author : dnetesn
Score : 88 points
Date : 2021-02-05 11:41 UTC (1 days ago)
(HTM) web link (nautil.us)
(TXT) w3m dump (nautil.us)
| favoritecolor wrote:
| Love seeing these types of posts on HN! Every now and then I see
| a post about olfaction, and since I am in the olfactory receptor
| research space, I just want to put my two cents out there.
|
| Digital chemical sensing is hard, and yet biological chemical
| sensing is amazing. Understandably, there's always been immense
| interest in digitizing the biological process of smell. People
| have been pitching various technologies, from the early days of
| the WaspHound[0] and DARPA's largely failed RealNose project[1],
| to current efforts from startups[2] and big players in
| perfumery[3].
|
| It is my opinion that all of these technologies are solving the
| wrong problem. Olfactory receptors are just plain horrible
| proteins. They're extremely difficult to produce, and even when
| you can express them, they have exactly the wrong type of
| properties. Each olfactory receptor responds to many different
| chemicals with really bad sensitivity. While that works really
| well for animals, these properties are a nightmare for
| digitization.
|
| If we want to digitize chemical sensing, I believe we will need
| better proteins than naturally occurring olfactory receptors. And
| that's what I am trying to do currently in my Ph.D. research!
|
| [0] https://en.wikipedia.org/wiki/Hymenoptera_training [1]
| https://www.defensedaily.com/darpa-awards-contracts-for-sens...
| [2] https://yesse.tech/ [3]
| https://www.firmenich.com/company/research
| unnouinceput wrote:
| Ahh, I bet this tech will be first used to add one more layer for
| Big Brother surveillance, and maybe if there is something else to
| be squeezed from it will be used for medical purposes as the
| article envision. Hold on to your horses because it's gonna get
| worse first without knowing if will ever be better after.
| dnate wrote:
| you underestimate the need of rich people for health care. It
| will be first used to cure the rich.
| ogig wrote:
| Electronic noses are a recurrent thought of mine. Aplications
| would be countless. Now, the prospect of using mice noses and
| then scan their brains as a shortcut feels wrong, like, animal
| slavery wrong. I know, these are lab mices, and we are eating
| millions of animals everyday, and so on, still, can't avoid the
| feeling. Imagine the device; air flows to a chamber filled with
| electrode implanted mice, the software analizes the signal and
| prints, in paper, a results reports. Rick & Morty league.
| [deleted]
| jacquesm wrote:
| Combine an electronic nose with Boston Dynamics hound and you
| have a pretty good recipe for a nightmare or a horror movie.
| During the day it recharges... during the night it hunts... and
| it _never_ stops chasing you.
| [deleted]
| carapace wrote:
| Boston Dynamics Bloodhound :(
| didgeoridoo wrote:
| "Black Mirror Did It!" is the new "Simpsons Did It!"
| oa335 wrote:
| On the podcast Invisibilia I heard a fascinating story about a
| woman who could smell people who would develop Parkinson's, well
| before other diagnostic tests. Here's an article about her:
| https://www.npr.org/sections/health-shots/2020/03/23/8202745...
| TaupeRanger wrote:
| Unfortunately, diagnosis is almost never the actual problem in
| any of these diseases... it's what to do when you discover it.
| Not to mention the problem of over-diagnosis and iatrogenic harms
| that happens when we know _that_ you might have something but not
| _where_ or to what extent you have it, requiring more tests and
| stress.
| sfink wrote:
| The treatment of some of these diseases (especially cancer)
| depends heavily on _when_ you discover it. If this were built
| into every cell phone, nobody would make it past stage 1
| cancer.
|
| ...well, almost nobody. "You're gonna die because you didn't
| call your mother often enough."
| TaupeRanger wrote:
| Treatment != Outcome. Until an RCT is completed, we won't
| actually know if such diagnostic devices are a net good or
| harm. You are ignoring the very real effects of iatrogenic
| harms and the psychological harms of giving people alerts
| that "cancer is detected!!!" when in actuality they would've
| been fine and never noticed any symptoms whatsoever. Not to
| mention the associated medical costs, tests done, time
| wasted, etc. This is why mammograms are so controversial:
| they might save you from dying of cancer, but they don't
| actually reduce your overall mortality. Screening doesn't
| always save lives by default. It's complicated.
| https://www.bmj.com/content/352/bmj.h6080
| sfink wrote:
| Sure. I'm aware of the difficult tradeoffs of screening.
| But the fact that screening tests X and Y are not worth
| doing isn't really adequate to write off a whole new world
| of additional screening tests, many of which would have
| very different tradeoffs. (Olfactory tests are far less
| invasive, for one.)
