From an interview with the prolific inventor in Popular Mechanics (HT: Megan McCardle):
Popular Mechanics: Yet health-care costs do keep rising. Is there a point at which we simply can't afford the most advanced treatments?
Kamen: Diabetes alone, if you include all of the long-term, insidious consequences of a lifetime of diabetes, is responsible for about 30 percent of the federal reimbursement for healthcare. Taking care of the diabetic every day is a small piece of it. But what if tomorrow we could wipe out diabetes, suddenly everybody takes a pill and it cures the people that have it, and it inoculates the other people so they'll never have it? Forgetting what a great life that would give people and their families, you take care of 30 percent of what now we project as this insurmountable problem of healthcare, which they project is going to kill us.
Well, it would kill us if we look at the 30-year actuarial data based on our 19th century confidence in technology. But I'm sure in 1920 if you asked actuaries to say what percentage of our GDP are we going to spend taking care of people with polio, they'd say: "They get polio, it goes to their lungs, they sit in iron lung machines, they could live a whole lifetime with three people watching over them. We can't support them all."
But what did it cost to deal with everybody with polio? Oh, $2 apiece. We gave them the Salk vaccine. But in the 1920s Salk wasn't around yet.
I'm with Kamen on the importance of market incentives in spurring innovation in health care, but I don't know if the Polio vaccine was the best example for him to use here: Salk refused to patent it1. Nevertheless, even if he had patented it, the cost of the vaccine could still have been far less than the cost of keeping people alive in iron lungs, so Kamen's point still stands. He could have used a better example though to support his point. Back to the interview:
PM: In other words, R&D spending now may save money later?
Kamen: If you project forward these horrific costs of treating everybody and you want to assume we are not going to respond to that by making the therapies better, simpler and cheaper and in some cases completely wiping out the [diseases], well you know what? We might actually get to that situation—if we stop investing in technology, if we stop believing that the future ought to be better than the past.
If we want to sit here and keep assuming we should be fighting, and that we should be striving to spend less of our intellectual power and our money on great achievements to come in healthcare—that we should be fighting to make it a smaller piece of our economy—I want to know what you want to make a bigger piece of our economy. What do you want to see the future look like?
I think this debate shows a fundamental lack of vision, a lack of confidence, a lack of understanding of what's possible.
Coincidentally, Tim Ferriss blogged about Kamen today, and in the comment thread I mentioned that Kamen was featured on an episode of the Sundance Channel series Iconoclasts (he was paired with Isabella Rossellini). Kamen is a fascinating character, which made this a fascinating episode to watch. Here is a brief clip from that episode.
The photo above of Dean Kamen accompanied the Popular Mechanics article.
1If Salk's research weren't funded by the University of Pittsburgh and National Foundation for Infantile Paralysis -- if, say, he had been the founder of a start-up pharma company -- he would have had to patent the vaccine in order to recoup his and his investors' investment in the drug's development.
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7 comments:
"Diabetes alone, if you include all of the long-term, insidious consequences of a lifetime of diabetes, is responsible for about 30 percent of the federal reimbursement for healthcare. Taking care of the diabetic every day is a small piece of it. But what if tomorrow we could wipe out diabetes, suddenly everybody takes a pill and it cures the people that have it, and it inoculates the other people so they'll never have it? Forgetting what a great life that would give people and their families, you take care of 30 percent of what now we project as this insurmountable problem of healthcare, which they project is going to kill us. "
"Last year what did we spend in the United States on soft drinks? $121 billion.... I'm not against soft drinks—I think you ought to buy all the soft drinks you want. "
I bet you do think so, Dean, since sugary high-carb manufactured filth like soft drinks and fast food are a major part of causing diabetes, and other conditions that pays the pharma industry to produce non-curative, treatment-only pills that barely outperform placebos.
