Telemedicine: The future of health care is already here
Technology that enables telemedicine is set to change the medical field for patients, doctors, and investors.
- Digital technologies that disrupted industries like communication and transportation are steadily changing health care, too.
- Virtual health care will save consumers money while growing the industry by billions of dollars.
- Non-visit care combined with smartphone apps will give patients more power over their health care.
Progress in health care over the last 200 years has typically resulted from technological development, as new devices and medicines became available. Today, as technological innovation disrupts entire sectors of the economy, doctors and health care professionals are more than willing to adopt, and even promote, new approaches to health care.
Yet there is still much more room for growth. Telemedicine or "virtual check-ups" is one such area. Mobile devices and other computing advances have already drastically changed how we do business, communicate, and live our lives. The ways we receive medical care have started to follow suit.
Michael Dowling has a birds-eye view of the evolution of patient care. The president and CEO of Northwell Health, New York State's largest health system, Dowling reflects on the availability of thousands of health-care-related apps in his recent book, Health Care Reboot: Megatrends Energizing American Medicine. He notes that some apps connect to wearables that calibrate blood pressure, heartbeat and medical implants that can monitor breathing, glucose levels or other health indicators. Many of these apps alert doctors when a patient needs a check-up, blood work or prescription changes.
All of this is resulting in a new shift toward technologically driven health care that will improve how patients are cared for. In his book, Dowling writes:
.. the in-person visit in health care—what is now the first step in many medical encounters—might be someday thought of as a last resort, after first exploring options to safely and effectively resolve a patient's needs remotely.
The future of telemedicine or virtual health care
Telemedicine allows A&E doctors at Dole Hospital – which doesn't have a neurology department – to obtain an immediate diagnosis for their patient by a neurologist in Besancon hospital, seen over the doctor's shoulder. This system allows doctors to exchange medical imagery and the patient's file.
(Photo by: BSIP/UIG via Getty Images)
Dr. Eric Topol of the Scripps Research Institute is an ardent proponent of increasing the role of technology, especially smartphones, in the way that health professionals conduct business. In his book, The Patient Will See You Now, he emphasizes that clinicians and medical organizations need to put technological solutions at the forefront of health care strategy and delivery.
Noting that "the culture of medical practice is famously conservative," Topol concedes that it will be a challenge, but the opportunities are too great to pass up.
Major players in the health care field are already implementing telemedicine. Dowling states in his book that:
At Kaiser Permanente, 52 percent of 'the more than 100 million patient encounters each year are now 'virtual visits,'' via text messages, calls, email, or video conferencing.
Dowling adds that health care technology falls within two primary categories: facilitating the delivery of care and consumer interactions.
Continuing technological advancements will spur non-visit health care and improve value-based health care solutions. Companies such as Apple, Amazon, Facebook, Google, and Microsoft have already publicly expressed interest in continuing to grow their health care presence. For years, Apple has been consolidating medical records on iOS through extensive partnerships with major medical centers – including Johns Hopkins, Cedars-Sinai, and Geisinger Health System.
One of the more noteworthy entrants is Haven, a nonprofit collaboration between JP Morgan, Berkshire Hathaway, and Amazon. Haven's goal is to improve health care services and lower costs for the three companies while making primary care easier to access.
Technological health care solutions in action
Erica Jensen, with her 5-month-old daughter, Charlee Jaques, by her side, video conferences with her doctor, Dr. Marie McDonnell, from her mother's home.
(Photo by Dina Rudick/The Boston Globe via Getty Images)
Amazon made another big splash last year when it announced that it had acquired PillPack, an online pharmacy. PillPack is a high-profile example of a telemedicine solution that brings the Silicon Valley spirit into the medical arena. PillPack's digital pharmacy platform manages patient data and controls logistics for delivering and managing customers' medical needs.
Innovations continue to unfold every day. In April 2019, Northwell Health launched an Emergency Telepsychiatry Hub that provides around-the-clock mental health care. People in crisis no longer have to wait long hours during crucial times of need. Patients have benefited from drastically reduced waiting times to speak to someone who can help them – members of an expansive team that includes 23 psychiatrists and 9 behavioral health practitioners with master's level training
Already, the new telemedicine service has brought the wait time down 90 percent to an average of 45 minutes. Northwell is increasingly integrating these services to many of its hospitals and centers. Jonathan Merson, MD, medical director of Northwell Emergency Telepsychiatry Hub Program, stated, "It's a technology that has no boundaries and the goal is simple: No patient experiencing a behavioral health emergency should have to wait to be seen."
