Notes & Links: September 27, 2013

A Field Test of Web-Based Screening for Dry Eye Disease to Enhance Awareness of Eye Problems Among General Internet Users A Latent Strategy to Promote Health.
File this under ‘It Didn’t Take That Long”. Kawashima, Uchino, Kawazoe, et. al publishing in JMIR demonstrate that we are now seeing the Internet and Web 2.0 mimicking what we’ve come to love on TV the shilling of diseases to promote either a product or service. 

The Web site they reference is for self-checking by consumers/patients to draw attention to dry eye disease through the use of a questionnaire and identifying those with a higher risk. Dry eye exists.

The increasing prevalence of dry eye disease worldwide is an important public health problem, especially in developed countries with advanced information technology and those with an aging population. In Japan, the incidence rates of dry eye disease are almost 22% and are over 10% in female and male computer users, respectively, implying that the country has more than 24 million affected individuals. One reason for the rapid rise in the number of cases of dry eye disease over the last few years is thought to be prolonged visual display terminal (VDT) exposure because of increased computer use. VDT exposure is also becoming common in the general population because of the widespread use of mobile technology and portable information terminals, especially smartphones, among all age groups. The number of Internet users worldwide has doubled in the past 5 years. Japan had approximately 94 million Internet users in 2010, representing 78.2% of the Japanese population

The study had two parts. First, a Web based survey with self screening on dry eye symptoms. The second phase was the measurement of tear secretion and physical survey with lifestyle questionnaire. The second part was directed at those respondents with subjective dry eye symptoms based on part one. 

Here are the principle results:

In this study, a Web-based self-screening questionnaire was used to draw attention to dry eye disease among general Internet users and identify those at higher risk. Of the 1689 visitors to the survey website, 58.0% (980/1689) completed the first phase of the study, 36.2% (355/980) had five or more dry eye symptoms, 27.9% (99/355) completed the second phase of the study, and 32.3% (32/99) had tear production of ≤5 mm. This self-screening tool therefore identified a few individuals with probable dry eye disease. We speculate that a high number of general Internet users have latent dry eye symptomatology

A couple of points to note. The authors say they have not identified what factors encourage people with probable dry eye to seek medical help. Second, the study was organized by Carepro, Inc. which offers a convenience for commuters at Yokohama Station for just $6.50. Anyone can be tested for dry eyes, bone density, or lung function.

I am at sixes and sevens over this because the Web based survey to drive patients to a physical exam smacks of creating a disease to drive revenue. At the same time offering commuters a place to have examines performed while on their way home or to work seems valuable. What is that balance and how can we achieve it?

Physicians care about patients and money, ctd.
Austin Frakat writing in The Incidental Economist examines a reanalysis of data from study published in 2011 “How payment systems affect physicians’ provision behavior–An experimental investigation” Frakat first look at this is here

In the reanalysis the author states:

We find that most subjects attach a positive weight to patients’ health and, further, we observe substantial heterogeneity in the degrees of physician altruism. Our results indicate that some subjects attach a higher value to their own profit than to the patient benefit (26%), while others either attach equal weights to profit and health benefit (29%) or put an even higher weight on the patient (44%).

Frakat captures best what this means here: (I added the bold.)

The model that the doctor always and only cares about what’s best for the patient is old fashioned and, frankly, dangerous. Even if and when it’s true, patients would be better served if they played a more active role in their own care. Don’t presume your doctor’s values and incentives are aligned with your own. Ask questions. Do research. Behave like the consumer you should be. It’s your body, health, and life. And, if your doctor isn’t responding the way you’d like, fire him.

This is the money shot because it speaks to the current trend of patients using the Internet to learn about their health. And the mirror of that, the majority of physicians still uncomfortable with active, engaged, aggressive, and smart patients who question. It would be interesting to look at the physician participants in another study to determine if one, medical students today are more interested in active engaged patients and will they foster that.And, second to see how it matches the groups above. Are those more interesting in patient care more willing to engage with active patients? Or are those interested in revenue less interested in active engaged patients since it may be a cost/time issue. 

This trend in engaged patients is as important as Obamacare, new drug discoveries, bending the cost curve on healthcare, etc. It is how the buyer and the seller find the balance that benefits both.