Skipping the 20th Century
Wireless science in resource-poor countries
Researchers armed with nothing more exotic than cell phones and laptop computers are plugging into worldwide efforts to conquer ancient and modern plagues, and to prepare for those to come.
Their collaborations breach traditional barriers of geography, nation, even language, and they are transforming the way scientists are trained and science is conducted. In a sense, the digital revolution has enabled resource-poor countries to skip the 20th Century, and to catapult into a new scientific age.
“In the scientific discipline of informatics, global dialogues are just a completely commonplace occurrence,” says Dan Masys, M.D., who chairs the Department of Biomedical Informatics at Vanderbilt University Medical Center.
“I think that is the earmark of 21st Century science,” he says. “It transcends geopolitical boundaries with a transparency that is so casual and taken for granted that we don’t even think about it.”
Masys is the principal investigator of a five-year, $3 million grant awarded this spring by the National Institute of Allergy and Infectious Diseases to construct a database that can track the changing face of AIDS in six Latin American countries: Argentina, Brazil, Chile, Haiti, Honduras and Peru.
The grant is part of a global program called IEDEA—International Epidemiologic Databases to Evaluate AIDS—that aims to improve the monitoring of and response to the rapidly mutating human immunodeficiency virus (HIV).
“This is a very clever adversary,” explains Masys, who led biomedical informatics programs at the National Library of Medicine and the University of California, San Diego, before coming to Vanderbilt last year. “Because it has a lot of genetic instability, it essentially can emerge with a resistant strain by just random selection of mutants that are not adequately suppressed by certain drugs.
“So Job No. 1 is accurate observation of patterns of disease which we can then combine with modern molecular biology and genetics to understand why those global patterns are occurring.
“This type of data can help in resource allocations in health systems planning so that each of these individual nations can anticipate patterns of disease spread or complications of HIV or the almost inevitable diffusion of new genetic variants that may have originated elsewhere in the globe ...
“And with that insight, to be able to create better drugs and intervention strategies that are not based on drugs. They may be public health strategies, sanitation or other forms of intervention that are equally or more effective.”
IEDEA is not unlike the current worldwide effort to track the spread of avian flu. “That kind of early monitoring of the events that are occurring in distant countries, but which can quickly become our own health problems on a national level, is a key feature of these scientific networks that are global in scale,” Masys says.
“The fundamental statement here is that knowledge is power,” he asserts. “And to the extent that we have new and better means of acquiring and disseminating knowledge, we actually change the balance of power in health, the balance of power relative to our adversaries, the scourges of humanity.”
Jumping into hyperspace
Masys doesn’t talk like a computer nerd. That’s because he’s not.
Trained as an oncologist, he first realized the power of computing in the late 1970s when he wrote a software program to relieve the drudgery of tracking patients through clinical trials.
That led to an offer from the National Cancer Institute to help build a database called PDQ—Physician Data Query—“really the first electronic textbook of oncology that could be kept up-to-date over night,” he says. At that point, Masys says, “I jumped to hyperspace, and have pretty much been there ever since.”
After a couple of years at the NCI, he transferred to the National Library of Medicine, where—as an officer in the U.S. Public Health Service—he directed the Lister Hill National Center for Biomedical Communications.
Masys also was the program architect and first director of the National Center for Biotechnology Information, which hosts the DNA data from the Human Genome Project.
He moved to UCSD in 1994. “It was in that regard that I was first asked by the HIV centers there… to help improve their informatics and data management support for HIV research,” he says. Some of their studies were “just amazingly data intensive.”
It was good training for his current challenge—achieving uniformity and consistency in a wildly diverse collection of research capabilities.
“In Haiti and in Brazil, they have very large centers with Ph.D.-level data management staff, (while) in Honduras they have one computer in a clinic, and they are paying one doctor part-time to do the data entry,” Masys explains.
“So part of the aspect of this project is to provide outreach and training in the principles of what’s called Good Clinical Practice, which are international standards for conducting research in a way that respects the ethical principles of informed consent and which makes the data verifiable and timely, so that it’s possible to ensure scientific integrity.
“The form it will take may range from helping people to create paper forms—on three-by-five cards in some countries—and others to create secure Web portals for communication of their data. And we’re prepared to do both those things and everything in between.”
The program allows for visits to each of the sites to ensure the accuracy and completeness of the data, and to provide educational outreach by Vanderbilt faculty. In return, Masys says, his co-investigators may do some teaching of their own. “This may also provide a very nice educational vehicle for Vanderbilt students to learn about how science is done in other countries,” he says.
Epidemic surveillance, even one with a worldwide reach, is not new. “There have been many reporting sources,” Masys says, “but they tended to report in their own format and at their own pace and using heterogeneous dissimilar computer systems…
“The difference over the last 10 years has been the emergence of the Internet and the emergence of computing technologies that are cost-effective even in developing countries, and our ability to make measurements in a systematic way across the many countries and populations of the world.
“So we can do this with greater uniformity and much faster than we could before… with eyes and ears on the ground in essentially every region of the globe.”
Masys is well aware of the logistical and occasional political nightmares that can play havoc with the conduct of science, but he’s convinced that technology—combined with the can-do spirit displayed by his co-investigators—will overcome any challenge.
“You have science that runs on batteries in many developing nations of the world,” he explains. “Combine that with innovations such as Wi-max, a wide-area data networking, where one can put a transmitter on a single cell-phone tower and be able to provide high-speed Internet services to a region that’s 30 miles in diameter from one device.
“That is the kind of leap forward that means we don’t need wires to connect with one another either by voice or data across increasingly large regions. The net effect of that is being able to recruit new people into research activities who were not previously involved because of the cost and expense of installing an infrastructure for doing that.”
Even if funding for the network doesn’t continue beyond five years, the relationships forged by this project will probably be “enduring legacies,” Masys predicts.
“The international bonds of trust and collegiality and friendship that come out of these research collaborations are likely to be the foundation for other abilities we’ll have in the future to push the boundaries of science… and (they won’t be) limited to HIV.”
The Internet can be a humbling experience for U.S. researchers, who are accustomed to being at the pinnacle of scientific achievement.
“That sensitivity of knowing instantly how other people interpret what we’re doing is a very important component of good citizenship in a global knowledge economy,” he says, “and I think also a healthy form of humility.
“National chauvinism doesn’t really suit us very well in a world where what we do dramatically affects others, and what they do dramatically affects us on an hour-to-hour basis.
“… So this shrinking globe, propelled by competing communications technologies, is probably the single greatest force at work I think in our society,” Masys concludes. “It’s done more to transform the nature of business and the nature of government and the nature of political forces than anything that has preceded it.
“It’s rightly viewed as a tremendous threat to totalitarian regimes, where controlling the flow of ideas is essential to maintaining one’s power base.
“It’s funny,” he wonders, “if we had the Internet somehow magically appearing in antiquity, would we have even invented countries?”