Shall we do less diagnosis--or more? The dividing line is clear: The governing elite wants us to have less, everyone else wants more. So who will win? In the long run, the will of the vast majority will prevail, but in the short run, it's a jump-ball between "less" and "more," between the rationers and the consumers. So the only question is how much damage the elites will do in the short run, before the long run trend of technological exuberance asserts itself. So it's important to understand: The real bending of the curve that is going on today is not the flattening out of any cost curve, but rather, the attempted flattening out of the innovation curve. And if the innovation curve is flattened, the cost curve will rise, even as productivity and life-prospects fall.
And because the bulk of the Main Stream Media are in tune with the rationing, restrictionist elite, news about breakthroughs is reported, but MSM reporters choose not to make the connection between the science of healthcare and the politics of healthcare. So science, and scientific entrepreneurship, does its thing, in its sphere, while politicians do their thing, in their sphere--and never the twain shall meet, at least not in Washington DC.
Except, of course, when politicized activists seek to do the bidding of the political class, seeking to flatten out the innovation curve. Recently here at Serious Medicine, we have taken note of the pushback against diagnosis, including CT scans. The SMS view is that various healthcare reformers and gadflies, in their zeal to see Obamacare enacted, and in their larger green zeal to see an overall de-technologification of society, are doing their best to minimize the importance of early diagnosis, because they think it will be cheaper for the government. Ignorance might not be bliss, but it is cheaper--in the short run.
Such willful blindness was the backstory, for example, of the mammogram flap of late last year, as the US Preventive Services Task Force, convened by the federal government, recommended fewer screenings for breast cancer. The recommendations were immediately hooted down, of course, which reminds us how politically toxic such rationing-think is among ordinary people. Indeed, such screening "savings" are the dictionary definition of penny-wise and pound-foolish; yet that's all too often the story of government finance--today's governments, eager to make their own budget numbers look good, will happily push vastly greater quantities of red ink onto tomorrow's budget.
Still, there are legitimate issues of concern surrounding some kinds of diagnosis. Yesterday in The Wall Street Journal, reporter Laura Landro noted some challenges to CT scans--specifically the danger of radiation. But as Landro also notes, there are plenty of alternatives, from different scanning technology to reductions in the radiation dose:
While one CT scan has a minimal risk for any patient, "the damage from radiation is thought to be additive over time," says Steven Birnbaum, a radiologist affiliated with the center and developer of the program. In 2008, 15% of scans were canceled and 15% switched to an MRI or ultrasound as a result of the program.
Health-care providers are also taking steps to lower the radiation dose in tests that are deemed necessary by changing the speed of the scan or the intensity of the radiation. Using scans on cadavers, for example, researchers at Loma Linda University Medical Center reported in December that they were able to reduce radiation exposure by 95% and still detect kidney stones.
So there are ways to overcome these challenges, while continuing to pursue the best possible diagnosis. And now a new report from Israel tells us that diagnosis of coronary artery disease might be done through a simple stress test on a finger--repeat, on a human finger. It doesn't even break the skin. This possible breakthrough was first seen on Breakthrough Digest, and offers plenty of hope:
Researchers at Rabin Medical Center used an innovative respiratory stress test developed by SPIROCOR TM Ltd. The test uses a Pulse Oximeter (PPG) to measure a patient’s blood flow in the finger in response to his or her paced breathing for 70 seconds. PPG data captured in the study are recorded immediately and analyzed using a proprietary algorithm that determines the Respiratory Modulation Response in a percent value. The findings of this study were further validated in research recently published in Cardiovascular Revascularization Medicine.
“Identifying significant coronary artery disease through non-invasive testing is very challenging,” said Dr. Ran Kornowski, Director, Interventional Cardiology, Rabin Medical Center, Tel Aviv. “This study shows that the SPIROCOR test is a simple and non-invasive test that independently predicts significant coronary artery disease in patients referred for a coronary artery evaluation.”
The point here is that if science is allowed to continue, as well as entrepreneurship, we will see all sorts of breakthroughs of this type. We will get closer and closer to the "Tricorder" that we saw on the old TV show "Star Trek"; a completely non-invasive medical device. Indeed, GE's V-scan, released last year, is a major step toward the iPhone-ization of healthcare (there's an app for that!). But there's a lot more Moore's Law-ing to be done before we get to Trekkie technology. And yet to get that nirvana of non-invasiveness, the answer is not to do less R&D, it's to do more.
And in the long run, it will all be cheaper, just as we have seen with every other category of electronics. That's a the machinery Spirocor uses, pictured above. No doubt there's a lot of capital tied up in Spirocor's R&D--it takes vast brain power to miniaturize machines. And in addition, if the technology proves out, Spirocor deserves a great return on its investment. But as with cell phones and every other kind of electronic device, the price will plummet as soon as this finger-meter--although Spirocor prefers to call it a "pulse oximeter"--is mass produced. So bring it on!
In the pithy formulation of Serious Medicine Strategist Jeremy Shane, "Technological innovation + valuable need x affected population = bending the cost curve."
And a last point: Before your elected representatives, Senators or Members of Congress, vote on the Obamacare healthcare bill, why not ask them if they are familiar with Breakthrough Digest, or any of the news therein? If not, then chances are that they don't know much about bending the curve on healthcare.
Actually, Mr. Pinkerton, the pulse oximeter is already a simple and cheap (out of patent) device fouhnd ubiquitiously in every hospital. It is like TENS, in that the companies that originated the technology penetrated fully and now are desperate to find follow-on growth opportunities. The value here is all in the algorithm and data supporting it, not the sensor.
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