People and technology can revamp healthcare
HEaLTH
DRUG BUST Alan Cassels
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RIStOtle SaID that man is a political animal. to Descartes, man was a thinking being. Jean-Jacques Rousseau said that man was ultimately a moral being. I am prone to think that what most characterizes humanity is the fact that we create tools – man as toolmaker. Of course, we are moral, thinking, political animals, but the ingenuity we apply to making tools to serve our needs and make our lives easier and more fulfilled, as well as healthier, is a useful lens through which to examine the state of healthcare today. Modern healthcare is mostly about the creation of systems that manage the use of tools – pharmaceuticals, vaccines, complementary medicines, surgeries, medical diagnostic equipment and computers – all of which make the delivery of healthcare more efficient and more capable of conquering disease and alleviating suffering. Improvements in the important determinants of health – better hygiene, working conditions and social supports – provide many of us with lives that are less nasty and brutish and longer than our forebears, but healthcare technologies have also helped make us healthier. the importance of focusing on the use of healthcare technology is intensified by one simple fact: so much of our collective wealth goes toward paying for it. In Canada, public healthcare continues to eat more than 40 percent of provincial revenues, an amount that, similar to an unchecked tumour, only knows how to grow. Our
neighbours to the south, currently facing the most monumental healthcare debate in a generation, spend more per capita on healthcare than any nation in the world, trapped by a dysfunctional system that manages to leave 47 million people without healthcare insurance. It comes down to our use of tools. are we using healthcare technologies – both high and low tech – optimally and efficiently, with the right tool being used at the right time on the right patient for the right reasons? and if not, why not? We’ll never get to a sustainable, patientcentred health system without a more
about getting the next newest thing. For years now, academics and policymakers have been beating the drum about the need for the adoption of electronic patient records, acting almost as if digital records were the deus ex machina that would drop on to the stage and save us from a tragic end. I agree with some of their reasoning. For instance, I agree that computerized physicians’ offices could make patients visits more efficient and drug prescriptions more readable, while also preventing needless in-office duplication and disruption. electronic records could help
The champions of Medicine 2.0 want to use the Internet to transform the world of the patient and rail against the paperbased, doctor-knows-best mode of healthcare.
rational and judicious use of these tools and we certainly can’t keep throwing more and more money down the black hole of healthcare and getting less and less in return. Yet how often do we hear policymakers talk about the systematic elimination of waste in our health systems? Strangely, not often. When healthcare wonks frame discussions on how to improve healthcare, they tend to focus on the desire for new gadgets, more MRIs, new drugs and evidence of an enduring belief that improving healthcare is really just
patients acquire important, health-related information, tailored for them with the touch of a button and potential negative drug interactions could be identified and avoided. as a researcher, I see great promise in electronic records, especially in the use of monitoring and analyzing the impact of decisions made by the healthcare system. how did patients fare on drug x? Did drug x cause more hospitalizations or deaths in patients who took it, compared with patients who took the older drug Y? With electronic systems, we
ATTENTION
Alan Cassels is the author of Selling Sickness and the aBCs of Disease Mongering and a drug policy researcher at the University of Victoria. could answer those questions and ensure we are getting the healthcare we are paying for. When new information emerges about the safety of a drug or a diagnostic test, doctors could use their computers to find their patients and advise them of a particular drug or test recall, something which can’t happen now in the paperbased way of doing things. at the end of the day, electronic patient records are unlikely to save healthcare. It’s going to cost a lot of money to create an army of digital doctors, and, as with the adoption of any new technology, things sometimes go horribly wrong in unintended ways. I’m mindful of the central tenet of edward tenner’s book, Why Things Bite Back: Technology and the Revenge of Unintended Consequences, which reminds us that despite how clever we humans are in creating new tools and gadgets, they often crash and burn when used in the real world. One of the ways electronic health records might backfire is in breaches in privacy and confidentiality that arise from the collection and storage of confidential patient data. Data can be used, but it can also be abused. I don’t think a considerate approach need slow down
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OCTOBER 2009
