The document discusses various developments in medical profiling and online medicine, and explores their ethical implications. It analyzes case studies of online health information, online personal health records, buying medicines online, telemedicine, personal genetic profiling, and body imaging. For each case, it discusses potential benefits but also risks or harms, and provides recommendations aimed at maximizing benefits and minimizing harms in a way that respects various ethical values around privacy, individual autonomy, reducing harm, fairness, and social solidarity.
Patient Safety: Evolving from Compliance to Cultureclinicalsolutions
Patient Safety, evolving from Compliance to Culture with McKesson http://www.mckesson.com/static_files/McKesson.com/MPT/Documents/PatientSafety_WHT260.pdf
Social networking, a relatively new communication phenomenon, has the ability to provide education, foster advocacy, promote the profession, and influence mental health policy. It also has the potential to violate boundaries, infringe on privacy, create liability, and damage professional credibility. A review of the literature revealed limited research has been conducted concerning the impact and use of social networking sites in nursing practice and other healthcare disciplines.
In Psychiatric/Mental Health Nursing, communication is the foundation of the therapeutic alliance. Because social networking communications have the potential to positively and negatively affect this alliance, it is imperative to develop guidelines for prudent and resourceful usage of social networking media that complies with practice acts, promotes professionalism, and maintains work-life balance for the psychiatric mental health nurse. This session will provide an overview of different types of social media outlets, review published position statements from other healthcare disciplines, and consider best practices for Psychiatric/Mental health nursing.
Patient Safety: Evolving from Compliance to Cultureclinicalsolutions
Patient Safety, evolving from Compliance to Culture with McKesson http://www.mckesson.com/static_files/McKesson.com/MPT/Documents/PatientSafety_WHT260.pdf
Social networking, a relatively new communication phenomenon, has the ability to provide education, foster advocacy, promote the profession, and influence mental health policy. It also has the potential to violate boundaries, infringe on privacy, create liability, and damage professional credibility. A review of the literature revealed limited research has been conducted concerning the impact and use of social networking sites in nursing practice and other healthcare disciplines.
In Psychiatric/Mental Health Nursing, communication is the foundation of the therapeutic alliance. Because social networking communications have the potential to positively and negatively affect this alliance, it is imperative to develop guidelines for prudent and resourceful usage of social networking media that complies with practice acts, promotes professionalism, and maintains work-life balance for the psychiatric mental health nurse. This session will provide an overview of different types of social media outlets, review published position statements from other healthcare disciplines, and consider best practices for Psychiatric/Mental health nursing.
mHealth Applications: Current Projects and their Status: Understanding the 12 Application Clusters of mHealth by C. Peter Waegemann, Executive Director, mHealth Initiative
By Annette Gardner, PhD, MPH
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
The Patient Protection and Affordable Care Act (ACA) is an opportunity to coordinate care among health care providers and transform local nets into seamless systems of care. The study conducted by Dr. Annette Gardner, PhD, MPH, at the Philip R. Lee Institute for Health Policy Studies, UCSF, shows safety net integration activities in five counties—Contra Costa, Humboldt, San Diego, San Joaquin, and San Mateo—suggests much progress has been made to this end in these counties.
This Report describes the factors that affect a local safety net's ability to develop integrated delivery systems and lessons learned from the implementation of 30 safety net integration "best practices".
Work activities give rise to many hazards which present risks to workers and the public.
The HSC/E are responsible for regulating such risks.
Source : http://www.hse.gov.uk – Blog : http://rismandukhan.wordpress.com
Advocacy Workshop, National Rx Drug Abuse Summit, April 2-4, 2013. Successful Strategies for Community Change - Part 2 presentation by Fred Wells Brason II and Connie M. Payne.
AIDSTAR-One HIV Treatment Guidelines in Guyana - The Fast Track to Diagnosis ...AIDSTAROne
This case study details Guyana's process for revision of their national HIV treatment guidelines, based on WHO's 2010 revised recommendations . While many countries are still working to revise their national guidelines in response to WHO's latest guidance, the National AIDS Programme in Guyana has been implementing elements of WHO's 2010 recommendations since 2006.
www.aidstar-one.com/focus_areas/treatment/resources/case_study/guyana_treatment_guidelines
What eHealth strategies work and do not work, and what should be implemented to effectively meet these healthcare “transformational” imperatives?. Crawford J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
mHealth Applications: Current Projects and their Status: Understanding the 12 Application Clusters of mHealth by C. Peter Waegemann, Executive Director, mHealth Initiative
By Annette Gardner, PhD, MPH
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
The Patient Protection and Affordable Care Act (ACA) is an opportunity to coordinate care among health care providers and transform local nets into seamless systems of care. The study conducted by Dr. Annette Gardner, PhD, MPH, at the Philip R. Lee Institute for Health Policy Studies, UCSF, shows safety net integration activities in five counties—Contra Costa, Humboldt, San Diego, San Joaquin, and San Mateo—suggests much progress has been made to this end in these counties.
