Songs of ANAGURA | The Characters Appearing in Anagura

Searching for spatial information science that would be useful for
everyone in the future,
the Anagura researchers went to meet six researchers.

I am developing devices that transform people's information into value. The first is Shiawase [Happiness]. I am studying methods of making biometric information useful for health in preparation for the time in the near future when an ultra-small biometric sensor is completed. When I heard about a researcher using biometric information to treat and prevent lifestyle-related diseases, I went along to meet him at the university hospital where he works.

(At Kyushu University Hospital on a certain day in the year 2011)

Researcher: You specialize in diabetes. What are the problems now in the world of diabetes?

Nakashima: According to the results of a statistical survey conducted by the Ministry of Health, Labor, and Welfare in fiscal 2007, there are 8.9 million people in Japan suffering from diabetes. This figure is increasing today, but the problem lies in the way it is increasing. The number is continuing to rise at an accelerated rate. Even if medicine does its best, we cannot decrease this rising number of patients. Moreover, medicine is powerless in dealing with the estimated 13.2 million people who have a pre-diabetic condition.

Researcher: When the pre-diabetic people are included, then, this means one in six of the Japanese people have diabetes. This is a startling figure. What do you mean when you say that medicine is powerless?

Nakashima: In the case of diabetes, there is a gap between what the administration expects medicine to do and what medicine actually can do. About five million patients are visiting hospitals as outpatients, but the remaining patients, nearly four million of them, are just not bothering. There is a strong possibility that such patients will eventually suffer from complications. Rather than the condition itself, diabetes becomes a serious illness when it advances and complications emerge. Then patients have to begin receiving treatment whether they like it or not, and this involves enormous national health insurance costs. [Note 1] It is only patients who visit hospitals who incur medical expenses. Unless symptoms appear, people with a pre-diabetic condition don't go to the hospital, do they? As much as possible, we should really be treating the pre-diabetic stage, thereby preventing the disease, but at present there is only an after-the-fact response. That's the problem.

Researcher: Why do diabetics and pre-diabetics not bother about their own illness?

Nakashima: In the case of cancer and heart disease, almost all people receive a medical examination when symptoms appear. For example, about 500,000 people a year get cancer, and almost all of them go to see a specialist sometime. It's a critical illness after all. But when diabetes occurs, since it is not painful or itchy, people think they don't need to bother. If this situation continues, however, Japan will go bankrupt. Already the working population is declining because of the low birthrate and aging. If we also lose people in their forties and fifties, at the prime of their working lives, to complications from diabetes, labor productivity will fall significantly, and it will become impossible to support Japanese society. And needless to say, the people who suffer most are the patients themselves.

Note 1: According to data released last year by the Ministry of Health, Labor, and Welfare, of total medical expenses of ¥34.8084 trillion in fiscal 2008, medical expenses for diabetes amounted to ¥1.893 trillion, up ¥42.2 billion over the previous fiscal year. The increase of diabetes and the increase of national health insurance expenses are a threat to national finance.

Researcher: That's precisely why preventive medicine is so important, isn't it? Could biometric sensors play a role in treating and preventing diabetes?

Nakashima: I am very hopeful indeed. The day when patients visit the hospital is not a normal day. It is a special, abnormal day. Since diabetes is a lifestyle-related disease, it is necessary to understand a patient's normal everyday life. I often hear stories about patients who are particularly careful on the day before a medical examination only, and then after the examination is over go and eat greasy Chinese noodles on the way home. In that sense, a biometric sensor would be useful in recording real-time everyday information.
Also, when they visit the hospital, I ask patients about their daily lives, but they tend to conceal the truth and embellish their replies. For example, when I ask about exercise, the patient may say that he took my advice and tried his best, but actually that is not necessarily the case. It seems that when they come face to face with a doctor, Japanese want to be praised, so they tell lies and pretend they are following instructions. The biometric sensor would be effective in reducing such fabrication and increasing the amount of objective data.

Researcher: I see. The biometric sensor would be effective on the front lines of medicine, wouldn't it?

