Wanted: Smarter Patients

Diagnostic devices are big business worldwide. Diagnostic imaging -- tools like X-ray machines and MRIs -- alone accounted for nearly a quarter of global medical-device sales revenues in 2009, to the tune of more than $50 billion. But the tools are designed for rich countries, to be used by skilled technicians to uncover rich-world medical conditions -- which is unsurprising, given that the United States, Germany, Japan, France, Italy, and Britain account for 70 percent of global sales. (Three-quarters of those medical devices that do end up in developing countries do not function and remain unused.) To empower medical consumers in poor countries, diagnostic technologies need to be very simple, hygienic, and cheap. Think of mobile-phone-based eye exams, cholesterol and glucose test strips, and the home pregnancy test.

Diagnostics for All (DFA), a nonprofit medical firm, is working on a range of such simple tests for use in the developing world. Its initial project is designed to spot the side effects of medicines used to treat people with tuberculosis and HIV/AIDS in developing countries. Around a quarter of the 2.8 million people in the developing world on AIDS medications are suffering liver damage as a result, compared with a 2 percent rate in the United States, thanks in large part to more active (but currently expensive) screening after which treatment regimens are changed. The DFA test, targeted to cost 10 cents or less, is a piece of paper that changes color, like a chemistry class pH tester, depending on liver toxicity -- one color indicates the need for closer monitoring, another the need to change the treatment immediately. The company is also developing a test for spoiled milk and an aflatoxin test that will allow farmers to identify crops affected by mold that can cause stunting and liver damage. It will do so at one-twelfth the cost of existing tests.

DFA tests don't require clean water, syringes, refrigeration, lab equipment, or skilled technicians. Users put a drop of blood, urine, or milk on the edge of the paper, and it is wicked to the test material printed on the card, which changes color if the milk is spoiled, the liver is damaged, or the crop has been affected by the mold that produces aflatoxin. They literally blot test material onto paper.

DFA's CEO, Una Ryan, told me that the company is contemplating similar tests for fever and diarrhea. Given the quality of health-care services in many developing countries, that kind of information could be lifesaving. And if it empowers some patients to demand more from their health-care workers, it might play an important role in improving the quality of service provided to everyone else, too.

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RMDUENAS

8:47 AM ET

October 4, 2011

what about implementingthe other part of the solution?

...And having these doctors face accountability in the form of fines or even prison time? The one who went to school, the one who studied, the one who has the responsibility to heal, the one who took an oath, is the doctor, not the patient. It might be well intentioned, but placing the weight of having the knowledge to receive correct treatment on the patient, or the parents of the patient, in order to have better chances of obtaining adequate medical care sounds not very realistic.

I am university educated, I ask a lot of questions to my doctors and, invariably, half of them feel threatened by what I ask and my limited knowledge. I can only imagine what it would be like for a mother in rural Tanzania to dare to ask a question, and to receive a rude answer from one of these doctors.

It is the doctor who has to determine how educated the patient is and, based on that, assume the correct approach, and not the other way around. If patients could diagnoses themselves, then they would not need doctors!

ONESON

11:08 AM ET

October 8, 2011

Agreed

If patients could diagnoses themselves, then they would not need doctors! We need to look for another solution for the problem.
oyunlar

MIAMILAWYER

10:08 AM ET

Smarter Patients

I agree that the doctors need to be held accountable for the level of service that they provide. However, the onus really is on each patient to ensure that they are receiving proper medical care. We need to focus on educate the patients in order to prevent illness, maintain wellness and ensure that the physicians are performing their duties properly.

URGELT

3:01 PM ET

October 5, 2011

The Monopoly of Doctors

Take a longer view, and see where we are really going. Yes, medical tests are being developed that are cheaper. Technology is beginning to deliver solutions to medical needs which can be used outside of the medical monopoly. But it's going to go much further.

In time, consumers will be able to diagnose their own ailments with probes, implants, test strips, and computerized artificial intelligence. They'll even be able to diagnose genetic vulnerabilities to diseases. And if they can diagnose these conditions, why run to a doctor to fix them? Treatment recommendation can be automated, too. So can many of the treatments.

The medical monopoly owes its existence to the huge amount of information that had to be mastered to provide adequate patient care in the early 20th Century. When that information can be mastered by computers instead, the need for the medical monopoly will plummet.

Surgery? Machines can be made which will do repetitive tasks far more reliably than any human.

Drugs? Likewise, with the added benefit that every possible drug interaction can be detected and disasters prevented automatically. Doctors don't do nearly as well with this; it's difficult to remember how all drugs interact with each other. Most doctors know some of it. They can't possibly know it all. Machines can, and computers are cheap and becoming cheaper.

Dietary advice? Doctors are horrible at dietary advice, largely because so little is understood about cellular operation and the role of nutrition, and so dogma unsupported by science is the rule, not the exception. Advancing understanding of cells and nutrition, and the tests that will follow, will allow consumers to know exactly what they should eat to correct even a minor dietary deficiency. In fact, we'll be able to return to a very old idea: treating ailments with foods.

The simple truth is that the medical monopoly is under assault by technology. There is a long way to go; many, many decades will be required to fully dispense with it. But the process by which it will happen is already visible.

Think about that when an arrogant, bored doctor fails to bother to examine a sick child. He's an anachronism. The future will strip him of his monopoly and instead empower consumers, and that's a good thing.

RNIELSEN

8:34 PM ET

October 19, 2011

Patient Education

Some of the responsibility lies in the hands of medical and public health editors developing more easy-to-read patient education materials in all languages.

YARINSIZ

October 28, 2011

The one who went to school,

The one who went to school, the one who studied, the one who has the responsibility to heal, the one who took an oath, is the doctor, not the patient. It might be well intentioned, seslichat but placing the weight of having the knowledge to receive correct treatment on the patient, or the parents of the patient, in order to have better chances of obtaining adequate medical care sounds not very realistic

PRELIOCIVEDE

4:39 AM ET

November 1, 2011

Excellent outline of what

Excellent outline of what World Health Organization might be? and how our thinking about health care needs to change to build a better outlet online system.

Foreign Policy Magazine

The key to improving medical care in the developing world isn't better doctors -- it's educating everyone else.

BY CHARLES KENNY | OCTOBER 3, 2011

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