This Report describes the factors that affect a local safety net's ability to develop integrated delivery systems and lessons learned from the implementation of 30 safety net integration "best practices".
Work activities give rise to many hazards which present risks to workers and the public.
The HSC/E are responsible for regulating such risks.
Source : http://www.hse.gov.uk – Blog : http://rismandukhan.wordpress.com
Advocacy Workshop, National Rx Drug Abuse Summit, April 2-4, 2013. Successful Strategies for Community Change - Part 2 presentation by Fred Wells Brason II and Connie M. Payne.
AIDSTAR-One HIV Treatment Guidelines in Guyana - The Fast Track to Diagnosis ...AIDSTAROne
This case study details Guyana's process for revision of their national HIV treatment guidelines, based on WHO's 2010 revised recommendations . While many countries are still working to revise their national guidelines in response to WHO's latest guidance, the National AIDS Programme in Guyana has been implementing elements of WHO's 2010 recommendations since 2006.
www.aidstar-one.com/focus_areas/treatment/resources/case_study/guyana_treatment_guidelines
What eHealth strategies work and do not work, and what should be implemented to effectively meet these healthcare “transformational” imperatives?. Crawford J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
Regulatory Considerations in Precision Medicine: Navigating the Approval ProcessClinosolIndia
Precision medicine, with its focus on tailoring medical treatments to individual characteristics, presents unique regulatory challenges in the drug development and approval process. This ppt delves into the regulatory considerations associated with precision medicine, exploring the key aspects that pharmaceutical and biotechnology companies need to navigate
Future of Healthcare – Leadership Challenges
Further to several additional expert workshops this year, we are delighted to share an updated global perspective on the future of healthcare. Produced in partnership with Duke Corporate Education (http://www.dukece.com), this adds new insights on the pivotal shifts taking place across the sector plus viewpoints on some of the core implications for leadership. Topics include the growing power of data; the rising impact of urbanisation on health; increasing patient centricity; the need for more flexible organisations and the move of innovation activity eastwards.
Available as both this report and as an accompanying presentation (https://www.slideshare.net/futureagenda2/future-of-healthcare-15-october-2019-182433390) this is now being used to inform and provoke further debate around the world. As ever we would like to thank all those who have given their time and insight to contribute to this project.
Patient Safety: Evolving from Compliance to Cultureclinicalsolutions
Patient Safety, evolving from Compliance to Culture with McKesson http://www.mckesson.com/static_files/McKesson.com/MPT/Documents/PatientSafety_WHT260.pdf
Patient Safety: Evolving from Compliance to Cultureclinicalsolutions
Patient Safety, evolving from Compliance to Culture with McKesson http://www.mckesson.com/static_files/McKesson.com/MPT/Documents/PatientSafety_WHT260.pdf
Patient Safety: Evolving from Compliance to Cultureclinicalsolutions
Patient Safety, evolving from Compliance to Culture with McKesson http://www.mckesson.com/static_files/McKesson.com/MPT/Documents/PatientSafety_WHT260.pdf
Patient Safety: Evolving from Compliance to Cultureclinicalsolutions
Patient Safety, evolving from Compliance to Culture with McKesson http://www.mckesson.com/static_files/McKesson.com/MPT/Documents/PatientSafety_WHT260.pdf
Patient Safety: Evolving from Compliance to Cultureclinicalsolutions
Patient Safety, evolving from Compliance to Culture with McKesson http://www.mckesson.com/static_files/McKesson.com/MPT/Documents/PatientSafety_WHT260.pdf
In July 2018, NITI Aayog published a Strategy and Approach document on the National Health Stack. The document underscored the need for Universal Health Coverage (UHC) and laid down the technology framework for implementing the Ayushman Bharat programme which is meant to provide UHC to the bottom 500 million of the country. While the Health Stack provides a technological backbone for delivering affordable healthcare to all Indians, we, at iSPIRT, believe that it has the potential to go beyond that and to completely transform the healthcare ecosystem in the country. We are indeed headed for a health leapfrog in India! Over the last few months, we have worked extensively to understand the current challenges in the industry as well as the role and design of individual components of the Health Stack. In this post, we elaborate on the leapfrog that will be enabled by blending this technology with care delivery.
