In the previous posts [1-2] we considered some important problems of modern medicine. In this post we consider a simple solution to three such problems:

-the conceptual problem;

-the side effect problem;

-the information overload problem.

A simple solution to the mentioned three problems is to use mapping tables to match medical treatments with the best results to particular groups of patients (having similar responses to treatments), characterized by segments of important parameters related to a condition or disease.

Let us consider a simple example, where the parameter is a weight of a patient. If the optimal dose in clinical trials on patients with weight of 90 kg was 90 mL, then the best dose for a patient with a weight X kg should be X mL. This give us a mapping table between weights and the best dosages to patients to avoid side effects.

Let us consider a process of medical treatments by drugs in some details. After a drug has been administered into a body, there is some time delay until this drug reaches the patient’s blood system. Initially, a concentration of the drug in the blood will be low and there will not be an active treatment; but after it reaches some critical level (called a level of treatment or efficiency) an active treatment will start. If the concentration of the drug reaches some other critical level (called a side effect level or toxicity level) this drug starts to harm the patient’s body. After reaching its maximum, the concentration of the drug in the blood will be decreasing due to the work of the liver and kidneys, which remove all waste and foreign substances to the body from the blood into urine. This process schematically is shown in figure 1.

Fig. 1

The green line is the level of treatment (efficiency); the red line is the level of toxicity (side effects); and the blue curve is the concentration of the drug in the blood. The zone between these two levels (treatment and toxicity) is called a safety treatment zone.

As we can see from this figure, the safety dosage of a drug/vaccine is a dosage that results in the concentration of the drug/vaccine that is not crossing the toxicity (side effects) level. In other words, the safety dosage of a drug/vaccine is the dosage where the concentration of the drug/vaccine is in the safety treatment zone. To determine dosages which results in the safe concentrations we need to divide the standard dose on the weight of treated persons, who have not side effects.

Suppose that in clinical trials, 5,000 patients with weight of 90 kg were given a standard dose of 0.9 mL of a covid-19 vaccine (a one dosage vaccine) and have not experienced side effects. From this information we can derive a safe concentration of 0.01 mL/kg (=0.9mL/90kg). Now we can derive a safe dosage -d for any weight -w as d=0.01*w. For example, a person with a weight of 45 kg needs only 50% of the standard dose to avoid side effects. In this simplified abstract example, the relation between optimal treatments (dosages) and segments (weights) is linear. In real life examples, such relations are not simple and are represented by mapping tables, based on relevant parameters.

Suppose, we need to administer a vaccine to 100,000 persons (residents of a city). If we use the standard dose of the vaccine for all patients, we get 20% of cases with side effects, which is 20,000 persons. If we adjust dosages to weights of patients and take into account their type of blood, sex, and age, the result will be zero number of side effects. The difference of 20,000 persons with side effects is not an abstract number or a mental concept/idea, it is a real physical effect in the real physical world, which has a significant importance for our society.

This solution, based on mapping tables, is a bridge between the old concept of medical pills and the new concept of personalized medicine. This bridged concept is called Optimized Practical Medicine (OPM) concept (we optimized different treatments for different groups of patients in practical and efficient way).

It solves the conceptual problem by proposing the new bridged (between the current two) concept (OPM), side effect problem by optimal matching of medical treatments to groups of patients with similar responses to these treatments, and information overload problem by replacing Big Data + Artificial Intelligence solutions with simple mapping tables, which significantly reduce rates of human and medical errors.

In the next post we consider a simple way to correctly interpret results of diagnostic medical tests or procedures

References

[1] A simple solution to some problems of modern medicine. Part I: the conceptual problems

[2] A simple solution to some problems of modern medicine. Part II: other problems