Nakashima: There is one big problem, however. The explosion in the amount of information available is inundating the world of medicine as well. That is to say, the surplus of information is paralyzing our hospitals. Since the capacity for gathering information and sharing information has increased drastically thanks to the advance of information technology, people tend to jump to conclusions and think that, say, doctors and patients can easily share information or data can easily be visualized in a graph. But that is a headache for doctors. For example, even if a patient continues to send an electrocardiogram from his home for 24 hours, the doctor has no time to continue reading it. In the present situation in which the high-level information processing of data received depends on human beings, there is a complete overflow of information in hospitals. Doctors are being forced to take responsibility for this flood of unprocessed information.

Researcher: What is your solution for this problem?

Nakashima: After organizing the explosive amount of information, I think it is necessary to supply patients with appropriate information at the proper time. We believe that such information can be effective as a drug, just like ordinary medicine, so we call it the "Info-Medicine." In other words, we prescribe information as a drug.[Note 2]

Note 2: The "Info-Medicine" is proposed by Professor Haruyuki Tatsumi of Sapporo Medical University.

Researcher: How will the "Info-Medicine" be prescribed to patients?

Nakashima: Diabetes has few subjective symptoms, so it is important to change attitudes and encourage people to act. For example, even when patients do go to the hospital, they don't see any visible effects of treatment for diabetes, so there is a strong tendency for them to get fed up and think of not going to the hospital. At such times, even an e-mail saying "Don't forget your medical appointment tomorrow" has some effect. Or an e-mail might be sent to check on the patient's condition, saying things like "You haven't measured your weight recently, have you?" Recently accelerator sensors have progressed, so when a patient lacking exercise uses an elevator, the advice might be, "Use the stairs next time!" And conversely, when the patient follows advice, he or she can be praised.

fig.01 Image of a Patient and the "Info-Medicine"

Researcher: It is important to deliver such information just at the right time, isn't it?

Nakashima: Since it is possible to detect dangerous signs by acquiring biometric data almost in real time, the danger can be avoided by supplying information to the patient. At such times, the important point is proper timing and appropriate information. Also, since the patient himself knows only too well that he is not getting enough exercise or not measuring his weight regularly without being told so by others, it is important to transmit the information in a manner that doesn't rub the patient the wrong way. Sometimes it is important to give praise, sometimes to admonish in a strong tone. An extremely human approach is necessary.

Researcher: How will the "Info-Medicine" be made?

Nakashima: From the point of view of the medical side, the "Info-Medicine" supports the processing of information by the medical provider. The establishment of this mechanism is a solution to the explosion of information. In preparing the "Info-Medicine," first of all we made a medical blueprint of standard judgments that anyone would make---in other words, a manual showing the shortest medical process. We call this the "critical path." This term is used for the systematic control of power generation plants as well. If this critical path is used as a yardstick, judgments in this area need not be made by doctors but can be made before a medical examination by medical providers other than doctors.

Researcher: So the critical path is a tool for enhancing the efficiency of medicine.

Nakashima: On the other hand, in the treatment of lifestyle-related diseases, individual patients require different guidance. In many cases, the same method cannot be expected to have the same effect. If an "Info-Medicine" were concocted based only on the results of biometric tests on one patient, even if it were effective for half of the other patients, the remaining half may react to the message of the "Info-Medicine" and might even become angry. It will be necessary to create individual profiles, including personality and situation, and accumulate knowledge about what "Info-Medicines" are required by what kind of people and how they can be prescribed so as to bring about a change in behavior. What is required here is objective information, so the biometric sensor will be useful. As data accumulates on patients' changing physical condition due to everyday lifestyles and analysis advances, gradually effective ways of prescribing the "Info-Medicine" will come into view. The algorithm for determining what "Info-Medicine" is best for a certain patient will become more accurate. As a result, patients will be able to change their behavior in an agreeable manner.

fig.02 Image of Information Circulating Between Patient and Medical Provider

Researcher: Moreover, the sharing of such knowledge could be utilized for patients who are not going to the hospital at present and pre-diabetic patients, couldn't it? I hope that we engineers can also help in forming this knowledge.

Naoki Nakashima Associate Professor, Chief of International Medical Relations Office, Medical Information Center, Kyushu University Hospital

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