Sunday, January 30, 2011

Obama on Malpractice Reform: No Change That We Can Believe In

Did you see that Barack Obama is now pushing medical malpractice reform, as part of his moving to the center? You would be forgiven if you got that impression, because the idea that the administration has moved to the middle on malpractice has been a major meme emerging from the President’s 2011 State of the Union address. And yet it’s simply not true. The White House and the Democratic Party are still as devoted as ever to the financial interests of trial lawyers--no matter what the cost to the country.

Gullible media coverage aside, there’s no real evidence that the President has given an inch on the basic issues of medical lawyering and liability. Nevertheless, those are the issues that are not only making healthcare more expensive, but are also stifling the Serious Medicine innovation that would make healthcare cheaper, as well as better. After all, it’s not what lawyers do to doctors that matters most, it’s what lawyers do to us--to our health and to our life-prospects.

Yet many Americans might have the impression that something big is happening in medical malpractice, that the political ice is breaking on “med mal.” In the course of defending his Obamacare legislation in his January 25 SOTU Obama declared, “I’m willing to look at other ideas to bring down costs, including one that Republicans suggested last year--medical malpractice reform to rein in frivolous lawsuits.”

Those 26 words set off a wave of media interpretation--and over-interpretation. A headline at a affiliate read, “Obama pushes limits to medical malpractice suits.” Mark McKinnon, well-known Republican media consultant, wrote the next morning in The Daily Beast, “I was pleased to see President Obama talk about tort reform.”  And the headline atop a post in The Frum Forum by Dr. Stanley Goldfarb of the University of Pennsylvania medical school proclaimed, “Obama Takes the Lead on Malpractice Reform.”

Yet maybe we need to look at the situation more closely. Dr. Goldfarb, for instance, asserts that malpractice reform is “a key part of the required approach to avoid financial calamity.” Dr. Goldfarb is absolutely right, but there’s no evidence that Obama agrees with him. An occupational hazard of punditry, to be sure, is to assume that the other person agrees with you, even to the point that you, the pundit, find yourself filling in the blank spaces between the other person’s words. Indeed, so long as a powerful person, such as a president, says he is willing to “look at” an idea, some proponents will wishful-think equivocal words into unequivocal support.

In fact, Obama’s 26 words in the SOTU need to be weighed against the two years of his presidency, where no serious action against “frivolous” lawsuits has been taken, to say nothing of the multiple lawsuits that are merely costly and harmful. Once again, we can observe that an overall cost to the country is a direct gain for the tort bar. Inside every one of those million- and billion-dollar settlements is a 40-percent contingency fee to a trial lawyer. And trial lawyers as a group, of course, are smart enough to share their wealth with politicians who protect their ongoing system of litigation plunder. Weighed against the deep structure of pro-trial-lawyer interests inside the Democratic Party, the brief words of a president in the middle of a re-election campaign seem fleeting indeed.

Of course, some might say that the White House has been busy, what with Egypt and all. But on Sunday morning, January 30, even as events in Egypt dominated the news, the White House was still prominently featuring its boilerplate State of the Union promotion package. And that’s right and proper, because, after all, we have a large federal government that does many things at once.

So perhaps elsewhere in the executive branch, we might hope, top aides and advisers are diligently crafting a new look at malpractice. That’s a possibility--but let’s take a look.

Accompanying the President’s SOTU was a White House fact sheet, boldly titled, “President Obama's Plan to Win the Future."  And in that document we find this single sentence: “The President is urging reforms to further reduce the rate of health care cost growth, including medical malpractice liability.” That’s it--just 19 words. Hard to call that much of a foundation for med mal progress.

Meanwhile, as another part of the White House communications effort, on January 28, Health and Human Services Secretary Kathleen Sebelius, the administration’s point person on health issues,
sat down for a Q & A session with reporters/bloggers; only one “Q”, out of the 13, concerned malpractice. And to that Sebelius answered, “The President has said pretty consistently that he does not support caps,” referring to the idea of limiting liability damages--a central plank of malpractice reformers. Instead, Sebelius cited new government efforts at “gathering data” on lawsuits and their effect on the cost of healthcare. She was referring to a plan that she herself launched in September 2009, when HHS began doling out $25 million in grants to encourage states to experiment with ways to deter malpractice lawsuits. These “demonstration projects,” as they are called, are based on existing programs in which doctors who make a mistake--or are accused of making a mistake--apologize early and seek to negotiate a settlement with the victim. Other projects include screening systems in which states have formed medical-expert panels which must rule that patients’ complaints have merit before they may sue.

Such plans are a good idea, but they have had little effect, because they fail to take into account the great-white-shark voraciousness of malpractice-feasting trial lawyers. If one Googles just the two words “malpractice money,” for example, one immediately sees an ad for a malpractice attorney, complete with a toll-free number to call.

It might seem obvious that ambulance-chasing comes at a cost to the healthcare system--reasonable estimates vary from $55 billion to $200 billion a year--but for her part, Sebelius doesn’t seem to agree; as she told her questioner, “malpractice insurance rates are a tiny fraction of healthcare costs.” As an aside, we might note that it’s little wonder that Richard Foster, chief actuary of the Medicare program, is skeptical that any savings will be achieved through Obamacare.

Moreover, in an opinion piece for AOL News, signed by Sebelius, the word “malpractice” did not appear once. In other words, without the prompt of a question, Sebelius and her HHS ghostwriters make no effort to highlight malpractice. In fact, a look at the HHS website finds nothing new on med mal. Yet this absence should be no real surprise, in view of Sebelius’ background; she spent a decade as the executive director of the Kansas Trial Lawyers Association.  (We might also note that one can hear only the sound of med mal silence, too, at the Department of Justice.)

Yet the idea of malpractice reform is popular with many key constituencies and much of the public, and so the President has talked up the idea of med mal from time to time. On June 15, 2009, for example, he addressed the American Medical Association in Chicago, saying that he understood that “doctors feel like they are constantly looking over their shoulder for fear of lawsuits.” He added, in words suggesting that he felt the medical profession’s pain: “Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That's a real issue.”  So yes, the AMA got a little bit of neo-Clintonian triangulation, as well as pain-felling, but no commitments.

The President added more soothing words, even as he denied the central policy goal of the AMA--that is, to impose caps on damages as a way of disincentivizing their enemy, the trial lawyers. Finally, he shifted the focus back to his own goal at the time, which was garnering support for his healthcare legislation:

While I’m not advocating caps on malpractice awards which I believe can be unfair to people who've been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That's how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.

