An interesting article http://earlywarn.blogspot.com/2011/07/us-survival-statistics.html#more discussed marginal returns from medical care. I'd describe the curves shown as "squaring the curve". It's what happens when survival rates for individual illnesses improve, but the underlying problem of the aging process isn't addressed.
Most major causes of death grow exponentially with age - roughly 7% per year. Demographers will tell you that reducing the death rate from any given illness by 50% will give a pretty marginal improvement in overall longevity because the death rate from other things will grow very quickly and replace most of the improvement. In fact, reducing the overall deathrate by 50% would only increase lifespan by about 10 years.
The answer: research aimed at aging itself. This would be much, much more cost effective than trying to hold back the tide of individual illnesses. Unfortunately, drug companies don't want to tackle that - they publicly say so.
Now, is aging curable? Of course. The human body is not supernatural - it's an engineering marvel that can be reverse engineered and understood.
Why do small mammals like mice live 4 years and very similar small mammals like bats live 40 years? Why do some birds live 6 years, and other 60 years? There are obviously very small genetic differences that can be understood and used to develop drugs or genetic treatments.
To believe otherwise is, IMHO, a religious statement.
Tuesday, July 19, 2011
Friday, July 15, 2011
Is more spending on medicine good?
It's often said that the US spends twice as much as other countries like Canada and the UK, while it's residents live no longer.
So, are we wasting our money?
No.
Simple comparisons are seductive, but misleading.
The US has significantly more obesity than the rest of the world (the health effects of this - diabetes, heart disease, etc are commonly known as "diseases of affluence - this isn't a moral judgement, it's a reflection of the fact that affluence brings more and cheaper food, and less physical labor), and that obesity has been rising during the last 30 years. Obesity has a very large effect on lifespan and morbidity - this has to be taken into account in any analysis.
Further, the US funds drug development for the rest of the world.
Bottom line: as agriculture and manufacturing shrink due to continuing growth in labor productivity, goods give way to services. Which service sectors of the economy would you consider as value added? Which would you target for expansion: entertainment, law, finance, or medicine???
So, are we wasting our money?
No.
Simple comparisons are seductive, but misleading.
The US has significantly more obesity than the rest of the world (the health effects of this - diabetes, heart disease, etc are commonly known as "diseases of affluence - this isn't a moral judgement, it's a reflection of the fact that affluence brings more and cheaper food, and less physical labor), and that obesity has been rising during the last 30 years. Obesity has a very large effect on lifespan and morbidity - this has to be taken into account in any analysis.
Further, the US funds drug development for the rest of the world.
Bottom line: as agriculture and manufacturing shrink due to continuing growth in labor productivity, goods give way to services. Which service sectors of the economy would you consider as value added? Which would you target for expansion: entertainment, law, finance, or medicine???
Sunday, July 10, 2011
Medical research
I read http://cassandralegacy.blogspot.com/2011/07/peak-university.html and thought the following:
As best I can tell, medical research is being stifled by "careerism", in which researchers produce as little as possible about a topic which is as narrow and limited as possible, in order to publish a string of papers just important enough to publish. That way they can get the maximum number of papers from the minimum of real research, and preserve and extend their career.
This has the effect of delaying real breakthroughs as long as possible.
What do you think?
As best I can tell, medical research is being stifled by "careerism", in which researchers produce as little as possible about a topic which is as narrow and limited as possible, in order to publish a string of papers just important enough to publish. That way they can get the maximum number of papers from the minimum of real research, and preserve and extend their career.
This has the effect of delaying real breakthroughs as long as possible.
What do you think?
Friday, March 20, 2009
Saturday, March 7, 2009
Whither the economy?
I have to admit that I have no idea what's going to happen. We have commercial/industrial RE problems; we have more ARM resets to come; we have Warren Buffet saying 09 and 10 are going to be terrible; we have GM sidling closer and closer to Chapter 11.
In retrospect I think that it's going to look like the Fed and Treasury made a big mistake, when they gave in to those who were complaining about moral hazard and allowed Lehman to go under. It kind've looks to me like the overseas liquidity that was floating us has just disappeared, not to come back except through T-bills. That would mean that the only source to finance the US trade deficit will be governmental, which means enormous federal deficits and borrowing indefinitely. Not good.
Let's hope we get plug-in hybrids going ASAP, to start work on eliminating our oil import portion of the deficit.
In retrospect I think that it's going to look like the Fed and Treasury made a big mistake, when they gave in to those who were complaining about moral hazard and allowed Lehman to go under. It kind've looks to me like the overseas liquidity that was floating us has just disappeared, not to come back except through T-bills. That would mean that the only source to finance the US trade deficit will be governmental, which means enormous federal deficits and borrowing indefinitely. Not good.
Let's hope we get plug-in hybrids going ASAP, to start work on eliminating our oil import portion of the deficit.
Tuesday, February 24, 2009
More on: we need better medicine
Medical care in the US has many, many deficiencies: care is fragmented; physicians are rewarded for "procedures" and tests, not for thinking; physicians are obsessed with billing, and distracted from real care; there's far too much overhead; medical records and care in general is badly under-automated; far too many people are excluded from the system; etc, etc.
That's not at all the same thing as "health care getting worse". Perhaps we're just becoming more and more acutely aware of what's possible, and how far we are from it.