Using technology-enabled social prescriptions to disrupt healthcareDr Sven Jungmann
As chronic diseases are increasingly straining healthcare systems, social factors are gaining importance. Since the birth of social medicine (19th century), we saw many failed attempts to beat the dominance of the biomedical model. Social prescriptions have come, raising hopes that non-biomedical solutions will improve outcomes and optimise resource use. Social Prescriptions connect citizens to support to address social determinants of health and encourage self-care for physical and mental health. Social prescriptions can make us healthier cheaper and with fewer side effects than most drugs. Social prescriptions can become a disruptive force as they can be personalised, improve lifestyle-related diseases, and support non-biomedical issues affected by social determinants of health.
20 tendencias digitales en salud digital_ The Medical FuturistRichard Canabate
Resaltado de las tendencias que darán forma a la atención médica post COVID19.
No se trata de enumerar estas tendencias, sino de dar una valiosa visión de los factores de conducción detrás de ellas mientras que es muy específico. Se trata de mostrar cuáles son las áreas exactas que deben destacarse entre todas las áreas en el tema "IA en la atención médica", por ejemplo.
La Version 2023 de la doctrine du numérique en santébenj_2
Dans la logique d’État-plateforme, la Doctrine du numérique en santé constitue le document de référence pour les acteurs de l’écosystème de la e-santé, qui développent ou opèrent des services numériques au bénéfice des professionnels du système de santé et in fine des usagers. Elle s’adresse principalement aux entreprises du numérique en santé et plus largement aux structures publiques ou privées, de toutes tailles, qui créent, maintiennent ou développent des services numériques en santé.
Etude Biomédicaments et Bioproduction 2023 en France et en Europebenj_2
Synthèse réalisée à partir d’Étude et caractérisation de la filière des biomédicaments en France, étude réalisée en 2023 par Mabdesign pour France 2030, l’Agence de l’innovation en santé et sa stratégie d’accélération Biomédicaments et Bioproduction en thérapies innovantes,
France Biotech et France Biolead.
Cette étude a été réalisée sur 8 pays : France, Royaume-Uni, Suisse, Portugal, Italie, Belgique, Irlande et Allemagne.
Les données utilisées s’arrêtent en juillet 2023.
État des lieux du marché des biomédicaments dans le monde et en Europe
3ème édition de l’Observatoire du transfert de technologie en Santébenj_2
États des lieux du transfert de technologie en Santé : vers une meilleure structuration des négociations d’accords publics/privés.
France Biotech, l’Association des entrepreneurs de l’innovation en santé et KPMG en France, avec le soutien de l’Agence Innovation Santé et de bpifrance, publient la 3ème édition de l’Observatoire du transfert de technologie en Santé.
Confiance et utilisation du numérique en santé, sécurité́ des données de santé, retours d’expérience de Mon espace santé... afin de mieux déceler les habitudes et les freins des Français en matière de numérique en santé, la Délégation au numérique en santé (DNS) a mené́, avec Verian (ex Kantar Public) et Harris Interactive, une vaste enquête qualitative et quantitative intitulée « Les Français et le numérique en santé ».
Décret n° 2023-1222 du 20 décembre 2023 relatif à la prescription électroniqu...benj_2
Le décret définit les conditions de mise en œuvre et d'entrée en vigueur de la prescription électronique entendue comme la dématérialisation des prescriptions de soins, de produits de santé et de prestations établies ou exécutées par les professionnels de santé et leur transmission à l'assurance maladie par voie électronique. Il définit également les droits des patients à l'égard de ces précisions dématérialisées et de leurs conditions d'exécution ainsi que les cas ou circonstances dans lesquels la dématérialisation pourra, par dérogation, ne pas être mise en œuvre par les professionnels.
Feuille de route décarbonation de l'industrie pharmaceutiquebenj_2
Décembre 2023: Afin de lutter contre le réchauffement climatique et réduire les émissions de gaz à effet de serre associées à la production et à la consommation de médicaments en France, le Gouvernement a annoncé un plan de décarbonation pour l'industrie pharmaceutique.
