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He marvels, as should we all, at the still wildly imprecise, almost ethereal nature of reading those images from the nether-world within: its extant artfulness, its continued reliance on the exquisiteness of human cognition, and its seeming imperviousness to machine replicability. But confronted by this clear threat to his tech agenda, Kessler goes into classic Silicon Valley health care denial.

But instead of drawing the obvious conclusion—that IT will ship this stubbornly human physician specialty across the ocean on the other end of a broadband connection—Kessler loads up his book with better and faster core diagnostic technologies. Then he misses the only point relevant to his own hypothesis: Such technologies will, inevitably, require more physician labor to mediate, not less.

In his search for better and faster, which often coincides with smaller and more precise, Kessler takes us on a tour of diagnostic technologies that seek out previously undetectable brain aneurysms, coronary artery occlusions, and miniscule but menacing colon cancers. As champions of public health - and ultimately patients ourselves, this is exactly what we want from our medical technologies. But do they really scale? Of course not.

If techno-evangelist Kessler had Googled any actual health services research, he would have discovered that faster and better diagnostic imaging technologies not only will not replace radiologists but will actually increase the need for radiologists to cope with the wealth of new patients eligible for or at least demanding access to the new technologies. He also would have discovered an increased demand for nearly every other kind of physician, downstream of those new technologies, to cope with all the false positives; to perform all the biopsies and other diagnostic surgical procedures they would inspire; to treat the complications and sequelae from all those new interventions; and to initiate ever earlier and aggressive medical and surgical treatment on asymptomatic patients who would have muddled along until their previously undiagnosed condition erupted and killed them.

In a rare moment or two of lucidity, Kessler actually admits that some aspects of medical technology might not scale in ways that would increase diagnostic certainty and reduce costs.

Andy Kessler | Penguin Random House

This he discovers during side trips to pharmaceutical-testing labs, where he watches several apparently personality-free scientists tricking mice into growing cancers and screening chemical compounds for new cures. Here, The End of Medicine inadvertently introduces us to the real underlying reason why doctors do not scale and medical knowledge only exacerbates our awareness of our ignorance: complexity theory.

There are too many human, physiological, phenomenological, and raw scientific factors involved in the actual practice of medicine; the closer we look at the miracles of our own bodies and minds, the more confused we become, and the more we want the human reassurances that only hands-on doctoring can bring. This is the bitter pill that managed care choked on for more than a decade before giving up and simply increasing copayments for physician visits.

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And this is still the reason that public and private health plans alike have always treated new medical technologies as if they were guilty of inflating costs until proven innocent. Simply stated: Diagnosing more does not necessarily mean curing more, but it does mean that we have more to treat. His entire hypothesis thus threatened by his actual observations, Kessler throws up his hands and heads back to the radiology department, treating us to yet another lesson in geometric scaling of computer chips designed to diagnose more diseases for which those arithmetic labs may or may not ever be able to find effective drugs.

He also was a senior campaign strategist for Montana Gov. Brian Schweitzer back in His thesis -- hardly original -- is that Congress has sold out to big business, to the detriment of us ordinary Joes and Joans. Thus, it's a "hostile takeover" of democracy by selfish corporations that want to erode our wages and benefits. Sirota's solution -- again, hardly original -- is to raise taxes on the rich and use the bounty to buy benefits for just about everyone else.

He claims that the current tax regime leaves money in the pockets of "people who don't really need it. Sirota's attacks primarily are against the Bush administration's domestic agenda. Once in a while, he hits the mark.

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His chapter challenging the administration for prohibiting the reimportation of prescription drugs from countries like Canada for safety reasons is a tour de force. Tim Pawlenty, who has favored reimportation. But for the most part, the arguments are cheapened by the author's left-brain bias. During the last recession, he asserts, our government "laughed at American workers as they lost their jobs.


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Mankiw's remark, though clearly impolitic, was not a gibe: It was simply a statement of economic theory. Sirota says his book "systematically reviews in plain English how we're getting screwed, debunks the lies that are used to justify the screwing, and shows the very simple things our government could be doing to improve the lives of millions of citizens.

The End of Medicine

It is designed to arm you with knowledge you can use to help reclaim our government. E-mail comments to editors barrons. All Rights Reserved. A Silicon Valley take on how to "scale" health care. Plus, an overrated political screed. Dow Jones, a News Corp company. News Corp is a network of leading companies in the worlds of diversified media, news, education, and information services.

Dow Jones. News Corp. By Jay Palmer.


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