Nick Ross does it again

See my previous posts on this subject here, here and here.

First, my standard disclaimer:  I am in favour of the NBN and rather despair that Malcolm Turnbull – who really should know better continues to promote what he must know to be an inferior policy for either party-political or purely budgetary reasons.  Lots of Australian tech journalists continue to hold him to account for it – notably Renai LeMay at Delimiter (twitter) and Nick Ross from ABC Tech and Games. Nick and Malcolm had a bit of an exchange at the kickstarter conference recently.

Nick’s latest effort is a massive opus on why he continues to support the ALPs broadband policy over the LNPs.  This certainly isn’t surprising, given the digital column miles Nick has put in previously.  He’s certainly committed to the cause.

In addition to sending Nick links to my blog posts on telehealth, I have messaged him my email address and offered to discuss with him why I think his assertions on telehealth are incorrect.  I’ve had no response to this offer and his replies to my blog posts have consisted of telling me that I’m wrong (with no evidence to back it up) that he “doesn’t post things that are incorrect” and a request for me to lay off because he thought that my nitpicking was damaging the pro-NBN stance we both have.  I have forwarded him some Queensland media links – which he has been happy to use in the article, I note, but has not at any time addressed my long-form criticisms of his telehealth misinformation.  I’m very disappointed that most of the too-ing and fro-ing about these articles take party political lines – people accuse Nick of anti-LNP bias while people arguing the case are accused of being LNP hack.  The comments on Nick’s article and this response demonstrate this clearly.

Well, Nick, I am calling you on your bullshit one last time.

  1.  As Malcolm (and I) have pointed out, many centres are using current broadband for telehealth (including Queensland Health) and the bandwidth is adequate for medical consultations.  Provide evidence on how NBN will improve this
  2. Please provide any sort of costed document to support the fact your ridiculous (and as yet, repeated without even a single link to support the savings) assertion that savings in health will fund the NBN by themselves
  3. Please explain how your assertions about ambulance transfers, in-house monitoring, and diagnosis and triage are more correct than my disputations of them here.
  4. Please explain to me having a kinect sensor monitoring someone for a fall delays admission to a nursing home.
  5. A significant proportion of your links are to firms selling telehealth services.  Do you think these people are likely to be giving you unbiased advice?   Can you comment on how you think it would be accepted if I, as a doctor, was to say to a patient “I am going to put you on a drug because the drug company representative promoting it tells me it is the best drug ever”

And finally – and I cannot begin to explain to you how glad I am you did –  included this in your article:

Another class of patient that would benefit from telehealth is those whose immune systems are suppressed, either by disease (AIDS is only the most famous, not the only immune-suppressing disorder) or by treatment either with steroids or a large number of chemotherapy drugs. Wherever possible, such patients need to avoid hospital, both for their benefit and so they don’t become “Typhoid Mary” carriers of resistant bacteria to others.

The potential cost savings from not having to touch infectious patients are also substantial.

This is unmitigated bullshit of the highest order and demonstrates to me more clearly than ever that you do not have the faintest idea about what healthcare actually involves.  Fortuitously, it also exactly falls within my area of specialisation and I therefore look forward to you either: a) admitting that you are wrong; b) asserting that I am wrong and displaying your arrogance or c) actually trying to engage people who have relevant expertise in the debate.

You are correct that there are many diseases which result in immunosuppression.  There are around 25,000 people in Australia living with HIV (2Mb PDF), only about 1/6 of whom have advanced disease and would be considered immunosupressed.  Patients who are receiving immunosuppressant therapy do need regular review (and frequently blood tests as well) – usually in outpatients.   This is certainly an area where good telehealth could make a difference; although again, this is being done with existing telehealth technologies.  The patient will actually need to see a healthcare professional to have the blood tests, however;  there are advances in microarrays that can be “bloodtests on a chip” but these are many years away from being in the home and plugged into a free USB socket.

