Saturday, April 30, 2011

Here come the WHO-crats. World Health Organization takes on chronic disease. But how? With research, medicine, and cures? Or with national, and now international, nanny-statism?

The Washington Post reports this morning on a World Health Organization (WHO) meeting in Moscow on public health, food, and lifestyle.   In the pages of the Post, the issues seem so clinical and laboratory-like.  But in reality, popular passions are certain to be provoked--and so popular sovereignty must once again be invoked.   

It's great to eat right and be healthy, but those who wish to eat wrong still have rights--and they will fight to preserve them.   As we shall see, new rules on what you can eat--that is to say, new rules on personal freedom--are coming.   And the Obama administration appears to be an eager participant into the next round of a restrictive rule-writing process.   Post reporter Will England sets it up: 

The World Health Organization focused for decades on infectious diseases, but now it’s putting non-communicable diseases near the top of its agenda. The fight against heart disease, diabetes, stroke, lung cancer and chronic respiratory disease may not seem as heroic as the struggle against smallpox or H1N1, but chronic illnesses account for 63 percent of deaths worldwide — 70 percent in the United States and 90 percent in Russia.

Important statistics, reminding us that the stakes are, indeed, high.   And then he adds these hopeful words about improving the quality and length of life:

“And these [chronic diseases] are preventable,” said Margaret Chan, director general of WHO, at a three-day series of meetings here this week devoted to chronic diseases. “People don’t have to suffer. People don’t have to die.”

OK, so far, so good.  The Serious Medicine argument is that health insurance, for example, is a lot less important to people than health itself.  It’s medical science we need, much more than healthcare finance.    And so just as we eliminated many killer infectious diseases in the last century, it would be a humanitarian achievement if we could eliminate many killer chronic diseases in the next century.  

But as the Post article makes clear, the WHO vision of better health for the future is driven more by politics than by science.   That is, the leaders of his new health push will be bureaucratic regulators, not disease-eradicators.   We also need medical science more than we need governmental red tape, however well-meaning that red-tape might seem to be.  

Indeed, as we keep reading the Post article, a disturbing pattern starts to appear.  We see much discussion--and real action--leading toward government regulation of human behavior, and little or nothing about the transformative or curative science.  It would be useful, for example, if leaders were focusing on better treatments and cures for diabetes or chronic respiratory disease.  And while of course such scientific research is occurring, it does not appear that such scientific research is anywhere close to the top of WHO’s international agenda.  

Instead, we see what appears to be nanny-statism--not only at the national level, but also at the international level.  That is, WHO and various governments and NGOs are coming together to start passing restrictions on diet and lifestyle and behavior patterns.    Education about health is fine, so long as its genuine, fact-based education, provided by an unbiased trustworthy source.  Freedom means freedom, but freedom can always be better informed by the truth.

Indeed, many companies are heavily involved in good-hearted public education.  One such company is Dole Foods.  Inspired by the visionary leadership of owner David Murdock, Dole has created the Dole Nutrition Institute, which spends many millions each year in pro bono efforts to inform Americans, especially, the young, about the benefits of healthy eating and a healthy lifestyle.   To be sure, Dole is in the healthy foods business to begin with, but the Nutrition Institute's health-promotion  efforts reach far beyond what Dole sells.   Indeed, Murdock has personally endowed an entire research campus in North Carolina, dedicated to public-spirited research on nutrition and health.

Murdock and the Dole Nutrition Institute provide a sterling example of education for health.   And their efforts are all voluntary; we can note that neither Murdock nor the Dole Nutrition Institute, has any power to make anybody do anything.

Yet as we know, government operates on a different principle--the principle that if persuasion doesn't work, there's always the option of coercion.