Ce guide du déposant est destiné aux déposants qui souhaitent suivre une procédure selon le Traité de coopération en matière de brevets (PCT) et insiste sur les particularités des procédures PCT devant l'OEB. Il est appelé "Guide euro-PCT" afin de le distinguer du Guide du déposant du PCT publié par l'OMPI ("Guide PCT de l'OMPI").
INPI : Le palmarès 2016 des déposants de brevets en France en 2016benj_2
Le Top 3 modifié et un nouvel entrant parmi les 10 premiers déposants. Des changements de stratégies de propriété industrielle. La recherche publique de plus en plus visible. Une concentration significative du nombre de demandes de brevets publiées.
Télémédecine et autres prestations médicales électroniquesbenj_2
France, 10 Février 2016, CNOM: Le Conseil national de l’Ordre des médecins publie son avis sur
« l’ubérisation » des prestations médicales
Répondre aux besoins médicaux des patients sans laisser s’installer une ubérisation de la médecine
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Personalised healthcare short guide (for web)
1. Medical profiling
and online medicine:
The ethics of ‘personalised
healthcare’ in a consumer age
A guide to the report
2. Table of contents
Introduction 01
What is ‘personalised healthcare’? 02
Ethics 03
Intervention 04
Case studies
Online health information 05
Online personal health records 06
Buying medicines online 08
Telemedicine 09
Personal genetic profiling 10
Body imaging 11
Conclusions 12
3. NUFFIELD COUNCIL
ON BIOETHICS
01
Introduction
This guide summarises the conclusions
and recommendations that are discussed
in more detail in the Nuffield Council
on Bioethics’ report Medical profiling
and online medicine: The ethics of
‘personalised healthcare’ in a consumer
age (published October 2010).
New developments in medical profiling
and online medicine are promised by
their providers as leading to a new
era of ‘personalised healthcare’. These
developments include:
• irect-to-consumer body imaging
d
(e.g. CT and MRI scans) and personal
genetic profiling as a health check
• he increase in websites that
t
provide health advice, diagnosis,
storage of health records, and
medicines for sale.
The technologies behind these
developments are already being used
in positive ways. For example, the
UK’s National Health Service (NHS)
uses approved genetic tests to detect
rare genetic disorders. We explore
the more controversial uses of these
technologies, and the extent to which
they really do lead to healthcare
becoming more personalised.
Notes in square brackets refer to the chapters in
the report.
4. 02 NUFFIELD COUNCIL
ON BIOETHICS
What is ‘personalised
healthcare’?
The term ‘personalisation’ has become very
widespread, with many companies, policy
makers and doctors claiming that this is the
future of healthcare.
We found several meanings for ‘personalised healthcare’. For
example, it can mean healthcare that is tailored to a person’s specific
characteristics, or healthcare where more responsibility is given to
individuals rather than medical professionals [Chapter 1].
Links with responsibilisation and consumerisation
Some of these types of personalised healthcare correspond with two
key social pressures, called ‘responsibilisation’ and ‘consumerisation’.
These pressures are not just relevant to healthcare, but present
particular ethical challenges for the developments being considered
in this report.
‘Responsibilisation’
Policy makers in the UK and elsewhere often encourage people
to take more responsibility for their own health – to lead a
healthy lifestyle and play an active role in managing their
healthcare. Developments in medical profiling and online
medicine can provide new tools to enable people to take
more responsibility for their health.
‘Consumerisation’
There is nothing new about being able to select and pay for
healthcare in the private sector, but today even public healthcare
services are aiming to become more user focused. A consumerist
approach to healthcare and the new technologies available have
been seized upon by firms offering medical profiling and online
medicine services [Chapter 2].
5. NUFFIELD COUNCIL
ON BIOETHICS
03
Ethics
The following five ethical values are
important when considering developments
in medical profiling and online medicine:
1 Private information should be safeguarded.
2 ndividuals should be able to pursue their own
I
interests in their own way.
3 The state should act to reduce harm.
4 ublic resources should be used fairly
P
and efficiently.
5 ocial solidarity (sharing risks and working
S
together to protect the vulnerable) should
inform public policy.
Conflicting ethical values
These ethical values often conflict with one another. All are
important and no one value ‘trumps’ another.
In the following case studies, we examine the benefits and harms in
each situation. We then attempt to ‘soften’ the conflicts between the
ethical values by respecting each of them as much as possible and
making recommendations that are evidence-based, proportionate
and feasible [Chapter 3].