That leaves patients with severe immunosuppression;  for example in induction chemotherapy for leukaemia.  Depending on the chemotherapy used, these patients can have no infection-fighting white blood cells for weeks.  They are at risk of rapidly developing life-threatening infection.  Some low(-er)-risk ones may be managed as outpatients with antibiotics.  The rest require admission for observation – as they may rapidly develop sepsis – where the greatest determinant of survival is time to receipt of antibiotics -which will always be longer if patients are at home.  This downside of being at home overwhelmingly outweighs any theoretical (ie: has never been proven) benefit that may come from them staying out of hospitals.

Your link relating to “not having to touch infectious patients” is to a commercial site that does not provide any evidence to back up your assertion.

What costs are these?  Handwashing?  Healthcare staff should be doing that anyway, and has been consistently shown to be one of the most cost-effective interventions at preventing infection.  Gloves?  Similarly, these are part of the WHO-recommended standard precautions.  Physical examination contributes to the making of an accurate diagnosis, so what about increased costs of investigations and imaging that would (more than) offset cost-saving from whichever of these things you actually meant?

So, Nick…

You incessantly lambast Malcolm Turnbull for not espousing an evidence-based policy, but you cherry-pick studies that support your own pre-existing theories, link to commercial providers who are selling telehealth products as if they are impartial third-parties and continue to make unsupported assertions that I (and others) have been directly challenging since August last year.  You provide no actual figures to support your cost savings and have never directly addressed specific queries on from where you arrive at your assertions.

I don’t give a toss about allegations of ABC bias, but your articles are clearly more opinion and wishes than facts.  Stating your feelpinions over and over and over again, louder and louder and in longer and longer articles does not make them true.  Refusing to admit there might be any other points of view make you look like your mind is very firmly closed (which I think it is), but bollocking Malcolm for the same thing while doing it yourself makes you look like an outrageous hypocrite.

Put up your evidence, engage with people who disagree with you rather than going off at them, or just STFU.

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14 Responses

  1. Nick says:

    Hi Trent. Check your twitter DM. I replied a few times. Ignore everything I wrote and check out the NZ CBA.
    Counters just about everything. Nick

    • Trent says:

      Nick,
      I got your DMs. What I didn’t get was engagement about the issues I raised.
      My point isn’t that there’s a CBA in New Zealand, it’s that you’ve said we have a bigger economy than NZ therefore it will save us more. Find me a health economist who agrees with you. Maybe we’ll save more, but your opinion doesn’t make it fact.

      And the remote monitoring stuff remains unaddressed. Show me some papers about it and then we’ll talk.

  2. sortius says:

    While I realise you are passionate about healthcare & have spent a long time working in the sector, I do think you’re missing a lot of the point with Nick’s articles.

    Firstly, there is an endless supply of peer reviewed studies showing that telehealth/ehealth are beneficially both financially & for the patient’s comfort. Some studies show as much as $3m for an ICU (http://www.capsil.org/files/Telemedicine%20and%20Telehealth%20Outcomes%20Research.pdf) & are being phased into mainstream medicine (http://www.uq.edu.au/coh/) due to the benefits.

    You speak of cherry picking, but you, yourself, are cherry picking pieces of Nick’s arguments to support the idea he is an hypocrite, however fail to see the bigger picture which is: attempting to deliver telehealth over copper will be a disaster at best. Then there’s Turnbull’s claim AU doesn’t need two satellites to service remote areas, which you ignore completely. These are the areas that will benefit the most per person by having high speed internet access (especially higher upstream).

    Your conclusions that Nick has only linked commercial sites (which is wrong) & therefore is wrong baffles me. A quick google will give journal articles on infectious diseases (http://cid.oxfordjournals.org/content/51/Supplement_2/S224.full), or general cost savings for telehealth (http://www.jtt.rsmjournals.com/content/9/6/311.short). If you just search Scholarly you’ll find endless articles & studies that are cited many times, so I don’t know how you weren’t aware of them.