The AMA did, in fact, endorse Obamacare--despite its not making any headway on caps. Yet while the AMA might have been an easy sell, others were more suspicious. The day after Obama’s AMA speech, The Wall Street Journal editorial page nailed the issue in a piece entitled, “The Malpractice Gesture.” That edit noted how Obama was able to orate sweet nothings and yet persuade gullible audiences that he was on their side:

The paragraph he appended to his stock speech on health care for the American Medical Association yesterday didn’t offer much detail--"I do think we need to explore a range of ideas," he boldly declared--but trial lawyers and their stratospheric jury awards and settlements have led to major increases in the medical malpractice premiums, thus driving up the overall cost of U.S. health care.

The Journal emphasized that there was nothing specific about med mal in Obama’s words--indeed, that his deeds, in preserving the status quo, contradicted his words:

Mr. Obama's cri de coeur might have had more credibility had he not specifically ruled out the one policy to deter frivolous suits. "Don't get too excited yet," he warned the cheering AMA members. “Just hold onto your horses here, guys. . . . I want to be honest with you. I'm not advocating caps on malpractice awards.” In other words, the tort lottery will continue. California, of all places, has had great success in holding down liability costs for doctors and hospitals after a 1975 reform that limited pain and suffering damages -- balanced against the public interest of fairly treating victims of genuine malpractice.

And so the Journal summed up Obama’s deliberate fuzziness, providing some pointed political context:

Mr. Obama showed again with his AMA speech that he's willing to nod at the concerns of his political opponents and take media credit for brave truth-telling, only to dump his conciliation if it offends liberal interest groups.

Mr. Obama's aides have openly told the press that he views medical liability as a “credibility builder”--that is, a token policy to keep the health-care industry at the bargaining table. Given that the only “bargain” that seems likely to emerge is another major step toward total government control of the health markets, the President seems to be counting on credulity.

So there you have it: Obama said something nice but vague about malpractice reform a year and a half ago--a “credibility builder” for the credulous. And so what has happened since? Who was right: the AMA in its hope that Obama would deliver legal reform of some kind, or the Journal in suspecting that Obama was playing a rhetorical shell game? As we have seen, in Fall 2009, the Obama administration established kumbaya-ish “demonstration projects,” but in his January 2010 SOTU, the President made no mention of malpractice reform.

Indeed, in the two years of Obama’s presidency, virtually nothing has happened on the key issue of malpractice reform--namely, requiring a cap on the shark-like entrepreneurialism of the trial lawyers. Oh wait, something did happen: This past Tuesday night, the President said that he would “look at” malpractice reform. Nevertheless, anyone still thinking that Obama truly wishes to do something about med mal--thereby alienating the trial lawyers whom he needs to finance his re-election--should consult the “Peanuts” character Charlie Brown, still hoping for Lucy to keep the football in place so that he can actually kick it.

One clear-eyed observer is Forbes magazine’s David Whelan, who observed in the wake of the 2011 SOTU that the president’s nice words about malpractice “warrant skepticism.”

OK, Forbes is over on the political right, but even The Washington Post noticed that Obama wasn’t saying very much in his SOTU--about malpractice, or, indeed, about anything else. And this non-specificity, the paper surmised, was a deliberate strategy. And yet, as the Post’s Ruth Marcus noticed, even a few friendly words were enough to make many observers happy. In a Friday column entitled, “From President Obama, lots of talk, little leadership,” Marcus criticized the 44th President for merely outlining, as opposed to advocating, “potentially cost-saving measures to control Medicare spending.” She added caustically, “Emphasis on potentially.” Yet Marcus lamented that “some serious people” had “grasped at wispy tendrils of seriousness” in the president’s speech. And yet detecting such seriousness was an illusion, she concluded: “I hope they are right but fear that they are deluding themselves.” In other words, anything Obama said about a tough issue on Tuesday night was not to be taken seriously--because Obama himself wasn’t taking his words seriously.

So where do we stand? I put the question to Jim Wootton, former president of the U.S. Chamber Institute for Legal Reform, who foresees med mal gridlock ahead:

There is no doubt that the President's stated openness to medical liability reform legislation has put the issue “in play” . . . But it is too early to be very optimistic that the House, Senate and White House will find enough common ground for meaningful medical tort reform to be enacted in the next two years. Each of these institutional players has different incentives which will influences how they approach this issue.

The Republicans in the House want to quickly satisfy their constituents who have been pressing for tort reform for 15-20 years--which to most of them means hard caps on non-economic damages. Yet the Senate Democratic Leadership is known to be quite sympathetic to the personal injury lobby, which is adamantly opposed to all tort reform, particularly caps on damages.  

So there the issue sits: in stasis. Obama mentioned med mal in 2011, but his position today--and prospects for any reform--are the same now as they were in January of last year, when he didn’t mention med mal at all.

So the Serious Medicine lesson here is that absent a profound change in thinking, as opposed to mere partisan shuffling, there’s little prospect for med mal reform. Even if Republicans were to win the Senate and the White House in 2012, there’s no reason to think that the med mal situation would change; after all, from 2003 to 2006, when Republicans controlled everything in Washington, nothing happened med mal-wise.

We can conclude: If malpractice reform is merely seen as being for the convenience and enrichment of doctors, drug companies, and medical equipment makers--as is often said--the goal will never be seen as being so important as to justify overturning the status quo.

What needs to be understood, therefore, is that the real issue is not so much what the trial lawyers do to doctors, but rather what the trial lawyers do to the prospect of Serious Medicine--the medicine that saves lives and bends the cost curve. That is, if malpractice suits simply add $100,000 or so to every doctor’s annual costs, well, in the minds of most Americans, that’s acceptable.

Yet if GlaxoSmithKline pays out $6 billion or more for Avandia, as has been reported, that's most likely the end of diabetes research for GSK, and for many other firms, too.   Circling trial lawyers are not going to be deterred by any sort of mediation project--they want the money.   In addition to caps on damages and limits on contingency fees, the needed reform for pharmaceuticals and medical equipment is this: If the FDA approved the product, the maker of that product can't be sued.   The FDA doesn't have to approve anything, but if it does, then whoever makes the product in good faith shouldn't be subject to a lawsuit--period.

In fact, the real cost of medical torts--and it is enormous to the point of incalculability--is the paralysis of scientific progress across the medical sector, because nobody wants to take possession of information that could later inculpate them, in some perhaps unforeseen way, in a future class-action suit.

