The Brass Tack

Let's get down to it.

One qualm on health care: innovation

Posted by srconstantin on July 13, 2009

Glenn Reynolds writes about his family and health care.

President Obama talks about the importance of prevention in a way that suggests that when people have heart attacks it’s their own fault. But my wife, a longtime vegetarian and marathon runner, had a freak heart attack at the age of 37.

It wasn’t from too many Big Macs. After some rough patches, she’s now doing well, thanks to an obscure and expensive anti-arrhythmic drug called Tikosyn, and an implantable cardioverter/defibrillator. Not too long ago, she’d have been largely bedridden. These medical innovations made the difference between the life of a near-invalid and a life that’s close to normal.

My mother had a hip replacement. Her hip didn’t break – she basically wore it out with exercise. When the pain got too bad, she got it replaced, and now she’s moving around like before, only painlessly. Not too long ago, she would have been chairbound.

My father had prostate cancer; his doctor suggested waiting but on biopsy it turned out to be pretty aggressive. It was treated with radioactive “seed” implants. He’s now been cancer-free for several years, without the side effects of earlier treatments — or, worse, of cancer.

My daughter had endoscopic sinus surgery this spring. She had been sickly and listless, complaining of constant migraine headaches, missing a lot of school, and generally looking more like a zombie than a teenager. Several doctors dismissed her problems, or prescribed antibiotics that didn’t help much, until we found one who took the extra step.

A head CT scan done on a fancy new in-office machine showed a nasty festering infection, the surgeon cleaned it out, and now she’s like a normal kid again. Before laparoscopy, her condition

would probably have remained untreated, and she would have been another “sickly” kid. Better to be well.

The normal critique of socialized medicine is to point out that people have to wait a long time for these kinds of treatments in places like Britain. And that’s certainly a valid critique. I’m sure my mom and daughter would still be waiting for their treatments, while my father and wife would probably be dead.

The key point, though, is that these treatments didn’t just come out out of the blue. They were developed by drug companies and device makers who thought they had a good market for things that would make people feel better.

The success and cheapness of universal healthcare in other industrialized countries has to be considered in the context of a world where the US exists — one country where it’s possible to make colossal profits by inventing a new drug or procedure. Diminish those profits and you might well get fewer new ideas, in the US and in the rest of the world. Now, maybe there’s a moral case to be made that health care ought to be more broadly shared even if less innovative. But it’s hard to measure just how much you lose from the procedures that never get invented, or never tried:

The death of Dr. Helen would have shown up in any system’s statistics. It’s a hard fact which is easy to measure, hard to game. But if she had merely been bedridden, the loss that represents would be hard to measure, and easy for the system to “improve” by deciding that being bedridden wasn’t so bad, after all. An old woman waiting for a hip replacement (or not getting it at all?) A daughter whose health was sort of permanently dragged down by a lingering infection? The system rarely looks for ways to fix things that the system doesn’t measure.

(Megan McArdle.)

A couple years ago, Jon Cohn wrote on the issue of innovation, arguing that most medical discoveries are not profit-motivated, but made in universities and funded by the NIH. Drug companies spend a lot of money on R&D that isn’t really innovation, like “me-too drugs.” But this argument seems thin. First of all, would the government spend so much on the NIH if medicine weren’t big business? The Bayh-Dole Act allowed federally funded researchers to take out patents and otherwise work closely with “commercial concerns” to profit from their research. The NIH has a close, not to say corrupt, relationship with drug companies. Secondly, to say that drug companies waste a lot of money doesn’t imply that the money they do spend on R&D isn’t valuable. Cohn thinks that Obama’s independent advisory boards can replace that messy, profit-driven mechanism by deciding what research actually produces clinical value. The market can’t do that, he argues, because insurance companies are short-sighted, but “The government, by contrast, has plenty of incentive to prioritize these sorts of investments.” Really? Is there no shortsightedness in government, where there are term limits? And what really is the incentive for any advisor to produce clinical value? How, if not by market discipline, can you hold decisionmakers accountable for the drugs and procedures that are never invented?


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