Technophyte

In an unsettling Businessweek Online article, brought to my attention by blogger cyrus of Fractal Dimension, surgeon/mathematician and Kaiser Permanente exec Dr. David Eddy says that many treatment decisions made by medical professionals are still based on personal medical knowledge, rather than irrefutable proof.

A surprising 20% (only one-fifth!) of what doctors do today, the article states, is backed by hard evidence. In an interview that Dr. Eddy gave on PBS, he speaks of a quality crisis, in which

the care that [the healthcare industry is] delivering is highly variable. The same patient can go to three different doctors and get three different recommendations.

Eddy espouses evidence-based medicine (EBM) as the way to solve the crisis. As some readers comment at the end of the article, EBM is apparently standard already in some medical learning institutions.

But when one considers the astronomical cost of clinical trials, which is the only way to gather the evidence for EBM in the first place, one can’t help but wonder: how long will it take before there is enough information for us to truly benefit from EBM? And, more disturbingly, what on Earth do we hapless patients do in the meantime?

Curiously, Eddy has developed a virtual model, called Archimedes, that uses mathematics and simulation to aid health care decision-making. It’s an intriguing concept to be sure, and bravo to the effort of bringing together such disparate disciplines to tackle an enormous problem. Let’s just hope that the final results are brought to market soon, and that they don’t end up costing us even more to use.

Whether or not you agree with it, I highly recommend this piece.

» evidence-based medicine, Archimedes

For heavy net surfers and Firefox users, here’s a neat little tip that I only recently discovered.

To load favorite sites that you visit on a daily basis, such as your own webmail account or blog, you can save yourself the tedium of typing a long URL by assigning a keyword to the site. Right click the desired bookmark and select Properties. In the Keyword field, type in something short and sweet (and unique to your site). Since I check Gmail everyday for my personal correspondence, I assigned the letter “g” to it.

So now, whenever I need to open my mail, I just type my one-letter keyword in the URL bar of my Firefox browser, hit Enter, and Gmail loads lickety-split.

Funky little time-savers like this are pretty numerous within online applications and desktop productivity software. Unfortunately, most of them are never learned by the people who use the apps everyday because… well, it’s tough enough trying to get your spreadsheet or email to do what you want it to do. Who the heck has the time to learn the little things?

» Firefox

Apparently the Digg effect does not translate smoothly into the offline world. As GruntDoc writes, having one’s blog mentioned in a newspaper is no guarantee of getting a spike (or even a bump) in one’s traffic.

One possible reason is that people who read print are different from people who spend all their time online, reading blogs. Could be. But it could also be that dead-tree publications just don’t have the same reach as television, because by all accounts being featured on primetime TV most decidedly causes a spike in online traffic, be it blog or website.

In their 2003 book Special Treatment, authors Soden and Dumas write that roughly 2 million hospital-confined patients in the US every year becoming infected with something new during their stay, and a stunning 90,000 of them die as a result.

Hospital-acquired infections, also called nosocomial infections, harbor the additional risk of being caused by strains of bacteria that are already resistant to most antibiotics.

The solution? Everyone—doctors, nurses, orderlies, patients, and companions—should wash their hands more effectively and more often.

Ironically, among the different kinds of health care workers mentioned above, doctors are the ones who most often do not properly follow guidelines about hand hygiene.

Yabba-dabba-doo.

“Doctors object to the gathering of data,” says this New York Time article detailing the outrage of some US doctors over how pharmaceutical companies track their prescribing habits. This data has enormous strategic value to big pharma, and I am honestly surprised that American doctors were not aware it was being done.

“I was pretty surprised that they kept that data, and I was not happy at all,” Dr. Abramson said. “I said, ‘Why is that data even kept?’ ”

In the context of our own healthcare system, I wonder if this practice also happens in the Philippines. I realize that we are not as technologically advanced as industrialized nations, but surely the idea has at least been considered? We’re talking about all the same multinational firms, after all, with operations all around the world. And where there’s a will, there’s always a way.

I’m glad, though, that some effort has been exerted to change the way things are done:

Since then, Dr. Abramson has become something of an activist against the lunches and gifts that the pharmaceutical industry dispenses to doctors. His gastroenterology group in Cedar Rapids, Iowa, accepts neither, he said.

After all, as one of my professors in college used to say, there’s no such thing as a free lunch.

It was announced late last month that 1,000 New York-based doctors will be getting electronic medical record (EMR) systems for their patients, at a cost of about US $27 million, to be deployed over the next three years. I wonder how they solved the ethics issues, the privacy concerns, the user resistance, and the interoperability difficulties?

Still, there are a lot of problems that could be solved by a well-run EMR system. Hope they get it right.

Those of us interested in the US healthcare business would benefit from Matthew Holt’s FierceHealthcare, a daily email that brings together news about the biz, like stories involving Medicare, electronic medical records, HIPAA, and related issues.

Although some of the topics aren’t relevant to non-Americans like me, having one source to view a rundown of recent healthcare articles (particularly from major news organizations) is still a convenience I appreciate. And the focus on the business side of the industry, rather than the research aspect, gives it a unique advantage.

Consultant Holt maintains an opinionated blog called, rather plainly, The Health Care Blog. Check it out.

Respected medblogger Kevin, M.D., referring to an article in The Boston Globe, writes about a new profession that has “sprouted” (like Athena, or mushrooms) in medicine: that of the patient advocate.

This “adult family member — preferably one who is well-educated, tactful, feisty, and unemployed” (oh me oh my, what are the odds of having someone like that lurking in your living room?) is supposed to be with your sick self throughout your illness, guarding your best interests as you talk to doctors, deal with hospitals, navigate the health system in all its complexity.

I see validity in the argument of some doctors that bringing in a patient advocate may not always be helpful, as it adds yet another variable to an already complicated equation.

However, I also can’t help but think that, as my sister battled metastasized breast cancer years ago, if the many people who loved her had known of such an option, they would have moved heaven and earth to give her that option, that foot soldier, that extra hope.

Whatever it takes to heal the patient, I think, should be tried. Anne Rice once said, “Only in complexity can we find answers.”

Whatever it takes.