The Obama Administration recently announced the formation of the “Brain Activity Map Project” to be funded by the National Institutes of Health and other public and private foundations and organizations to undertake a ten year study of the human brain. The effort, which is similar to the organized effort to map the human genome is expected to cost at least 300 million dollars a year over the ten years. It is anticipated by scientists that it will be much for complex and difficult to undertake than the genome project. The hope is to develop a complete model of brain activity and the process of neuron firings that lead to cognition.
The Institute of Medicine and the National Research Counsel announced the pre-publication release of their report on their recent comparison of health care data between the U.S. and 16 other countries which crosses all age categories. The other countries include Canada, Japan, Australia, Germany, Austria, Denmark, Finland, Norway, Portugal, Sweden, Switzerland, the Netherlands, the United Kingdom and Spain. This is a fascinating read entitled U.S. Health in International Perspective: Shorter Lives, Poorer Health is currently available to read on line for free at the National Academies Press website. The U.S. generally finished near the bottom in most categories for the population under the age of 75. Our post 75 population, outscores their peers elsewhere.
The writer and curmudgeon Ambrose Bierce once described a banker as a person who wants to sell you an umbrella on a sunny day. A former judge and friend recently described an insurance company in similar terms as selling you coverage for everything except loss. One of the strange anomaly's of health insurance companies is that they make their money by not providing you the coverage you think that you are paying for. Health insurance companies have grown so big and powerful that in about half of the states there is little or no competition beyond two major providers. They make billions of dollars a year, but they do little for the price beyond providing a largely unnecessary financial load on the most expensive health care system by half in the world.
Henry Kissinger famously stated during the Nixon years that “Power is the greatest aphrodisiac.” More than a century earlier Abraham Lincoln noted that “Nearly all men can stand adversity, but if you want to test a man’s character, give him power.” Every hospital as an institution has a power structure among its medical staff. Powerful members of a medical staff are never the subject of sham peer review and rarely the subject of any kind of meaningful peer review. Armed with the control over the peer review process and the statutory immunity and other protections, medical staff leaders wield an immense amount of personal power over those on the medical staff that the view as threats, competitors, or of a lesser station that need to be put in place because of racial or sexual bias or just because they get a level of glee out the use of power to “kick down.”
The Republican Candidate’s debate last week with all of the emphasis on who is and will be the darling of the Tea Party graphically underscored the American value creep of the past four decades away from what used to be community responsibility. Rep. Paul, a physician, continues to rail against the “individual mandate” in the Health Reform legislation enacted by Congress and signed by Mr. Obama in 2009. He views it as a slap in the face of individual rights, because it curtails personal freedom by removing the personal freedom to choose to remain uninsured, whatever the consequences. Moderator, Wolf Blitzer, posed the question to him that if a healthy 30 year old chose not to obtain insurance but was suddenly confronted with an unexpected need for medical assistance, should be be denied treatment?
Andy Kessler is an irreverent, flip and highly readable writer who poses an interesting single question and than doggedly pursues an answer, with a lot of biting asides to entertain the reader. The question is, given the exponential decline in cost of technology in Silicon Valley and its exponential increase in power and effectiveness, why hasn’t medical technology turned over the same returns to deliver more effective health care at a cheaper cost. There are a number of reasons including the inherent slowness of the treatment and study process, the FDA, entrenched economic interests and the focus on treatment rather than prevention.
Recent developments in brain scanning through technological refinements of SPECT, fMRI and PET scans that monitor water, blood and/or glucose movement in the human brain to observe actual brain functioning as opposed to structure are providing a wealth of new information concerning its organization, complexity and integration. Ray Kurzweil believes that exponential improvements in the temporal, spatial resolution and bandwidth of the human brain which is doubling each year, will successfully enable us to reverse engineer the human brains principals of operation in the first half of this century. This will result in that he calls the “Singularity” where machine based intelligence surpasses that of all humans combined, creating a disruptive transformation in human capability. This capability he believes will be a billion times more powerful that all of human intelligence today.
Within several decades information based technologies will encompass all human knowledge and proficiency, ultimately including the pattern recognition powers, problem solving skills, and emotional and moral intelligence of the brain itself.
If one had to design a health care system that would seem doomed to failure one might start with one in which the providers of care were fragmented, independent and driven through the reimbursement system to provide ever more services that generate higher income on a fee for service basis. The system would provide care to patients who were isolated from the economic costs of the services by third party payments, through employer funded insurance coverage. Third party payers would make their money through reducing premium payouts, by simply delaying or not paying out what they contracted to provide or extorting deep provider discounts in exchange for directed volume. The approach to care of individual patients would be ad hoc, without significant oversight. Severely ill patients would be passed back and forth by all providers like the black queen of spades in a deck of cards. Bad debts would be written off as “charity care.” Insurance premiums would rise faster than the world’s oceans in global warming. Sound familiar?
There is much anticipation over the soon to be released new edition of the Diagnostic and Statistical Manuel of Mental Disorders (DSM –V) by the American Psychiatric Association (“APA.) It is due in 2012. There are many interests involved in the development and recognition of categories of mental disorders. (There is still controversy over whether there is mental “illness,” but there is more congruence over the existence of “disorders.” The late poet, Theodore Roethke, once wrote, “What is mental illness, but nobility of soul at odds with circumstance?” The APA, the psychiatric profession, the pharmaceutical industry and other groups have a much bigger and more complex investment in the definition of categories of mental illness.
