Category Archives: data saving lives

an idea of earth shattering significance

ok.

been looking for alignment between a significant industry sector and human health. it’s a surprisingly difficult alignment to find… go figure?

but I had lunch with joran laird from nab health today, and something amazing dawned on me, on the back of the AIA Vitality launch.

Life (not health) insurance is the vehicle. The longer you pay premiums, the more money they make.

AMAZING… AN ALIGNMENT!!!

This puts the pressure on prevention advocates to put their money where their mouth is.

If they can extend healthy life by a second, how many billions of dollars does that make for life insurers?

imagine, a health intervention that doesn’t actually involve the blundering health system!!?? PERFECT!!!

And Australia’s the perfect test bed given the opt out status of life insurance and superannuation.

Joran wants to introduce me to the MLC guys.

What could possibly go wrong??????

Illumina’s $1000 genome

This article nice frames the immaturity of the technology in the context of population health and prevention (vs. specific disease management), and even references the behaviour of evil corporations in its final paragraphs.

 

Cost breakdown for Illumina’s $1,000 genome:

Reagent* cost per genome — $797

Hardware price — $137**

DNA extraction, sample prep and labor — $55-$65

Total Price = $989-$999

* Starting materials for chemical reactions

** Assumes a four-year depreciation with 116 runs per year, per system. Each run can sequence 16 genomes.

http://recode.net/2014/03/25/illuminas-ceo-on-the-promise-of-the-1000-genome-and-the-work-that-remains/

Illumina’s CEO on the Promise of the $1,000 Genome — And the Work That Remains

March 25, 2014, 2:18 PM PDT

By James Temple

Illumina seized the science world’s attention at the outset of the year by announcing it had achieved the $1,000 genome, crossing a long-sought threshold expected to accelerate advances in research and personalized medicine.

The San Diego company unveiled the HiSeqX Ten Sequencing System at the J.P. Morgan Healthcare Conference in January. It said “state-of-the art optics and faster chemistry” enabled a 10-fold increase in daily throughput over its earlier machines and made possible the analysis of entire human genomes for just under $1,000.

Plummeting prices should broaden the applications and appeal of such tests, in turn enabling large-scale studies that may someday lead to scientific breakthroughs.

The new sequencers are making their way into the marketplace, with samples now running on a handful of systems that have reached early customers, Chief Executive Jay Flatley said in an interview with Re/code last week. Illumina plans to begin “shipping in volume” during the second quarter, he said.

The Human Genome Project, the international effort to map out the entire sequence of human DNA completed in 2003, cost $2.7 billion. Depending on whose metaphor you pick, the $1,000 price point for lab sequencing is akin to breaking the sound barrier or the four-minute mile — a psychological threshold where expectations and, in this case, economics change.

Specifically, a full genomic workup of a person’s three billion DNA base pairs starts to look relatively affordable even for healthy patients. It offers orders of magnitude more information than the so-called SNPs test provided by companies like 23andMe for $99 or so, which just looks at the approximately 10 million “single-nucleotide polymorphisms” that are different in an individual.

With more data, scientists expect to gain greater insights into the relationship between genetic makeup and observable characteristics — including what genes are implicated in which diseases. Among other things, it should improve our understanding of the influences of DNA that doesn’t directly code proteins (once but no longer thought of as junk DNA) and create new research pathways for treatments and cures.

“The $1,000 genome has been the Holy Grail for scientific research for now over a decade,” Flatley said. “It’s enabled a whole new round of very large-scale discovery to get kicked off.”

Cost breakdown for Illumina’s $1,000 genome:

Reagent* cost per genome — $797

Hardware price — $137**

DNA extraction, sample prep and labor — $55-$65

Total Price = $989-$999

* Starting materials for chemical reactions

** Assumes a four-year depreciation with 116 runs per year, per system. Each run can sequence 16 genomes.

Source: Illumina

Some have questioned the $1,000 claim, with Nature noting research centers have to buy 10 systems for a minimum of $10 million — and that the math requires including machine depreciation and excluding the cost of lab overhead.

But Flatley defended the figure, saying it’s impossible to add in overhead since it will vary at every research facility.

“Our math was totally transparent and it is exactly the math used by the (National Human Genome Research Institute),” he said. “It’s a fully apples-to-apples comparison to how people have talked historically about the $1,000 genome.”

He also questioned the conclusions of a recent study published in the Journal of the American Medical Association, where researchers at Stanford University Medical Center compared results of adults who underwent next-generation whole genome sequencing by Illumina and Complete Genomics, the Mountain View, Calif., company acquired last year by BGI.

They found insertions or deletions of DNA base pairs only concurred between 53 percent and 59 percent of the time. In addition, depending on the test, 10 percent to 19 percent of inherited disease genes were not sequenced to accepted standards.

“The use of [whole genome sequencing] was associated with incomplete coverage of inherited disease genes, low reproducibility of detection of genetic variation with the highest potential clinical effects, and uncertainty about clinically reportable findings,” the researchers wrote.

Or as co-author Euan Ashley put it to me: “The test needs some tough love to get it to the point where it’s clinical grade.”

Flatley responded that the sample size was small and that the sequencing platforms were several years old. But he did acknowledge they are still grappling with technology limitations.

“What’s hard is to determine whether there’s a base inserted or deleted,” he said. “That’s abioinformatics problem, not a sequencing problem. That’s a software issue that we and others and the whole world is trying to work on.”

But, he stressed, that shortcoming doesn’t undermine the value of what the tests doread accurately.

“There are many, many, many things where it’s clinically useful today,” he said.

Flatley pointed to several areas where we’re already seeing real-world applications of improving sequencing technology, including cancer treatments targeted to the specific DNA of the tumor rather than the place where it shows up in the body. There are also blood tests under development that can sequence cancer cells, potentially avoiding the need for biopsies, including one from Guardant Health.

Another promising area is noninvasive prenatal testing, which allows expecting parents to screen for genetic defects such as Down syndrome through a blood draw rather than an amniocentesis procedure.

The technology can delineate the DNA from the fetus circulating within the mother’s bloodstream. It’s less invasive and dangerous than amniocentesis, which involves inserting a needle into the amniotic sac and carries a slight risk of miscarriage. Because of that risk it’s generally reserved for high-risk pregnancies, including for women 35 and older.

Illumina, which offers the blood screening for out-of-pocket costs of around $1,500, recently funded a study published in the New England Journal of Medicine that found the so-called cell-free fetal DNA tests produced more accurate results than traditional tests for Down syndrome and Trisomy 18, a more life-threatening condition known as Edwards syndrome.

“It gives some earlier indicators to women in the average risk population if their babies have those problems,” Flatley said. “I think that it will broaden the overall market, and there are other tests that can be added over time.”

