Radically different by 2010
It's 2010, and the Internet portal that greets you every morning tells you a whole lot more than "You've got mail!" It also reminds you that your yearly physical is two weeks away, that your genetic map indicates a propensity for heart disease and that Johns Hopkins has new research on the kind of prostate cancer that killed your grandfather.
You're a little worried that despite the encrypted firewall, the wrong people - your employer or the government - will get access to your family medical record. But you're willing to trade a little privacy for state-of-art care and the chance to live a few extra years.
You're spending more on health care, the money going less to doctors than to prescription drugs and diagnostic tests - and, oh, yes, for that artificial spring-loaded hip that rejuvenated your golf game and that artificial spring-loaded skin that rejuvenated your face.
The reward is peace of mind.
After all, when your child passes out on the school playground, how much is it worth to you that his medical records and his genetic proclivities speed to the hospital before he or you get there?
How much is it worth that you can go online and design your own health plan, keeping in mind that you and your children possess genetic markers that make it likely you'll need, say, 10 times the typical amount of prescription drugs over your lifetimes?
And how much is it worth that your diabetic mother can have her glucose monitored in her apartment or onboard a cruise ship, and that her doctor and you can download the real-time sugar levels 24 by 7?
Welcome to the brave new world of medicine envisioned by health experts, insurers, dot-coms and analysts at a recent e-commerce health-care forum sponsored by Forrester Research.
"By 2010, 60 percent of what we are doing in doctors' offices today, we are going to do anywhere - at home, on the road, on the run," said Douglas Goldstein, author of E-Healthcare: Harness the Power of Internet e-Commerce & e-Care. He predicts a major consolidation of doctors' offices, hospitals and e-health care, so they can take advantage of the huge number crunching and data sorting possible via the Internet.
Upper-middle-class consumers will wield their money like kings, experts said, and with it will demand unprecedented levels of choice, quality, trust and privacy; designer therapies and round-the-clock monitoring of chronic conditions; tests for every looming disease; and a never-before-seen ease of access to health care - all folded together over the Internet.
"People will get a full-body CAT scan or genetic tests because they can," said Eric Brown, who leads Forrester's health-care research team. "If it costs $1,200, they might say, 'This year I won't go on that vacation. Instead, I'll figure out if I can prolong my life 15 years.'"
A CNN poll last year asked, "If you had access to your genetic code, would you want to know what diseases you are predisposed to get?" Sixty-four percent said "yes." That's up from 50 percent six years earlier.
"If you had a 90 percent chance of going blind by a certain age, it would be nice to know that, and to know about any treatments," said Dr. Brad Bowman at WellMed, a health assessment Web site. "Especially if there is a 50 percent chance your kids will get it, too."
The mapping of the genetic code - the rough draft was completed last summer - has started a revolution in knowledge about diseases and new drugs and genetic therapy that can mitigate them. That revolution is expected to spread through the entire health-care industry and the Internet as companies learn to use the information and interactive technology to offer never-before heard of personalised tests and therapies.
The linchpin will be the consumer's health portal, which could be cobbled together by a health insurer, a doctors' group, a finance company or a server such as Yahoo!, said Michael J. Barrett, senior analyst at Forrester Research's health-care e-commerce research team. The portal will give advice every morning. There will be links to research on the half-dozen diseases for which your parents and kids have an unfortunate genetic propensity. Doctors and pharmaceutical companies will market directly to your family, with banner ads advertising free parking while-you-wait for gene therapy, kidney dialysis or handheld-device syndrome.
When you learn that you're due for the yearly physical, you might click on the "All tests'' option on your DNA sample (a nurse took a cheek swab at the local 7-Eleven) on your health-care portal. You can visit the provider section and run a quality check on your primary care physician. You'll click on the link, book an appointment and authorise password-protected read-only access to your health-care information. You'll then approve direct payment to the doctor.
Later, you might find that tests are positive for three new genetic markers. The results argue for tweaks in your diet and a different monthly protein-neutralising drug. The test warns that you have a predisposition for an eye disease, so without delay you book an appointment with an ophthalmologist, hoping to keep the condition a susceptibility, not a certainty.
Or you may find that you share a genetic marker with 100,000 others. Using the Internet, you might be able to band together with some of those people for a cyber protocol with 10,000 of them who already are showing signs of a certain type of heart disease to find that 8,000 are struggling, but the 2,000 that are running three times a week and taking the blue pill for gene therapy are finding terrific relief. Voila!
In an interactive project already under way, the Health Care Finance Administration is spending $28 million to test a plan to monitor diabetics around the clock, combining nurses' visits with an interactive camera and monitoring devices. Patients with tremors can push easy-to-see buttons that can measure blood pressure or drip glucose into their systems. The information can transfer automatically to the nurse on call.
That might mean that someday diabetics won't be able to sneak even a doughnut without their body signaling its insult to the pancreas to the snoopy online nurse and the concerned real-life doctor.
The Internet works both ways, though. While doctors and nurses might be able to learn too much about you, patients and their families will likely bombard their doctors with questions about every new promising or lunatic treatment they spot on Web sites linked to their diseases.
That still will be a good thing, Bowman said. Internet-aided medicine will free doctors and nurses from paperwork so they can do what they do best.
"It's my hope that doctors and patients will have more time to spend together face-to-face in fine-tuning health care," he said. "They can do more medicine and less information chasing."
