When I survey all the technologies that will transform health care of the future for the better, I always return to the tremendous potential of telemedicine. Much like how Amazon transformed how we shop, telemedicine can bring health-care providers to your town (or even your home) through your phone or your computer. Such technology diminishes the need to travel for consultation and follow-up, acting as a force-multiplier that will positively disrupt health care.
Though still in its early stages of development, telemedicine is already used for myriad specialties, spanning from the obvious dermatology, pathology and radiology to trauma surgery, pediatric cardiac intensive care, maternal-fetal medicine, and even my field of infectious disease. In many contexts, telemedicine acts not solely as a mechanism to reach areas without access to advanced sub-specialists, but to augment the care of those with high risk and complex conditions, such as traumatic injuries and HIV. Because of its proven value, telemedicine has been embraced by the medical community for almost every facet of medicine, save one: medical abortions, where politicians in some states have increasingly sought to regulate it to the point of virtual unavailability.
A medical abortion is the terminating of an early (seven to nine weeks) pregnancy via a medication called Mifeprex. It is a major advance in reproductive medicine, as it eliminates the need, in many cases, for more costly and complicated later surgical abortions. It is safe and effective. Often, during the process of going through a medical abortion, consultation with a physician or, in some states, a nurse practitioner or physician’s assistant, experienced in such treatments is needed to monitor the process and ensure that no further intervention is necessary. In areas of the country in which access to such providers is not convenient or available, telemedicine brings this treatment to women who choose to employ it.
However, states such as Arkansas, Idaho, Iowa and many others have banned the use of telemedicine for medical abortions. In Arkansas, the same day that legislators passed a bill declaring a state emergency due to a lack of access to health care in underserved areas and encouraging the use of telemedicine, it passed a ban on the use of telemedicine for pregnancy terminations. Unfortunately in Pennsylvania, abortion as such is so heavily regulated under the Abortion Control Act and the Abortion Oversight Act that new laws basically have nothing left to regulate.
In light of this worrisome trend, the recent ruling by the Iowa Supreme Court to strike down this ban in that state is encouraging.
But why was this particular delimitation on the scope of telemedicine even pursued?
Is it because of some inherent shortcoming of telemedicine unique to the area of reproductive medicine? No. There is not a justifiable medical reason for this restriction. The answer is that many people seek to restrict the rights of women to their own bodies while at the same time dictating how physicians and other health-care providers practice medicine — a double injury to the causes of liberty and free enterprise.
More than 20 years ago, the U.S. Supreme Court ruled that states cannot criminally ban early-term abortions, declaring this “a rule of law and a component of liberty that we cannot renounce.” That the Court has repeatedly upheld this ruling has stymied would-be theocrats who have sought to place every conceivable burden — short of an outright ban — on the right of a woman to obtain an abortion. Such burdens trample physician autonomy along with women’s individual rights on the road to foisting a religiously derived view of fetal rights onto the entire populace.
This strategy of making the ending of a pregnancy as arduous as possible is apparent not only in telemedicine bans, but also in the efforts to dictate that physicians must have hospital admitting privileges, and must perform what is usually an office-based procedure in ambulatory surgical centers. Such regulations were the subject of a recent Court of Appeals for the 5th Circuit ruling, placed on hold by the U.S. Supreme Court, that upheld restrictions that even stipulate how many parking spaces are required for a facility that provides abortion procedures. This case is now heading to the U.S. Supreme Court, where this latest example of government intrusion into medical practice will hopefully be rescinded.
It does not matter that the medical service in question in these cases is abortion, because abortion is a right and the government’s circumscription of it is tantamount to the nullification of that right, as well as of a physician’s right to practice medicine.
Telemedicine is path-breaking technology that will revolutionize health care and improve access to care, control costs and open up whole new avenues for innovation. It must not be left susceptible to government interference that clearly vitiates the once-sacrosanct U.S. Constitution’s principle of liberty.
Adalja is a quadruple board-certified physician in Pittsburgh. Follow him on Twitter: @AmeshAA