Google Health 2018: Best — and Worst — Case Scenarios

We went brainstorming to see how open architecture might affect wellness, sex, eldercare, insurance and other health concerns.

Dark Side of the Internet: Pro-Anorexia Sites

The free-wheeling information economy of the global Internet won’t always be there to save us. We’ll have to be sure we make the right health choices.

The “Ashley Treatment”: Hard Choices for Life Enhancement

Life enhancement innovations like cosmetic neurology, 20-15 LASIK, non-therapeutic abortion, body modification and other elective surgeries are an inevitable part of medical care in a free society. Enhancing the life of your child should be included in that list.

Walmart’s Loss Leaders: First Beyonce, Now Prozac (fluoxetine hydrochloride)

Walmart’s ability to drive down the cost of genercic drugs is a good thing. But in the pharmaceutical context, questions arise…

Enhancement Amok: Barry Bonds’ Choices

The notion that the patient knows what’s good for him gets kicked in the head with the chilling story of baseball’s Barry Bonds and his long-time affair with drugs to improve his game. A Sports Illustrated  excerpt from the new book Game of Shadows by Mark Fainaru-Wada and
Lance Williams (see video interview) describes the Bonds regimen and the coterie of semi-medical experts pushing him drugs:

In addition to growth hormone and testosterone, doping calendars showed
that Bonds used insulin along with steroids; the drug’s anabolic effect
was significant, especially when used in conjunction with growth
hormone. He also popped Mexican beans, fast-acting steroids thought to
clear the user’s system within a few days. The label of the container
read, "Andriol. Undecanoato de testosterone" — in English:
testosterone decanoate. Early in the 2001 season, the calendars
indicated Bonds tried trenbolone, a steroid created to improve the
muscle quality of beef cattle. Within the year it would be the chemical
foundation for a new formulation of the Clear, the undetectable steroid
Conte obtained from an Illinois chemist, Patrick Arnold.

The web package presents the issue from all angles, describing how athletes and their facilitators lied, cheated and broke the law while chasing record book glory, fan acclaim and multi-million dollar paychecks.

Panexa: Ask your doctor [parody]

A direct-to-consumer drug advertisement headlines:
Panexa. Ask your doctor for a reason to take it.

The Merd Pharmaceuticals Group’s prescribing information for Panexa (Acidachrome Promanganate) says that the prescription drug "should only be taken by patients experiencing one of the following disorders: metabolism, binocular vision, digestion (solid and liquid), circulation, menstruation, cognition, osculation, extremes of emotion." Side effects are novel: "PANEXA can contribute to developing inhumanly powerful tongue muscles, capable of licking through steel." Pregnant women and squirrels have special warnings, but the best line is about the pediatric use:

Pediatric use: Expired PANEXA
may be disposed of by feeding to children in a bowl with milk.

Of course, it’s all a well-crafted joke. But there’s a Cafe Press gift site where you can buy a Panexa T shirt or mug for the doctor on your list who needs another freebie pharma tshatshke.

We’ll be talking about direct-to-consumer advertising at the Health IC Summit next month in the Healthcare Consumerism session.

Home HIV Tests vs Medical Paternalism

OraquickLast week, the U.S. Food and Drug Administration held a meeting to consider whether a popular rapid HIV test used in clinical laboratories should be approved for home use. The 
OraQuick ADVANCE Rapid HIV-1/2 Antibody Test from OraSure Technologies used oral fluid specimens swabbed from the outer gums and provides results within 20 minutes at home. (An example of a positive result — two horizontal lines in the test window — is shown at left.)

In the hands of professionals, the OraQuick test has a long and successful track record. The FDA is obviously concerned that the test should be simple for untrained consumers to perform and to evaluate, but as long as it works well enough, who could object?

Medical professionals could object. A Boston Herald story points out that the glass is half empty: Solitary suffering risk with at-home AIDS tests. The chief of the infectious diseases center at the Boston Medical Center notes that professional testing is "a great opportunity to connect people to a mental health clinician, doctor and nurse. All that goes away with home testing.” That may be true, but consumers deserve to know on their own.

