Revolutionizing Medicine Today

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We have the tech right now, today, to completely revolutionize medicine.

 

I'm sure you knew that no two hospitals, in any region, will share patient information.  Yes, there are privacy rights.  I understand this.  However, there is non-personal healthcare information which doctors and hospitals could share yet still do not . . . i.e. sharing the effectivity of treatments, sharing correct/incorrect diagnosis.   They won't share any of this information and I argue, deliberately, to your peril. 

 

Steel clad silos

Hospitals can't share information even if they wanted otherwise.  Each hospital uses different data formats and different data systems.  Even though the AMA (American Medical Association) sits on top of this industry and regulates that industry heavily, it will not move to improve this one basic "feature".  The process of moving your information from one doctor to another is deliberately employing 18th-century technology -- the printer and paper.

If you want to get a different opinion of your symptoms, you will have to go to another doctor (at another hospital), request paper-transfer of your information/history, and then wait for your new doctor to get that information and read it.  Are you kidding me?

 

Who cares?

How many hospitals follow-up with a patient and ask them if they are getting better?  This never happens.  This fact should be ringing all kinds of alarm bells in your head.  A lack of follow-up in any industry means that company doesn't give a hoot about how you are doing nor about how THEY are doing.  There are no lessons being learned in modern medicine.  Hospitals are meat-grinders.

 

You are an experiment

If hospitals treated each patient as a unique medical experiment which in reality we are, they would be capturing historical data of symptoms, prescribed treatment, and effectivity of those prescriptions.   Even if one hospital were to capture the COMPLETE progress of its patients, put it into an intelligent database, beginning to end, this would be a huge leap forward.

 

Moreso, as these hospitals will not interchange patient data, there is no way to capture any improvements in health-care as an industry nor share the results of their experiments universally.  Yes, you are a medical experiment.  Each time you step into a hospital, you rely on a human to interpret your symptoms and make a connection to some known cause which they may (or may not) happen to remember (or know).  It is a medical miracle if they get it right. 

This is why getting multiple opinions on your symptoms is very important.  You have to do the legwork which the medical industry refuses to do for you.  It's ridiculous!  It is not like the medical industry is a fractured industry of competition . . . it is heavily governed and regulated exclusively by a cartel (AMA).

 

Medical revolution is lowest hanging fruit

Modern AI (artificial intelligence), available today, could revolutionize patient diagnosis and treatment.  Since the AMA sits on top of this industry, silo'ing medical information, it has exclusivity of that information and a monopoly on your health care.  That industry never has any financial incentive (or moral compulsion) to improve.  And the entire industry stagnates. 

 

The harsh reality is that doctors don't have any incentive to share information either . . . least of all putting their diagnosis and medical results into a database for an AI to learn from and make intelligent correlations between historical symptoms and historical cures.  Certainly, this technology would replace a major function of the doctor (diagnosis).  I am not surprised they would be quietly (but firmly) keeping the lid down on this pandora's box.

 

The human body is not evolving like technology does.  The knowledge of human biology and curing human ailments are finite.   Doctors are hoarding information and health secrets to protect their utility.  There is absolutely no incentive for sharing progress and shared learning.  At least not at the pace they could be progressing if they leveraged 21st-century technology.

 

Medical doctors of the past, and as well today, are merely learning cause and effect relationships in the human body.  Artifical intelligence is fantastic in matching cause and effect relationships.  Millions of times better than a human brain.  However, without a common medical database, without a network of knowledge sharing, there is no possibility of creating this value for people right now.  Fundamental values in the medical industry would have to first change.  Foremost, they would really have to care about your health as an incentive.  As well, the AMA would have to begin caring about how they dispense health care.

 

All this technology is sitting at our feet today . . . not tomorrow, today!  Millions of lives could be saved every year we wait for a belligerent industry to become invested in saving lives.

This is the biggest travesty of our time.  Perhaps people just do not know that a brilliant medical future is just around the corner, but we have a corrupt medical cartel that purposely looks straight ahead . . . to our detriment.

 

What is the first step toward revolution? 

Build a competitive health-care market outside the monopoly of the AMA cartel.

Comments

Ari Silverstein Added Dec 14, 2017 - 8:56am
It’s not only that they use different data formats and data systems that they can’t share information, patients have the right to have their medical records private.  The last thing we need is for one hospital with poor data safety to allow the public to view the medical records of any patient to have ever visited any hospital. 
 
As for the fact there are different data formats and data systems, that’s no fault of the AMA.  In a free country all hospitals should be free to use whatever system works best for them. 
William Stockton Added Dec 14, 2017 - 10:24am
Ari, there is a difference between hospitals sharing patient's information and hospitals sharing ITS own performance information. 
 