But there are ethical issues that arise as prenatal genetic tests become more popular and revealing, including whether parents will one day terminate pregnancies based on intelligence, height, eye color, hair color or minor diseases.

For that reason, Illumnia refuses to disclose those traits that are decipherable in the genome today.

But Flatley said they couldn’t stop purchasers of its machines from doing so, nor competitors like BGI of China (for more on that issue see Michael Specter’s fascinating profile of the company in the New Yorker ). Flatley said there needs to be a public debate on these issues, and he expects that new laws will be put into place establishing commonsense boundaries in the months or years ahead.

“This isn’t something we think we can arbitrate,” he said. “But we won’t be involved directly in delivering [results] that would cross those ethical boundaries.”

Flu Trends fails…

  • “automated arrogance”
  • big data hubris
  • At its best, science is an open, cooperative and cumulative effort. If companies like Google keep their big data to themselves, they’ll miss out on the chance to improve their models, and make big data worthy of the hype. “To harness the research community, they need to be more transparent,” says Lazer. “The models for collaboration around big data haven’t been built.” It’s scary enough to think that private companies are gathering endless amounts of data on us. It’d be even worse if the conclusions they reach from that data aren’t even right.

But then this:
http://www.theatlantic.com/technology/archive/2014/03/in-defense-of-google-flu-trends/359688/

 

http://time.com/23782/google-flu-trends-big-data-problems/

Google’s Flu Project Shows the Failings of Big Data

Google flu trends
GEORGES GOBET/AFP/Getty Images

A new study shows that using big data to predict the future isn’t as easy as it looks—and that raises questions about how Internet companies gather and use information

Big data: as buzzwords go,it’s inescapable. Gigantic corporations like SAS andIBM tout their big data analytics, while experts promise that big data—our exponentially growing ability to collect and analyze information about anything at all—will transform everything from business to sports to cooking. Big data was—no surprise—one of the major themes coming outof this month’s SXSW Interactive conference. It’s inescapable.

One of the most conspicuous examples of big data in action is Google’s data-aggregating tool Google Flu Trends (GFT). The program is designed to provide real-time monitoring of flu cases around the world based on Google searches that match terms for flu-related activity. Here’s how Google explains it:

We have found a close relationship between how many people search for flu-related topics and how many people actually have flu symptoms. Of course, not every person who searches for “flu” is actually sick, but a pattern emerges when all the flu-related search queries are added together. We compared our query counts with traditional flu surveillance systems and found that many search queries tend to be popular exactly when flu season is happening. By counting how often we see these search queries, we can estimate how much flu is circulating in different countries and regions around the world.

Seems like a perfect use of the 500 million plus Google searchesmade each day. There’s a reason GFT became the symbol of big data in action, in books like Kenneth Cukier and Viktor Mayer-Schonberger’s Big Data: A Revolution That Will Transform How We Live, Work and Think. But there’s just one problem: as a new article in Science shows, when you compare its results to the real world, GFT doesn’t really work.

GFT overestimated the prevalence of flu in the 2012-2013 and 2011-2012 seasons by more than 50%. From August 2011 to September 2013, GFT over-predicted the prevalence of the flu in 100 out 108 weeks. During the peak flu season last winter, GFTwould have had us believe that 11% of the U.S. had influenza, nearly double the CDC numbers of 6%. If you wanted to project current flu prevalence, you would have done much better basing your models off of 3-week-old data on cases from the CDC than you would have been using GFT’s sophisticated big data methods. “It’s a Dewey beats Truman moment for big data,” says David Lazer, a professor of computer science and politics at Northeastern University and one of the authors of the Sciencearticle.

Just as the editors of the Chicago Tribune believed it could predict the winner of the close 1948 Presidential election—they were wrong—Google believed that its big data methods alone were capable of producing a more accurate picture of real-time flu trends than old methods of prediction from past data. That’s a form of “automated arrogance,” or big data hubris, and it can be seen in a lot of the hype around big data today. Just because companies like Google can amass an astounding amount of information about the world doesn’t mean they’re always capable of processing that information to produce an accurate picture of what’s going on—especially if turns out they’re gathering the wrong information. Not only did the search terms picked by GFT often not reflect incidences of actual illness—thus repeatedly overestimating just how sick the American public was—it also completely missed unexpected events like the nonseasonal 2009 H1N1-A flu pandemic. “A number of associations in the model were really problematic,” says Lazer. “It was doomed to fail.”

Nor did help that GFT was dependent on Google’s top-secret and always changing search algorithm. Google modifies its search algorithm to provide more accurate results, but also to increase advertising revenue. Recommended searches, based on what other users have searched, can throw off the results for flu trends. While GFT assumes that the relative search volume for different flu terms is based in reality—the more of us are sick, the more of us will search for info about flu as we sniffle above our keyboards—in fact Google itself alters search behavior through that ever-shifting algorithim. If the data isn’t reflecting the world, how can it predict what will happen?

GFT and other big data methods can be useful, but only if they’re paired with what the Science researchers call “small data”—traditional forms of information collection. Put the two together, and you can get an excellent model of the world as it actually is. Of course, if big data is really just one tool of many, not an all-purpose path to omniscience, that would puncture the hype just a bit. You won’t get a SXSW panel with that kind of modesty.

A bigger concern, though, is that much of the data being gathered in “big data”—and the formulas used to analyze it—is controlled by private companies that can be positively opaque. Google has never made the search terms used in GFT public, and there’s no way for researchers to replicate how GFT works. There’s Google Correlate, which allows anyone to find search patterns that purport to map real-life trends, but as the Scienceresearchers wryly note: “Clicking the link titled ‘match the pattern of actual flu actvity (this is how we built Google Flu Trends!)’ will not, ironically, produce a replication of the GFT search terms.” Even in the academic papers on GFT written by Google researchers, there’s no clear contact information, other than a generic Google email address. (Academic papers almost always contain direct contact information for lead authors.)

At its best, science is an open, cooperative and cumulative effort. If companies like Google keep their big data to themselves, they’ll miss out on the chance to improve their models, and make big data worthy of the hype. “To harness the research community, they need to be more transparent,” says Lazer. “The models for collaboration around big data haven’t been built.” It’s scary enough to think that private companies are gathering endless amounts of data on us. It’d be even worse if the conclusions they reach from that data aren’t even right.

