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Hackers Find Fatal Flaw in Insulin Pump
https://www.wired.com/story/medtronic-insulin-pump-hack-app/
Another really cool article that highlights the classic tradeoff with security – making it harder for bad guys to hijack your implanted insulin pump also makes it harder to build your own customizations. The Looper community of diabetics have each built their own digital, artificial pancreas. It’s pretty wild to reprogram an implantable blood sugar monitor programmed to message one’s pump to release insulin. I’ve got to salute the ingenuity of these folks, even as I worry about programming errors (and wonder when an official, FDA-sanctioned version of this tech comes to market). Until then, these older, less-secure, but hobbyist-friendly insulin pumps will persist, and leave the patients vulnerable to pump hijackers.
– Nicholas Genes, MD, PhD
This is some serious John Grisham stuff right here. Overdosing someone’s insulin pump remotely with your smart phone? The saddest thing is that the company producing the insulin pumps did NOTHING after being notified of the security flaw until these security hackers created the app to exploit the security flaw and discussed it at a nationwide security conference. Only then did Medtronic replace all of the affected insulin pumps. Makes one wonder how many Medtronic pacemakers/defibrillators might have the same flaw, doesn’t it? I may or may not have been known to change the TV stations in restaurants using an app on my cell phone. Imagine being able to whip out your iPhone to give some annoying person in the room a “shocking” experience.
– William Sullivan, DO, JD
Insurance Denials Dish out Death
US Insurance companies are great — for shareholders. They really know how to extract money from healthy patients and restrict it from going to sick patients — their profits are astounding and their stocks have been doing pretty great. At some point the public may demand some kind of accountability — insurance companies are certainly not putting this profit into any kind of innovation, or hiring of more call center staff. It seems unfair to require people to pay hundreds of thousands of dollars to health insurers over a lifetime when they’re healthy, then deny coverage on obscure technicalities, or make sick people jump through unnecessary, time-consuming hoops to receive benefits. But our society can’t seem to ask the insurance industry to do anything other than make shareholders happy, even if it’s killing us.
– Nicholas Genes, MD, PhD
As if it is not hard enough to practice medicine in the US, now we have insurances interfering with medical decision making too? Insurances are now requiring approvals which postpones care. Additional checks and balances to “guide” physicians about the best approaches to guard against unnecessary treatment and reduce costs? My major issue with this is, now, not only do we have non-medically trained business people telling us what we can and can’t do, but stuck in the middle are the patients who are suffering due to unnecessary delays in their care. Healthcare in the US is broken…and we wonder why physician burnout rates are so high.
– Salim R. Rezaie, MD
Insurance denials cause deaths. When insurers fail to pay for medically necessary care or deliberately delay medically necessary care, they are practicing medicine. When insurers practice medicine, they should be subject to the same liabilities as other medical providers. End of story. Prior authorizations have no purpose other than to frustrate clinicians and patients to the point that they no longer seek testing. I helped create a policy advocating greater scrutiny on insurance denials so that ACEP could begin fighting back against arbitrary insurance denials. So far…nothing. Instead we do victory laps around the ER when the Joint Commission says we can eat food at our desks because we’re too busy to take breaks. Our priorities are just a little off.
– William Sullivan, DO, JD
Gut Microbes Eating Medication
https://chemistry.harvard.edu/news/gut-microbes-eat-our-medication
This was just a genuine pleasure to read. Clever people noticing things, making reasonable assertions and testing them. You don’t need to understand the latest gut microbiome gene assays or the details of L-dopa’s structure to appreciate their approach and success. And hopefully we’ll be a few steps closer to more consistently absorbed drugs.
– Nicholas Genes, MD, PhD
The microbiome fascinates me. The process that these scientists went through to discover how certain bacteria metabolize dopamine is praiseworthy and I hope they get much more recognition for their efforts. For how much we know about certain areas of medicine, our knowledge of how the microbiome influences our health is still in its infancy. We’re naive if we believe that medications only have an affect on the organ systems we want them to target. Studies show that different bacteria in the gut can affect our weight and many disease processes. I foresee one day prescribing mixes of specific bacteria to ingest along with medications. One day we may learn that telling someone to “eat s*** and die” will have just the opposite effect.
– William Sullivan, DO, JD