Also, as frustratingly and tragically far as US healthcare is from what it ideally should be, it still appears to be as good or better than any other system in the world. Elsewhere, coverage is far more universal, but care is very badly rationed; research is a little less oriented toward big pharma (which is good), but fundamental drug research is mostly done in the US, and the US subsidizes the rest of the world by selling drugs at much lower prices than in the US.
The US has a larger % of people who are poor and without good health coverage than many countries, and therefore doesn't compare well. In that case, income distribution is indeed the key thing. OTOH, infant mortality in the US is decreasing, and adult longevity is increasing.
That's not at all the same thing as "health care getting worse". Perhaps we're just becoming more and more acutely aware of what's possible, and how far we are from it.
Also, as frustratingly and tragically far as US healthcare is from what it ideally should be, it still appears to be as good or better than any other system in the world. Elsewhere, coverage is far more universal, but care is very badly rationed; research is a little less oriented toward big pharma (which is good), but fundamental drug research is mostly done in the US, and the US subsidizes the rest of the world by selling drugs at much lower prices than in the US.
The US has a larger % of people who are poor and without good health coverage than many countries, and therefore doesn't compare well. In that case, income distribution is indeed the key thing. OTOH, infant mortality in the US is decreasing, and adult longevity is increasing.
Saturday, February 7, 2009
We need better medicine...
An article in the New York Times ( http://www.nytimes.com/2009/02/01/business/01unbox.html?em ) on disruptive, systemic improvements in medicine got me thinking:
30 years ago published studies in a peer-reviewed journal, (based on nothing more than detailed interview of the patient - no electronic medical records required) found that a simple decision-tree based computerized patient history/complaint program could do as well as the average doctor in diagnosis (half of all doctors are below average...). if we can match the 75th percentile, we'll have improved care for 75% of patients. Automated diagnosis should have been widespread decades ago.
Obviously, a computer-assisted diagnosis would be the very best, getting the best of both worlds. Also, such a system would help with self-care enormously.
The bottom line is that the quantity of medical information outstripped the ability of humans to process it many decades ago - that's why we have specialists. Right now they're doing quite badly: repeated studies find that common ailments don't get the standard of care from 40-80% of the time. We desperately need to automate as much as possible.
I've observed doctors quite a bit professionally and personally over the years in settings that range from primary care to tertiary care in the best teaching hospitals (including Mayo Clinic and the ER on which the television show was based), and I've found that most doctors do most diagnosis with very simple "cookbook" algorithms/decision trees. Any honest physician or participant in the health system will confirm this. This is not at all hard to duplicate (and then out-perform) in software. The doctor detectives you see on television, who diagnosis rare illnesses and track down problems with psychic accuracy....well, they may exist, but most patients don't see them.
The suggestion that software that out-performs most physician diagnosis couldn't have been developed decades ago seems laughably absurd to me. It's obviously physician resistance to competition.
Most physicians (and vets, for that matter), are miserably bad at interviewing, recording and remembering complete, accurate patient histories, primary and specialty physicians alike. That's the very first thing that should be automated, and it forms the basis for good diagnosis.
Also, treatment needs to be computer-assisted. There are many studies that say that common problems, for which standards of care exist, don't get the proper treatment 40-60% of the time.
Automated diagnosis & treatment can't do miracles. But most people get sub-par diagnosis and treatment, and this can be changed. Also, such systems would help patient education, compliance and self-management.
Physician hostility to expert systems prevents them from improving. If such systems were welcomed, widespread and worked with by a very large number of physicians, they would begin to capture the very best approaches.
30 years ago published studies in a peer-reviewed journal, (based on nothing more than detailed interview of the patient - no electronic medical records required) found that a simple decision-tree based computerized patient history/complaint program could do as well as the average doctor in diagnosis (half of all doctors are below average...). if we can match the 75th percentile, we'll have improved care for 75% of patients. Automated diagnosis should have been widespread decades ago.
Obviously, a computer-assisted diagnosis would be the very best, getting the best of both worlds. Also, such a system would help with self-care enormously.
The bottom line is that the quantity of medical information outstripped the ability of humans to process it many decades ago - that's why we have specialists. Right now they're doing quite badly: repeated studies find that common ailments don't get the standard of care from 40-80% of the time. We desperately need to automate as much as possible.
I've observed doctors quite a bit professionally and personally over the years in settings that range from primary care to tertiary care in the best teaching hospitals (including Mayo Clinic and the ER on which the television show was based), and I've found that most doctors do most diagnosis with very simple "cookbook" algorithms/decision trees. Any honest physician or participant in the health system will confirm this. This is not at all hard to duplicate (and then out-perform) in software. The doctor detectives you see on television, who diagnosis rare illnesses and track down problems with psychic accuracy....well, they may exist, but most patients don't see them.
The suggestion that software that out-performs most physician diagnosis couldn't have been developed decades ago seems laughably absurd to me. It's obviously physician resistance to competition.
Most physicians (and vets, for that matter), are miserably bad at interviewing, recording and remembering complete, accurate patient histories, primary and specialty physicians alike. That's the very first thing that should be automated, and it forms the basis for good diagnosis.
Also, treatment needs to be computer-assisted. There are many studies that say that common problems, for which standards of care exist, don't get the proper treatment 40-60% of the time.
Automated diagnosis & treatment can't do miracles. But most people get sub-par diagnosis and treatment, and this can be changed. Also, such systems would help patient education, compliance and self-management.
Physician hostility to expert systems prevents them from improving. If such systems were welcomed, widespread and worked with by a very large number of physicians, they would begin to capture the very best approaches.
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