June 25, 2004

Screen them all

I blogged about Bush's mental health initiative at the
CNEhealth.org Blog

My basic argument is that 1. massive screening for broad ranges of illnesses is becoming feasible, 2. it is irresistible from a public health perspective, 3. that such programs are likely to turn into expensive projects benefitting decisionmakers, pharmaceutical companies and involved organisations far more than the citizens. Not to mention that they will not be the ones suffering from the integrity and privacy problems.

Very timely Reason took up the issue of how medical regulators oppose self-diagnosis. The idea seems to be that people cannot handle screening and diagnosis of their own (or their children's) health themselves but broad screening implemented within non-medical organisations such as schools will be beneficial. It really lays the paternalistic and organisation-centric outlook bare: don't trust people, trust organisations and expert groups.

It bears reiterating: as medical sensors become cheap, small and expendable they can be integrated into everyday life. We already have home pregnancy and AIDS tests, and home DNA tests are on the way (mail order tests already exist). Add to this bacterial and viral detectors, and within a few years it is quite feasible to have a microlab within one's mobile phone signalling the presence of pathogens. Screening can be implemented by people themselves, integrated into the normal caring for children and family rather than centralized through enormous programs and databases.

Worried that the disadvantaged will not get access? Spend the money on subsidies or send out test kits. Worried about how people will react to the information? What guarantees do we have that people will react better to centralized testing? Handling a potentially serious diagnosis requires some maturity and is helped by the presence of a caring professional. But home pregnancy tests does not seem to ruin that many lives, and help many more. A home dyslexia test might be even more useful.

It will take a while before understanding of the enormous potential of ubiquitious medical sensors will sink in among people, both health consumers, doctors, health organisations and politicians. It is revolutionary in the sense that it undermines monopolies of diagnosis and suggests a very different approach to maintaining public health. Perhaps one could call it P2P - patient to patient.

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