Other Practice-related news:

• The case of a small device that (controversially) enables family physicians to diagnose nerve diseaseillustrates the technology-driven and -enabled trend toward the simplification of care such that eventually patients and ultimately machines can handle all healthcare. Neurologists’ concerns that serious misdiagnoses can occur may be valid for now but may not be strong arguments versus the good that the machines can do, and will ultimately be addressed anyway. The trend is inexorable. 

   

• A new Nikon Imaging Centerat the University of California in San Francisco houses state-of-the-art optical microscopes that can capture real-time video of a protein moving inside a cell. We’ve reported on this technology before; what’s interesting now is the creation of such imaging centers at biotech “magnet” sites around the world. 

   

• One of the few good things to emerge from the war in Iraq may be an automatic language interpreter, which appears to be almost ready for prime time.

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New York Times reporter Jennifer Alsever provides statistics and tidbits on medical tourism from the US to Thailand, Costa Rica, Malaysia, and elsewhere for surgical, medical, and dental treatments costing 20 to 80 percent less than in the US. The growing trend is “hastened by the fact that 46 million Americans are uninsured and that health insurance costs are soaring,” she writes.

• Bangkok’s Bumrungrad International Hospital sees 55,000 American patients a year. 

   

• Medical Tours International has 12 registered nurses and three doctors who help patients plan medical treatment and trips, and evaluate the overseas hospitals and doctors. 

   

• In 2005, Medical Tours International sent 1,324 people to India, Costa Rica, Thailand, and Brazil. In April 2006, an uninsured furniture store manager paid US$295 to PlanetHospital to help him plan a trip to a Max Hospital in New Delhi for spinal surgery. 

   

• He paid $9,000 for the three-week trip, which included a five-day hospital stay, airfare, hotel and sightseeing. At home, it could have run $36,000 to $50,000. 

   

• The author of the forthcoming (February 2007) book “Patients Without Borders: The Smart Traveler’s Guide to Getting High-Quality Affordable Healthcare Abroad” traveled to Costa Rica last spring for dental work. The treatment and trip cost $2,100, instead of the $4,100 it would have cost back home. 

   

• GlobalChoice Healthcare’s menu includes a coronary artery bypass for $11,438 in India (vs. $75,536 in the US) and a knee replacement for $17,824 in Singapore (vs. $36,664). 

   

• United Group Programs, an insurer in Florida, offers medical travel health plans to 4,300 corporate clients, of whom some 40 now offer those plans to employees. 

   

• The Joint Commission International, the international arm of the US-based Joint Commission on Accreditation of Healthcare Organizations, has accredited 100 foreign hospitals since its start six years ago. 

   

• PlanetHospital offers patients nervous about foreign doctors a plan whereby an American doctor travels with the patient overseas to perform the surgery and handle follow-up care back home. PlanetHospital’s price for a heart valve replacement in India with an American doctor is $11,000. That includes the doctor’s malpractice insurance as well as airfare and hotel for both physician and patient. The surgery typically costs about $55,000 in the United States. PlanetHospital now offers it to insurers, which can offer it to employees. 

Medical Tourism: Unions Oppose

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In August, the United Steelworkers union prevented Blue Ridge Paper Products from sending a willing employee overseas for gall bladder removal and treatment for a shoulder nuscle. Medical tourism agency IndUShealth was to have made the arrangements. The union called it a “shocking new approach” to cutting healthcare costs, and demanded that the employee be offered treatment within the United States. The company acquiesced, but still plans to offer the overseas option to its salaried employees.

In a letter to US congressional healthcare committees, Steelworkers’ president Leo W. Gerard wrote: “No U.S. citizen should be exposed to the risks involved in traveling internationally for health care services.” “Experts predict,” writes New York Times reporter Saritha Raim “that globally standardized health care delivered in countries like India and Thailand will eventually change the face of the health care business.” The pressure to outsource health care is inevitable, an economist with the World Bank told her. But vowing to fight any effort by American companies to send employees abroad for treatments, a United Steelworkers spokesman said the 850,000-member union is “confident that we are in a position to block any employees being exported to India, Thailand or Mexico,” and added: “The ailing American health care system cannot be cured by sending patients abroad.”

Med Tech Dumbs Down the Specialties

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Some 12,000 of the nation’s physicians have purchased a US$5,000 handheld device that, in just 15 minutes and at a reimbursement of US$250 by many insurers, checks patients for nerve disease. “Such a diagnosis,” reports Reed Abelson of the New York Times, “might otherwise require extensive testing by specialists.” Many neurologists and some insurers have doubts about the ability of general practitioners to make a correct diagnosis, and Abelson cites some instances to show that misdiagnosis happens.

The popularity of the device, Neurometrix’s NC-stat, may be more the result of sharp and ethically and legally questionable sales practices, though the company does not agree. The test is generally used to check for signs of nerve damage associated with carpal tunnel syndrome, diabetes, or low-back pain. Since receiving US Food and Drug Administration in 1998, the company estimates that more than 500,000 patients have been tested. Biosensors are attached to the skin to stimulate nerves, and the handheld device records the results, which can be transmitted to Neurometrix which provides a diagnosis by a fax or e-mail within minutes. Neurometrix’s president claims that the system removes much of the complexity inherent in traditional neurology exams, enables all physicians “to replicate the diagnostic accuracy of the specialist,” and represents “a new standard of care.”

Microscope Center

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Six state-of-the-art microscopes worth more than US$2 million have been installed at the new Nikon Imaging Center at the University of California in San Francisco. One of only two in the US, the Center will be used not only by campus academics but also by biotechnology companies as “Part of [the university’s] public service mission.” Corporate scientists will pay an hourly fee of apparently as low as US$50 per hour for access to the microscopes. Access to such a facility is part of what makes the Bay Area a magnet for biotech companies, San Francisco’s mayor told Bernadette Tansey of the San Francisco Chronicle. Nikon is loaning the six high-tech microscopes at no cost and paying the salary of the center’s director, in return for “the chance to work with top-flight academic scientists as well as a place to demonstrate the instruments on-campus to biotech executives and other potential purchasers,” writes Tansey. The high-resolution light microscopes can capture live action in a single cell and track the movements of a single protein. On the Center’s opening night, Tansey saw a digital movie being made of a fruit fly cell dividing into two cells. “The duplicate sets of DNA-bearing chromosomes lined up and swept apart from each other as if they were performing a ballroom dance,” she wrote.

Automatic Language Interpreters

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The US military’s Joint Forces Command has been testing laptops with software that interprets spoken English and Arabic, in Iraq. If the software is uncertain about what one party said, it presents choices on the computer screen for the speaker to choose. Unlike the “Phraselator” used by US soldiers in Afghanistan, which can only speak from a list of commonly useful phrases such as “get out of the car,” the new software is not limited to pre-chosen phrases.

The military is testing two systems, one from SRI International called “IraqComm” and one from IBM called “MASTOR.” The latter (which is also available for Mandarin Chinese as well as Arabic) is not perfect but “you can communicate a concept and you can elicit a response from someone” according to IBM’s chief of language technologies. The US military official overseeing the projects expects it could be 2009 before real-time interpretation devices will work in noisy and difficult battlefield conditions, implying that they already work well in quiet environments such as offices.