As we have learned here in the US on other issues, government-funded “education” has a way of turning into hectoring, taxing, and mandating.  Indeed, even research itself can be skewed, in the name of driving such research to a pre-designated conclusion.  That has been, for example, the twisted and coercive fate of much "research" and “education” about global warming and climate change.   Without attempting to delve into the science at all, suffice it to say that the US government got way ahead of what was scientifically demonstrable, to say nothing of politically feasible.   Indeed, the backlash against climate change should serve as a sobering warning sign to would-be food czars.   

And while the science of, say, the dangers of some lifestyle habits, such as smoking or snuff, are completely settled, it's still the case that tobacco users have rights--even if not everyone agrees.

So we can only wonder what future policy directives will be coming out of WHO and lesser entities in the months and years to come.   Here’s more from the Post report:

No tobacco and less sugar, fat and especially salt are WHO’s top targets; reducing alcohol consumption and increasing exercise are right behind. Those factors alone account for 25 million of the 36 million deaths attributable to chronic diseases annually, according to WHO, and place a huge economic burden on families and nations.  But a cigarette is not like a microbe: It can’t be eliminated by a doctor. Fighting chronic diseases requires political decisions — in areas as disparate as finance, regulatory policy, agriculture, education and trade — and the will to see them through.

OK, so we are starting to see a pattern here: The WHO meeting seems to be a chance for international officials to gather together work through their whole policy arsenal; as the Post piece says, “in areas as disparate as finance, regulatory policy, agriculture, education and trade.”

A cynic would say, here’s a big opportunity for big government to get a lot bigger, as regulators, inspired by this Moscow conference, return to their home countries full of newfound zeal. 

And once again, we can note: Even in that litany of governmental tasks mentioned above, there was no mention of medical research.  What if we could develop a cure for diabetes?  Or a foolproof appetite suppressant?  Or some other outside-the-box approach that we might not have even thought of yet?   Wouldn’t such a techno-fix be an easier way to solve some of these public health issues, thus obviating the need for heavy-handed regulation?  Sure it would.  Which leads one to wonder: Could it be that those WHO officials and their allies are uninterested in scientific transformation precisely because they are more interested in social regulation?   That is, the WHO-crats would rather have the bureaucratic regulation (imposed, of course, by people like them), than the scientific transformation (achieved, most likely, by scientists they barely know). 

And in fact, in the hands of bureaucrats education always seems to turn into regulation; as the Post article suggests, the Moscow conference is just the beginning.  That is, the corporations will get their say, and then the bureaucrats will take it from there.  

Unhealthy food, and what to do about it, was the most sensitive topic at the gathering here. Representatives of PepsiCo, Coca-Cola and Nestle joined the discussions after a decision by WHO to allow the big international food concerns a voice as the organization prepares an agenda for a U.N. meeting in September.

So we can expect that in that next meeting, in tandem with the UN General Assembly this September,  we will see a lollapalooza of new decrees and rules.   UN pronouncements don’t have force in the US, of course--except when they do; there’s no shortage of internationalist-minded activists and even jurists in the US who think that it is their job to “harmonize” American policy and culture with that of the rest of the world.   

For her part, WHO director-general Chan jumps in with her own view on the future.  Speaking of voluntary industry actions: “Self-imposed voluntary action is a good first step.”   And if voluntary action is the "first step," what, we might ask, is the second step?    For her part, US Health and Human Services Secretary Kathleen Sebelius, also in Moscow, agreed that companies ought to get the first opportunity to do the right thing.  But then she added, “there’s definitely a role for regulation.” 

So stay tuned for a fight on the US homefront.   Fighting off the excesses of the WHO-crats and their US allies will be another mission for libertarians, tea partiers, and all those who think that people should have freedom of choice--even the freedom of choice to make mistakes.   Yes, there are a many ways to weave personal responsibility into society--variable pricing for health insurance is one of many possible incentivizers--but there will be a backlash against overweening regulation that crimps freedom.  This is America.  Here, the people rule. 

Healthy eating is good, and informed consumer choice is good, too, as part of our overall commitment to personal freedom and individual dignity and autonomy.   But if the Affordable Care Act of 2010, aka "Obamacare," is an indication, any idea that paternalistic public health officials think is a good idea--will soon be a mandatory idea.