So what’s the way out? The way out is circuitous: Ultimately, we have to get to cures, because good health is both better, and cheaper, than sickness. But to get to there, to get to better medical outcomes in the long run, we have to change the legal system in the short run. Changes in the legal system will encourage innovation, information-sharing, and mass production of new medical products. That’s a bright prospect that will entice ordinary Americans who are at present indifferent spectators to the ongoing brawl between opponents and proponents of malpractice reform.

Here’s the bottom line: Advocates of legal reform must therefore become advocates of a comprehensive strategy for Serious Medicine, because only by making their argument larger and more promising can advocates make a persuasive case to Middle America. Cures are not just a good idea, cures are a big idea--the kind of idea that blows away the pecuniary interest of trial lawyers and their political grantees. And so it’s that big idea of cures that must be invoked in favor of med mal as part of a Serious Medicine Strategy. Anything less simply won’t get the job done.

As the late management guru Peter Drucker observed, as a general rule, a new idea has to be ten times better than the old idea to be accepted and to replace the old idea. And so we can see what has gone wrong with med mal over the years: People might think med mal is a good idea, but they don’t see med mal as ten times better than the status quo, and so reform goes nowhere. What med mal reformers need to do is link reform to the larger issue of cures. Cures, that is, as both a humanitarian goal and a money-saving strategy. Seen that way, cures are a ten-times-better idea than John Edwards & Co. Present the American people with a choice--what do you want: Cures for killer diseases? Or more trial lawyers flying around in private jets?

If we cure diabetes, for example, we as a nation won’t spend $200 billion caring for diabetes. Although diabetes is often linked to obesity, about a quarter of diabetes patients in America were born with the condition. And even for those who can be said to be “at fault,” the plain reality is that we are paying for their care. So it makes sense for us, as part of our Serious Medical Strategy, to work with those seeking to reduce obesity. And to applaud, for example, the fitness efforts of Michelle Obama.

Moreover, since we have developed a commercial culture which is seemingly dedicated to fattening us up--candy companies, for example, spend their time figuring out new methods of mixing sugar and salt in ways that are irresistible to our lizard-brain food reflexes--we need to develop equally shrewd counter-measures. And yet here again, the trial lawyers are a major obstacle to progress. If the lawsuits keep coming against weight-loss products--Fen-Phen awhile back, Zenical more recently--then we're stuck in a repetitive get-fat rut. (What’s needed, of course, is personalized medicine, so that those relatively few who are at risk from Fen-Phen, or Zenical, or anything else are warned away. And yet such personalization won’t happen, Jim Wootton explains, so long as the trial lawyers are able, through the legal discovery process, to comb through every medical record, looking to make a new class-action lawsuit.)

So once again, the way out is medical science--cures. The idea of cures, that is, as an articulated national goal, the sort of articulation that’s been missing from the debate for the past two decades, as we focused instead on health insurance. A Manhattan Project-like focus on cures would necessitate the sweeping away of the trial lawyers. During World War Two, nobody sued the A-bomb project.

The quest for life-improving, cost-saving Serious Medicine should of course be a bipartisan effort.  This is, President Obama should want to cure diabetes, not only because he is a compassionate man but also because he wants to make healthcare--and Obamacare--affordable. But to achieve those goals, Obama will have to do more than talk the talk of med mal; he will have to walk the difficult walk of enacting genuine legal reform.

Perhaps it’s time to recall the old Jack Benny routine, “your money or your life.” In the comedian’s case--Benny portrayed himself as an epic tightwad--the choices of “money” or “life” were almost interchangeable. Even as a menacing robber threatened him, Benny answered, “I’m thinking, I’m thinking.” In the real world, of course, life is more important. But what if we knew that we could have both: money and life? That is, what if we could come to see that cures are cheaper than sickness-and cheaper than care? That has been true for polio, and smallpox, and tuberculosis, to name three diseases that we have mostly eliminated. So why not take the same cost-effective approach to diabetes, Alzheimer’s, and cancer?

Yes, such cure would be a great challenge, but the reward would be much greater. It is simply inconsistent with the work of the nation to let legal pirates and plunderers continue to hollow out our healthcare industry--and our own health. The status quo is costing us both our money and our lives.

Rich Lowry's "The Madness Lobby": For all the craziness in the world, it's the craziness next door that scares us the most. We should seek to cure it, but first we have to get the government to stop subsidizing it.

The sturm und drang in Egypt might be dominating the news, but for most Americans, the sturm und drang that might be occurring inside the head of a neighbor is a lot scarier.   Earlier this month, on a Saturday in Arizona, we were reminded that our failure to grapple with mental health issues has tragic consequences: Six people dead, a Member of Congress seriously wounded.   For a few days, it seemed as if the murderous Jared Loughner would become yet another political football: Could his evil deeds be blamed on Rush Limbaugh?   Would gun control as an issue be revived?   But even before the Egypt unrest, the politics of Tucson had faded, because it became obvious that Loughner himself was not political--he was a lunatic schizophrenic.  And so his deeds couldn't be blamed on a political party or a communications medium.   Loughner was just another in a long line of crazy lone gunmen.

At that point, the politicos, and the chattering class, start to lose interest.   If it's no longer a political fight, well, find another political fight, such as taxes, spending, or the budget deficit.

Yet in view of the horrible carnage that Loughner caused, perhaps we shouldn't turn away from the mental-illness issue so quickly.    Perhaps we should realize that there are more Loughners out there--indeed, their numbers could be growing, relative to the population.  If so, then as a matter of self-defense, we need to think about how well we are dealing with mental health issues.

For decades, Dr. E. Fuller Torrey has been arguing that we have been badly mishandling mental illness, and that consequences of that mishandling have made all of us worse off.   He has argued that the de-institutionalization of the mentally ill--an effort that united liberals, libertarians, and budget-cutters--has in fact merely shifted the burden from institutions to the streets, and then to prisons.  That is, as the mentally ill were pushed onto the streets, they were "free" to hurt themselves and to hurt others.  The most casual observation--from a safe distance--of many homeless people should be enough to convince an honest observer that the homeless have problems greater than the lack of housing.  Indeed, after committing an unknown number of crimes, many of the homeless end up in prison.  It's almost hydraulic: Empty out the mental hospitals, fill up the prisons.

In addition, Dr. Torrey advances the theory that schizophrenia is the result of contagion--a virus.   This theory flies in the face of the received neo-Freudian wisdom, that schizophrenia is the result of bad parenting of some kind.  And it also flies in the face of received neo-Marxist wisdom, that schizophrenia, like all mental illness, is the result of unjust social conditions.  And in the face of received neo-Szaszian wisdom, which holds that much mental illness is simply an illusion concocted by bureaucrats and Nurse Ratched types.  And in the face of neo-Foucaultian wisdom, which holds that mental illness is at least in part the result of society-wide sexual compulsion and repression.  The common thread running through these four "neos" is the general sense that the mentally ill are victims, and that society, instead, is at fault.

