Dr. Azizi Seixas: The Importance of Equitable Healthcare

University of Miami’s Miller School of Medicine recently announced that renowned Dr. Azizi Seixas and researchers at the University’s Media and Innovation Lab (TheMIL),  have launched the MILBox program – a groundbreaking study supported by Amazon Web Services and Open Health Network that will use data from wearables and in-home sensors to create “digital twins.” With this information, health care practitioners could apply AI to an individual’s digital twin to virtually test/evaluate various treatment options and potential outcomes before applying them in the physical world.

DocWire News spoke with Dr. Seixas, who was selected by Cell Press as one of America’s most inspiring Black scientists in 2020, about TheMIL’s mission is to create and accelerate the development of personal/precision healthcare technologies that are accessible and equitable for greater populations, especially those who encounter barriers to affordable healthcare/health maintenance.

DocWire News: Can you provide us with some background on yourself, and your speciality?

Dr. Azizi Seixas: Sure. I’m associate professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine and the founding director of the newly formed Media and Innovation Lab, which is the… I think state of the art academic center that focuses on health technology and innovation, but not with the ultimate goal of being a venture studio spinning out commercial program, but more so centered in the entire mission, is being a trusted source of information and resource to the public. And so we focus on population health equity, as well as, just creating the next generation of innovations that people can use right now, as opposed to the next 10 years.

Can you talk to us about the University of Miami Miller School of Medicine’s Media and Innovation Lab’s MIL Box Program?

So, the MIL box is really part of a flagship solution in our research vertical. Myself and my colleague, Dr. Girardin Jean-Louis were both awarded national institutes of health funding to tackle some core fundamental public health issues around Alzheimer’s, dementia, as well as cardiovascular disease among Blacks and Hispanics. And so what we did from this was that when COVID hit and or patients and or participants were reluctant to come into the office for us to do just basic research operations and to do physicals, this was an idea that I’ve had for the last four or five years. And we kind of accelerated the progress on the creation of the MIL box and essentially what it is. It’s a remote health monitoring solution that captures a wide variety of clinical, as well as behavioral and environmental factors.

So we send to people’s homes, it’s called the MIL box because you get it in the MIL box in many ways, and it has ambulatory blood pressure monitor. It has a ring that measures cardiopulmonary coupling. It has two different watches that assesses sleep and wake activity. It also has a MiFi, which is a hotspot because all those devices are going to be tethered. It has a smartphone because we send people information and questions because we are trying to capture their lived experience in the moment. And we send a scale and we measure their ear quality as well, such as, PM 2.5 on temperature and humidity. And essentially what we’re creating is an opportunity for us as a healthcare system to fill a significant void in the amount of data that we have on our patients, especially in between visits. Right? And because oftentimes we rely on patient’s word of mouth and that’s great, but there is oftentimes a recalled bias. And also it does not provide moment to moment assessment of real data.

And so in many ways, the MIL box satisfies two core things. It provides an operational apparatus to conduct research remotely. It also provides a remote health monitoring solution that health systems, as well as clinics or cares, could facilitate whereby it can extend treatment and care for health systems but also it allows a new way, a new paradigm whereby people who may not have insurance, then they might be able to participate in some form of remote health monitoring that, to be quite honest is much, much better from a standpoint of providers because you can actually act much quicker and you can do a lot more preventive care.

And the other third value proposition of the MIL box is that not only does it provide apparatus for research and an apparatus for remote health monitoring that could potentially drive down cost, but it creates an opportunity for us to really fulfill our promise of precision and personalized medicine, where once we’ve collected sufficient data on the individual, because in our studies, we are monitoring people over a seven day period, over 24 hours. And this will allow us to create digital replicas of individuals. And our hope is that from there, once we’ve had sufficient data, we will then be able to create what we call digital replicas of the system. What happens behaviorally, what happens digitally, what happens with your environment, how that influences your different clinical factors. And this will be almost like your own personalized algorithm. And what that allows for us to do meaning not just us as clinicians and researchers, but also everyone in the healthcare system whereby, we can provide a lot more precise evidence based recommendations.