And so, once again, the American people will have to rise up and defend their rights.  Including their right to do things that Washington DC doesn't approve of.   Such populist rebellions have happened before, even very recently.  And now it looks as if another such upsurge is coming.  

Tuesday, April 26, 2011

A Vaccine for Alzheimer's?

The basic argument of this blog is that it's better to pay to cure a disease than to merely pay--and pay, and pay, and pay--for care.

So now we are reading in the thepharmaletter:

A vaccine that has the potential to stop Alzheimer's disease progression could be available within a few years, according to reports in the UK’s Daily Mail and Daily Express newspapers. The product in question, known as CAD106, comes from the research laboratories of Zurich, Switzerland-based biotechnology firm Cytos Biotechnology (SWX: CYTN), which is also developing anti-smoking, obesity and flu vaccines.

There's no guarantee that any of these new potential vaccines will work, of course, and they may all prove to be an absolute fizzle.  Still with good leadership and the right economic and regulatory climate, we would be having a lot more of this productive scientific research.  And history tells us that good things come out of a heavy commitment to research.

Here in the US, that would mean a lot more hope about Medicare, for example, and a lot less fear.

And by the way, shouldn't this industry be in the US? Or is the economic plan for the 21st century to simply print dollars?  How long do we really think that will last?  

Saturday, April 9, 2011

Serious Medicine Crash Update--The world confronts a new "superbug" that could jeopardize modern medicine. Yet the antibiotic pipeline is drying up, an 81 percent decline. Health insurance can finance that sickness, but it can't prevent or cure that sickness. In other words, we have an elaborate and expensive system for caring for illness, but not for curing illness.

Once again, we are confronted with a new and potentially lethal epidemic.  The Lancet, the British medical publication, reports on the rise of a bacterial "superbug" that could reintroduce the risk of incurable infection, thus threatening all contemporary surgical practices.   As The Lancet puts it, "The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed."   And yet as the chart above shows, new antibiotics are down by more than four-fifths in the last quarter-century.  

As of now, nobody really knows the extent of the ultimate danger--although public health experts are worried.   After all, even before NDM-1, we have seen the deadly resilience of other kinds of infections, such as MRSA and extensively drug resistant tuberculosis.   In other words, even as we have turned our attention to major new killers among us, such as Alzheimer's Disease, we confront the potential recrudescence of mass contagions, even epidemics.    

Oh wait. we haven't really turned our attention to Alzheimer's.  We have mostly ignored the public health threat posed by Alzheimer's, too--except when it comes to paying for its costs.   We are heavy on insurance and light on cures.   Which, of course, is a formula for ruinous expenses, for individuals and for nations, combined with lack of hope against the ravages of disease.  

And thus we are reminded of the reality that health is more important than health insurance.  That is, medicine is more important than medical-finance mechanisms.   If new deadly strains of bacteria emerge, it matters little that we have health insurance, if at the same time we lack a cure.  Health insurance wouldn't have done any good in the 14th century, during the Black Plague, which killed perhaps a third of Europe.  Nor would health insurance done much good in the 20th century, when the Spanish Flu killed perhaps 50 million worldwide.  And the same could be said, more recently, of HIV/AIDS.   Health insurance is essentially retrospective; it is the financial after-effect, or shadow, of the medicine's ability to prevent or cure a disease--or not.  

Meanwhile, in the 21st century, we face a new superbug in the form of an enzyme, New Delhi metallobeta-lactamase, or NDM-1, that destroys carbapenems, an important category of antibiotics used for challenging hospital infections. NDM-1 has been found in many different kinds of bacteria, as The Wall Street Journal reported.  The Journal's Sten Stovall writes that "some experts warn health-care provision is in danger of reverting back to a pre-antibiotic era in which hip replacements, care of preterm babies and advanced cancer treatment are no longer possible."  And then Stovall quotes David Livermore, director of antibiotic resistance monitoring at the U.K.'s Health Protection Agency: "So much of modern medicine—from gut surgery to cancer treatment, to transplants—depends on our ability to treat infection. If resistance destroys that ability then the whole edifice of modern medicine crumbles."

