tag:blogger.com,1999:blog-82522523723981534582024-03-05T12:54:10.065-05:00A Doctor for GoodAnonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-8252252372398153458.post-73872979394583608742013-08-21T19:49:00.000-04:002013-08-21T19:49:26.055-04:00Questions and Answers: Part 2<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">Continued...</span><o:p></o:p></div>
<div style="margin: 0in 0in 0.0001pt;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">How will people find the site?</span></b><o:p></o:p></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">There are two different audiences
for whom the site will hopefully be useful or interesting. One is a non-professional
audience. This is the main group for whom the project is created. This group
encompasses the broadest possible swath of the population. Initially the site
will be promoted through word of mouth and personal social networks. At
this point there is no budget for advertising. There
will not be the ability to promote the site on search engines.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">What is available at the beginning is
a relatively small network. An
initial marketing strategy will need to include free sources such as articles
in local news/periodicals. Web based articles on relevant topics can be
commented on and a link posted in the comments section. Connections with prominent individuals interested in the open-source arena and we can seek promotion of the project through their broader networks. As mentioned in
the “who will use this” section – it will more likely be younger individuals, and venues such as <a href="https://news.ycombinator.com/news" target="_blank">Hacker News</a> can be sought after to to promote the project to that
demographic.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">Who are the users of the image
database?<o:p></o:p></span></b></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">Anyone. I have read many stories that describe products being used in
completely different ways than the inventor originally imagined. I think the project, if viable, in and of itself demonstrates the promise of broader citizen
participation in medical science. The original spark for the idea developed out
of a conversation between a medical student and a computer scientist. That combination are potential users of the image database. <o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">I can imagine a clinical physician or
researcher in an academic medical center using the large data files for academic projects or research. <o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">A
database that can be displayed in an online webpage format – like the results
of a Google image search – will have broad uses. I have watched as a competent doctor
stepped out of the patient room and used a Google image search to compare what she saw to image search results during patient care - this database could provide, I believe, an equivalent result, without the
extraneous results you get with that type of search. I have personally been a medical
student looking at similar but smaller databases for examples of a rash while trying to
learn - this could database could provide that with likely a larger
volume of images. My hope is that be making the source code (the images) open,
the project is not making a judgment on who can or cannot use the information or for what
purpose. Rather, by providing aggregated information that is not currently available,
it may create a category of users that I cannot yet imagine. My hope is to attract users that are currently beyond my imagination.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">What kind of access do they
need? </span></b><o:p></o:p></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">Full and open access. This is a
project to aggregate and to curate. A librarian does not own the
knowledge in a library, but rather acts as a facilitator to others get at the
information. This project is intended to be used in a similar way, as a facilitator
to get at a particular type of information. With regards to the distribution and format of the database, I view this as partially a budget question. Initially, I
envision a database of images (such as .jpg files) with metadata attached (such as age, gender) to it that
are stored on a secure server. During the initial phases, access to the database can be
requested via an email, and will be shared in a zipped file. This can be emailed or shared
via online file sharing mechanism to anyone who requests access. It would be one of the least expensive ways to begin development.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">A subsequent project is the ability to deliver the collected images online, in a manner visually similar to the results
of a Google image search. This would allow for browsing/searchable access without
the need to know how to manipulate the contents of a large zipped file. This will ability is more costly from a web development perspective, and unlikely to be completed in the initial phases of the project.</span><o:p></o:p></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">Are there any partnerships that you
make ahead of time or will they be organic from the site?</span></b><span class="apple-converted-space"><span style="font-family: Arial, sans-serif;"> <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span class="apple-converted-space"><span style="font-family: Arial, sans-serif;">Partnerships
will be multi-faceted. Some will be cultivated during the development, while it
is hoped others will be created organically from the project itself. During the development
phase partnerships from special groups may provide mutual benefit. Foundations
that focus on a specific disease category such as psoriasis may find this
project to add value to their members as a way to contribute to medical science. As such, they may seek to promote it among their
membership. Additionally, non-medical groups such technologists passionate
about open-source technology development may find the project interesting from
their perspective and can promote the spread by word of mouth in order to participate in open-source health projects. Currently, there are few such projects.<o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">How will user-submitted
images/privacy be protected?</span></b><o:p></o:p></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">This is a critical question. <a href="http://adoctorforgood.blogspot.com/2013/04/the-potential-exists.html" target="_blank">In a previous post</a> we discussed how people share photos online by the billions. I
believe there is a large portion of society that is willing and desirous to
spend a small amount of their time in order to contribute to a project that will have
an aggregate good. At the same time, there is an imperative to protect personal/private information such as your personal health information.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">Initial measures to protect
privacy:<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">- Image suppliers will be encouraged
not include pictures that contain the full of their face, tattoos or other easy
to identify markings. <o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">- During uploading there will not
initially be a username or log in, so as not to link a user with an image.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">- The user will have the right to
their own information, meaning they can request to have it deleted from the
database at any time.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">- We will not store any personal identifying information (PII) with the uploaded image,
or even request it for uploading. The exception will be an email address, which will not be mandatory. An email address can provide a way to communicate with users about the project. Additionally, an email address can allow the user to request an image be deleted at some later date. <o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">- IP addresses will not be
recorded at the time of image submission.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">- No PII will be included in the
distribution of the database.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">-All privacy policies will be
kept transparent, and will be reviewed periodically, by user request or
suggestion, or if new information regarding privacy maintenance comes to light.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">If anyone can download an image
what protections, if any, are in place to protect the original submitters’
privacy? </span></b><o:p></o:p></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">The primary goal is to provide an
open space where this information is available. By adhering to the privacy
strategy mentioned in the question above it is creating a layer of protection
for the original submitter. A submission will constitute an implicit and explicit
agreement to participate in the project and its purpose. By not asking for a
name, address, credit card, or phone number there will be data to track the
image to a certain individual. In order to request for your personal picture to
be removed at any time there are several strategies to do that. One is to
provide an email or to provide a unique tracking number for the image so it can
be requested to be removed at any time. The database will not include any of
this linking information. This type of privacy of, of a skin photo, is
currently maintained in these databases that are actively available. In
summary, the primary means of ensuring user privacy is to collect/store minimal
amounts of personal information with the submitted image. <o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">How will this project be
sustained? </span></b><o:p></o:p></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">At this point, there is no money
generating from the project. At the initial phases it will be sustained with donations
and grants and personal income.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">There are several models of
financial sustainability such as user fees, subscriptions, advertising,
partnerships that find the project valuable to fund – however nothing specific has been decided at this point. <o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">The <a href="http://adoctorforgood.blogspot.com/2013/05/forward-movement.html" target="_blank">Shuttleworth flash-grant</a> is
the reason the project will exist in the world beyond sketches on the back
of a napkin. </span><o:p></o:p></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">Is there a commercial aspect to
it? <o:p></o:p></span></b></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">There
is no commercial aspect to the project currently. While their may exist
commercial applications in the future – the idea was conceived envisioning the ethos
of <a href="http://www.wikipedia.org/" target="_blank">Wikipeda</a>, <a href="http://www.ubuntu.com/" target="_blank">Ubuntu</a>, and <a href="http://www.ushahidi.com/" target="_blank">Ushahidi</a>. These are all projects that provide value to those
use them. They create value but are not specifically designed for the purpose
of revenue generation. There are commercial models that could be applied to this type of platform such as advertising physician/dermatology offices based on location.
This type of model will not be pursued at the outset.<o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">Are you actively seeking
additional funding?<o:p></o:p></span></b></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">Not at the
moment.</span><o:p></o:p></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">What are other potential funding sources? </span></b><o:p></o:p></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">More funding will not be pursued
from outside sources until a proof of concept can be illustrated. A proof of concept means a working website, with ability to upload images to a database, and a database that includes pictures of skin with information attached. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">We first have
to prove there is something of value worth funding in the idea. Until that point the small
grant and out-of-pocket finances will provide the financial input. In the
future, I have considered seeking funding from one of the crowd-sourced funding
platforms such as <a href="http://www.kickstarter.com/" target="_blank">Kickstarter</a>, <a href="http://www.indiegogo.com/" target="_blank">Indiegogo</a>, or foundations.</span><o:p></o:p></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif;">Are you supporting this out of
pocket as a labor of love? </span></b><o:p></o:p></div>
<br />
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif;">We have received one grant but
this is also a labor of love.</span><span style="font-size: 13.5pt;"><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.com0tag:blogger.com,1999:blog-8252252372398153458.post-13265753241214446072013-08-14T18:09:00.002-04:002013-08-14T18:09:22.654-04:00Questions and Answers: Part 1<!--[if gte mso 9]><xml>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">One of the underlying assumptions about the crowd-sourced
skin image database is that an open platform to gather information can produce
as good, or better, results. The open-ness of the platform allows for
non-professionals to contribute in a way that will add value.</span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Some details of the project have been described elsewhere in
this blog. Below is an opportunity to discuss some specific questions about the
project.</span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<div style="border-bottom: solid windowtext 1.5pt; border: none; mso-element: para-border-div; padding: 0in 0in 1.0pt 0in;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-bottom-alt: solid windowtext 1.5pt; mso-padding-alt: 0in 0in 1.0pt 0in; padding: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">All of the questions and answers are
directly related to the idea of a <a href="http://adoctorforgood.blogspot.com/2013/05/forward-movement.html" target="_blank">Crowd-sourced dermatology database</a>. The
project will be a web (and eventually mobile) based platform for individuals to
upload images of a skin lesion or condition that has previously been evaluated
and diagnosed by a medical professional. Requiring a diagnosis from a medical
professional is for the purpose of facilitating greater accuracy. Doctors see
millions of patients per year with skin related issues. Small percentages of
those daily encounters are currently being captured in a database for future
use. The intention is Not for self-diagnosis by patients, but rather to enable
individuals to contribute to the scientific/biological body of knowledge. The
images, freely given to the database, will be de-identified. The privacy of an individual’s
health/skin related concern is as important as the collection of skin images
for furtherance of medical science. The collection of images has value in the
form of aggregated biological information. The database will be open-source. One
way to view this project is thus: skin rashes/skin diseases are a manifestation
of our common biological and genetic code. By aggregating submitted skin
pictures from a global community into database, and then sharing that biologic information
in an open source environment starts to create for medical science what computer
science has done with <a href="http://en.wikipedia.org/wiki/Open_source" target="_blank">open-sourcecomputer code</a>.</span></span></div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;">_________________________________________________________________________</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Question & Answer</span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Who are your target users? </span></b></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">This is a marketing question. This frames the issue in terms
of narrowing to a unique user group. Narrowing to a specific a group thus makes
the problem of spreading the word about the project easier. No specific
category or group will intentionally be excluded from the project.</span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><a href="http://adoctorforgood.blogspot.com/2013/05/data-exhuast.html">Millions of
individuals</a> in the US are seen yearly in medical facilities for a skin