The truth is that most of the first world's health problems are self inflicted, and those smart enough to live healthily don't need to worry about most of them, like the diabetes epidemic or lung cancer. (not all diabetes can be prevented, but most diabetics bring the infliction on themselves with poor diet and obesity)
The diseases that aren't self-inflicted, are mostly the result of aging. If we want to stop these afflictions, then we need to invest in retarding the aging process, which is a genetically programed process that begins to happens when our cells telomeres run out (every time a cell undergoes mitosis it clips the end of the protective telomeres). So our society needs to invest in genetic engineering research and nanotechnology to make significant progress. Old-school pharma won't be able to produce pills to make much progress from this point of our technological development.
JK,
I doubt that Dean Kamen hopes more people get diabetes. Also, non-smokers get lung cancer too. Finally, Kamen's point about the dangers of stifling innovation would apply to innovation in genetic engineering and nanotechnology as well.
I did make more a political point about this on Megan's blog, drawing on a comment Kamen made in that Iconoclasts episode (he makes it in the clip I linked to), but as per my previous comment about the evolving trajectory of this blog, I don't think I'll make that comment here.
You're right, I don't think Dean consciously hopes people get diabetes. I was being facetious to highlight the conflict in those two statements. Dean, while a brilliant inventor, appears to be wearing blinders when it comes to the social environment (this is the guy who thought the Segway would revolutionize transportation, after all). He sees coming up with a pill as a cure for diabetes when the disease can be prevented by doing what he says he doesn't want to interfere with: junk food! When you're a hammer, everything looks like a nail.
I don't support stifling innovation either. But not every commercial interest, contrary to fundamentalist capitalist thought, promotes innovation at an optimal rate where it is needed. Especially in an industry loaded with dinosaurs like the pharma industry, which actually stifles competition by sending their guys to the FDA (kinda like the Federal Reserve/Treasury acting on behalf of certain of its sponsors). The quantum leaps in human knowledge are most often found in universities and government-funded research. The University of Texas at Austin announced recently that they have an AIDS vaccine in development, for example. I'm sure the scientists behind that are thrilled they are possibly on the way to saving millions of lives and are not thinking about making a dollar off of each vaccine sold. The notion that innovative people make their discoveries motivated by monetary profit is a myth, perpetuated by other interests. They make their discoveries because they are innovative. Inventors/scientists, etc want to be earn a living for their work, but curiousity and the excitement of discovering new things is the motivator. Perhaps there is a way to encourage large pharma companies to engage in the more impactful research universities do, e.g. a reduced tax rate for a major discovery that saves xxx lives or adds xxx quality life-years to the population. (Just shooting from the hip here, who knows.)
Lung cancer is very rare in non-smokers or those not exposed to heavy second-hand smoke. And diabetes is rare in people who are not overweight and eat healthy. Sounds like if we really wanted to, we could take care of a lot of financial problems.
Coincidentally, I stumbled on a brief Wired article* just before I came back to your blog that also notes that many of todays medical conditions are chronic problems due to the genetic process of aging. Therefore, the logical thing to do is attack the aging process itself. This is not something that lends itself to short term profit. But spending hundreds of millions a year to plug leaky dams with fingers is what you would call a Sisyphean endeavor. (* re. the article: mitochondria are basically symbiotic organisms that reproduce on their own, so the telomere-preserving/extending technology i mentioned would most likely work with them also.)
PS, I understand the new direction you want to take, so i know you may not respond to everything here.
I just want to add that the reason that inventive types make their discoveries mostly with government funding (or a generous wealthy patron) is because at places like universities, they can act largely under their own direction, wherever they think they can make the most impact. If these people work at, say, Pfizer, they will have to work on whatever product they are told they have to work on, something decided by business minds focused on the end of quarter numbers, not imaginative, inventive minds focused on changing the world. This is why many brilliant people leave private practice for lower pay at a university.
It's true that some free market zealots elide the contributions to research made by universities, non-profits, and government. I touched on that in the post, with my explanation of why Salk wasn't a great example for Kamen to use. But there are a couple of things worth bearing in mind here. The first is that there is much less of a demarcation today between for-profit corporations and university research departments than in the past. Think of a start-up like the battery maker A123 which is staffed in part by MIT faculty, funded by major corporations and VC firms, etc.
