The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor

Former Wall Street tech investor and electrical engineer Kessler is trying to find the next big thing that Silicon Valley can bring its economies of scale to in the form of ever increasing processing power at ever lower cost. He believes that computing (hardware and software) can do for medicine what it has done for banking and retail - replace people with automation, save lots of money and improve results. As a technical, but not medical, person I find his vision of a medical revolution in the next decade or so is fairly compelling. The shift he envisages is from one from often futile, expensive and invasive treatment of advanced congestive heart disease, stroke and cancer to one of early detection leading to less invasive, less costly and more effective treatment. The exciting thing about his vision is that it seems to rely less on speculative technologies like nanobots and futuristic drugs, that may be viable in a couple of decades, and more on technologies that already exist and are in use but need to be improved upon to be more cost effective and more precise. Imaging and detection of specific protein markers for various cancers feature large in his vision. The book is full of amusing anecdotes and characterizations and is a narrative reminiscent of Hiaasen's novels of his quest to try and understand how the technologies of Silicon Valley can be applied to medicine, a quest that covers trade shows, conversations with medical researchers, venture capitalists and so on. This book may not be for the prudish, politically correct or for those that just want the facts. Otherwise you'll find it a surprisingly entertaining read given the subject matter, the coverage of which did not disappoint either.

What a great book. I highly recommend it. Andy Kessler delivers again. Curious and passionate, though always a skeptic, Mr. Kessler takes readers on a journey through one of the most important and complex subjects of the day - US Health Care system. The system is in shambles - over 40 mm Americans are uninsured, as many as 100 mm are under-insured, we spend twice as much per capita on healthcare as other developed countries with little to show for it and as Americans (think baby-boomers) get older, healthcare costs will really become a bottomless pit (these costs are currently ~15% of the economy and growing at double-digit rates, while the economy grows at 2-4% per annum - scary math.) Something needs to be done now, before the expenditures on sick and elderly become unsustainable. Mr. Kessler is "money" guy (see his other books "Wall Street Meat" and "Running Money" - both are great) and is looking for SCALE - massive cost reductions akin to those we constantly see in tech world. He looks for "SCALE" on the cutting edge of tech and R & D and rightly focuses on the most overlooked part of the healthcare system - early detection and prevention. The writing is crisp and very funny (Mr. Kessler's trademark) though could use a tad more structure (at times it feels like reading "On the road.") Get this book, you will learn a great deal and will have a blast!

Kessler wrote this book for himself and his generation, but of course, we can all benefit from his insights. If he is right, when he sates that the medical reform he describes will transform 70-something guys into 50-something guys, then I maybe I can also qualify as a baby-boomer. Unfortunately, the implication is that better health care will allow guys like me to live longer ... thereby depleting our Social Security and Medicare "trust funds" even more than currently forecasted. Today many believe that neither Social Security nor Medicare will be around for the boomers anyway (at least in its present form), so Kessler's book is timely. Something has to be done, and most agree that the most pressing of the two is Medicare. Andy describes a reasonable scenario how such change might come about. Consider the problem. Today the Health Care Industry accounts for about 15% of GDP. That's 1.8 Trillion dollars, where 5% of the sickest account for 47% of the expenditures. Dr. Simplot, one of the key players, has the answer to spiraling costs: "Just keep people from getting sick in the first place" and that's pretty much the theme of the book. So what if we had a health care system where all the incentives (primarily profit) were designed to prevent chronic disease? We'd be able to eliminate the last ten years of misery prior to dying in a medically induced coma in the last month. We'd be able to eliminate the huge psychological and monetary expense to those left behind. But most appealing, to me, is the idea of maintaining a high quality of life until the last week or month and then dying at home of "natural causes." Hospitals and doctors would rarely be used. Kessler, a hedge fund guy who made a fortune by investing in "things that scale," believes we're close to making it happen. Not 20 or 10 years away, but in the next five. High tech Silicon Valley guys like Kessler refer to scaling as something that can always be made smaller, cheaper, faster, and better. Usually this involves silicon which is plentiful and very cheap. Every new generation (think CPUs, memory, mass storage, and cell phones) creates entire new industries ... which then enables the next generation of silicon to be made SCF & B and the cycle repeats. Traditional medical guys who currently dominate the power structure aren't able to appreciate scaling. It goes against everything they've ever believed in. After all, you have to wait for lab results, patients get well slowly ... it all takes time. Normally, biology doesn't scale and FDA approved biology is VERY slow and VERY expensive. Besides, many patients need their doctors, who tend to provide as much psychosomatic counseling as anything else. But maybe it doesn't have to be that way for all of us. Some of us believe in the HMO idea of preventative medicine ... only we want even more control. No problem, the younger doctors are coming and they're the ones who like toys, computer databases, and new technology. Toys like LASIK

I read this book in one sitting interrupted only by a four-hour break to sleep! My first thought on finishing it was to marvel that any book so enjoyable to read could be so thought provoking, educational and stimulating, especially when the subject is as forbidding as the state of the US Health Care industry! I don't ever remember reading a book of non-fiction where I immediately wanted to go back and start reading it again from the beginning. The book is definitely written for the general reader and he keeps the medical jargon to a minimum. Another refreshing aspect of this book is that it is not political. He does not blame "big pharma" or the government or the FDA or the AMA or whoever. He seems to realize that all that will do is put people's defenses up and thwart his desire to start a debate on this incredibly important subject. There are some heroes in the book, however, like Don Listwin (ex- Cisco and Openwave) who has founded (and largely funded himself) the Canary Foundation, the nation's only non-profit organization devoted exclusively to early detection of cancer. More than half our medical dollars in the US are spent in the last year of life. Only a fraction of one percent is spent on the detection of the big three: cancer, heart disease and stroke, the early identification of which would significantly reduce the incidence of early death and chronic illness here and all over the world. The implications, social and economic, are staggering and all for the good. (Perhaps it will be a thorough exposition of those implications that will finally change the terms of the debate.) Andy has not got the answer and does not pretend to. But he provokes us to ask some very good questions. As much as the book leaves us wanting more, the question is where do we go next? We know what the problem is. Where do we go from here? Hopefully with Andy as our guide, if he continues in this vein, it will be a heck of a ride. Buy this book; you will NOT be disappointed.

I enjoyed Kessler's other books, and this one is just as enjoyable, following him around as he tries to figure out if technology changes medicine. The stories are hilarious, he spends time with doctors and in labs but the best ones are watching him get scanned and getting blood to do tests on himself. By the end of the book, you figure out that cheap enough chips find heart problems and cancer early enough to something about it, which is good, since lots of heart attacks in my family. I recommend it, I'm giving one to my doctor.