And there are plenty of others, of course, who see mental illness deriving from dysfunctional brain chemistry, brought on by genetics, vaccines--although the argument about vaccines and autism has been thoroughly discredited--and the overall environment.

In other words, Torrey's work has plenty of enemies.   But it also has plenty of new allies, we might note, as more and more ailments are discovered to be the result of bacteria and viruses.  For example, the 2005 Nobel Prize in Medicine went to two Australians who confounded centuries of received scientific wisdom by demonstrating that peptic ulcers come from bacterium Heliobacter pylori, and not, say, onions or tabasco sauce.   Indeed, in 2009, The New Scientist published a pathbreaking piece, "Six Diseases You Never Knew You Could Catch--citing new research on the communicability of breast cancer, prostate cancer, obesity, diabetes, obsessive-compulsive disorder, and, yes, schizophrenia.  Many of these new insights can be traced back to the work of Paul Ewald, an evolutionary biologist at the University of Louisville, and Gregory Cochran, a physicist and anthropologist at the University of Utah.

In other words, we could be at the edge of a new precipice of discovery--a new dawning of realization that much of what we have thought about disease was wrong, or at least insufficient.   If so, surely there  should be more Nobel Prizes for this work--perhaps to Torrey, perhaps to Ewald and Cochran.

But in the meantime, as Loughner reminds us, we are still reeling from the consequences of wrong-headed decisions.  If schizophrenics have a virus, not only should they be kept under supervision for their own sake, but also for our sake, doubly.  That is, not only might they be dangerous, in terms of violence, but they might be dangerous in terms of contagion.

And so to Rich Lowry's brilliant piece in National Review Online, and in his syndicated column around the country, in which he took on those who have worked so sedulously for so long to prevent effective treatment for the Loughners of our world.  As Rich wrote, this "madness lobby" is not only working out of ideological zeal, it is working because it is getting paid to work--the madness lobby's efforts are subsidized by the taxpayers.  That's right: We have been paying to keep madmen, and madwomen, on the streets.   The whole piece is well worth reading, but here's an excerpt:

President Obama was too sweeping when he said we shouldn’t point fingers. Our ire should be directed at the mental-health “advocates,” federal bureaucrats, and crusading civil libertarians who fight to maintain a status quo that makes it hard to treat the mentally ill. They are the madness lobby.

They aren’t responsible for Jared Loughner or his crimes. They do deserve the blame for a system that willfully lets people fall through the cracks and pretends diseased minds can make rational decisions. At its best, this system is cruel in abandoning the ill to their suffering; in exceptional cases, it is reckless in leaving dangerous people to do harm to themselves or others. The madness lobby helps make the literally lunatic act of violence a routine part of the American landscape.

A group of “anti-psychiatrist” thinkers provided the philosophical impetus for emptying our mental institutions. Thomas Szasz, Michel Foucault, and others ably demonstrated the power of idiot ravings to increase the sum total of human misery. Szasz compared psychiatry to slavery, while idealistic lawyers who wanted to vindicate the civil rights of patients launched an assault on commitment laws.

In a combination of foolish budget-cutting and misconceived compassion (some of the institutions were indeed horrors), states began to dump people out of mental hospitals in the 1960s. In his book The Insanity Offense, Dr. Torrey documents how, as the numbers of mentally ill in institutions declined throughout the 1970s and 1980s, the numbers on the streets or in jails increased. For many of the mentally ill, deinstitutionalization was essentially a shuffle — from hospital to prison.

In the 1970s, a Wisconsin court struck down the state’s civil-commitment law in a decision that reverberated nationally. In writing his 2008 book, Dr. Torrey visited Alberta Lessard, the schizophrenic woman whose case prompted the decision. Still untreated, she had spent time homeless and had never held a job, had been charged with ten crimes, and lived with constant delusions of people persecuting her.

In the wake of Lessard and similar decisions, it became the rule in most states to wait until someone is on the very cusp of suicide or murder to commit him. And it nearly became impossible to force the mentally ill to take their medication, in or out of the hospital.

Today, even with the human wreckage of its handiwork all around us, the madness lobby persists. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) funds efforts to liberate the seriously ill from their treatment. Writing in The Weekly Standard, Sally Satel recounted a case in Maine where a SAMHSA-funded outfit got a patient out of the hospital over the objections of his parents; he killed his mother with a hatchet two months later.
Mental illness is the only disease that has an influential lobby devoted to not treating it.

So there we have it.  If the Loughner issue fades away, not only will it be a lost opportunity, in terms of doing justice for the Tucson victims, but it will also be a lost opportunity in terms of safety and security for the rest of us.  

Tuesday, January 25, 2011

President Obama promises to "look at" ideas on malpractice reform

Text reads:

Sebelius served as executive director and chief lobbyist for the Kansas Trial Lawyers Association (now Kansas Association for Justice) from 1977–1986

Sunday, January 23, 2011

What a REAL cure strategy would look like. Lou Weisbach of the American Center for Cures provides a compelling vision.

As noted here this morning, the NIH initiative to establish a National Center for Advancing Translational Sciences (NCATS) is a worthy effort. But at the same time, NCATS must be kept in perspective; it is a good start, but it is only a start. In the words of Lou Weisbach, co-founder of the American Center for Cures:

It means there’s a seed of recognition that the current system needs change. It’s a positive small step at a time when the disease community yearns for a major overhaul that has been long overdue. At what point will the government treat its suffering taxpayers who have diseases with the sense of urgency that they are entitled to?  It’s time to BAILOUT the suffering American public with whatever it takes to bring mission, urgency, and accountability to their plight. It’s time for the silent, passive disease community to DEMAND the change necessary to bring real hope and transparency to the hopeless among us. Virtually the same percentage of people dying of cancer in America in 2011 as in 1950 should be alarming to all of us. What else do we need to know to demand a American Center for Cures type, FULLY FUNDED MISSION.

As one might gather, Weisbach is passionate on the issue.  Yet we note some numbers that underscore Weisbach's energy, and that should get us all fired up.    The new NCATS will be funded with a billion dollars--assuming that it gets funded at all.  If it is funded, that $1 billion will be about the price of a new drug, under the most optimistic accounting.  To put it another way, that $1 billion will be about 3 percent of the NIH budget.   Or, finally, that $1 billion will be just 1/2600th of the total healthcare spend in the US.   About the only number bigger than that is the total loss to productivity and economic output imposed by sickness and disease.   Has this been a good allocation of resources for America?  To let spending for research--especially he crucial category of translational research--be dwarfed by spending for care?

