
HBS Student Creates Smartphone App To Detect Malaria - mixednuts
http://bostinnovation.com/2011/07/08/hbs-student-creates-smartphone-app-to-detect-malaria/
======
maxklein
The sad part is: This app is basically useless. Malaria has very distinct
symptoms. Malaria also has a 3-day pre-roll period where you know you are
about to get malaria, but you are not yet in bed. Also, Malaria is the #1 drug
every chemist stocks in malaria-infested areas. Furthermore, taking a malaria
pill even if you don't have malaria has no side effect.

What this means is that if all the criteria of bad luck come together:

1\. Person does not know the symptoms for malaria

2\. There is no chemist around who stocks malaria pills

3\. The illness for some reason instantly hits the person without the pre-roll
period

...then the person for whom all these criteria comes into question is about
99.99% not likely to have an Android phone around. And 100% not likely to have
a lifelens attached to the phone.

~~~
kenjackson
This is from Wikipedia:

 _The mainstay of malaria diagnosis has been the microscopic examination of
blood. Although blood is the sample most frequently used to make a diagnosis,
both saliva and urine have been investigated as alternative, less invasive
specimens.

Areas that cannot afford laboratory diagnostic tests often use only a history
of subjective fever as the indication to treat for malaria. Using Giemsa-
stained blood smears from children in Malawi, one study showed that when
clinical predictors (rectal temperature, nailbed pallor, and splenomegaly)
were used as treatment indications, rather than using only a history of
subjective fevers, a correct diagnosis increased from 2% to 41% of cases, and
unnecessary treatment for malaria was significantly decreased._

It certainly sounds as there is use for diagnostics tools.

~~~
maxklein
You still don't get it. It's not neccessary to diagnose for malaria via blood.
Malaria patients know they have malaria in almost all cases, because they are
familiar with the disease. As soon as the symptoms show, they take the
tablets. If the problem is not fixed, then it was not malaria. But if you live
in a malaria area and you have the typical malaria fever, 99.9% of the time it
will be malaria.

Blood diagnosis is unnecessary and expensive. Just take the pills.

~~~
kenjackson
I'm no expert. I don't claim to be. My point is that people actually appear to
do testing. Now maybe you should relay your message to these testers, but it
doesn't appear to be uncommon.

In fact, there's a whole Wikipedia page dedicate to Malaria testing:

<http://en.wikipedia.org/wiki/Malaria_antigen_detection_tests>

And they note more than 20 commercial products for sale that test for Malaria.

Here's a paper from the NIH on the importance and state of rapid Malaria
diagnosis:

<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2223842/>

Here's another NIH paper talking about an Malaria eradication, and a big part
of their plan is diagnosis:

<http://www.ncbi.nlm.nih.gov/pubmed/21311583>

Again, I'm not expert (or even novice), but looking at the literature and what
people in the field are working on -- it looks like they make use of
diagnostic tools for Malaria. I've certainly seen no papers saying that
diagnostics isn't useful in 99.99% of all cases, just pop a pill. Not saying
that that's not what should be done, but I find the evidence thus far lacking.

