Praxeon Blog

MyDailyApple Upgrade : Redesigned and Community-Powered

MyDailyApple has always included the best objective health information on the web. But sometimes news and medical research is not enough. Often, it's a real person's experience that helps you gain that key insight to better understand your health.

So starting today, MyDailyApple will include the discussions from the best on-line health communities. Real patient experiences - relevant to your interests - will be on display in a new "Your Communities" tab. You will have the ability to read, interact and discuss with real people - similar to you.

The community discussions are just the start. You will also be able to recommend or criticize articles to other members of the MyDailyApple community. Reading and commenting on an article is just one of the ways we're making it easier to learn about your health while helping others.

We've also made a few other improvements to make your health exploration easier:

• New site organization making it easier to find and read the information you're looking for.
• A remember topics section to more easily remember your health interests.
• A medical expertise selector that lets you control the type of content displayed by your level of expertise and comfort.
• The ability to view your news just for today, or to catch up on developments over the past week.

There are a few more improvements too - but we'll let you discover them on your own!

Now more than ever, in one place you can find the right health information - whether it's news, research, blogs, discussions, medical reference, or clinical trials - relevant just for you - right when you need it most. And all with the opportunity to learn from and inform other patients like you.

The new MyDailyApple: Learn your Health and Help Others.

Praxeon Provides Medical Research for Kosmix RightHealth

New Service Helps Consumers Find Medical Literature In Their Health Search

Boston, MA – August 11, 2008 – Praxeon, Inc. announced today that its consumer health news and search site, MyDailyApple™ (www.mydailyapple.com), will provide advanced reading content for Kosmix™ RightHealth. RightHealth searches the health Web and categorizes it into useful modules for consumers giving them the relevant information they need to explore and learn about any health topic. The “Advanced Reading” module will now feature medical literature served from MyDailyApple. MyDailyApple’s evidence-based material will give RightHealth users access to the latest literature and research breakthroughs relevant to their query.

“Praxeon's patent-pending semantic fingerprinting, natural language query and profile-based filtering technology is what sets Praxeon apart from other health information and search companies,” said Kevin Cronin, CEO of Praxeon. “Now this technology, combined with some of the most authoritative medical content, will be available on one of the most trafficked health online sites.”

“At Kosmix, we are focused on delivering the most relevant content from a variety of sources – basic facts, advanced reading, expert opinions, forums, videos and images – to users searching for health information online,” said Ravi Raj, vice president of products at Kosmix. “Praxeon’s strong technology gives us the ability to offer millions of RightHealth users with advanced reading material and additional information for their health care needs.”

About Kosmix

Kosmix, headquartered in Mountain View, Calif., takes traditional Web search to the next level by organizing content to let consumers explore, discover and learn about any topic, connecting them to information that makes a difference in their lives. Consumers get a 360 degree view of topics that includes videos, images, reviews, discussions and expert opinions. At the core of Kosmix is a powerful content categorization engine which powers its vertical consumer sites, RightHealth, RightAutos and RightTrips, and the recent alpha of its horizontal platform, Kosmix.com.

About Praxeon

Praxeon’s sophisticated technology is revolutionizing the way people get health care information. Praxeon’s products have been extensively tested and validated by healthcare providers and by more than 20 health advocacy groups. In 2007, Praxeon was voted “Best Health Search Company” at the Health 2.0 Conference in San Francisco, CA.

Comparing Semantic Fingerprinting to other search technologies

Today I came across this Venture Beat post about Twine, which provides an enumeration of technologies by which a computer can come closer to true understanding. I'll repeat that list here and include semantic fingerprinting. I'll go from most complex to most feasible.

1. Natural language. This is the Hard AI problem of teach a computer to read and understand written (or spoken) language. The computer may respond in a variety of different ways, but I think the most commonly discussed is 'question answering', in which you ask a question and the computer tells you the answer. The meme for this seems to be a system that can answer 'Who did Dick Cheney shoot?', and also respond to 'Who shot Dick Cheney?' (as of today, nobody has). Systems without 'understanding' tend to give the same answer to both question. Ask Google and you'll see.
2. Semantic search. This is something of a gray area because there aren't many great examples to point to. But it seems to be essentially an offshoot of the Semantic Web idea, in which people associate structured tags with text content. Semantic search technologies are working more with hard facts than the web search engines of today. However they require additional effort from content publishers that may or may not ever happen (my money is on 'not'). Semantic search systems can do question answering without natural language understanding, because the data they are working on has been specially encoded for them by humans. It's really more like database technology.
3. Statistical analysis and keyword search. Documents are treated simply as collections of words. Some attention is paid to word proximity, and a lot of attention is paid to headings and links, but generally speaking the search engine does not try to 'understand' anything. The power of this technique is that no complex modeling is required on the part of the search engine developer, and no burden is placed upon the content author either. Boolean search has proven to be immensely scalable, largely (as far as I can tell) because the system is restricted to accepting very simple input.

