Sunday, March 29, 2009

Death of Online Gamers - Real Challenges

Technology certainly has allowed convenience of communications, commerce, and collaboration. It also has spawned new ways of viewing entertainment as well as new forms of play.

Yet this recent Associated Press article "Deaths of gamers leave online lives in limbo" demonstrates we haven't realized its effect on society particularly when it comes to "alternative lives" or "second lives" on the internet in forms of online gaming. When someone passes away, who is responsible for communicating to those unseen others which a person may spend quality time together in the virtual world, but may be unbeknowst to those in the real world?

It's not in the role of an advanced directive, which is a document that directs doctors what type of care you wish to receive (supportive care, CPR, ventilation, IV fluids, antibiotics, etc.) if you cannot speak for yourself. But who does one inform?

The article in its entirety follows:

Deaths of gamers leave their online lives in limbo (AP)

* Posted on Sat Mar 14, 2009 1:39PM EDT


NEW YORK - When Jerald Spangenberg collapsed and died in the middle of a quest in an online game, his daughter embarked on a quest of her own: to let her father's gaming friends know that he hadn't just decided to desert them.

It wasn't easy, because she didn't have her father's "World of Warcraft" password and the game's publisher couldn't help her. Eventually, Melissa Allen Spangenberg reached her father's friends by asking around online for the "guild" he belonged to.

One of them, Chuck Pagoria in Morgantown, Ky., heard about Spangenberg's death three weeks later. Pagoria had put his absence down to an argument among the gamers that night.

"I figured he probably just needed some time to cool off," Pagoria said. "I was kind of extremely shocked and blown away when I heard the reason that he hadn't been back. Nobody had any way of finding this out."

With online social networks becoming ever more important in our lives, they're also becoming an important element in our deaths. Spangenberg, who died suddenly from an abdominal aneurysm at 57, was unprepared, but others are leaving detailed instructions. There's even a tiny industry that has sprung up to help people wrap up their online contacts after their deaths.

When Robert Bryant's father died last year, he left his son a little black USB flash drive in a drawer in his home office in Lawton, Okla. It was underneath a cup his son had once given him for his birthday. The drive contained a list of contacts for his son to notify, including the administrator of an online group he had been in.

"It was kind of creepy because I was telling all these people that my dad was dead," Bryant said. "It did help me out quite a bit, though, because it allowed me to clear up a lot of that stuff and I had time to help my mom with whatever she needed."

David Eagleman, a neuroscientist at the Baylor College of Medicine in Houston, has had plenty of time to think about the issue.

"I work in the world's largest medical center, and what you see here every day is people showing up in ambulances who didn't expect that just five minutes earlier," he said. "If you suddenly die or go into a coma, there can be a lot of things that are only in your head in terms of where things are stored, where your passwords are."

He set up a site called Deathswitch, where people can set up e-mails that will be sent out automatically if they don't check in at intervals they specify, like once a week. For $20 per year, members can create up to 30 e-mails with attachments like video files.

It's not really a profit-making venture, and Eagleman isn't sure about how many members it has — "probably close to a thousand." Nor does he know what's in the e-mails that have been created. Until they're sent out, they're encrypted so that only their creators can read them.

If Deathswitch sounds morbid, there's an alternative site: Slightly Morbid. It also sends e-mail when a member dies, but doesn't rely on them logging in periodically while they're alive. Instead, members have to give trusted friends or family the information needed to log in to the site and start the notification process if something should happen.

The site was created by Mike and Pamela Potter in Colorado Springs, Colo. They also run a business that makes software for online games. Pamela said they realized the need for a service like this when one of their online friends, who had volunteered a lot of time helping their customers on a Web message board, suddenly disappeared.

He wasn't dead: Three months later, he came back from his summer vacation, which he'd spent without Internet access. By then, the Potters had already had Slightlymorbid.com up and running for two weeks.

A third site with a similar concept plans to launch in April. Legacy Locker will charge $30 per year. It will require a copy of a death certificate before releasing information.

Peter Vogel, in Tampa, Fla., was never able to reach all of his stepson Nathan's online friends after the boy died last year at age 13 during an epileptic seizure.

A few years earlier, someone had hacked into one of the boy's accounts, so Vogel, a computer administrator, taught Nathan to choose passwords that couldn't be easily guessed. He also taught the boy not to write passwords down, so Nathan left no trail to follow.

Vogel himself has a trusted friend who knows all his important login information. As he points out, having access to a person's e-mail account is the most important thing, because many Web site passwords can be retrieved through e-mail.

Vogel joked that he hoped the only reason his friend would be called on to use his access within "the next hundred years or so" would be if Vogel forgets his own passwords.

But, he said, "as Nathan has proven, anything can happen any time, even if you're only 13."

___

On the Net:

http://www.deathswitch.com

http://www.slightlymorbid.com


Sunday, March 22, 2009

What's the Best Medicine / Treatment? Doctors Don't Know

Fascinating article from the Associated Press titled, "What's the best medicine really?" in which a government panel will try to determine which therapies and medications are better than others in a study of "comparative effectiveness". Funded by the stimulus package passed by Congress, about $1.1 billion will be spent understanding this.

