Customer Reviews

The End of Medicine, How Silicon Valley (and Naked Mice) will Reboot your Doctor

5 star:		(25)
4 star:		(13)
3 star:		(10)
2 star:		(5)
1 star:		(8)

 

 

THESIS:
Direct visualization and personalized self-testing will replace current indirect poke-and-guess diagnostics. Docs will be thrown out of work. "Geeks are at the gates" of medicine.

METHOD:
Man-On-the-Street, Guy-Just-As-Intimidated-and-Ignorant-As-You-Are holds your hand for a walkthrough of medicine's thrilling futuristic Jetsonesque Road Ahead.

DISEASES:
Mainly heart attack, stroke, cancer. Snippets on obesity and others.

TECHNOLOGIES:
Various sorts of new digitally assisted internal 3D scanning and modeling methods, automated scan picture interpretation systems, computerized gene screening, etc. Basically it is CAM - Computer Assisted Medicine.

TONE:
Silicon Valley bravura.

HUMOR:
Labored.

KUDOS:
Covers (in passing) the ridiculous Lipitor scam (much better treated in Abramson's "Overdosed America : The Broken Promise of American Medicine").

QUOTE:
"Medicine is not vertically integrated or horizontally integrated - it's not integrated at all!"

VEHICLE:
Would've worked better as a medium-to-long magazine article in say Vanity Fair or Esquire or Men's Health. And some well-chosen pictures would've been worth 10,000 words.

WRAPUP:
Digital technology (along with money of course) is certainly the god of Kessler's idolatry, that comes through clear enough. This treatment of health care issues is about a quarter inch deep, but not a bad starting point for further amateur reading. Anyway most disease is probably psycho-spiritual - all this other stuff is just business.

As a neurologist well aware of medicine's many shortcomings, I was hoping to find that a smart outsider like Kessler would provide some fresh insights and solutions. Unfortunately, he didn't, and I was very disappointed.

First, the style was annoying. Name-dropping and pointless dialogues were apparently meant to pass for breezy, energetic journalism. But the biggest problem was that Kessler didn't do his homework. For example, he unaccountably decided that CT scans of hearts were superior in all ways to echocardiograms, which he regarded as second-rate rip-offs. He completely missed the point that echocardiograms show the heart's walls and valves in motion (the heart is a pump, it moves -- get it?), portraying its physiology and function in a way that no static anatomy test such as a CT could show.

The author failed Medical Reporting 101 -- evidently so confident in his own wisdom that he didn't have to get his facts straight. I imagine he's a better investor than medical reporter, but, due to his lack of due diligence in getting his medical facts straight, this reader won't bother to investigate his other books.

I just finished reading Andy Kessler's book and found it fascinating. As a physician, the medical technologies reviewed in the book were not new to me, but the concept of how digital technology could scale and disrupt was very thought provoking. I believe the premise of Mr. Kessler's book is right on the mark, and I have recommended it to dozens of friends across the country who endeavor to lead meaningful change in an industry that is long overdue for some. By the way, the author's characterization of the industry and profession, while not flattering, was also largely very accurate. This is a must read for anyone interested in healthcare.

I enjoyed Kessler's other books, and this one is just as enjoyable, following him around as he tries to figure out if technology changes medicine. The stories are hilarious, he spends time with doctors and in labs but the best ones are watching him get scanned and getting blood to do tests on himself. By the end of the book, you figure out that cheap enough chips find heart problems and cancer early enough to something about it, which is good, since lots of heart attacks in my family. I recommend it, I'm giving one to my doctor.

I read this book in one sitting interrupted only by a four-hour break to sleep! My first thought on finishing it was to marvel that any book so enjoyable to read could be so thought provoking, educational and stimulating, especially when the subject is as forbidding as the state of the US Health Care industry!
I don't ever remember reading a book of non-fiction where I immediately wanted to go back and start reading it again from the beginning.
The book is definitely written for the general reader and he keeps the medical jargon to a minimum. Another refreshing aspect of this book is that it is not political. He does not blame "big pharma" or the government or the FDA or the AMA or whoever. He seems to realize that all that will do is put people's defenses up and thwart his desire to start a debate on this incredibly important subject.
There are some heroes in the book, however, like Don Listwin (ex- Cisco and Openwave) who has founded (and largely funded himself) the Canary Foundation, the nation's only non-profit organization devoted exclusively to early detection of cancer.
More than half our medical dollars in the US are spent in the last year of life. Only a fraction of one percent is spent on the detection of the big three: cancer, heart disease and stroke, the early identification of which would significantly reduce the incidence of early death and chronic illness here and all over the world. The implications, social and economic, are staggering and all for the good. (Perhaps it will be a thorough exposition of those implications that will finally change the terms of the debate.)
Andy has not got the answer and does not pretend to. But he provokes us to ask some very good questions. As much as the book leaves us wanting more, the question is where do we go next? We know what the problem is. Where do we go from here? Hopefully with Andy as our guide, if he continues in this vein, it will be a heck of a ride. Buy this book; you will NOT be disappointed.

