Healthcare, medicine & pharmaceuticals

Medical identity theft up

An American report on crime in 2007 found that more than 250,000 Americans a year had experienced medical identity theft. This figure is sure to have risen, with continued electronic storage of medical records. People who have their identities stolen become liable for thousands of dollars of medical bills that they have never incurred. Worse, they often do not find out until they are in an emergency.

The thief may use your name and Social Security number, or stolen insurance information, to impersonate you. The only way to stop this is to have more rigorous security procedures in place, in the same way that banks have stepped up online security. Unfortunately, protection available under the Fair Credit Reporting Act for traditional identity theft is not available for medical theft and victims can be liable for many years and suffer a low credit rating, until the case is resolved. Privacy laws even demand that the thief’s medical records contained in your records must be kept confidential!

E-records and systems-thinking in healthcare

Only 17% of doctors and 10% of hospitals in America have basic electronic systems for patient records. So the Obama administration intends to spend over US$19 billion to remedy that, in the belief that it will save money in the long run. It should also improve quality of care because doctors will have a better understanding of the overall system, such as interactions between drugs, the spread of illnesses, and new treatments.

There are two groups that will want e-records – doctors and hospitals – and it is understood that hospitals are more likely to have the funding and the enthusiasm to want to go ahead with it. Doctors and hospitals that make “meaningful use” of e-records will be rewarded via Medicare or Medicaid funds. The danger of such a system is that various vendors, like General Electric and Siemens, will be vying for the job and the hospital e-systems used now will need to be fully compatible with any doctor systems that may follow later.

Medical records will be much more complex than, say, banking transactions. In health care, there must be standardised codes for every illness, treatment, or problem, otherwise it becomes difficult to share that information. Sharing information is a crucial aspect of keeping electronic patient records and is also liable to medical identity theft, as noted above, so there must be rigorous safeguards. Whatever is easy to share, is easier to steal.

X-rays and the algorithm method

Healthcare is increasingly moving towards predicting illnesses in advance, rather than waiting for them to materialise. Early predictions encourage people to take steps to reduce the chances of succumbing to them. One example is osteoporosis of the knees because, once someone has it, there is very little they can do about it.

A new technique, developed in America, uses a computer program to analyse x-rays of the knee to give early warnings of osteoporosis. Researchers analysed digital x-rays taken in the 1980s to detect any chemical or structural alternations in the cartilage and bone that were associated with degeneration of the joint. They then used a computer algorithm to predict which knees were most likely to suffer osteoporosis later; it was 72% accurate, nearly 20 years before symptoms were reported.
If this concept were applied more widely, and algorithms used to predict other illnesses, then healthcare would become cheaper as people would use less invasive methods of taking control of their own health before problems could develop.

Is fighting illness making more people sick?

It may be easier to raise funds for research into high-profile diseases like AIDS, malaria or TB, but money spent on this is diverted from improving health systems in poor countries. According to a WHO report, development assistance for health increased four times from $US5.6 billion in 1990 to $US21.8 billion in 2007. Until now, it was not known how that money was spent and whether it was directed effectively towards the everyday work of hospitals and clinics.

One problem is that healthcare workers tend to move to international organisations for high salaries. The programs that they join may address issues of “global importance” but the report wonders whether they “serve the specific needs of the countries” they are in. Even so, 3 million HIV sufferers now have access to drugs, 23% of children now sleep under pesticided nets and global immunisation rates have increased.

While many healthcare systems appear to be in a poor state, this cannot all be blamed on wrongly-directed funding programs, so much as decades of neglect and insufficient investment combined with civil and political unrest and poverty. As the rich countries tend to reduce their donations in a recession, it will become more important for organisations to justify their spending and ensure that it goes where it is sustainable and effective, not just on popular projects.

The future of flu

First it was avian flu; then it was swine flu. While many of us might claim to have “the flu” when we have the sniffles, seasonal influenza kills about 30,000 people in the US each year. The fact that only a few people have died of swine flu suggests it is not quite the danger it once looked. But experts say it is too early to tell. The world’s policymakers, according to The Economist, “should not be fooled into thinking” that the new virus will go away for long, even if cases decline for a while. So far, the virus has affected 168 countries in all continents.

A New Scientist poll asked health officials, epidemiologists and flu researchers how they viewed the swine flu pandemic, in particular, how worried they were, how well their country was prepared, and how they would prepare their families. Half of them were concerned about their nation’s ability to cope and half had taken at least one special measure to protect themselves or their families from a severe outbreak of swine flu. Two-thirds thought higher virulence was possible but only a few said it was likely.
More serious is the possibility of a hybrid virus, where someone already infected with bird flu contracts swine flu. The other problem is the possibility of resistance to the drug, Tamiflu, which is widely stocked for this epidemic.

Only three flu pandemics were studied in detail during the 1900s, so we may not be able to predict with any certainty how this one will behave. But it is as dangerous to overstate the dangers as it is to be too complacent. When the WHO raised its six-point pandemic alert to phase five, it gave international media a field day. But, as one commentator said, “flu has surprised us before”. Predicting the future of flu is difficult.