So yes, the economic foolishness of these choices, not to mention the humanitarian losses, ought to make all of us as passionate as Weisbach.

Interestingly, Weisbach has taken the next step.  Working with leaders in Chicago, including mayoral candidate Gery Chico, Weisbach has put together a visionary proposal for an American Center for Cures, to take physical form in Chicago.   Here are some illustrations, below.   The first is an overall look at the proposed campus:

The next is an "arch of inspiration":

And finally, a look at an medicine-oriented art work that might grace the campus:

To be sure, the ACC and these structures have yet to take shape, and are yet to be funded, but we can say that the momentum has shifted, as those who have chosen to focus on health insurance these past decades are now coming to realize that the real expense is disease, not health insurance.  And that growing realization will move the ACC closer to fruition.

And we might note, of course, that such a Center, doing real translational work, would be a huge boon not only to health, and to the overall economy (helping people to be healthier), but it would also be a boon to the local economy.   That's why Chico and other Chicagoans want the ACC for their city; one question is why other locales haven't yet embraced this obvious tool for economic development. 

Encouraging news from the National Institutes of Health. Could this be the beginning of a new focus on cures?

The New York Times reports this morning that Dr. Francis Collins, director of the National Institutes of Health, is planning on creating a new National Center for Advancing Translational Sciences, aimed, as the Times' Gardiner Harris explains, at creating "a billion-dollar government drug development center to help create medicines."  The key phrase here is "translational."  That is, the conversion, or translation, of scientific insights into actual cures--the kind that a patient can actually receive from a doctor or hospital.  

For too long, the rap on the NIH has been that it funds "curiosity studies," in the mordant phrase of Lou Weisbach, co-founder of the American Center for Cures, a Chicago-based advocacy group.   In the past, Weisbach has estimated that the translational research at the NIH has amounted to no more than $40 million--that's out of a $30 billion budget.    It's that "lost in non-translation" problem that explains why NIH funding can double, as it has in the past decade, and yet the results can be so disappointing.

But all that could be changing, thanks to Dr. Collins.  And with that change comes perhaps the realization that if the goal, in these tough fiscal times, is to reduce spending, deficits, and debt, well, there are two ways to do that.  The first way is to chop.  (An approach not without its downsides.)  And  the second way is to solve the problem.    If we were ever to cure cancer, for instance, the government wouldn't spend much on cancer, and neither would the rest of us.

Out of that change could come a larger change: A shift at the NIH to a more DARPA-like mission of actually determining what needs to get done and then doing it, e.g. deciding, a half-century ago, that the nation needs a survivable communications network, and then funding the research for a decade. That research, of course, gave us the freely available Internet--a perfect example of public support for a project that was eventually turned over to the private sector and became one of the greatest boons to humanity ever.   If the NIH could play a DARPA-like mission, strategizing on translational medical research, we could see effective mobilization for cures, with an Internet-like impact.

So it will be interesting, of course, to see how the political community reacts to this news.  Will politicians oppose it for one reason or another? Applaud it?  The best of them, of course, will seek to up the ante.  If a billion dollars is good, ten billion is better.

And of course, the government itself doesn't have to spend this money--the needed capital is sitting, in stagnant pools, one might say, waiting to be activated for a good purpose.  Indeed, the legendary medical philanthropist Mary Lasker once referred to money as "frozen ideas."  Those ideas can be used for good or ill, but it's hard to think of a better good than medical research that alleviates suffering for all humanity.   So by all means, let's unfreeze money from around the planet to work on a planetary objective.

Of course, such mobilization would require much more than NIH activism: It would require a rethinking of our whole system.   These charts here show that the once-robust pipeline of new drugs has petered out, and research money from the big Pharma companies has peaked out, as this graphic in the Times this morning illustrates:

What's needed is much more--more of everything, as Samuel Gompers might have said.  For example, we not only need more capital going into the medical sector, we also need better regulation of the medical sector.   We could start with reforming the FDA; it doesn't make sense for the Food and Drug Administration to be dually mandated to focus on salmonella in spinach and at the same time, the safety and effectiveness of a cancer drug. The two skill sets are simply much different, and the regulators should be the best at both, with a clear understanding of the differences between monitoring food safety and facilitating safe new cures. And if that means separating the "F" from the "D," so be it. Once upon a time, the federal Departments of Labor and Commerce were the same agency, and that evidently didn't make a lot of sense, either.

And of course, we might add that it's crazy to tolerate litigation as a horrendous burden on the cure sector.  It's not just the cost of litigation, in malpractice and settlements; as Jim Wootton, a longtime litigation expert in DC observes, the real cost of the trial lawyers is gumming up the work of research, by stifling the free flow of data across silos.    If the American people understood that the likes of John Edwards were imposing a low ceiling on the cure horizon, they would demand political action to open up more space for an ambitious effort.  Which, of course, would in turn bring in new capital to the medical sector.

And so out of all those necessary changes could come the largest change of all: The idea that paying for health care is not as smart, or compassionate, as paying for a health cure.   Care for the afflicted is always right and necessary, but cure is always better.

Saturday, January 22, 2011

Barbara Walters Special: "A Matter of Life and Death." Interesting that the show is about health, not health insurance.

On February 4,  ABC News legend Barbara Walters is hosting a special on heart attacks and heart disease.  Of course she is: She herself is a heart-surgery survivor, and obviously the experience--not to mention the reality that she is alive--made a deep impression on her.   We might note that the issue for Walters, and for the vast majority of Americans, is not health insurance, but rather, health itself.   That is, most Americans can pay their health insurance bills, one way or another, through insurance, their own funds, or charity.  Yes, of course, healthcare is expensive, but as the legendary medical activist Mary Lasker said, "If you think research is expensive, try disease!" 

So the real issue, then, is mobilizing society on behalf of research, medicine, and cures.  Because then, in addition to being the personal benefits of health, society will benefit from better healthcare outcomes. Indeed, in the long run, better health is not only cheaper, but more economically constructive, because new industries are created, and people are more productive.  

And we might consider this quote from Bill Clinton, cited in the ABC press release, describing his own heart surgery "I realized there was really no alternative, if I wanted to live, I had to do this."  That sums it up--for him, and for all of us.  

