Technology

Margaret McCartney

When we are recommended an operation or healthcare intervention, it’s likely we’re going to want some information about it. Not just who will do it, where and when, but also the chances of whether it could damage, maim or even kill. All procedures – even straightforward ones – entail the risk of complication, so it’s important to be informed.

One way of doing this is to use “calculators” to predict these health risks. Some of these are available online, often targeted at assessing cardiovascular risk. By entering your age, smoking history, blood pressure, family history and diabetic status, a calculation is made projecting risk for cardiovascular disease over the following years.

Continue reading “Plus and minuses”

By Ross Tieman

Fishing around for information on hospital rankings, I came across a Spanish state research body that monitors the quality of 18,000 hospital websites worldwide. At first, the idea seemed bizarre – something dreamed up by a hypochondriac with an IT addiction.

But in fact the Cybermetrics Lab, an arm of the Spanish National Research Council, ranks websites of many kinds that are sources of scientific information, helping save time for researchers, and hopefully, by benchmarking, aiming to improve availability of information.

But that begs some questions. What’s the point of hospital websites? Who are they trying to reach, with what information?

Margaret McCartney

Some illnesses are more expensive to treat than others. While most people accept this fact, they do not like the idea that healthcare might be rationed according to cost, and react angrily to suggestions that certain interventions might “cost too much”.

The relative cost-effectiveness of different treatments can be difficult to pin down. The National Institute for Clinical Excellence, for example, assessed drugs for the treatment of dementia and rejected them on the grounds of excessive expense – a decision criticised by those who believed the potential cost-saving on carers’ time was not being evaluated correctly. This kind of problem occurs in all sorts of medical treatments, where the discrepancy between research findings and real-life outcomes are hard to measure.

Take angina, which, until the 1960s, was treated with drugs. Next came coronary artery bypass grafting (CABG), developed to supply the heart muscle with blood when its own circulation failed, usually due to plaque formation (atheroma) in an artery.

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By Nicholas Timmins

To their advocates, electronic medical records are the Holy Grail. Something not just desirable but essential for the practice of modern medicine. To the sceptics, they remain an expensive, potentially dangerous and unproven set of technologies.

Across the world, however, healthcare systems and governments are investing in electronic medical records – even if getting them up and running is proving a struggle everywhere.

That they are needed is not in question. Don Detmer, chief executive of the American Medical Informatics Association, says medicine is fracturing, with doctors becoming ever more specialised. The pace of research is such that no individual doctor can keep up. Patients are no longer treated just in primary care settings or hospitals but in a wider range of environments, by a wider range of clinicians, and for a wider range of illnesses as patients live longer, often with multiple chronic conditions.

“It used to be that medicine was pretty safe because it was mostly pretty ineffective,” says Mr Detmer. “Today it is both effective and potentially dangerous.” The record, in effect, becomes the glue that holds a patient’s treatment together: sophisticated electronic records provide decision support tools to help with diagnosis and reduce the chances of dangerous drug interactions, while providing the basis for a good medical audit of the outcome of treatment.”

But while electronic records have been around in one form or another for well over 20 years, not even the most advanced country has them operating everywhere yet – and this in a world that routinely banks, orders books, music and many other goods online and, for those with the money and technological sophistication, runs its pensions, investment and other complex financial products electronically.

Continue reading ‘System upgrade’

Andrew Jack

Good news for the hundreds of people heading to Geneva over the weekend for the World Health Assembly, the annual meeting of the World Health Organisation (WHO).

Because it was felt ministers might need to head home rapidly to cope with the coming flu pandemic, the usual ponderous eight-day agenda has been pared back to a nimbler five. They will also be spared the usual ritual debate over whether Taiwan should be allowed to attend as an observer, now that China has waived its objections.

But those assembled should take advantage of the new focus on flu to reflect on the breakdown in smoothly coordinated, science-based responses, with instances of pig culling, lengthy human quarantining and warnings against travel to Mexico and other affected areas, which went well beyond WHO advice. Those who have diverged from official advice should be held to account.

They should also discuss other flu-related themes including tougher animal surveillance, access to scarce drugs and vaccines, improved biosecurity], and whether the current WHO pandemic alert system needs to be revised to incorporate a measure of likely severity.

Finally, as they head for home, they should also remember the many other important health issues that the flu has pushed to one side, including drug resistant TB and counterfeit medicines.

Nicholas Timmins

Sometimes you really do wonder whether the Conservatives are remotely ready for government. The travails of the NHS’s £12.7bn project to create an electronic medical record for all are well known. The health department has just come up with its latest plan to rescue it.

Your guess is as good as mine about whether it will work. But it at least applies to the real world. At the Conservative spring conference at the weekend, David Cameron, the Tory leader, was talking about what he quaintly calls the “NHS supercomputer” as though this was some mighty black box sat in a field somewhere in the middle of England.

Not needed, he said, because “in this age of austerity, a web-based version of the government’s bureaucratic services like Google Health or Microsoft Health Vault cost virtually nothing to run”.

The Conservatives have clearly been listening to snake oil salesmen. Applications like these may well play an important part of patient controlled, and patient accessed, records. But the idea that either of these remotely amount to the patient administration system, appointment booking, test ordering and recording, digital imaging equipment, clinical coding, the decision support systems and the myriad other items needed in a hospital or GP practice to create a full electronic record in the first place is laughable. It really is not a choice between £12.7bn and “virtually nothing”.

Read an FT special report on the world’s best chance to tackle malaria

Watch video interviews with six experts at the “Malaria: getting to zero” conference on April 15 – 17 2009

View an interactive world map showing malaria prevalence and conditions in individual countries

The Economist has published a wide-ranging report on medicine and technology

Ravi Mattu

In this amazing video, scientists from the University of California, Davis and Mount Sinai School of Medicine have filmed for the first time the transfer of the HIV virus from an infected cell to a non-infected one.

According to the school’s website :

“Our findings may explain why attempts to develop an HIV vaccine have so far been unsuccessful,” said Thomas Huser, one of the study’s authors and chief scientist at the UC Davis Center for Biophotonics Science and Technology (CBST), where the video images were produced using advanced, live-cell video imaging microscopy.

While previous efforts to create an HIV vaccine have focused on priming the immune system to recognize and attack surface proteins of free-circulating virus, the current results indicate that HIV avoids recognition by being directly transferred between cells.

“We should be developing vaccines that help the immune system recognize proteins involved in virological synapse formation and antiviral drugs that target the factors required for synapse formation,” explained Huser, who is also an associate professor in the UC Davis Department of Internal Medicine.

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Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog: www.margaretmccartney.com/blog

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow

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