Book Review for “The End of Medicine” by Andy Kessler

medicine

Before you take the time to read either this review or the actual book, I offer “fair warning” on the following:

1) Kessler writes with very “colorful” language. If you are easily offended by profanity – don’t read this book.

2) Kessler writes with a “stream of consciousness” as this is really more of a diary of his adventure to see if scalable technology can be applied to medicine, than a typical work of non-fiction. The book is often disjointed and it requires a fair amount of concentration to keep the focus. Some of the medical and scientific research is obviously difficult for lay people (like me) to understand and the fact that Kessler writes of his experiences as they occur does nothing to make understanding any easier.

3) I have a huge personal bias toward technology as a viable solution to most of “what ails us” – in every sense of the word. Kessler simply validates my inherent bias, so this will be a favorable review. If you think I hype his research and conclusions and avoid any “balance” – well, you will simply have to read the book and do your own personal critique.

Kessler is a retired money manager who made a fortune for himself and others investing in technology. He has written two books on the subject and has great “street cred” in both the technology and investment communities. His premise for “The End of Medicine” is quite simply this: technology has completely changed such industries as finance, computing, telecommunications and music/video by taking expensive breakthroughs and making them incredibly cheap through scalability. The disruption has been on a truly massive scale. Why not apply that same principle to the $1.8 trillion health care business where the easiest way save money is to stop people from getting sick in the first place?

Because of his credibility, he gains access to physicians, researchers, code writers and entrepreneurs that have already made the major breakthroughs to bring about the end of medicine as we know it today. You get to meet the folks that have set the stage for the massive disruption that is about to take place – with physicians, insurance companies, Big Pharma, and (gulp) even those of us who sell health insurance for a living.

The focus of his journey is what Kessler calls “The Big Three” – heart attack, stroke and cancer. These medical problems represent the lion’s share of expense in the U.S. today. He begins by investigating EBT scanning and getting his calcium score, (say goodbye Lipitor) then moves to 256 slice CT scanning, 3D technology, and the SilverHawk Plaque Excision System brought to you by Dr. John Simpson, the man that developed angioplasty in America (say hello plaque removal) ends by watching what he calls “naked mice” (they have no fur) injected with cancer cells and then injected again with molecules that find the cells and actually light them up – pointing to the exact spot of the cancer (say goodbye mammogram).

Kessler says the breakthroughs already exist to turn these three medical challenges – heart attack, stroke and cancer – into very inexpensive preventable events. All we need is scale, challenge to the current parties interested in the status quo, and a little help from the FDA.

Because so much of scanning and imaging already uses silicon, it is only a matter of time (when it comes to silicon remember that time moves very rapidly) before we can scan individuals for $100 per visit, determine if they have arterial plaque, and excise it if they do. Breakthroughs in the GRIN technologies (genetics, robotics, information, and nano) and the use of molecular imaging make it possible to actually light up cancer cells from the inside – as opposed to using radiation from the outside that really has no way to identify a cancerous mass in soft tissue (most cancers) until it has become very large. We can then use the very same technology to “zap” it on sight.

The challenge now is to create the scale needed to allow for huge and massive change. Kessler discusses how Big Pharma and their allies will fight to keep statins as a better option to prevention through what he calls the “cholesterol conspiracy”. He doesn’t accuse hospitals and physicians of creating a “cancer conspiracy”, but he does wonder out loud if there might be such a problem given the huge amount of money involved. Finally, Kessler points out how the FDA is essentially built along a “treatment rather than prevention model” in their approval process.

His question is a simple one: with the billions of dollars being spent to treat “The Big Three” – doesn’t it make sense to spend a fraction of that amount on preventative research? His answer obviously is yes – and the challenges mentioned above are now starting to crumble.