NDM-1 has been observed in Bangladesh, India, Pakistan, where it is easily found in drinking water and sewage near healthcare facilities.  As The Hindu reported in New Delhi, the Indian government is "in denial" over the threat to public health posed by NDM-1.  And, more ominously for Americans, NDM-1 has also been found in Britain, which qualifies as a near neighbor to the US in this globalized world.   

So we can ask: What is the US government doing about NDM-1?   No doubt officials at the Centers for Disease Control and the Public Health Service are monitoring the news, and doing what they can, but who thinks for a minute that the threat of NDM-1 is anywhere high on the Washington DC agenda?  And even if it were, monitoring a disease is little better than providing health insurance--when confronted with a serious health threat, what's really needed is science, as opposed to finance.  

Meanwhile, as Stovall explains, there's little in the way of new antibiotics: "Over the past three decades only two new classes of antibacterial medicines have been discovered, compared with 11 in the previous 50 years."  Indeed.  As the chart above, put together by Eric Utt of Pfizer, shows, the "pipeline" of new antibiotics is, indeed, running dry--down 81 percent in the last quarter-century.

As the Journal’s Stovall observes, in the US, hospital-acquired, drug-resistant bacterial infections kill 63,000 patients each year and cost $34 billion.  And yet in the current political and economic climate, he continues, we see a lack of financial incentives to spur pharmaceutical companies to invest in researching and developing new antibiotics.  Stovall quotes Astra Zeneca CEO David Brennan: “Discovery needs to be underpinned by new financial mechanisms that allow companies to receive a return on their investment in new drugs, while limiting their use to situations of greatest need."

And yet, Stovall continues, “Experts say it isn't viable for drug companies that spend millions developing a new antibiotic medicine then to be told by regulators to hold it in reserve for the next emergency. A fresh approach and new business model for antibiotics R&D is needed, they say. Options include new models for compound-sharing in discovery research, the revisiting of previously discarded compounds with modern methods, and the involvement of public funding in antibiotic R&D.”

The collapse of the antibiotic production line is another instance of the Serious Medicine Crash; we are seeing plummets in the larger category of new drugs and devices that parallel the collapse of antibiotic production.   Indeed, we are also seeing a collapse of the medical venture capital market.  

If this crash continues and worsens, leaving us vulnerable to public health threats such as NDM-1, then the debate over health insurance that has transfixed American public policy for the last three decades will look like small potatoes--or worse, the debate will look like a dangerous diversion, a diversion that took our collective eye off the ball of our own health and longevity.

Here's a screengrab of the WSJ story: 

Wednesday, April 6, 2011

National Health Service Rationing--Nothing new there. And meanwhile, a "game-changer" in the US, if we want it.

The BBC reports that the UK's National Health Service traditional approach to medicine--rationing by queue--is worsening.    Meanwhile, there's hope on the horizon, in the form of a new treatment for heart disease--not that the DC political class seems interested.  

Let's start with the BBC story.  Yes, resources are scarce, but as noted here many times at SMS, healthcare is a good that people want--they will pay for it.  Indeed, it's a "superior good"; as incomes rise, demand for healthcare rises.  And while it's certainly true that incomes have been flat or even negative in many sectors of late, the overall income trend is up, around the world.   And so of course, demand for healthcare has risen.  It's foolish, indeed, to fight something that people want--especially in recessionary times, when the US market, in particular, is looking for new demand drivers.  

