QUALITY/CONSUMER/TECH: Health — On Demand by Pat Salber

Pat Salber writes The Doctor Weighs In, and she has some pretty interesting thoughts about this consumer health schtick. I cross-posted here but go check out her blog too!

The Internet has changed the way we do so many of life’s routine activities. We shop on-line for clothes, food, birthday presents (thank heavens–no more going to the post office), insurance, dates, and new friends. The list of things we can do and get on the net just goes on and on. PEERtrainer (www.peertrainer.com) has joined many other websites as a convenient, fun way to meet people with common interests and goals. It offers peer support and accountability with 24/7 convenience, and if desired, anonymity. And the Internet is changing the face of health care as well. I belong to Kaiser Permanente, an integrated health care system that makes it easy to make appointments on-line as well as to refill and have my medications mailed to me. I can get my lab results via a secure website and I can communicate with my physician via email.

But I never thought I would be able to get health and wellness services on the web. This weekend, I was at a medical conference and learned about an amazing new website: www.keepyoursight.com. A young ophthalmologist, Sean Ianchulev, described how his company, Peristat Group, has developed a way to screen for glaucoma on-line. Now, I guess I am a little out of date. My first thought was, "How are they going to deliver that little puff of air to my eye via the web?" Of course, that is not the only way to screen for glaucoma anymore. Rather, machines that test your peripheral vision have replaced the air puffs in many health care settings. This type of testing is called perimetry. The Peristat Group has figured out how to mimic what on-site perimetry machines do — on-line. That means, anyone can get screened for glaucoma in the privacy of their home anytime they want. It’s a bit complicated and takes some practice, but the site takes you through some simple instructions and then allows you to practice until you get the hang of it. Dr. Ianchulev tells me they built algorithms into the on-line test that help them weed out tests that are not performed properly. He also tells me they are developing an on-line test for macular degeneration, one of the leading causes of blindness in the US. Imagine, as this technology gets better and better and the test-taking gets easier and easier, glaucoma testing, testing for macular degeneration, and who knows what else, will be available to people “On Demand.”

As we move into an age where consumers are being asked to shoulder more and more of the financial burden of health care, I suspect we will see even more innovation in the delivery of services. The FDA recently turned down the request to have statins, very effective cholesterol-lowering drugs, available over-the-counter (OTC). Opponents of OTC statins worried that consumers would not recognize the rare, but serious side effects of these relatively safe medications. However, such dangerous drugs as aspirin and acetaminophen (e.g., Tylenol) have been available OTC for decades. I can’t tell you how many people I treated for overdoses of these benign drugs during the years I practiced emergency medicine. I think the argument of having to protect the public is one that will not hold up in the long run. Combine the use of home testing electronic devices with great interactive web-based programs, OTC availability of cholesterol-lowering drugs and blood pressure-lowering drugs, and on demand lab testing (available in many states) and you now have a way to get treatment of these common conditions to millions of people who are now untreated or undertreated…and for a fraction of the cost.

I think innovations in health care delivery, such as these, are very exciting, but also threatening to the same folks who have been promoting "Consumer Directed Health Plans" as the way to save the disintegrating American health care "system." But, hey, if I have to pay for it out of my pocket, I am going to get what I want, how I want it and when I want it. If I can get it for free on the net in the middle of the night, I say, bring it on. “Health On Demand,” — now this will usher in the age of real consumer directed health care.

6 replies »

  1. Would aspirin be OTC if it applied as a new drug today? Why they didn’t take cigarettes off OTC and make them available only with a prescription shows what money in healthcare will do to health. As for antibiotics getting less and less effective, well prescription only hasn’t prevented that. Who’s fault is it? Docs? Patients? Computers and pharmacy could do a lot to prevent patient misuse. What I’ve learned about professional groups is that protecting the gatekeeper role is the biggest impediment to advancement and improvement.

  2. Breaking down the barrier of consumption of prescribing medicines (Pill Power) will greatly increase health and reduce costs. In my opinion (which I’ve commented about before), many more things should be OTC. Statins and Plan B at the top of the list.
    In a better world, a brief conversation with your pharmacist would replace a wasteful trip to the doctor for simple ailments. This of course excludes things cases such as antibiotics, where an OTC would erode the utility of each pill through some mechanism (evolved bacteria tolerance, in this case). Once again, we see a better outcome through the careful use of Mill’s Harm Principle.