January 15, 2021 - Podcast

Episode 78—Anxiety, and Big Brother

Chest pain sends millions of Americans to the hospital every year fearing that they are having a heart attack. Yet historically, in 8 out of 10 patients evaluated in hospital emergency departments, chest pain was not caused by a heart attack or other cardiac event. Instead, anxiety, undiagnosed, untreated or under-treated, is likely the cause of chest pain in as many as half of patients deemed at low risk for a cardiac event. Researchers at the IU School of Medicine are investigating the best care options for the 40 percent of people who go to the hospital emergency department with chest pain that is determined to be caused by anxiety. IU scientist Kurt Kroenke and Paul Musey say emergency department care for anxiety typically ends with discharge once a heart attack or related problem has been ruled out, leaving many of these patients confused about the cause of their chest pain symptoms and what to do next. As a result, they often continue to suffer and may return due to persistent or recurrent symptoms. With input from patients, clinicians, researchers and health system leaders, Kroenke, who is a co-developer of the most frequently used primary care anxiety screening tool, and a team of researchers is investigating what emergency departments can do to support the large number of individuals whose chest pain derives from anxiety. They will utilize three care options to determine which works best: treatment of anxiety by a primary care practice; self-paced cognitive behavioral therapy via the internet, enhanced by peer support from individuals who understand the challenges of managing anxiety; and live video chat cognitive behavioral-therapy sessions with a psychologist. Kroenke says emergency department care is stressful and costly. Detection of anxiety in low-risk chest pain patients and treatment referral options, he says, would have great value for both patients and healthcare systems.

In other news, homeowner associations across cities such as Indianapolis are increasingly partnering with private companies to surveil their neighborhoods with automated license plate readers. The technology allows homeowner associations to use technology similar to what law enforcement agencies use to identify, catalog and distribute any passing vehicle’s model, color and license plate number. But civil liberties advocates like Angie Raymond, an associate professor of business law and ethics at IU Bloomington, are worried about putting such powerful technology in the hands of the untrained, and about its potential for abuse. Raymond says she worries about the lack of policies dictating how an individual can access and use the information. She says automated license plate readers can easily track and disseminate information about neighborhood visitors who have a perfectly legitimate reason for driving in the neighborhood. Moreover, that information can become part of a larger database held by the entity providing the technology. Private entities can surveil us without being bound in many instances by the law, she says. The big divide is in the way that information is gathered, stored, shared, and retained. Raymond says law enforcement, local governments, universities and other public institutions have certain procedures and policies to practice safe data management. That’s often not the case with homeowner associations. Raymond says neighborhood leaders considering this method of combating porch pirates and other potential uses of the technology need to ask themselves what the data will do, how it will be used, what rules are in place to protect the innocent, and how that data will be shared and stored by the entity that provides the technology.