So where does that leave semantic fingerprinting? Semantic fingerprinting is like:

• Natural language, in that the user input is accepted in the natural written or spoken form.
• Semantic search, in that the fingerprint contains true concepts rather than opaque words.
• Keyword search, in that it is based on boolean search technology.

It is unlike:

• Natural language or semantic search, because the output of the system is an organized set of documents, rather than a specific answer to a question.
• Keyword search, because the user input is not limited to keywords.
• Semantic search, because it operates on documents rather than facts.
• Statistical techniques, because a domain model is required.
• Statistical techniques, because the search results are organized according to insight gained from the domain model.

As far as I know, semantic fingerprinting is uniquely suited to search-like problems in which the input is one or more complex statements (optionally combined with restrictive keywords), and the output is an organized collection of documents. Some application examples:

• Presenting medical evidence to answer a complex medical question.
• Showing medical content (e.g. guidelines, alerts) that is related to a patient electronic medical record.
• Guiding keyword-based search results using a patient profile. A keyword or two may constrain the hit list, but the profile strongly influences the relevance ranking.
• Delivering health news and alerts to a patient, based on their health profile.
• Making social connections between patients, and between patients and providers, based on their health profiles and areas of expertise.
• Automatically showing related content next to blog and discussion posts.

The Big Idea : Personalized Health Information

We've all seen the searches in television commercials : 'hypertension', 'diabetes', 'ankle sprain'. But if professional health information is a Ferrari, the typical search results from a simple keyword query is more like a shiny tricycle. The novelty quickly wears off; we know there's a bigger world of information out there, but how to access it?

Being a patient is a journey. There's a period of initial diagnosis, learning basic disease information, then achieving a deeper understanding, gaining experience with the personal aspects of the condition, sharing information and gaining support from peers, and eventually giving back to the community through mentoring or active involvement in patient support and disease advocacy. The journey is complex and personal; health information resources on the web should understand this and support it.

Personalization is the key. In order to go beyond the introductory 'What is Hypertension', a health site needs to learn about your personal health history, family health history, medical conditions, and treatments. From this basic, anonymous, health profile, you can realize immediate benefits

• Personalized health news, selected from the best sources to match your profile
• Personalized search results, highlighting important factors such as connections between symptoms and conditions, side effects, drug interactions, and factors in your family history that may influence diagnosis, risk factors, and treatment.
• Personal connections to other patients that share a similar profile.

You are now 'plugged in' to your condition, continuously updated with relevant information, able to delve deeper into background material and research, and connected to peers.

Next, you'll begin to communicate with your health provider. Personal health records are coming into being in many forms, and there are great benefits to integrating the physician's view of the patient with the patient's own health profile. Using the health profile, the patient is seeing information written for patients, with the ability to venture into more advanced material if they desire. From the physician's point of view, the patient health profile becomes more than a bookkeeping system; it's a window into the best, most relevant, most applicable guidelines and research that they can use to make real-time decisions.

Realizing this vision, a personalized health information system that bridges new patients, mentors, and health care providers, is not a simple task. It is not all about technology, although innovative technology is required. It is not all about discussions and social networking, although effective communication is required. The system we describe can only be built by connecting patients, providers, content developers, industry, and medical information systems, using new technology that truly understands the language and structure of medicine.

This complete solution, this 'Big Idea', is what we're working towards.

You say Segment, we say Archetype

The subject of search segmentation has been coming up lately in the mainstream search engine world. Because we are focused on a particular user group, medical professionals, the notion that each search is directed towards completing a particular task jumped out at us right from the beginning. In fact it's one of the first concepts that Rishi Sikka, our CMO, contributed to Curbside.MD when we began working with him.

Curbside.MD has been operating for over a month now, and we have answered many thousands of questions. Recently, we took a slice of those searches and analyzed them, looking at the questions and the answers that Curbside.MD delivered. We realized that the questions people ask can be binned into at least one well-defined category. Rishi coined the term 'archetype' to describe these categories, and we have been using that word ever since.

So, without further adieu, here is a pie chart showing the distribution of archetypes for professional medical questions (people sometime ask Curbside.MD questions that do not relate to the practice of neurology; these are discarded). As you can see, the most popular archetype is Therapy. These questions concern the best way to treat a patient, and account for about 50% of the total. For example:

• Should sacral meningocele surgery be performed in adults?
• Management of acute myocardial infarction in the setting of multi-trauma

The 4 next most common archetypes are about equally common. They are:

Differential Diagnosis

•       What brain lesions can cause a patient to develop a ptosis?

Work-up

• What is the work-up for a patient with tinnitus and vertigo?