This is the first Kessler book I have read and I like his style. He is casual and irreverent, but still stays on target throughout. The basic premise- if one can use that term for a non-fiction book- is that surely there must be a "Silicon Valley" angle to medicine that allows for reduction of costs while also increasing quality (like with computers). He uses his connections and charm, I guess, to travel about the country meeting with some of the top minds in medical research and pokes and prods to see where there might be opportunity for "things that scale". He sort of discovers what he already knew- that biology is not like physics (he has a double E degree) and that health care is not like any other business. Very bureaucratic, very disconnected. Doctors disagree about even the most fundamental concepts and there is no universal pool of knowledge to draw from. In other words, they mostly function as independent corporations and thus duplicate or even cancel out a lot of effort.

Kessler uses his Wall Street intuition to pick up on clues as to where this will all lead, and make his best guess on what the future of medicine will hold. His faith in the microchip- or nanochip- is near fanatical, and is never far from the crux of what he considers to be the brightest hope of medicine in the U.S. One thing I liked was that with his focus on science and business and tech solutions he was able to avoid letting this degenerate into a book just arguing about the merits or lack of a single payer system. He mentions this, but mostly just to shrug it off.

This isn't JAMA or Nature or anything, and you're not going to be blown away with hyperbole about cures and miracles of modern medicine, but you are going to get an overhead view from a smart but non-medical guy who writes well. Worth the read, and worth thinking about. Oh yeah- and he says we'll live to be a 100 pretty soon.

Despite its casual and sometimes derogatory style, this book represents a bold peek into the inside working of modern health care in America since the 1960's, till the present time. In particular, the author's background in the money market and economics and his fascination with medical sciences since young age have empowered him in grasping the complex aspects of medical technology and health management.

With a constant eye on the economic cost of various medical procedures, from angioplasty, mammography, CT and MRI imagery, to blood and genetic tests, the author questions the reasoning behind such health care behemoth. His fascination with the silicon revolution of implanting intellectual property on chips that perform endless precious functions is haunting him in his conquest to change medicine. His dream is not hard to materialize. It is only a matter of time until many medical procedures could be done on the cheap.

The combination of economic reasoning, with critical and sharp evaluation of medical practices, and the keen interest of a non-medical author in medical sciences render the book invaluable stimulus to rethinking the whole policy of assessing cost of procedure, reducing cost of high tech machinery, and reevaluating the role of insurance monopoly on health care.

The author explains his standing towards the health care. As a frequent helpless patient and through many encounters with medical procedures, he sensed the agony of countless number of like patients in dealing with expensive, unaffordable, and unreliable health care. He was destined to be a physician since young age hadn't he experienced a shocking c-section on a dog by his pal's veterinarian dad. That steered him away to fast pace life on Wall Street.

In his narration of the discovery and industrial application of the x-ray, the axial computational tomography, and the magnetic resonance imaging, the reader could sense depth of research on the part of the author in preparing his subject. The only boring aspect of the book is the sleazy comments and long conversational dialogues that span many short chapters. Those undermine the hard work and thorough research the author took pain to accomplish.

The "end of medicine" as the author sees it is the beginning of the new silicon dominated medicine. Yet, there will be no end of poorly informed public, greedy commercial profiteering, and politically manipulated educational system. Obese people will still enjoy pizzas, ice cream, smoking, and beer unless a new silicon invention could regulate what each individual should consume for the next meal, snack, or keep elaborate individual's records on eating and exercising habits. Such individualized health silicon policeman could indeed reduce the national burden of preventable diseases that only require habit modification.

Mohamed F. El-Hewie
Author of
Essentials of Weightlifting and Strength Training

Kessler wrote this book for himself and his generation, but of course, we can all benefit from his insights. If he is right, when he sates that the medical reform he describes will transform 70-something guys into 50-something guys, then I maybe I can also qualify as a baby-boomer. Unfortunately, the implication is that better health care will allow guys like me to live longer ... thereby depleting our Social Security and Medicare "trust funds" even more than currently forecasted.

Today many believe that neither Social Security nor Medicare will be around for the boomers anyway (at least in its present form), so Kessler's book is timely. Something has to be done, and most agree that the most pressing of the two is Medicare. Andy describes a reasonable scenario how such change might come about.

Consider the problem. Today the Health Care Industry accounts for about 15% of GDP. That's 1.8 Trillion dollars, where 5% of the sickest account for 47% of the expenditures. Dr. Simplot, one of the key players, has the answer to spiraling costs: "Just keep people from getting sick in the first place" and that's pretty much the theme of the book.

So what if we had a health care system where all the incentives (primarily profit) were designed to prevent chronic disease? We'd be able to eliminate the last ten years of misery prior to dying in a medically induced coma in the last month. We'd be able to eliminate the huge psychological and monetary expense to those left behind. But most appealing, to me, is the idea of maintaining a high quality of life until the last week or month and then dying at home of "natural causes." Hospitals and doctors would rarely be used.

Kessler, a hedge fund guy who made a fortune by investing in "things that scale," believes we're close to making it happen. Not 20 or 10 years away, but in the next five.

