Home' Technology Review : November December 2009 Contents FROM THE EDITOR
TECHNOLOGY REVIEW NOVEMBER/DECEMBER
FROM THE EDITOR
When I was a young man and very poor, I lived in West Oak-
land, a neighborhood of rundown Victorian houses on the
flatlands east of San Francisco Bay, down by the Port. It doesn't
matter how I came to be there: in brief, I had nowhere else to go.
This was years after the factories had left Oakland, when crack
was like a plague, and long before the technology boom brought
software and life-sciences companies, a new population that
was middle class and ethnically varied, and developers who built
lofts and restaurants for the new residents. When I lived in West
Oakland, on the street where the Black Panther Huey Newton
was shot as he left a crack house one bleary morning, few of us
had regular jobs; the town was mostly African-American; and, of
course, no one had health insurance. When we got sick, we went
to the emergency room of Highland Hospital in East Oakland.
Once, a feral cat bit through the tendon in my right wrist.
When my arm swelled alarmingly, Kenny D--- (who paid for his
habit repairing Chester Street's cars) drove me to Highland. I
waited hours to be seen, more to be admitted. I wasn't impatient;
there were others in worse shape. A young man, maybe 15 years
old, had been shot in the leg and was handcu ed to a gurney, a
kind of bloody, swollen diaper attached to his leg. He waited, too,
while a fat, bored cop dozed beside him. I was delirious by the
time I got a bed and antibiotics. I spent two weeks in Highland.
On another occasion, I noticed that the side of my neck was
strangely deformed. Again, I went to the emergency room of
Highland. They scheduled a biopsy. The lump was a tumor, but the
harried doctors were uncertain: was it malignant? Weeks of inef-
fectual diagnosis followed. What was strangest of all (and what I
don't understand now) was that I wouldn't say or couldn't remem-
ber the genetic condition that caused the tumor, which I had
known about all my life. I was dazed by poverty and misfortune.
I lived in West Oakland after I had a job and the money to leave,
fixed by some obscure spirit of loyalty. This time in my life made
the strongest possible impression; I have never forgotten it, nor
ever gotten over it. Oakland was my education in sympathy, and it
formed what political feelings I possess. But my experiences there
were never directly reflected in any of the magazines I have edited,
which have been concerned solely with technology and science.
Recently, I saw a PBS Frontline documentary called The
Released, which followed a group of poor, mentally ill men after
they were released from jail. Each left with a bus ticket, $75 in
cash, and two weeks' worth of medication. The men did badly in
homeless shelters and group homes. They could not find work
and did not take their medications; soon they were back in prison
or dead. What reminded me of my time in Oakland was that none
of the hospitals or clinics had records of which medicines had
e ectively treated the men's mental illnesses, and the men them-
selves wouldn't say or couldn't remember. They were ghosts. I
was badly upset by The Released and wanted Technology Review to
ask this question: Is there a technological solution to this small
part of our larger health-care troubles?
David Talbot, our chief correspondent, found the answer.
Boston Medical Center (BMC), which serves many of the city's
poorer patients, has built a network of physician-based electronic
records, linking the hospital with 10 community health centers
(see "Prescription: Networking," p. 34). We were eager to learn if the
network helped the people it was meant to help, so Talbot spent
days in the emergency room of BMC. There, he met Vera Sinue,
who had been admitted with unstoppable vomiting.
Talbot describes what happened next: "The attending physi-
cian, Aneesh Narang, was understandably worried. He asked
if this had happened before; she muttered that it had happened
only in childhood. A sudden and acute bout of vomiting might
... require speedy surgery. ... But Narang called up the electronic
records ... [and] quickly saw that Sinue hadn't told the full story.
In fact, vomiting was a chronic issue; it topped her list of medical
problems. ... It's not clear why Sinue hadn't disclosed this infor-
mation. (She later told me she might have forgotten.) ...
[S]uch miscommunication 'is not really that surprising---we get it
all the time,' says Andrew Ulrich, an emergency room physician
who is also vice-chair of BMC's emergency department. 'You'd be
amazed what people don't remember.' "
BMC's network is not sophisticated technology. The electronic
records have neither genomic data nor images. But those records
saved Sinue from a CT scan and a dose of radiation. She was
given antinausea drugs and intravenous fluids. "Once the crisis
passed," Talbot writes, "a talk with a physician revealed that Sinue
was distraught over a personal issue. When the subject came up,
she was overcome with nausea. She got a referral for what she
probably needed most: counseling."
Often, a technology is "emerging" only in context. But when
the context is su ering, it can make a small but important
di erence. Write and tell me what you think at jason.pontin@
technologyreview.com. ---Jason Pontin
Ghosts in the Machine
HOW MY PERSONAL EXPERIENCES PROMPTED
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