Ornish on Digital Health

The limitations of high-tech medicine are becoming clearer—e.g., angioplasty, stents, and bypass surgery don’t prolong life or prevent heart attacks in stable patient; only one out of 49 men treated for prostate cancer benefit from the treatment, and the other 48 often become impotent, incontinent or both; and drug treatments of type 2 diabetes don’t work nearly as well as lifestyle changes in preventing the horrible complications.

http://www.forbes.com/sites/johnnosta/2014/03/17/the-stat-ten-dean-ornish-on-digital-health-wisdom-and-the-value-of-meaningful-connections/

3/17/2014 @ 11:09AM |1,095 views

The STAT Ten: Dean Ornish On Digital Health, Wisdom And The Value Of Meaningful Connections

STAT Ten is intended to give a voice to those in digital health. From those resonant voices in the headlines to quiet innovators and thinkers behind the scenes, it’s my intent to feature those individuals who are driving innovation–in both thought and deed. And while it’s not an exhaustive interview, STAT Ten asks 10 quick questions to give this individual a chance to be heard.  

Dean Ornish, MD is a fascinating and important leader in healthcare.  His vision has dared to question convention and look at health and wellness from a comprehensive and unique perspective.  He is a Clinical Professor of Medicine, UCSF Founder & President, nonprofit Preventive Medicine Research Institute.

Dr. Ornish’s pioneering research was the first to prove that lifestyle changes may stop or even reverse the progression of heart disease and early-stage prostate cancer and even change gene expression, “turning on” disease-preventing genes and “turning off” genes that promote cancer, heart disease and premature aging. Recently, Medicare agreed to provide coverage for his program, the first time that Medicare has covered an integrative medicine program. He is the author of six bestselling books and was recently appointed by President Obama to the White House Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. He is a member of the boards of directors of the San Francisco Food Bank and the J. Craig Venter Institute. The Ornish diet was rated #1 for heart health by U.S. News & World Report in 2011 and 2012. He was selected as one of the “TIME 100” in integrative medicine, honored as “one of the 125 most extraordinary University of Texas alumni in the past 125 years,” recognized by LIFE magazine as “one of the 50 most influential members of his generation” and by Forbes magazine as “one of the 7 most powerful teachers in the world.”

The lexicon of his career is filled with words that include innovator, teacher and game-changer.  And with this impressive career and his well-established ability to look at health and medicine in a new light, I thought i would be fun–and informative–to ask Dr. Ornish some questions about digital health.

Dean Ornish, MD

Dean Ornish, MD

 1. Digital health—many definitions and misconceptions.  How would describe this health movement in a sentence or two?

“Digital health” usually refers to the idea that having more quantitative information about your health from various devices will improve your health by changing your behaviors.  Information is important but it’s not usually sufficient to motivate most people to make meaningful and lasting changes in healthful behaviors.  If it were, no one would smoke cigarettes.

2. You’ve spoken of building deep and authentic connection among  patients as key element of your wellness programs.  Can digital health foster that connection or drive more “techno-disconnection”?

Both.  What matters most is the quality and meaning of the interaction, not whether it’s digital or analog (in person).  Study after study have shown that people who are lonely, depressed, and isolated are three to ten times more likely to get sick and die prematurely compared to those who have a strong sense of love and community.  Intimacy is healing.  In our support groups, we create a safe environment in which people can let down their emotional defenses and communicate openly and authentically about what’s really going on in their lives without fear they’ll be rejected, abandoned, or betrayed.  The quality and meaning of this sense of community is often life-transforming.  It can be done digitally, but it’s more effective in person.  A digital hug is not quite as fulfilling, but it’s much better than being alone and feeling lonely.

3. How can we connect clinical validation to the current pop culture trends of “fitness gadgets”?

Awareness is the first step in healing.  In that context, information can raise awareness, but it’s only the first step.

 4. Can digital health help link mind and body wellness?

Yes.  Nicholas Christakis’ research found that if your friends are obese, your risk of obesity if 45% higher.  If your friends’ friends are obese, your risk of obesity if 25% higher.  If your friends’ friends’ friends are obese, your risk is 10% higher—even if you’ve never met them.  That’s how interconnected we are.  Their study also showed that social distance is more important than geographic distance.  Long distance is the next best thing to being there (and in some families, even better…).

5. Are there any particular area of medicine and wellness that might best fit in the context of digital health (diet, exercise, compliance, etc.)?

They all do.

6. There is much talk on the empowerment of the individual and the “democratization of data”.  From your perspective are patients becoming more engaged and involved in their care?

Patients are becoming more empowered in all areas of life, not just with their health care.  Having access to one’s clinical data can be useful, but even more empowering is access to tools and programs that enable people to use the experience of suffering as a catalyst and doorway for transforming their lives for the better.  That’s what our lifestyle program provides.

 7. Is digital health “sticking” in the medical community?  Or are advances being driven more by patients?

Electronic medical records are finally being embraced, in part due to financial incentives.  Also, telemedicine is about to take off, as it allows both health care professionals and patients to leverage their time and resources more efficiently and effectively.  But most doctors are not prescribing digital health devices for their patients.  Not yet.

 8. Do you personally use any devices?  Any success (or failure) stories?

I weigh myself every day, and I work out regularly using weight machines and a treadmill desk.  I feel overloaded by information much of the day, so I haven’t found devices such as FitBit, Nike Plus, and others to be useful.  These days, I find wisdom to be a more precious commodity than information.

 9. What are some of the exciting areas of digital health that you see on the horizon?

The capacity for intimacy using digital platforms is virtually unlimited, but, so far, we’ve only scratched the surface of what’s possible.  It’s a testimony to how primal our need is for love and intimacy that even the rather superficial intimacy of Facebook (or, before that, the chat rooms in AOL, or the lounges in Starbucks) created multi-billion-dollar businesses.

My wife, Anne, is a multidimensional genius who is developing ways of creating intimate and meaningful relationships using the interface of digital technologies and real-world healing environments.  She also designed our web site (www.ornish.com) and created and appears in the guided meditations there; Anne has a unique gift of making everyone and everything around her beautiful.

 10. Medicare is now covering Dr. Dean Ornish’s Program for Reversing Heart Disease as a branded program–a landmark event–and you recently formed a partnership with Healthways to train health care professionals, hospitals, and clinics nationwide.  Why now?

We’re creating a new paradigm of health care—Lifestyle Medicine—instead of sick care, based on lifestyle changes astreatment, not just as prevention.  Lifestyle changes often work better than drugs and surgery at a fraction of the cost—and the only side-effects are good ones.  Like an electric car or an iPhone, this is a disruptive innovation.  After 37 years of doing work in this area, this is the right idea at the right time.

The limitations of high-tech medicine are becoming clearer—e.g., angioplasty, stents, and bypass surgery don’t prolong life or prevent heart attacks in stable patient; only one out of 49 men treated for prostate cancer benefit from the treatment, and the other 48 often become impotent, incontinent or both; and drug treatments of type 2 diabetes don’t work nearly as well as lifestyle changes in preventing the horrible complications.

