[p2p-research] Wellness and a balance between doctors and p2p

[Paul D. Fernhout]

In general, I've argued that universal health insurance would be beneficial 
to p2p in the USA, because it would allow more people to participate online 
without fear of not having health care.

I say "insurance" very deliberately there, because the insurance is 
generally for interacting with the conventional medical system. Otherwise 
might would call it "universal health care", though even that term is 
somewhat limited in scope:
   http://en.wikipedia.org/wiki/Universal_health_care
What we need is more "universal health" or a "universal wellness promotion" 
but that is still a concept for a future Star Trek society. :-)
  http://www.kurtz-fernhout.com/oscomak/AchievingAStarTrekSociety.html

There are arguments raised against universal health insurance in the USA, 
specifically by the conservatives that it subsidizes people who have made 
poor lifestyle choices (smokers, heavy drinkers, overeaters, couch potatoes, 
and so on). I think our society encourages those sorts of things, including 
from the profit motive but also be being stressful to live in, so I don't 
fully agree these things are 100% the individual's fault (smoking is one way 
to deal with stress, for example, plus cigarettes are heavily advertised), 
but I can see there is some truth to the "moral hazard" argument as well as 
underwriting unhealthy behavior.

Likewise, others suggest that health insurance subsidizes those who choose 
mainstream medicine over alternative medicine, which is not often covered. 
So, you can get ten triple-bypass heart operations, but acupuncture, 
massage, religious retreats, positive thinking gatherings, living in nature, 
organic gardening or just buying organic food, taking Omega-3 fatty acid 
supplements, or all other sorts of alternative approaches to "wellness" are 
not covered. Thus health insurance diverts money from those possibly 
low-cost health-promoting things by pulling it out of the pocketbook and 
earmarking it for mainstream health care before the individual can decide to 
pursue an alternative with it. So, in that sense, health insurance damages 
societal wellness.

So, clearly, health insurance can have harmful impacts.

I've realized, in that sense, in the USA, just judging by my own 
experiences, those without health insurance make heavier use of the internet 
to diagnose and treat illness, and in the process of doing that may engage 
in many p2p activities. Example:
   http://www.healthboards.com/
"Dealing with a medical condition is often difficult. Connecting with others 
who are going through the same thing can make a world of difference. 
HealthBoards.com is a place where you can make those connections. We provide 
a unique one-stop peer support community with over 150 message boards on 
various diseases, conditions, and health topics. And through a partnership 
with WebMD, we provide a comprehensive Health Guide with valuable health 
information and tools for managing your health."

Another example of such discussion:
"Why does a CT scan cost so much in the USA?"
http://www.catscanman.net/blog/2007/10/why-does-a-ct-scan-cost-so-much-in-the-usa/comment-page-2/

I've found some useful stuff online in all sorts of places, often through 
Google (plus, some not useful or harmful stuff). There is a lot of truth here:
   "The New Company Health Plan is Google"
http://www.ginside.com/content/2007/03/dilbert-google-heatlh-plan.jpg

So, in that sense, lack of universal health insurance in the USA is 
promoting p2p efforts -- desperate efforts often times, granted, and so 
maybe not the kind we want to be promoting, but that's the way it is (at 
least in the USA).

And within that context, there might be ways that P2P ideas could help 
further with the desperate situation that does not seem to be about to 
resolve by government action anytime soon?
   "Sick and Wrong"
   http://www.rollingstone.com/politics/story/29988909/sick_and_wrong

By the way, two related jobs at Hesperian, who make the freely downloadable 
book "Where There is No Doctor" which they say is for both "underdeveloped" 
and "overdeveloped" countries (I'll mention the more socio-techy one):
   http://www.hesperian.org/about_jobs.php
"Job Announcement: Communications and Outreach Manager ... The 
Communications and Outreach Manager will help lead efforts in the next year 
to strengthen relationships with partner organizations that distribute and 
use Hesperian�s content, and to build our grassroots advocacy program in 
conjunction with US-based and international partners. The Communications and 
Outreach Manager will lead the process to develop a marketing and outreach 
plan for the New Where There Is No Doctor and our new initiatives around the 
digital delivery of our content."

Maybe someone could make the argument to Hesperian to be more p2p-ish?

Anyway, I just wanted to raise this aspect of how improving universal health 
insurance may have some negative impact on p2p in the short term. That 
doesn't mean I'm against universal access (I'm all for single-payer in the 
USA, like promoted here: http://www.hr676.org/ ). I'm just thinking that 
this is an issue, that people turn to p2p when they have no access to a 
doctor, as a minor countertrend to the idea that people with universal 
health insurance otherwise may feel more free to try new things or feel more 
free to go without a formal job for a time. Sadly, in the USA, access to 
health care is tightly linked to having a "good" job, and people without 
health insurance have, by, one estimate a 40% greater chance of dying per 
year. Anyway, I'd be curious if there are foreign language p2p things that 
are like HealthBoards and if they see as much desperate discussion?

Certainly, within the USA, it's been raised that the internet has changed 
how patients are interacting with doctors in general. One example, 
applicable even for people with health insurance:
"Armed with online health information: Doctors, patients adapt as the 
Internet intervenes in health care"
http://www.marketwatch.com/story/doctors-patients-adapt-as-internet-intervenes-in-health-care
"""
Feder's experience underscores how the doctor-patient relationship is 
changing from one that pits a passive patient against a paternalistic doctor 
to more of an active collaboration. Some of the shift is driven by financial 
need. With more cost-sharing and high-deductible health plans emerging in 
employers' benefits mix, patients are under pressure to take more 
responsibility for their care and its costs.
   "Consumers are forced to be more empowered, whether it's higher copays 
for physicians or having to make decisions about things," said Mark Bard, 
president of Manhattan Research, a health-care market research firm in New 
York. "They need access to information on the front line, and increasingly 
physicians are being shown that information."
   Nearly two-thirds of physicians say the trend of patients coming in armed 
with online information is positive, up from 62% in 2004, according to a 
recent study from Manhattan Research. The referrals increasingly work both 
ways. Slightly more than half, or 52%, of 1,300 U.S. doctors said they 
recommend health-related Web sites to their patients.
"""

Maybe a broader theme (following Manuel de Landa on meshwork/hierarchy 
balance), is just, what is the appropriate balance for promoting wellness 
between a p2p health information meshwork and a formal medical hierarchy?

--Paul Fernhout
http://www.pdfernhout.net/