Taking medication to address a health concern can be tedious and depressing. I know first hand having been diagnosed as diabetic. Those of us on insulin go through the daily routine of checking our blood sugar; administering our insulin; counting carbohydrates; and ensuring we get a sufficient amount of exercise in so that we can burn that excess sugar.
Monitoring all this is a pain in the ass.
I can only imagine what monitoring concerns tuberculosis patients have. Although the disease is relatively rare today, thousands of Americans have it and have to undergo a time consuming and expensive regimen of monitoring adherence to drug prescription usage and dosage. According to a piece written by Rose Stuckey Kirk, smartphone technology can be used to reduce the costs of implementing patient monitoring programs, thus facilitating the effectiveness of drugs used to combat the disease.
In her piece, Ms. Kirk describes how video directly observed therapy can be used to ensure patients are taking medication as described. Using smartphone technology, a patient video records when they take their medication and submits the record to his doctor. This approach to drug monitoring is now being used in San Diego, New York, San Francisco, and London. I hope that the technology can be used in other cities here and around the world as well.
What concerns me however, is whether current public and regulatory policy is supporting this path to improving public health. For example, in the Maryland General Assembly, the House will take up HB 48, a bill that prohibits certain telephone companies from replacing landline or wireline service with certain wireless telephone service, subject to certain exceptions. The bill also prohibits the Maryland Public Service Commission from authorizing such replacements. That bill is scheduled to be introduced on the House fllor on January 8.
In Georgia, the Georgia Public Service Commission adopted in October 2013 a rule that would require low income Lifeline recipients of free cell phones to pay five dollars a month for their mobile service. The rule, which is currently being challenged in federal court by CTIA, was implemented to address potential fraud in the Lifeline system.
These two actions could adversely impact efforts to adopt the broadband technology necessary for making the tuberculosis drug monitoring program more widespread for patients. Prohibiting replacement of legacy networks with wireless networks means a wireless broadband network with less of the capacity needed to manage data traffic for drug monitoring and other mobile health services.
A five dollar fee on low income Lifeline recipients puts a subscriber in a position of deciding between accessing broadband data services or using funds for other items.
If people with health needs are to make the most of new technology; if our social policy is to ensure that all citizens are getting the best care available; and if our social goal is universal access to a broadband network that makes delivery of the technology and health services more effective, then public policy should reflect that.