Medicine Will Die—Long Live Medicine

Medicine Will Die—Long Live Medicine

he End of Medicine, a new book by Andy Kessler, has attracted much attention in the financial community. The author has not only made a lot of money riding the tech wave, he has also made a significant splash as a published savant/comic. In his prior works—the national bestsellers Wall Street Meat (and its companion, How We Got Here) and Running Money, about errant Wall Street analysts and hedge-fund honchos, respectively—and in his current work, Kessler never fails to entertain, cracking up his readers at the expense of the targets of his investigations. Yet he constantly informs while putting forth important ideas. The End of Medicine is about the death of medicine as we know it—which he unabashedly compares to witchcraft—and its future rebirth.

As you might suspect, Kessler is a very bright guy who asks good questions. Why is it that a system characterized by bigness—big pharma, huge hospital chains, extensive managed care organizations, and so on—is dysfunctional and may be going broke? Could the near-socialization of medicine make it immune to new technologies, which have dramatically reduced costs in many other industries? This is the process of scaling, the exponential reduction in the cost of a developing technology. Yet Kessler wonders why, despite scaling’s enormous advantages, medicine has not yet benefited from them. So he begins to sniff around current developments in medicine, searching for the light of day in the hope that he will discover where (and when) the first explosion of changes will occur.

Three major diseases—heart attacks, strokes, and cancer—consume much of the $1.8 trillion spent on medicine in the U.S. annually (15% of the entire economy). Yet very little is spent on early detection. To Kessler this is a travesty, but he believes that the problem will be solved sooner than later by a “killer app” (as they say in Silicon Valley) provided by technology. Why wait until you’ve got a full-blown disease when it’s immeasurably easier to deal with it if you can detect it early? Why even get a disease if you can prevent it? And detection/prevention technology is here already.

The technology is very expensive, however. No sweat, says Kessler. This is exactly the kind of problem that scaling resolves. Despite the bureaucratic wall surrounding medicine, he believes scaling will end-run around it. CT scans, nanochips … these technologies and others, when made affordable by scaling, will search for the precursors of heart attacks, strokes, and cancers and draw your attention to taking the necessary preventive measures.

These technologies, moreover, will obviate the need for doctors, according to Kessler, who believes that doctors (along with nurses and medical bureaucrats) are a significant part of the problem of high medical costs. They are part and parcel of the bureaucracy that bogs everything down and limits expenditures for remedial actions. After describing his demeaning and perfunctory encounters with doctors throughout the book, Kessler even expresses the hope that the profession will largely disappear. This, he points out, has been the consequence of scaling in many industries, shrinking entire occupations, such as stock traders, tellers, phone operators, draftsmen, film editors, postal sorters, etc.

Currently, doctors cannot be certain of what is going on in our bodies unless cost is no object and they are experts in detection/prevention technology. But in the new world of medicine that Kessler envisions, silicon chips can embed the knowledge of the best doctors and lead us to a world in which inexpensive technology can keep us healthy by preventing diseases or shooting them down before they take us down. Tempus neminem manet (time waits for no one).

  • Kessler A, The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor. Collins, New York, 2006.

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