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Will Tomorrow’s Medical Innovations Be There When You Need Them?

We must protect the freedoms necessary for the advancement of medical technology.

by
Paul Hsieh

Bio

November 14, 2013 - 11:10 pm
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How much has American medicine changed in the past 30 years?

Let’s turn the clock back to 1983. A middle-aged man, Dan, is crossing the street on a busy midday Monday. An inattentive driver runs a red light and plows into Dan at 45 mph, sending him flying across the pavement. Bystanders immediately call for help. An ambulance rushes Dan to the nearest hospital. In the ER, the doctors can’t stabilize his falling blood pressure. They prep him for emergency surgery. The trauma surgeon tries desperately to stop the internal bleeding from his badly fractured pelvis but is unsuccessful. Dan dies on the operating table.

The surgeon gives Dan’s wife the sad news: “I’m sorry, but your husband’s injuries were too severe. We did everything we could. But we weren’t able to save him.”

Fast forward to 2013. Dan’s now-grown son Don suffers the same accident. But within minutes of his arrival in the ER, he’s sent for a rapid trauma body CT scan that shows the extent of the pelvic fractures — and more importantly, shows two badly torn blood vessels that can’t be easily reached with surgery.

An interventional radiologist inserts a catheter into the femoral artery in Don’s right leg. Watching live on the fluoroscopy screen, the radiologist skillfully guides the catheter through the various twists and turns of the arterial system and positions it at the first of the two “bleeders.” From within the blood vessel, he injects specially designed “microcoils” into the torn artery and stops the bleeding. He then guides the catheter to the second bleeder and repeats the procedure. Don’s blood pressure recovers. The surgeons now have time to repair Don’s pelvic fractures and other internal injuries.

The surgeons give Don’s wife the good news: “Your husband’s injuries were pretty bad. But we were able to fix everything. He’ll still have to go through recovery and physical therapy. But he should be back to normal in six months.”

Most Americans are familiar with the enormous changes in consumer technology over the past 30 years.

VCRs have been replaced by DVDs, which have in turn been replaced by streaming and on-demand video. Home computers are now smaller and cheaper than in 1983, yet far more powerful. Smartphones didn’t exist 30 years ago. Today, most people take for granted that they have access to the nearly the entire sum of human knowledge at their fingertips. As Twitter CEO Dick Costolo told students in his 2013 University of Michigan commencement address: “When I was your age we didn’t have the Internet in our pants. We didn’t even have the Internet not in our pants — that’s how bad it was.”

However, many Americans may not be aware of similar advances in medical technology. CT scanners in 1983 used to take several minutes to acquire relatively crude pictures of the human body. Today, a high-resolution full body scan takes only a few seconds. Typically, the limiting step is no longer the scan time, but rather how long it takes to safely move an injured patient on and off the CT table.

Similarly, the specialized microcoils used by Don’s doctors to save his life didn’t exist 30 years ago.

In 1983, being diagnosed with AIDS was tantamount to a death sentence. Now, new drugs allow patients infected with HIV to live for decades. Survival rates for many common cancers such as breast cancer and prostate cancer have improved significantly due to advances in surgery, chemotherapy, and radiation therapy. Modern PET-CT scanners now routinely use antimatter (as in Star Trek) to diagnose early cancers more accurately than was ever possible in the 1980s.