6. 04 NUFFIELD COUNCIL
ON BIOETHICS
Intervention
If there is broad agreement that a new
development in medical profiling and online
medicine is likely to cause significant harm,
then intervention by governments or other
organisations is justified.
Types of intervention
Coercive vs non-coercive
Some interventions involve formal state-specific forms of
coercion, such as laws and regulations, while others do not, such
as voluntary codes of conduct or education campaigns.
Specific vs general
Some interventions are specific to the product or service in
question, while others are more general, for example general
professional codes or rules about data protection.
Choosing interventions
The intervention should be proportionate to the problem. Less
coercive interventions should be explored first, unless the degree of
harm in a particular case merits a more stringent type of intervention.
More general forms of intervention are often preferable to more
service- or product-specific ones, particularly where technology is
rapidly changing and specific rules can quickly become outdated.
Interventions should also be feasible. There may be times when
measures could not realistically be enforced, would be very expensive
or could have negative side effects [Chapter 4].
7. NUFFIELD COUNCIL
ON BIOETHICS
05
Case studies
Online health information
People have always been able to access health information in
newspapers and magazines, but the internet has opened up a
range of new possibilities for conveniently finding and exchanging
information on health. This can increase people’s involvement in their
own health and provide them with valuable support from others.
However, it is difficult for people to assess the accuracy of
information they are getting online, and they may not know who has
access to any personal information they submit. There are no strong
incentives for information providers to follow best practice.
The best websites are based on high quality research, originate
from an independent not-for-profit organisation, are independently
evaluated and continuously updated.
We conclude…
• ll websites containing health information should contain
A
key details about, for example, the basis of the information,
the authors, funding arrangements, and how any personal
data will be used. Websites should seek accreditation from
recognised schemes.
• overnments should ensure that high quality health
G
information is available on the internet and doctors should
direct patients to these sites.
• octors should receive training and advice on caring for
D
patients who use the internet to access information about
diagnosis and treatment [Chapter 5].
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Case studies continued
Online personal health records
Both public and private healthcare providers are starting to offer
online health records services.
Through its HealthSpace website, the NHS currently intends to
provide everyone in England with online access to a summary of
their medical records, including information about their current
and past health problems, medication and allergies.
Several commercial companies, mainly in the US, provide services
that allow people to organise their personal health information,
integrate health records from different providers, and share them
with other people, including healthcare professionals.
These services allow more convenient and patient-centred control
of health records. However, there is potential for misuse of stored
information.
We conclude…
• overnments should set up accreditation schemes for online
G
health record providers to improve transparency and standards
on how personal information is stored and used. Providers of
these services should seek accreditation from such schemes.
• uring the signing-up process, online health record providers
D
should provide potential users with information about data
security and legal rights.
• esponsible bodies in the EU, such as the UK Information
R
Commissioner’s Office, should apply European Union data
protection legislation to online health records used by people in
the EU [Chapter 6].
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Buying medicines online
Online pharmacies can allow people to buy medicines conveniently
and privately. Great Britain has a registration system for online
pharmacies to help people identify legitimate websites.
The internet can also be used to buy medicines for which people
do not have a prescription and which are illegal in their country.
People doing this risk buying harmful, fake or low quality medicines
and could miss out on advice offered by doctors and pharmacists.
It could also lead to an increase in antibiotic resistance arising from
misuse of antibiotics.
The extent of any harm
currently being caused
is not known but the
potential for harm is great.
As with all online services,
the international nature
of the problem makes it a
difficult area to regulate.
We conclude…
• egistration schemes for online pharmacies, such as the one
R
in Great Britain, should be mirrored in other countries.
• overnment websites should provide information about
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the risks of buying medicines online and how to identify
a registered online pharmacy.
• octors should receive training and advice on how to deal
D
with patients who may be buying medicines online.
• overnments worldwide should set and enforce regulations
G
on the supply of antibiotics in their country [Chapter 7].
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Telemedicine
Telemedicine refers to any healthcare that involves communications
technology and an element of distance. It includes patients and
doctors communicating with each other electronically, and medical
devices being operated remotely.
Although some types of care will always need to be delivered in
person, telemedicine has the potential to offer care to people in
their own home and increase equitable access to healthcare services.
Telemedicine could have a particularly positive impact in developing
countries, for example, by enabling doctors to seek expert opinions
from specialists in developed countries. Telemedicine may also
have an impact on the ‘brain drain’ effect of doctors moving from
developing countries to work in developed countries.
