Sacramento, Oct 8 (AP/UNB) — Dr. Anna Nguyen spoke with none of the five patients she treated on a recent weekday morning. She didn't even leave her dining room.
The emergency physician nevertheless helped a pregnant Ohio woman handle hip pain, examined a Michigan man's sore throat and texted a mom whose son became sick during a family trip to Mexico.
Welcome to the latest wrinkle in health care convenience: the chat diagnosis.
Nguyen's company, CirrusMD, can connect patients with a doctor in less than a minute. But such fast service comes with a catch: The patient probably won't see or talk to the doctor, because most communication takes place via secure messaging.
"We live in a consumer-driven world, and I think that consumers are becoming accustomed to being able to access all types of service with their thumbs," CirrusMD co-founder Dr. Blake McKinney said.
CirrusMD and rivals like 98point6 and K Health offer message-based treatment for injuries or minor illnesses normally handled by a doctor's office or clinic. They say they're even more convenient than the video telemedicine that many employers and insurers now offer, because patients accustomed to Uber-like convenience can text with a doctor while riding a bus or waiting in a grocery store line.
Millions of Americans have access to these services. The companies are growing thanks to a push to improve care access, keep patients healthy and limit expensive emergency room visits. Walmart's Sam's Club, for instance, recently announced that it would offer 98point6 visits as part of a customer care program it is testing.
But some doctors worry about the quality of care provided by physicians who won't see their patients and might have a limited medical history to read before deciding treatment.
"If the business opportunity is huge, there's a risk that that caution is pushed aside," said Dr. Thomas Bledsoe, a member of the American College of Physicians.
Message-based care providers say they take steps to ensure safety and recommend in-person doctor visits when necessary. Nguyen, for instance, once urged an 85-year-old woman who contacted CirrusMD about crushing chest pain to head to an emergency room.
These companies note that a thorough medical history is not crucial for every case. They also say doctors don't always need vital signs like temperature and blood pressure, but they can coach patients through taking them if necessary. Doctors also can opt for a video or phone conversation when needed.
Even so, the companies estimate they can resolve more than 80 percent of their cases through messaging.
About 3 million people nationwide have access to CirrusMD doctors, mostly through their insurance. The insurer or employer providing the coverage pays for the service, allowing patients to chat with doctors at no charge.
At first glance, a visitor to Nguyen's Sacramento home wouldn't be able to tell if she was the doctor or the patient during her recent shift. She sat at her dining room table and tapped her iPhone to bounce between patients.
The doctor's phone started dinging shortly after her five-hour shift began.
She gave physical therapy recommendations to the pregnant woman and helped a Colorado man who hurt his back moving boxes at work. A Michigan man checked in about his sore throat as that conversation wound down.
Then the mom messaged from Mexico. Her 6-year-old started vomiting and developed a fever and diarrhea after his brother and father became sick during a vacation. Nguyen wanted to know how the boy was acting, so she asked several questions and requested a picture.
The emergency physician could tell by his skin color that he wasn't dehydrated.
"The picture itself looks reassuring," she said. "If he had encephalitis, he'd be really confused and out of it."
The doctor said she thought the boy just had a stomach bug, and she told his mother to make sure he kept drinking fluids.
Nguyen said she enjoys this type of care because the format gives her more time with patients.
"I think patients will like it a lot because most really hate going to their doctor," she said referring to the hassle of setting an appointment, getting to the office and then waiting for the visit.
Some patients simply don't have time for all that.
Ohio Wesleyan University student Jasmine Spitzer contacted a 98point6 doctor in a panic earlier this year because her throat was sore, and the music education major had an opera recital coming up. She texted for help as she walked to class.
The doctor couldn't prescribe anything. But she sent pictures of common medications Spitzer could buy, including cough drops with lower levels of menthol, which dries out vocal chords.
"I wish that there is a way for me to ... tell her, 'Thank you so much, you kind of saved my life,'" Spitzer said. "I was able to give my recital and it was great."