The VCs (Venture Capitalists) are starting to circle the startups in the scanning and imaging business. The huge players like GE, Siemens and others now have a competition every year in San Francisco called the “Face Off” dueling each other with faster and more detailed scanners and 3D imaging, and the attendance is off the charts. Retired Cisco executive, Don Listwin has invested millions with the Hutchinson Cancer Research Center in Seattle and now spends his time and talent raising millions more to research molecular imaging. Finally, George Mills (Deputy to the Deputy Director of the FDA – you just have to love this stuff) has set the protocols in place for limited use of molecular imaging on real live people so long as they are tied to other drug testing. The “back door” to early detection is open.

Kessler’s own words:
“All of these eureka moments woke my sleepy butt up. Seeing digital imaging and plans for a cancer detection chip and a back door open at the FDA for all of this was all I needed. Change was a-comin’. The geeks weren’t just the gate, they’d laid siege and were halfway up the ladders with Treos drawn, ready to attack.

The same thing that happened in other endeavors is about to happen in medicine: embedding the knowledge of doctors into software and silicon. It produces medicine for consumption. Microsoft and Intel did this for computers. The high priests of mainframe computing gave way to empowered users. Their programming expertise became embedded into a consumable spreadsheet product – customize for your own use. Eventually, the COBOL programmers disappeared, opening up massive new markets.

You can smell it from this far away. Doctors are toast. It’s the magic pill – heart attacks, stroke and cancer are cured. Except there is no magic pill, but we get the equivalent of it. If health care budges even slightly from chronic care to early detection, the waves of change rip through medicine like CAT 5 hurricanes. Every assumption about how many doctors and what type and what they do comes into question.

I fired my doctor, but what a huge hassle it was even to get my blood drawn. But it’s just starting. Radiologists are being replaced by computer-aided detection. Ophthalmologists are being shut out by LASIK. Pharmacists dispensing statins will be replaced by cheaper-in-the-long-run plaque-removing procedures. Dieticians will be replaced by minimally invasive stomach-stapling surgery. Physical-peddling physicians will be replaced by 256-slice scanning machines. And then, we can only hope cancer specialists get replaced by an antibody-laden cancer detection chip.

Will we see doctors in soup lines or selling pencils out of tin cups on the street corners? Are you kidding me? There is so much work to do. When the PC kicked mainframe booty, tech employment went up by a factor of 1,000, maybe more. But it shows up in a different form.

It’s all about research and development and specialists. Which antibodies do we put on the chip? What patterns are we looking for in the arteries leading to the left ventricle? Which drugs, as proved by imaging, actually kill tumors?

Those who figure this out, the knowledge creators, don’t sell their knowledge in eight or ten minute chunks. It’s not a game of one-off, but of selling in mass quantities. They’re the Embedders and Productizers – the Scalers.

This could really flip. Medicine really could go from chronic care to detection. Just a change in how dollars are spent means we would get a huge growth area in the economy instead of a huge financial burden. A double whammy. The stock market will help allocate capital to this business, rather than some socialist system of sphincter pricers at Medicare in Washington, D.C.

Investors will swarm like killer bees. Once there’s a product to consume, one that gets cheaper and cheaper every year, well, then, change is almost automatic. Control shifts. Industries die and new ones are born. Boil some water. Get clean sheets. Call the midwife. Start picking names. This will be the first really new industry in the 21st Century.

Time to start another hedge fund?”

Should the “flip” Kessler mentions above take place it will mean massive disruption. His main focus is on the medical community but of course the impact will be huge on the financing side as well. But I think an argument needs to be made that the solution to so many of our current challenges in financing health care at both the Medicare and employer level might actually lie in this disruption – not to mention better results and longer lives through prevention.

Despite the fact that the book is a bit disjointed, it is an easy read. I strongly encourage anyone engaged in the debate about the future of health care and health care financing to read this book. There is so much going on right now that the mainstream media misses completely. Personally, I think Kessler’s book underscores how completely out of touch the mainstream is right now. But, you know I would say that.

Richard Matthews is a broker in South Carolina and Vise President of Consumer for Health Care Choices. Contact him at ram@dmcollc.com

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