8 ms·
I can't get past the adblocker spam, but I'm going to guess this woman had APL (acute promyelocytic leukemia, caused almost exclusively by a very specific chrom
by apathy 10y ago
I can't get past the adblocker spam, but I'm going to guess this woman had APL (acute promyelocytic leukemia, caused almost exclusively by a very specific chromosomal translocation) and the doctors didn't think to look for Auer rods and thus did not try FISHing for the translocation. APL is deadly (5% survival) if treated incorrectly but curable (95%) if treated correctly. However, something or other about that differential has been a standard question on the hematology medical boards for, what, 3 decades now?
John Welch, Rick Wilson, Tim Ley and colleagues showed how to do this several years ago: http://jama.jamanetwork.com/article.aspx?articleid=897152 http://jama.jamanetwork.com/article.aspx?articleid=897152
I'm curious whether this case was confounded by cytogenetic complexity, which was part of the problem in that case. Ley later diagnosed Lukas Wartman, a fellow in his lab (or, more like, they worked together to figure out what to do), too:
http://oncology.wustl.edu/people/faculty/Wartman/Wartman_Bio.html http://oncology.wustl.edu/people/faculty/Wartman/Wartman_Bio...
Lukas did not look nearly as healthy as he does in that picture when I saw him last. He is a great scientist and what he had (adult acute lymphoblastic leukemia, ALL) is a nasty malignancy to treat. Children with ALL tend to do well, but their disease typically seems to arise from different underlying causes than adults, who do poorly.
(Not-so-ninja edit: Here is Lukas' own writeup of his experience. He was in a much tighter spot than I recalled: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850894/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850894/
Even children in second relapse are viewed as bad news. Adults in second relapse are generally considered dead men walking. Anyways, read the paper if you're curious.)
If Watson caught that the woman had (say) Ph+-like ALL and suggested the right TKI, that will impress me quite a bit, because I've seen someone die from a wrong guess on the latter. On the other hand, if it was APL, they fucked up the differential somehow and are probably kicking themselves.
(Double not-so-ninja edit: It wasn't APL-vs-AML, or ALL subtyping. Another poster kindly pointed out the primary source for this news, and something doesn't add up.shrug)
- jacquesm 10y agoIt would definitely be impressive, but it doesn't mean much without knowing how many times it mis-diagnosed. IBM is very good at PR and Watson is milked for every little bit so I'm always a bit suspicious about it in triumphant announcements like these. After all, winning the lottery is a lot less impressive if you've bought a few million tickets and this article says absolutely nothing about any kind of controls or whether or not this was a one-off performance or if it would work at scale.
- apathy 10y agoWell, to play devil's advocate, if all the tickets are free, and the attending gets to ignore all the ones that don't win, that could be useful. FWIW, here's Lukas' writeup of his experience. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850894/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850894/
- smallnamespace 10y ago> if all the tickets are free They're definitely not free; doctors have to evaluate what Watson says, and if Watson is wrong a significant fraction of the time, then doctors will spend a lot of time and energy barking up the wrong tree.
- jfoutz 10y agoEh, it's a tool. Some are useful, some less so. I imagine this would be a tier two kind of thing. It's an unusual case, what suggestions does the robot have? Maybe something obscure and easy to forget.
- apathy 10y agoDoctors have to evaluate what patients say, too, and they're forgetful or clueless at least as often as anyone else. If the cost-benefit analysis favors having Watson (or whatever) around, great, if not, great, just another decision to make.
- bitmapbrother 10y agoThat's pretty cynical of you. Perhaps you should give credit where credit is due instead of attributing it to just PR. Watson diagnosed an illness that was undetected by her doctors. This happens all of the time and people die because of this or live in misery because of it. If Watson can prevent even a fraction of the rampant misdiagnoses and aid in the actual determination of the illness then it's in our benefit to use the information it provides.
- sk5t 10y ago
- teej 10y agoThe primary source as far as I can tell is this? http://www3.nhk.or.jp/news/html/20160804/k10010621901000.html http://www3.nhk.or.jp/news/html/20160804/k10010621901000.htm.... Somewhere elsewhere said that the article says that Watson diagnosed her with "secondary leukemia".
- apathy 10y agoVery odd. To my knowledge, STAG2 deletions or mutations don't respond any differently to most other primary or secondary AMLs. (In fact, usually a secondary AML is a worse diagnosis as it means they have progressed from something like MDS, which itself has a shitty prognosis). Something is not quite right here. One possibility is that Seishi Ogawa's group has figured out that something off-label can more effectively treat cohesin mutants and it is under review. But I'm not sure how Watson would have known about that. Interesting. Probably my reading is flawed, but this doesn't make sense.
- mmaunder 10y agoShouldn't the headline be "Doctors use powerful computer to aid diagnoses." The article unashamedly dives straight into robot doctors.
- necessity 10y agoI suggest NoScript. All anti-adblock spam and paywalls are javascript.
- apathy 10y agothanks! It seems obvious now that you point it out, but that's how most good ideas work :-)