Abortion? The Google Doctor Can't See You Now
As the Washington Post among others reported Monday, Google is testing a new service "that provides live video chat advice to searchers looking for information on some medical conditions." The feature, uncovered by a Reddit user who noticed his Android phone suggested "Talk with a doctor now" when he did a search about "knee pain," may be a forerunner of the mass adoption of telemedicine to cost-effectively provide information, evaluation and treatment, especially for those in rural and under-served areas.
But if the new video consultations catch on (consultations whose costs Google will cover during this testing period), they will nevertheless be limited, and not just because most states prohibit doctors from practicing across state lines. As The Atlantic recently reported, "Medicated abortions provided via telemedicine" have already been blocked by opponents across much of the country.
As Alana Semuels explained, telemedicine is already delivering health care and saving millions of dollars for patients and doctors in even the remotest areas of Alaska. One assessment showed that "telemedicine saved Medicaid and Medicare 19 percent on costs when it helped offer hospital-level care in patients' homes."
But there is one procedure that, though it could be easily, safely, and cheaply administered via telemedicine, is widely unavailable: the termination of a pregnancy. Fifteen states have adopted bans on telemedicine abortion since 2010. The practice was only ever available in three states--Iowa, Minnesota, and Texas--though Texas now has banned it. In Iowa telemedicine abortion continues to be available, though is being challenged in courts, and in Minnesota the legislature passed a ban, which the governor vetoed.
Of course, the growing opposition to what foes of reproductive rights brand "webcam abortions" has nothing to do with women's health or safety and everything to do with abortion itself.
Three years ago, a study published in the journal Obstetrics and Gynecology found that allowing physicians to remotely supervise administration of the pregnancy-ending drug RU-486 is just as safe, effective and acceptable to patients as a face-to-face office visit. In the first 10 years since its introduction in the United States, over 1.5 million women used RU-486 to induce abortions. The mortality rate for RU-486 (also known as Mifeprex) is one in 100,000; by contrast, Viagra's is five in 100,000. Even the small number of "adverse events" (14 deaths and 612 hospitalizations) could not be confirmed by the FDA to be related to the drug itself, prompting medical ethicist Arthur Caplan to warn:
"Unless these groups have some broader heartburn over the notion of rural areas getting access to doctors by video, I don't think this is in any way a serious complaint. Clearly we don't have enough primary care providers. One way to solve this is through telemedicine. We don't want to be attacking that, we probably want to be celebrating it."
But in Iowa as in states like Arizona, Kansas, North Dakota, Nebraska and Tennessee, attacking telemedicine and the doctors who deliver it is exactly what Republicans are doing. As the Quad City Times reported in February, the Iowa House voted for a prohibition on just such procedures. By a 55-42 vote, legislators passed House File 2175, which would "ban the practice of doctors prescribing abortion-inducing drugs from remote locations, typically using a video link." But while that bill has not yet become law, the Iowa Board of Medicine ruled physicians to be present and to perform a physical examination before drugs are dispensed. (Planned Parenthood of the Heartland, which since 2008 has helped 6,400 women access abortion services via telemedicine, is currently appealing to the state supreme court.)
Planned Parenthood spokeswoman Angie Remington summed up the situation many Hawkeye state women face:
"The intent was really for women to be able to receive the care they need without having to travel 500 miles round trip...Through this program, there have been many women who have told stories like, 'I don't think I would have been able to get an abortion, if not through this service.'''
But if anti-abortion forces have their way, no American woman would be able to get an abortion through any telemedicine service. To put it another way, they will ensure that the Google doctor can't see you now.