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44 weeks ago
44 weeks ago Link To Comment
BW, No of course not but again the lack of profitability is due to government imposed rules. All of those markets you reference, such as China have only 5 big multinationals doing antibiotic r&d, again because it takes on average 12 years and at least $5 Billion for each drug considered, again because THE USA sets the standards for drug approval and all other countries follow the USA standard. All of the smaller drug companies in these countries are doing generics as soon as the big pharma patents expire which in the US is 12 years. They are taking the safe route to making money. None are willing to bet the farm on new drug development. The success rate of new drug development is about 9% which translates to 9 failures out of 10 tries, actually 10 out of 11 but for sake of simple math we'll round to 10%. At $5B per development, and 12 years on average to get to market, and let's say 1 new drug development per year, pharmaceutical companies are spending $60 Billion over 12 years to get 1 $5 Billion drug to market that will only make money for 8 years on average to make back the $5 Billion or if they aren't precluded by government maybe the $60 Billion or a subset of $60 Billion. Of course that's why brand name drugs cost so much. All of this time and expense is to make absolutely sure no future thalidomide tragedy might occur. We blindly demand zero risk. If the drug causes no harm, how do you prove it to 100% certainty? You don't but 12 years of development and phase 1, 2, 3 trials is the standard today. Of course if you have a favored political group like the homosexual lobby, you can get the government to bend the rules, allow test shortcuts, fund the research, accept the risk for the pharmaceutical company to get a drug out there relatively fast. While there are calls for government to accelerate antibiotic development, no government is doing anything yet. I'm afraid, the death rate will have to rise to epidemic proportions before governments fund the pharma industry, reduce testing and trials ala HIV drug trials, shield pharma from risk before you'll see anything done.

So it costs today $60 Billion to develop 1 successful drug (10% success rate). Let's take CDC figures for antibiotic resistant superbug deaths per year, which is 23,000 per year multiplied by 8 years divided into $60 Billion, you have to charge each patient $326,086 just to break even without even considering interest on that $60 Billion capital investment just to develop one drug. No one is going to pay that to a pharma company and the government won't subsidize it either.

As for government investment because the free market isn't working, the reason the free market isn't investing, isn't working is because they can't make a profit BECAUSE OF THE GOVERNMENT DEMANDING ZERO RISK AND IMPOSING RULES THAT IMPEDE THE MARKET. If you accept some risk, then the market would respond as it has with HIV drug treatments. Did people die due to faulty HIV drugs? Undoubtedly but no one is complaining. Another thing the government can and should do is to push for new test protocols based upon advances in science & technology that might shorten trial times and costs significantly. Rules built and mostly unchanged since the 1970s might be out of date but no one is researching that possibility for improvement of things.

See the following for some basic info cited above ...
http://labsoftnews.typepad.com/lab_soft_news/2012/09/need-for-new-antibiotics.html and http://www.who.int/bulletin/volumes/89/2/11-030211/en/index.html and http://www.pjonline.com/news/why_are_there_so_few_antibiotics_in_the_research_and_development_pipeline and http://www.reuters.com/article/2011/02/14/us-pharmaceuticals-success-idUSTRE71D2U920110214 and http://www.ehow.com/facts_6848737_length-drug-patents.html and http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/76xx/doc7615/10-02-drugr-d.pdf and http://www.nbcnews.com/health/more-23-000-killed-superbugs-us-each-year-cdc-says-8C11167661
44 weeks ago
44 weeks ago Link To Comment
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44 weeks ago
44 weeks ago Link To Comment
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44 weeks ago
44 weeks ago Link To Comment
Because of the changes in bioethics that were happening even before Obamacare mandates, for many people the answer to the title question is no. Tomorrow's medical innovations won't be there, because today's already aren't for many people. Medicine has undergone a sea change since the late 1980s, and all of us are at risk.

Wesley J. Smith has documented the new reality ably and aptly in his books Forced Exit and The Culture of Death, and in his blog on National Review's website.

Death panels have been at many hospitals for years. Some states, such as Texas, have codified "futile care" into law, permitting hospitals and doctors to override family wishes and end care for those deemed not likely to survive. Those people aren't getting today's "medical innovations", needless to say, let alone tomorrow's.

Families around the country have reported finding that "DNR" (do not resuscitate) has somehow magically been written on elderly loved ones' medical paperwork, even though it was obviously contrary to the loved ones' stated wishes. The staff's response typically is, "Oh, I don't know how that got on there." The elderly have no value in the new bioethics, you see.

Doctors advocate--and get--"termination" (abortion) for abnormal fetuses, so that some 90% of all with Down's syndrome are aborted, for example. "Your fetus has X abnormality or will have Y genetic problem, but we can take care of that here. Let's make an appointment." You think Planned Parenthood is the abortion problem? Try again. Most abortions take place in hospitals and outpatient clinics affiliated with hospitals for eugenic reasons, not at Planned Parenthood.

