Arnold Kling  

Medical Technology

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Glenn Reynolds asks for my comments on a book by Andy Kessler. I'll pass on that, but speak to the general thesis that medical technology will advance rapidly in the coming years.

I am generally optimistic about medical technology, but I expect the pace of advance to take a while to pick up, for three reasons.

1. Our economic incentives are biased in favor of incrementalism, rather than radical change.

2. The most interesting opportunities call for subtle control over processes at the cell level.

3. The brain is the last frontier.

I'll expand on each of these points.

1. Just a couple of the many biases for incrementalism:

(a) The easiest way to get funding for research is to renew an existing grant. If you want to get a new grant for an original idea, you have to sell it to people who have gotten where they are today based on different ideas.

(b) Executives have an easier time figuring out the return on investment in medical technologies that represent incremental improvements over existing technologies. With incremental improvements, it is easier to gauge the cost of the approval process, the market potential, and so forth. You know that insurance companies will pay for incrementally better technology.

But incrementalism drives costs more than benefits. You diagnose cancers sooner, but at some point earlier diagnosis does not improve longevity. You develop a slightly better pill to treats allergy symptoms or shoulder pain, but in the grand scheme of things it is not so important. Like Glenn Reynolds, I prefer outside-the-box thinkers, such as Aubrey de Grey, who I mentioned in Crisis of Abundance.

2. The most interesting opportunities require subtle control. You want to shut down process X but leave all other processes unchanged.

For example, in the holy grail of a cancer vaccine, you want to attack cells that are replicating at a dangerously high rate (cancer cells), but leave other cells alone.

Or consider another holy grail--a diet pill that stops calories from turning into fat, without otherwise interfering with digestion or causing harmful side effects. Again, the trick is to shut down one process without altering other processes.

My guess is that the level of control necessary to do these sorts of things will take quite a while to achieve. To build the "designer viruses" or whatever is needed to achieve Holy Grail medicine will involve a combination of nanotechnology and DNA technology, in addition to more understanding of how the targeted processes work.

3. Finally, the brain is the last frontier. It's still hard to study the brain in a low-risk way. The brain is very complex--we don't have knees and shoulders completely figured out, but I think we're much farther along there than we are with brains. Until we figure out the brain, then the best we could look forward to is a life free of cancer, free of heart disease, etc., but where everyone dies of Alzheimer's or Parkinson's.

My guess is that we will see spectacular improvements in medicine over the next few decades. But I'd be wary of the analogy with Moore's Law. The path for getting from here to there is not as well laid out.

Having said all that, Derek Lowe would be a better person to ask about the outlook for medical research.


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