Telemedicine will save billions
Telemedicine services are not only smart, they are also necessary. The American Association of Medical Colleges has already projected that there may be a shortage of some 40,000 primary care physicians (PCPs) in the coming decade. Increased virtual services will alleviate this shortage and allow already-overworked clinicians to focus on giving advanced care to patients in more critical situations.
Another consideration is the economic value of telemedicine services. An Accenture analysis found that the use of telehealth services could generate up to $10 billion annually over the next few years.
Without needing to expand the workforce, telemedicine can assist and augment medical professionals' activities. Personalization and efficiency will benefit the individual patient as the tools for controlling their own medical records and care plans allow them to become more engaged.
What health conditions can be treated via telemedicine?
Telemedicine is being used by rescue services in Hesse, Germany, to better treat patients in urgent conditions.
(Photo by Arne Dedert/picture alliance via Getty Images)
Telehealth is also useful for people whose frailty or chronic condition make it difficult to visit a doctor's office. There have been significant developments in what some medical providers are calling remote patient monitoring tools. For example, smart phones or tablets of people with Type 2 diabetes can automatically log blood glucose data from their monitoring device. Physicians can check these analytics any time and adjust treatment as needed.
Telemedicine is also more efficient than office visits or house calls for non-chronic health issues. A quick follow-up by video conference can ensure a patient is following their physician's directions. Medication management – confirming compliance with prescription doses and schedules, ensuring there are no troublesome side effects – is another helpful application of telehealth.
The technology that drives telemedicine is only in its infancy, but it will gain increasing prominence in the medical field and public sphere as innovations skyrocket and new startups enter the arena. As people grow accustomed to the ability to chat to their doctors without passing through a waiting room, to receive instant attention based on data from their medical devices, and to control their health from the palm of their hand, the life-saving convenience of telemedicine will be realized. That future is already under way.
A new study finds that some people just want privacy
- Despite its reputation as a tool for criminals, only a small percentage of Tor users were actually going to the dark web.
- The rate was higher in free countries and lower in countries with censored internet access.
- The findings are controversial, and are limited by their methodology to be general assumptions.
What do half of those words mean?<p> For those who don't spend all of their time on the internet, a few of these terms might be new to you. We'll go over them first before we continue. If you do know all of these terms, you can skip ahead to the next section.<br> <br> <em>Surface Web:</em> The regular internet that you can find with a search engine. You're on it right now; unless my work is shared in places I don't know about. <br> <br> <em>Deep Web</em>: The part of the internet not indexed by search engines. This includes things like your email inbox; you can't get there from a search engine but have to enter a password to find it from another page. You've probably visited the deep web today too. </p><p><em>Dark Web</em>: A subsection of the deep web that requires special software to access. While not everything there is bad, there are social media sites, email services, hidden forums, and even puzzle games down there; this is also where you would find the places for illegal markets and other, extremely nefarious, things.</p><p> <em>Tor:</em> A kind of software that allows users to browse the internet in near-total anonymity. It does this by encrypting connection data and scrambling the route a computer takes to connect to a site, thus making it difficult, but not impossible, to find who is using a particular website. The potential value of this to criminals should be evident to you. <br> <br> While it often gets bad press for how it can be used for illicit purposes, it should be said it was created and used by the United States government for often banal purposes. The leaders of the Tor Project often remind the public that "normal people" use Tor for everyday internet activities as well.</p><p> As a personal example, I once used it to get around the Great Firewall of China when I wanted to get to the regular, uncensored internet.</p>
Back to the study<p> The study observed the final destination of a random selection of Tor users and determining if they went to surface websites or more hidden areas of the internet after connecting to the Tor network. This was done by monitoring the data from entry points in the Tor network, which would allow an observer to find out that somebody is going to a particular place, but not who.</p><p> Those going to surface websites were assumed just to be using Tor for anonymity and security, while those going into the dark web were presumed to be more likely to be using it for less legal reasons. <br> </p><p> Despite the popular conception of Tor as a tool for criminals looking to cover their tracks, only 6.7 percent of these users went to sites defined as the dark web, which were themselves not necessarily devoted to illegal <a href="https://www.sciencealert.com/only-a-small-fraction-of-the-dark-web-is-being-used-for-hidden-activity-study-finds" target="_blank" rel="noopener noreferrer">activity</a>. </p><p> The results were further broken down by country, which revealed another layer of information. The authors noted that in countries deemed "not free" by Freedom House, the rate of possible malicious use goes down to 4.8. In countries considered free, the percentage nearly doubles to 7.8 percent.</p>