|
| It's also something of a UX issue. Nobody is going to write
| an app that rings the cancer alarm after one positive.
| People might write an app that sends raw results to your
| doctor or medical monitoring service, and you get an email
| requesting an appointment to discuss your latest status.
| And if your breath results say that you're gonna die in the
| next 10 days and there's nothing to be done (exaggerated
| for effect), well then... maybe it won't send an email
| after all.
| dontreact wrote:
| I honestly think the aversion to screening has more to do
| with other political and economic factors. For example,
| lung cancer screening has been shown to clearly reduce all-
| cause mortality in an extremely comprehensive study with 7
| years of followup (NLST). These results are also replicated
| in studies around the world.
|
| The problem is, how do you properly incentivize patients,
| providers and payers to actually implement this? The
| payoffs are not immediate but are rather long term for
| everyone involved: it takes 6+ years to clearly see the
| significant mortality reduction payoff actually show up in
| the data. The downsides, on the other hand, are immediate
| (another trip to the hospital/imaging center, deaths due to
| false positives, increased costs, more work for
| clinicians).
| toast0 wrote:
| Incentivising patients should be the easiest part.
| People, generally, would like to live longer, and if you
| make imaging convenient and work on the messaging, you
| can get good compliance, at least for the screening part;
| compliance for interventions would still be an issue, I
| presume.
|
| For providers, provide the studies and incentives.
| Bonuses for lung cancer screening work, or % of patients
| screened (of eligible patients seen above age X, who
| haven't been screened, don't have a counter indication to
| screening, etc).
|
| For payers, I think there's two classes of payers; long
| term payers like national health services; and short term
| payers like US health insurance where people can change
| insurance every year.
|
| Long term insurers can (and should) be looking at their
| budgets and data (their own, but also studies like you
| mention) to find out what things to prioritize. Depening
| on your perspective, goals could be to maximize good
| years of life given the budget or to minimize future
| budget needs given the current budget.
|
| Short term payers are going to have a hard time
| prioritizing long term issues. Reducing future costs for
| your insurance pool doesn't help you much when your pool
| can change every year. To incentivize this through
| economics, we would need to somehow increase the time
| exposure of the provider. Something along the lines of
| the insurance carried for a given year has partial
| responsibility for future years. Of course, that would be
| an administrative nightmare.
| dontreact wrote:
| I don't know the literature as well for Breast Cancer, but
| at least as implemented in the UK there seems to be clear
| evidence for reduction in all-cause mortality.
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121088/
|
| Edit: hastily posted an article without reading it... this
| is not correct.
| TaupeRanger wrote:
| This study demonstrates what would be necessary to show a
| _possible_ reduction - it doesn 't show an _actual_
| reduction. But it would be encouraging to see such a
| study at some point.
| dontreact wrote:
| Also I think you are painting an ongoing disagreement in
| the medical community (do we need to measure all-cause,
| or just breast cancer related mortality) as settled.
|
| There are good arguments on both sides, but I think that
| we have a much better shot at turning the breast-cancer
| specific mortality boost into all-cause mortality boost
| by continuing to improve treatment, biopsy, screening
| etc.
| dontreact wrote:
| Yeah I messed this one up. Thanks. I think my point about
| Lung Cancer in the other thread. still stands.
|
| There are no RCTs, but at this point it seems not likely
| to happen for mammography. Perhaps for DBT though. I am
| optimistic that DBT + AI assistance will produce
| significantly different results than screening using a
| single reader on mammography.
| Dumblydorr wrote:
| There was a cat named Oscar in the Steere House nursing home in
| Providence, RI, who was kind of a jerk. However, he had one
| incredible power. The advanced dementia ward where he lived had
| numerous sick patients. Sometimes, He would jump onto one of
| their beds. Sure enough, hours later, that patient would die. He
| had a remarkable record, over 20 cases in a row were predicted
| correctly.
|
| It must've been smell, he sensed the deterioration from
| biochemical signals. Why he liked to be around death, I don't
| know, cats are strange!
| TaupeRanger wrote:
| Sounds apocryphal or just flat wrong. A cat that jumps up on a
| bunch of beds in such a place is bound to do so on the beds of
| dying patients. The dying ones probably got more visits from
| doctors, family, etc. and the cat could've been responding to
| the presence of humans, or any number of other factors. To
| assume it was smelling imminent death and jumping on the bed to
| signal it is way beyond what you could possibly prove.
| WhompingWindows wrote:
| It's not flat wrong nor apocryphal, check your facts, his
| performance was studied and published in a book and in the
| New England Journal -- do you think the NEJM is likely to
| publish pure aprocryphal falsehood?