For some reason, surging demand for healthcare is regarded as being in a different category from other kinds of demand.  We have to "bend the curve," we are constantly told. But we might ask: What if some "curve bender" had decreed, in 1910, “We are spending too much on cars”?  After all the 1910 thinking might have gone, we have enough cars--defined as the “right” people have them.  And o there’s no need for anyone else to have them, cluttering up the roads, etc.  If such a decree would have stuck in 1910, thus thwarting the Model T and everything else that came out of mass production, lower prices, and higher wages, not only would a whole new industry of been thwarted, but so would the American Dream of prosperity and mobility.   And so instead we'd have a world of relatively few hand-crafted cars--very expensive, and not very good, in spite of the hand-crafting.   What really guarantees the functioning of a machine, we have learned, is mass production. And oh, by the way, speaking  we might not have had the industrial plant that we later needed, in two world wars, to make war-winning vehicles and tanks and airplanes.    

The same process--mass-produce it to make it better and cheaper--has been in medical procedures and devices.  That's how we got from open-heart surgery to angioplasties and stents, and now, to a new kind of heart valve from Edwards Lifesciences, Medtronic, and Abbott Laboratories.   In the words of one scientist, the Sapient Valve is "a game changer," because surgery won't be required--the devide can be snaked into the chest through a catheter.    If it's a game-changer for patients, it will also be a game-changer for healthcare providers.  And assuming that the FDA and the trial lawyers don't find a way to shut this innovation down, it could be a major export item.  

So the goal should be to provide the most efficient, least-obstructed--and therefore cheapest--pipeline from consumer demand to medical supply.  If the government wants to help, it can mostly help by funding the sort of medical research that makes disease and treatment cheaper.   Rationing is not popular, especially in a news-rich environment; indeed, to the extent that rationing cripples the process of ramping up supply--and the lower costs that come from economies of scale--then that rationing process leaves healthcare not only scarcer, but more expensive on a per-patient basis. 

Thus the choice: Do we want less of an item and more expense, or do we want more of an item at less expense--and greater quality?   That should be the no-brainiest of no-brainer questions, but in Washington, the issues are always cast in the shortest of short terms.  If it bumps up the deficit in the next year or two, it's bad.   Period.  End of discussion.   And that means that long term health and wealth are consigned to the present-value dust bin of the over-the-horizon the future. 

Friday, April 1, 2011

Newt Gingrich Defends Serious Medicine--update

Tweeted out to more than 1.3 million people. 

Newt Gingrich and Serious Medicine--Vindicating the Upward March of Science and Technology

Newt Gingrich has taken a bold stand on behalf of scientific advancement, better public health, and economic growth: As reported in Politico this morning, he stood up for funding of the National Institutes of Health.   At first blush, Gingrich’s stance might seem like standing up for apple pie--not bold at all.  But in fact, the politics of science, left and right, are prickly and tricky.  It seems, today, that it’s a lot easier to find opponents of science than proponents, at least in policy circles.  And yet of course, it’s science and its handmaiden, technology, that opens the door to both better personal health and more economic growth.   

From the left, Gingrich is confronting a peculiar school of ideology that holds that medical science is less important than social science. That’s the sort of politico-bureaucratic thinking that gave us Clintoncare and then Obamacare; it’s an obsession with health insurance, as distinct from health itself.  Furthermore, it’s the idea that scientific advancement is less important than social justice; indeed, it’s the fear that scientific advancement will somehow waylay the march toward equality and social justice.   On top of all anti-technological thinking come the Greens, who see just about any sort of progress as a transgression of their steady-state worldview.  

And on the right, Gingrich confronts a strain of libertarian purity that rejects the idea that collective political action can accomplish anything worthwhile.  Such a vision would be news to the leaders who mobilized science and technology to win, say, World War Two, or to eradicate smallpox or to build the Internet, but it’s a strong and well-funded impulse in Washington today.  The Cato Institute, for example, has called for abolishing the NIH.   The scientific establishment, to be sure, does itself no favors when it embraces the “magical thinking” of the Greens on carbon dioxide, but that’s an argument for checking-and-balancing Big Science,  and for pointing it in more constructive directions--not eliminating it.    

