The free market of smartphone apps can teach medicine a lesson

So I have a Droid.  I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC.  I waffled for a long time.  In fact, I almost purchased a Casio phone that was marketed as water and impact resistant.  “Mil-spec,” was the phrase used … a phrase which appeals to me as a one-time Air-Guard flight surgeon.  What it meant to me was, “you can’t hurt it.”

Still, I was attracted by medical applications and the assorted other cool things a Droid can do.  I mean, my old phone didn’t have a Magic 8 Ball, for crying out loud!  More to the point, my old phone didn’t have Epocrates, or the Emergency Medicine Residents Association Guide to Antibiotic Therapy.  It lacked a flashlight, an MP3 player, a protractor and a scientific calculator.  (It also weighed a fraction of my Droid, but that’s what belts are for). On my old phone, I couldn’t have taken a photo of an ECG, turned it into a pdf file, and e-mailed it to our fax-impaired cardiologist.

My old phone was difficult to use for text messaging, and I’ve turned into a person who texts a lot.  Especially my wife, who has been ill for several months.  We text each other like teenagers!  Well, not quite as quickly or frequently…and we don’t send incriminating photos.  Still, the point remains.  I admit, I really like my phone.

Imagine my annoyance, then, when I broke my phone’s belt-clip case.  I went back to the Verizon store (about 8 months after purchase) and was told by a sheepish salesperson:  ‘Uh, yeah, we don’t make those anymore.  You might try one made for a Droid X or a Droid 2.’  Read:  ‘We don’t support ancient devices like that these days.’

It wasn’t as if I asked for a new shoulder strap for my bag-phone, or a ribbon for my typewriter!  I wasn’t looking for new wires for my telegraph machine!  In less than a year, my phone (with more processing power than NASA probably had for the entire 1960s) was old school.

Now as annoying as that is, and as much as I’ve complained about it to my wife and friends, it’s pretty cool.  Technology is moving forward in the communications arena at a blinding pace.  And why is that?  Why is it that the latest i-Pad is so cool, and affordable, that people fly from the UK to stand in line in New York just to have the first one?  Why is it that my phone is far more complex than I am capable of understanding, but doesn’t cost a car payment to carry around?

Just a suggestion, but it may be that nasty thing called “the free market.”  In the computer and communications world, everyone wants to make a buck by creating a cool new device, and they know that it has to be quickly and widely available and also affordable.  Furthermore, it always has to ‘out-cool’ the last device to get the consumer’s money.  So, amazing devices just keep falling from the sky, tempting us with their capabilities and sucking the money directly out of our wallets.

If only medicine could learn a lesson here!  Imagine the nightmare if cell-phones were covered by insurance, or by federal programs.  Imagine the mind-numbing speed at which the technology would become widely available to the public!  Imagine…a bag phone in every car.  A phone capable of transmitting…the human voice! All for a price vastly higher than its actual worth!  Try to envision some folks being able to afford phones, while others couldn’t but were subsidized by the phone-contracts of those who could.  (Think carefully here about how few of our poorer, state-supported patients lack cell-phones).

I believe that if we could extricate ourselves from the morass of insurance and government involvement in health-care, the technology and service available would be a sight to behold.  Devices and drugs that we only wish for might appear before our eyes, and might save lives that would have been lost.

I’m no simpleton.  I know that it’s not exactly the same thing.  Government and insurance are wrapped into the practice of medicine like aggressive cancers.  And the costs of many therapies dwarf the price of telecommunications.  But I wonder, are they high because we didn’t learn from the very beginning how to make them better, cheaper and more available?

Next time you upgrade your phone, or your kid’s phone, pause and think about how much better-off we might be if we had taken a page from the play-book of the cell-phone and computer companies.

Maybe when it all comes crashing down around us, we can use their example to rebuild even better than before.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test.

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