98point6 customers first describe their symptoms to a chatbot that uses a computer program to figure out what to ask. That information is then passed to a doctor for diagnosis and treatment.
"There are many, many cases where the physician does not have to ask a single additional question," CEO Robbie Cape said.
The company launched its service in January 2018 with 600 customers and expects to have about 1 million people signed up by the end of this year.
K Health also started in 2018 with a business that offers personalized health information to patients who might otherwise Google their symptoms. Those patients then have an option to chat with a doctor.
These companies say their doctors often answer an array of quick questions as well provide care. Nguyen had a Louisiana woman send her a picture of her thumb, which she punctured cleaning out a chicken coop, just to see if the doctor thought it might need attention.
Patients and doctors have long emailed outside of office visits, usually about prescription refills or follow-up questions. These newer, message-based treatments often involve care by a physician who doesn't know the patient and who may have a limited view of that person's medical history.
That concerns Bledsoe, the American College of Physicians doctor. He noted, for instance, that a patient who wants a quick prescription for another bladder infection may actually need a cancer test.
"Sometimes what seems to be a limited problem to a patient is actually part of a bigger problem that requires some more evaluation and treatment," he said.
Virtual care like this also might lead to antibiotic overprescribing, said Dr. Ateev Mehrotra. The Harvard researcher said it's probably easier for a doctor who knows a patient to explain face to face why they don't need a medicine than it would be for a stranger to deliver that news by text and risk upsetting a customer.
CirrusMD and 98point6 executives say they closely monitor antibiotic prescription rates and take other precautions. Neither company prescribes highly addictive painkillers, and 98point6 sends doctors through six months of training.
Instead of hurting care, these chat-diagnosis companies say they help by improving access, especially if someone's regular doctor isn't available.
"We're meant to fit into your life," Cape said.
Caracas, Oct 8 (AP/UNB) — The software company Adobe says it is cutting off its accounts in Venezuela, the latest repercussions of U.S. financial sanctions targeting President Nicolás Maduro.
The California-based firm on Monday cited sweeping measures by the administration of President Donald Trump announced Aug. 5 banning companies and individuals from doing business with Maduro's socialist government.
Adobe is best known for its graphics and multimedia software including Adobe Acrobat, Photoshop and Adobe Flash that enable online websites.
Its cutoff follows a move by Major League Baseball to ban its players from the Venezuelan Winter League because of the sanctions.
U.S. officials back Venezuelan opposition leader Juan Guaidó's bid to unseat the socialist government, saying Maduro's election last year was a fraud.
Venezuelan officials didn't immediately comment on the move by Adobe
Washington, Oct 8 (AP/UNB) - The United States is blacklisting a group of Chinese tech companies that develop facial recognition and other artificial intelligence technology that the U.S. says is being used to repress China's Muslim minority groups.
A move Monday by the U.S. Commerce Department puts the companies on a so-called Entity List for acting contrary to American foreign policy interests.
The blacklist effectively bars U.S. firms from selling technology to the Chinese companies without government approval.
Commerce Secretary Wilbur Ross said in a written statement Monday that the U.S. government "will not tolerate the brutal suppression of ethnic minorities within China."
The blacklisted companies include Hikvision and Dahua, both of which are global providers of video surveillance technology.
Hikvision said in a statement Monday that it respects human rights and strongly opposes the Trump administration's decision. The company said it has spent a year trying to "clarify misunderstandings about the company and address their concerns," and that this will hurt its U.S. business partners.
Prominent Chinese AI firms such as Sense Time, Megvii and iFlytek are also on the list. Sense Time and Megvii are known for the development of computer vision technology that underpins facial recognition products, while iFlytek is known for its voice recognition and translation services.
The companies are among 28 organizations added to the blacklist Monday. Along with the tech companies, the Commerce Department's filing targets local government agencies in China's northwestern Xinjiang region.
The filing said the listed groups have been implicated in "China's campaign of repression, mass arbitrary detention, and high-technology surveillance" against Uighurs, Kazakhs and other predominantly Muslim minority groups.