condition. There are more globally, although that data is harder to find. A
percentage of these individuals who seek professional medical care for a
dermatologic issue will be willing to contribute a picture (taken by themselves
or others) of their skin for a project to contribute to the greater scientific/medical
good. The greater good in this case is the aggregate of many people’s skin
images. A target user has access to an internet connection (via mobile or
desktop) and access to camera. Increasingly, that is through a smartphone
camera with web access. The target user is more likely younger (15-35
demographic) given the facility and comfort with sharing information online. A user/contributor
will likely have a strong interest in their personal health and an interest in
contributing what they have learned about themselves to a larger project that
has endurance beyond that moment in time. The individual action contributes a single
potential to a greater good. A contribution is an individual action for others
to use, however not in the exact same way as Wikipedia. A </span><a href="http://www.wikipediastudy.org/docs/Wikipedia_Overview_15March2010-FINAL.pdf"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">survey
of Wikipedia users and contributors</span></a><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"> suggested that it was primarily
young (26yr), single (~67%), males (86%) who had completed high or college (33%
and 25% respectively) that contributed articles to the website.</span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Individuals who have
an interest in health research are also target users. Those who have desire to
utilize an open database will also have incentive to promote image
contributions to the site. Target users with a specific interest in the
database include health educators (to use the site to show an array of images
of a certain type) and learners (medical students, nurses). </span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Who are the people who will submit pictures? </span></b></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Anyone willing to contribute a
picture of an abnormal skin lesion with a diagnosis, which has the rights to do
so, is welcome. The expectation is that the image has been seen by a medical
professional such as a nurse practitioner or an emergency room physician and
that diagnosis will be linked to the submitted image. Two broad categories of
people are envisioned as image submitters: Non-professionals and medical
professionals. A non-professional means a non-medical professional. A bank
teller, a lawyer, a student are all examples. The non-professional is
envisioned as submitting an image of themselves, their own individual skin. At
the point of image submission it will be explicit in the fact that personal information
will not be linked in order to protect the personal medical issues of those
wishing to contribute. Image submissions from non-professionals other than the
primary individual (such as a friend or relative) will be allowed, but made
explicit the person whose skin is in the picture has given consent for that
image to be shared in a de-identified manner. </span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Medical professionals may also
contribute images. A health practitioner with the interest, time, and
inclination, with the patients’ explicit consent, can submit images.</span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Why do they want to upload their picture? </span></b></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">At the initial stages, the
immediate gratification for the contribution will be a thank you email (if an
email address has been provided) and the knowledge and warmth that comes from
contributing to the greater good. Why do people contribute to online forums for
car maintenance, or pot-hole repair, or Wikipedia articles? There is a
satisfaction that comes from contributing to something larger than yourself.</span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">The psychology of this contribution
model will use that as an underlying assumption: people are inherently good. People
desire to be part of a project for a greater good. This is not to say that we act
in altruistic and benevolent ways in all our every action. The main goal for
initial iteration would be building up a database of images. People interested
in contributing to that project will upload their picture. Even at a fraction of
the potential user base, the will create a much larger open-source dermatology
database than currently exits. That is because the number of images in any open-source
dermatology database = 0.</span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">There are several ideas that are
being considered for user feedback that will help motivate and keep
contributors engaged/active/and spreading the word.</span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Possible incentive structures for
an image contribution:</span></span></div>
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Access
to images with similar diagnosis – allowing a user to browse an online picture
bank of images with similar diagnosis “oh that looks like what my skin looks like…”</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Allowing
users who submit images to track changes in lesions or moles over time. A
picture taken year on year could provide side by side comparison for changes in
size/shape/color. This would require the ability to match the image to the same
individual, such as a user account. </span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Allowing
specialized dermatology interest groups with dispersed geography to share images,
as the database will be openly available to them.</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Suggestions
are welcome.</span></span></li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;"><b>
</b></span><br />
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; vertical-align: baseline;">
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Who is making the diagnosis? </span></b></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; vertical-align: baseline;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">This has
been discussed several times, including in this post above. </span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; vertical-align: baseline;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">A
diagnosis will be made by a medical professional. The credibility of the
medical professional is implicit in the fact of image submission. It will be
articulated at the time of image submission, then implicitly assumed that user
has entrusted their skin issue to someone with the ability to evaluate and
manage skin conditions. It is not the aim of the project to verify medical licenses.
In addition to submitting the image and the diagnosis, the user will be asked
to provide several pieces of additional information. One piece of information
will be the type of medical professional making the diagnosis. Professionals
can include: Nurse Practitioner (NP), Doctor, Physician’s Assistant (PA),
Dermatologist, Family Doctor, Emergency Room Physician. </span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; vertical-align: baseline;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; vertical-align: baseline;">
<span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Who are the people reviewing the
pictures?<span style="mso-bidi-font-weight: bold;"> </span></span></b></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; vertical-align: baseline;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">At the
outset, when image volumes are low, I will be reviewing the pictures. This will
not be a diagnostic review. The initial image review will focus on visibility/clarity
of the image. The image review will assess if it is a picture of skin, or is it
not skin. It will look for any identifying features in the photo such as names
or faces. Images that do not pass this bar will be sent back to the submitter
and not included in the database. The number of images submitted will be
counted in order to determine the percentage that are submitted but are not
appropriate (such as a non-skin image). Once the image volume becomes great to
be handled by a single individual others will be asked to assist and divide up
the work. The bio and contact information of anyone with access to the data of
images will be provided transparently on the site. In subsequent iterations it
is one of the goals to have users contribute to the review process. It does not
take a medical professional to look at a series of images and determine which a
picture of skin and which is a picture of Mickey Mouse. Non-professionals can
also review images and flag them for image clarity. </span></span></div>
Anonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.com0tag:blogger.com,1999:blog-8252252372398153458.post-78799837556987561982013-07-11T22:08:00.002-04:002013-07-11T22:08:22.217-04:00Accuracy<!--[if gte mso 9]><xml>
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<![endif]--><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Accuracy is an interesting thing in medicine. There is an assumption, this unspoken hope, from those who seek medical care that the
answer they get is correct. Certainty breeds confidence, and confidence (without
reference to accuracy) breeds a measure of certainty. A diagnosis, confidently stated can lead to a feeling of reassurance, and that the answer/the diagnosis is accurate. Physicians are intensely trained, and have a high level of professionally acquired skill. However, medical practitioners are not perfect. The idea that medical
purveyors are inacurate, and do not come up with the correct answer the first time (or the second
or third time) propels the success of television dramas like House, M.D. </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">When thinking about curating a medical database of many user
submitted images, the topic of accuracy arises. Can we trust a citizen, a
user, a non-professional to contribute an image of a skin lesion? Will it be labeled with the <i>correct </i>diagnosis? In my mind this is an open question. As described previously,
we like to share images - think about the number of pictures uploaded to Facebook
daily. The number of encounters with medical professionals related to skin
issues far outstrips the number of pictures in currently available databases (see prior posts). It
is the belief of this project that people can be trusted to contribute to a
scientific project in a meaningful (meaning accurate) way. As a first pass, the uploaded image
will rely on the diagnostic accuracy of the medical professional who evaluates
the rash or lesion. It is trust given to the user/image contributor that they are contributing what a medical professional has communicated.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">The question that has been in my mind recently – How accurate are
medical professionals when pronouncing a diagnosis regarding the skin?</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">I conducted a review in the published scientific literature and
come across some information shared below which will shed some light on this question. This is by no means an exhaustive review. If you are interested in the full paper please <a href="mailto:johnticeparks@gmail.com" target="_blank">email me</a>, however they are easily accessible via <a href="http://www.ncbi.nlm.nih.gov/pubmed" target="_blank">Pubmed</a>. Below
you will find a listing of medical/scientific studies from the 1970s through to
the present which look into this question. The year of the study publication is
listed as well as the title of the medical paper and a brief description along with an accuracy rate in the text. In many cases accuracy is defined as the diagnosis given to the picture or patient after examination as compared to the correct diagnosis which is typically a biopsy-which serves as the final arbiter of correctness in skin diagnosis.</span></span><br />
<br />
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<br />
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<b><span style="font-family: "Arial","sans-serif";">1972<span style="mso-tab-count: 1;"> </span>Accuracy
of Dermatologic Diagnosis by Television</span></b></div>
</div>
<div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Comparisons of
diagnoses made by black and white television viewing of slides of dermatologic
lesions to those made from directly viewing of the same slides in color revealed
that in 85% to 89% of cases the dermatologists were as accurate by television
as on direct examination. Color television improved accuracy only slightly, but
was more acceptable to the dermatologists as less time was required to reach a
diagnosis. </span></div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none; text-indent: -.5in;">
<b><span style="font-family: "Arial","sans-serif";">1983<span style="mso-tab-count: 1;"> </span>The
Prevalence and Accuracy of Diagnosis of Non-Melanotic Skin Cancer in Victoria </span></b></div>
</div>
<div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Surveys of Victorian
[Australian] dermatologists and pathologists were undertaken to determine the
number of patients attending medical practitioners with non-melanotic [non-cancer] skin
cancers and solar keratoses. Accuracy of clinical diagnosis studies suggest
that the correct diagnosis of these tumors is being made clinically [in person] in
approximately 70% of cases by experienced clinicians. </span></div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<b><span style="font-family: "Arial","sans-serif";">1989<span style="mso-tab-count: 1;"> </span>The
Development of Expertise in Dermatology</span></b></div>
</div>
<div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">To examine
the development of expertise in dermatology at five levels of expertise. A total of 100
slides [pictures], 2 typical and 3 atypical, from each of 20 common skin disorders,
were presented to six subjects at each of the following levels: second-year
preclinical medical students, final year medical students, residents in family
medicine, general practitioners, and dermatologists. Accuracy of diagnosis rose
from 21% for medical students to 87% for dermatologists.</span><span lang="EN" style="font-family: "Arial","sans-serif"; mso-ansi-language: EN;"></span></div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<b><span style="font-family: "Arial","sans-serif";">1990<span style="mso-tab-count: 1;"> </span>Accuracy
in the Clinical Diagnosis of Malignant Melanoma </span></b></div>
</div>
<div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">The computerized
database (1955 through 1982) of the Oncology Section of the Skin and Cancer
Unit of New York (NY) University Medical Center includes data on 13,878
lesions. Of these lesions, 214 were diagnosed clinically and histologically as
malignant melanoma (MM)...The diagnostic accuracy for the best period (1974
- 1982) was 64%. The diagnosis of MM was made in 84.5% of the
histologically proved cases of MM, reflecting a high degree of sensitivity.</span></div>
</div>
<b> </b><br />
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<b><b><span style="font-family: "Arial","sans-serif";">2001<span style="mso-tab-count: 1;"> </span>A
comparison of dermatologists' and primary care physicians' accuracy in <span style="mso-tab-count: 1;"></span> diagnosing melanoma: a systematic review</span></b></b></div>
<b>
</b></div>
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;"></span></span><span style="font-family: "Arial","sans-serif";"></span></div>
<b><div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<b><span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Studies were evaluated to determine the sensitivity and specificity of
dermatologists' or PCPs' [Primary Care Providers - also known as general practitioners, commonly family doctors or internal medicine doctors in the US] ability to correctly diagnose lesions suggestive of
melanoma and to perform biopsies or refer patients with such lesions. For
diagnostic accuracy, sensitivity was 0.81 to 1.00 for dermatologists and 0.42
to 1.00 for PCPs. None of the studies reported specificity for dermatologists;
one reported specificity for PCPs (0.98). For biopsy or referral accuracy,
sensitivity ranged from 0.82 to 1.00 for dermatologists and 0.70 to 0.88 for
PCPs; specificity, 0.70 to 0.89 for dermatologists and 0.70 to 0.87 for PCPs.