At the same time, the power of comprehensive lifestyle changes is becoming more well-documented.  In our studies, we proved, for the first time, that intensive lifestyle changes can reverse the progression of coronary heart disease and slow, stop, or reverse the progression of early-stage prostate cancer.  Also, we found that changing your lifestyle changes your genes—turning on hundreds of good genes that protect you while downregulating hundreds of genes that promote heart disease, cancer, and other chronic diseases.  Our most recent research found that these lifestyle changes may begin to reverse aging at a cellular level by lengthening our telomeres, the ends of our chromosomes that control how long we live.

Finally, Obamacare turns economic incentives on their ear, so it becomes economically sustainable for physicians to offer training in comprehensive lifestyle changes to their patients, especially now that CMS is providing Medicare reimbursement and insurance companies such as WellPoint are also doing so.  Ben Leedle, CEO of Healthways, is a visionary leader who has the experience, resources, and infrastructure for us to quickly scale our program to those who most need it.  Recently, we trained UCLA, The Cleveland Clinic, and the Beth Israel Medical Center in New York in our program, and many more are on the way.

 

Anne Wojcicki lays out 23andMe’s vision…

 

http://www.engadget.com/2014/03/09/future-of-preventative-medicine/

Anne Wojcicki and her genetic sequencing company 23andMe are locked in abattle with the FDA. Even though it can’t report results to customers right now, Wojcicki isn’t letting herself get bogged down in the present. At SXSW 2014 she laid out her vision of the future of preventative medicine — one where affordable genome sequencing comes together with “big data.” In addition to simply harvesting your genetic code, the company is doing research into how particular genes effect your susceptibility to disease or your reaction to treatments. And 23andMe isn’t keeping this information locked down. It has been building APIs that allow it to share the results of its research as well as the results your genetic tests, should you wish to.

It’s when that data is combined with other information, say that harvested from a fitness tracker, and put in the hands of engineers and doctors. In the future she hopes that you’ll see companies putting the same effort into identifying and addressing health risks as they do for tracking your shopping habits. Targetfamously was able to decode that a woman was pregnant before she told her father, based purely on her purchase history. One day that same sort of predictive power could be harnessed to prevent diabetes or lessen a risk for a heart attack. Whether or not that future is five, 10 or 15 years off is unclear. But if Wojcicki has her way, you’ll be able to pull up health and lifestyle decisions recommended for you with the same ease that you pull up suggested titles on Netflix.

A couple of terrific safety quality presentations

 

Rene Amalberti to a Geneva Quality Conference:

b13-rene-amalberti

http://www.isqua.org/docs/geneva-presentations/b13-rene-amalberti.pdf?sfvrsn=2

 

Some random, but 80 slides, often good

Clapper_ReliabilitySlides

http://net.acpe.org/interact/highReliability/References/powerpoints/Clapper_ReliabilitySlides.pdf

Big data in healthcare

A decent sweep through the available technologies and techniques with practical examples of their applications.

Big data in healthcare

Big data in healthcare

big data in healthcare industrySome healthcare practitioners smirk when you tell them that you used some alternative medication such as homeopathy or naturopathy to cure some illness. However, in the longer run it sometimes really is a much better solution, even if it takes longer, because it encourages and enables the body to fight the disease naturally, and in the process build up the necessary long term defence mechanisms. Likewise, some IT practitioners question it when you don’t use the “mainstream” technologies…  So, in this post, I cover the “alternative” big data technologies. I explore the different types of big data datatypes and the NoSQL databases that cater for them. I illustrate the types of applications and analyses that they are suitable for using healthcare examples.

 

Big data in healthcare

Healthcare organisations have become very interested in big data, no doubt fired on by the hype around Hadoop and the ongoing promises that big data really adds big value.

However, big data really means different things to different people. For example, for a clinical researcher it is unstructured text on a prescription, for a radiologist it is the image of an x-ray, for an insurer it may be the network of geographical coordinates of the hospitals they have agreements with, and for a doctor it may refer to the fine print on the schedule of some newly released drug. For the CMO of a large hospital group, it may even constitute the commentary that patients are tweeting or posting on Facebook about their experiences in the group’s various hospitals. So, big data is a very generic term for a wide variety of data, including unstructured text, audio, images, geospatial data and other complex data formats, which previously were not analysed or even processed.

There is no doubt about that big data can add value in the healthcare field. In fact, it can add a lot of value. Partially because of the different types of big data that is available in healthcare. However, for big data to contribute significant value, we need to be able to apply analytics to it in order to derive new and meaningful insights. And in order to apply those analytics, the big data must be in a processable and analysable format.

Hadoop

Enter yellow elephant, stage left. Hadoop, in particular, is touted as the ultimate big data storage platform, with very efficient parallelised processing through the MapReduce distributed “divide and conquer” programming model. However, in many cases, it is very cumbersome to try and store a particular healthcare dataset in Hadoop and try and get to analytical insights using MapReduce. So even though Hadoop is an efficient storage medium for very large data sets, it is not necessarily the most useful storage structure to use when applying complex analytical algorithms to healthcare data. Quick cameo appearance. Exit yellow elephant, stage right.

There are other “alternative” storage technologies available for big data as well – namely the so-called NoSQL (not only SQL) databases. These specialised databases each support a specialised data structure, and are used to store and analyse data that fits that particular data structure. For specific applications, these data structures are therefore more appropriate to store, process and extract insights from data that suit that storage structure.

Unstructured text

A very large portion of big data is unstructured text, and this definitely applies to healthcare too. Even audio eventually becomes transformed to unstructured text. The NoSQL document databases are very good for storing, processing and analysing documents consisting of unstructured text of varying complexity, typically contained in XML, JSON or even Microsoft Word or Adobe format files. Examples of the document databases are Apache CouchDB and MongoDb. The document databases are good for storing and analysing prescriptions, drug schedules, patient records, and the contracts written up between healthcare insurers and providers.

On textual data you perform lexical analytics such as word frequency distributions, co-occurrence (to find the number of occurrences of particular words in a sentence, paragraph or even a document), find sentences or paragraphs with particular words within a given distance apart, and other text analytics operations such as link and association analysis. The overarching goal is, essentially, to turn unstructured text into structured data, by applying natural language processing (NLP) and analytical methods.

For example, if a co-occurrence analysis found that BRCA1 and breast cancer regularly occurred in the same sentence, it might assume a relationship between breast cancer and the BRCA1 gene. Nowadays co-occurrence in text is often used as a simple baseline when evaluating more sophisticated systems.

Rule-based analyses make use of some a priori information, such as language structure, language rules, specific knowledge about how biologically relevant facts are stated in the biomedical literature, the kinds of relationships or variant forms that they can have with one another, or subsets or combinations of these. Of course the accuracy of a rule-based system depends on the quality of the rules that it operates on.

