The vision

In the Western world the incidence of IBD has stabilised – but it far outstrips mortality (by 5 to 1) so prevalence continues to rise.

Scotland and Canada are expecting to hit 1% any moment now. Elsewhere IBD continues to rise inexorably.

As the world adopts a western lifestyle it is IBD and not just type 2 diabetes, obesity and cancer that is grabbing the world’s attention. The food industry is under intense scrutiny. Too much animal protein, food processing and additives (especially emulsifiers) are prime targets. We are only just realising the enormity of the problem – how do remove them whilst feeding a planet that once starved. Global food security is a planet-wide emergency.

This is a truly global problem that needs global solutions. Solutions that are scalable, that are deliverable to individual patients as well as communities, solutions that are precise and personal

The taps are fully on at both ends.

We still do not know what causes IBD, nor do we know how to stop it. There is no known cure. But medicine(s) are getting more targeted and more effective. Combinations of drugs are being combined just as they were with HIV and Hepatitis C.

Patients are prescribed tailored therapies AND dietary solutions AND microbiome pills. These are relatively crude attempts at precision for now but they are getting more precise.

At diagnosis patients now have bloods taken for serum protein analysis and DNA extracted for whole genome sequencing. A full dietary and micronutrient analysis is performed. Stool samples allow microbiome sequencing. The first endoscopy is read by the GI and a machine, the same for the biopsies. These are sequenced – every single cell type. More data for the machine. Data data data. IBD has revealed itself as the ultimate #bigdata problem.

And this is just at the beginning. What will it tell us? What can we learn? What drug for what patient at what time? What dose? 1 drug or 2 or 3 – what combination? What diet strategy? Diet alone? Stool transplantation? Who? What? Where? When?

IBD is all about big data to build predictive models.

Data is streaming into research teams from hospitals (as above ) but also from patients direct – straight from them and their 1000 dollar supercomputers – their smartphones.

A digital photo provides full nutrient analysis on a meal, daily stool analysis is performed by a Bluetooth enabled adaptor, plus tracking (ACTIVE and PASSIVE) … exercise and sleep and travel and mood … your phone provides data …. It will even unlock toilets.

We have had virtually no predictive ability in IBD. We have had increasingly effective therapies and better monitoring strategies (out of necessity). But for too long our patients have been treated reactively.

A patient gets symptoms, there is a delay, a diagnosis of IBD is made, already there is bowel damage, we make our best guess at the right starting treatment, option 1 makes the patient sick due to side effects, option 2 does not work and option 3 is only partially successful. All the time the inflammation continues to grumble and irreversible bowel damage accumulates. Eventually it is too much – the patient has a blockage – an operation is needed. Bowel removed – maybe a stoma. They are well for a while, move house get married new job … they feel well. But the inflammation has recurred – silently first – then it hits a threshold and bang – a patient not seen for 5 years is admitted as an emergency in the middle of the night – another operation.

All of these mistakes – they are all data points – we can accumulate them all from the many hundreds and thousands of patients (half a million in the UK , many more globally) and we can start to learn

To learn more we watch people in real-time – many of the same mistakes are being made, the same lack of predictive ability is a huge problem

But now we monitor along the way and we sample – blood, saliva, biopsies, stool – microbiome, single cell analysis etc

Every point is a data point

We collect data from patients at source – they can do this digitally

We find out how THEY are doing at each point – how is this affecting their LIVES- sleep, mood, energy, relationships etc etc

More data now – we really can start to build modes

And now we have systems in place – systems to provide care & collect data

The data has started to feed algorithms – we start to have predictive ability

We are now in 2025 – patients control their care via their smartphones – data in, recommendations out, communication and SUPPORT – psychological, social, community – hyper-personalized – wherever they are in the world

They still get disease

They still get flares

They are still prone to depressive attacks

The drugs are not perfect

But we use the data to navigate a path through all of these decision points so that they can help make all the best choices – including lifestyle, including dietary and microbiome manipulation, including CBT meditation and personalised training plans

This gets better and better for the system continues to learn

And finally … we have enough data to know the who and why of disease onset

So patients are no longer patients – from birth we navigate not just patients but whole societies away from the complex environmental, sociological and physical factors that lead to disease

This is IBD

But this is any common complex disease

And this is life

This is true data driven innovation and a realisation of our near future