|
| I volunteered in the Steere House and met the cat, and my
| close family member was a higher-up in the org and personally
| witnessed the cat's abilities numerous times.
|
| https://en.wikipedia.org/wiki/Oscar_(therapy_cat)
|
| https://www.nejm.org/doi/full/10.1056/NEJMp078108
| TaupeRanger wrote:
| It is likely both. The link you provided is not a study.
| How many times did the cat jump up on the bed of a non-
| dying patient? How often on the beds of any random patient,
| making his jumps on the dying patients' beds simply part of
| the noise? Without a real study, we can't attribute
| superpowers to a cat.
| jacquesm wrote:
| It may be true. But also: it may be coincidence, there is a
| chance that the cat naps on the beds of people that are
| lying quietly, which is something that probably precedes
| death more often than it does not, the cat may sleep on
| other beds but nobody thinks much of it and so on.
|
| What the NEJM publishes is not always accurate or even
| true, there have been numerous examples of retracted
| studies so no need for the appeal to authority.
|
| If it is true then someone should figure out the mechanism
| and prove it otherwise it might just as well be
| coincidence.
| aaron695 wrote:
| It will be fake, try reading this -
| http://skepdic.com/oscar.html
|
| What is funny is someone killed Oscar with a bed pan after
| the original story come out. Sure it also is probably not
| true (The story also sounds apocryphal), but we can pick
| our realities -
|
| https://scienceblogs.com/insolence/2007/08/19/oscar-the-
| deat...
| deathlight wrote:
| I always come back to this clip in situations like these:
| https://www.youtube.com/watch?v=xSVqLHghLpw
| tmoertel wrote:
| Alternative explanation: Oscar the cat was just really good at
| murder.
| rbobby wrote:
| Most likely explanation.
|
| Source: I have a cat.
| phenkdo wrote:
| Technically, this doesn't seem to be a nose per se, but more
| creating a sensor to detect molecules for which the mammalian
| nose has evolved to detect. If we have an excitatory pattern,
| then most AI techniques should be able to detect it easily.
|
| Instead of creating a single modality i.e. artificial noses or
| ears, medicine would benefit from a multimodal sensory system
| that uses vision, smell, auditory and perhaps even taste, _in
| conjunction_, as the human body is rich with signals through all
| these modalities.
| aaron695 wrote:
| > _in conjunction_
|
| Given the decades of research into an electronic sense of smell
| and the billions of $ it will be worth if we can get a
| electronic nose, why are we jumping the gun to the other
| things?
|
| > a sensor to detect molecules for which the mammalian nose has
| evolved to detect.
|
| This would be a modern marvel and so far impossible. It also
| wouldn't have to be mammalian, there's no reason to limit it.
|
| > If we have an excitatory pattern, then most AI techniques
| should be able to detect it easily.
|
| Exactly. I'm not sure why you'd need AI at all. It should just
| be a look up table.
|
| An electronic nose is a big deal.
|
| We are talking the ability to know what people or vehicles are
| carrying without a search, tracking people and animals over
| land, the ability to find every truffle in a field, it should
| help us create smells like 4D cinema, find pollution in water
| and air and land, track leaks, cooking, find animal and mineral
| resources, animal husbandry and medicine.
| Animats wrote:
| _An electronic nose is a big deal._
|
| Yes. The sensors are the problem. Processing the data
| probably isn't a huge job.
|
| There was a startup trying to do this in 1999.[1] Cyrano
| Sciences, Inc. They got some Small Business Innovation
| grants.[2] They were trying to build a chemical weapons
| detector badge, an oil/fuel leak detector, and related
| devices. They developed a handheld unit, the Cyranose 320.[3]
| They were acquired by Smiths Detection (UK). They sell
| various devices for detecting explosives, drugs, disease
| carriers, and such. "Currently trialing rapid detection
| airborne COVID-19."[4]
|
| [1] https://www.scientificamerican.com/article/how-close-are-
| art...
|
| [2] https://www.sbir.gov/sbc/cyrano-sciences-inc
|
| [3] https://spinoff.nasa.gov/spinoff2001/ps4.html
|
| [4] https://www.smithsdetection.com/canary-biological-
| detection-...
| durovo wrote:
| How about using an animal's nose instead of an electronic
| nose? Detect the brain signals and let the "AI" figure out
| the patterns when the animal inhales something. No need to
| create a new nose from scratch, no need to train the animal
| as well.
| shawnz wrote:
| > why are we jumping the gun to the other things?
|
| Perhaps all those kinds of sensors could be cleverly combined
| in ways that make them more feasible/reliable, not less.
|
| If we limit ourselves to designing it with the same specific
| conceptions of smell that we have, we might be unnecessarily
| making the job harder for ourselves, or missing easy
| optimizations that would make it more effective.