What does this mean for the internet?<iframe width="730" height="430" src="https://www.youtube.com/embed/MBh7K5ooF2s" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> The dark web might be a little lighter than previously suggested. While it is true that there is some horrible stuff down there, this study suggests the people getting to it using the Tor network are overwhelmingly using it for legal, and perhaps even banal, purposes. This interpretation is additionally supported by the difference in usage across countries judged free and not free. In those countries with censorship, where a variety of tools must be used to get to sites like Facebook or Wikipedia, the percentage of users going towards locations on the dark web was smaller.</p><p>The authors conclude:</p><p style="margin-left: 20px;"><br> "The Tor anonymity network can be used for both licit and illicit purposes. Our results provide a clear, if probabilistic, estimation of the extent to which users of Tor engage in either form of activity. Generally, users of Tor in politically "free" countries are significantly more likely to be using the network in likely illicit ways."</p><p> Additionally, they mention that the Tor network's infrastructure is predominately in free countries, which then see higher rates of its use to reach places that could advance illegal activities. This find may be of interest to policymakers who may wish to balance the promotion of autonomy and the freedom of information with the goal of preventing crime.</p>
What’s the catch?<iframe width="730" height="430" src="https://www.youtube.com/embed/2UNUMgM9Gwo" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> It has been suggested that the internet is the first thing humanity ever created that we don't fully understand. If that is true, it should surprise nobody that there are objections to the methods used to study it. <br> <br> The executive director of the Tor Project, Isabela Bagueros, explained their objection to the study's methodology and assumptions to <a href="https://arstechnica.com/gadgets/2020/11/does-tor-provide-more-benefit-or-harm-new-paper-says-it-depends/" target="_blank" rel="noopener noreferrer">Ars Technica</a>:</p><p style="margin-left: 20px;"> "The authors of this research paper have chosen to categorize all .onion sites and all traffic to these sites as "illicit" and all traffic on the "Clear Web" as 'licit.'</p><p style="margin-left: 20px;">This assumption is flawed. Many popular websites, tools, and services use onion services to offer privacy and censorship-circumvention benefits to their users. For example, Facebook offers an onion service. Global news organizations, including The New York Times, BBC, Deutsche Welle, Mada Masr, and Buzzfeed, offer onion services.</p><p style="margin-left: 20px;">Whistleblowing platforms, filesharing tools, messaging apps, VPNs, browsers, email services, and free software projects also use onion services to offer privacy protections to their users, including Riseup, OnionShare, SecureDrop, GlobaLeaks, ProtonMail, Debian, Mullvad VPN, Ricochet Refresh, Briar, and Qubes OS…...</p><p style="margin-left: 20px;">Writing off traffic to these widely-used sites and services as "illicit" is a generalization that demonizes people and organizations who choose technology that allows them to protect their privacy and circumvent censorship. In a world of increasing surveillance capitalism and internet censorship, online privacy is necessary for many of us to exercise our human rights to freely access information, share our ideas, and communicate with one another. Incorrectly identifying all onion service traffic as "illicit" harms the fight to protect encryption and benefits the powers that be that are trying to weaken or entirely outlaw strong privacy technology."<br> </p><p>The critique here is justified; there are legitimate websites hidden behind layers of security which were deemed "illicit" by this study's methods. Many people are just trying to protect their anonymity when using them. However, the study's authors based their assumption on previous studies that demonstrate that these hidden sites are used for illegal activities at a higher rate than other parts of the <a href="https://www.cigionline.org/sites/default/files/no20_0.pdf" target="_blank" rel="noopener noreferrer">internet</a>.</p><p>Until a more rigorous and ethically ambiguous method of determining exactly what people using the network are doing on these dark websites is utilized, the findings of studies like this will be general and based on broad assumptions. </p><p>Despite all of this, we can take a few things from this study: most people using Tor to explore the internet aren't using it for evil, those using it in places with limited freedom of information are even less likely to use it for such purposes, and external factors can have significant impacts on how people use a tool such as the internet. <br></p>
Mice will even run on a wheel in nature. Pheromones help inspire that behavior.
- University of California, Riverside researchers discovered a link between scent and fitness motivation in mice.
- The vomeronasal organ is activated by the smell of pheromones, influencing sexual behavior and cardiovascular activity.
