Biosurveillance

You're being watched almost everywhere you go.  As well, what you buy, eat, wear, text or post is tallied up somewhere and that information used for marketing or manipulation purposes.  Although I don't suffer from paranoid schizophrenia, I usually find this prospect loathsome, but in this week's podcast, Rick and I discuss a new type of societal watchfulness known as 'biosurveillance,' and acknowledge that not only is individual health likely to benefit, so is community health.  That's in the current issue of Annals of Internal Medicine.

The study is entitled, "Improved Diagnostic Accuracy of Group A Streptococcal Pharyngitis With Use of Real-Time Biosurveillance."  Investigators examined over 82,000 patient visits for sore throats at large retail clinics.  A metric called the Centor score is typically used to predict the likelihood that someone with a sore throat and a number of other signs and symptoms actually is infected with group A streptococcal bacteria and requires a prescription for antibiotics.  When local incidence data is added to this score the question assessed was whether it improved diagnosis and treatment.

RLPP is the new acronym introduced to me by this study.  It stands for recent local proportion positive and is real time data on the incidence of group A streptococcal pharyngitis (sore throat) for the 14 days previous to a person's clinic visit.  Use of this factor along with variable Centor scores would allow tens of thousands of persons who would have been missed previously to be correctly diagnosed and avoid treatment in tens of thousands more who really didn't require antibiotics for group A strep infection.  Not only would this save the healthcare system a lot of money, it saves money for individuals by either not requiring them to purchase antibiotics or getting it right in the first place, thereby sparing them a second clinic visit.  Finally, reducing or eliminating unnecessary use of antibiotics helps us all by removing a huge stimulus for the development of drug resistant bugs.  Sounds like a win-win to me.

So why isn't biosurveillance adopted everywhere, right now?  The authors point out that a host of other infectious diseases besides group A strep are likely candidates for such data collection.  Rick and I agree that once electronic medical records become commonplace and data can be delivered directly to clinicians to incorporate into their decision making, the potential for this strategy will be realized.  Interestingly, both Google searches and Twitter are being surveyed by a host of researchers right now to mine infectious disease data.  A recent Johns Hopkins study demonstrated that Twitter reveals what people are doing in real time, whether that's going to a medical clinic or shopping for cold remedies, while searches of Google searches can reveal local trends on what people are seeking, whether that's an all night pharmacy or urgent care clinic.  Synthesizing this data with incidence will no doubt provide a very robust picture of real time community health and point the way to effective intervention.

Other topics this week include treating obsessive compulsive disorder in kids in JAMA, the proper interval for kidney dialysis to take place in NEJM, and predicting erectile dysfunction after surgery for prostate cancer, also in JAMA.  Until next week, y'all live well.

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