Receiver operating characteristic curves for biopsy or referral ability were
inconclusive. The study concluded that </span></span><span style="font-weight: normal;"></span><span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">published data are inadequate to demonstrate differences in dermatologists' and
PCPs' diagnostic and biopsy or referral accuracy of lesions suggestive of
melanoma.</span></span></b><span style="font-weight: normal;"></span>
</div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<b><span style="font-family: "Arial","sans-serif";">2003<span style="mso-tab-count: 1;"> </span>Comparison
of diagnostic accuracy for cutaneous malignant <span style="mso-tab-count: 1;"></span>melanoma between general dermatology, plastic
surgery and pigmented lesion <span style="mso-tab-count: 1;"></span>clinics.</span></b><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt; text-transform: uppercase;"></span></div>
</div>
<div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Since the 1980s there
have been dedicated pigmented lesion clinics (PLCs) in the U.K. This study
compared the false-negative rate (FNR) of clinical diagnosis with other clinics
of primary referral of malignant melanoma (MM) in the same geographical area. <span style="text-transform: uppercase;"></span></span></span></div>
<span style="font-weight: normal;">
</span><div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">The case notes of 731
patients were available, of whom approximately two-thirds initially attended
the PLC, one-fifth the General Dermatology clinics (D) and the remainder were
divided approximately between Plastic Surgery clinics (P), other clinics (O)
and the general practitioner (GP). The FNR was lowest for the PLC, at 10%,
compared with 29% (D), 19% (P), 55% (O) and 54% (GP) (P < 0.0001). </span></span></div>
<span style="font-weight: normal;">
</span><div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-size: xx-small;"><span style="font-weight: normal;"><i><span style="font-family: "Arial","sans-serif";">**Accuraccy rates can
be considered 100 - percentage above (ie: Accuracy at the dermatology clinic:
100 - 29% false negatives = 71% accurate/true positive diagnosis.</span></i></span></span><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;"></span></div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<b><span style="font-family: "Arial","sans-serif";">2003<span style="mso-tab-count: 1;"> </span>Pattern
analysis, not simplified algorithms, is the most reliable method for teaching dermoscopy for melanoma diagnosis to
residents in dermatology</span></b></div>
</div>
<div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This study
investigated the diagnostic performance of three different methods of teaching
dermoscopy when used by newly trained residents in dermatology to diagnose
melanocytic [cancerous] lesions. Pattern analysis yielded the best mean diagnostic accuracy
(68.7%), followed by the ABCD rule (56.1%) and the seven-point check-list
(53.4%, <i>P =</i> 0·06). </span></span></div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<b><span style="font-family: "Arial","sans-serif";">2004<span style="mso-tab-count: 1;"> </span>A
retrospective biopsy study of the clinical diagnostic accuracy of common <span style="mso-tab-count: 1;"></span>skin diseases by different
specialties compared with dermatology </span></b><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;"></span></div>
</div>
<div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">The clinical diagnoses
of family physicians, plastic, general, and orthopedic surgeons, and internists
and pediatricians versus dermatologists were correlated with the
histopathologic diagnoses. In total, 4,451 cases were analyzed. Dermatologists
diagnosed twice the number of neoplastic and cystic skin lesions correctly
(75%) than nondermatologists (40%). The clinical diagnosis rendered by family
practitioners matched the histopathologic diagnosis in 26% of neoplastic and
cystic skin lesions. Inflammatory skin diseases were correctly diagnosed in 71%
of the cases by dermatologists but 34% of the cases by nondermatologists.</span></span></div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none; text-indent: -.5in;">
<br /></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none; text-indent: -.5in;">
<b><span style="font-family: "Arial","sans-serif";">2004<span style="mso-tab-count: 1;"> </span>Diagnostic
Accuracy and Image Quality Using a Digital Camera for Teledermatology</span></b></div>
</div>
<div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">The study was designed
to evaluate the effectiveness of digital photography for dermatologic diagnoses
and compare it with in-person diagnoses. There was 83% concordance [agreement] between
in-person versus digital photo diagnoses. Concordance with biopsy
results [agreement about accuracy] was achieved in 76% of the cases. Image sharpness and color quality
were rated "good" to "excellent" 83% and 93% of the time,
respectively.</span></span></div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none; text-indent: -.5in;">
<b><span style="font-family: "Arial","sans-serif";">2008<span style="mso-tab-count: 1;"> </span>Diagnostic
accuracy and appropriateness of general practitioner referrals <span style="mso-tab-count: 1;"></span>to a dermatology out-patient clinic </span></b></div>
</div>
<div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">A study was undertaken
of new referrals by GPs to a dermatology clinic in a district general hospital
over a 6-month period. 686 consecutive referrals to one
consultant were analyzed for diagnostic accuracy and requirement for referral.
47% of referral letters contained the correct diagnosis. Viral warts and
psoriasis were best diagnosed (82 and 78%, respectively). Seborrhoeic warts
and dermatofibromas caused difficulty (22 and 19%, respectively). Cutaneous
malignancy was correctly diagnosed in 45% of referrals, and eczema, the
commonest condition referred, in 54% of cases.</span></span></div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; tab-stops: 418.5pt; text-autospace: none;">
<span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;"><span style="mso-tab-count: 1;"> </span></span>
</div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<b><span style="font-family: "Arial","sans-serif";">2009<span style="mso-tab-count: 1;"> </span>Teledermatology:
A Review of Reliability and Accuracy of Diagnosis and <span style="mso-tab-count: 1;"></span>Management</span></b></div>
</div>
<div style="border: solid windowtext 1.0pt; margin-left: .5in; margin-right: 0in; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Accuracy rates ranged
from 30% to 92%for clinic dermatologists [meaning in person] and from 19% to
95% for tele-dermatologists [meaning diagnosis via picture image].</span></span></div>
<span style="font-weight: normal;">
</span><div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<br /></div>
<span style="font-weight: normal;">
</span><div class="MsoNormal" style="border: none; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-border-alt: solid windowtext .5pt; mso-layout-grid-align: none; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0in; text-autospace: none;">
<span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Tele-dermatologists
and clinic dermatologists completely agreed with each other in 41% to 94% of
cases. They had partial agreement in 50% to 100%.</span></span><span style="font-family: "Arial","sans-serif";"></span></div>
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
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<b><span style="font-family: "Arial","sans-serif";">2012<span style="mso-tab-count: 1;"> </span>Accuracy in
skin cancer diagnosis: A retrospective study of an Australian <span style="mso-tab-count: 1;"></span>public hospital dermatology department</span></b></div>
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<span style="font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">Histology [under the microscope diagnosis] for
all skin biopsies and excisions performed in an 18-month period at a public hospital
dermatology department were reviewed. 6,546 biopsies/excisions were performed,
identifying 55 melanomas. The sensitivity [also often thought of as <i>accuracy</i>]
of melanoma diagnosis was 76%. 11% of melanomas were diagnosed as dysplastic
naevi (moles).</span></span><span style="font-family: "Arial","sans-serif";"></span></div>
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</b></b><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">There is a range in the level of accuracy. It is not surprising that dermatologists, who have more experience with skin have higher accuracy rates. It is interesting to note that accuracy is not 100% for dermatologists all of the time.</span></span></div>
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"> </span></span></div>
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">With regard to a skin image database another questions arises: Are 10,000 images that are 99% accurate better or worse than 1,000,000,000 images that are 60% accurate? </span></span></div>
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">At this point I think it is still an open question. </span></span></div>
Anonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.com0tag:blogger.com,1999:blog-8252252372398153458.post-48565001858378290722013-06-11T17:52:00.000-04:002013-06-11T17:52:11.961-04:00Informational Asymmetry<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Accurate, timely, relevant information is a prerequisite for
effective delivery of healthcare services at the individual and population
level. A healthcare provider uses information, consumed in a myriad of forms, and filters the filters the new information through a framework of experience, to arrive at a conclusion and a plan of action. Jerome Groopman has detailed many of these thought patterns
of doctors in <a href="http://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/0547053649">How
Doctors Think</a>. The book describes numerous limitations to informational processing at the individual level.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">An example clinical encounter is described:<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">A 28 year old female develops a painful rash on her left forearm. It starts without any apparent cause to the patient. The young lady has no
other chronic medical issues and takes no regular medications. There has been
no travel, no recent contact with any sick persons, and no change in her
regular routine as a consultant. For several days the rash
progressively worsens, and pain increases. She schedules a visit with a dermatologist. In
the medical encounter with the health professional a broad list of
possibilities is considered. It could be one of several types of infections, it
could be an allergic reaction, it could be underlying chronic skin condition
that is just manifesting at this time. Tests of the skin are
obtained, and treatment was prescribed.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Informational input needs to be accurate. The best thing in
medicine is the people, the patients. Patients know the most about themselves
and how they are feeling at any particular time. The challenge is in the
details. For those not familiar with medical language it is not easy to remember
the specific terminology, or names of medications. Was it ciprofloxacin or
levofloxacin? What was the result of the heart test? Was there any particular
exposure to the skin, or any new detergent, or perfume? Many times details of exposure and chronology stand out in peoples’ minds, often times they do not. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">At the level of the professional, clinical information is
filtered through an information mesh-work to pull out the important pieces of
data in order to arrive at the conclusion/diagnosis. The process of training
physicians in the U.S. system involves a high volume of exposure to individual patient
care in an appropriately graduated structure. The broad experience base generates a
mental framework that subsequent information is processed through. This is
what Groopman discusses as heuristics; the experience-based
technique for problem solving. The challenge in medical training is that is
often hard to infuse more wisdom than their experience allows.