I’ll bet the home HIV test gets approved, but the much larger issue — the professionals’ reflexive disdain for self care — is only going to get hotter. In an excellent opinion piece in TechNewsWorld titled Forward Future Requires Past Principles, Sonia Arrison, director of Technology Studies at the Pacific Research Institute, makes the case:

Life, liberty, and the pursuit of happiness are core human rights that should be the foundation of all policy. Every individual should have the ability to avoid death and pursue survival. Regulations that ban life-saving procedures or tests, such as a ban against at-home AIDS tests, violate this right.


Dr. Google Saves a Baby

Over 73 million Americans use the Internet to answer health questions, harrying their doctors with self-diagnoses and putting stress on the physician-patient relationship. Medical web sites, disease discussion forums and health blogs give the "Worried Well" an endless supply of symptoms and therapies to ponder.

DrgoogleBut sometimes, the Internet can save some pain, some suffering — and some billing. An article in the Google Blog reports on a premature baby admitted to an ER with very low hemoglobin levels. ER doctors told the parents that an immediate emergency blood transfusion was necessary, but Dad whipped out his Palm computer and Googled the Web. He found an on-line article in American Family Physician that a hemoglobin drop in premies was  "not uncommon." After a respectable period of further study, the docs agreed that the kid was fine. Dad wrote:

Google literally saved our newborn son from having to endure an extremely dangerous, and totally unnecessary, blood transfusion.

Maybe Googling should be added to the list of standard medical practices.

To Scan or Not to Scan: A $300 Question

In the wake of some high profile lung cancer news this month, an AP story today by Marilynn Marchione, "Smokers Flock to Hospitals for Cancer X-Ray," reports on the stampede of smokers who are signing up for CT scans that could potentially spot tumors long before they show up on a conventional x-ray. The deaths of ABC newsman Peter Jennings and Dallas star Barbara Bel Geddes, and the recent lung cancer diagnosis of Dana Reeve, wife of actor Christopher Reeve, have heightened U.S. cancer awareness.

As we wrote last month, advances in digital imaging techniques are producing stunning CT images that look more like living tissue and less like black-and-white x-rays. Marilynn’s article quotes individuals who have signed up for the $300 scans — not necessarily covered by insurance — in order to get "piece of mind" rather than the diagnosis of a current condition. The resolution of CT scans is so good that minor lumps and bumps may cause false positives for cancer, potentially resulting in unnecessary biopsies and surgeries.

While some eminent physicians have recommended early CT scans, the American Cancer Society, the federal government and  "a raft of cancer specialists" caution against the test until a huge new study proves that such early detection is worthwhile —  so that it would be covered by insurance. One hospital lung specialist even stopped her at-risk 82 year old mother from getting scanned. Maybe it means a possible false positive, but it seems to me that $300 is small price top pay for your mother’s piece of mind.

At-Home Pharmacogenomics: Mail Order DNA Tests

Genelexdrugreactionb"The Perfect Gift for the Genetic Age"

Doctors prescribing medicines use way too much trial and error to match drugs and doses. If the first prescription doesn’t work, they try a different drug, change the dosage or start looking for interactions with other drugs the patient is taking. Success is counted when the side effects are not too gruesome and the patient improves.

Pharmacogenomics, combining pharmaceutical knowledge with our increasing understanding of the human genome, analyzes a patient’s genotype to find prescriptions that maximize effectiveness and minimize side effects. It can also reduce adverse drug reactions, a major cause of healthcare mortality.

Ten years ago, genetic testing like this was strictly a laboratory affair. Today, you can do it at home with products like Genelex’s mail order DNA test kits that screen for drug reactions, identify disease tendencies and even check ancestry and paternity. Tests cost anywhere from $250 for an identity profile to $1,590 for a Platinum Package.

The Genelex web site is split into branches "For the Public" and "For Medical Professionals." It’s the public side that suggests DNA testing as a nice gift … maybe for Fathers Day or Valentines Day, I guess.