Advanced ICT for World Health

Advances in information and communications technology in the last decade have already made a significant impact on problems related to world health and hold promise for improvements in world health.  These can be seen in at least four distinct areas:  international awareness of health problems and of resources or methods that may ameliorate them; possibilities for immediate real-time tracking and epidemiological analysis for rapid infectious diseases such as SARS; understanding of the biotechnological roots of specific diseases, such as DNA sequencing for viruses that cause disease; and enhanced design and management of databases to serve larger scale research purposes, with data warehousing/data mining possibilities and records of important worldwide developments in health.  

Unfortunately, there are negative sides to this opening horizon of electronic communication and research for health.  Primarily these dangers relate to inadequate protection for individuals’ privacy, or to commercial profit-making:  denial of insurance due to knowledge of private health information not adequately protected by law, excessive charges by institutions, or aggressive marketing that encourages fear of certain health dangers in connection with particular commercial solutions and specific kinds of medicines (trademarked, price controlled), in order to increase corporate gain.

International Awareness and Real-Time Epidemiology

The Centers for Disease Control and Prevention (CDC) have successfully used the Internet as a position from which to launch significant international preventive and charitable efforts and as a communications support for many related purposes.  In one example, CDC is serving as an intermediary or means of referral, for the recycling of unused (expensive) AIDS drugs from the U.S. to developing countries where they may not be available.  In cases where a patient has died, leaving significant amounts of medicine, U.S. law prevents the drugs from being re-used in the United States.  Foreign physicians participating in the program of making the unused drugs available said they have never had any negative effects from using the medications.[1]

One of the most striking recent historical events, which argues for international information-sharing in health matters, is the rally of scientists and medical staff against the SARS epidemic that broke out in China and affected several nations, including Canada and the U.S.   In March of 2003, two people in the same family living in Toronto, Canada, died from cases of atypical pneumonia.  CDC and the WHO were able to trace the outbreak to particular travelers entering Canada and the United States from East Asia, where cases of the disease were reported with growing frequency.  During the first couple weeks of the epidemic, China resisted making information about the problem public, but by April 2003 (one month into the epidemic), the country’s Minister of Health, Zhang Wenkang, strongly supported open communication in order to contain and defeat the disease.  Dr. Julie Gerberding, Director of the CDC, coordinated an open collaboration to handle the medical crisis, using the best ICT methods available to her.  She had earlier initiated the Emergency Response Center at CDC, a "high tech war room" that allows the CDC to connect with scientists around the world. 

In Canada, working closely with the World Health Organization (WTO) and the U.S. CDC, the Ontario Ministry of Health and Long Term Care had set up 10-day quarantine areas in acute care hospitals, dedicated phone lines to handle the (10,000 per day at peak) phone calls, and government INFOline and Telehealth Ontario within 12 days, to help those self-isolated during the outbreak.[2] 

The World Health Organization (WHO) had previously developed a strategy to respond to deliberate use of biological or chemical agents as well as natural epidemics in May of 2002 by forming the Global Outbreak Alert and Response Network.[3]  During the SARS outbreak, CDC’s Emergency Response Center, together with WHO, enabled the use of a "virtual lab" where collaborating medical scientists hurried to “detect, identify and analyze the responsible agent for SARS in record time.”[4]  By the end of six months, 8098 deaths had occurred due to SARS cases in 31 countries, including China, Taiwan, Hong Kong, Singapore, Germany, the United States, and Canada.  The rapid response brought international benefits, and was a “poster-case” for how developed ICT could impact a threat to health in large populations.  Researchers now believe that the quick action taken by public health officials in this case may have saved as many as one billion lives.[5]

Satellite Tracking for Epidemiology

Geographic Information Systems (GIS) produce maps that can support health professionals by giving immediate overviews of information on a large scale, enabling best targeting of resources and other solutions.  GIS can supply near real-time access to patterns of land use, vegetation, water bodies, and population centers; and also helps to develop usage numbers for health services that are most used or most needed.  With current GIS software, many kinds of predictive modeling are given bigger scale and enhanced detail, as examiners consider changes or impact of decisions, and ways to address contingencies.[6]

Just as satellites and the Internet led to an explosion of information, these technologies are making it possible to acquire high-quality epidemiological data with a precision and speed that could not have been imagined a decade ago.[7]

For epidemiological problems that take effect on the scale of the whole earth, newest methods of satellite surveillance can analyze spatial data using GIS to interpret complex mapped patterns in biological terms and to estimate risks:

Of all infectious disease systems, those that involve free-living invertebrate vectors or intermediate hosts are most susceptible to changing environmental conditions, and have hitherto received most attention from the marriage of analytical biology with this new space technology.[8]

The technologies now used for epidemiology, a combination of mapping software, quantitative analysis, analytical biology, and space-age satellite imagery, have been applied to the study of, among other things:  malaria, sleeping sickness, and tick-borne and other parasite infections.  In a different and individual application, challenging medical undertakings (such as heart surgery for an isolated, remote patient) are also sometimes undertaken remotely now, using satellite imagery and the help of an expert, mentor-physician.