Certainly, information acquired through reading builds and expounds the mental
framework. That is how a medical student can know someone has appendicitis
before they have ever seen or diagnosed their first case. The modern challenge is that there are now (as of 2010) 75 medical trials, and 11 systematic reviews of trials, per day.(<a href="http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000326">Ref</a>) All of that newly created information adds layers of nuance to the diagnostic and treatment processes. The human body and its ailments have not suddenly altered, but the highest value testing and treatment practices do change over time. This is the modern challenge, the smartest individual in the world does not have the capacity to consume and retain all of that information. An internet connected provider, speaks to a potential of leveling the playing field, by having access to up to date information. This ultimately will be a good thing. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Asymmetry is the disunion that happens when the processing
framework fails to properly connect and add value during the throughput of
individual data. Miss-connections include: the drug was X, not Y as the patient had originally remembered it.
The previous electrocardiogram (EKG) was not available to compare for any
change. From the provider perspective: that type of case, with similar type
symptoms, lab results, and outcome has not been encountered before. Is this a new presentation of a new disease, or an unusual combination of symptoms for a common disease. Or from a dermatology perspective - a specific
type of skin rash has not been seen before.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Facilitating a more open posture for informational flow,
such as producing open source medical databases, offers a potential to augment
the processing framework. At the individual level an open-source dermatology database (adequately marketed) could be searched, just
like I have observed Attending physicians search Google Images for skin
diagnosis. The open data could be accessed to augment the providers information mesh-work
in order to decrease the probability of asymmetry. The leverage of computers/screens/phones
is informational connection. This rationale assumes that the answer is out
there somewhere. Finding the answer is a matter of reducing the asymmetry. When
we open informational networks it is not immediately clear how commercial value
will be derived. However, connecting people to the right information at the right
time is one of the challenges we have taken on as we try and keep ourselves and
our society healthy<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The young lady described above is my wife. After time, testing, and contact with multiple medical professionals, she was
ultimately diagnosed with phyto-photo dermatitis. That term was coined by Klaber
in 1942.(<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2385151/pdf/ulstermedj00126-0058.pdf">Ref</a>) It is a skin eruption caused by exposure to certain plants and their
extracts and then being exposed to sunlight. Kelly reviewed the literature and
reported that various authors make mention of the fact that the condition was
probably known of in countries such as India, Arabia and Egypt many centuries
before Christ.</span><o:p></o:p><span style="font-family: Arial, Helvetica, sans-serif;">(</span><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2385151/pdf/ulstermedj00126-0058.pdf" style="font-family: Arial, Helvetica, sans-serif;">Ref</a><span style="font-family: Arial, Helvetica, sans-serif;">) The rash resolves over time, and with some steroid cream. She is doing well. Reducing the asymmetry in our own lives would have helped us avoid such an arduous process for a rash that has been around and known for such a long time. </span></div>
Anonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.com0tag:blogger.com,1999:blog-8252252372398153458.post-910674329775283892013-05-31T14:15:00.000-04:002013-05-31T14:15:02.239-04:00Forward Movement<span style="font-family: Arial, Helvetica, sans-serif;">I recently received an email, the contents of which are shared below:</span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-color: white; color: #222222;">CONGRATULATIONS!</span><br style="background-color: white; color: #222222;" /><br style="background-color: white; color: #222222;" /><span style="background-color: white; color: #222222;">You have been nominated by <a href="http://aliquidnovi.org/" target="_blank">Andrew Rens</a> to receive a Shuttleworth </span><span style="background-color: white; color: #222222;">Foundation Flash Grant to work on your CrowdSourced Dermatologic </span><span style="background-color: white; color: #222222;">Picture Database. We have a funding model that rewards brilliance and </span><span style="background-color: white; color: #222222;">new ideas by awarding full-time Fellowships. However, bubbling around</span><br style="background-color: white; color: #222222;" /><span style="background-color: white; color: #222222;">the periphery of our model it has become clear that there are voices </span><span style="background-color: white; color: #222222;">that are not heard, ideas not seen and Fellows that are not ready to </span><span style="background-color: white; color: #222222;">be Fellows - just yet... This is where you and the new Shuttleworth </span><span style="background-color: white; color: #222222;">Flash Grant come in.</span><br style="background-color: white; color: #222222;" /><br style="background-color: white; color: #222222;" /><span style="background-color: white; color: #222222;">We tasked our Fellows to seek out and nominate an impressive change </span><span style="background-color: white; color: #222222;">agent, who may not be able to concentrate on their brilliant idea yet. </span><span style="background-color: white; color: #222222;">This grant is for the sum of $5,000 and will be awarded to you </span><span style="background-color: white; color: #222222;">personally to bring that idea forward. The only string attached is </span><span style="background-color: white; color: #222222;">that we ask you to live openly, tell us and the world what you have </span><span style="background-color: white; color: #222222;">done with the money.</span><br style="background-color: white; color: #222222;" /></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-color: white; color: #222222;">_______________________________________________________________________</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-color: white; color: #222222;"><br /></span></span>
<span style="color: #222222; font-family: Arial, Helvetica, sans-serif;">I am very thankful for the opportunity. This</span><span style="color: #222222; font-family: Arial, Helvetica, sans-serif;"> pilot financing will be used for website development and beta-launch. T</span><span style="color: #222222; font-family: Arial, Helvetica, sans-serif;">he bottleneck up to this point has been mobile and web development. T</span><span style="color: #222222; font-family: Arial, Helvetica, sans-serif;">he goal is to use as </span><span style="color: #222222; font-family: Arial, Helvetica, sans-serif;">many open-source platforms as possible in order to limit cost and because the project speaks to open-source values.</span><br />
<br />
<div class="MsoNormal">
<b><span style="font-family: Arial, Helvetica, sans-serif;">Concept for Open
Source Dermatology Database<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The pilot grant will be used for the development of a platform (website-mobile if finances allow). The platform will be used to facilitate the proof
of the following idea: An global online community of non-professionals can effectively
create a database of dermatology skin pictures of sufficient accuracy and
volume such that it will produce a database that is more valuable compared to current
proprietary databases. One unique value of this project is that the
product – the database with tagged skin images will be made available under a
creative commons data license to all. The data represents a collection of global biological information. The project is trying to use the website as a
platform for sharing this knowledge in the form of skin pictures.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">This has never been tried before, in quite this way.
Patientslikeme.com enables the sharing of patient contributed information, the angle is more from a patient support group perspective. Another uniqueness for this project is the
idea of the medical community inviting wisdom and participation from
patients. The openness and invitation to contribute is a different posture
compared to the current status of medical knowledge creation. Medical research is currently conducted in such a way that information about how <i>you </i>reacted to a medication is recorded from you as a one in a large study. The information is stored in a data-set and is the property of
the university medical center or pharmaceutical company conducting the research. The research subjects rarely have complete/open/free access that they were a part of creating. The current posture infuses the culture surrounding personal medical records in the United States. In many instances, there is formality and red tape
to cut through in order to obtain your personal health information - in an age where access to information is becoming more ubiquitous. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">This concept brings up large questions. At this point, these are open questions for the which the implementation of the project will seek to address. That is a part of the joy of the project for me. From the viewpoint of the physician, one question is how accurate do you need the diagnosis on the
submitted picture. We know that not every visit with a doctor generates the <i>correct</i>
answer with regards to a skin rash. There are not the resources to follow
up and send a dermatologist and examine and biopsy
every piece of skin from a submitted image. The first layer is to ask the user
to submit an image of a skin lesion or rash <i>only </i>after it has been evaluated by
a medical professional. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial, Helvetica, sans-serif;">Several
other open questions:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial, Helvetica, sans-serif;">How do you ensure unhelpful image submissions are limited (ie. non skin)?<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial, Helvetica, sans-serif;">What is the
photographic/pixel quality needed in order for the image to be seen clearly/re-usable and ultimately useful?<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial, Helvetica, sans-serif;">What data needs to be submitted along with the image? To much information and you lose participants, too few pieces of info (age, diagnosis) and you limit the power of the database.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial, Helvetica, sans-serif;">How do you
guard against fraud such as fake/false submissions?<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial, Helvetica, sans-serif;">Should you
be required to submit an image in order to use the database?</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Arial, Helvetica, sans-serif;">At this point I am seeking to engage with web developers and move the idea forward.</span></div>
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Anonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.com0tag:blogger.com,1999:blog-8252252372398153458.post-45634253310646378162013-05-27T16:54:00.002-04:002013-07-13T06:27:09.067-04:00Data Exhaust<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #222222;">In 2010 more than a billion visits were made to clinicians in
the United States by patients in the ambulatory setting. </span><span style="color: #222222;">Ambulatory means an office based, outpatient clinic. This is
compared to, and specifically <i>not </i>an emergency room, or surgery, or a clinic
inside of a hospital, but a free standing building. Most of those patients were
seen by general practitioners.</span></span><br />
<span style="color: #222222;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #222222;">Of those 1 billion encounters approx. 50 million left their visit
having been diagnosed with a disease of the skin or subcutaneous tissue (a word meaning just underneath the skin). These numbers of skin disease diagnosis come from visits to pediatricians,
family medicine physicians, as well as dermatology specialists.</span><span style="color: #222222;">This data is from the publicly available <a href="http://www.cdc.gov/nchs/data/ahcd/namcs_summary/2010_namcs_web_tables.pdf" target="_blank">National Ambulatory Medical Care Survey</a>, conducted yearly by the United States Centers for
Disease control.</span></span><br />
<span style="color: #222222;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span>
<span style="color: #222222;"><span style="font-family: Arial, Helvetica, sans-serif;">The table below displays results for skin diagnosis for the
years 2008, 2009, and 2010.<o:p></o:p></span></span><br />
<span style="color: #222222;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 4.65pt; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 1184; width: 211px;">