There is no reason why the hospital cannot share treatment results universally while redacting patient's personal data associated with those treatments/symptoms.
The problem is that there is no incentive for hospitals to improve.  It is not a "free" system as you noted.  Do you see a legal alternative to the AMA? 
Ari Silverstein Added Dec 14, 2017 - 1:47pm
I wasn’t aware lack of data regarding treatment results was holding back medicine.  To be sure, the more information the better, but unless you can direct me to a link whereby someone prominent in medicine is making the argument that major breakthroughs elude us because of data sharing issues, I don’t see the great big idea.
 
There are lots of alternatives to the AMA, I just don’t understand why you feel an alternative is necessary.  The AMA is probably the most respected and well known medical association. From what I understand about them they do good work and are an excellent source of information. I just went on their website and the first article listed had this as title “8 in 10 physicians have experienced a cyberattack New AMA research stokes vital conversation about how to best protect vulnerable patient records.”  
A. Jones Added Dec 14, 2017 - 6:02pm
The AMA is the principal organization responsible for limiting the number of medical schools allowed to exist in the U.S., as well as the principal organization that helped implement state licensure for graduates of state-accredited medical schools — a requirement to practice medicine legally.
 
Like all restraint-of-trade legislation, mandatory state accreditation for medical education and mandatory state licensure for the right to practice medicine did nothing to improve health care for patients (although it was promoted to the public as such) but did much to improve the economic lot of physicians by limiting the number of trained physicians relative to the number of patients: the fewer the physicians, the higher their incomes.
 
See:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1293684/
"The two faces of medical education: Flexner and Osler revisited"
(1992) by Alfred Tauber, M.D., professor of medicine at Boston University School of Medicine. The complete article is here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1293684/pdf/jrsocmed00106-0012.pdf Full article
 
"Flexner" refers to Abraham Flexner, a former owner of a prep school in Kentucky who took casual surveys of 155 medical schools throughout the U.S. (backed financially by the Carnegie Foundation) and issued a report to his financial backers known today as The Flexner Report (a/k/a Carnegie Foundation Bulletin Number Four) published in 1910. Among other things, the report claimed there were too many medical schools in the United States, and that too many doctors were being trained. One consequence of his report, resulting from the consolidation of many medical schools, was reversion of American universities to male-only admittance programs to accommodate a smaller admission pool (U.S. universities had been admitting women since 1833 beginning with the opening of co-educational Oberlin College).
 
The combination of peer-review guilds like the AMA plus restraint-of-trade laws such as state licensure has not only reduced the number of physicians in practice (thus increasing their incomes) but it has also biased so-called "orthodox medicine" toward allopathic approaches to treatment (i.e., surgery and drugs), thus promoting the idea that anything other than those two approaches is medical quackery.
 
Physicians are not required to become members of the AMA but they are required to obtain state licensure to practice. The abolition of state licensure might be the single most effective change we could make to enhance competition in the field of medical practice, offering the very likely outcome of lower costs for patients, as well as increased choice of available treatments.
A. Jones Added Dec 14, 2017 - 6:14pm
You might enjoy this blog by a cardiologist in San Francisco:
 
http://alertandoriented.com/
Alert and Oriented
Michel Accad, M.D.
 
" 'Alert and Oriented' is a medical phrase that describes the mental status of a patient who, despite being in serious shock from trauma or disease, maintains clarity of mind and focus of thought.
 
Sadly, the medical community enmeshed in today's health care system is like a patient in acute shock. The only chance to survive is to remain alert and oriented.
 
I hope that the articles presented here about medicine, medical ethics, medical economics, and health care policy will provide readers with valuable insights and shed some light on the health care system disease that plagues us. Without a clear understanding of the issues at hand, it is hard to imagine a path out of the professional morass."
Katharine Otto Added Dec 14, 2017 - 6:52pm
William,
While ideally the sharing of medical records could benefit patients, the fact is that medical records are a mess.  They are full of irrelevant, outdated, and flat-out wrong information.  Patients' conditions, especially in the hospital, change on a moment-to-moment basis, and it's hard for medical records to keep up.
 
While government regulations, like HIPAA, drastically inhibit the free flow of information, I don't believe the AMA plays a major role.  I do see that doctors themselves are so fearful of litigation that they are reluctant to share information on formal or informal bases with their peers.  It's too bad that doctors are so afraid, because they could learn a lot from each others' successes and failures.  
 
But hospitals have become battlegrounds, and camaraderie among doctors and other staff is long gone.  Medical records are not what they could be, so I'm not sure sharing would provide the educational advantage you envision.  
 
Theoretically, patients do own their medical records, even though they have to jump through lots of hoops to get copies.  I believe every patient should keep copies of her own records, if only to have the information easily available in an emergency, say in a different town.
William Stockton Added Dec 14, 2017 - 8:19pm
Ari,  "There are lots of alternatives to the AMA"
 
What are these alternatives besides home remedies or flying to Mexico?
William Stockton Added Dec 14, 2017 - 8:20pm
 "The abolition of state licensure might be the single most effective change we could make to enhance competition in the field of medical practice, offering the very likely outcome of lower costs for patients, as well as increased choice of available treatments."
 
