The Economist Asia - 24.02.2018

12 The EconomistFebruary 24th 2018

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Digital doctors

Sir William Osler, arguably the

greatest physician of the 20th

century, said this about being

one’s own doctor: “A physician

who treats himself has a fool

for a patient.” The idea that the

digital revolution in medicine

will allow patients to manage

their own medical care is naive

(“Doctor You”, February 3rd).

Doctors and surgeons

devote seven or more years of

their lives acquiring the knowl-

edge, judgment and experi-

ence that allows them to be

qualified to care for patients. In

fact it takes all these years to be

able to do just three things:

make a correct diagnosis,

arrive at a prognosis and apply

the correct treatment. Your

presumption that, without

medical training and experi-

ence, anyone can play app

roulette, surf the net and be-

come his own doctor, is folly.

FREDERICK HOLMES

Professor emeritus of medicine

University of Kansas Medical

Centre

Kansas City, Kansas

The root cause that explains

whyIThas failed to transform

the delivery of medical care is

the information “disorder”

deeply embedded within

mainstream medical practice

and in new alternatives to that

mainstream. The only remedy

is to define generally accepted

standards of care for managing

clinical information (patient

data and medical knowledge).

These standards are missing

from medicine. As a rough

analogy, imagine an economy

operating without broad-

based accounting principles

for financial information. The

effects would be crippling.

That is where the health-care

industry is now.

Medical records have al-

ways been plagued by dis-

order, both paper and electron-

ic. To bring order, support tools

that aid clinical decisions

should be designed to identify

the required patient data and

couple that data with medical

knowledge, rather than being

based on algorithmic and

probabilistic standards.

LINCOLN WEED

Underhill, Vermont

H.L. Mencken once said, “For

every complex problem there

is an answer that is clear, sim-

ple, and wrong.” Medical apps

help people who are mostly

young and mostly well and

who want to consult a doctor

quickly. They exclude those

who suffer a greater burden of

ill health. Simple ITanswers

exist at the expense of the

more complex and expensive

patients who must continue to

rely on their traditional general

practices for health care. Those

practices will have less income

if they lose young, healthy

patients to apps, butwill have

to do more work caring for the

complex cases.

The research evidence does

not suggest thatthis new ser-

vice results in better access or

better quality care with fewer

costs. Doctors want innova-

tions that will improve the

workload and workforce crisis

in the National Health Service,

rather than fake innovations

that make the crisis worse.

TERRY KEMPLE

Former president

Royal College of General

Practitioners

Bristol

“Doctor You”? A catchy phrase

for your leader, but it would be

better if we had a movement

based on “Doctor with You”.

DAVID CUMBERLAND

Kuala Lumpur

Europe’s migrant crisis

Although Charlemagne

touched on some criticisms of

Italy’s intervention in Libya’s

migrant crisis, they were swift-

ly brushed under a carpet

threaded with niceties about

Marco Minniti, the Italian

interior minister (February

3rd). Organisations such as

Amnesty International do not

“hate” Mr Minniti. Rather,

many of us are deeply trou-

bled by the effect of his poli-

cies. Italian and European

co-operation with Libya

means that tens of thousands

of people are trapped in a

country where they face horrif-

ic human-rights violations.

The Libyan government is

refusing to take the steps neces-

sary to overhaul its rotten

migration-management sys-

tem. These steps must include

ending the detention and

abuse of refugees and migrants

and recognising the status of

the UN. The fact that Mr Min-

niti and his fellow European

ministers of interior are not

making theirassistance to

Libya conditional upon such

measures speaks volumes

about their priorities. It also

makes such co-operation

unlawful. We should focus on

resettling refugees out of Libya

and bringing stability to a

divided country. Europe must

do much more to protect the

women, men and children

trapped in Libya. By closing its

doors it is abandoning them to

a wretched future.

MATTEO DE BELLIS

Amnesty International

London

Gun demographics

“How many more?” (February

17th) stated that the shooting at

the Marjory Stoneman

Douglasschool in Florida “was

merely America’s 18th school

shooting this year”. To many

people that might sound like it

was the 18th where someone

killed, or tried to kill, students.

In fact, the figure of18 comes

from an anti-gun group and

counts any incident where a

gun was fired on or near school

property, including accidental

discharges and one incident

where a veteran with PTSD

shot himself in a school’s

parking lot when the school

was closed.

MICHAEL BEARD

Portland, Oregon

It is unlikely that a generation

raised on lockdown drills, with

access to phone footage of gun

rampages and a waning in-

terest in hunting, will grow up

parroting the National Rifle

Association’s rhetoric as en-

thusiastically as today’s politi-

cal leaders. Change is coming.

JOAN MAHER

West Bradford, Pennsylvania

An Olympic effort

One issue that remains taboo

when it comesto doping in

sport (“Whatever it takes”,

February 10th) is the use of

criminal sentences to combat

it. The traffickers of the banned

substances are punished, but

in most countries the athletes

face no criminal charges. This

is unfair. In October 2015 the

World Anti-Doping Agency

issued a statement opposing

the criminalisation ofdoping

in sport. One of its reasons was

that the system of sanctions,

including the right to appeal to

the Court of Arbitration for

Sport, is sufficient. Well,

obviously, it is not.

OLEKSANDR OVCHYNNYKOV

Strasbourg

Another way to fight doping in

addition to the onesyou listed

is retesting. This allows for the

storing of blood or urine sam-

ples taken from athletes who

are tested in order to retest it

once detection methods have

improved. The deterrent effect

is that a doped athlete takes the

risk that his result will be

disqualified long after his

performance at the Olympics,

or any other tournament he

competes in, up to two years

after the sample was collected.

SARKIS HOMBERGER

Geneva

A government in distress

A little over a year ago you

nicknamed the British prime

minister “Theresa Maybe”

(January 7th 2017). After her

subsequent disasters, I think a

more apt moniker would be

Theresa Mayday (“A sea of

troubles”, February 3rd).

JAVIER SEMPERE

Madrid 7

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