And most doctors agree with this practice to save the medical system money that would otherwise be spent for treatment of those born with expensive problems. Which could include your kid one day. Wait till prenatal testing for autism or below-average IQ becomes available.

Recently many reports have surfaced about aggressive tactics on the part of organ grabbers to push families into agreeing to donate a loved one's organs, even before death is officially declared. That's because organ transplantation is highly profitable, while continuing treatment for someone in intensive care is not so much. In Washington, DC, someone deemed not likely to survive with no family available will be presumed to have consented to organ donation absent evidence to the contrary.

Doctors are routinely advocating removing feeding tubes and hydration a la Terri Schiavo, so that "unworthy" patients dehydrate to death, an agonizing way to die. First, do no harm, now lost with these professionals.

Doctors and other medical staff now have begun to advocate withholding most medical care from such people as smokers and the obese. Now doctors are asking questions about your sexual practices, as a New York Post article noted in September. Be ready to answer the questions, "Are you sexually active? If so, with one partner, multiple partners or same-sex partners?" If you don't comply with the approved sexual lifestyle as doctors define it, you might one day find yourself without care too.

So the title question is a straw man. Many are left out in the cold now. Many more will follow, and it has little to do with Obamacare and everything to do with the maturing bioethics. You might be ahead if you don't trust your doctor, Obamacare or not.
44 weeks ago
44 weeks ago Link To Comment
At a certain point, further development will fail because there will no longer be sufficient numbers of people able to pay for it to make it practical. As it is, health care costs continue to rise at a rate higher than the growth of income for most people. Medical care back say in the 1950 was "affordable" even for those without health insurance. And while technology in most fields results in lower prices (computers, TV sets, most electronics), this is not true in health care. Perhaps because government plays such a large role in health care. You will note that in fields where neither government or insurance companies have a role to play, such as the use of lasers to treat eye problems, the cost continues to drop so it is "affordable" for more people. However, in the rest of the health care industry, the opposite is true. Health care is becoming less and less affordable for most Americans. The major reason appears to be "government".
44 weeks ago
44 weeks ago Link To Comment
Within 20 years a significant amount of the new technologies and developments will come out of China. 30 years ago some of the best Chinese researchers trained here and stayed here because there was no real research/medical base to go back to in China. Now, many companies look to Chinese based CROs and university researchers to perform development work. The next step is the origination of the concepts there, development there and further degradation of US capabilities.
44 weeks ago
44 weeks ago Link To Comment
With all due respect, the future you're depicting is laughable. And I say this as someone who's been living in China for the last decade and who works in medical software/translation. I'm not worried at all about China overtaking the US, at least in medicine, since 1) EBM has only just reached China, 2) Chinese unis invest little in research and facilities, and 3) the vagaries of Chinese market controls, e.g. the Bureau of Price Management that sets Gov't-determined prices. And all of that is without me mentioning the entrenchment and even protected status enjoyed by traditional Chinese medicine in society and medicine despite a vast dearth of evidence indicating it actually works.
44 weeks ago
44 weeks ago Link To Comment
For those interested in the real-life technology behind the opening fictional scenario, here's a nice medical slideshow from a UCLA interventional radiologist:

http://www.slideshare.net/pryce27/life-saving-embolizations
44 weeks ago
44 weeks ago Link To Comment
Tomorrow's innovations.
Enough with the innovations, enough with the constant need for "progress," OK??
The world will do quite nicely with 2013 levels of medical technology for quite some time. We would do spectacularly with 1993 levels.
All that these "innovations" really accomplish is to sucker people into spending more and more and more money on "new and improved" stuff that is ultimately only an improvement in the bank accounts of the drug companies, medical equipment companies, and insurance companies.
44 weeks ago
44 weeks ago Link To Comment
sorry to tell people, but you low info voters may get insurance, but you may never be able to find a doctor.

And that confirms that Obamacare was never about health care, but only about insurance.
44 weeks ago
44 weeks ago Link To Comment
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