So, if Mr. Rodriguez is having a problem with his diabetes, we can’t just look at Mr. Rodriguez’s diabetes as just his own doing where he needs to reduce the amount of carbs and sugars that he’s ingesting or eating but instead there might be a whole host of contextual behavioral and environmental factors that might be impacting him. He may not be aware of that, physicians and treatment teams may not be aware of that. And so we might be able to pick up upon these new wants interactions, that impact Mr. Rodriguez’s ability to control his glucose level. And that will lead to hyper personalized solutions. But here is where it doesn’t enter up. What it also provides is that it allows us as treatment teams to actually start to simulate potential reactions to treatments.

So, one of the things that we know and I’ve oftentimes said is that, there are about 20% of individuals who should not be on certain statins, and these are certain types of medications. There are ways in which you can minimize adverse reaction to these types of medications. And one way to do it is through pharmacogenetics but another way to do this is to… When you’ve learned, Mr. Rodriguez is you need algorithm, his biochemistry and his behavior and how all of that is nested within an environment. You can actually simulate to see how Mr. Rodriguez will actually respond to a particular medication before you even give it to him. And so this will actually reduce adverse reactions, it will increase adherence to treatments and it will lower costs. So those are the three to four value propositions of the MIL box.

How big an emphasis does this program put on helping traditionally underserved communities?

It’s huge. So the three studies that we’re currently rolling this out on focuses on black and brown communities. And this is the DNA of the media and innovation lab that we believe in health for all. Okay? So while others may focus on health equity, which is important, but the fundamental reason behind health equity is that, if everyone has, not just equal opportunity, because I know some people oftentimes talk about, well, health equity is about equal opportunity, but we know that there’s some people who might be more privileged to either take up that opportunity. And so we want to actually increase level of access to these types of digital solutions. And there’s a huge focus on that.

No, I don’t think we’ve solved everything per se, but in many ways what we can do, and this is why we’ve provided in and released… Put out these press releases because while we are working with large companies like on Amazon, on Open Health Network and we’ve partnered with a T-Mobile and we’ve partnered with Everly Health and all these other companies that… Some we are partnered with in some ways that if we can bring great minds, great companies together, we as researchers, we as scientists, we as clinicians can develop the technology, but we’re going to need everyone else to come in and to support us so that we can skill this, so that it’s not just focused on urban areas. We’re focused on rural areas as well, because there is great need throughout the United States.

How has artificial intelligence enhanced precision medicine, and what is the future of precision medicine?

I think it can help significantly. And I think what we’re trying to do with the MIL box is that instead of just relying on programmers to actually create these algorithms top down, what we are generating is essentially data on underserved communities that individuals… Data scientists and computer scientists don’t actually have. And so we are answering that call where people who might say a well, a particular sense or algorithm does a horrible job detecting respiratory systems or pulse oximetry in people who look like me. And so what we’re saying is that should not be an excuse anymore. Instead, we need to ensure that if we are creating an AI solution, then AI solutions must actually benefit all, its responsible AI.

And so what AI will be able to do from a technical standpoint is that once we’re able to get as much information as possible, and this could be an iterative evolution where we can foresee someone using the MIL box over long periods of time, and therefore the AI will be able to detect exactly what are the idiosyncrasies of that particular individual. And so, AI can help to create models that focus on certain disease states or it would be a general health and wellness algorithm as well. So AI plays a huge role in terms of understanding what might be driving certain diseases and wellness outcomes, but it can also help to optimize solutions and to find the right recommendations and solutions.

You were chosen by Cell Press as one of the most influential black scientists in America. How important is diversity in the scientific and medical communities?

It, my friend, it’s huge. It’s absolutely huge, my friend. It’s huge. Here’s why, what we do know, in terms of creating a world that is just equitable. We’re not saying that people who look like me should have a monopoly on doing this type of work, right? So I have phenomenal colleagues who are not black, or who may not be racial, who may not identify as a racial, ethnic minority. However, what the research has born oath is the fact that, racial, ethnic minorities are more likely to do this type of work in terms of ensuring that there is not only just representation, but there’s influence at the table. Right? And so what we think and what we are trying to do is that, not only do we believe that representation is key, but we also believe that we understand the lived experience of black and brown folks and racial, ethnic minorities.

