Laurie Bouck

Last spring, when I was covering a medical conference, I used my cell phone incessantly for several days as I tracked down various doctors to interview for a set of news articles about their presentations. I kept my phone on as I walked from Moscone Center to the train to go home at the end of each long day downtown, and worried about what calls I might miss when the train went underground.

One night, when I got off the train in my neighborhood, I realized that the weather that day was, in fact, absolutely stunning. Who knew? I had been inside all day, running from session to session and downing coffee and sandwiches in the press room. That night, the sky was pink from the setting sun, the air soft and warm, and the tree leaves the pale green of spring. Just as I started to relax and enjoy the evening, my phone rang. I jumped and rummaged in my bag for the phone, but it was silent. That noise wasn’t my phone’s ring tone. I stopped on the sidewalk and listened. No, it wasn’t my phone - it was a songbird. Perhaps the bird was trying to tell me to turn off my phone.

And so, when my husband and I decided to upgrade our old cell phones a few days ago, a growing necessity for our respective work, I had mixed feelings about it. On the one hand, I craved a hip new Blackberry to replace my boring, 4-year-old flip-open phone and (wouldn’t it?) enhance my un-hip life. On the other hand, I wondered what owning a Blackberry, commonly referred to as “Crackberries” out here because they are so addictive, would do to me.

When he brought home a Blackberry-esque cell phone for each of us (Blackberries, we decided, were too expensive), within minutes I had it turned on and was playing with it. To keep the kids busy so I could tinker with my phone, I gave them our old cell phones. My four-year-old was not interested in them, but my six-year-old, the High School Musical fan, was. Soon she had curled up on a chair in the living room, poking at buttons to change the the screen image and theme colors of the phone. Before long, she was playing all the different tinny-sounding ring tones on the phone, over and over and over again. When I told her to put the phone away, she rolled her eyes at me. When we took it away, she pouted.

The next morning over breakfast, my husband and I excitedly pulled out our new phones and tried to figure out how the camera function worked. My older daughter ignored her cereal and poked more buttons on her “new” cell phone as well. When I looked up, though, my four-year-old was staring at me, hands on her hips, with an expression of wise exasperation. Um… did I forget to get you your cereal, honey?

“Okay, everyone, put the phones away,” I said. I turned mine off and got back to more important business: breakfast.

Last week, internet search giant Google released the Google Flu Trends tool, which tracks possible flu outbreaks by compiling data on how often people use flu-related search terms such as “flu symptoms” and “chest congestion”. Google Flu Trends provides raw data, but not context. Each year, close to 100 million Americans search for health information online, but not everyone who searches for health information is injured or ill. Since I write about medicine, for example, I usually search for health information online for my writing projects, not personal knowledge. Other searches, it seems, might be done out of idle curiosity, or even result from a keystroke error in the search bar.

Is Google Flu Trends just another odd little Google project that their employees tinker with at the Googleplex in Mountain View in between running the search engine and scanning in every book ever written? Apparently not. Google mapped five years’ worth of their flu data against flu data from the Centers for Disease Control and Prevention (CDC), which the agency compiles from health care providers, emergency room visit statistics, and other sources. Data from Google correlated closely with CDC data, often predicting flu outbreaks a week or two before the CDC. Google will soon publish a paper on its methodology in an upcoming issue of Nature.

Health care researchers already search for trends in anonymized electronic medical records (EMRs) that some practices use to record patient medical data and prescriptions. More digital data will become available in the future as EMRs become more common (especially since the federal government is providing financial incentives for Medicare providers to adopt e-prescribing, starting in 2009) .

For various reasons, however, many patients are not entirely honest with their doctors about their symptoms and medical concerns, a problem health care providers have struggled with for years. A patient might be embarrassed about a medical problem, forget to mention a symptom, or simply not realize that a symptom is significant. For this reason, search engine data might provide an even larger, and potentially more accurate, data pool than EMRs to indicate the actual incidence of conditions such as pre-diabetes or early heart disease, for example. Public health officials could then use the data to create more effective screening and prevention campaigns.

A bipartisan survey released earlier this week found that health care is the second largest concern for voters in the upcoming presidential election, after concerns about the economy. The survey of 1,500 potential voters, who were polled from October 5 through 9 of this year, was conducted by the Partnership to Fight Chronic Disease.

Almost 60% of those surveyed said that health care is a “major issue” in their upcoming choice for president, according to a recent press release by the organization. Health care is also the top personal concern for men and women, who worry most about the cost of health care. Almost 70% of respondents said that chronic diseases should be diagnosed and treated better in order to control costs.

