Healthcare, medicine & pharmaceuticals

The unwired hospital bed

The sight of someone you love on a hospital bed joined with tubes or wires to several monitors can be disconcerting. New technology promises to remove those wires and use one single, weightless electrode patch, which consolidates all the others and works with a radio transmitter. The name for this is “epidermal electronics” and it’s part of a growing field, called mHealth, because it uses mobile technologies.

The opportunities for mHealth are endless as so many conditions can be continually monitored from home. The Nuvant Mobile Cardiac Telemetry System can detect arrhythmias using a 5x15 cm gadget on a patient’s chest, which transmits to a nearby centre. Or sensors could be used on someone all the time to detect whether they are at risk of a heart attack. This kind of monitoring will help reduce medical costs and play a preventative role too.

For example, a study in 2008 found chronically ill patients enrolled in a “home telehealth” program in the US experienced a 25% drop in bed days of care, 19% fall in hospital visits, and the average cost was $US1,600 each, compared to $US13,121 for conventional home-based primary care. But relatively few patients are receiving this kind of care today. This may be lack of financial support for patients over 65. Or it may simply be caution about using new technologies. People will have to get used to being monitored without looking as if they are.

Diabetes is the new health monster

Diabetes is a new pandemic, a disease spreading across continents through the developed and developing world. It’s not even a virus. Whether it hits children, old people or the rich, it is an expensive and debilitating disease that demands continuous treatment until death. The drugs are available but, as is often the case, they are not always available where they are most needed. More important, diabetes is a disease that can be prevented.

Let’s start with children. India has trouble feeding its 1.2 billion population and yet obesity and diabetes in children has become a problem for middle class families. Some 23% of urban 5-14 year olds are overweight and 11% are obese. India has the highest number of diabetics in the world – 51 million of them. This is partly because they adopted the same affluent lifestyles as in the West and partly because South Asian people seem genetically more susceptible to it.

Unfortunately for Chinese children, a recent US study found diets rich in vegetables and fruit still led to obesity. Researchers put this down to heavy use of deep frying and stir-fries, as well as increased consumption of Western food. About 20% of Chinese children and a third of boys are overweight, compared to less than 2% in 1985. This is a frightening increase, compared to the rate in America.

According to the American Diabetes Association (ADA), a quarter of US adults have diabetes. In a 199-country analysis, the number of adults with diabetes has doubled in the past 30 years to 347 million in 2008. This is attributed to population growth and aging, as well as unhealthy diet and sedentary lifestyle. Obesity is a risk factor for type 2 diabetes and obesity among children is increasing: more than 20% of American children 2-5 years old are overweight or obese. However, 80% of worldwide diabetics are expected to be living in low or middle income countries in 2030 so the problem is unfortunately not confined to the rich West.

In Africa, where malaria and HIV were the main killers, lifestyle diseases are taking over. The region is used to high starch diets and drought, so people take pride in gaining weight as proof of wealth. Moreover, Kenyans are suffering the “Coca-Colaisation” of their society and the government is considering banning advertising near schools. Africans, like South Asians, also have a strong gene for diabetes.

If 7.8% of the global population will be diabetics by 2030, it will be an enormous drain on our medical system. Moreover, the West overpays for insulin, because there are cheaper versions of it that are often ignored in favour of the expensive versions. Insulin turned 90 in 2011 but does not cure diabetes; it only staves it off. Some $US418 billion was spent on insulin in 2010, which went to a small group of beneficiaries including Novo Nordisk, Eli Lilly and Sanofi-aventis. It could help if health services starter to buy cheaper versions, which would allow smaller companies to produce cheap insulin in competition with the global giants.

With these startling statistics in mind, it will be critical for governments to pay more attention to the supply and cost of insulin, and emphasise the prevention of obesity and diabetes. This could be an uphill battle, given the attractiveness of this massive lifelong market to Big Pharma.

(NB: McDonald’s has just reduced the number of fries in a Happy Meal and added apple slices, carrots, raisins, mandarin and pineapple slices to the meal. This reduces its calorie count by 20%.)