    In summation: no, Nick is not being a hypocrite. He has asked Turnbull for details many times & all that is given is arrogant or churlish statements showing contempt for any scrutiny. Nick may not be a telehealth guru, but knows his technology, & does look into this deeper than commercial sites as you suggest. The reason the NBN is far superior to Turnbull’s thought bubbles is for two reasons: 1) they are thought bubbles, not plans, 2) What little detail has been given is a grim picture of attempting to revive a network that’s on the verge of collapse due to poor maintenance.

    If you’re going to question the conclusions of an article, go for it, but calling Nick an hypocrite for publishing well researched articles that don’t line up with your opinions is a little rich.

    • Trent says:

      Thanks for the reply, sortius – I appreciate the engagement and the evidence (hint, hint Nick).

      I never said telehealth is no good and has no benefits at all, just that it isn’t the panacea that Nick makes it out to be.

      Telehealth works over copper right now. As I said in one if my previous posts, the NBN won’t solve the problems that are inherent difficulties if telehealth. Better picture, less latency perhaps, but not less clunky.

      I haven’t commented on Turnbull’s satellite comments, because it’s not my area. I’m no network engineer, so what Nick is saying about that may well be right.

      I’m cherry-picking the health parts of his argument because that’s what I know. And what I know to be wrong.

      • sortius says:

        Just a side note: just as with the move from dialup to broadband gave incentive better interface design/capabilities of websites, the move from copper to NBN services will give incentive for better telehealth solutions.

        The reason why telehealth is so clunky now is that so few people have the services to handle it. If all the copper in Australia was upgraded & no last mile cable was more than 1km, sure, VDSL would work, but that’s not going to happen. As you would have seen from my latest article, I have 1.5km of copper between the exchange & myself, yet a fault has made my connection barely workable. Forget telehealth, I can barely Skype my family: back to mobile phone for me.

        The bottom line is that we shouldn’t be stepping sideways, especially with so many applications for the NBN. Not just telehealth, but ecommerce, legal services, education, & teleworking.

        I suggest reading the NZ CBA, with a 6 fold population density & 70% GDP per capita of Australia, the savings may be more than just proportional to the size of our economies or populations

        It’s a difficult thing to call, but citing the NZ CBA is valid & meaningful in the debate over telehealth benefits of the NBN’s mix of FTTN/Fixed Wireless/Satellite.

  3. I think you can either have an agenda and pursue it; or be a journalist. Nick has to learn that if he wants to be a journo then he has to be a journo – ask the questions, report the answers, report the facts… but his berating and young-Greens-like harassment of Turnbull at Kickstarter with what, I agree, is an absolutely bullshit halo-like adoration of the potential of telehealth (which is already in wide use for that which it is useful for) was the definition of unprofessional.

  4. Nev says:

    5…….Can you comment on how you think it would be accepted if I, as a doctor, was to say to a patient “I am going to put you on a drug because the drug company representative promoting it tells me it is the best drug ever”…..

    Ever prescribed Lipitor?

    http://www.proteinpower.com/drmike/statins/pfizer-in-hot-water-over-lipitor-marketing/

  5. Ramon says:

    Dear Trent,

    I am going to disagree with the comments you have with respect to bandwidth requirements for tele-consultations. I definitely feel that much higher fidelity video would be of benefit for surgical consultations.

    In my experience with remote consultations, the low resolution and low magnification of existing tele-medicine solutions often necessitates return visit consultations to confirm or deny suspected findings/outcomes/complications. This is not usually an issue for medical consults. Improving that single aspect would in my view, have a small but real effect on tele-medicine as it currently exists in my large state (WA). It would require investment at rural/remote health facilities to achieve that. Clearly home tele-consults are going to remain rather limited for quite some time.

    Beyond that are the unknown possibilities enabled by NBN combined with future technology.

    It doesn’t take much vision to recognise the benefits of a remote consultation whose fidelity rivals that of face to face.

  6. Ramon says:

    Generally: wound healing of all kinds, and especially complex wounds of skin grafts
    Specifically: Hand injuries.

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