The Optimistic Futurist: Digital health data will improve care, spur debate
By Francis Koster
There is an area of science that is likely to take our current public policy debate about the appropriate scope of government regulations and raise the volume quite a bit. In my opinion this debate is not likely to capture the public’s attention before the coming election, but as a futurist I believe the clash between science and the politics surrounding regulation will become louder in years to come. One drum being banged loudly this election cycle is that government has too many regulations. Some people claim regulations are stifling job creation, and the cure is to cut the budget of the agencies that make these burdensome regulations, or eliminate the regulators altogether. (North Carolina took steps in this direction two years ago, when it cut twice as much from the enforcement budget of the Department of Environment and Natural Resources as the average cut from other state agencies.) This point of view is being countered by others who point out that many of these regulations are in place to protect the health of the general public, and that if protecting the public from illness or death requires a regulation, so be it. So far, this point of view is more of a whisper. So what is the area of emerging science that is going to reframe this already shrill debate? Data mining of accumulating electronic health records. In 1854, Dr. John Snow started treating victims of cholera in London. More than 500 people died in the first week the disease surfaced. Desperate to figure out what was causing the epidemic, he worked round the clock for days to hand-draw a map containing the location of all the homes of the sick and dying, and he realized that everyone who was sick got their water from the same well. He persuaded local officials to remove the well pump handle, and the epidemic stopped. Today, a high school student using Google Maps could probably draw that same map in a few minutes by combining death notice addresses and well locations readily available on the Internet. Medicine has been slow to adopt computers as a part of the daily process. At this writing, only about one-third of all U.S. hospitals have electronic medical records up and running, and about half of all doctors’ offices. Those institutions that do have computerized records not only improve patient care and lower cost of treatment, they help create much larger searchable databases that have to potential to change public health. These databases do not contain the individual patient’s identity, but just like Dr. Snow’s map, they can be used to detect patterns so intervention can begin. What is emerging is the ability to do analysis in two dimensions — over large areas and longer time periods. The massive databases already in place contain information on prescription patterns, reasons for emergency room visits and diagnosis. These data elements will help researchers recognize and stamp out the causes of disease. We are now seeing the early use of this data to spot outbreaks of disease in specific geographic locations where no one suspected a problem. In 2011, one study reported on the discovery of 42 unsuspected disease clusters in 13 states, using what will soon be considered primitive detective tools. About 1 in 30 American children are born with a significant birth defect, causing untold misery and expense. Recent analysis discovered that marijuana use by a female weeks and months before conception increases birth defects. Before this study, many medical professionals assumed it was harmful only after conception. On the other side of the coin, a number of studies have found that various birth defects may be due to occupation-related chemicals causing damage to the father’s sperm, not some issue with the mother’s behavior during pregnancy. Few researchers had been looking in that direction before. A good source of information on these topics is the third edition of EPA’s publication “America’s Children and the Environment.” What I am pointing you toward is that technology and science will soon expand our society’s knowledge of where diseases occur, and what may be causing them. I believe this will lead to greater cries for regulation of disease- causing behaviors and ingredients, and a greater understanding of their cost to society. This in turn will lead to a greater effort to hold organizations accountable. And this will be turning up the volume of our current debate about the role of government and regulation. One step I take when I hear people complain about excessive regulation is to ask for examples. This often results in both of us learning things from each other that lowers the volume of the discussion and leads to better hearing. Listening to each other about these complicated issues can invent a better future for all. • • • Francis P. Koster lives in Kannapolis. His “Optimistic Futurist” column appears every other Sunday. For more information, visit www.TheOptimisticFuturist.org.