This week: Family doc pain, bird flu fears and digital twins

Good morning, here’s what we’re following in the world of health security this week, from the big problems with primary care to worrying lapses in the bird flu response:

Disappearing doctors

A new survey from the Alberta Medical Association?has revealed ?that 20 percent of family physicians in the province believe their practices are “unlikely to be financially viable” in six months (the survey was conducted in January). A majority of the doctors polled graded the financial condition of their practice as being poor or very poor —?only 8 percent said their practice was in good or excellent financial shape. Indeed, practices in the province have been closing. In April, several Medicentre walk-in clinics and family practices in Calgary and Edmonton?closed , impacting around 7,000 patients, because they were unable to cover rent or other operating costs.?

Those patients in big cities might be able to find another doctor, but losing a family physician in rural parts of Canada may mean patients have to travel great distances for health care. In Ontario, approximately 670,000 people live more than 50 kms from their family doctor, according to new data from the Ontario College of Family Physicians (OCFP) and?reported last week ?by?The Globe and Mail. A full 133,000 of those live more than 200 kms from their doctor.?

The OCFP data also shows that the number of Ontarians without a family doctor is climbing —?2.52 million people were without a doctor in 2023, up from 1.85 million in 2020. The lack of primary care also means that preventative care becomes more difficult. For instance, the study cited in the?Globe?found that more than 60 percent of eligible women who live less than 10 kms from their doctor got a pap screen to test for cervical cancer, but only 48 percent of those who are more than 200 kms from their doctor did.

READ MORE FROM PPF:?Primary Care for Everyone: An Urgent To-Do List for Reform

Meanwhile, in B.C. last week four rural hospitals had to temporarily?pause emergency services ?due to limited availability of doctors and nurses. “Some of those emergency rooms, you might face a note on the door saying facility closed, head to [another] location,”?Paul Adams, Executive Director of the B.C. Rural Health Network, told the CBC. “It's just a tragedy what's happening to our emergency medical system and our primary care within rural B.C.”

Worrying H5N1 response?

On Friday, the Centers for Disease Control (CDC)?reported three more presumptive human cases of H5N1 in Colorado. The three people were workers who were culling infected animals at a poultry facility that was experiencing an outbreak. They experienced mild symptoms. ?

More concerns are being raised about pandemic readiness, should H5N1 bird flu adapt to spread easily between humans. Part of that readiness hinges on dairy farmers taking steps to limit the virus’s spread amongst cattle —?and in some places, farmers have been reluctant to participate. Reuters?reported last week ?that interviews with Michigan producers, state health officials, researchers and industry groups, along with data, show “limited dairy farmer participation in efforts to stem and study the virus.” For example, “calls from local health officials go unanswered, money for dairy farm research is left unclaimed, and workers still milk cows without extra protective gear.”? ?

Michigan has seen two of the four known human cases of H5N1 in the U.S. since March. Part of the farmers’ resistance may lie in recent memories of the COVID-19 pandemic. “Nobody knows if these things that we're being told to do are going to stop it,” one farmer told Reuters. ?

But the complacency might be on both sides, according to?a story ?in the?Los Angeles Times?this week. It reported that the president of the Raw Milk Institute, a raw milk advocacy group, emailed the FDA’s acting director in mid-June with a tip that a raw milk dairy herd had been infected and that people had probably consumed the contaminated milk. The FDA reportedly quickly thanked him for the tip, but never followed-up. The state of New Mexico, where the infected herd was located, only learned of the tip last week, after the newspaper inquired.?

Meet your digital medical twin

A digital twin is an imagined, digital version of a person (or product or company) that can be used to simulate instances and outcomes. The concept isn’t new, but use of digital twins in health care is still in its infancy. Is that about to change? A Glasgow-based tech firm?has proposed that digital twin technology could help clear NHS backlogs?— and it is hoping to work with the new Labour government to do so. The company, Simul8, believes that in a hospital environment, for instance, digital twin technology would help streamline decision-making, allowing hundreds of simulations to be tried and tested cheaply each day to allocate resources and care.?Meanwhile in Canada,? B.C.’s Fraser Health has been one of?the early adopters ?of the digital twin concept. ?

As?Axios?noted ?this week, digital twin technology’s use in health doesn’t have to be at the point of critical care, like a hospital.?It can be an everyday occurrence. Twin Health, for instance, creates digital twins of patients using blood pressure and heart rate measurements from wearable sensors. It passes data to health-care providers, while at the same time giving its wearer personalized tips on diet, sleep and exercise. The company’s CEO told?Axios?that people can reverse diseases —?that “people that are diabetic become non-diabetic” and “get off medicines.”?

Health data under attack

The founding CEO of the U.K.’s National Cyber Security Centre (NCSC), Ciaran Martin, said that he was?“horrified” by the recent ransomware ?attack on hospitals in London, but “not completely surprised.” The recent attack has prompted concerns that the NHS remains vulnerable due to outdated systems, failures in basic security practices and the ongoing presence of “single points of failure.” ?

It’s a common problem around the world. This past week saw yet another major data breach in the U.S. — this time in Florida. Hackers?reportedly ?accessed what they’ve claimed is 100 gigabytes worth of information from that state’s department of health, including employee records, passport scans, prescriptions and other personal information. The hacker group RansomHub claimed responsibility and leaked the data online when it did not receive its demanded ransom payment (Florida prohibits state agencies from paying ransoms). In the U.K., the hackers that targeted the hospital and clinic network in London demanded ￡40 million —?and have also not been paid.

Oversharing

In a different kind of data leak, Bloomberg?discovered ?recently that online trackers on the websites of some of the U.S.’s biggest health care companies are sharing data with major tech platforms, unbeknownst to patients. Bloomberg found that trackers for Facebook “could access patients’ dates of birth and phone numbers” on a site for Cigna Group’s pharmacy unit. Sites for CVS Health Group “allowed Social Security numbers, passwords and dates of birth to be read by analytics company Quantum Metric.”?

And, in yet another blow to UnitedHealth Group, Bloomberg found that people signing up for accounts at its pharmacy benefit division might have part of their Social Security numbers “sent to an Adobe Inc. marketing service.” These trackers remain even as two major U.S. health companies, Kaiser Permanente and Blue Cross Blue Shield Association, grapple with lawsuits that allege their websites sent data to platforms and sites like Google, Bing, X and TikTok.?