The Partnership to Fight Chronic Disease states that over 75% of U.S. health care dollars (in both public and private programs) are spent treating chronic diseases. I’m not surprised to read this. I was once told that 10% of Medicare patients have diabetes, but their health care costs take up 25% of the Medicare budget. All told, chronic disease costs eat up about 96% of Medicare’s budget and 83% of Medicaid’s budget, according to the organization.

At a presentation on aging that I attended last year, the speaker pointed out that medicine has moved from “cure to care” — in other words, most diseases these days are managed long-term rather than cured with medical or surgical interventions. People are living longer, but not necessarily better, as chronic disease rates have been increasing steadily each year. Today, many experts, such as those affiliated with the Stanford Center on Longevity, are trying to prevent or delay the onset of chronic disease in order to cut medical costs and improve people’s quality of life.

Voters seem to understand how the burden of chronic disease affects our health care system. It will be interesting to see how this issue plays out in November.

Deductibles and health insurance premiums are going up rapidly, according to the latest Kaiser Family Foundation Employer Health Benefits survey, especially among small businesses. About two-thirds of small businesses offer health insurance plans to their employees, and of those about one-third of the plans have a yearly deductible of $1,000 or more, according to the survey. Average health care premiums paid by employees have risen five percent since last year, and roughly doubled since 1999.

In response to this trend, the Blue Cross Blue Shield Association has partnered with state governments in Oklahoma and Arizona to develop a health care premium subsidy program for small businesses with 50 or fewer employees, CQ HealthBeat News reported recently. Close to 20% of the population in both states is uninsured, according to the article. Over half of the employees who signed up for the Oklahoma program (called Insure Oklahoma), had been uninsured previously. Advocates of the partnership hope that these subsidies will decrease or eliminate the number of uninsured people in these states, CQ HealthBeat News reported.

Another good idea in today’s economy: vegetarianism. A NewScientist.com article in July cited a Cornell University study that showed that if all Americans ate a vegetarian diet (unlikely, I know, but possible), they could reduce the amount of fossil fuel used to produce food by one-third. Producing animal products consumes far more energy than producing plant products for human consumption. Plants such as feed corn must be grown and transported to animals in another field in order for the animals to grow large enough to eat. Then the animals or their dairy products must be processed and transported to the grocery store. Corn meant for human consumption only takes one field and, once harvested and processed, is transported directly to the grocery store.

The health benefits of eating a plant-based or plant-biased diet are well documented. Eating less meat and dairy and more fruits, vegetables, and grains can save money on both energy costs and health expenses. Eating more plant products might not be a radical idea, but it could directly impact the troubled economy.

First, the bad news. In a survey of 686 Americans, the National Association of Insurance Commissioners found that Americans, feeling the pinch of our is-it-a-recession-yet? economy, have cut back on their health care spending. Twenty-two percent of those surveyed said they are visiting their health care provider less often, and 11% are filling fewer prescriptions, decisions that can have serious repercussions for patients. People in the poorest households, making less than $25,000 per year, are most likely to skip appointments and drop or delay filling prescriptions, according to the survey. An article in yesterday’s Wall Street Journal pointed out that the number of prescriptions filled has dropped for first time in ten years, almost 2% in the most recent fiscal quarter.

If the poorest Americans are having trouble getting needed medical care, it’s time for some intervention. Who’s intervening? The pharmaceutical companies. Yesterday’s Kaiser Daily Health Policy Report cited an article about this connection in CQ HealthBeat. The Pharmaceutical Research and Manufacturers of America (PhRMA) have given $11.3 million to indirectly support the beleaugered State Children’s Health Insurance Program (SCHIP), a program targeted to children in low-income households and administered by the Centers for Medicare & Medicaid Services (CMS). The PhRMA money will help fund advertisements by a SCHIP advocacy group in support of a SCHIP expansion bill vetoed by President Bush (HR 3963), Kaiser reported.

Insuring more poor children is ethicially sound. Not coincidentally, it will also boost sagging pharmaceutical industry profits if these children receive needed medication for asthma, diabetes, and other illnesses.

I remember the first time I saw New Orleans, in June of 2001. I was flying in from California to work at a medical trade show at the Ernest J. Morial convention center. The green, lush, humid city was so different from the brown, parched hills I had left behind that I suddenly became homesick for the humid, overgrown, mosquito-infested summers of the upper Midwest, where I grew up. I didn’t realize how much I had missed the general fecundity of life near muddy rivers and lakes.

It was my first real business trip, and I was thrilled to travel on someone else’s dime. I had bought a travel guidebook, hoping to haul my co-workers out to eat beignets and crawfish and bread pudding with bourbon sauce in the French Quarter. Could we squeeze in a garden tour or a paddleboat ride up the Mississippi or a jazz club or (one co-worker’s favorite) a swamp tour that promised alligator spottings, I wondered? No — I had to work. We slogged onto the shuttle to the convention center each morning, and took turns running the booth where we were selling patient education brochures.