Friday, January 21, 2011

A challenge to Serious Medicine

The Huffington Post's Howard Fineman reports that President Obama's upcoming State of the Union address will be a sort of "Sputnik 2"--that is, a call for scientific and technological mobilization, of the kind that we saw in the wake of Sputnik, the first satellite launched into orbit, by the USSR, back in 1957.

That's fine and good, if Obama really pushes science and technology, as opposed to merely recycling "green jobs" and overall education spending.  

But Serious Medicine Strategists, and their allies, the Hamiltonians, do face a challenge: 

The public appears to think that the best place to make cuts is in infrastructure and science and medical spending.  The screengrab below is from the latest NYT/CBS poll: 

A reminder: The forces of science and medicine and progress always need to make their case to the public. That doesn't mean blind support for the status quo, of course, it means a serious look at the sort of scientific and medical research that is needed; that is, what is likely to pay off in ways that the American people will find persuasive. 

Wednesday, January 19, 2011

Dueling worldviews on the jobs impact of the healthcare bill.

Is this fair reporting?

The Washington Post and AP run a story headlined, "FACT CHECK: Shaky health care job loss estimate."    Says that the GOP is on "shaky" ground when it says that Obamacare will hurt jobs.

But the WP/AP story makes no mention of a new letter signed by 200 Republican economists--including big names, such as Doug Holtz-Eakin, June O'Neill, and Art Laffer--that says that the legislation will, in fact, hurt jobs.   Seem like an omission to me.

This was the subject of my "Skype Gripe" on "Fox News Watch" home page. Should be posted soon.

Monday, January 17, 2011

Steve Jobs needs Serious Medicine, not health insurance.

Text reads: "Apple CEO Steve Jobs says he will take leave from his duties to focus on his health."

Obama administration using tax dollars to trumpet Obamacare.

Seen in my Gmail account this morning.

Saturday, January 15, 2011

"Giffords' Doctors Adjusting To Role As Rock Stars." Why is it that nobody thinks of health insurers, public and private, in similar terms?

The headline in the Huffington Post reads, "Giffords' Doctors Adjusting To Role As Rock Stars."  Quite so.  Drs. Peter Rhee and Michael Lemole are, indeed, heroes.

So why is it that nobody thinks of health insurers, public and private, as "rock stars." And the answer, of course, is that health insurance is not heroic.  Medicine that heals is heroic, while finance that pays the bills is necessary, but something less than heroic.   Sort of makes you wonder why politicians would put so much emphasis on healthcare finance.

As argued at National Review Online earlier this week, Serious Medicine is simply more important--to Gabrielle Giffords, and to all us--than insurance.

Tuesday, January 11, 2011

Chicago: A new hub for Serious Medicine?

Will Chicago emerge as a new hub for Serious Medicine?  Let's hope so. As argued here many times, Serious Medicine is a win-win-win-win.  That is, a win for patients, obviously.  But also, a win for the healthcare sector, because we need economic sectors that are expanding.  In addition, Serious Medicine is a win for technological spinoffs, and thus a win for the overall economy.

But of course, somebody has to start. As we all know, the distinct idea of Serious Medicine has been submerged in the overall soup of "healthcare reform," or, if one prefers, "Obamacare."

Meet Gery Chico.  He's running for mayor of Chicago, and he wants to start something.  Big.  In Chicago.

As The Chicago Sun-Times reports this afternoon, Chico held a press conference in the Windy City,

Calling it a “game-changer” with the job-creating punch of O’Hare Airport, mayoral challenger Gery Chico vowed Tuesday to find a home in Chicago for a $3 billion complex devoted to curing deadly diseases.
“You do whatever it takes to make something like this happen. Talk about a game-changer. . . . This can define this city for the next hundred years if we get this right,” Chico said.
“Imagine if we start to cure diseases and all those trillions [spent] to deal with the symptoms to those diseases and providing treatment to those diseases is taken away.”
The idea of an American Center for Cures is the brainchild of Chicago businessman, Lou Weisbach, and a Miami physician, Rick Boxer.

What the Weisbach and Boxer have figured out is three-fold: First, the center of gravity in the healthcare debate has shifted from cure to care. Second, a comprehensive approach to combating disease--a Serious Medicine Strategy--is needed, because the incentives are now stacked in favor of medical maintenance; that is, the status quo. And third, the Serious Medicine idea needs a place to crystallize. So why not Chicago? The Sun-Times story continues:

For more than ten years, Weisbach and others have been trying to convince Congress to take some of the money currently earmarked for the National Institutes of Health (NIH) and divert it to a mega-center devoted to finding a cure for cancer, Alzheimers, Parkinson’s, diabetes, heart and other deadly diseases.
They’re asking Congress for a guarantee of $36 billion a year for six years to operate the center. That’s not counting the $3.5 billion it will take to construct the multi-building complex.
Despite support from Connecticut Senator Joe Lieberman and others, the dream has gone nowhere amid opposition from the powerful health-care lobby that makes its money treating patients.
“Curing is not what they do and the reason is very simple: There’s really no money in cures. They’re not bad guys. They’re not bad people. But they have a responsibility to shareholders,” Weisbach said.
“It’s unconscionable that we allow a system that doesn’t prevent or cure anything — any major diseases in 60 years — to continue on and just close our eyes.”
Enter Chico, the all-purpose mayoral troubleshooter who has served Mayor Daley as chief of staff, school board and park board president and chairman of the City Colleges board.
If he’s elected mayor, Chico is promising to find a way to make it happen in Chicago. He would find and clear the “acres and acres” of land needed to house the six-building complex and provide taxpayer subsidies to help defray construction costs.
He would also provide “seed money” for development and raise money to lobby Congress.
“I’ve been around long enough to hear the quest for being on the world stage and being a world-class city. We just tried it with the Olympics,” Chico said.
“If we’re gonna pursue something, it ought to be like this, which has a permanence to it in terms of job-creation and spin-off jobs that would be unlike anything I’ve ever seen in the history of this city.”

Sunday, January 9, 2011

Two articles for the Manhattan Institute's Medical Progress Today, on C.P. Snow's "The Two Cultures," and on FDA Reform.

In the last century, the dominant impulse of American healthcare policy has shifted decisively--from cure to care.  Whereas once we sought to eliminate disease through science, now we seek finance disease through insurance.  Why did this huge shift occur?   The answer can be found in the shift in power relations between two cultures in today’s society, one focusing on dynamic science, the other focusing on static literary, political, and legal worldviews.   