And so some of the questions that we might be queued in on, or some of the significant determinants that others may not be queued in on, because it’s just not their lived experience. This is where we can push science to the next level, right? Because oftentimes if we continue to look at the usual suspects of risk factors, then what we’re doing is that we’re not really kind of advancing science and coming up with new ideas and new solutions, instead we’re just kind of reinventing the wheel. So diversity provides diversity of perspective, diversity of ideas, diversity of solutions, diversity of methods, in which we can understand these diseases and health and wellness, as well as diversity in the way in which we can create solutions.

And lastly, we do know that in order for people to actually participate in the entire healthcare journey, that they must be engaged. And so, engagement with the community is key. This doesn’t mean that I believe that a monopoly on engagement with regards to racial, ethnic minority groups are underserved communities, but what we have done, and this is what we’ve done with our studies is that we actually have a community steering committee that helps to guide the direction of these studies. So it’s never just us sitting in our ivory tower. We have the community right beside us keeping us anchored. And that is what AI and precision and personalized medicine must do, if it wants to be inclusive where health is for all.

Is there any other research you’re currently involved in that you would like to tell us about?

Sure, we’re doing a ton. So here’s what people can look out for in on the horizon. Is that the MIL box is our remote health monitoring solution. What we’re trying to upgrade that, we’re trying to upgrade it where you don’t necessarily need to depend on devices. Instead, you may have a smartphone and we can do basic clinical vital examination and we’re creating new solutions that will allow us to do that. But also if we’re using sensors that we want to ensure that when you do facial recognition of someone with darker skin neck, it doesn’t give error readings or inaccurate readings. So we are focused on that as well, health for all, but then we are evolving the MIL box into the MIL box DTF, the digital therapeutic, tackling issues, such as Alzheimer’s dementia and aging, tackling issues are on perinatal care, particularly among black and brown moms. And so these are some of the things that we are focused on.

We’re not just the health monitoring, but also creating digital therapeutics, sending to people’s homes, making it accessible, but also today we’re launching a flagship seminar series free, where we’re partnering with some of the top digital mental health companies, where we are offering a solution. We’re offering ourselves as a resource to the community. The one thing that we know that COVID has done, it has turned our families and our country and our world upside down and right side up and upside down again. And so our kids and our families are suffering from tremendous emotional and mental health issues, as well as just having their adequate social and emotional learning development.

So here’s what we’re saying. There’s so many of these digital mental health solutions out there, parents just don’t know, especially in under served communities. So what we’re saying is, we’re having a free seminar and if you can’t attend, it’s going to be on our YouTube channel so you can see, and we are going to have these companies come in and talk about your solution. Talk about how to use this, because we don’t know how to use this. And this will in many ways solve an issue that we have.

It’s hard to gain access to a mental health practitioner. It’s hard to actually find the time to have access to a mental health practitioner. And it also reduces the amount of stigma because people don’t want to be seen or be known that they’re actually going to a therapist, although that should not be the case, but having a digital mental health solution can actually, in many ways, buffer feelings of stigma and it can, in many ways, provide access in an on demand way where you don’t have to take off from work, take off from lunch or anything like that for giving to see a therapist. Instead, all of those things in terms of mental health resources are on demand and you can access them at any time.

Any closing thoughts?

Well, I just want to thank you so much, Rob, for giving us the opportunity to really talk about the work that we’re doing, and we believe that we have a moment. We have a moment that can evolve into a movement. We can’t do it alone here in The Media and Innovation Lab. And we truly, truly want your audience to come join us, reach out to me at the University of Miami. And I am willing to hear and work with anyone who has the vision and mission to make sure that health is for all. And we can use digital technology as the means by which we can tackle some of our more vexing, unseemingly intractable health issues. And so, this should not happen under our watch, it will not happen under our watch. And we’re inviting everyone to be part of this moment to be part of this movement.