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VCRs have been replaced by DVDs, which have in turn been replaced by streaming and on-demand video.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.
In many ways, this is the best time ever to be a physician.
It’s easy to take such progress for granted. But such innovation doesn’t “just happen.” Instead, it requires a background of economic and political freedom. Just as in the wider economy, turning a good idea into a successful medical device requires vision and business acumen as well as technical expertise. It requires the freedom to take risks and experiment. And it requires the freedom to fail — a necessary part of the freedom to succeed.
So what will be the future of medical innovation under ObamaCare?
Bloomberg columnist Megan McArdle calls this one of the big open questions. In her piece “Is Obamacare Pulling the Plug on Medical Innovation?” she noted:
The only way to find out, of course, is to wait (though really, we’ll still end up arguing: If medical innovation falls, the law’s supporters can always say it would have fallen anyway; if it goes up or stays steady, the opposition can always argue that it would have risen further). But here’s one sign to watch: Venture-capital investment in medical technology seems to be falling fast.
Is this related to Obamacare? Frustratingly, it’s hard to tell… [But] a tax on medical devices and a more stringent cost-control environment could hardly help.
As a practicing physician, I’m deeply troubled by the possibility of any slowdown in innovation, especially because we’re on the cusp of a new round of potentially game-changing medical advances. Some recent examples include:
* Personalized medicine using individuals’ genetic data
* New diagnostic tests that can detect lung cancer with a breath
* “Spleen on a chip” to fight infection
As McArdle notes in a separate piece, other innovations may be less glamorous but still vitally important in preserving quality of life, such as a new bladder control prosthesis that helps prevent urinary infections in patients with spinal cord injuries and neurodegenerative diseases.
But many medical device manufacturers run on extremely thin margins. Small differences in the tax and regulatory environment can mean the difference between a product coming to market — or being abandoned as not worth the effort.
It’s easy to see the lives saved by products that exist. But it’s almost impossible to know which lives would have been saved by innovations that never made it to market. This is just an application of Frederic Bastiat’s old principle of “the seen vs. the unseen.”
Fortunately, we can take steps to protect and improve American medical innovation.
One step would be to repeal the ObamaCare medical device tax — a measure which has broad-based support from legislators in both political parties.
Another would be to reduce (and eventually eliminate) the strangling effect of FDA regulations on medical device and drug development. This will be especially important as we confront dangerous new challenges such as drug-resistant “superbugs” as well as still-unsolved current challenges such as Alzheimer’s disease.
Above all, we should foster a climate of moral and cultural approval for medical entrepreneurs. Honest businessmen who become wealthy creating valuable medical devices should be lauded as life-savers, not vilified. I want as many people as possible to become millionaires if they can do so by honest trade, selling products that benefit my life. Such businessmen should be regarded as heroes, just as many happy Apple customers (myself included) regard Steve Jobs as a hero.
Thirty years from now, you may be the badly injured patient lying in the trauma bay of your local ER. I hope that never happens to anyone. But if it does, you’ll be damned glad that the devices saving your life are real-life products, not just abandoned prototypes gathering dust somewhere in a laboratory basement.