Clearly, New Orleans was poor. The air-conditioned ride from the hotel next to the French Quarter to the enormous convention center was probably walkable, but I doubt the visitor’s bureau wanted conventioneers to look closely at the tiny run-down houses, sketchy-looking bars and restaurants, and broken pavement that reminded me of the south side of Chicago. I knew the crime rate was high, too. Still, I loved New Orleans because it was so different from where I lived: the music, the southern accents, the humidity, the alligators, the fried food for breakfast, lunch, and dinner. When I got back, I told my husband that we needed to take a vacation there some day.

Then Katrina hit. I spent a week glued to the television every night, yelling variations on why the doesn’t somebody help these people? I held my own infant daughter as I watched parents pass a baby in diapers onto a bus that they couldn’t get on themselves to escape the flooded city. The television showed images of bodies floating face-down in the water, of a young woman going into a diabetic seizure after yelling “I don’t want to die!” in the convention center where I had been. Each day that people were still stuck in the city, I became more incredulous and horrified.

The memories return to me, unwanted, with Hurricane Gustav currently headed for New Orleans, even though New Orleans is almost fully evacuated now and far better prepared for a hurricane than it was before Katrina. I told my husband Katrina was the worst thing I ever saw on television. There was nothing to do but watch the misery unfold, and watch the places I had been become utterly unrecognizable.

Statistically, married men and women enjoy better health than their single, separated, divorced, or widowed counterparts. But the size and scope of this “health benefit” have changed dramatically over the past few decades, with disparities between the experiences of men and women, according to a new analysis in the September issue of the Journal of Health and Social Behavior (“The Times They Are a Changin’: Marital Status and Health Differentials from 1972 to 2003″ by Hui Liu and Debra J. Umberson).

The authors track the self-reported health status of married and unmarried men and women over three decades. In 1972, women who were married, divorced, widowed, or never married all had about the same rate of excellent/good health (a probability of about .92), while separated women had lower rates of excellent/good health (a probability of about .9). Married men in 1972 were more likely to report excellent/good health (about .92 probability) than those who were widowed, separated, or divorced (about .91 probability). Never-married men were least likely to report good/excellent health (about .89 probability). By 2003, however, the dissolution of a marriage had become a health liability for both genders. Men and women who went through separation, divorce, or the death of a spouse had the worst health, the authors write.

Over the years, unmarried men have become about as healthy as married men, in contrast to the 1972 statistics. The authors attribute this increase to better social support for single men, although they point out that there are many other ways to interpret this data, such as improvements in medical care since the 1970s. Widowed people in 2003, especially women, had far worse health than married men and women. Ultimately, the authors find marriage a risky proposition these days because so many marriages fail. They conclude that “getting married increases one’s risk for eventual marital dissolution, and marital dissolution seems to be worse for self-rated health now than at any point in the past three decades.”

Why is post-marriage life so dismal for both men and women? Studies have shown that marriage provides economic benefits and social support, both of which can positively impact a person’s mental and physical health, the authors write. If a married couple is deeply unhappy, however, separation or divorce seems like a solution that will ultimately make each partner happier and healthier. The authors point out that the couple pays the price, though, in the increased economic strain of maintaining separate households. If a partner has been out of the workforce for a while the economic blow is even worse, and can harm their health even more.

The produce section of my local urban grocery store, recently renovated with wide plank flooring and festive wooden bins to look like the inside of a country barn, boasts piles of tempting summer fruits and vegetables. It all looks delicious, the peaches and corn and deep purple eggplants, but I pause when I reach the tomatoes. And the peppers. And I wonder what other produce might make the news with a new salmonella outbreak.

Google’s HealthMap provides a visual compilation of a range of diseases reported in the past 30 days from various sources, and in the U.S. salmonella tops the list. The most recent Salmonella saintpaul outbreak, initially blamed on tainted tomatoes, began in April and was finally traced to a pepper farm in Mexico on July 30, according to an article in the Washington Post. Over 1,300 people contracted Salmonella saintpaul this summer, the article stated.

Earlier this month, the center for Science in the Public Interest called for a better labeling process to track where each piece of produce originates, in order to quickly find the source of tainted foods. Growers fought against more stringent produce labeling for years, but they also lost more than $100 million in revenues when tomatoes were mistakenly blamed for the most recent outbreak.

Just to be safe, I’ve avoided raw tomatoes all summer. I usually use raw tomatoes year-round, and rarely stop to think about whether they are in season, or where they come from. Chile? Guam? Who knows? All I know is that I need tomatoes for a recipe I’m making. But I’m rethinking my blindness to the seasons, and the price (energy consumption, possible difficult-to-trace foodborne illness) of eating food grown so far away. How many trucks, ships, and airplanes has this produce been on, before it is presented (and misrepresented) to me as if I had pulled off a country road to buy fresh fruit at a farmstand? Lately I’ve started going to my local farmers’ markets for produce, where the path from farm to fork is shorter and far less deceptive.

