Expert Patients - A New Healthcare Paradigm

Categories

Health

Society

Healthcare is a business - one of the major productive enterprises in the industrialized world. How much of this business is really 'taking in our own laundry' is hard to tell at a glance.

Some say that the business with disease is largely responsible for keeping us sick, as there is no financial reward in having a healthy population. On the other hand, much money is to be made from selling remedies that do not cure but merely alleviate our symptoms.

Doctor yourself - take responsibility for your own health - is the motto of Andrew W. Saul, one of the major proponents of orthomolecular medicine, a system of health care based on supplying the nutritional elements we are often missing in our diet.

We are moving into a third healthcare revolution says Kathryn Alexander, one of the leading experts in detoxification and dietary healing who lives in Queensland, Australia and who has lectured on the dietary approach to health in the USA, Europe and Australia.

Dietary Healing - by Kathryn Alexander

Kathryn has traced the forces for change in our medical system. She says that the internet-driven knowledge revolution and the new tendency to electronically record patient data in electronic health records may be helping to overcome the current, profit-centered approach to health. By analyzing the collected data we will discover what actually works and start to rearrange healthcare to be more efficient.

The fact that our personal health records are actively being collected and will in the future be coveted objects of trade, according to Kathryn will actually catalyze patients, the real owners of these personal data, to band together. Patients will become a force in their own right with policy forming and decision making powers and together, they might just be able to tip the balance in favor of real prevention...

- - -

Expert Patients and the New Healthcare Paradigm

by Kathryn Alexander

(First published in Nexus Magazine - December 2007/January 2008)

A rapid escalation of the ongoing global power struggle in the US$3 trillion health sector ⁽¹⁾ is challenging the status quo between global pharmcos, pharmacy industries and guilds, the all powerful fiefdoms of clinicians, government agencies, politicians and the health insurance industry.

This perfect storm is due to a unique combination of interconnecting drivers that collectively offer the winner, in this high stakes game, to take all. This would be achieved by acquiring control of the supply and cost of all medications and complementary products, as well as controlling the knowledge of what actually works for each and every patient according to their own genetic profile.

This contest of strength is showing all the characteristics of a dirty war as all sides start to realise the ramifications of winning and ramp up their efforts to grab the high ground and the knowledge asset acquired via the new electronic health records (EHR), by harvesting information from the data provided by the support services associated with it.

The primary driver for this power shift is the inability by Western governments to meet the direct costs of escalating health bills due to an explosion of modern day non-contagious epidemics with associated rising costs of products and services, plus the indirect costs to the economy due to loss of income from decreased productivity (days off work) and future income lost by premature death. For example, the annual cost of obesity (and its related conditions, diabetes, heart disease and stroke) contributes US$93 billion to the nation’s yearly medical bill, ⁽²⁾ while in Britain, the financial impact of obesity is estimated to reach £45.5 billion per year by 2050. ⁽³⁾

When the indirect costs of welfare and income tax reduction are factored into the equation, along with meeting the costs of a rapidly increasing ageing population (the over 65s are set to comprise 20% of the population in the USA by 2030), it becomes apparent that all Western governments, whether welfare or private healthcare orientated, will need to implement dramatic cost saving strategies if they are to survive the projected rate of increase in chronic disease and stay abreast of the next wave in “predictive and preventive medicine” – the new designer drugs tailored for genetically distinct groups that will tackle disease before you get it, ripening the market for long-term drug dependency.

Navigating the third healthcare revolution

According to Sir Muir Gray, Director of Clinical Knowledge of the UK’s National Health Service (NHS), we’re moving into a 3rd healthcare revolution which will be knowledge-based, where the “knowledge [of what works] will become the enemy of disease”. ⁽⁴⁾

The first revolution was the discovery that dirty water produced disease; the second revolution was the discovery that chemicals could influence the course of disease, and this third revolution will be driven the new-found ability of knowing what actually works (of today’s medications and procedures) for each and every individual and, more importantly, which emerging medical breakthroughs could work. Governments and insurers will take the lead of Sir Muir Gray, who says “the application of the knowledge we already possess will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade”. ⁽⁵⁾

In a bid to control the knowledge, governments, insurance companies, clinicians and pharmaceuticals are building their own electronic health databases to plug in everyone’s medical records (and eventually every genome) in order to harvest the knowledge of which clinical procedures deliver the best outcome, the risks and benefits of drugs within given populations, environmental factors and geographic variations in disease and, most importantly, the cost-saving benefits or revenue generating capacity that this knowledge will bring.

The capacity to enter information into a database in real-time has far-reaching implications for all involved. The sharing of data across multiple parties, including general practitioners, specialists, clinics, hospitals and support services (pathology, radiology), not only provides the clinician with all the information relating to the medical events of the patient, but the benefits and risks of any new drug, product or procedure will be realized in a comparatively short time which will release those that pay and those that prescribe from the bondage of the pharmcos and manufacturers of new technology and enable more cost-effective treatments that achieve better outcome for patients. The UK government’s expected cost of running the NHS’s new IT systems could cost £40 billion by 2014, a huge increase on the budgeted cost in 2002 of £6.2 billion.⁽⁶⁾ Where are the tangible benefits for patients?
 
To date most of these repository projects have run into problems due to the resistance of clinicians, who traditionally collect and effectively “own” patient information, to enter this data and share it with the owners of the new repository systems or, in many cases, even the patients themselves.  However, this is not hindering the funding of these systems by governments as without access to this type of knowledge they have nothing to combat spiralling healthcare costs.
 
The insurance industry is also taking a keen interest in accessing the knowledge from these harvested repositories. In the US, health insurer Kaiser Permanente, which has 8.7 million members, employs over 13,700 physicians and runs more than 30 medical centres,⁽⁷⁾ has already established its own repository and through the harvesting of data can now offer treatment to members whose data indicate that they may be heading towards an adverse event, such as a heart attack, so producing large savings for the organization.
 
With the pharmaceuticals taking a keen interest in acquiring the harvested knowledge from these massive data repositories, the battle for control is also touching on a range of issues regarding ownership of individual and collective data. 
 
Each country seems to be tackling the issue of identity verification along similar lines using either national identity cards, welfare or tax numbers, whilst, at the same time, arguing for a national ID card or exchanges that can link multiple existing ID systems together for health and welfare. Much confusion exists around ownership and privacy where most governments and corporations seem to use privacy legislation as a reason not to provide information to citizens.

In order to avoid this tricky issue of ownership, a common approach is to allow personal information within a health record (including the DNA profile) to be sold without permission so long as the person’s name is not included. This "de-identified" rationale falls down on two points: firstly, it is possible to reconstruct identities from these databases using new probability software; and secondly, current practices allow de-identified information to be sold by a third party, without the owner’s permission, to multinational insurance companies, which, in effect, challenges the whole principle of ownership and legalises theft by corporate bodies.
 
Unless ownership of individual data and the range of issues surrounding the rights of access and use of aggregated data are established for the citizen and the common good, then the likely default position will be a few powerful multinationals controlling the knowledge in collaboration with governments.

In order to put the endpoint of this power game into context it is necessary to recognize not only the US$3 trillion industry that’