Bitcoin and Medicine

All right, confession time. That was a clickbait title. What I really want to talk about is the blockchain technology underlying Bitcoin and its possibilities in health care.

Basic definitions first. Blockchain is a public ledger, or database of every transaction conducted stored on it. It is decentralized in that no transaction is controlled by a third-party organization, think credit card companies and all the activities they do regarding transactions.

Transactions are verified through the use of public and private keys. Think of keys as electronic signatures that show you are who you say you are. Whenever you make a transaction (e.g., pay money with something, trade data, etc.), your keys and transaction data are written in a block. This block is attached to a previously written block, hence the name blockchain.

To verify the transaction, the blocks are stored by every user, or nodes, in the network. The correctness is checked by using previous blocks. Thus, the process is peer-to-peer rather than through a third-party financial institution. However the encryption can be difficult for regular users to solve. There are special users called miners, whose sole goal is to validate and add transactions to a ledger for a reward, such as Bitcoin. They find the key that belongs to the original transactor, which requires substantial computation time and processing power.

Bitcoin is the most prominent application of the blockchain technology. It is a currency that can be used to buy services through peer-to-peer networks without the involvement of a middleman. It’s like cash, but you can give it to anyone in the world. However, Bitcoin is not blockchain. Bitcoin is the application. Blockchain is the technology. This distinction needs to be made because there are possible applications of blockchain that aren’t cryptocurrencies. Other uses for blockchain include digital contracts, peer-to-peer data sharing, and the Internet-of-Things transactions (Note: Internet-of-Things means any device connected to the Internet or each other. So that means your phone, your Alexa, your computer, your home appliances with wifi, etc.).

The advantage of this approach is that anyone in the world can make transactions with each other securely and without involvement of a third-party. The record is also public, allowing transparency.

So what can blockchain offer health care? One is through direct financing. The implications are vast. Rather than have a single entity verify all transactions in, say, a hospital, you could have a peer network quickly verify all services and all outcomes. How about across an entire health care system? You could have records of all prescriptions and electronic health records across different institutions. Say goodbye to silos! What if one country has corrupt or failing financial institutions? It would be a great boon for citizens of that country to bypass those institutions.

Another use is for patients, research organizations, health care systems, and governments to share health data on an anonymous public ledger. These can include genomic data, medical records, prescriptions, and data from wearable devices. I have to admit, though, this idea seems kind of iffy to me. The privacy issues would be huge! And it would be difficult to convince organizations to release data from a centralized location to decentralized places. I’d have to know what measures can be taken to protect an individual’s health information before making a judgement.

However, there are numerous issues besides privacy that must be overcome before there can be wide adoption. Many of these will apply to Bitcoin specifically. I know that many of the alternative applications out there try to handle these issues, but there’s not much out there in the literature currently on those things. The problems are:

Slowness: currently, the Bitcoin network can only process a few transactions per second (in the single digits versus thousands for VISA). It takes ten minutes for a Bitcoin transaction to be processed, while credit card payments take seconds. I imagine that other blockchain applications face the same issue.

Size issues: A blockchain can only be a certain size. Health care data are huge and can go into the petabytes depending on the dataset.

Hacking: A single entity can take control of the majority of the network and manipulate the entire blockchain.

Energy: At least with Bitcoin, mining takes a lot of electricity, which is expensive and can be harmful to the environment. To scale this up, this issue needs to be addressed.

Regulations: Yes, I know the point of Bitcoin is to take power away from governments. But if you want health care data to be used in the block chain, appropriate guidelines must be established.

My opinion is that this technology is very promising. Having even more data certainly excites my researcher brain. However, the obstacles are vast and overcoming them is critical to widespread adoption. Whether it’s possible to solve them remains to be seen. Also, much ink has been spilled on Bitcoin and not other applications of the blockchain technology. I worry that too much attention is being paid to Bitcoin as an investment vehicle and not the innovations of the blockchain.

Summary: Blockchains are methods to facilitate peer-to-peer transactions across the globe without the need for a middle man. This has the potential to transform health care financing and access to health care data. However, many obstacles remain, which will prevent widespread adoption in the near future.

And if you’re thinking about investing in blockchain products

  1. Do not put more than what you’re willing to use. Right now, all the coins are extremely volatile. Bitcoin has previously lost 80% of its value in one day.
  2. Do not go to cryptocurrency forums. The amount of propaganda and unsupported assertions is staggering. The more you read from people, the more confused you’ll get.
  3. Read this article:
  4.  Learn as much as you can. This might be contradictory to point 2, but there are many helpful YouTube videos and books (I recommend Andreas Antonopoulos, although be aware that he is highly positive on Bitcoin).

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