~~~
maxklein
The people who need to diagnose it are in a hospital, where they can just use
one of many methods. They don't need to to peer through an android lens.
Laymen rarely need to diagnose malaria because the symptoms are very very
clear.

~~~
kenjackson
From the other poster, this is from WHO:

"Clinical diagnosis, the most widely used approach, is unreliable because the
symptoms of malaria are very non-speciﬁc."

From the last NIH paper I referenced, "Many of malaria's signs and symptoms
are indistinguishable from those of other febrile diseases."

Here's a paper from the Lancet about Malaria misdiagnosis:

<http://www.ncbi.nlm.nih.gov/pubmed/15555670>

From the above: "Effective and affordable treatment is recommended for all
cases of malaria within 24 h of the onset of illness. Most cases of "malaria"
(ie, fever) are self-diagnosed and most treatments, and deaths, occur at home.
The most ethical and cost-effective policy is to ensure that newer drug
combinations are only used for true cases of malaria. Although it is cost
effective to improve the accuracy of malaria diagnosis, simple, accurate, and
inexpensive methods are not widely available, particularly in poor communities
where they are most needed."

Additionally people apparently can build up a resistance to the Malaria
treatment. See:

<http://www.irinnews.org/Report.aspx?ReportId=78014>

 _“When people are sick in Mali, the doctor will usually tell them they have
malaria whether or not they test for it,” said Fatou Faye, an infectious
diseases researcher and trainer at a privately funded medical laboratory, the
Charles Merieux Centre in Bamako.

“The patients then buy anti-malarial drugs in the street and build up a
resistance to treatment.”

As a result, according to research by Dr. Imelda Bates at the Malaria
Knowledge Project (MKP), part of the Liverpool University School of Tropical
Medicine, this means people miss other causes of feverish illness such as
pneumonia and meningitis, which can cause further illness and even death._

Again, I'm not saying your wrong necessarily, but everything I read seems to
point to the fact that low-cost accurate Malaria diagnosis would be useful.

~~~
btilly
_Again, I'm not saying your wrong necessarily..._

Actually you're telling him that he's acting exactly like people commonly do
in malarial areas, and are informing him that simply taking that course of
action breeds worse varieties of malaria, and causes people to die of
unrelated diseases that could have been treated.

This strongly suggests that he has practical experience with malaria. And is
useful information for him about how the advice he has based on experience is
suboptimal.

~~~
maxklein
Medicine is a game of probability. If you have malaria symptoms in a malaria
area, the chance of you having malaria are around 99%. Every other disease
with similar symptoms (e.g Typhoid) is pretty rare.

When it comes to peoples lives, people very quickly reach the optimal
solution. It's what humans do best. This android solution is a theoretical
solution from people who have never experienced malaria and don't even live in
an area where malaria exists.

Yes, I have practical experience with malaria. I also have practical
experience with android phones. I am actually qualified to make experience-
based judgments on the feasibility of that tool, and quoting theoretical
papers may win you arguments on the internet, but it will have little
practical usage.

When there is a disease in an area that has existed for so long that people
have built genetic resistance to it, at the cost of having occasionally sickly
children, then trust me, modern methods that work will quickly be selected.

Modern methods that don't work (bed mosquito nets), will be selected away.

Armchair solutions for problems you only partially understand are pointless.

------
stephenhuey
The article claims that 90% of 8+ million childhood deaths in sub-Saharan
Africa are caused by malaria, but the World Health Organization says it's
responsible for only 20% of child deaths. Moreover, the latest estimates for
annual deaths from malaria (all ages) is 780,000. In any case, it's a lot, and
I'm glad this team has delivered a useful tool!

<http://www.who.int/features/factfiles/malaria/en/index.html>

[http://healthland.time.com/2011/04/26/malaria-deaths-are-
dow...](http://healthland.time.com/2011/04/26/malaria-deaths-are-down-thanks-
to-u-n-commitment/)

~~~
kmccarth
thanks for the links

------
hobonumber1
What's the deal with all the snarky remarks? They made something with the
intention of solving a serious problem. Cut them some damn slack.

------
_shane
The fact that it's a smartphone, or that it's running Windows 7, or that it
was developed in Silverlight doesn't seem to have anything to do with the fact
that we're looking at a glorified microscope.

Surely there's a cheaper way to get a microscopic image of a blood sample in
Africa than flooding villages with Windows smartphones.

~~~
shaggyfrog
If this "glorified microscope" allows people to do their jobs tangibly better
-- in this case, detect malaria -- then what exactly is the cost problem in
your mind? We're not talking about gold-plated custom-designed malaria
detection devices... we're talking about (commodity) smartphones with a small
lens affixed and some software installed.