WTO offers free software to help epidemiologists’ research, which combines GIS with open databases, statistical and analytical combinations, and SQL programming options.  Key features of the freeware product, Epi Info™, include maximum compatibility with industry standards, including:  Microsoft Access and other SQL and ODBC databases, Visual Basic, Version 6 World Wide Web browsers and HTML conversion.

Investigators can the map incidence and prevalence of a medical problem using statistically adjusted “theme maps,” with biological and environmentally relevant details, over time.  Statistical clustering of the illness cases can be combined with other significant circumstantial factors to calculate estimated risk or direction of movement of a disease vector.  This could be useful both for the economics of maintaining health (estimating “burden of disease”) on larger scales and for predicting and addressing risks from occurring health problems, such as a current viral respiratory disease.  As an example, health officials arranged for placement of water pumps into certain villages in the Sudan (identified through GIS and statistical analysis) where guinea worm infestation as well as environmental conditions led to severe problems with this parasite (especially harmful for children).[9]  Researchers were also able to conduct impact assessment relative to the village water initiative using GIS and statistical tracking.

Selected Biotechnology Issues

Many forms of innovative use of biotechnology are taking place with historically unprecedented speed, affecting everything from criminal identity tracking to anti-aging.  In one practical example, University of California at Davis studied the outbreak of bird flu in Southeast Asia.  By January of 2004, researchers at Davis were tracing the contacts (using GIS) of those birds infected in Hanoi to check that the virus had not started to spread.  Dr. Carol Cordona of UC Davis reported that the veterinary researchers were able, within days, to establish the genetic sequence of the particular poultry virus active in Hanoi, Vietnam (responsible for certain human deaths).[10]  Widespread culling of Asian poultry stock had been occurring, creating significant economic loss and health concerns about further spread of the disease to humans.  

The speed of this kind of biochemical research has become possible through collaborative work of multiple universities in different nations, using databases and tools such as The Protein Databank (operated by Rutgers University, UC San Diego Supercomputer Center, and University of Maryland Biotechnology Institute).  Many additional international universities (such as Osaka University, National University of Singapore, Cambridge Crystallographic Data Centre UK, and Max Delbrueck Center for Molecular Medicine in Germany) carry mirror sites to this database resource, and they contribute software, models, and research projects to a variety of efforts.[11]

Databases and Data Mining

The advent of second generation distributed data warehouses, smart agents, and online analytical processing has opened a window of opportunity for using large data collections to create timely understanding of connected problems or events.  A true data warehouse uses multi-dimensional database technology (“data cubes”) and identifies and tracks sources, transformations, usage, relationships, and history of each data item.[12]  Use of this kind of system, reviewing multiple gigabytes and even terabytes of information, permits the rapid global scale actions like the CDC’s virtual labs and Emergency Response Center during the SARS epidemic.  Independent software agents extract, filter, and integrate required details of information with a scale and speed that human reviewers or readers cannot match.

Commercial Interests

In the health field, massive cumulative databases have taken form through allied insurance companies, hospital systems, medical practices, and national chain drug stores (prescription sellers).  Once a person ends up diagnosed with certain kinds of disease such as diabetes, fibrosis, cancer, hepatitis, or AIDS, it becomes difficult (and expensive!) if not impossible to get insurance, unless they have luckily remained employed and stayed many years with the same carrier.  Further, legal disputes have recently been initiated against medical care alliances and hospital chains for routinely charging far higher fees (possibly more than ten-fold higher according to discussion on National Public Radio) to the uninsured or partially insured, compared to charges for people covered by insurance or Medicare.[13]  This uneven effect too relates to sharing private medical information in support of commercial success for “medical industry.”  In the hospitals’ defense, it must be noted that they carry the burden in the ERs, as medical-care-of-last-resort for the poor.

Although there are valid reasons for the sharing of medical information between the doctor and the insurer, more suspect uses of the information have been common.  Prior to late April of 2003, a marketing firm, life insurer, or bank could gain access to a person’s health insurance information without the referenced individual ever becoming aware of it.[14]  This kind of information has been used to deny employment or eligibility for loans and other benefits.  Compliance with the new Federal regulation is still sketchy, and a victim of denial of service will have a difficult and expensive legal battle to correct errors or gain needed support.