Ideological blips aside, the last three centuries of the industrial revolution have demonstrated the power--and popularity--of scientific discovery, technological innovation, and a rising standard of living.   Indeed, as China and India remind us, the rest of the world is now joining in.  We can all benefit from techno-marvels (even as we defend against some of them), but we know for sure we will have to compete to reap the greatest benefit. 

It’s to Gingrich’s enormous credit that he sees the value of that big-picture reality, even it costs him politically in the short run.   As Politico’s Kate Nocera reports:

Gingrich differentiated himself a bit from cut-first-ask-questions-later Tea Party Republicans, saying he helped balance federal budgets in the 1990s through a combination of smart reductions and targeted funding increases to critical research agencies that help improve care and contain costs long-term, the Institute of Medicine and the National Institutes of Health.

Gingrich said he was “deeply opposed” to the proposed billion-dollar cuts to the NIH and while the medical center needed bureaucratic reforms, investing in research now would save incredible amounts of money in the future – especially relating to diseases like Alzheimer’s and Parkinson’s.

Gingrich is right.  We won’t save much money on healthcare by chipping away at existing treatment models.  Instead, we will save money by transforming existing treatment models, to the point where the disease itself is transformed out of existence.  That is, we will cure diseases, not just care for them.  It’s cheaper to beat than to treat.  

Let’s take Alzheimer’s Disease (AD) as an example.  As former Supreme Court Justice Sandra Day O’Connor wrote last year, we are spending nearly $200 billion a year on AD care, mostly through  Medicare (plus another $200 billion a year, we might add, in uncompensated costs for caregivers), and yet we are spending only around $500 million a year on AD research.   That’s penny-wise and pound-foolish.  

Obviously, it’s cheaper, as well as more compassionate, to cure the malady than it is to care for it.   As O’Connor observed, we don’t spend money on polio anymore, not because we streamlined treatment, or because we are heartless, but because we eliminated the disease itself.   Or as the Alzheimer’s Association puts it: 

Meeting unmet medical needs for both prevalent and rare conditions promises even greater benefits. Consider again Alzheimer’s disease. In addition to the heartbreaking human toll, without a disease-modifying breakthrough, the cumulative costs of care will exceed $2 trillion in the next decade and $20 trillion from 2010 to 2050. The number afflicted will soar to 13.5 million. A breakthrough by 2015 that delayed the age of onset of Alzheimer’s disease by just 5 years, however, would mean 1.6 million fewer affected by Alzheimer’s and savings of $42 billion a year to Medicare and Medicaid by 2020, and more than $362 billion a year by 2050.  Research into Alzheimer’s treatments and even potential vaccines is underway in America and, with enhanced and sustained support, provide our greatest promise for reducing the spiraling Medicare and Medicaid costs associated with this disease.

To put it another way, in 2010, AD is costing America about 1.2 percent of GDP, headed toward four of five percent of GDP in the coming decades.    Speaking of the financial impact of AD treatment last year, one top researcher chose a vivid metaphor that’s even more vivid this year:   "We have a tsunami coming at us, and we're sitting in a rowboat," said neurologist Richard Mayeux of New York's Columbia University to the Washington Post in 2010. Surely that can’t be a good idea.  So a “cure strategy” might seem like an obvious approach.   We will all still die, of course, but we live longer and better first.  As an economist might say, in living longer, we will more fully amortize the investment we and society made in our own human capital.   

And there’s an important lesson here for conservatives and libertarians: The reality of rising costs is what drives people to seek health insurance of various kinds, and to seek government help in paying their bills.  And that treatment, as we have seen, is expensive.  It’s expensive because disease is expensive.  In February, I elaborated on this point for The Washington Examiner, citing Baumol's Law.  So the goal is harness the power of industrialization and mass-production to make goods cheap.  That’s why aspirin and bandages, for example, is cheap.   The wondrous inventions of one era are the commonplace of a later era.  That’s part of progress.  

