Transforming Epidemiology in an Era of Big Data and Small Budgets - - PowerPoint PPT Presentation

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Transforming Epidemiology in an Era of Big Data and Small Budgets - - PowerPoint PPT Presentation

Feb 26, 2023 338 likes •549 views

Transforming Epidemiology in an Era of Big Data and Small Budgets Michael S Lauer, MD, FACC, FAHA Director, Division of Cardiovascular Sciences NHLBI/NIH June 19, 2013 Disclosures: None (I trained at Framingham) National Heart, Lung, and

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Transforming Epidemiology in an Era of Big Data and Small Budgets

Michael S Lauer, MD, FACC, FAHA Director, Division of Cardiovascular Sciences NHLBI/NIH June 19, 2013 Disclosures: None (I trained at Framingham…) National Heart, Lung, and Blood Advisory Council Meeting

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Matthew Fontaine Maury

  • “Depot of Charts and

Instruments”

  • “Patterns Everywhere”
  • Inventories of

barometers, compasses, sextants, chronometers, log-books, maps, and charts – “rubbish”

  • Standard log forms and

“bottles in the sea”

Mayer-Schonberger V, Cukier K, Houghton Miflin, 2013

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The Result: Data as A Disruptive Technology

  • 1.2 million data points
  • Transformed shipping
  • “Conceived outside

traditional academic circles”

  • “Unearthing data from

material that no one thought had any value”

  • Data use many times

http://www.raremaps.com/gallery/detail/18671?view=print

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“Datafication”

  • Anything into data
  • See things on a big

scale that cannot be seen on a small one

  • “It will bring

fundamental changes”

  • OK to re-use data
  • N = All

Mayer-Schonberger V, Cukier K, Houghton Miflin, 2013

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Leveraging Data

Frolkis J, Lauer MS. N Engl J Med 2003;348:781-90

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Take a Step Back

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“Whether or not the correction of these abnormalities once they are discovered will favorably alter the risk of development of disease, while reasonable to contemplate and perhaps attempt, remains to be demonstrated…”

Annals Internal Med 1961;55:33-50

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Our Primary Model Develops

1948 1983 1985 1987 1988 1992 1999 2006 2000

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Despite New Era, Continued Successes

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CV Epidemiology Financials (~$160M/Yr)

62 39% 68 43% 29 18%

RPGs Cohort, WHI Contracts Grants other than RPGS

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Big Picture: ($M/Year averages 2009-12)

293 11% 68 2% 2,080 76% 309 11%

Other Contracts Cohort, WHI Contracts RPGs Grants other than RPGS

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Lots of Critics…

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Transformation is in the Air…

“A large sample size does not solve every problem. But it allows us to do a lot more, and sometimes it is just what we need.” “US models are being eclipsed by non-US studies that are much larger, yet considerably less expensive.” “These themes [include] integrating ‘big data’ science into the practice of epidemiology…foster integration with trials.”

JAMA 2012;308:1804-5; Cancer Epidemiol Biomarkers Prev 2013;22:508-16; Epidemiology 2013; 24:349-51 12

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An Increasingly Complex World

13 Schadt EE. Nature 2009;461:218-23; Barbabasi A. NEJM 2007;357:404-7

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  • UK Biobank
  • Danish National Registries
  • HMO, integrated systems
  • Regional opportunities: Delaware, SEER
  • Professional registries: NCDR, GWTG, STS
  • Ontario Health Study
  • Claims data (CMS, Aetna, Optum, MPCD)
  • PCORI

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Disruptive Models

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Disruption: Investigator-Initiated Grants…

Wells JM et al. N Engl J Med 2012;367:913-21

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Patient-Initiated Internet Research

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Wicks P et al. Nature Biotechnology 2011;29:411-414 “Attempting to establish the efficacy of a treatment in a prospective manner inevitably draws comparisons with methodologies that have the highest standards of rigor, and by comparison this discipline is in its infancy.”

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Creative (Disruptive) Business Models

  • L
  • Large
  • LEveraged
  • E
  • Embedded
  • External
  • Valuable
  • I’
  • Inexpensive
  • Integrated
  • Investments
  • Sound science

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  • Council BEE Working Group
  • Veronique Roger, Chair
  • Bruce Psaty, NHLBAC
  • BEE members to be named
  • Caroline Fox and David Gordon, NHLBI
  • Preserving investments
  • Short-term renewals of FHS and MESA
  • Note CHS example
  • Consider models for cohorts, other opportunities

Next Steps

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Thank You (Incomplete List)

Diane Bild Gary Gibbons Susan Shurin Alan Michelson Paul Sorlie Richard Fabsitz Jean Olson Gina Wei Cheryl Jennings Larry Fine Yves Rosenberg Denise Simons-Morton Daniel Levy Steve Mockrin Bob Balaban James Crapo Zak Kohane Jim Kiley Keith Hoots Denise Bonds Nakela Cook Gail Pearson David Gordon Sonia Skarlatos Denis Buxton Zorina Galis Nancy Geller Chris O’Donnell Nancy Miller Richard Hodes Deborah Zarin Francis Collins Chris Granger Robert Califf

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