~~~
jarrett
Do we know that it helps people do their jobs better? The article left me with
this question: Is this different than other microscopes that you could use in
the field, and if so, how? Does this make it easier/cheaper for the trained
personnel to detect malaria? Maybe it does--I'm just not clear on that point
after having read the article.

~~~
nasht
The real point is that now the mobile worker doesn't have to carry a phone + a
large microscope. The mobile phone is continuing to replace more and more
objects. Radio, tv, camerea, video, internet browser, and now microscope. Many
more devices will be adapted to take advantage of the phones computation
capability as well as things like GPS, internet etc. BTW, if that mobile
health worker has to make a choice between purchasing a microscope and
purchasing a phone, they are probably going to purchase the phone.

------
rcavezza
I feel there's a huge flaw in the logic with this application.

If these people could afford smart phones, they probably wouldn't have a huge
malaria problem.

Am I missing something?

~~~
mousa
Wealthy Africans get malaria too, and besides, even the poor will be getting
smart phones soon.

It's going to be like cell phones which were pretty ubiquitous in the third
world years ago when it wasn't even the case here. They bypassed landlines and
went straight to cell, and the same will probably be true of computers and
smart phones.

~~~
Apocryphon
Not to mention this can always be an ad hoc tool for aid workers and doctors.

------
marshray
_Next, the application’s user simply has to know the difference between a
healthy blood sample and one infected with malaria_

So...it's a microscope lens for a smartphone? Isn't that something already
developed? What about this app "detects malaria"?

~~~
mrcharles
Well, given the look of the two slides, it seems like it wouldn't be the most
difficult problem in the world to do some image analysis to determine.

~~~
marshray
That would be an interesting article, but as far as I can tell this thing is
nothing but a microscope.

You're going to need a trained human in the loop just to handle the blood and
apparatus in a sanitary way.

Humans are inherently better than any app at the image task, so why not just
let the human do it?

This looks like a non-solution to me.

~~~
shaggyfrog
You have some false assumptions in your argument, mainly that it's just as
easy to train and distribute humans across Africa (and elsewhere) to do
malaria diagnosis as it is to develop and distribute copies of this software.

Moreover, as the software is improved, updating the software -- and raising
the baseline of quality -- is a unique advantage over the "just use humans"
solution.

~~~
marshray
The scenario is not "download an app and it detects malaria".

The scenario is "person trained to work with blood samples without
spreading/contracting HIV deployed into field packing a small digital
microscope and support software built on WP7." This person is likely already
doing a variety of other community medicine and is the closest thing to a
medical doctor many of their patients will ever see.

There's no argument against giving the practicioner a helpful tool, only that
it may be automating an insignificant part of the overall problem (looking at
the image).

------
yaix
Its basically a microscope in a smartphone.

However, I see a few practical problems when these high end phone get
distributed in Africa by some aid organization. Because an expensive high end
phone is also a good gift. I hope they will maintain statistics of how many of
these high end phones actually reach the medical centers. And how many of them
remain in the med center after a year. Sometimes its better to just send a
microscope that can not be used for anything else but blood samples.

------
jhamburger
Great feel good story, hard not to see a ton of potential in the 1st world
market too though. Imagine a comprehensive self-diagnosis app?

~~~
bugsbunnyak
Not launched yet, but there will (hopefully soon) be an XPrize for that:
[http://www.xprize.org/prize-development/life-
sciences#artifi...](http://www.xprize.org/prize-development/life-
sciences#artificial)

------
athom
Oh, wow...

Okay, I just spent the better part of an hour working on a comment on this
(hey, I just passed a hematology course, sooo... ;), and then, as I _finally_
got around to checking out the website, I catch this line in the video
(emphasis mine):

"All that's really needed from an individual is a drop of blood from the
finger to create a _thin smear on a slide_ for analysis with standard
protocols."

That's a _lot_ different from what the linked article claims (again, emphasis
mine):

"A single drop of blood from the patient is required _then smeared on the
microscopy lens_."