<tbody>
<tr style="height: 18.2pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td colspan="4" nowrap="" style="border-bottom: none; border: solid windowtext 1.0pt; height: 18.2pt; mso-border-left-alt: solid windowtext .5pt; mso-border-right-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 158.0pt;" valign="bottom" width="211">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">Primary diagnosis at office visits, classified by major disease
category. United states. 2008-2010<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 18.2pt; mso-yfti-irow: 1;">
<td colspan="4" nowrap="" style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; border-top: none; height: 18.2pt; mso-border-left-alt: solid windowtext .5pt; mso-border-right-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 158.0pt;" valign="bottom" width="211">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">Diagnosed as: <b>Diseases of the skin and subcutaneous tissue</b><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
</td>
</tr>
<tr style="height: 18.2pt; mso-yfti-irow: 2;">
<td nowrap="" style="border-left: solid windowtext 1.0pt; border: none; height: 18.2pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 32.05pt;" valign="bottom" width="43">
<div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif;"><b>Year<o:p></o:p></b></span></div>
</td>
<td nowrap="" style="border: none; height: 18.2pt; padding: 0in 5.4pt 0in 5.4pt; width: 106.0pt;" valign="bottom" width="141">
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: right;">
<span style="font-family: Arial, Helvetica, sans-serif;"><b>Number<o:p></o:p></b></span></div>
</td>
<td nowrap="" style="border: none; height: 18.2pt; padding: 0in 5.4pt 0in 5.4pt; width: 10.0pt;" valign="bottom" width="13"></td>
<td nowrap="" style="border-right: solid windowtext 1.0pt; border: none; height: 18.2pt; mso-border-right-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 10.0pt;" valign="bottom" width="13"></td>
</tr>
<tr style="height: 18.2pt; mso-yfti-irow: 3;">
<td nowrap="" style="border-left: solid windowtext 1.0pt; border: none; height: 18.2pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 32.05pt;" valign="bottom" width="43">
<div align="right" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: right;">
<span style="font-family: Arial, Helvetica, sans-serif;">2010<o:p></o:p></span></div>
</td>
<td nowrap="" style="border: none; height: 18.2pt; padding: 0in 5.4pt 0in 5.4pt; width: 106.0pt;" valign="bottom" width="141">
<div align="right" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: right;">
<span style="font-family: Arial, Helvetica, sans-serif;"> 50,224,000 <o:p></o:p></span></div>
</td>
<td nowrap="" style="border: none; height: 18.2pt; padding: 0in 5.4pt 0in 5.4pt; width: 10.0pt;" valign="bottom" width="13"></td>
<td nowrap="" style="border-right: solid windowtext 1.0pt; border: none; height: 18.2pt; mso-border-right-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 10.0pt;" valign="bottom" width="13"></td>
</tr>
<tr style="height: 18.2pt; mso-yfti-irow: 4;">
<td nowrap="" style="border-left: solid windowtext 1.0pt; border: none; height: 18.2pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 32.05pt;" valign="bottom" width="43">
<div align="right" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: right;">
<span style="font-family: Arial, Helvetica, sans-serif;">2009<o:p></o:p></span></div>
</td>
<td nowrap="" style="border: none; height: 18.2pt; padding: 0in 5.4pt 0in 5.4pt; width: 106.0pt;" valign="bottom" width="141">
<div align="right" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: right;">
<span style="font-family: Arial, Helvetica, sans-serif;"> 43,109,000 <o:p></o:p></span></div>
</td>
<td nowrap="" style="border: none; height: 18.2pt; padding: 0in 5.4pt 0in 5.4pt; width: 10.0pt;" valign="bottom" width="13"></td>
<td nowrap="" style="border-right: solid windowtext 1.0pt; border: none; height: 18.2pt; mso-border-right-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 10.0pt;" valign="bottom" width="13"></td>
</tr>
<tr style="height: 18.2pt; mso-yfti-irow: 5;">
<td nowrap="" style="border-left: solid windowtext 1.0pt; border: none; height: 18.2pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 32.05pt;" valign="bottom" width="43">
<div align="right" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: right;">
<span style="font-family: Arial, Helvetica, sans-serif;"><u>2008<o:p></o:p></u></span></div>
</td>
<td nowrap="" style="border: none; height: 18.2pt; padding: 0in 5.4pt 0in 5.4pt; width: 106.0pt;" valign="bottom" width="141">
<div align="right" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: right;">
<span style="font-family: Arial, Helvetica, sans-serif;"><u> 46,097,000 <o:p></o:p></u></span></div>
</td>
<td nowrap="" style="border: none; height: 18.2pt; padding: 0in 5.4pt 0in 5.4pt; width: 10.0pt;" valign="bottom" width="13"></td>
<td nowrap="" style="border-right: solid windowtext 1.0pt; border: none; height: 18.2pt; mso-border-right-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 10.0pt;" valign="bottom" width="13"></td>
</tr>
<tr style="height: 18.2pt; mso-yfti-irow: 6; mso-yfti-lastrow: yes;">
<td nowrap="" style="border-bottom: solid windowtext 1.0pt; border-left: solid windowtext 1.0pt; border-right: none; border-top: none; height: 18.2pt; mso-border-bottom-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 32.05pt;" valign="bottom" width="43"></td>
<td nowrap="" style="border-bottom: solid windowtext 1.0pt; border: none; height: 18.2pt; mso-border-bottom-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 106.0pt;" valign="bottom" width="141">
<div align="right" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: right;">
<span style="font-family: Arial, Helvetica, sans-serif;"> 139,430,000 <o:p></o:p></span></div>
</td>
<td nowrap="" style="border-bottom: solid windowtext 1.0pt; border: none; height: 18.2pt; mso-border-bottom-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 10.0pt;" valign="bottom" width="13"></td>
<td nowrap="" style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 18.2pt; mso-border-bottom-alt: solid windowtext .5pt; mso-border-right-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 10.0pt;" valign="bottom" width="13"></td>
</tr>
</tbody></table>
<span style="color: #222222;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #222222;">Considering the previous post indicating the size of currently
active skin image databases, these numbers suggest they are performing at a margin
below their capacity. The implicit suggestion here is that at every office visit that a healthcare provider diagnosed a skin disease, if a picture image was also captured (by doctor or patient) and contributed to a common database, the
volume of images would far outpace the current offerings This gap represents the
data exhaust of the clinical encounter. There is valuable information captured
in the eye of the professional, used to make decisions and move forward with
treatment. The utility of the information carries forward in the mind’s eye of
the individual doctor which made the decision about the diagnosis. However, when it is
not shared, the utility of that encounter has diminishing returns, as the doctor retires from practice for example.<o:p></o:p></span></span><br />
<span style="color: #222222;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #222222;">This is occuring in the context of <a href="http://www.engadget.com/2012/03/29/nielsen-smartphones-account-for-nearly-50-percent-of-us-mobile/" target="_blank">50%</a> of the U.S. cellular phone market
with smartphones as of early 2012</span>. That means a portion of each of these doctor’s visits (i the United States) happens with a either a patient or physician, or both, with an internet connected
camera sitting in their pocket throughout the entire experience. My personal
experience with patients and my own family suggests we are utilizing this
technology to take pictures of things that happen to our skin. Unfortunately, there is not yet a platform for citizens to participate in the science. <o:p></o:p></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Thinking forward, this idea is inherently a global project. As robust
mobile telephony spreads there is global potential. A <a href="http://en.wikipedia.org/wiki/List_of_countries_by_number_of_mobile_phones_in_use" target="_blank">chart </a>aggregated on
Wikipedia suggests 5 billion people live in countries with >70% mobile phone
penetrance.<o:p></o:p></span><br />
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">Allowing the non-professional individual to contribute to the commons is the conceptual next step.
The crowd-sourced dermatology database is one platform for one disease category
that will attempt to capture that potential.<o:p></o:p></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">Much in the same spirit that built open source soft-ware, this data is inherently
part of the global commons. Human biology is unique to the individual, but also shared and common to us all. The data from personal pictures of a patient's skin
is inherently private-in the sense that it is connected to one individual and
part of their personal health record, protected and disclosed at their
discretion. However, in another very real sense the image skin forms part of a
common knowledge. The coders who produced much of the Linux operating system,
which forms infrastructure that supports much of the internet, contributed
their knowledge to a common project. It allowed those that came after them
to use prior leaps in knowledge to step even further. This pursuit of
open knowledge, rich in other fields, has found limited voice in the house of
medicine up to this point. This project represents a new kind of trial, a proof of
concept. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><a href="mailto:johnticeparks@gmail.com" target="_blank">Email </a>with questions.</span><o:p></o:p>Anonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.com0tag:blogger.com,1999:blog-8252252372398153458.post-72081563035161310952013-05-10T16:15:00.001-04:002013-05-10T16:15:34.852-04:00Strengths, Weaknesses, Opportunities, Threats<div style="text-align: left;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div dir="ltr" id="docs-internal-guid-29d87030-8fd1-7707-a55e-00500be13d54" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<div style="text-align: left;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;">Concept
of Crowd-Sourced Dermatologic Picture Database</span></span></div>
</div>
<div style="text-align: left;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br />
<span style="vertical-align: baseline;"></span>
</span></div>
<div dir="ltr" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<div style="text-align: left;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;">Project:
An online and mobile platform through which participants voluntarily submit user-obtained
images of a skin rash or lesion that has been evaluated and diagnosed by a health
professional. </span></span></div>
<div style="text-align: left;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
</div>
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<div style="text-align: left;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 1.15;">The purpose is to create the largest database
database of </span><span style="line-height: 14px;">dermatologic</span><span style="line-height: 1.15;"> images</span></span></span></div>
</div>
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<div style="text-align: left;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 1.15;">The unique value added will be that the raw data will be curated as an open source project. </span></span></span></div>
</div>
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<div style="text-align: left;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 1.15;">The intention is </span><i style="line-height: 1.15;">not </i><span style="line-height: 1.15;">to make medical diagnosis. Nor is the goal to have individuals contribute without professional interaction. There is a level of accuracy that is needed between image and diagnosis. That exact level remains point is an open question. Non-professionals up to this point are typically not involved in this way with the collection of biologic data. This project is unique </span><span style="line-height: 14px;">because</span><span style="line-height: 1.15;"> opens up the potential volume of contributors to the civic space, while actively engaging in answering the question on accuracy. </span></span></span></div>
</div>
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<div style="text-align: left;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 1.15;">The hypothesis behind the project is that a larger volume of images even at a lower accuracy rate is of equal or greater value compared to the proprietary curated databases.</span></span></span></div>
</div>
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<div style="text-align: left;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 1.15;">Participation will open to
contribution to by all; and the resultant community product (the database) will be made openly accessible to all, layman and professional alike.