Why the neediest patients get the worst care

Thanks to the efforts of an inspiring physician, Jeffrey Brenner, the Compstat policing method of mapping crime by time and location has been applied to medicine. In Camden, NJ, where he practised, 1% of patients account for a third of the city’s medical costs. The reason for this is the people with the highest need actually receive the worst care.

Brenner made block-by-block maps of the city, colour coded with hospital costs and discovered that two tower blocks were making heavy use of hospitals. In six years, 900 people accounted for 4,000 hospital visits and $US200 million in medical bills. He came to believe that patients in emergency rooms and hospital beds were actually failures of the health system because they could have been treated before the problem reached this level. For example, a child with asthma may go to hospital three times a year with bad asthma attacks because she never uses her inhaler and eats poorly.

One firm had increased the amount their employees had to contribute to health insurance and found employee health costs still continued to rise. The reason was because early retirees with chronic conditions could not afford the extra payments and so missed out on prescriptions and doctor visits. Then they ended up in emergency care. The upshot is that the system does not deal well with patients who need it most. Emergency rooms are designed for car accidents, not for a patient with a chronic heart problem.

Denmark has reduced the number of its hospitals from 150 to 71 and expects to have less than 40 in five years. This is because it offers quality out-patient care, including paying doctors to offer email, out of hours consultation, and nurses for complex care. In America, CareMore, is one company doing just that for the elderly.

The founder of CareMore noticed that, thanks to so-called health-maintenance organizations (HMOs), lowering costs became more important than giving care. He realised it is better to fix a problem at step 1 for $10 than step 10 for $30 yet the American health system simply focused on repair, rather than prevention. He discovered one third of patients failed to attend doctors visits, mostly because they couldn’t get there. CareMore provides free transport. Non-compliance with drug taking is also a problem, so CareMore provides “talking pill boxes”. Finally, some of the problems with diabetes can be minimised early, such as mending wounds before they lead to amputation. CareMore set up a wound clinic.

These examples sound rational and sensible. It is hard to believe that the current system of medicine lumbers on, becoming more and more expensive, yet less able to serve its market. With the aging of societies, it is crucial that some of these ideas are adopted – and quickly.

America keeps getting bigger

It is a health emergency, but nothing much is being done: Americans are becoming fatter. In the past 15 years, adult obesity rates have doubled or nearly doubled in 17 states. Yet 20 years ago, no state had an obesity rate over 15% but today they all do. Obesity is just one aspect of the problem; diabetes and hypertension are two of the effects of it.

The highest obesity levels are in the southeast, near the Gulf and Atlantic coasts, except Oklahoma and Michigan, and minorities are disproportionately affected by it. Some 40% of African Americans were obese in 15 states. Among Latinos, it was 30% in 23 states. So the message needs to be well targeted at them, as well as the rest of the population. Only in California and Texas was there an increase in physical activity from 2007-2009 but, even then, 25% of adults in California are obese.

The study, titled “F as in Fat” by Robert Wood Johnson Foundation and the Trust for America’s Health, highlights the need for encouraging more physical activity in schools and communities, making healthy food more affordable, and using “pricing” strategies for other foods. The government could, for example, change agricultural subsidies for companies producing unhealthy food or restrict marketing to children.

While Big Food (and Big Sugar) has its grip on America – and the rest of the world – we don’t see much hope for small measures. Corporations are getting fat on the obesity of America and Big Pharma, in turn, can get fat on their illnesses. It would take a very brave government to stand up for the health of its citizens by making it difficult for Big Food to continue to dominate American plates.

Big medical spending by the few

We should not be surprised by this statistic: 5% of America’s population is responsible for almost half of total medical spending. Some 10% spent 64% of the total and the top 1% spent 20% of total medical spending. In fact, from 2005-2009, spending rose 23% to $US2.5 billion and insurance premiums rose by nearly 15%.

Meanwhile, the average person cost the health system about $US233 in 2008, compared to $US7,317 in the top half. The top 1% spent $US76,476. The reason for these disparities is that adults over 55 cost more and people with a chronic health condition (hypertension, high cholesterol, diabetes) are two to four times more likely to be in the top 5%.

The report says that higher spending is because of doctors and hospital visits, but does not comment on why so many people have chronic health conditions. See: Why the neediest patients get the worst care; America keeps getting bigger.