The second point is that the danger in putting too much weight on government research is that, in democracies, governments are always pressured to spend on current demands: if you freeze Social Security, seniors will raise hell, but if you freeze funding for the National Institutes of Health, you won't get anywhere near the outcry.
The bottom line is that our current health care system dominates the world in innovation and R&D -- including government, university, and corporate research -- and I think Kamen is right to worry about that getting jeopardized by the "fierce urgency of now", to borrow a phrase.
As for cancer, believe me, anyone can get it. It's not a moral judgment on your lifestyle. A went to college with a kid who never smoked and died of lung cancer at 19. He was a hemophiliac though, I don't know if there's any connection with that.
Re scientists preferring to do research in academia, see my earlier post about Jim Collins and his comparison of Merck to Pfizer. Collins pointed out that Merck tried to foster an academic-type of environment for its researchers.
"The first is that there is much less of a demarcation today between for-profit corporations and university research departments than in the past. Think of a start-up like the battery maker A123 which is staffed in part by MIT faculty, funded by major corporations and VC firms, etc. "
Good, point, and one that was written about in that Crichton novel NEXT, now that I think about it. Also, university funded reseachers/inventors do still need to solicit funding which requires proving to others the value of their work. Still, in general, inventors in these university/government settings prove their ideas' worthiness by metrics other than how quickly it is monetized. I'd hate to see the state of particle physics, for example, if it were left up to private corporations to fund its study. I remember that post, and the Merck/Pfizer comparison is good, but if true then Merck is still trying to create an artificial environment to give those within it the "feeling" of academia. Maybe those men and women would be able to contribute more in the real thing. I don't know.
"As for cancer, believe me, anyone can get it. It's not a moral judgment on your lifestyle. A went to college with a kid who never smoked and died of lung cancer at 19. He was a hemophiliac though, I don't know if there's any connection with that. "
Certainly there are many cases of cancer and other diseases that are not a judgement on your lifestyle. Genetic conditions like what you describe only warrant sympathy. However when disucssing things on a societal level I don't think it is often effective to view things through an arbitrary and personal moral lens. Especially when the example you gave lends itself to a solution (related to technology mentioned earlier) that would even less tactful to suggest in this kind of context as Kerry bringing up Cheney's daughter in a gay-issues debate.
To throw out a personal anecdote of my own, I had a grandmother that had two forms of cancer, both self-inflicted. The first was skin cancer from spending summers baking herself to get tan. While I realize no one wants to be two-tone in the bedroom, lol, there are just some things fair skinned people shouldn't be allowed to do. Baking yourself bronze is one of them. The second cancer she got, the one that killed her, was lung cancer, brought on by a life time of smoking. I wonder what ever happened to the scientists hired by the tobacco companies in the 70s to participate in the industry lies regarding the cancer sticks health. Did they ever get work again? Had they no shame?
The fact is that there is a huge amount of self-inflicted health problems in the system, and most of the health problems a genetically healthy individual in a first world country has to face are aging-process or personal choice related issues that won't go away, no matter how many dollars we throw at them, until the root causes are attacked - self-destructive behavior and the genetic aging process.
If I were king of the world, to alleviate the cost of healthcare, I'd:
1 Legislate healthiness as much as possible, including targeting makers of so-called "food" with highly negative value, and make them put a skull and crossbones on their poison, if they are allowed to sell it at all.
2 Re-direct healthcare dollars and make tax breaks to stimulate research into attacking the genetic cause of the aging process itself, instead of band-aids.
MSN ran this today:
Health Reform Idea: Put down the doughnut
I've got an anecdotal counter-example, but it hits too close to home for me to want to share it at this point, so I'll let you have he last word in this thread and -- as a change of pace from this grim topic -- invite you to view a few humorous videos I've posted up thread -- particularly the two Robot Chicken clips in the most recent (as of the time of this comment) post and the Management Leisure Suit clip.
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