Excellent suggestion A. Jones
William Stockton Added Dec 14, 2017 - 8:29pm
Katharine,  "While ideally the sharing of medical records could benefit patients, the fact is that medical records are a mess."
 
Yes, of course documentation in hospitals is a mess.  There is no standards and no incentive to fix the maladies in our current health care system.  It is as inefficient as any government controlled enterprise.  
 
And you are right.  Having the medical industry pool information in a central database is impossible without a wholesale fixing of so many issues with healthcare.  The point of this article is to educate people on technological opportunities that could save many lives.
This should be the underlying goal in an industry that claims to be about such.  I argue, just as you, that saving lives is not a priority or we would see hospitals getting multiple doctor's opinions for diagnosis as a regular service. 
Leroy Added Dec 14, 2017 - 9:31pm
Excellent article, William.  It's amazing that China is light years ahead in this regards.  Going the doctor and going to the hospital is pretty much the same thing.  You register when you go in.  If you don't have one you will be issued a card with a magnetic stripe.  Whenever the doctor sees you, he put the information into the record on the spot.  Not the nurse but the doctor.  If you get an MRI and go see a specialist, you just give him the card and the doctor can see what was done previously.  When you see the other doctor, he can pull up the MRI and the diagnosis on his terminal.  Of course, there are no privacy rights in China.  You don't have to ask for your records; they give them to you.  It is your responsibility to keep track of it.  I guess there are just too many people to keep track of the records.
Ari Silverstein Added Dec 15, 2017 - 8:13am
Your last comment to me suggests you don’t know what the AMA is.  The AMA doesn’t deliver medical care.  It’s simply a healthcare provider industry group.  Specifically, it’s the largest association of doctors in the country.  So its competition isn’t home remedies or Mexico, its competition is the likes of:
 
American Hospital Association
Association of American Physicians and Surgeons
American College of Physicians
American Academy of Family Physicians
American Academy of Pediatrics
National Association of Medicaid Directors
American Medical Women’s Association
Federation of American Hospitals
Student National Medical Association
American Heart Association
American Lung Association
The National Center on Addiction and Substance Abuse
American Cancer Society
William Stockton Added Dec 15, 2017 - 12:35pm
Ari,  Your comparison of the AMA to these other groups is like comparing the federal government to local governments.
 
"Profession and Monopoly, a book published in 1975, also condemned the AMA for limiting the supply of physicians and inflating the cost of medical care in the U.S. The book asserted that physician supply is kept low by the AMA to ensure high pay for practicing physicians. It states that in the United States the number, curriculum, and size of medical schools are restricted by state licensing boards controlled by representatives of state medical societies associated with the AMA."
 
The AMA isn't just a lobbying group.  The AMA is not just a healthcare provider group.  The AMA is the single largest controlling body in the medical industry. This group sets policy for the nation's healthcare.  There is no other larger and more powerful entity in US healthcare.
William Stockton Added Dec 15, 2017 - 12:44pm
Leroy,  Regarding Chinese healthcare, your points (experience?) are very interesting.  Thanks for your insight.
Ari Silverstein Added Dec 15, 2017 - 3:31pm
William: I agree but at least it’s a comparison of apples to apples.  Comparing the AMA to Mexico or home remedies is a comparison of apples to oranges. 
Dino Manalis Added Dec 15, 2017 - 4:10pm
That's why we need competition in the health care industry and it's good to discuss your health with health insurance staff who may help you in different ways to improve your health.
Leroy Added Dec 15, 2017 - 7:04pm
Just think what could be accomplished if we could combine outcomes with DNA. 
John Minehan Added Dec 16, 2017 - 11:44am
There are provisions in the HIPAA Privacy Rule for sharing de-identified PHI.
John Minehan Added Dec 16, 2017 - 11:59am
"As for the fact there are different data formats and data systems, that’s no fault of the AMA.  In a free country all hospitals should be free to use whatever system works best for them."
 
But there are Federal standards for that; see 45 CFR 170.102.  
Katharine Otto Added Dec 17, 2017 - 9:25am
Leroy,
Thanks for your insight into how medical care works in China.  We are hot on confidentiality in this country, but I'm not so sure there is much of that, and I'm not sure anymore that confidentiality is such a good thing.  Anyone who controls any part of payment has access to medical records.
 
Also, China incorporates alternative therapies, like acupuncture.  I visited with a medical acupuncture group and saw how it was used regularly in the hospitals there.  I hope these traditional practices aren't lost with modernization.
A. Jones Added Dec 17, 2017 - 11:57pm
I hope these traditional practices aren't lost with modernization.
 
Chinese hospitals and clinics resort to practices like acupuncture mainly because they don't have wide enough access to western drugs.
 
They don't resort to it in order to "perpetuate old, honorable system of ancestors."

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