</span></span></span></div>
</div>
<div style="text-align: left;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /><span style="vertical-align: baseline;"></span>
</span></div>
<div dir="ltr">
<table style="border-collapse: collapse; border: medium none; text-align: left; width: 624px;">
<colgroup>
<col width="*"></col>
<col width="*"></col></colgroup>
<tbody>
<tr style="height: 0px;">
<td style="background-color: #4a86e8; border-bottom: #000000 1px solid; border-left: #000000 1px solid; border-right: #000000 1px solid; border-top: #000000 1px solid; padding-bottom: 7px; padding-left: 7px; padding-right: 7px; padding-top: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; vertical-align: baseline;"><b><span style="font-family: Arial, Helvetica, sans-serif;">Strengths</span></b></span></div>
</td>
<td style="background-color: #4a86e8; border-bottom: #000000 1px solid; border-left: #000000 1px solid; border-right: #000000 1px solid; border-top: #000000 1px solid; padding-bottom: 7px; padding-left: 7px; padding-right: 7px; padding-top: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; vertical-align: baseline;"><b><span style="font-family: Arial, Helvetica, sans-serif;">Weaknesses</span></b></span></div>
</td></tr>
<tr style="height: 0px;">
<td style="border-bottom: #000000 1px solid; border-left: #000000 1px solid; border-right: #000000 1px solid; border-top: #000000 1px solid; padding-bottom: 7px; padding-left: 7px; padding-right: 7px; padding-top: 7px; vertical-align: top;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Monetary
cost of starting (website) is relatively cheap in early stages.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Small
team in initial phase. Low manpower costs up-front.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Participation
with website/database could enable users immediate gratification. Access to image
database is free/open to world for research etc. i.e. - other skin conditions with similar
“tags” could show up on screen after submission.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">The
concept readily taps into
the ethos for a more genuine/communal
approach to solving the worlds problems</span></span></div>
</li>
</ul>
</td>
<td style="border-bottom: #000000 1px solid; border-left: #000000 1px solid; border-right: #000000 1px solid; border-top: #000000 1px solid; padding-bottom: 7px; padding-left: 7px; padding-right: 7px; padding-top: 7px; vertical-align: top;"><ul></ul>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Limited
accountability over submitted images. As a truly open site limited ways to
prevent upfront the inappropriate image submissions (ie genitals or cartoon
images)</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Similar to prior: at
beta stage (unless there is some type of research funding) has limited ability to “double
check” validity of user-submitted diagnosis. Relying on trust-worthiness of the crowd of participants (this could also be a strength). Cost of double checking images via phone, or person-person review would be large.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Limited initial monetary and human capital (person-hours) to devote to early development of project.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Initial small team has limited execution experience in the entrepreneurial space.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Not-for-profit driven at conception; not extensive thought has been given to potential for monetization which may limit broader
interest/investment.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Has never been truly tested in this specific way, first-mover advantage, which brings with
it all of the potential pitfalls such as potential for legal disadvantages.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><br /></span></span></div>
</li>
</ul>
</td></tr>
<tr style="height: 25px;">
<td style="background-color: #4a86e8; border-bottom: #000000 1px solid; border-left: #000000 1px solid; border-right: #000000 1px solid; border-top: #000000 1px solid; padding-bottom: 7px; padding-left: 7px; padding-right: 7px; padding-top: 7px; vertical-align: top;"><ul></ul>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; vertical-align: baseline;"><b><span style="font-family: Arial, Helvetica, sans-serif;">Opportunities
</span></b></span></div>
</td>
<td style="background-color: #4a86e8; border-bottom: #000000 1px solid; border-left: #000000 1px solid; border-right: #000000 1px solid; border-top: #000000 1px solid; padding-bottom: 7px; padding-left: 7px; padding-right: 7px; padding-top: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; vertical-align: baseline;"><b><span style="font-family: Arial, Helvetica, sans-serif;">Threats</span></b></span></div>
</td></tr>
<tr style="height: 0px;">
<td style="border-bottom: #000000 1px solid; border-left: #000000 1px solid; border-right: #000000 1px solid; border-top: #000000 1px solid; padding-bottom: 7px; padding-left: 7px; padding-right: 7px; padding-top: 7px; vertical-align: top;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="font-family: Arial; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;">Potential
for database of vast size, larger than current private
databases (see previous post)</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
</li>
<li dir="ltr" style="list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 1;">Medicine
is specialized, and the culture is often slow to adapt and adopt change. This </span><span style="line-height: 13px;">intransigence</span><span style="line-height: 1;"> allows space for
innovation with a relatively lower risk of early competition compared to other
industries.</span></span></span></div>
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 1;"><br /></span></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline;">Ability
to tap into the power of the crowd - similar to paradigm shifts already further
along in encyclopedias (think Wikipedia) and news (think Twitter). E</span><span style="line-height: 1;">nabling the
community to more fully participate in the health conversation has potential for better
outcomes/lower costs.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="line-height: 1;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;">Riding
with the wave of the “crowd sourcing” concept, not in a hollow way that
some companies are trying to do for marketing purposes.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
</li>
<li dir="ltr" style="list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 1;">This
project would solve 1 problem-crowd source 1 </span><span style="line-height: 13px;">specific</span><span style="line-height: 1;"> health niche. If there is proof of
concept --> idea becomes a building block of a larger project to </span><span style="line-height: 13px;">crowd-source</span><span style="line-height: 1;"> health data then → build on the data to aid in diagnosis, treatment, research.</span></span></span></div>
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 1;"><br /></span></span></span></div>
</li>
</ul>
</td>
<td style="border-bottom: #000000 1px solid; border-left: #000000 1px solid; border-right: #000000 1px solid; border-top: #000000 1px solid; padding-bottom: 7px; padding-left: 7px; padding-right: 7px; padding-top: 7px; vertical-align: top;"><ul></ul>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="font-family: Arial; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;">Smart
phone technology and the rapid pace of product development and iteration means the next generation of IT minded doctors (US/India or any other global player) can be expected to move quickly into the crowd-sourcing concept </span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
</li>
<li dir="ltr" style="list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 1;">Medical
Culture at large makes a baseline assumption that </span><span style="line-height: 1;">the doctor, the professional, contains sacred knowledge.This project tries to break in and take some of the power away from the dominant culture, which can be threatening. If dermatologists feel threatened there is easy risk of blowback such as being accused of
being unsafe for patients.</span></span></span></div>
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<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><a href="http://news.cnet.com/8301-11386_3-57471378-76/screen-yourself-for-skin-cancer-with-this-free-ios-app/?part=rss&subj=news&tag=title" style="text-decoration: none;"><span style="color: #1155cc; text-decoration: underline; vertical-align: baseline;">Michigan
Iphone app</span></a><span style="vertical-align: baseline;">:
screen self for skin cancer w/ free iphone app.</span></span></div>
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
</li>
<li dir="ltr" style="list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #1155cc; line-height: 1; text-decoration: underline; vertical-align: baseline;"><a href="http://www.visualdx.com/" style="line-height: 1; text-decoration: none;">VisualDx</a> </span><span style="vertical-align: baseline;"><span style="line-height: 1;">-
made and marketed exclusively for physicians. However, a conceptual step could lead to a patient version for </span><span style="line-height: 13px;">submitting</span><span style="line-height: 1;"> images and the organization already has infrastructure, connections, and momentum.</span></span></span></div>
<div dir="ltr" style="font-family: Arial; line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
</li>
<li dir="ltr" style="font-family: Arial; list-style-type: disc; vertical-align: baseline;">
<div dir="ltr" style="line-height: 1; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #1155cc; text-decoration: underline; vertical-align: baseline;"><a href="http://www.patientslikeme.com/" style="text-decoration: none;">patientslikeme.com</a> </span><span style="vertical-align: baseline;">- already
exists, brand recognition, is crowd sourcing patient support groups. Contains 1,000+ conditions, and 156,241 patients when last accessed. </span></span></div>
</li>
</ul>
</td></tr>
</tbody></table>
</div>
Anonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.com0tag:blogger.com,1999:blog-8252252372398153458.post-18967728310345359312013-04-16T17:05:00.006-04:002013-04-16T17:12:08.528-04:00The Potential Exists<span style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">People like to share photos. </span><br />
<span style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">The challenge becomes getting the right context (age/gender/associated symptoms), the right label (diagnosis), the right amount of accuracy and pixel clarity to any uploaded image.</span><br />
<br style="background-color: white; font-family: arial, sans-serif; font-size: 13px;" />
<span style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">Online Databases - the purpose of the the sites compiled here seem to be mainly informational/educational. Dermnet, Dermatlas from Hopkins, and DermIS seem to me more aimed at at educating medical professionals. Visualdx is one product of the company Logical Images. Their images can only be accessed through their apps.</span><br />
<br />
<div style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">
<br /></div>
<div style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">
<a href="http://www.visualdx.com/features" target="_blank"><span style="color: blue;">Visualdx </span></a><br />
- Private entity. A for-profit owned by parent company Logical Images. Sells online and app program to doctors/nurse/medical practitioners to help increase accuracy of diagnosis by provided images of common skin conditions.<br />
- Containing "<span style="font-family: Tahoma, Helvetica, Arial, sans-serif; line-height: 18px;">25,898 unique images</span>"</div>
<div style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">
<div>
<br /></div>
<div>
<a href="http://www.dermnet.com/about-us/" target="_blank"><span style="color: blue;">Dermnet </span></a></div>
- Founded in 1998 by Thomas Habif, MD. The "largest independent photo dermatology source dedicated to online medical education though articles, photos and video."<br />
<div>
- Per the site, "more than 23,000 images, Dermnet.com contains the largest number of dermatology images online"<br />
<br />
<div>
<a href="http://dermatlas.med.jhmi.edu/derm/" target="_blank"><span style="color: blue;">Dermatlas</span><span style="color: black;"> </span></a>from Johns Hopkins</div>
<div>
<span style="font-family: arial, helvetica, sans-serif;">- Founded by Dermatologist from Johns Hopkins, the "purpose of this WWW site is to enable health care professionals, parents, and patients to access high quality dermatology images for teaching purposes"</span></div>
</div>
<div>
<span style="font-family: arial, helvetica, sans-serif;">- Images submitted by and large from healthcare professionals </span></div>
<div>
<span style="font-family: arial, helvetica, sans-serif;">- Contains, "</span>13,052 images from 628 contributors"<br />