| benkoller wrote:
| > Instead of creating a single modality i.e. artificial noses
| or ears, medicine would benefit from a multimodal sensory
| system that uses vision, smell, auditory and perhaps even
| taste, _in conjunction_, as the human body is rich with signals
| through all these modalities.
|
| Thats a great thought right there. Adding an over-time
| perspective would make this even more powerful, as a lot of
| information is encapsulated in change, not just absolute
| observation.
|
| I wonder how much of the required sensing tech is already
| available, but most likely not rated for medical usage yet.
| isoprophlex wrote:
| With all the "deep x" going around, i for one can't wait for the
| development of some otolaryngology killer ai tech named "deep
| throat"
| the-dude wrote:
| _Deep_
| cgravill wrote:
| There are some companies such as https://www.owlstonemedical.com/
| who've made some progress on medical diagnosis from breath
| sfink wrote:
| It's interesting to think of this from a security point of view.
| What data can be exfiltrated? How much signal are we giving off
| all the time that would leak information on way more of what's
| going on inside than we realize?
|
| If Spectre can use a timing side channel to peer into regions of
| memory that were not supposed to be accessed, how many more side
| channels are there in a human body that mostly wasn't designed to
| conceal anything? (That's not exactly true, we've evolved to hide
| quietly, many things hunt by smell, women conceal their state of
| fertility, etc. But technology can access a _much_ lower
| threshold of signal than anything evolution has had to worry
| about.)
|
| If you listen closely enough, I'd expect we're all open books.
| Time the exact duration that nerve impulses travel, that blood
| coagulates, that sweat is produced, that hormones are released,
| etc. Look at the ratios of chemicals produced by digestion,
| respiration, locomotion, etc.
|
| Technologists are already mining some of this wealth of signal
| from just filtered speech recordings. There's _so_ much more that
| could be harnessed (and abused).
| dontreact wrote:
| Tech is interesting, title is clickbait. There are many important
| conditions which will leave no trace outside the body. This is
| why long term I'm excited about ultrasound getting cheaper,
| allowing individuals to look inside themselves more frequently.
|
| As a novel signal or biomarker, figuring out aromatic traces of
| diseases we didn't even know about seems cool too. So in that
| sense this is interesting.
|
| But no, diagnosing disease is obviously multimodal. And I'm not
| at all convinced this would even be the most important modality,
| even in the distant future.
| CodeGlitch wrote:
| I'm excited about the prospect of more consumer level medical
| diagnosis systems. As you say cheaper ultrasound at home would
| be awesome, and the results could be sent to a trained
| physician/ai to tell you if the dark mass is supposed to be
| there. Putting people's health into their own hands is a
| positive IMHO.
| trhway wrote:
| dogs smelling covid
| https://www.nature.com/articles/d41586-020-03149-9 :
|
| "Riad Sarkis, a surgeon and researcher at Saint Joseph University
| in Beirut, is part of a French-Lebanese project that has trained
| 18 dogs. Sarkis used the best two performers for the airport
| trial in Lebanon. The dogs screened 1,680 passengers and found
| 158 COVID-19 cases that were confirmed by PCR tests. The animals
| correctly identified negative results with 100% accuracy, and
| correctly detected 92% of positive cases, according to
| unpublished results."
|
| btw, 10% of passengers are covid positive, and i'd guess most are
| asymptomatic as most of them wouldn't be flying otherwise.
| appleflaxen wrote:
| How is a digital nose different than a mass spec applied to
| sweat/blood/saliva?
| sfink wrote:
| That seems like trying to figure out the plot of a book given a
| histogram of its letter frequencies.
|
| A mass spectrometer is not going to be able to distinguish a
| rich mixture of compounds. Nor can it distinguish molecules
| with the same elements.
|
| But it's been done, and apparently might still be in limited
| use:
| https://en.wikipedia.org/wiki/Mass_spectrometry#Respired_gas...
| petra wrote:
| How does the process for distinguishing a rich mixture of
| compounds looks like ? How complex/automatable is it ?
| sfink wrote:
| From the article, it sounds like doing it in a way that
| approaches the sense of smell is quite hard, and no
| adequate approach has yet been figured out.
| Metacelsus wrote:
| >A mass spectrometer is not going to be able to distinguish a
| rich mixture of compounds. Nor can it distinguish molecules
| with the same elements.
|
| That's why GC-MS/MS is a thing
| ryzvonusef wrote:
| as an anosmic by birth, please give me a device that lets me know
| the food i'm taking is bad, have had a few close encounters with
| food poisoning
| rtx wrote:
| Never thought about this side effect. What precautions do you
| take.
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