The Chinese embassy and several of the targeted companies didn't immediately return requests for comment Monday.
The Trump administration earlier this year used the same blacklisting process to punish Huawei, the Chinese telecom giant targeted by the U.S. over national security concerns. Added to the list in June were five Chinese groups working in supercomputing.
Ross said Monday's action will ensure U.S. technologies "are not used to repress defenseless minority populations."
China is estimated to have detained up to 1 million Muslims in prison-like detention centers in the region. The detentions come on top of harsh travel restrictions and a massive surveillance network equipped with facial recognition technology. China has denied committing abuses in the centers and has described them as schools aimed at providing employable skills and combating extremism.
Cape Canaveral, OCT 8. (AP/UNB) — The solar system has a new winner in the moon department.
Twenty new moons have been found around Saturn, giving the ringed planet a total of 82, scientists said Monday. That beats Jupiter and its 79 moons.
"It was fun to find that Saturn is the true moon king," said astronomer Scott Sheppard of the Carnegie Institution for Science.
If it's any consolation to the Jupiter crowd, our solar system's biggest planet — Jupiter — still has the biggest moon. Jupiter's Ganymede is almost half the size of Earth. By contrast, Saturn's 20 new moons are minuscule, each barely 3 miles (5 kilometers) in diameter.
Sheppard and his team used a telescope in Hawaii to spot Saturn's 20 new moons over the summer. About 100 even tinier moons may be orbiting Saturn, still waiting to be found, he said.
Astronomers have pretty much completed the inventory of moons as small as 3 miles (5 kilometers) around Saturn and 1 mile (1.6 kilometers) around Jupiter, according to Sheppard. Future larger telescopes will be needed to see anything smaller.
It's harder spotting mini moons around Saturn than Jupiter, Sheppard said, given how much farther Saturn is.
"So seeing that Saturn has more moons even though it is harder to find them, shows just how many moons Saturn has collected over time," he wrote in an email. These baby moons may have come from larger parent moons that broke apart right after Saturn formed.
Seventeen of Saturn's new moons orbit the planet in the opposite, or retrograde, direction. The other three circle in the same direction that Saturn rotates. They're so far from Saturn that it takes two to three years to complete a single orbit.
"These moons are the remnants of the objects that helped form the planets, so by studying them, we are learning about what the planets formed from," Sheppard wrote.
Just last year, Sheppard found 12 new moons around Jupiter. The Carnegie Institution had a moon-naming contest for them; another is planned now for Saturn's new moons .
The jury is still out on whether any planets beyond our solar system have even more moons. For now, Saturn has the most known moons.
Monday's announcement came from the International Astronomical Union's Minor Planet Center.
London, Oct 5 (AP/UNB) — Prince Harry is suing The Sun and the Daily Mirror, two of Britain's most popular tabloid newspapers, over alleged phone hacking.
Buckingham Palace confirmed Saturday that claims regarding "illegal interception of voicemail messages" were filed on Harry's behalf. The palace declined to say more or provide details "given the particulars of the claims are not yet public."
News Group Newspapers, which owns The Sun and the now defunct News of the World, acknowledged the prince's High Court action while Reach, which owns the Mirror, said it was "aware that proceedings have been issued" but hasn't yet received notice of them.
The cases escalate Harry's fight with the British tabloids. It comes days after his wife, Meghan, the Duchess of Sussex, sued the Mail on Sunday for alleged copyright infringement, misuse of private information and violating the U.K.'s data protection law after the paper published a letter she wrote to her father.
Harry then lambasted British tabloids after Meghan filed her lawsuit on Tuesday, saying in a statement that his wife's lawsuit, which was months in the making, was a response to a "ruthless campaign" to smear her by creating "lie after lie at her expense" during her maternity leave.
British tabloid newspapers have paid millions of dollars to settle claims that their employees had hacked the phone voicemails of celebrities, politicians and others in the public eye. The News of the World was shut down in 2011, at the height of the hacking scandal.