Naturally, all parties involved have a stake in this because there will be losers. Although the article states that it is a secret that newer medications don't need to be better than older proven therapies, that isn't true. It's that the public is unaware that for FDA approval, medications only need to be better than placebo.

Pharmaceutical companies rarely do comparative effectiveness studies because they can backfire. Note how Bristol-Myers Squibb compared its cholesterol lowering medication PRAVASTATIN (PRAVACHOL) against Pfizer's ATORVASTATIN (LIPITOR) in the PROVE-IT study. Bristol-Myers sought to prove that its medication was better than the newer one, LIPITOR. They were wrong and it cost them.

The real challenge isn't just understanding what works better than others. The real challenge is how to get this information to doctors consistently and in a timely manner. Research shows that on average it takes 17 years for medical research and findings to be practiced routinely in the community doctor offices. Whether the internet and information technology shortens this time frame remains to be seen. As a result, all the studies in the world are meaningless unless those at the front lines - doctors and patients get this information.

I am skeptical that any study will ultimately help manage healthcare costs.

Sunday, March 15, 2009

How to Negotiate Medical / Hospital Bills

A recent NY Times piece titled Bargaining Down the Medical Bills which has practical advice on how one might negotiate medical and hospital bills particularly in the time where everyone is looking for areas to save money on.

Highlights:
  • DON’T BE SHY
  • OFFER TO PAY CASH UPFRONT
  • BE RESPECTFUL
  • STRIKE A DEAL, THEN CHECK IN
  • MAKE A COUNTEROFFER

Of course I appreciated the opportunity to be quoted as well.

Wednesday, March 11, 2009

Salaried Doctors Might Be the Answer to the Healthcare Crisis

Recently NBC Nightly News suggested that doctors on salary might be the answer to the healthcare crisis. Specifically, without a financial incentive to do more, that is reimbursement which is fee for service, that doctors can focus more on medical care rather than making a business and living.

They point to Kaiser Permanente as an example.

What's the Best Medicine / Treatment? Doctors Don't Know

Fascinating article from the Associated Press titled, "What's the best medicine really?" in which a government panel will try to determine which therapies and medications are better than others in a study of "comparative effectiveness". Funded by the stimulus package passed by Congress, about $1.1 billion will be spent understanding this.

Naturally, all parties involved have a stake in this because there will be losers. Although the article states that it is a secret that newer medications don't need to be better than older proven therapies, that isn't true. It's that the public is unaware that for FDA approval, medications only need to be better than placebo.

Pharmaceutical companies rarely do comparative effectiveness studies because they can backfire. Note how Bristol-Myers Squibb compared its cholesterol lowering medication PRAVASTATIN against Pfizer's ATORVASTATIN (LIPITOR) in the PROVE-IT study. Bristol-Myers sought to prove that its medication was better than the newer one, LIPITOR. They were wrong and it cost them.

The real challenge isn't just understanding what works better than others. The real challenge is how to get this information to doctors consistently and in a timely manner. Research shows that on average it takes 17 years for medical research and findings to be practiced routinely in the community doctor offices. Whether the internet and information technology shortens this time frame remains to be seen. As a result, all the studies in the world are meaningless unless those at the front lines - doctors and patients get this information.

I am skeptical that any study will ultimately help manage healthcare costs.

Saturday, March 7, 2009

Virtual Colonoscopy? Just Say No

The Center for Medicare and Medicaid Services -- CMS -- is asking for public input on whether virtual colonscopy - CT scanning of the colon -- should be a covered benefit in Medicare to screen for colon cancer.

In early 2008, the American Cancer Society (ACS) added virtual colonoscopy as well as stool DNA testing on its list of suggested screening methods for colon cancer. Screening for colon cancer is recommended for all adults 50 years and older. Besides these two options, the others are:

  • fecal stool testing (FIT or FOBT) annually
  • double contrast barium enema every 5 years
  • flexible sigmoidoscopy every 5 years
  • colonoscopy every 10 years

While I understand why ACS recommended adding virtual colonoscopy to its list, I don't agree with them. Although it is not as invasive as a sigmoidoscopy or colonscopy since patients lay on the CT scanner table while an x-ray technician works the machines to allow xrays to peer into the body, the colon preparation as well as the insufflation of air to distend the colon, is still required. Also, there is exposure of radiation which increasingly a question doctors are facing. Is doing a scan worth the risk of radiation exposure and potentially higher risk of cancer?

More importantly, if a colon polyp or growth is seen on the virtual colonoscopy, patients still need to have an invasive procedure - sigmoidoscopy / colonoscopy - to do a biopsy or removal of the lesion in question. At least these procedures don't involve any radiation as the instrument is essentially a fiber optic cable.

With the healthcare crisis upon us and the nation asking itself what is affordable and reasonable and what is not, CMS hopefully will not recommend virtual colonoscopy to be added to its list of covered benefits. While the technology is attractive, there are other proven screening tests that albeit uncomfortable are life-saving and don't subject people to unnecessary radiation.

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