Be careful betting on the future of medicine

Posted on January 29, 2014

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Progress...?

How advanced is this?

Have you ever known someone who thought in the manner of, “Oh, I don’t have to worry about such and such. By the time that’s a problem we’ll have figured out how to take care of it.”

Cars and gasoline is probably where this is most pervasive. “Global warming? CO2 emissions? Air pollution? Whatever. Everyone will be driving electric cars eventually anyways.”

Off to driving their Hummer they go.

This extends to human health. Some people, a disturbing amount, think things like “Diabetes? Pshhh. I’m not concerned about diabetes. By the time I have an issue with that we’ll be able to transplant a pancreas like nothing. In fact, we’ll probably be able to 3D print it and have a robot insert it into my body, all while I’m watching Desperate Housewives.”

Off to Cinnabon they go.

It’s almost like they think technological advancement magically happens. Where one day, poof, a particular innovation just appears, like it was guaranteed all along. It’s not as if tons of incredibly bright people are working their asses off to fix these problems. (I’d say this is more the media’s fault than any one person’s. It’s hard to go a day without hearing about some “amazing new treatment.”)

Ben wrote to me in Thoughts on hamstring curls:

“Now, I have to say that I’m not very concerned about my meniscus situation because the reality is, they are making huge advances in cartilage restoration, preservation, and treatment each and every day.”

I’m currently making my way through the book The Second Machine Age: Work, Progress, and Prosperity in a Time of Brilliant Technologies, which is about the digital age, what it’s been, and where it’s going. 

Anyone familiar with the topic will have heard of Moore’s Law:

the observation that, over the history of computing hardware, the number of transistors on integrated circuits doubles approximately every two years.

So, we’re able to double our computing power every 18 months or so. Where, over time, we are able to exponentially increase our computing power.

Exponential graph

Exponential function.

Because we’ve been able to drastically improve the amount of computing power we can put in a single chip, we’ve been able to concurrently decrease the costs of computing goods. Less hardware to get same (or better) performance = less cost to produce said hardware.

This is why digital technology has blown us away. The authors of the book reference the world’s top computer in 1997 took up 80% of a tennis court. In 2006, we were able to generate what this supercomputer could do in something the size of a shoebox: The Playstation 3.

While continuing to talk about the crazy progress of the digital age, the authors write:

“As Moore’s Law works over time on processors, memory, sensors, and many other elements of computer hardware (a notable exception is batteries, which haven’t improved their performance at an exponential rate because they’re essentially chemical devices, not digital ones)…”

Note the parentheses. While a throwaway sentence in the book (it’s in parentheses after all), this is a crucial statement for the future of medical technology.

So many of the things we’re trying to improve with the human body involve non-digital processes, such as chemical ones. In fact, I’m not sure you can argue anything in the body is digital. We don’t operate in zeros and ones. Can the digital age help medicine? Of course. Does it exponentially improve our health? Not even close.

When it comes to advancement, technological improvement is not uniform. All areas do not improve at the same rate. We may have gotten tennis court size computers down to Playstations, and I’m sure soon phones, but we still flush our shit down a hole like we did in the 1700s.

Let’s use the same amount of time as the computer example, 9 years. Because this data only goes to 2004, I’ll use 1995-2004. In 1995 a brand new white male could expect to live to 73.4, on average. In 2004, the number goes to 75.7. The medical world is moving slower than the third season of Homeland.

Not to mention many could argue just because we keep people breathing longer, doesn’t mean we keep people living longer. There’s a difference between being alive and being able to live one’s life.

When it comes to treating cancer our first big breakthrough was, “Let’s try to kill some of the body, then hope the tumor doesn’t come back.” After 25 years we made a big breakthrough in 1965. Rather than only use one drug, we should use multiple. We went from “Let’s gently try to kill things” to “Let’s REALLY try to kill things.” It’s only recently we’ve been made headway on targeted treatment, ~70 years after we first started chemotherapy.

I’m not discounting our progress; I’m saying it’s nothing resembling an exponential function.

Forecasting accurately is insanely hard, if not impossible. (See: All of economics.) When it comes to the digital future, it can be even more difficult as imagining exponentials is tough. Even forecasting 5 years is hard. For fuck’s sake, I’m still waiting for the day the weathermen can predict tomorrow morning. When it comes to forecasting medicine, it’s much easier. You can go, “In 5 years it’ll probably be a bit better than it is now.”

Bringing me back to Ben,

“Now, I have to say that I’m not very concerned about my meniscus situation because the reality is, they are making huge advances in cartilage restoration, preservation, and treatment each and every day.”

“I’m sorry man, this isn’t true. Arthroscopy, which is how these surgeries are done, became mainstream ~35 years ago. In that timespan our idea of meniscal surgery has moved from “Take it all out” (menisectomy) to “Take as little out as possible” (partial menisectomy). We haven’t come far, and there’s no indication we’re getting anywhere.

ACL surgery decades ago revolved around patellar grafts. The gold standard is still patellar grafts. This is what all the high level athletes have done. They don’t have any of the new age stuff done. IT band grafts, hamstring, achilles, robotic surgery, etc. They have what was being done 3 decades ago as it’s still what’s considered best.

Even if we do come up with some great meniscal remedy, by the time it’s mainstream, we know it’s safe, it’s approved, would almost assuredly be at least 10 years from now.

Next, chances are it will be using foreign substances. Which in the body is never better than your own body. And we are nowhere near making surgery a “routine procedure.” No surgery, any time, especially orthopedic surgery, is routine or noninvasive. Not until they stop making people sign the, “You could die during this,” amongst other factors.

The only possibility I’m aware of that seems like a panacea is nanotechnology. This is Star Trek type shit. Something like where we are able to build microscopic robots, insert them into your knee, they go around cleaning up stuff, repairing things, then we take them out and you’re good as new. Lord knows how far away that is.

Lastly, what if it takes 20 years (or whatever) for some great remedy to come about? What if 10 years from now is when you end up really needing it? 10 years of your life is a lot of time to have significant issues. You’re making a risky gamble.

Sorry for the rant, but betting on the future in this context is ill advised in my mind. Taking the best care of your knee right now FOR the future is a much better approach. Then, if something comes along, great. But how much better would it be to not need something to come along because you’ve taken great care of the leg in the meantime? Hell, if you take good care of your leg, you could have bone on bone and still have great function! Playing sports at a high level? No. Great daily function? Absolutely.

As a tangent, where we’ve actually come very far in all this stuff is not the surgical procedures, but the physical therapy. We used to cast people up for months after a knee surgery. Now we make them move the day of surgery!

Remember how I said we’ve gone from “Take it all out” to “Take very little out?” We’ve even found physical therapy after something like a meniscal tear is just as effective as meniscal surgery. Further illustrating how far we haven’t come: No surgery for a meniscus issue is often better than surgery! We’ve gone from “Take it all out” to “Take very little out” to “Don’t even open the knee because our surgical procedure is worthless.”

Ignore the media on this topic and take a hard look at the data. Even if you want to compare yourself to an athlete, the likelihood of a professional athlete returning to form after this surgery is no better than a coin toss. The guy who did Adrian Peterson’s surgery, Dr. James Andrews, is actually the doctor who found this out!

Again, sorry for the rant. I’ve spent a lot of time thinking about this topic.”

Thinking about what we’re on the verge of can be intoxicating. But, be careful about being too optimistic. Thousands of years ago we invented the wheel and the sack. It took until 1970 for someone to go, “Why don’t we combine these things?”

Rolling suitcase

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