There has been little research on the impact of different types of
telemedicine on doctor-patient relationships or on whether they
bring cost savings.
We conclude…
• ublic healthcare systems should offer telemedicine
P
services where they can feasibly and cost-effectively
help to reduce inequities in access to healthcare.
Any impacts on the doctor-patient relationship
should be evaluated.
• nternational agencies should encourage
I
telemedicine networks in developing countries
where they are shown to be beneficial, cost-
effective and sustainable.
• eveloped countries should monitor any impacts of
D
outsourcing their healthcare services to developing
countries via telemedicine, for example on the
‘brain drain’ effect [Chapter 8].
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Case studies continued
Personal genetic profiling
Several companies, mainly US-based, now offer personal genetic
profiling services for disease susceptibility. After analysing a sample
of DNA (e.g. from a saliva sample sent in the post), they claim to be
able to tell healthy people about their risks of developing common
diseases in future, such as cancer, Parkinson’s disease and diabetes.
These services can cost up to US$2000.
The tests might provide reassurance or enable people to take
preventative action. However, there are a number of potential
downsides:
• The test results can be unreliable and difficult to interpret.
• ‘Good’ results may lead to complacency in lifestyle.
• earning about risk of disease could be upsetting, particularly if no
L
treatments are available.
• There is potential for misuse of personal genetic information.
• eople may seek unnecessary further tests or advice from their
P
doctor.
The number of people using genetic profiling services and whether
this is currently leading to any actual harm is not known.
We conclude…
• egulators should request evidence for any claims being made by
R
companies about the clinical value of their tests.
• overnment websites should provide information about the risks
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and benefits of personal genetic profiling, including the relevance
for insurance.
• ompanies should not knowingly analyse the DNA of children
C
unless certain criteria are met.
• octors should receive training on giving advice to patients about
D
commercial genetic profiling services.
• ompanies should voluntarily provide clear information on the
C
limitations of genetic profiling and what will happen to people’s
data [Chapter 9].
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Body imaging
Commercial companies are now offering people a ‘health MOT’
using body imaging technologies such as CT and MRI scans. They
claim to look for early signs of conditions such as cancer and heart
disease, and can cost more than £1000.
The tests can put people’s minds at rest, or encourage them to
seek treatment and make lifestyle changes. However, there are a
number of potential downsides:
• CT scans expose people to radiation, which can be harmful.
• The results can be difficult to interpret.
• RI scans often pick up ‘abnormalities’ which are actually
M
harmless, but which could lead to unnecessary anxiety and
further invasive tests.
• There is potential for misuse of personal health information.
The number of people using direct-to-consumer body imaging
services and whether this is currently leading to any actual harm is
not known.
We conclude…
• ompanies that sell body imaging services as a health check
C
should be regulated to ensure they are meeting standards of
quality and safety.
• irect-to-consumer whole body CT imaging should be banned.
D
Part-body CT scans should only take place if it is in the best
interests of the customer.
• overnment websites should provide information about the
G
risks and benefits of commercial body imaging, including the
relevance for insurance.
• ompanies should voluntarily provide clear information on the
C
limitations of direct-to-consumer body imaging, and what will
happen to people’s data.
• octors should receive training on giving advice to patients
D
about direct-to-consumer body imaging services [Chapter 10].
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Conclusions
Personalisation
All the developments in medical profiling and online medicine
considered in the report offer increased ‘personalisation’ to some
extent. But many of the claims for more individualised diagnosis and
treatment seem to be overstated and should be treated with caution
at the present time. For example, commercial genetic profiling
and body imaging have the potential to tailor healthcare to the
individual, but that potential has yet to be fully realised.
Consumerisation
All the developments considered by the report can lend themselves
to the provision of healthcare as a consumer good. We think choice
is often a good thing, but to work effectively in healthcare it needs
to be accompanied by proper information and advice.
We also need to find ways of balancing individual choice with
the principle of social solidarity – i.e. that we should share the
responsibility to help people in need.
Responsibilisation
The developments considered in this report can lead to new
obligations and expectations for the individuals who use them.
For example, online personal health records systems can place new
demands on individuals to check their records and ensure
their security.
We think responsibility for handling new risks associated with these
developments should be placed in the hands of those best placed to
manage it. In some cases this is the state, in some cases the medical
professional, and in other cases the individual. Each case needs to be
considered on its own merits.