Why are burns victims dying earlier?
Treatment for severe burns is better than ever, but some survivors are succumbing to unrelated diseases much earlier in life.
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Acclaimed burns specialist Dr Fiona Wood has seen the kinds of trauma that would reduce most of us to a blubbering mess.
She performs miracles daily, regularly treating patients with deep and widespread burns that would have been fatal a generation ago.
At Perth’s Fiona Stanley Hospital and Children’s Hospital, Dr Wood and her team don’t just work on treating the immediate trauma, they also strive to ensure patients have minimal scarring.
“For a coffee scalding of a child, which happens so often it’s frightening, we are now at the point where 80 per cent of our patients leave with no visible scarring,” she said.
It’s breakthrough medicine but Dr Wood noticed that, although patients survived, and others left scar free, unexpected conditions began to emerge.
Her concern was triggered when a 7-year old who survived a massive burn successfully made it through treatment and the rehabilitation, only to die three years later of a rare cancer.
It was a huge blow after the many years of treatment, and the relationship she had developed with the boy and his family.
“We see trauma that other people shouldn’t see,” she said. “I think my coping strategy for many years has been that whenever something is so distressing I have to learn from it. To make sure I honour that death by learning how to reduce the level of suffering in the future.”
Dr Wood and her team set about exploring whether the burn, or anything along the continuum of treatment might have contributed to the onset of the severe and fatal cancer. At international conferences other doctors had anecdotal evidence of patients later developing life-threatening illnesses but there was no easy way to find out if the theory was supported by the evidence.
“Having a burn requiring hospitalisation will change your life trajectory. It appears to unmask the diseases of ageing, but we don’t know why”
“We found an individual case that was unexplainable. And when we looked at the big population health database we started to see patterns emerge of the acute burn changing into a chronic problem that we never imagined we’d see,” she said.
It’s not just cancer that emerged as an issue. The Fiona Wood Foundation cross-referenced 30,000 burns patients with 120,000 non-burns patients on the West Australian health database and found other anomalies.
“Having a burn requiring hospitalisation will change your life trajectory. It’s not just cancer, it’s everywhere you look — infection, heart disease, gut problems, neurological problems. It appears to unmask the diseases of ageing, but we don’t know why,” Dr Wood said.
“I don’t have 30 years of research left in me, so how can we look for this needle in a haystack?”
After seeing a demonstration of IBM Watson winning the game show, Jeopardy, Dr Wood found a potential solution.
Lead researcher at the Fiona Wood Foundation, Dr Mark Fear is in charge of the program to mine the corpus of information out there that may hold the clue to why burns patients are dying early.
“I can only read three papers in a day even if I work really hard. I can’t read 30,000, 40,000, 30 million without some guide on where to look. The data is coming out so much faster, there’s no way to keep on top of it.”
“Watson gives an ability to rapidly assimilate the literature, rank them in terms of importance, and to find the links between burns and other diseases,” he said.
The institute already has a number of promising leads, which can be explored using the technology. A scar is the body’s fibrotic response to an injury, where connective tissue is laid down to repair the wound. However, Dr Wood and Dr Fear suspect that the process of scarring may be causing the immune system to itself change. It’s as if the immune system, in protecting one part, is creating diseases elsewhere.
“We know that a burn on the back of your hand will change the nerves on the opposite side. It will change your brain. And it will change the cell bodies around the spinal cord,” Dr Wood said. “We’re trying to understand how that happens.”
“I am an absolute believer in harnessing the power of AI”
With Watson the institute is mapping and identifying pathways that may be driving the fibrotic response and that may be linked to the long-term health problems. The technology is allowing them to process far more data, and better search for signals among the noise.
“When I did my honours project after university I was sequencing a single piece of DNA 500 bases long,” Dr Fear said. Now you’re sequencing the genome in a day. What PhDs are doing in our lab now, I just wouldn’t have been able to do in 50 years.”
According to Dr Fiona Wood, a “paradigm shift” is now taking place in medical research.
“I am an absolute believer in harnessing the power of AI. To do that we need to engage with the data. It’s also the cognitive offloading, such that we can focus in and change the speed at which we do things and the capacity to get the answers. That’s the way forward.”
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