In the early 1900s, President Theodore Roosevelt decided to dig the Panama Canal, but he knew he would never succeed if malaria and yellow fever decimated the workforce, as had happened in  the French canal-building effort two decades earlier.   Medial scientists of TR’s day had not yet developed effective treatments for those diseases, but they had learned that mosquitos were the vector, or transmission agent.  So President Roosevelt simply ordered mosquito habitats cleared away from the canal worksite; as a result, infection and death rates were minimized, and the path between the seas was completed.  

Using today’s terminology, we could say that TR “bent the curve” on healthcare costs, and yet he did so not by crimping down on treatment, but by crimping down on the disease itself.  We might note, to be sure, that TR’s environment-changing solution was in keeping with those disease-attacking times; back home in the US, progressives were using the same methods to improve hygiene and sanitation, dramatically reducing rates of infectious disease.  Indeed, all through the early 20th century, forward-looking public health advocates--untroubled by “wetland” protectors and NIMBYs--drained swamps and launched other mosquito-abatement measures.   As a result, malaria and yellow fever virtually disappeared from the US.  

Later, another President Roosevelt, Franklin, also chose to fight disease.  In 1938, FDR established the National Foundation for Infantile Paralysis, soon to become known, after a groundswell of public support--“Send your dime to President Roosevelt!--as the March of Dimes.   Instead of proposing national health insurance as part of his Social Security retirement plan, FDR gave Americans something more precious: health itself.   In 1955, the announcement of a successful new Salk polio vaccine cheered a relieved and grateful public.   

The dominant idea then was not to provide insurance for disease; it was to do away with disease.   And the added advantage to such an approach--beat, don’t treat--was not only its humanitarian impact, but also that it cheaper in the long run.  The expense of developing the polio vaccine was minuscule, compared to the expense of providing multiple wheelchairs and iron lungs, to say nothing of the cost of lost productivity from those afflicted.   

Now we can fast forward to the end of the 20th century.  In the 1990s, Bill Clinton proposed a national health insurance plan that focused entirely on health insurance, as opposed to the actual science of health.   According to science-policy historian Daniel Greenberg, in Clinton’s 1993 speech outlining his healthcare plan to Congress, “The President made no mention of medical research or the role of improved scientific understanding of disease in protecting the health of the American people.”  Instead, he focused solely on “universal access to medical care and cost containment.”

And the subsequent Obamacare, of course, followed the same formula: a huge increase in “coverage,” even as the pipeline for new drugs and cures--and hope--continued to dry up.   

So what changed over the last century?  How did we go from trying to eliminate dreaded  disease to being content merely to finance its ravages?   How could it be, for example, that today we spend $172 billion a year treating Alzheimer’s Disease, but only about $500 million a year  researching the malady?

And the problem will get worse in the decades to come:  Do we really think we can manage the Alzheimer’s epidemic through either budget cuts or “financial innovation”?  Unfortunately, no presidential March-of-Dimes-like effort is in sight, to mobilize against Alzheimer’s Disease, or against any other costly killer.  

One reason for this dire policy reversal might be found in a 1959 lecture, “The Two Cultures and the Scientific Revolution,” delivered by the Englishman C.P. Snow at Cambridge University, later turned into a still-in-print book.  “The intellectual life of the whole of western society,” Snow declared, “is increasingly being split into two polar groups.”  One of these groups is the literary, or traditional culture; the other is the scientific culture.   “Between the two,” Snow continued, stretches “a gulf . . . of hostility and dislike, but most of all lack of understanding.”   

Snow had served as technical director for the Ministry of Labour during World War Two; he had seen, up close, the struggle to advance vital scientific research--most notably, the tide-turning technology of radar.  It was the scientific culture, Snow argued, that had devised the tools for defeating Hitler; yet, after the war, it was the literary culture that had triumphed, submerging the future progress of science in a languorous bath of aesthetic styles and judgments.  Snow, a notable author, well-versed in the humanities, decried the excessive influence of “the literary intellectuals,” who, he added, “while no one was looking took to referring to themselves as ‘intellectuals’ as though there were no others.”  As a result, science, as well as the positive transformations that science can bring, was being pushed out of contemporary political and policy equations.  

This dethronement of science was a huge loss, declared Snow.  “Scientists have the future in their bones,” he added, and yet “the traditional culture responds by wishing the future did not exist.”  That is, scientists seek to advance and change the future, while the literary culture is content to muse over the present.   And yet presently, Snow lamented, “It is the traditional culture . . .  which manages the western world.”

Predictably, Snow’s broadside against the humanities attracted immediate counter-fire.   The eminent literary critic F.R. Leavis denounced Snow as a “public relations man” for science, suffering from “complete ignorance” about the humanities--ignoring the fact that Snow, in addition to his government service, had published 17 novels and works of fiction, as well as a biography of Anthony Trollope.  Yet Snow was adamant: Science should take the lead, as opposed to those he termed “natural Luddites.”

Updating Snow, we can observe that in our time, the literary/humanities culture has been fused with the political/legal/social science culture, creating the current policymaking juggernaut, which we might dub the “literary-legal complex.”  We might further say that the literary-legal complex is inherently oriented to predictability, according to its non-scientific, even anti-scientific, prejudices.  And so the literary-legal worldview focuses on transactions and rule- making--creating durable, but inherently limited, routines in its own image.  By contrast, science is unpredictable and open-ended: the work of scientists disrupts predictable and familiar routines, remaking the world in heretofore unimagined ways.  So people of a scientific turn of mind, for example, produce vaccines, unsentimentally disrupting painful--but at least familiar--patterns of sickness and death.   By contrast, in past eras, the literary-legal turn of mind debated whether it was a sin to use vaccines, thereby thwarting God’s will.   Today, many of those who still retain that predictability-oriented turn of mind are still happy to see science restrained--by custom, law, or lawyers. 

Meanwhile, in politics today, we see endless ideological battles within the left and right factions of the literary-legal complex, over the financial metaphysics of health insurance, pro and con, and little consideration of where health actually comes from.  Thought-leaders of the two parties,  sharing a common background in humanities and the law, naturally end up with similar conclusions about the primacy of predictable transactions and rules.   And so their policies, dueling as they might be, end up mirroring each other.  

The left, inspired by theorists and social critics--leavened with a little Green pseudo-science--produces policies in its own image: regulations, consent decrees, sweeping theories of legal liability.   The right, on the other hand, re-reads the Constitution and studies economics, while seeking further inspiration in the novels of Ayn Rand.  That is, both sides ignore science, because they don’t know science.   So if the left says that the government should provide health insurance, the right says, no, the market should provide it.  And in the midst of that ideological  rumble, the idea of actual improvements in health--improvements that come from medical science--is sadly forgotten. 

