The Doctor Weighs In

CareSpan International “exists to bring comprehensive, integrated, lower cost medical care, wellness, and occupational health to workers and other persons in need worldwide.” The company uses telemedicine and mHealth applications to “lower transaction costs and extend medical reach.” Watch the video to hear CEO Mark Winter explain what they are doing....
Technological Darwinism and the Social Contract

Technological Darwinism and the Social Contract

Article by Terry R. Knapp, MD This is truly a golden age of innovation and technological success in medicine. We can define and catalogue the genetic blueprint of the individual patient. We can replace hearts, and corneas, and livers, and lungs, and more. We can install an artificial pancreas that uses microelectronics to meter and infuse insulin as metabolic requirements change throughout the course of a diabetic’s day. We can cure cancers by wiping out the entire immune system, and then replacing it. Why, we can actually go far beyond prolonging life—we can, and do, prolong death. We can also violate patient privacy without patient knowledge. We can exploit the economic basis of health care delivery by recommending tests, treatments and interventions with marginal, or even negative, individual benefit. And we tend to justify it all based on obeisance to innovation and technology. The stark truth that constitutes the ugly underbelly of technology and innovation is that we have failed to reconcile technological advances with the social contract between the individual patient and the health care industry. My ninety-year-old mother-in-law has late-stage Alzheimer’s disease. In a mirror, she does not recognize the person looking back at her. This spring, she had a small lump in her breast diagnosed on excisional biopsy (local anesthesia, outpatient) as low grade carcinoma. The recommendation: modified radical mastectomy with consideration of follow-up chemo and/or radiation therapy. The decision: No thanks. The conclusion: the physician made a recommendation whereby technology triumphs over common sense. Sometimes we seem to forget that life, after all, is a finite condition. Just what responsibilities to the social contract do...