As we have seen, the left has sought to address health concerns by overlaying social science on top of medical science, even if such spending is a) unpopular, and b) not the real solution.  So Gingrich was on to something when he said in the same Politico piece: “When Obamacare is repealed we can’t go back to a world that led us there, which was the same world that led us to Hillarycare which is why we have to have a replacement.”  In other words, even if Obamacare is repealed--and Gingrich hopes and expects that it will be--the same political forces that propelled its enactment will still be in place, waiting for a future opportunity to re-enact a similar bureaucratic program. 

For his part, Gingrich’s healthcare solution is more than just cures:  In the same talk that Politico reported on, he also called for tort reform, which would help end the Serious Medicine Crash.  And he advocates rooting out Medicare and Medicaid fraud, suggesting that anti-fraud efforts could save  $70 billion to $120 billion a year.  

And he further added, “And the cost of defensive medicine today is $800 billion a year.... If we fixed these two things we would have more than enough money to cover the uninsured.”  Eliminating defensive medicine is another way of saying, “improve treatment.”  And one key to improving treatment is the profound acceleration of medical technology, to Silicon Valley levels of productivity and achievement, as argued here at SMS.

So when Gingrich talks about healthcare overhaul, he is talking about many interlocking elements: funding medical research leading to cures, weeding out fraud and abuse, squelching abusive and counter-productive lawsuits, and then using information technology to improve healthcare delivery across a nation of 300 million Americans.  This is a huge challenge, of course, because these gains must be frameworked within a proper respect for ethical and privacy concerns.   To that list we can add, by the way, a thorough overhaul of the way that both the FDA and the NIH do business--as Gingrich has advocated many times.  The FDA is too restrictive, and the NIH, in the mordant phrase of Lou Weisbach, co-founder of the American Center for Cures,  “seems more interested in doing curiosity studies” than in focusing on translational research.   It would, indeed, be easier to justify NIH spending if it thought of itself in more of a DARPA model.  That is, decide what needs to be done, and then finance the doing of it.  

In other words, this medical agenda won’t happen without a lot of thought--including thought by governments at all levels.  We might ask ourselves: Is anybody going to trust private companies to do all this?  Give insurance companies, for example, the power to push aside lawsuits?   No.   True reform will only come from massive buy-in across the whole of our society.  And the process of achieving that buy-in is inevitably political.  Indeed, American history shows that what’s popular, and what works, and what endures is a productive cooperation of the two sectors, public and private. 

And there’s abundant recent evidence that this public-private approach has succeeded in healthcare--that is, the fusion of medical research and entrepreneurship, for the betterment of both.   

Harvard health economist David M. Cutler has been prominent in quantifying the economic gains of better health; he has showed that the gains vastly exceeded the economic cost of healthcare.  This is an important point: If one only looks at the cost of healthcare--$2.6 trillion at last count--and not at the benefits (not limited, of course, to economic benefits), then healthcare looks fantastically expensive.  Yet if one calculates the value of better and longer living, then the picture looks completely different---like a bargain, in fact.    

As Cutler wrote in his 2003 book, Your Money or Your Life,  "The conclusion is clear: We spend a lot more on heart attack care than we used to, but we get even more in return.”  And the same applies to other kinds of medicine: “We spend a lot on medicine, but we get more in return. . . . a central feature of the medical system is the increasing value it provides over time.”   

We might note, of course, that not all healthcare is that productive.  It’s smarter and cheaper--and ultimately more compassionate--to deal with disease before it strikes.   That’s the logic of vaccines.  But at the same time, the requirements of compassion necessitate spending money even on “futile care.” The challenge, then, over time, is to improve health so that we spend money on genuine rehabilitation.  Helping the paralyzed to walk again, for example, is vastly superior to merely financing wheelchairs.