Smearing the lens directly seemed an interesting idea, although it poses a few
challenges I'll touch on shortly. However, a close listen to the video makes
it clear that's _not_ what the project purports to do. The Lifelens "hardware"
-- the lens -- is just meant to give a phone camera microscopic capabilities.
How well that works isn't too clear, but it's definitely not the same thing.

It would actually be quite difficult to get an acceptable specimen on a tiny
lens. The standard laboratory method is to place a drop of blood on a slide,
then use another slide to draw it out into a thin film. Here's a quick video
that shows a pretty good example:

<http://www.youtube.com/watch?v=iA6ce-3sYgk>

Note how the tech drags the slide back at an angle over the drop, then pushes
it forward almost immediately. It takes good timing and a lot of practice to
get it right, and then you have to find _just_ the right part of the specimen
for a proper analysis. What you get in a typical thin smear is a range of
population densities, from a clumpy mess of cells crowding and overlapping
each other, to rarefied lines and clusters of cells spaced widely apart. The
nice, evenly spaced fields shown in the article are just a small region of the
full sample, usally a couple fields behind the feathered edge. Getting that is
a challenge just in the laboratory. On a tiny lens in the field? I'll believe
that when I see it, and this is just the second step! (Getting the sample is
the first) The specimen still has to be stained.

While RBCs with their hemoglobin do _en masse_ make blood red to reddish-
purple, individual red cells don't actually show a lot of color without
staining. Nor do white cells; they just look a bit larger and grainier than
reds. To better examine cell structures, a stained specimen is needed. The
standard analytical sample is a Wright stained thin film smear, which requires
three different stains be applied and washed in sequence. This stuff doesn't
just wash off, either, so don't expect to use the same lens twice. Again,
however, that's not what the project actually claims to do. What it _does_
claim, on the other hand, strains credulity in other directions.

Sad to say, but a half-sphere lens on a phone camera does not a microscope
make. Without going too deep into details (I hope), proper microscopy requires
close attention to the properties of light and lenses. You can't just point a
powerful lens at a specimen and expect to get a good image. You also need to
ensure sufficient lighting, proper contrast, and _control your depth of
field!!!_

I cannot emphasize that last point enough! Even squashed nearly flat under a
cover slip, any specimen you examine is still three dimensional, with details
you can only see by shifting the microscopic stage up and down by _very_ small
amounts. The depth of field is very narrow. A professional scope's fine
adjustment is fine enough to shift focus on a cell from "front" to "back" and
anywhere in between. As you might imagine, that requires keeping the stage
very, _very_ still. That's why scopes _have_ specimen stages. You won't get
that out of a phone camera without clamping it down.

That's what made the article's statement so interesting. If an acceptable
specimen could be obtained by smearing the lens directly, the fixed position
might allow for proper analysis, but that's not what the project purports to
do.

It might be interesting to see where this project goes, but at this point,
it's still looking very alpha to me. I'd wait 'til they show this thing in
action.

EDIT: Minor spelling error.

------
john_horton
[http://www.quora.com/How-important-is-accurate-diagnosis-
in-...](http://www.quora.com/How-important-is-accurate-diagnosis-in-a-
comprehensive-plan-to-fight-malaria)

------
sliverstorm
Hope they've considered the fact that the sample will need to be cleaned off.

------
drdaeman
Is it a Windows Mobile advertisement?

------
tedjdziuba
> Enter Cy Khormaee, a Harvard Business School student, and his team at
> Lifelens.

I believe you mean "HBS Student Takes Credit for People who Created an App to
Detect Malaria".

~~~
localhost3000
It's a Boston-centric publication. Why wouldn't they anchor it to one of
Boston's best known institutions?

If it said "Harvard grad student" there would be far less vitriol here. The
fact that it is someone at HBS getting some startup press really pisses you
off - doesn't it?