Where I live, you can’t throw a pebble without hitting someone who works at a technology company. Technology rules the Bay Area. Blackberries, iPhones, iPods, Bluetooth headsets – I see them everywhere. LinkedIn Profile? Done. Twitter? Been there. Blog? Of course! Don’t you?

Although I work online almost every day, I barely touched anything with a silicon chip in it until I was in college, when PCs were just catching on. When I was ten, I borrowed my parents’ old typewriter to write short stories for fun. I remember that the keys would cross and jam if I typed too fast. Sometime I’d land my hands back on the keyboard wrong after I pushed the carriage return, and type a line of gibberish before I realized what I’d done.

As someone who remembers the drudgery of using carbon paper and correction fluid and smudgy typewriter ribbons at her first office job, I’m all in favor of technological advances. But making things easier can create fresh problems, and as manual and electric typewriters faded away, repetitive strain injuries such as carpal tunnel syndrome began to rise. With a typewriter, you have many built-in breaks for your hands, such as pushing the carriage return or feeding in a fresh sheet of paper. Without any electronic boost, manual typewriter keys also require a fair amount of pressure just to work. All this slows down your typing speed, but it doesn’t hurt your hands.

Today’s keyboards and devices encourage a light touch and micro-movements of the hands and wrist, with minimal breaks. This hardware irritates the nerves, tendons, and muscles in the hands and arms, creating new medical problems such as “Blackberry thumb.”

The hardware manufacturers generally seem uninterested in the injuries their devices have caused. Dell Computer, for example, the largest desktop and laptop manufacturer in the world, ships standard PCs with an ergonomically-unwise flat keyboard and mouse. They do provide a handy one-page description of how to set up your desktop computer on their website, but users who want to prevent a repetitive strain injury need to pay extra for break software and ergonomic tools.

Instead of repetitive strain injury prevention, the technology industry has focused on increasing revenues by adding lots of (often unnecessary) features to devices and by shrinking the footprint of silicon chips as much as possible. Smaller chips lower chip manufacturing costs and ultimately technology device costs, and help manufacturers shrink devices to make them lighter and more portable. Not surprisingly, lighter, smaller, cheaper, feature-rich devices are more attractive to customers.

Enter Apple Computer, whose forthcoming MacBook laptop is rumored to have an iPhone-like touch screen user interface. It sounds cool, and probably will sell like hotcakes, but it also sounds like a fresh source of injuries. Using a touch screen, presumably touching the screen lightly with just one or two fingers, is hardly the same experience as pecking away at a typewriter.

When I pick up the phone, the friendly woman’s voice greets me in Russian. Or maybe it’s Romanian? Or Polish? Then she begins a long discussion about an upcoming medical appointment in the mystery language. I know this because she mentions my name and a local medical center in English. She calls about once a month, a glitch in some health care provider’s electronic appointment reminder system.

Ah, medical information technology. I still can’t decide whether I like it or not. At my daughter’s pediatrician’s office, I wonder why they’re still using a giant, scribbled-over paper appointment book and paper folders to hold medical records. Then I remember that a shift to appointment scheduling software and electronic medical records could mean technology glitches like my periodic Russian phone calls and the imposition of a laptop screen between the doctor and me when we talked. On the other hand, I reason, it’s incredibly useful when a doctor I’m visiting can pull up electronic test results from another doctor I saw recently. Yet this easy access is also creepily Orwellian. How many people, exactly, do have access to my medical information? And what are they doing with it?

Sometimes, medical IT practices can cause real harm. A recent article in JAMA analyzed how radio frequency identification (RFID) devices, used to identify patients and equipment, can also interfere with medical equipment used to treat and manage medical problems. My daughter and I received RFID wristbands when she was born, in order to make sure that no unauthorized person took her from the hospital. Could the wristbands’ signals have interfered with the lifesaving equipment used on the infants in the neonatal ICU down the hall? Possibly, according to JAMA.

As I sort through my own opinions about information technology and medicine, the technology marches forward relentlessly. At the moment, the Markle Foundation, a public/private collaborative studying IT, health, and national security issues and endorsed by WebMD, the American Academy of Family Physicians, Microsoft Corporation, and others, is analyzing the public/private world of digital personal health information in an age of many grievous privacy breaches. The foundation has developed privacy guidelines for health information and services that consumers use online. With care, I think, health care IT will improve, but only in the way that medicine improves: by trial and error, educated guesses, and unanticipated consequences.