Web medicine

A power shift for patients takes first cautious steps.

The conference - Internet Healthcare 2000 - bears all the marks of an early computer show. Outside, 18 barely known companies vie for attention at slick booths. Inside the hall, speakers describe the promise of a medical industry transformed by the Internet.

They paint a beguiling picture. Online technology will lower bills, improve treatment, empower patients, possibly shrink hospitals, and allow alternative medicine to challenge traditional practices in an open market of ideas. There's only one problem.

That future comes with no road map and a dizzying array of side effects.

While other industries rush to the Internet, the $1.2 trillion healthcare industry inches cautiously forward. Its e-revolution looks as speedy as the Thirty Years' War and just as contentious. That's because Internet-inspired change will elbow aside many of today's entrenched players and, quite possibly, give patients more control than ever.

"I would say it's the biggest change in medicine since managed care," says Stan Bernard, a lecturer on healthcare management at the University of Pennsylvania's Wharton School in Philadelphia. "Patients will have greater involvement in their care and, I believe, will see greater responsiveness than under the doctor-patient traditional relationship.... Instead of the paternalistic model, there will be a partner model."

"In the long-term time horizon, this industry will be more radically transformed" than any other, adds Nelson Carbonell, president of Cysive, a Reston, Va., electronic business-systems company.

Some doctors have already glimpsed the future.

"The Internet is going to provide a rapid means and efficient means of communication, and patients aren't going to feel left out," says Jay Adlersberg, a doctor and TV medical reporter in New York. He foresees digital X-rays transmitted over the Internet to a doctor's office, doctors teaching and learning by Web video, and specialists doing delicate operations thousands of miles away using digitally controlled robots.

Even more mundane doctor-patient transactions will subtly tip the balance.

Sumit Dutta, a New York physician, still remembers his first patient to use the Internet for medical help. Another doctor had prescribed a medicine for the patient's skin condition, but her online research suggested she shouldn't use it. When Dr. Dutta read her evidence, he had to concur. "The idea is to have the ability to make the patient-physician experience better," he says.

Such a free flow of information empowers patients. "Doctors feel threatened by this," says Daniel Sands, a physician at Beth Israel Deaconess Medical Center in Boston. But "if you know of some medical news before I do, why shouldn't I stop and listen?" One of his patients - an elderly Lithuanian immigrant - can barely speak English but e-mails him for advice.

The challenge is that the Internet also generates mountains of misinformation. "We are facing patients who walk in sick, but they're not so sick that they can't carry a four-pound printout of paper from the Internet," Dr. Adlersberg says. "It's voluminous. [But] it's still a little bit of knowledge." Doctors say they already don't have enough time to spend with patients. If they suddenly have to disabuse them of Internet-borne misinformation, the relationship could suffer, some doctors argue. Perhaps new groups will take over as gatekeepers of medical knowledge.

It might be medical generalists with enough know-how to send patients to the right specialist, says Denise Silber, managing director of Healthtech Digital Communications, a healthcare marketing and advertising firm in New York. Or it might be one of the more than 17,000 medical Web sites currently dispensing information.

It may not be doctors at all, suggest some proponents of alternative medicine. For example, thousands of Internet users are forming online communities to discuss particular diseases. They share the latest research, talk about coping mechanisms, and solutions ranging from traditional therapies to alternative medicine.

"People want someone to tell their story to, this is part of the healing process, instead of just using a drug," says Gary Sandman, president of Integrative Medicine in Rockville, Md. "They will take their own healing into their own hands."

"People are beginning to see there are so many other ways to treat [disease]," adds Rodney Friedman of Wholehealth-md.com, an Internet startup based in New York. "We can't just turn our back and say: 'This isn't valid.' "

Traditional medical experts scoff at this approach. "I think we're in a golden age of quackery," counters Stephen Barrett, an author and founder of QuackWatch.com. "We're talking about millions of people who are blindly doing things because of an article or a talk show.... In 20 to 25 years, the whole concept of alternative medicine will disappear."

So far, the only entities falling off the radar screen are Internet healthcare companies. The trouble was readily apparent at last month's Internet healthcare conference sponsored by Rising Tide Studios, a New York-based Internet publisher. The first keynote speaker canceled at the last moment because his company, drkoop.com, is "exploring strategic alternatives." (Read: rapidly running out of cash.) Another keynoter, high-tech legend Jim Clark of Netscape fame, admitted he was naive when he started his online company, Healtheon. In one year, the stock price of the onetime highflyer has sunk from $126 to $20 per share.