High tech Silicon Valley guys like Kessler refer to scaling as something that can always be made smaller, cheaper, faster, and better. Usually this involves silicon which is plentiful and very cheap. Every new generation (think CPUs, memory, mass storage, and cell phones) creates entire new industries ... which then enables the next generation of silicon to be made SCF&B and the cycle repeats.

Traditional medical guys who currently dominate the power structure aren't able to appreciate scaling. It goes against everything they've ever believed in. After all, you have to wait for lab results, patients get well slowly ... it all takes time. Normally, biology doesn't scale and FDA approved biology is VERY slow and VERY expensive. Besides, many patients need their doctors, who tend to provide as much psychosomatic counseling as anything else. But maybe it doesn't have to be that way for all of us. Some of us believe in the HMO idea of preventative medicine ... only we want even more control.

No problem, the younger doctors are coming and they're the ones who like toys, computer databases, and new technology. Toys like LASIK machines for eyes, 256-slice CT scanners for cardiology, and PET scanners for cancer. Multiple databases for multiple purposes: some for allocating royalties based on patents, some for patient diagnostics (via your PC's modem), and some for medical research perhaps using the Wiki model. The idea is to make these databases as Google-like (easy to use) and as Linux-like (open-source) as possible.

Regarding new technology, it looks like it will actually be possible to interface biology directly with silicon. There are now techniques for attaching organic luminescent molecules to conductors (nanotubes). This will allow functional molecular imaging to happen ... all in 3D color. We'll be able to observe in soft tissue the birth, life and death of cancel cells, plaque in the blood and brain (Alzheimer's), and the functionality of new drugs ... all in 3D color.

At some point, we'll be able to build inexpensive chips with thousands of biomarkers that can be used for comprehensive health screens on a yearly basis ... but with economics that scales over time to monthly use ... or even daily use. No doctor required for screening. Doctors only get involved when problems are detected, at which point designer probes can be developed to correct the problem.

Of course, the critical link (or bottleneck) for anything new is the FDA and Kessler addressed that by describing a key change in the FDA's drug approval process called the Critical Path. It provides for a simplified process if the drug development company's will file their biomarkers at the same time they file for drug approval. It seems most of the biomarkers specifically created for drug testing disappear when the test fails (and most do), but this small change will encourage subsequent imaging critical to advanced research for similar drugs. It also provides a "back door" for simplified approval for biomarkers developed specifically for preventative medicine.

If it were anybody but Andy Kessler writing this book, I'd be a lot more skeptical, but if ever there was a "disinterested 3rd party" (in the legal sense), it's Kessler as the consummate outsider. Albeit an outsider with some unique talents. As an engineer Kessler quickly grasps the economics of the technology; as an investment analyst he is better able to evaluate the players necessary to make it happen. It's not unlike what Kessler did when he ran his hedge fund to over a billion dollars. It's hard to ignore Kessler.

What a great book. I highly recommend it. Andy Kessler delivers again. Curious and passionate, though always a skeptic, Mr. Kessler takes readers on a journey through one of the most important and complex subjects of the day - US Health Care system. The system is in shambles - over 40 mm Americans are uninsured, as many as 100 mm are under-insured, we spend twice as much per capita on healthcare as other developed countries with little to show for it and as Americans (think baby-boomers) get older, healthcare costs will really become a bottomless pit (these costs are currently ~15% of the economy and growing at double-digit rates, while the economy grows at 2-4% per annum - scary math.) Something needs to be done now, before the expenditures on sick and elderly become unsustainable. Mr. Kessler is "money" guy (see his other books "Wall Street Meat" and "Running Money" - both are great) and is looking for SCALE - massive cost reductions akin to those we constantly see in tech world. He looks for "SCALE" on the cutting edge of tech and R&D and rightly focuses on the most overlooked part of the healthcare system - early detection and prevention. The writing is crisp and very funny (Mr. Kessler's trademark) though could use a tad more structure (at times it feels like reading "On the road.") Get this book, you will learn a great deal and will have a blast!

Former Wall Street tech investor and electrical engineer Kessler is trying to find the next big thing that Silicon Valley can bring its economies of scale to in the form of ever increasing processing power at ever lower cost. He believes that computing (hardware and software) can do for medicine what it has done for banking and retail - replace people with automation, save lots of money and improve results. As a technical, but not medical, person I find his vision of a medical revolution in the next decade or so is fairly compelling. The shift he envisages is from one from often futile, expensive and invasive treatment of advanced congestive heart disease, stroke and cancer to one of early detection leading to less invasive, less costly and more effective treatment. The exciting thing about his vision is that it seems to rely less on speculative technologies like nanobots and futuristic drugs, that may be viable in a couple of decades, and more on technologies that already exist and are in use but need to be improved upon to be more cost effective and more precise. Imaging and detection of specific protein markers for various cancers feature large in his vision.

The book is full of amusing anecdotes and characterizations and is a narrative reminiscent of Hiaasen's novels of his quest to try and understand how the technologies of Silicon Valley can be applied to medicine, a quest that covers trade shows, conversations with medical researchers, venture capitalists and so on. This book may not be for the prudish, politically correct or for those that just want the facts. Otherwise you'll find it a surprisingly entertaining read given the subject matter, the coverage of which did not disappoint either.