TCS Daily


First, Do No Harm

By David Charles - January 30, 2002 12:00 AM

Imagine a woman in a rural community so small it doesn't have a first class breast clinic, and yet she has her mammography results analyzed instantly by cancer experts at a National Cancer Institute like New York's Sloan-Kettering Medical Center. Think of the cost savings if patients with chronic conditions -- which account for 79 percent of health care spending today -- could be monitored with digital connections that instantly alert their doctors to a problem.

What if two-way broadband connections would allow physicians to conduct the virtual equivalent of an office visit examination by monitoring a patient's EKG, blood pressure and other vital signs and talking with the patient while he or she rests comfortably at home, observed by the physician through a video connection to the doctor's computer screen.

This is not Buck Rogers future gazing. Telemedicine applications like this are being performed right now, but they are rare because getting the broadband connections means expensive private line connections and costly equipment.

I never thought I would see a prescription for high-quality, accessible health care written in the form of a merger proposal between two communications companies -- but the proposed merger of satellite TV carriers EchoStar and DIRECTV is exactly that.

The combined broadcast spectrum of these two companies would allow the merged company to deliver the high-speed data capacity known as broadband via satellite to every home, hospital and doctor's office in America. This widespread ability of broadband would finally make the promise of telemedicine available to millions of Americans.

Just what is telemedicine? It is the use of voice, data and video connections to link patients with medical services they need, even if the providers of those services are hundreds or even thousands of miles away.

My own work involves implanting in the body a device that delivers a small electrical impulse in the brain to reduce the symptoms of Parkinson's disease. In the near future I may be able to 'visit' a patient and adjust their brain stimulating device over a high speed Internet connection. But the lack of widespread affordable broadband connections, particularly in rural areas, is a serious stumbling block, even though telemedicine applications have proved dramatically effective where they've been tried.

This standoff between the potential benefits of telemedicine and the lack of broadband connections could end quickly if the Federal Communications Commission and the U.S. Department of Justice give their respective blessings to the merger.

Any home, anywhere in America, with one of those pizza-sized satellite dishes could become an extension of a teaching hospital or specialist's office hundreds or even thousands of miles away. Small-town doctors or rural health clinics could reach out to physicians anywhere in the country to examine their patients or evaluate lab results.

Unlike so many other problems in health care, this one has a simple solution. All the government has to do is take a page from the physician's Hippocratic Oath that says "First, do no harm."

In other words, the FCC and Justice Department shouldn't block this free-market solution to a public health problem. Denying Americans the benefits of improved telemedicine would be inexcusable when the capacity to increase those benefits is before us now.

Dr. Charles is the Director of the Movement Disorders Clinic at Vanderbilt University Medical Center and Chairman of the National Alliance of Medical Researchers and Teaching Physicians.
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