Epidemiology

• Is there a geographic trend to MS?
• Depression and weight gain

Research

• What are the underlying causes of Parkinson's Disease?

For some questions the intent is not clear, or does not fit cleanly into one of the archetypes. We'll be taking a deeper look at these questions and refining our ability to answer them.

Our research on archetypes has given us great ideas for ways that we can improve Curbside.MD, and we'll be describing and implementing many of them in the coming months.

If you have a question about the meaning of a particular archetype, or about an archetype that I haven't mentioned, please submit a comment and I'll collaborate with Rishi to get your answer.

A United Front

You know that you’re on a good path when you have the company of people you trust.  That has been our feeling as we march through the hurdles in creating a trusted medical community.  That company in our case is the Myelin Network.  The network includes organizations such as the Accelerated Cure Project, National Multiple Sclerosis Society, The Montel Williams Multiple Sclerosis Foundation, Hunter’s Hope, The PMD Foundation, and The Transverse Myelitis Association.  We have all united in a mission to do what we can to help improve the health standards for people with medical ailments.

The members of the network are helping by spreading the word about Curbside.MD through newsletters, postings, blogs, and links.  Most recently, we attended the American Academy of Neurology (AAN) conference in Boston along with Art Mellor’s team at the Accelerated Cure Project booth.  Art and his team were kind enough to share their booth with us so that we could present Curbside.MD to people attending the conference.  The conference was a great success and we very much enjoyed the company of Art, Julie, and the other volunteers during our week at the expo.

We believe that our partnerships will soon benefit tremendously by the most recent addition to the Curbside.MD team: Jacqueline Kinlow.  Jacqueline was most recently the Executive Director of the Myelin Project.  She was tremendously influential in creating the network in the first place and now we are delighted to have her lead the charge and expansion of our partnerships.

In addition, the Curbside.MD team is hard at work at creating other tools that we believe will help our partners.   For starters, we are creating a Curbside.MD remote search box that organizations can use to power their sites with our unique medical search technology.  This will provide their visitors with natural language medical search to better find the information that they are looking for.  Secondly, we will soon be rolling out the Curbside.MD Medical Forum that will be context-driven and enhanced by our very own Curbside.MD Consultant.   Our automated Consultant will participate by recognizing medical ideas and providing the most relevant medical evidence to further advance discussions.   Each of our partners will have their own meeting rooms where they will invite members to join and we believe that this will have a big impact in the way that people share their medical thoughts with each other.

We are very excited by these developments and are greatly appreciative of the support that we’ve received to date from our partners.

Are Middle-aged Male Mice at a Disadvantage?

Often the advice given to a woman with multiple sclerosis (MS) is not to exacerbate the condition by becoming pregnant. It appears that this advice is about to change. UCLA neurologists believe they’ve identified a basis for the controversial claim that the MS relapse rate for women during pregnancy decreases.

"Apr. 19, 2007 (KABC-TV) - Doctors diagnosed Melissa Glasser with multiple sclerosis at 15. MS is when your own immune system attacks your central nervous system….Despite this, she didn't want MS to stop her from having the family she dreamed of….For decades, scientists knew that something in pregnancy helped women with MS, but there are so many chemical changes researchers didn't know what to isolate. Now, UCLA neurologists say they think they've figured out the answer."

This report highlights estriol which is made in the placenta and has been observed to have the effect of reducing MS symptoms in women and the researchers at UCLA are planning a larger clinical trial with estriol at multiple sites.

The observation of the beneficial effects of estrogen hormones has been known for many years and it now appears that other estradiol derivatives, such as 17-beta-estradiol, also have a beneficial effect. A simple Curbside.MD search "What effect does estradiol have on the symptoms of MS?" traces what is known about the field from all the major sources of medical information available. Interestingly, there is an on-going clinical trial sponsored by the Hospices Civils de Lyon which hopes to control the symptoms in post-partum women: The POPART’MUS study is a European, multicentre, randomized, placebo-controlled and double-blind clinical trial, which aims to prevent MS relapses related to the post-partum condition, by administering high doses of progestin (nomegestrol acetate), in combination with endometrial protective doses of estradiol (see "Clinical Trials").

Unfortunately men may not be able to expect the same benefits from their hormones; research shows the same protective behavior for male mice does not hold. Middle-aged male mice are very sensitive to the symptoms of MS and are unresponsive to testosterone therapy (see “Best Hits”). In this case MS was induced by injection of homogenized brain or spinal cord with Freund’s adjuvant (experimental autoimmune encephalomyelitis).

Still, if male menopause proves to be a real condition rather than just emotional revenge, perhaps more men would consider estrogen therapy and MS might join the growing list of male conditions responsive to female hormones.

dennis.underwood@praxeon.com