Some kinds of marketing efforts relative to prescription drugs, arguably, also make wrong use of the influence of ICT on large masses of people.  Multimedia advertising messages carried over the Internet, satellite cable subscriptions, air waves, and email host organizations create a huge psychological influence.  One need only look at the strategies of the current Presidential candidates to see how seriously the peddlers of influence take the electronic media.

It is ironic, for example, that the Food and Drug Administration quickly passed a ban on ephedra, a herbal stimulant and natural decongestant that has been used for centuries internationally (granted, it is dangerous if used wrongly); when over-the-counter (often high-cost, pharmaceutical) drugs are sold relatively unregulated; and these may have equal or even more dangerous effects.  This refers to compounds like phenylpropanolamine (proven increased risk of stroke),[15] or alcohol and caffeine for that matter.

Conclusion

In conclusion, the expansion and development of ICT offers both near-miraculous solutions to old global health problems as well as very daunting challenges.  In looking over the changes discussed here, the most critical aspect of these four areas of impact, for the purposes of maintaining a good balance in human social benefits, would be continued growth in international awareness.  This can potentially stimulate new parts of the world’s population to gain and make use of the ICT advantages; and also serve to “keep honest” those societal parts whose profit-making assisted by ICT becomes greedy and excessive.

 

 



[1] Lindlaw, Scott, Associated Press, "National News" CDC Prevention News Updates, June 9, 2004, http://www.cdcnpin.org/scripts/Locates/LocateNewsResults.asp, accessed June 13, 2004.

[2] Ministry of Health and Long-Term Care, Ontario, Canada, “Severe Acute Respiratory Syndrome, SARS” Health Update, http://www.health.gov.on.ca/english/public/updates/archives/hu_03/hu_sars.html, accessed June 14, 2004.

[3] WHO Working Group on Chemical and Biological Weapons, World Health Organization, “Preparedness for Deliberate Epidemics,” http://www.who.int/csr/delibepidemics/en/, accessed June 12-15, 2004.

[4] Park, Alice, “Biographies of the World’s 100 Most Influential People,” Time Magazine, April 26, 2004, NY:Time Inc., 2004.

[5] Kaehler, T., “Graph and Forecast for the SARS Epidemic,” www.squeak.org/us/ted/sars-graph.html, accessed June 14, 2004.

[6] Ibid.

[7] World Health Organization, “GIS and public health mapping,” 2004, http://www.who.int/csr/mapping/gisandphm/en/, accessed June 16, 2004.

[8] Hay, S.I.; Randolph, S.E.; Rogers, D.F.; Baker, J.R.; Muller, R.; Rollinson, D., (eds.), Remote Sensing and GIS in Epidemiology, London:Harcourt International Academic Press, August 2000.

[9] Tempalski, B.J., “The Case of Guinea Worm: GIS as a Tool for the Analysis of Disease Control Policy,” Geographical Information Systems, Vol. 4, No. 2, 32-38, http://students.washington.edu/bjtemp/afr.html, accessed June 14, 2004.

[10] Pearson, H. and D. Cyranoski, “Bird flu attacks in Hanoi, spate of avian influenza has spread to people in Vietnam,” Nature News Service, MacMillan Magazines Ltd., 13 January 2004, http://www.nature.com/nsu/040112/040112-3.html, accessed Jun. 9, 2004.

[11] H.M. Berman, J. Westbrook, Z. Feng, G. Gilliland, T.N. Bhat, H. Weissig, I.N. Shindyalov, P.E. Bourne: The Protein Data Bank, Nucleic Acids Research, 28 pp. 235-242 (2000), http://www.rcsb.org/pdb/ accessed June 11, 2004.

[12] Rob, P. and Coronel, C., Database Systems: Design, Implementation, and Management, 5th ed., Thomson Learning Inc.: Boston MA: 2002.

[13] Lieff, Cabraser, Heimann & Bernstein, “Tenet Hospital Excessive Charges, Class Action,” February 2003, attorneys’ website:  http://www.lieffcabraser.com/tenet.htm, accessed June 18, 2004.

[14] HHS Press Office, Fact Sheet, U.S. Department of Health and Human Services, http://www.hhs.gov/news/facts/privacy.html, accessed June 18, 2004.

[15] Center for Drug Evaluation and Research, “Questions and Answers Safety of Phenylpropanolamine,” U.S. Food and Drug Administration, November 6, 2000, http://www.fda.gov/cder/drug/infopage/ppa/qa.htm, accessed June 18, 2004.