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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 suggests that a century-old vaccine may reduce the severity of coronavirus cases.
- A new study finds a country's BCG vaccination is linked to its COVID-19 mortality rate.
- More BCG vaccinations is linked to fewer severe coronavirus cases.
- The study is preliminary and more research is needed to support the findings.
Professor Luis Escobar.
Credit: Virginia Tech
- Jennifer Jacquet writes that effective shaming can be a powerful tool for social change.
- Tess Wilkinson-Ryan believes shame is useless in the case of the pandemic.
- The politicization of the coronavirus takes our attention away from the failure of the administration.
Jennifer Jacquet: How do You Punish Global Mega-Corp? Shame Them | WIRED 2014 | WIRED<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="e8063d7d3f1f4bcd47356380b06772d7"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/yl4NSy0SXtc?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>She backs this up with research on the fact that we're more likely to blame people of other races for standing too close and overestimating our own compliance with public health regulations while underestimating others. In conclusion, she calls for humility: don't get so caught up in your biases that you overlook other people's efforts. The real problem is "America's half-hearted reopening," the administration's consistently inconsistent messages, lack of national regulations, and the weaponization of a pandemic.<br></p><p>Wilkinson-Ryan's article is a fantastic example of what we <em>should</em> be focused on. But is shame really useless? I would argue no. </p><p>This goes back to <a href="https://bigthink.com/21st-century-spirituality/individualism-is-spreading-and-thats-not-good" target="_blank">differences</a> between individualistic and collectivist societies. In her book, <em>Is Shame Necessary? New Uses for an Old Tool</em>, NYU associate professor Jennifer Jacquet points out that shame served as a "primitive emotion" that worked well in tribes restricted by <a href="https://en.wikipedia.org/wiki/Dunbar's_number#:~:text=Dunbar's%20number%20is%20a%20suggested,relates%20to%20every%20other%20person." target="_blank">Dunbar's number</a>. Shame is a powerful motivational tool if you'll never know more than 150 people. Early societies were collectivist by default. </p><p>By contrast, guilt is experienced in private, away from the group—a marker of individualism. You need privacy to experience private emotions. Guilt, therefore, might be a Western emotional construct that evolved with large societies. Religions that evolved with it know the power of guilt. Yet does that mean we should leave shame behind? Jacquet argues against it. </p><p>She writes that the key is finding shame's "sweet spot." There are no clear "shame this, but don't shame that" guidelines, though Jacquet notes seven habits of effective shaming.</p><p style="margin-left: 20px;">"The transgression should (1) concern the audience, (2) deviate wildly from desired behavior, and (3) not be expected to be formally punished. The transgressor should (4) be sensitive to the group doing the shaming. And the shaming should (5) come from a respected source, (6) be directed where possible benefits are highest, and (7) be implemented conscientiously." </p>
People wait in line outside of a Costco in Brooklyn on May 14, 2020 in New York City.
Photo by Spencer Platt/Getty Images<p>Wearing a mask certainly concerns the audience, which is everyone. Refusing to mask deviates from <a href="https://www.ucsf.edu/news/2020/06/417906/still-confused-about-masks-heres-science-behind-how-face-masks-prevent" target="_blank">desired behavior</a> and is not formally punishable (though some cities are <a href="https://www.cnn.com/2020/07/03/us/california-mask-requirement-fine-trnd/index.html" target="_blank">changing that</a> due to non-compliance). Since masks have been <a href="https://www.theatlantic.com/ideas/archive/2020/06/dudes-who-wont-wear-masks/613375/" target="_blank">politicized</a>, number four is mostly off the table. Plenty of respected sources argue for masks, though that too is lost in the <a href="https://www.kcrw.com/news/shows/to-the-point/pandemic-masks-individualism-sunbelt-republicans" target="_blank">weaponization</a> of masks (which also effects the last two habits).</p><p>Jacquet writes that acceptable shaming often focuses on "the powerful over the marginalized." Yet no society has ever endured the reactive scrutiny of social media during a global pandemic. In a QAnon-fueled conspiracy theory-crazed culture, the powerful never look out for the marginalized, except in the deepest trenches where Trump is considered a savior bringing forth a new age. </p><p>(This sounds insane, and it is, but it's having <a href="https://theconversation.com/qanon-conspiracy-theory-followers-step-out-of-the-shadows-and-may-be-headed-to-congress-141581" target="_blank">real-world impact</a>. I spend considerable time <a href="https://conspirituality.net/" target="_blank">investigating conspiracy theories in the wellness community</a>, and this theory is spreading on the Left and Right.) </p><p>Jacquet and Wilkinson-Ryan intersect in their desire to see our better angels emerge. As Jacquet concludes, there have been plenty of effective shaming campaigns, such as shaming fisherman for killing dolphins and manufacturers for poor working conditions. In each instance, a marginalized group (or animal) received better treatment. </p><p>Wilkinson-Ryan's political assessment is spot-on, as marginalized communities need better leadership: the <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/immunocompromised.html" target="_blank">immunocompromised</a>, the <a href="https://www.theatlantic.com/health/archive/2020/07/us-repeating-deadliest-pandemic-mistake-nursing-home-deaths/613855/" target="_blank">elderly</a>, the <a href="https://www.nytimes.com/2020/06/16/us/coronavirus-inmates-prisons-jails.html" target="_blank">imprisoned</a>, <a href="https://www.wired.com/story/why-meatpacking-plants-have-become-covid-19-hot-spots/" target="_blank">workers in the meatpacking industry</a>. At the moment, however, our better angels are absent. That means shaming is one of the few tools in our arsenal that might provoke compliance. Or, as with anti-vaxxers, it might only make anti-maskers more committed to their lunacy. Tough call. </p><p>As Jacquet writes, "Shame's service is to the group, and when it is used well and at the right time, it can make a society better off." Since America can't do any worse, some well-intentioned and thoughtful shaming might make an impact, in inches if not in miles.</p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
A study of the manner in which memory works turns up a surprising thing.