Other economists have done similar work on other illnesses, showing how cure is cheaper than care.   Two academics, the University of Chicago’s Tomas Philipson and Stanford’s Eric Sun, estimate that the savings in the US from a single treatment for AIDS--the so-called HAART “cocktail”--have totaled at least $330 billion. Once again, healthy people live longer, produce more, and pay more taxes.   Another study on cancer found similar results: For a single decade, 1990 to 2000, researchers calculated that improvements in cancer survival generated a social surplus of between $1.6 trillion and $1.9 trillion.  
Who made money from that progress?  We all did.  Out of those gains, health care providers and pharmaceutical companies did well, but in fact, they captured only between 6-19% of that total.   In other words, of all the economic gains from enhanced cancer survivability, individuals, and the economy as a whole, captured between 81 and 94 percent.   That’s a lot of money--in the trillions.  So we can see, greater wealth for a healthy workforce is a spillover of Serious Medicine.  

And the prospect of using Serious Medicine to nurture a healthier workforce should attract the attention of political leaders looking for solutions to the deficit crisis.  Otherwise, when they tell the truth about fiscal challenges they will be greeted with partisan criticism--and little science-based support, because science was not engaged in the policy formulation process.  

Last summer, for example Rep. John Boehner, then the Republican Minority Leader, observed that an entitlement-cost solution should probably include raising the retirement age to 70.  Many Democrats rounded on Boehner, even as “deficit hawks” agree that a raising of the retirement age is an obvious solution.  So Boehner and like-minded leaders would have been well advised to embrace the idea that curing AD is cheaper than paying for its ill effects.  And how much would it add to the GDP if everyone works ten years longer?   Unfortunately, the prospect of science as a transformative agent is little heard in Republican circles these days.   It’s just not found in the talking points.   Some on the right seem to think that rhetorical escalation and ideological zeal will do the job of crushing Big Government.  They are wrong.   The problem of AD, to name just one costly illness, is not a problem of ideology, or market forces.  It is a problem of science and medicine.   If people get AD, they will suffer--and we will pay.  In such an instance, the financing mechanism is less important than the costly reality of the disease itself.   

For his part, Gingrich has always understood that conservatism can’t flourish without a modernizing, pro-technology spirit.   After all, it was the bourgeoisie--the Tea Partiers of their era, some might say--that championed the Scientific Revolution of the 17th century (Newton, Van Leeuwenhoek, Leibniz, Boyle).  And it was the enlightened fusion of science and statecraft in that era that led to the institutionalization of scientific and economic progress.  In 1660, for example, the Royal Society for Improving Natural Knowledge was established.  For three-and-a-half centuries, the Royal Society as been the intellectual equivalent of a holding company for just about every English scientist.  And Britain, of course, was the mother country of the industrial revolution.   

As far back as his book Window of Opportunity, published in 1984, Gingrich argued that the American right, by itself, was not strong enough to change the political culture.  The right needs to keep a principled alliance with science and technology, because it’s in technology that the invisible hand of the market is so often manifested.   That is, people know that market-capitalism works better because they can look around and see its fruits.  That’s a political winner: aligning the right with the forces of change and progress to do battle, if necessary, with the anti-technology left.  (Although one can always hope, of course, that pro-technology Democrats, in the FDR/JFK tradition will join the effort, and make scientific advancement a consensus issue, as opposed to a partisan issue.)   That's the Reagan model; the Gipper always wanted to associate himself with science and technology.   

Indeed, technology is the great game-changer--consider the device on which you are reading this blog posting.    And oh yes, it's better technology that enables wars to be won at less cost.

If we want to be healthy here at home, if we want to shrink federal spending, if we want to avoid defeat in the brain race with China--to say nothing of an actual conflict with China--we will have to embrace science.  In  a better America, support for science and technology would be completely bipartisan and mostly non-controversial. 

Unfortunately, that’s not the case.  So we should be all the more grateful that someone such as Gingrich stood up and said what needed to be said.   Politics aside, the fate of the nation is at stake.  We should all be able to rise above the blinders of ideology to see that centuries-old reality.