<br />
<a href="http://www.dermis.net/dermisroot/en/home/index.htm" target="_blank"><span style="color: blue;">DermIS</span><span style="color: black;"> </span></a>a collaboration between University of Heidelberg and University of Erlangen</div>
<div>
- Claiming<span style="font-family: arial, helvetica, sans-serif;"> to be the, "the largest dermatology information service available on the internet." but without reported numbers on their site that I was able to fine.</span></div>
<div>
<span style="font-family: arial, helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: arial, helvetica, sans-serif;">Several other sites which do not report where they images were obtained from nor how many images are in the collection are include: <a href="http://www.meddean.luc.edu/lumen/MedEd/medicine/dermatology/melton/content1.htm" target="_blank"><span style="color: blue;">Skin Cancer and Benign Tumor Image Atlas</span> </a>from Loyola University and <a href="http://www.healthcare.uiowa.edu/dermatology/DermImag.htm" target="_blank"><span style="color: blue;">Dermatologic Image Database</span></a> from University of Iowa</span></div>
<div>
<span style="font-family: arial, helvetica, sans-serif;"><br /></span>Seems like the a robust database currently contains between 10,000 - 20,000 mark. </div>
<div>
_____________________________<wbr></wbr>______________________________<wbr></wbr>_______________________________</div>
<div>
By Comparison:</div>
<div>
<span style="font-family: arial, helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: arial, helvetica, sans-serif;">Flickr reports to have<span style="color: blue;"> <a href="http://latimesblogs.latimes.com/technology/2011/08/flickr-reaches-6-billion-photos-uploaded.html"><span style="color: blue;">6 billion</span></a> </span>uploaded images.</span></div>
<div>
<span style="font-family: arial, helvetica, sans-serif;">searching for images tagged "skin" on Flickr yields -- </span><span style="background-color: #fefefe; font-family: arial, helvetica, sans-serif; line-height: 15px; text-align: center;">307,554 uploads</span></div>
<div>
<span style="line-height: 19.200000762939453px;"><span style="font-family: arial, helvetica, sans-serif;"><br /></span></span></div>
<div>
<span style="font-family: arial, helvetica, sans-serif;"><span style="white-space: nowrap;">Searching for "eczema" on Google Images results in -- 3,850,000 results</span></span></div>
<div>
<span style="white-space: nowrap;"><span style="font-family: arial, helvetica, sans-serif;"><br /></span></span></div>
<div>
<span style="font-family: arial, helvetica, sans-serif;"><span style="margin: 0px; padding: 0px;"><span style="line-height: 17.91666603088379px;">With regards to capacity for pictures, </span><span style="color: blue;"><a href="http://www.infodocket.com/2011/09/19/infographic-facebooks-huge-trove-of-photos-in-context-how-many-photos-have-ever-been-taken/" style="line-height: 17.91666603088379px;" target="_blank"><span style="color: blue;">this post</span></a> </span>speaks to the large volume of images on the internet, reporting 140 </span><span style="line-height: 17.91666603088379px; margin: 0px; padding: 0px;">billion photos hosted </span><span style="line-height: 17.91666603088379px;">on Facebook.</span></span></div>
</div>
Anonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.com0tag:blogger.com,1999:blog-8252252372398153458.post-33867757049956106882012-10-08T20:01:00.003-04:002012-10-08T20:01:24.580-04:00It's All In The Name - Good Incorporated <br />
<div class="MsoNormal" style="margin: 0in -0.05pt 0.0001pt 0in;">
<span style="font-family: Arial, sans-serif; font-size: 11.5pt;">The reason this blog
is called A Doctor for Good is due in part to the gentle yet persistent
suggestions of my lovely wife. I was hesitant about this title because without the context it can easily comes across as arrogant on my part. The word <i>Good, </i>in A Doctor for Good carries a double entendre throughout this entire endeavor. I am a doctor, and
with this medium will attempt to catalogue a</span><span style="font-family: Arial, sans-serif; font-size: 11.5pt;"> vision for a healthier society. The project described in the first post is part of that vision. However, the roots of my passion for change run deeper than solving health
challenges alone.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 11.5pt;"><br />
Below is a White Paper I first wrote as a medical student around 2006 based on
an idea that I first had as an undergraduate. The white paper is an
attempt to lay out a vision for a new kind of enterprise. This type of venture
was a unique type of undertaking in my mind when I first had the thought in
college. I later came to find out this kind of entrepreneurial arrangement was gaining wide attraction, and had been around for some time. The idea, now commonly referred to as social entrepreneurship or <a href="http://www.muhammadyunus.org/Social-Business/social-business/">social
business</a>, has been implemented in the real world with notable success by the
Grameen Bank and Dr. Muhammad Yunus.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial, sans-serif; font-size: 11.5pt;">The reason the project is
called Good Incorporated is thanks to a good friend of mine, Joel Wright. On a laid back Friday afternoon in his dormitory room on Hendrix College campus a group of
friends were hanging out. I described to them this rough idea formalized in the white paper below. After hearing my thesis Joel said, that
sounds like <i>good</i>…incorporated. The
name stuck. That has been the title of this project for about a decade. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin: 0in -0.05pt 0.0001pt 0in;">
<span style="font-family: Arial, sans-serif; font-size: 11.5pt;">It is important to me
to include this idea up front. I see the project described in the first post is
a building block in a larger economic and social pyramid. Every time I think about the title of this
blog, I think about <i>Good</i> as noun with potential for a concrete reality in
terms of the concepts and abstractions below. <b><o:p></o:p></b></span></div>
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<br /></div>
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<br /></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 11.5pt;">White Paper</span></b><span style="font-family: Arial, sans-serif; font-size: 11.5pt;"><o:p></o:p></span></div>
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<b><span style="font-family: Arial, sans-serif;"><span style="font-size: large;">Good Incorporated</span></span></b><span style="font-family: Arial, sans-serif; font-size: 11.5pt;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="margin: 0in -0.05pt 0.0001pt; text-align: center; text-indent: -0.05pt;">
<span style="font-family: Arial, sans-serif; font-size: 11.5pt;">The Goal, and why the world needs us to do this<o:p></o:p></span></div>
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<br /></div>
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<i><span style="font-family: Arial, sans-serif; font-size: 11.5pt;">Enabling our generation to sustain its standard of living and
ensuring others have the opportunities to do the same.</span></i><span style="font-family: Arial, sans-serif; font-size: 11.5pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
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<span style="font-family: Arial, sans-serif; font-size: 11.5pt;">We live in an age of
vast and ever growing wealth. The recent global economic slowdown merely
represented a shrinking of overall economic growth, rather than an absence of
it. Never in our history have we been so interconnected with the peoples and
cultures that live such vast distances from us. Efficiencies in population and
material transport have allowed entrepreneurs access to global labor and
consumer markets. This shrinking of borders has been exploited in ways that
take the global standard of living to unbelievable new heights. This has been detailed
nicely in works such as <i><a href="http://www.thomaslfriedman.com/bookshelf/the-world-is-flat">The World is
Flat</a></i> and <i><a href="http://www.thomaslfriedman.com/bookshelf/hot-flat-and-crowded">Hot, Flat,
and Crowded</a> </i>by </span><span style="font-family: Arial, sans-serif; font-size: 15px; text-indent: -0.05pt;">Thomas Freidman. </span><span style="font-family: Arial, sans-serif; font-size: 11.5pt; text-indent: -0.05pt;">The advent and propagation of information technology is
further contributing to the narrowing of economic and social gaps.
Unfortunately, a large number of global citizens have been “left-out” of this
interconnected, rich world. This means that they have not had a similar
opportunity to partake in the creation of individual or community prosperity to
the same degree.</span></div>
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<span style="font-family: Arial, sans-serif;"><span style="font-size: 11.5pt;">Traditional
multi-national companies have not championed that neglected population because
those markets, and those consumers, are not </span><i style="font-size: 11.5pt;">as</i><span style="font-size: 11.5pt;"> profitable. Their business
models and corporate charters are structured in such a way to create dis-incentive towards engagement with economically disadvantaged communities. Good Incorporated
believes that the opportunity to participate in a globalized world should be
offered to any individual regardless of their station at birth. We seek to do
this because we believe that by sharing in the exchanges of culture, history, language,
know-how, and ideas, we are in a better position to mutually enrich each other. Globalization and its
contiguous economic opportunities </span><span style="font-size: 15px;">doesn't</span><span style="font-size: 11.5pt;"> have to be a rich man’s only party.
Empowering others to take part in their local and global economies can have
beneficial effects on the sustainability and promulgation of overall global
prosperity. However, it will require us to muster a change in perspective. Today the traditional
business world is working from a specific and one-sided paradigm. What we are seeking to do
through Good Incorporated is fundamentally change the paradigm. It is the
underlying belief that profit, economic sustainability, and the social good are
not mutually exclusive pursuits. It is that belief which distinguishes this
endeavor from the traditional conceptualization of business while at the same time distancing itself from the work currently categorized as charity/foreign aid/humanitarian.<o:p></o:p></span></span></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 11.5pt;">Will this even work? </span></b><span style="font-family: Arial, sans-serif; font-size: 11.5pt;"><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 11.5pt;">Yes, it will work. We know
it will work is because the model of economies of scale has already been proven feasible as a
traditional business structure. [In this context feasible = profitable]. An example
business model to look at is Wal-Mart. Laying aside valid critiques of some of
Wal-Mart’s policies towards its employees, the <a href="http://money.cnn.com/magazines/fortune/fortune500/2012/full_list/">second
largest grossing company</a> in the U.S.A. was Wal-Mart in 2012. Understand that, and then consider the population that is the Wal-Mart client base? The answer: the middle socio-economic
classes of American society. Wal-Mart took something: in this case
household consumer goods and sold it at a price (and overall profit margin) low enough where American consumers
could buy. The model works at a 3% profit margin because of economies of the scale.
Those left out to globalization are the poor/middle classes around the world.
Imagine a product or service that can be provided at <u>X</u> cost. Imagine a
prime client base consisting of those currently left out from globalization.
Since traditional enterprise currently are not catering to or heavily pursuing that market, there
is ample opportunity for a huge market share. Based on the possible market, and the economy of
scale, <u>X</u> would have the potential decrease to a fraction of its original cost. What we are
talking about is on the scale of pennies a day. But, like Wal-Mart, if you sell enough units that it only costs you 1/2 a penny and you collect 1 penny, doing
that millions of times a day you are still a viable economic entity. <o:p></o:p></span></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 11.5pt;">Why Profit?<o:p></o:p></span></b></div>
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<span style="font-family: Arial, sans-serif; font-size: 11.5pt;">Profit is important
because it underpins structural economic validity and sustainability. It
is not the only operating goal, but it is a necessary part of operations. The way we currently
structure aide to those left out of globalization looks more like a band-aid.