And today, that same turn of mind seems As we are currently seeing, ideology is an endless fight that can never be resolved.  By contrast, technology is a fight that can be resolved.   Polio, for example, was resolved.   And we can resolve other diseases as well, if we want to.  But first, we will have to realize that our current exaltation of the literary-legal complex is the solution, but, in fact, the problem. 


And here's an earlier article, also for The Manhattan Institute's Medical Progress Today, published in early December: 

A consensus is developing that Alzheimer’s Disease (AD) is the next epidemic to worry about, both medically and fiscally.  But unfortunately, there’s nothing close to a consensus on what to do about it.  
Considerations of AD have been subsumed by the debate over spending and the deficit--although Washington mavens don’t yet seem to grasp that a fiscal solution is not possible without a medical solution.   Instead, policy chatterers have zeroed in on cutting entitlement spending, ignoring the medical problems of aging, favoring a strictly fiscal solution.  Such an approach has a soundbite-worthy appeal, but it disregards outside-the-beltway political reality: If the underlying problem of the disease itself is ignored--the incidence of AD is expected to triple in the next 40 years--then popular pressure to spend commensurately will not be ignored by politicians.   Indeed, we can note that if AD triples, it won’t matter much whether or not Obamacare lives or dies; either way, by mid-century, healthcare will be ruinously expensive.   

In the meantime, others seem to believe we should simply have a partisan brawl, aimed at gaining maximum political advantage going into the 2012 elections.  And of course, as soon as the ’12 elections are over, fighting over the ’14 elections will commence.   Yet amidst such see-sawing political  opportunism, we will continue to spend money on AD care--already more than one percent of GDP, and rising fast--without any real prospect for a cost-curve-bending cure.   

In August 2010, The New York Times reported on the work of a medical “jury” convened by the National Institutes of Health to evaluate the various treatments for AD.  The “verdict” of the NIH panel was discouraging in the extreme: “Currently, no evidence of even moderate scientific quality exists to support the association of any modifiable factor (such as nutritional supplements, herbal preparations, dietary factors, prescription or nonprescription drugs, social or economic factors, medical conditions, toxins or environmental exposures) with reduced risk of Alzheimer’s disease.”

To sum up: There's “no evidence” that anything we are doing to forestall or treat Alzheimer's is working.  The chair of the NIH panel, Dr. Martha L. Davigulus of Northwestern University, summed up the current state of research as “primitive.”
Yet we do see stirrings of a counteroffensive against the AD onslaught.  In October, former Supreme Court justice Sandra Day O’Connor, joined by Nobel medical laureate Stanley Prusiner and geriatric expert Ken Dychtwald, argued on the op-ed page of The New York Times for a more proactive strategy against AD and its costs:

As things stand today, for each penny the National Institutes of Health spends on Alzheimer’s research, we spend more than $3.50 on caring for people with the condition. This explains why the financial cost of not conducting adequate research is so high. The United States spends $172 billion a year to care for people with Alzheimer’s. By 2020 the cumulative price tag, in current dollars, will be $2 trillion, and by 2050, $20 trillion.

In addition, O’Connor, Prusiner, and Dychtwald brought up the benefits of an effective AD treatment: 

If we could simply postpone the onset of Alzheimer’s disease by five years, a large share of nursing home beds in the United States would empty. And if we could eliminate it, as Jonas Salk wiped out polio with his vaccine, we would greatly expand the potential of all Americans to live long, healthy and productive lives--and save trillions of dollars doing it.

That same month, another leading figure, California first lady Maria Shriver, made an overlapping argument: The goal should not be treating AD, the goal should be beating AD.  Speaking to ABC News’ Diane Sawyer, Shriver invoked the ambitious vision of her famous uncle, “We can launch an expedition on the brain, much like President Kennedy launched an expedition to the moon.”

Once again, the obvious wisdom: A cure for any malady is cheaper than palliative care.   That medical-fiscal reality was true for polio, as well as other diseases that have been mostly or completely eliminated--so why couldn’t it be true for AD?  

And yet the political establishment has paid little heed to O’Connor and Shriver, nor has it thought constructively about the polio precedent.  In the weeks since, two different “blue chip” deficit commissions have released weighty reports; both focused entirely on a “cut” strategy for healthcare, as opposed to a cure strategy.  

Why the neglect of the proactive cure-approach?  Perhaps Washington officialdom is simply incapable of a complicated “two cushion shot”--that is, hitting the billiard ball of medical research in order to hit the ball of lower costs in the long run.  Or perhaps the idea of scientific research, as opposed to writing checks and offering bailouts, is simply out of fashion in policy circles.   Or maybe Washington has quietly concluded that medical research--and just as crucially, the translation of medical research into actual medications in the marketplace--is hitting a dead end.  Why spend more money on, say, the NIH if nothing tangible is achieved?Why have faith in the pharmaceutical companies when a dozen anti-AD efforts have failed in mid- to late-stage testing since 2003?

Yet if nothing can be done to rekindle medical progress as a public-policy tool, then we are, in fact, doomed both to go gray and to go broke by the middle of this century--unless, of course, the death panels are called in.  

So is there any hope for a better outcome?  An outcome that’s both more compassionate--and less ruinous?   If there is such a hope, it will have to come from medical research.  Financial transactions won’t get us there; only scientific transformation can do the job.  

For their part, politicians can help, not by fighting each other, but by clearing away the legal and regulatory roadblocks to medical progress.  MI’s Paul Howard is correct in stating that the FDA is facing a “crisis of confidence”; critics on all sides agree that the agency is “broken.”   So the answer, of course, is to fix the agency, as part of an overall cure strategy. 

Will such an effort succeed?  There’s no way to know for sure, but our long national track record on public-private mobilization--from building the railroads to building the Interstates to building the Internet--should give us considerable hope.  If, that is, we can distill the right leadership lessons from those past large-scale successes. 

The political and economic reward for medical success is monumental.  With an effective treatment for AD, we could, of example, begin to think about raising the retirement age for Medicare and Social Security, thus solving much of the deficit problem.  

In addition, an AD breakthrough would shift cost calculations on just about every fiscal and economic variable.  Today, all those tens of millions--soon to be hundreds of millions--of people around the world suffering from AD are seen as a huge burden.  But with a real AD cure, they could become paying customers for whichever country is making the medicine, able to continue working and producing--for the betterment of each country, for the betterment of mankind.