- While there's no proof the same connection exists in humans, at least one elite athlete believes a link exists.
How do we smell? - Rose Eveleth<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="a8578bde67fc5b4a70746c49ca3a19cc"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/snJnO6OpjCs?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Many animals utilize olfaction to navigate their terrain. Comparatively, humans have a pretty weak sense of smell. For this study, the researchers looked at the vomeronasal organ (VNO), a feature of a number of amphibians and mammals, and its influence on volunteer wheel running (VMR) in mice.</p><p style="margin-left: 20px;">"Although the role of the vomeronasal chemosensory receptors in VWR activity remains to be determined, the current results suggest that these vomeronasal chemosensory receptors are important quantitative trait loci for voluntary exercise in mice. We propose that olfaction may play an important role in motivation for voluntary exercise in mammals."</p><p>The team chose fanatical runners that are more intrinsically motivated to get on the wheel than their peers. (The lab that produced this study even has a <a href="https://sites.google.com/ucr.edu/hrmice/home" target="_blank">High Runner Mice website</a>.) Apparently, these mice have strong vomeronasal sensory receptor neurons, which pick up the scent of pheromones (among others) as a form of motivation. </p><p>A link between these neurons and sexual behavior already exists; this study appears to expand the olfactory sense to another physical activity. The chemosensory signals received by VNO activation sets off a chain reaction in their nervous system. Just like humans can't help but dance to a good beat, mice crave the rush of running when the right scent hits them. </p>
Could this apply to humans as well?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDg1ODk4NS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyNTY4MzM0N30.N-53oWoMUAPMNa9_ZxeMx6YKFRLhD-k7RzUIK8Bvl2U/img.jpg?width=1245&coordinates=0%2C208%2C0%2C208&height=700" id="f048a" class="rm-shortcode" data-rm-shortcode-id="db26fd2092faab325198afcaf2dc018b" data-rm-shortcode-name="rebelmouse-image" />
Credit: BillionPhotos.com / Adobe Stock<p>Christopher Bergland thinks so. The elite athlete knows all about treadmills. He holds the <a href="http://www.recordholders.org/en/list/treadmill-bergland.html" target="_blank">world record for the longest treadmill run</a> over a 24-hour period. In a recent column, he claims that <a href="https://www.psychologytoday.com/us/blog/the-athletes-way/202011/need-motivation-exercise-olfaction-is-primal-motivator" target="_blank">scents have been motivating him to exercise</a> for decades.</p><p style="margin-left: 20px;">"Even as a middle-aged person with a middle-of-the-road libido, smells from my adolescence—such as classic Coppertone sunscreen mixed with a spritz of vintage Polo Green cologne—still give me a "Vroom!" feeling that gets my juices going. The same smells that I used to run five back-to-back marathons through Death Valley in near 130º heat and to break a Guinness World Record by running 153.76 miles on a treadmill decades ago, still motivate me to go for daily jogs at a 'conversational pace.'"</p><p>He still uses smells to inspire his workout regimen. In his 2007 book, "The Athlete's Way," Bergland discusses aromatherapy as a performance enhancement and motivational tool. This makes sense: we might have devolved in our olfactory senses a bit, but smells still heavily influence our world. Flavor, for example, is <a href="https://www.scientificamerican.com/article/experts-how-does-sight-smell-affect-taste/" target="_blank">just as much about smell as taste</a>. </p><p style="margin-left: 20px;">"Acquiring information related to scent through the back of the mouth is called retronasal olfaction—via the nostrils it is called orthonasal olfaction. Both methods influence flavor; aromas such as vanilla, for example, can cause something perceived as sweet to taste sweeter. Once an odor is experienced along with a flavor, the two become associated; thus, smell influences taste and taste influences smell."</p><p>We're certainly motivated to eat thanks to the scent of our favorite foods. The idea that smell would get us out of bed and onto a bike is not far-fetched, whether we realize it or not. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His new book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank" rel="noopener noreferrer">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>
Researchers dramatically improve the accuracy of a number that connects fundamental forces.
- A team of physicists carried out experiments to determine the precise value of the fine-structure constant.
- This pure number describes the strength of the electromagnetic forces between elementary particles.
- The scientists improved the accuracy of this measurement by 2.5 times.
The process for measuring the fine-structure constant involved a beam of light from a laser that caused an atom to recoil. The red and blue colors indicate the light wave's peaks and troughs, respectively.
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