While consumers are flocking to the Internet for healthcare advice, Internet companies are scrambling to figure out how to make money providing that data. According to Cyber Dialogue, which surveys Internet and non-Internet users, 47 percent of people who logged on in the past month searched for health information. Drug companies provide informational sites but many consumers see those as biased. Neutral sites are booming. Five-year-old Medscape, which operates CBSHealthWatch among other sites, counts 2.3 million registrations and adds four new members a minute. But it's not clear how many of those sites can turn a profit.

Their data "is very valuable and very free," says Michael Parker, vice president for healthcare at Razorfish, a digital solutions company based in New York. "The challenge is finding a way of connecting it to a source of revenue."

Those sites that made connections sometimes got their knuckles rapped. Drkoop.com, a popular information portal cofounded by former Surgeon General C. Everett Koop, has fallen on hard times after recent criticism that it didn't fully disclose its links to for-profit sponsors. Sometimes the advice they dole out is wrong. Last year, the journal Cancer surveyed 400 online health sites and found them riddled with inaccuracies. Some experts believe the medical-information sites will fade away because none have achieved the critical mass to attract sufficient advertising.

"The health-care portal is going away," says Andrew Lapham, chief executive officer of rehabmanager.com, a healthcare Web site that charges consumers a flat fee for its informational videos.

Other start up companies are trying to use the Internet to untangle a different part of the healthcare problem - back-office inefficiencies. According to Credit Suisse First Boston, administration costs eat up 18 cents of every healthcare dollar. "The US healthcare system - it's archaic," says Thaddeus Grimes-Gruczka, vice president of Cyber Dialogue. "The system is still 98 percent paper-based. We don't have that in banking. We don't have that in commerce. We don't have that in grocery shopping!"

As a result, the industry wastes an estimated $250 billion a year, analysts say. If the Internet could eliminate the inefficiencies and outright errors of today's system, the industry could charge less and do more.

Several companies are vying to become the industry's intermediary, zapping patient data and doctors' prescriptions around to hospitals, health-insurance companies, and drug stores. Mr. Clark founded Healtheon on the premise that instead of the $7 to $10 healthcare companies spend to process a claim, his company could do it for 30 cents. But several large health-insurance companies have formed their own Internet processing consortiums.

One, called MedUnite, brings together insurance companies such as Aetna and Cigna Corporation. Another consortium of medical-products makers is setting up a Web site to supply hospitals and clinics. One way or another, Internet-driven efficiencies will change the system, Clark adds.

Then there's the prescription mess. Pharmacies are popping up online to dole out medicine. But a couple of online drugstores have been sued for filling orders for Viagra without written prescriptions. To stop the process, the Clinton administration is moving to give the Federal Drug Administration new powers and more money for enforcement.

Still, the Internet will prove a positive force for healthcare, many observers agree.

"The Internet can do an enormous amount for patients," Mr. Lapham says. "If you look at healthcare, it's about customized information." One possibility: automatic patient monitoring. A small wireless sensor on the cap of a medicine bottle could tell a doctor each day whether his patients had used - or at least picked up - their medicine.

A medical devices firm is already looking at wireless sensors it could attach to its products. Once inserted into the body, the system could wirelessly communicate any challenges a patient might face. If doctors and nurses could monitor patients in their home, analysts say, then the need for hospital space could shrink.

Of course, the new paradigm of Internet medicine raises ethical questions. For example, when a doctor offers advice on an e-healthcare site, is he practicing or simply giving an opinion? Is it even appropriate to use e-mails to communicate with patients since the medium isn't secure? How will companies ensure that online patient records won't get hacked?

"We are crossing all kinds of boundaries," says Herbert Wong, chief executive officer of HealthAnswers Inc., an online information site based in Austin, Texas. "A physician doesn't have time to answer 467 e-mails from patients. Which one do you drop? Which one do you read?"

At least three healthcare groups are preparing codes of ethics for the new age of Internet medicine. But they are based on the premise that the industry can regulate itself. Not everyone believes that freedom will last for long.

"The move toward the Internet in the healthcare space is inexorable," says John Bentivoglio, special counsel for healthcare fraud at the US Justice Department. But "the public concern about privacy is so strong and the self-regulation by companies is so weak that I think someone ... is going to step in."

(c) Copyright 2000. The Christian Science Publishing Society

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