Donated foreign aid money only goes so far as the amount pledged and the length
of time it is promised. It functions, or has functioned, more as a superficial patch to the problem. Redistribution
of wealth through foreign aid has been around for a long time, but is it
sustainable? <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 11.5pt;">Counter that image with
the concept of capitalism. It is the argument of this white paper that capitalism
as it is currently operationalized globally does not work for the majority of
the world’s people. Bear in mind when writing about a global scale, that
includes the U.S. population. Why are they left
out? Why is capitalism not producing gains for a larger portion of the population?
The answer to this goes back to the current world views regarding capital production and charity or social welfare, and suggests a need to a <b>paradigm shift</b>. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;"><span style="font-size: 11.5pt;">The current globalized form of
capitalism could have left out many of world’s poor for 1 of several reasons: 1) It
could be that capitalism is inherently an unjust system and wherever it is implemented
will </span><i style="font-size: 11.5pt;">always</i><span style="font-size: 11.5pt;"> </span><span style="font-size: 15px;">proffer</span><span style="font-size: 11.5pt;"> inequality. Or, 2) as Good Incorporated believes;
capitalism leaves out many because the pursuit of profit is not currently mindful of social well-being. Additionally, socially beneficial pursuits such as those
advocated by civic organizations or communities of faith are reliant on donated
money, which as alluded to above, comes and goes with a whim and brings its own shackles. A Good Incorporated
endeavor is pursuit of the </span><i style="font-size: 11.5pt;">good</i><span style="font-size: 11.5pt;"> cause
coupled with profit, however </span><span style="font-size: 15px;">minuscule,</span><span style="font-size: 11.5pt;"> as a necessary requirement for the
continuation of the project. Profit is viewed a means to provide
feedback to the organization about the efficacy of execution of its core mission
without wasting energies away from the core project in order to address fund raising or other inefficient efforts.<o:p></o:p></span></span></div>
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<span style="font-family: Arial, sans-serif;"><span style="font-size: 11.5pt;">People who deeply care
about others and want to make social change their life's work in this world don’t become CEOs
and go into traditional business; they tend towards careers like social work. Pursuit
of the social the well-being of your fellow man has not been a quality traditionally
associated with a capitalist. It could be argued that a new word is needed for
this coupled concept.</span><span style="font-size: 11.5pt;"> We seek a new type of entrepreneurship. We seek to take our profits and
feed them back into communities. Similarly, the aim is to use profit not as a means of
extracting wealth-but rather creating value for people and communities. What if
a global corporation acted like a mom and pop store? What if
altruistic/socially minded people were at the helm of dynamic Fortune 500 companies?</span></span><span style="font-family: Arial, sans-serif; font-size: 11.5pt; text-indent: -0.05pt;"> </span></div>
Anonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.com0tag:blogger.com,1999:blog-8252252372398153458.post-87284200850919741982012-08-04T16:19:00.001-04:002012-08-04T16:22:38.532-04:00Background creates context<b id="internal-source-marker_0.08395752613432705"><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">A crop germinates in a context where the conditions allow. The ideas herein have been ruminating in my mind for some time. With this blog, the intention is sketch out my own background to enable the reader to understand where I am coming from. I hope to use this writing to further refine the ideas which have stayed locked in the silo of my own mind for too long.</span><br /><span style="font-weight: normal;"><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span></span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">The purpose of this blog is to lay out a vision. In the book </span><a href="http://www.amazon.com/Where-Good-Ideas-Come-From/dp/1594487715" style="font-weight: normal;"><span style="color: #1155cc; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Where Great Ideas Come From</span></a><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">, Steven Johnson describes something he calls a slow hunch. This is the process by which ideas take a long time to go from acorn to oak. I have always had an interest in writing, it is a way in which I find that I am able to refine a thought. This public diary may prove more helpful on a personal level, forcing me to clearly articulate a vision, than it will be for the reader. I am putting it in the public space because I believe these personal interests may have broader appeal.</span><br /><span style="font-weight: normal;"><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">My Background</span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">I was born in Mississippi, son of a single mother. For the first 11 years of my life I lived with my mom in the southwest corner of Arkansas, USA. When I was 11, my mother took a job as teacher with the Department of Defense Dependents Schools. This is the organization that hires teachers for schools on U.S. military bases overseas. These schools where children of U.S. military members attend school. She left a job teaching kindergarten in the United States and we moved to Japan first. After 2 years we moved to Seoul, South Korea. I spent 8th through 10th grade living in Seoul. We moved again, and for junior and senior year of high school we lived in Mons, Belgium. After high school, I returned to Arkansas to attend university. I went to a small liberal arts college in central Arkansas which was geographically close to my father. I completed medical school in Washington, D.C. Today, I am in my 3rd year of postgraduate clinical medical training (termed residency in the U.S., house officer in the British system) in family medicine in North Carolina.</span><br /><span style="font-weight: normal;"><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Concept: The value of the crowd. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Project 1, a foundation in a mental pyramid</span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">I have known Zach since high school. He and I have grown in friendship since that time. I had breakfast with Zach at a Panera several years ago and described an idea for using cell phones to identify dermatologic skin abnormalities. Smart phones have reached sophistication with a combination of camera, processing power, and internet connectivity that enable this to move out of the realm of science fiction. The idea is for a cell phone to take a picture of a skin lesion and use artificial intelligence algorithms which would correctly identify the diagnosis. To imagine how this would work, picture an episode of CSI (Crime Scene Investigators). During the crime solving music montage there is screen shot of a computer with fingerprints cycling rapidly through the screen until the correct match is made. The criminal is caught! I have also seen this on the silver screen with scenes of facial recognition technology with the computer successfully picking out the right face. This is not science fiction, airports are currently using the technology. </span><a href="http://gcn.com/articles/2003/01/23/tsa-set-to-test-biometric-systems-at-20-airports.aspx" style="font-weight: normal;"><span style="color: #1155cc; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">This article</span></a><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"> about facial recognition for airport security is almost a decade old. The cognitive leap to replacing faces with skin pictures is a short distance. A dermatologist in training spends time gaining exposure to thousands of mental images of abnormal skin (along with associated data points of gender, age, other symptoms, etc) and cataloguing that information attached to a “correct” diagnosis. An algorithm will search the submitted image for characteristic qualities (like the ID points on fingerprints) and produce a diagnosis, or list of probable diagnosis - in the same way a human physician operates. In fact, a version of this concept is operational as a medical device. A machine, </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/20956633" style="font-weight: normal;"><span style="color: #1155cc; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Melafind</span></a><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">, can detect a cancer in a specific type of small pigmented skin lesion better than a trained Dermatologist. The idea was to expand this to any type of skin lesion, not just something that was a potential melanoma.</span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"> </span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">Zach became interested in this idea. Our Panera coffee shop breakfasts continued sporadically. Zach emailed me and said he was having trouble locating a skin image database that would be sufficient in size to attempt such a project. The problem is that there exists no publically available skin image database. In order to “teach” an algorithm what the important characteristics of skin lesions are, you need a large set of photographs that are tagged with an answer, a diagnosis. Those types of image collections are all private. They exist either as </span><a href="http://www.visualdx.com/about/" style="font-weight: normal;"><span style="color: #1155cc; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">proprietary</span></a><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"> collections, or they are in the </span><a href="https://mdid.library.jhu.edu/" style="font-weight: normal;"><span style="color: #1155cc; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">possession of the academy</span></a><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"> for research or teaching purposes. Without the database, it is not possible to begin the development of this algorithm. </span><br /><span style="font-weight: normal;"><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span></span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">This was a daunting set back. The energy had stalled forward progress. The next link in the development of the concept was exposure to the ideas of </span><a href="http://www.ted.com/speakers/clay_shirky.html" style="font-weight: normal;"><span style="color: #1155cc; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Clay Shirky</span></a><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">. The ideas, freely available on the internet, have shaped my appreciation for the potential of </span><a href="http://www.ted.com/talks/clay_shirky_on_institutions_versus_collaboration.html" style="font-weight: normal;"><span style="color: #1155cc; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">collaborative solutions</span></a><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">. One of the things I hear in his work is this idea that the answers to problems which emerge from the crowd are more robust and have more potential. Organizing a truly crowd-sourced answer in a pre-internet world was virtually impossible. The internet, which is estimated to have penetration to a </span><a href="http://www.internetworldstats.com/stats.htm" style="font-weight: normal;"><span style="color: #1155cc; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">third of the global population</span></a><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">, enables the the concept. One widely used example of this methodology is Wikipedia. The challenge which Wikipeda addresses via the crowd is how to organize/update/and disseminate current and historical information on broad range of current and historical topics. The efficacy of the new method is punctuated by the passing of an old method which was previously used to address this challenge. Encyclopedia Britannica announced that it will </span><a href="http://www.guardian.co.uk/books/2012/mar/13/encyclopedia-britannica-halts-print-publication" style="font-weight: normal;"><span style="color: #1155cc; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">stop print publication</span></a><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"> this year. Similarly, Twitter and social media are challenging the professional journalistic class in answering the question of how society keeps itself informed. For exposure to these ideas, I owe Professor Shirky an enormous debt of gratitude. </span><br /><span style="font-weight: normal;"><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">How Society Keeps itself healthy - A Professional class of Doctors - Can the crowd compete?</span><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span></b><br />
<b style="font-weight: normal;"><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Zach and I met at Panera yet again. The barrier to forward progress was a current image database system characterized by proprietary images, locked away, unavailable for public use. This was an impediment that was scuttling a grand scheme to bring the power of technology to bear for improved health. The next conversation was full of questions. Since we don’t have access to a skin database how can we get the volume of necessary images to proceed? Could we get people to actually submit pictures of their own skin? What if we tried to crowd-source a database of skin images with diagnoses? On a technical level -how could we guarantee the quality of images submitted? Is this even legal? How can we protect the identity and personal health information of willing participants? Will this work? </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">We don’t yet know the answers to those questions yet. But with a low barrier to entry and a strong conviction in the belief that others will understand the potential of what we are trying to do, we are going to try.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"> </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">In the posts that follow I will elucidate answers to those questions as well as architect the pyramid, for which Project 1 is a first building block, a proof of concept. </span></b>Anonymoushttp://www.blogger.com/profile/02367698656479821883noreply@blogger.com0