Statistical or machine-learning–based systems operate by building classifications, from labelling part of speech to choosing syntactic parse trees to classifying full sentences or documents. These are very useful to turn unstructured text into an analysable dataset. However, these systems normally require a substantial amount of already labelled training data. This is often time-consuming to create or expensive to acquire.

However, it’s important to keep in mind that much of the textual data requires disambiguation before you can process, make sense of, and apply analytics to it. The existence of ambiguity, such as multiple relationships between language and meanings or categories makes it very difficult to accurately interpret and analyse textual data. Acronym / slang / shorthand resolution, interpretation, standardisation, homographic resolution, taxonomy ontologies, textual proximity, cluster analysis and various other inferences and translations all form part of textual disambiguation. Establishing and capturing context is also crucial for unstructured text analytics – the same text can have radically different meanings and interpretations, depending on the context where it is used.

As an example of the ambiguities found in healthcare, “fat” is the official symbol of Entrez Gene entry 2195 and an alternate symbol for Entrez Gene entry 948. The distinction is not trivial – the first is associated with tumour suppression and with bipolar disorder, while the second is associated with insulin resistance and quite a few other unrelated phenotypes. If you get the interpretation wrong, you can miss or erroneously extract the wrong information.

Graph structures

An interesting class of big data is graph structures, where entities are related to each other in complex relationships like trees, networks or graphs. This type of data is typically neither large, nor unstructured, but graph structures of undetermined depth are very complex to store in relational or key-value pair structures, and even more complex to process using standard SQL. For this reason this type of data can be stored in a graph-oriented NoSQL database such as Neo4J, InfoGrid, InfiniteGraph, uRiKa, OrientDB or FlockDB.

Examples of graph structures include the networks of people that know each other, as you find on LinkedIn or Facebook. In healthcare a similar example is the network of providers linked to a group of practices or a hospital group. Referral patterns can be analysed to determine how specific doctors and hospitals team together to deliver improved healthcare outcomes. Graph-based analyses of referral patterns can also point out fraudulent behaviour, such as whether a particular doctor is a conservative or a liberal prescriber, and whether he refers patients to a hospital that charges more than double than the one just across the street.

Another useful graph-based analysis is the spread of a highly contagious disease through groups of people who were in contact with each other. An infectious disease clinic, for instance, should strive to have higher infection caseloads across such a network, but with lower actual infection rates.

A more deep-dive application of graph-based analytics is to study network models of genetic inheritance.

Geospatial data

Like other graph-structured data, geospatial data itself is pretty structured – coordinates can simply be represented as pairs of coordinates. However, when analysing and optimising ambulance routes of different lengths, for example, the data is best stored and processed using a graph structures.

Geospatial analyses are also useful for hospital and practice location planning. For example, Epworth HealthCare group teamed up with geospatial group MapData Services to conduct an extensive analysis of demographic and medical services across Victoria. The analysis involved sourcing a range of data including Australian Bureau of Statistics figures around population growth and demographics, details of currently available health services, and the geographical distribution of particular types of conditions. The outcome was that the ideal location and services mix for a new $447m private teaching hospital should be in the much smaller city of Geelong, instead of in the much larger but services-rich city of Melbourne.

Sensor data

Sensor data often are also normally quite structured, with an aspect being measured, a measurement value and a unit of measure. The complexity comes in that for each patient or each blood sample test you often have a variable record structure with widely different aspects being measured and recorded. Some sources of sensor data also produce large volumes of data at high rates. Sensor data are often best stored in key-value databases, such as Riak, DynamoDB, Redis Voldemort, and sure, Hadoop.

Biosensors are now used to enable better and more efficient patient care across a wide range of healthcare operations, including telemedicine, telehealth, and mobile health. Typical analyses compare related sets of measurements for cause and effect, reaction predictions, antagonistic interactions, dependencies and correlations.

For example, biometric data, which includes data such as diet, sleep, weight, exercise, and blood sugar levels, can be collected from mobile apps and sensors. Outcome-oriented analytics applied to this biometric data, when combined with other healthcare data, can help patients with controllable conditions improve their health by providing them with insights on their behaviours that can lead to increases or decreases in the occurrences of diseases. Data-wise healthcare organisations can similarly use analytics to understand and measure wellness, apply patient and disease segmentation, and track health setbacks and improvements. Predictive analytics can be used to inform and drive multichannel patient interaction that can help shape lifestyle choices, and so avoid poor health and costly medical care.

Concluding remarks

Although there are merits in storing and processing complex big data, we need to ensure that the type of analytical processing possible on the big data sets lead to valuable enough new insights. The way in which the big data is structured often has an implication on the type of analytics that can be applied to it. Often, too, if the analytics are not properly applied to big data integrated with existing structured data, the results are not as meaningful and valuable as expected.

We need to be cognisant of the fact that there are many storage and analytics technologies available. We need to apply the correct storage structure that matches the data structure and thereby ensure that the correct analytics can be efficiently and correctly applied, which in turn will deliver new and valuable insights.

Australian Medicare Fraud

The quoted estimate seems a bit under…

http://www.abc.net.au/news/2014-03-06/australians-defrauding-medicare-hundreds-of-thousands-of-dollars/5302584

Video: 

Australian Medicare fraud revealed in new figures, 1,116 tip-offs so far this financial year

By medical reporter Sophie Scott and Alison Branley

Updated Fri 7 Mar 2014, 1:23am AEDT

New figures show Medicare is being defrauded of hundreds of thousands of dollars each year.

Figures released to the ABC show the Federal Government has received more than 1,000 tip-offs of potential Medicare frauds to date this financial year.

It comes as debate continues over a proposal put to the Commission of Audit to charge a $6 co-payment for visits to the doctor, which would reduce costs to the health system.

The Department of Human Services says its hotline has received 1,116 Medicare-related tip-offs since July 1, 2013.

Officers have investigated 275 cases, which has translated into 34 cases submitted to the Commonwealth Department of Public Prosecutions and 12 convictions.

The value of those 12 cases adds up to an estimated $474,000, with fraudsters ripping off an average of almost $40,000 each.

Department figures suggest most of the frauds come from outside the doctor’s office.

Ten of the 12 prosecutions this year were members of the public. One involved a medical practice staff member and one a practice owner.

“The Department of Human Services takes all allegations of fraud seriously and seeks to investigate where sufficient information is provided to do so,” a spokeswoman said.

The annual review of doctors’ use of Medicare, the Professional Services Review, showed at least 19 doctors were required to repay more than $1 million between them in 2012-13.

One doctor billed Medicare for seeing more than 500 patients in a day, and more than 200 patients on several other days.

