Health Law

THE END OF MEDICINE: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor by Andy Kessler, Collins 2007.

By Greg Piche'

    Andy Kessler is an irreverent, flip and highly readable writer who poses an interesting single question and than doggedly pursues an answer, with a lot of biting asides to entertain the reader. The question is, given the exponential decline in cost of technology in Silicon Valley and its exponential increase in power and effectiveness, why hasn?t medical technology turned over the same returns to deliver more effective health care at a cheaper cost. There are a number of reasons including the inherent slowness of the treatment and study process, the FDA, entrenched economic interests and the focus on treatment rather than prevention.

Kessler takes us through his exploration of the technological efforts to cure the ?big three,? cancer, heart disease and stroke including the promise of genetic based treatments and nanotechnology and the pharmaceutical sweat shops where as he puts it they seem to throw spaghetti against a wall to see what slides out.  He visits the use of mouse antibodies to inject into humans to create immunity from certain diseases and the omnipresence of hairless white mice sacrificing there all for the advance of human medicine.

    He arrives at some interesting conclusions after his journey that the real answer may not actually be on our focus on treatment and intervention, where the overwhelming majority of research dollars are spent, but on early detection and removal. He explores the advances in scanning techniques and in the use of nanotechnology and silicon chip technology to provide ongoing probes to pickup on and identify protein disease markers in the blood stream and the ability to discern cellular changes at the molecular level as having the potential promise to revolutionize the cost/effectiveness curve of medical technology.

But what if the spending was on detection instead of intervention?

With some breakthrough, the economic consequences can be 

staggering. If medicine as we know it is replaced by health

monitoring, hmmm. . . .

    The health monitoring research undertaken by the Fred Hutchinson Cancer Center (the ?Hutch?) in Seattle, supported and encouraged by entrepreneur Don Listwin, seems to offer an encouraging new direction in the focus of medical research in the direction of detection.  Kessler recognizes that change is happening but to move progress along more rapidly there needs to be a paradigm shift in the practice of medicine which has become calcified in no longer relevant models.

There are no best practices, just best doctors. It?s not an industry,

it?s a collection of studious folks who memorized the organic 

chemistry textbook. They?re isolated practitioners. Medicine is not vertically integrated or horizontally integrated -its not integrated at all!

Medical knowledge is scattered to the wind -little bits of it in 

lots of     individuals. There is no product - you and I are the 

product. Medicine consumes us.

    With the digitalization of healthcare information, there should arise a paradigm of accountability based on information, which may well extend our existence and reduce our allocation of resources. Perhaps were are reaching the knee of technological advance on the curve toward exponential results.

Full post as published by Healthcare Law Blog on August 21, 2010 (boomark / email).