- Researchers have found that some basic words appear to be more memorable than others.
- Some faces are also easier to commit to memory.
- Scientists suggest that these words serve as semantic bridges when the brain is searching for a memory.
Cognitive psychologist Weizhen Xie (Zane) of the NIH's National Institute of Neurological Disorders and Stroke (NINDS) works with people who have intractable epilepsy, a form of the disorder that can't be controlled with medications. During research into the brain activity of patients, he and his colleagues discovered something odd about human memory: It appears that certain basic words are consistently more memorable than other basic words.
The research is published in Nature Human Behaviour.
An odd find
Image source: Tsekhmister/Shutterstock
Xie's team was re-analyzing memory tests of 30 epilepsy patients undertaken by Kareem Zaghloul of NINDS.
"Our goal is to find and eliminate the source of these harmful and debilitating seizures," Zaghloul said. "The monitoring period also provides a rare opportunity to record the neural activity that controls other parts of our lives. With the help of these patient volunteers we have been able to uncover some of the blueprints behind our memories."
Specifically, the participants were shown word pairs, such as "hand" and "apple." To better understand how the brain might remember such pairings, after a brief interval, participants were supplied one of the two words and asked to recall the other. Of the 300 words used in the tests, five of them proved to be five times more likely to be recalled: pig, tank, doll, pond, and door.
The scientists were perplexed that these words were so much more memorable than words like "cat," "street," "stair," "couch," and "cloud."
Intrigued, the researchers looked at a second data source from a word test taken by 2,623 healthy individuals via Amazon's Mechanical Turk and found essentially the same thing.
"We saw that some things — in this case, words — may be inherently easier for our brains to recall than others," Zaghloul said. That the Mechanical Turk results were so similar may "provide the strongest evidence to date that what we discovered about how the brain controls memory in this set of patients may also be true for people outside of the study."
Why understanding memory matters
Image source: Orawan Pattarawimonchai/Shutterstock
"Our memories play a fundamental role in who we are and how our brains work," Xie said. "However, one of the biggest challenges of studying memory is that people often remember the same things in different ways, making it difficult for researchers to compare people's performances on memory tests." He added that the search for some kind of unified theory of memory has been going on for over a century.
If a comprehensive understanding of the way memory works can be developed, the researchers say that "we can predict what people should remember in advance and understand how our brains do this, then we might be able to develop better ways to evaluate someone's overall brain health."
Image source: joob_in/Shutterstock
Xie's interest in this was piqued during a conversation with Wilma Bainbridge of University of Chicago at a Christmas party a couple of years ago. Bainbridge was, at the time, wrapping up a study of 1,000 volunteers that suggested certain faces are universally more memorable than others.
Bainbridge recalls, "Our exciting finding is that there are some images of people or places that are inherently memorable for all people, even though we have each seen different things in our lives. And if image memorability is so powerful, this means we can know in advance what people are likely to remember or forget."
Image source: Anatomography/Wikimedia
At first, the scientists suspected that the memorable words and faces were simply recalled more frequently and were thus easier to recall. They envisioned them as being akin to "highly trafficked spots connected to smaller spots representing the less memorable words." They developed a modeling program based on word frequencies found in books, new articles, and Wikipedia pages. Unfortunately, the model was unable to predict or duplicate the results they saw in their clinical experiments.
Eventually, the researchers came to suspect that the memorability of certain words was linked to the frequency with which the brain used them as semantic links between other memories, making them often-visited hubs in individuals's memory networks, and therefore places the brain jumped to early and often when retrieving memories. This idea was supported by observed activity in participants' anterior temporal lobe, a language center.
In epilepsy patients, these words were so frequently recalled that subjects often shouted them out even when they were incorrect responses to word-pair inquiries.
Modern search engines no longer simply look for raw words when resolving an inquiry: They also look for semantic — contextual and meaning — connections so that the results they present may better anticipate what it is you're looking for. Xie suggests something similar may be happening in the brain: "You know when you type words into a search engine, and it shows you a list of highly relevant guesses? It feels like the search engine is reading your mind. Well, our results suggest that the brains of the subjects in this study did something similar when they tried to recall a paired word, and we think that this may happen when we remember many of our past experiences."
He also notes that it may one day be possible to leverage individuals' apparently wired-in knowledge of their language as a fixed point against which to assess the health of their memory and brain.
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