Cutting Edge

SAN FRANCISCO--Three of medicine and technology's minds gathered together Thursday at O'Reilly's Web 2.0 Summit to discuss the state of the U.S. health care system, and where it's going in the next few years. The outlook: good--just give us a swab of your cheek and $400 for the test.

Carol McCall, the vice president of research and development for Humana Inc., believes there's going to be an "explosion" of at-home testing services. Services like 23andMe (which uses a swab of your cheek) are some of the first on that front, leapfrogging tools that test for blood pressure and glucose levels, and going straight to the human genome. McCall said Humana is working with another company to create a test for cardiovascular health. (Heart disease is the nation's leading killer.) McCall believes that future advances in technology will bring similar at-home testing tools for other conditions.

One of the current limitations in testing technology is what to do with all the data that's being harvested to turn it into something doctors can actually use. Dr. Daniel Kraft, another panelist who is a faculty member at the Stanford Institute for Stem Cell Biology and Regenerative Medicine, said results from services like 23andMe are groundbreaking, but it's hard to meet patient expectations that something can be done immediately. "Right now there's not a lot of translation between genetic testing and a clinician...we need to have platforms built so I can understand the genome of that patient."

Dr. Daniel Kraft was one of three experts on a Web 2.0 Summit panel about the state of health care as technology advances.

(Credit: Stanford School of Medicine)

That framework of understanding is something that will take time--and more testing. Dr. Joanna Mountain, who is the senior director of research at 23andMe, says the company's project is building that database, although it has not yet fully been tapped due to our current level of medical science. McCall envisions something much larger though. "Why can't every citizen in this country be able to participate in studies?" she asked. "You'd have data from blood, spit, urine...and (have everyone) participate in a giant informational study. You can be a part of something real from a bottom up discovery."

For those not willing to share their genetic information so readily, the Web still holds promise. Mentioned were user forums, and live chat with physicians and nurses--things that can possibly cut out the need to go in for appointments in the first place.

The same approach is going on in the medical field with more and more use of tech to improve the patient experience. Kraft says doctors are putting more of a focus on simulation as part of the learning experience, similar to what's been done in the aviation industry: "Whole surgical teams can go into a simulation under stress and going in to de-brief afterwards," he said.

While these sweeping changes are unlikely to happen in the very near future, the process could be accelerated with the upcoming change in the White House. With many of the campaign promises of President-elect Barack Obama and former contender John McCain being centered on health care, there are high expectations for reform in both the insurance industry and medical records, the latter of which is currently being tackled by Google.

Mountain ultimately believes the biggest factor pushing reform will be transparency of that information, both in how her company handles customer results and on the part of the government, health care providers, and insurance companies. "It's a key theme that guides us."

Improved e-mail filtering and government crackdowns might've deterred some of the once-ubiquitous spammers peddling prescription-free Viagra on the Web, but a new study from Columbia University's National Center on Addiction and Substance Abuse has found that many of those sites are still alive and kicking.

The CASA study, resulting from its fifth annual "You've Got Drugs!" investigation, did find that there has been a decline in the total count of Web sites hawking controlled drugs: 365 of them, compared to 581 in 2007's study.

But it's still alarming, CASA said, because few of them require prescriptions for products that can be dangerously addictive. Forty-two percent of the sites said up-front that no prescription was required, 45 percent offered "online consultations," and 13 percent didn't mention prescriptions. Even for the sites that did require prescriptions, fraud could be easily committed because many accepted prescriptions via fax.

And despite the gray-market drug industry's reputation for specializing in male enhancement products, CASA's study found that the controlled drugs sold online most prolifically are benzodiazepines (Xanax, Valium), opioids such as Vicodin and OxyContin, and stimulants such as Ritalin and Adderall.

"This problem is not going away," CASA chairman and president Joseph Califano said in a release Wednesday. "It is morphing into different outlets for controlled prescription drug trafficking like Internet script mills and membership sites that sell lists of online pharmacies, and different payment methods like e-checks, COD (cash on delivery), and money orders."

On the brighter side, CASA praised the U.S. government for legislation that cracks down on the online sale of controlled drugs, and it recommended further measures: negotiating with foreign governments, for example, or getting search engines to block ads from unlicensed pharmacies.

One of the most high-profile drug-hawking spammers, Christopher William Smith, was sentenced last year to 30 years behind bars. His online pharmacy had been a $24 million operation.