Other cases uncovered by the ABC include:

  • Former police officer Matthew James Bunning has been charged with 146 Medicare frauds between 2011 and 2013. Investigators allege the 46-year-old removed Medicare slips from rubbish bins behind Medicare offices around Melbourne to produce forged receipts and illegally claimed more than $98,000 from the Government.
  • In January last year Korean student Myung Ho Choi was sentenced in a NSW district court to five years in prison for a series of fraud and identity theft charges that included receiving at least five paper boxes filled with blank Medicare cards intended for use in identity fraud.
  • In August last year NSW man Bin Li was sentenced in district court to seven years in prison for charges that included possessing almost 400 blank cards, including high quality Medicare cards, and machines for embossing cards.

Nilay Patel, a former US-based certified specialist in healthcare compliance and law tutor at Swinburne University of Technology, says the fraud figures are the “tip of the iceberg”.

“There is a lot more that we do not know and that really comes from both camps from the patients and the medical service providers,” he said.

He says Australia is falling behind the United States at preventing, detecting and prosecuting healthcare frauds.

“The safeguards [in Australia] are quite inadequate, the detection is more reactive that proactive and whatever proactive mechanisms that are there I think they are woefully underdeveloped,” he said.

Relatively ‘smallish’ but unacceptable problem: Minister

Federal Government authorities say they do not think Medicare fraud is widespread.

Minister for Human Services Marise Payne says the number of Medicare frauds are low compared to the number of transactions.

“I think when you consider that we have 344 million Medicare transactions a year it is a relatively smallish [problem] but that doesn’t mean it’s acceptable,” she said.

“One person committing a fraud effectively against the Australian taxpayer is one person too many.”

Ms Payne says the department uses sophisticated data matching and analytics to pick up potential frauds as well as its tip-off hotline.

The merger of Medicare with Centrelink also allows the bureaucracies to better share information and leads.

“The work we have done in that area is paying dividends,” Ms Payne said.

“There is more to do. The use of analytical data and risk profiling is highly sophisticated in the Centrelink space and we want to make sure we achieve the same levels in the Medicare space.”

The Australian Federal Police says it does not routinely gather statistics on the number of fake or counterfeit Medicare cards.

However, a spokesman says detections of counterfeit Medicare cards are rare.

“Intelligence to date indicates that the majority of Medicare cards seized that are of sufficient quality, are used as a form of identity, not intentionally to defraud Medicare,” a spokesman said.

A Customs and Border Protection spokeswoman says blank or fraudulent Medicare cards are not controlled under the Customs regulations and it is unable to provide seizure statistics.

The federal Ombudsman says he has not conducted any review or investigations into Medicare but did contribute to a 2009 inquiry into compliance audits on benefits.

The Medicare complaints detailed in the Ombudsman’s annual report relate to customers disputing Medicare refunds, not frauds.

‘People are just looting the money’

Sydney man Tahir Abbas is sceptical about the Government’s claims that Medicare fraud is not widespread.

Mr Abbas detected at least 10 false bulk billing charges on his Medicare statement between November and January valued at almost $750.

He was not in the country when many of the charges were incurred.

The charges were from a western Sydney optometrist who told the ABC they were unable to explain the discrepancies.

They said while Mr Abbas was billed, they never received payment.

How many times do we go and check our statements for Medicare particularly. Maybe with credit cards, bank details but not with Medicare. These people are just looting the money.

Victim of Medicare fraud Tahir Abbas

 

The owner told the ABC the system would not allow them to receive bulk billing payments for more than one check-up in a two-year period.

Mr Abbas said he believed his card had been misused by others for their own benefit.

“I was very disgusted to be honest,” he said.

“It’s all bulk-billed and they are charging the Government. But in a way the Government is charging us so we are paying from our pocket – it’s all taxpayers’ money.”

He has urged people to check their Medicare statements.

“How many times do we go and check our statements for Medicare particularly. Maybe with credit cards, bank details but not with Medicare.

“These people are just looting the money.”

Medicare has told Mr Abbas they are investigating.

High-tech Medicare cards needed?

Technology and crime analyst Nigel Phair from the University of Canberra says the Medicare card is an easy to clone, low-tech card that has been around for three decades.

While it is low in value for identity check points, it is a well-respected document.

 

“The Medicare card carries no technology which gives it additional factors for verification or identification of users,” he said.

“It’s just a mag stripe on the back, very similar to a credit card from the 1990s without any chip or pin technologies, which are well known to be the way of the future.”

He says Medicare is vulnerable to abuse because people’s data is stored in many places such as doctors’ surgeries and pharmacies.

“It’s very easy to sail under the radar if you’re a fraudulent user. And like all good frauds you keep the value of the transactions low but your volume high,” he said.

“Because all we do have is anecdotal evidence and no hard statistics, we really don’t know how bad this issue is.”

Ms Payne does not support upgrading the quality of Medicare cards.

“The advice I have is that that is not really a large source of fraud and inappropriate practices,” she said.

Do you know more? Email investigations@abc.net.au

 

Topics: fraud-and-corporate-crimehealthhealth-administrationhealth-policygovernment-and-politicsfederal-government,law-crime-and-justiceaustralia

First posted Thu 6 Mar 2014, 12:00pm AEDT

The Hammerbacher Quote

“The best minds of my generation are thinking about how to make people click ads… That sucks.”

 

http://www.businessweek.com/magazine/content/11_17/b4225060960537.htm

This Tech Bubble Is Different

By  

As a 23-year-old math genius one year out of Harvard, Jeff Hammerbacher arrived at Facebook when the company was still in its infancy. This was in April 2006, and Mark Zuckerberg gave Hammerbacher—one of Facebook’s first 100 employees—the lofty title of research scientist and put him to work analyzing how people used the social networking service. Specifically, he was given the assignment of uncovering why Facebook took off at some universities and flopped at others. The company also wanted to track differences in behavior between high-school-age kids and older, drunker college students. “I was there to answer these high-level questions, and they really didn’t have any tools to do that yet,” he says.

Over the next two years, Hammerbacher assembled a team to build a new class of analytical technology. His crew gathered huge volumes of data, pored over it, and learned much about people’s relationships, tendencies, and desires. Facebook has since turned these insights into precision advertising, the foundation of its business. It offers companies access to a captive pool of people who have effectively volunteered to have their actions monitored like so many lab rats. The hope—as signified by Facebook’s value, now at $65 billion according to research firm Nyppex—is that more data translate into better ads and higher sales.

After a couple years at Facebook, Hammerbacher grew restless. He figured that much of the groundbreaking computer science had been done. Something else gnawed at him. Hammerbacher looked around Silicon Valley at companies like his own, Google (GOOG), and Twitter, and saw his peers wasting their talents. “The best minds of my generation are thinking about how to make people click ads,” he says. “That sucks.”

