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.
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Top reviews from other countries
R. I. Dacre
Sadly malevolent view of our rosy medical progress
Reviewed in Canada on July 6, 2015