You might say Hammerbacher is a conscientious objector to the ad-based business model and marketing-driven culture that now permeates tech. Online ads have been around since the dawn of the Web, but only in recent years have they become the rapturous life dream of Silicon Valley. Arriving on the heels of Facebook have been blockbusters such as the game maker Zynga and coupon peddler Groupon. These companies have engaged in a frenetic, costly war to hire the best executives and engineers they can find. Investors have joined in, throwing money at the Web stars and sending valuations into the stratosphere. Inevitably, copycats have arrived, and investors are pushing and shoving to get in early on that action, too. Once again, 11 years after the dot-com-era peak of the Nasdaq, Silicon Valley is reaching the saturation point with business plans that hinge on crossed fingers as much as anything else. “We are certainly in another bubble,” says Matthew Cowan, co-founder of the tech investment firm Bridgescale Partners. “And it’s being driven by social media and consumer-oriented applications.”

There’s always someone out there crying bubble, it seems; the trick is figuring out when it’s easy money—and when it’s a shell game. Some bubbles actually do some good, even if they don’t end happily. In the 1980s, the rise of Microsoft (MSFT), Compaq (HPQ), and Intel (INTC) pushed personal computers into millions of businesses and homes—and the stocks of those companies soared. Tech stumbled in the late 1980s, and the Valley was left with lots of cheap microprocessors and theories on what to do with them. The dot-com boom was built on infatuation with anything Web-related. Then the correction began in early 2000, eventually vaporizing about $6 trillion in shareholder value. But that cycle, too, left behind an Internet infrastructure that has come to benefit businesses and consumers.

 

This time, the hype centers on more precise ways to sell. At Zynga, they’re mastering the art of coaxing game players to take surveys and snatch up credit-card deals. Elsewhere, engineers burn the midnight oil making sure that a shoe ad follows a consumer from Web site to Web site until the person finally cracks and buys some new kicks.

This latest craze reflects a natural evolution. A focus on what economists call general-purpose technology—steam power, the Internet router—has given way to interest in consumer products such as iPhones and streaming movies. “Any generation of smart people will be drawn to where the money is, and right now it’s the ad generation,” says Steve Perlman, a Silicon Valley entrepreneur who once sold WebTV to Microsoft for $425 million and is now running OnLive, an online video game service. “There is a goodness to it in that people are building on the underpinnings laid by other people.”

So if this tech bubble is about getting shoppers to buy, what’s left if and when it pops? Perlman grows agitated when asked that question. Hands waving and voice rising, he says that venture capitalists have become consumed with finding overnight sensations. They’ve pulled away from funding risky projects that create more of those general-purpose technologies—inventions that lay the foundation for more invention. “Facebook is not the kind of technology that will stop us from having dropped cell phone calls, and neither is Groupon or any of these advertising things,” he says. “We need them. O.K., great. But they are building on top of old technology, and at some point you exhaust the fuel of the underpinnings.”

And if that fuel of innovation is exhausted? “My fear is that Silicon Valley has become more like Hollywood,” says Glenn Kelman, chief executive officer of online real estate brokerage Redfin, who has been a software executive for 20 years. “An entertainment-oriented, hit-driven business that doesn’t fundamentally increase American competitiveness.”

Hammerbacher quit Facebook in 2008, took some time off, and then co-founded Cloudera, a data-analysis software startup. He’s 28 now and speaks with the classic Silicon Valley blend of preternatural self-assurance and save-the-worldism, especially when he gets going on tech’s hottest properties. “If instead of pointing their incredible infrastructure at making people click on ads,” he likes to ask, “they pointed it at great unsolved problems in science, how would the world be different today?” And yet, other than the fact that he bailed from a sweet, pre-IPO gig at the hottest ad-driven tech company of them all, Hammerbacher typifies the new breed of Silicon Valley advertising whiz kid. He’s not really a programmer or an engineer; he’s mostly just really, really good at math.

Hammerbacher grew up in Indiana and Michigan, the son of a General Motors (GM) assembly-line worker. As a teenager, he perfected his curve ball to the point that college scouts from the University of Michigan and Harvard fought for his services. “I was either going to be a baseball player, a poet, or a mathematician,” he says. Hammerbacher went with math and Harvard. Unlike one of his more prominent Harvard acquaintances—Facebook co-founder Mark Zuckerberg—Hammerbacher graduated. He took a job at Bear Stearns.

On Wall Street, the math geeks are known as quants. They’re the ones who create sophisticated trading algorithms that can ingest vast amounts of market data and then form buy and sell decisions in milliseconds. Hammerbacher was a quant. After about 10 months, he got back in touch with Zuckerberg, who offered him the Facebook job in California. That’s when Hammerbacher redirected his quant proclivities toward consumer technology. He became, as it were, a Want.

 

At social networking companies, Wants may sit among the computer scientists and engineers, but theirs is the central mission: to poke around in data, hunt for trends, and figure out formulas that will put the right ad in front of the right person. Wants gauge the personality types of customers, measure their desire for certain products, and discern what will motivate people to act on ads. “The most coveted employee in Silicon Valley today is not a software engineer. It is a mathematician,” says Kelman, the Redfin CEO. “The mathematicians are trying to tickle your fancy long enough to see one more ad.”

Sometimes the objective is simply to turn people on. Zynga, the maker of popular Facebook games such as CityVille and FarmVille, collects 60 billion data points per day—how long people play games, when they play them, what they’re buying, and so forth. The Wants (Zynga’s term is “data ninjas”) troll this information to figure out which people like to visit their friends’ farms and cities, the most popular items people buy, and how often people send notes to their friends. Discovery: People enjoy the games more if they receive gifts from their friends, such as the virtual wood and nails needed to build a digital barn. As for the poor folks without many friends who aren’t having as much fun, the Wants came up with a solution. “We made it easier for those players to find the parts elsewhere in the game, so they relied less on receiving the items as gifts,” says Ken Rudin, Zynga’s vice-president for analytics.

These consumer-targeting operations look a lot like what quants do on Wall Street. A Want system, for example, might watch what someone searches for on Google, what they write about in Gmail, and the websites they visit. “You get all this data and then build very rapid decision-making models based on their history and commercial intent,” says Will Price, CEO of Flite, an online ad service. “You have to make all of those calculations before the Web page loads.”

Ultimately, ad-tech companies are giving consumers what they desire and, in many cases, providing valuable services. Google delivers free access to much of the world’s information along with free maps, office software, and smartphone software. It also takes profits from ads and directs them toward tough engineering projects like building cars that can drive themselves and sending robots to the moon. The Era of Ads also gives the Wants something they yearn for: a ticket out of Nerdsville. “It lets people that are left- brain leaning expand their career opportunities,” says Doug Mack, CEO of One Kings Lane, a daily deal site that specializes in designer goods. “People that might have been in engineering can go into marketing, business development, and even sales. They can get on the leadership track.” And while the Wants plumb the depths of the consumer mind and advance their own careers, investors are getting something too, at least on paper: almost unimaginable valuations. Just since the fourth quarter, Zynga has risen 81 percent in value, to a cool $8 billion, according to Nyppex.

No one is suggesting that the top tier of ad-centric companies—Facebook, Google—is going down should the bubble pop. As for the next tier or two down, where a profusion of startups is piling into every possible niche involving social networking and ads—the fate of those companies is anybody’s guess. Among the many unveilings in March, one stood out: An app called Color, made by a seven-month-old startup of the same name. Color lets people take and store their pictures. More than that, it uses geolocation and ambient-noise-matching technology to figure out where a person is and then automatically shares his photos with other nearby people and vice versa. People at a concert, for example, could see photos taken by all the other people at that concert. The same goes for birthday parties, sporting events, or a night out at a bar. The app also shares photos among your friends in the Color social network, so you can see how Jane is spending her vacation or what John ate for breakfast, if he bothered to take a photo of it.

 

Whether Color ends up as a profitable app remains to be seen. The company has yet to settle on a business model, although its executives say it’ll probably incorporate some form of local advertising. Figuring out all those location-based news feeds on the fly requires serious computational power, and that part of the business is headed by Color’s math wizard and chief product officer, DJ Patil.

Patil’s Silicon Valley pedigree is impeccable. His father, Suhas Patil, emigrated from India and founded the chip company Cirrus Logic (CRUS). DJ struggled in high school, did some time at a junior college, and through force of will decided to get good at math. He made it into the University of California at San Diego, where he took every math course he could. He became a theoretical math guru and went on to research weather patterns, the collapse of sardine populations, the formation of sand dunes, and, during a stint for the Defense Dept., the detection of biological weapons in Central Asia. “All of these things were about how to use science and math to achieve these broader means,” Patil says. Eventually, Silicon Valley lured him back. He went to work for eBay (EBAY), creating an antifraud system for the retail site. “I took ideas from the bioweapons threat anticipation project,” he says. “It’s all about looking at a network and your social interactions to find out if you’re good or bad.”

Patil, 36, agonized about his jump away from the one true path of Silicon Valley righteousness, doing gritty research worthy of his father’s generation. “There is a time in life where that kind of work is easy to do and a time when it’s hard to do,” he says. “With a kid and a family, it was getting hard.”

Having gone through a similar self-inquiry, Hammerbacher doesn’t begrudge talented technologists like Patil for plying their trade in the glitzy land of networked photo sharing. The two are friends, in fact; they’ve gotten together to talk about data and the challenges in parsing vast quantities of it. At social networking companies, Hammerbacher says, “there are some people that just really buy the mission—connecting people. I don’t think there is anything wrong with those people. But it just didn’t resonate with me.”

After quitting Facebook in 2008, Hammerbacher surveyed the science and business landscape and saw that all types of organizations were running into similar problems faced by consumer Web companies. They were producing unprecedented amounts of information—DNA sequences, seismic data for energy companies, sales information—and struggling to find ways to pull insights out of the data. Hammerbacher and his fellow Cloudera founders figured they could redirect the analytical tools created by Web companies to a new pursuit, namely bringing researchers and businesses into the modern age.

Cloudera is essentially trying to build a type of operating system, à la Windows, for examining huge stockpiles of information. Where Windows manages the basic functions of a PC and its software, Cloudera’s technology helps companies break data into digestible chunks that can be spread across relatively cheap computers. Customers can then pose rapid-fire questions and receive answers. But instead of asking what a group of friends “like” the most on Facebook, the customers ask questions such as, “What gene do all these cancer patients share?”

Eric Schadt, the chief scientific officer at Pacific Biosciences, a maker of genome sequencing machines, says new-drug discovery and cancer cures depend on analytical tools. Companies using Pacific Bio’s machines will produce mountains of information every day as they sequence more and more people. Their goal: to map the complex interactions among genes, organs, and other body systems and raise questions about how the interactions result in certain illnesses—and cures. The scientists have struggled to build the analytical tools needed to perform this work and are looking to Silicon Valley for help. “It won’t be old school biologists that drive the next leaps in pharma,” says Schadt. “It will be guys like Jeff who understand what to do with big data.”

Even if Cloudera doesn’t find a cure for cancer, rid Silicon Valley of ad-think, and persuade a generation of brainiacs to embrace the adventure that is business software, Price argues, the tech industry will have the same entrepreneurial fervor of yesteryear. “You can make a lot of jokes about Zynga and playing FarmVille, but they are generating billions of dollars,” the Flite CEO says. “The greatest thing about the Valley is that people come and work in these super-intense, high-pressure environments and see what it takes to create a business and take risk.” A parade of employees has left Google and Facebook to start their own companies, dabbling in everything from more ad systems to robotics and publishing. “It’s almost a perpetual-motion machine,” Price says.

Perpetual-motion machines sound great until you remember that they don’t exist. So far, the Wants have failed to carry the rest of the industry toward higher ground. “It’s clear that the new industry that is building around Internet advertising and these other services doesn’t create that many jobs,” says Christophe Lécuyer, a historian who has written numerous books about Silicon Valley’s economic history. “The loss of manufacturing and design knowhow is truly worrisome.”

Dial back the clock 25 years to an earlier tech boom. In 1986, Microsoft, Oracle (ORCL), and Sun Microsystems went public. Compaq went from launch to the Fortune 500 in four years—the quickest run in history. Each of those companies has waxed and waned, yet all helped build technology that begat other technologies. And now? Groupon, which e-mails coupons to people, may be the fastest-growing company of all time. Its revenue could hit $4 billion this year, up from $750 million last year, and the startup has reached a valuation of $25 billion. Its technological legacy is cute e-mail.

There have always been foundational technologies and flashier derivatives built atop them. Sometimes one cycle’s glamour company becomes the next one’s hard-core technology company; witness Amazon.com’s (AMZN) transformation over the past decade from mere e-commerce powerhouse to e-commerce powerhouse and purveyor of cloud-computing capabilities to other companies. Has the pendulum swung too far? “It’s a safe bet that sometime in the next 20 months, the capital markets will close, the music will stop, and the world will look bleak again,” says Bridgescale Partners’ Cowan. “The legitimate concern here is that we are not diversifying, so that we have roots to fall back on when we enter a different part of the cycle.”

Vance_190
Vance is a technology writer for Bloomberg Businessweek in Palo Alto, Calif. Follow him on Twitter @valleyhack.