End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor by Andy Kessler

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The old country doctor complete with a dangling stethoscope and a wry bedside manner has gone the way of the village blacksmith. In his place are diagnostic software and other advanced technologies that can upgrade mere intuitions into virtual realities. But there is a problem. HMOs, lobbies, lawsuits and patients' insistence on personal care may limit these mind-boggling advances to a fortunate few. Andy Kessler's lively personal journey through the new frontier of medicine will evoke both laughter and alarm.

From the Publisher

You get sick; you go to your doctor. Too bad. Because medicine isn't an industry, it's practically witchcraft. Despite the growth of big pharma, HMOs, and hospital chains, medicine remains the isolated work of individual doctors -- and the system is going broke fast.

So why is Andy Kessler -- the man who told you outrageous stories of Wall Street analysts gone bad in Wall Street Meat and tales from inside a hedge fund in Running Money -- poking around medicine for the next big wave of technology?

It's because he smells change coming. Heart attacks, strokes, and cancer are a huge chunk of medical spending, yet there's surprisingly little effort to detect disease before it's life threatening. How lame is that -- especially since the technology exists today to create computer-generated maps of your heart and colon?

Because it's too expensive -- for now. But Silicon Valley has turned computing, telecom, finance, music, and media upside down by taking expensive new technologies and making them ridiculously cheap. So why not the $1.8 trillion health care business, where the easiest way to save money is to stop folks from getting sick in the first place?

Join Kessler's bizarre search for the next big breakthrough as he tries to keep from passing out while following cardiologists around, cracks jokes while reading mammograms, and watches twitching mice get injected with radioactive probes. Looking for a breakthrough, Kessler even selflessly pokes, scans, and prods himself.

CT scans of your heart will identify problems before you have a heart attack or stroke; a nanochip will search your blood for cancer cells--five years before they grow uncontrollably and kill you; and baby boomers can breathe a little easier because it's all starting to happen now.

Your doctor can't be certain what's going on inside your body, but technology will. Embedding the knowledge of doctors in silicon will bring a breakout technology to health care, and we will soon see an end of medicine as we know it.

Publishers Weekly

Kessler, bestselling author of Running Money, made his fortune speculating on Silicon Valley. Now he turns his nose for new technology to medicine. Will the same advances that revolutionized computers ripple through hospitals, changing how health care works? Kessler interviews doctors, technicians, radiologists and the businessmen behind technology in medicine. Advances in radiologywhich encompasses all the ways we peek inside our bodies, from X-rays to MRIsare beginning to make our hospitals look like Star Trek. New scanners can provide a high-resolution, three-dimensional image of the heart and allow doctors to spot blockages. Computer-aided diagnostic software is slowly replacing radiologists in looking for cancer in mammograms. But HMOs, lawsuits and patients' desire for personal care may prevent these new techniques from ever being used. As Kessler asks, "What if the future was here with no one to pay for it?" Kessler has a raconteur's ability to entertain, and his outsider's view of medicine is far from typical in a book on health care. However, his narrative is fractured by too many entertaining anecdotes, preventing his story from moving forward. The hors d'oeuvres are delicious, but in this meal, there's not enough room left over for the meat. (July) Copyright 2006 Reed Business Information.

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Broken Neck?

We were on our third pitcher when the conversation started getting interesting. I used to ski just about every year with Brad Miller. I'd known the guy forever, but then again, you never really know someone until the third pitcher. He was an equity salesman at Morgan Stanley out of San Francisco, back when I was an analyst following companies like Intel. I used to meet him and a few others on the ski slopes at Snowbird and Alta in Utah to, uh, discuss tech trends, at least that's what I put on my expense reports.

As the Red Hook slid down easy, Brad started babbling about a ski trip to Sun Valley, Idaho.

"It was one of those beautiful days-sun shining-it's getting warmer as the day goes on-my legs are feeling great," he started. I pretend to enjoy other people's skiing adventures but usually just think about myself in the deep stuff.

"Uh, you somehow forgot to invite me on this trip?" I joked.

"Must have been an oversight. Anyway, this is the first day of the trip. We're hitting the bumps just before lunch. You know that feeling, you hit the trough of the mogul, the snow kicks up behind you-you feel like a fucking rock star."

"Doesn't happen to me that much." I sighed.

"Then I catch my skis on some soft snow. Instead of the usual ass-over-teakettle fall, I get twisted in some weird half turn, my upper body goes 180 degrees and I end up looking uphill, my ass hits the top of the mogul and a shock wave rips up my spine-my glasses go flying, the whole damn thing."

"Jeez." Okay, now I'm paying attention.

"So I'm seeing stars-I'm dizzy, woozy, nauseous, sweating. It took me 15 to 20 minutes to get a grip. I side-track out and get on some green run and meet my buddies for lunch."

"They didn't wait for you?" I asked.

"Nah. So I immediately went for a beer, figured that should help, I'll be fine. After two sips, my neck is stiffening, seizing up, so I say, ‘Guys, I'm fucked. I gotta get out of here.' And they started laughing, ‘You wanna ride in the toboggan behind the ski patrol guy?' Yeah. Really funny. No fucking way."

"That would have been a sight!" I said.

"Yeah, maybe. So I rode the ski lift down, got to the bottom, and drove myself to the Wood River Memorial Clinic."

"And they patched you up?"

"I was third in line. Two people ahead of me had hit trees that day. Just my luck. I end up waiting four hours and then finally get an X ray, then a CAT scan, then another X ray. This very nice female doctor tells me the little wing piece on one of my vertebrae looks like it may have broken off. If it's floating around, it can cut your spinal cord and kill you. I needed an MRI, which they have in Boise. So I get strapped to this plastic backboard, head immobilized, and they put me in an ambulance for a three-hour ride to Boise-the long way, which had less bumps."

"Ouch."

"Just as the ambulance is about to leave, she says to me, ‘Oh, yeah, there's this other thing. You have this tumor-we don't know what to think. But that's not your immediate problem, we have to deal with your neck first.' The next three hours were not the most pleasant, as you can imagine."

"What was it?"

"Well, I get wheeled into the emergency room in Boise, still strapped to this board. I waited another three hours-there were only these curtains-a little girl next to me had drunk too much Jack Daniel's and was detoxing and some old guy on the other side was puking in a bucket."

I started laughing. "Sorry, that's not really funny." I put my beer down.

"It is now. So around three in the morning, I finally get an MRI. This really cool doctor comes out and tells me, ‘You didn't break your neck. Nothing to worry about there.' I felt relieved. But then he says, "However, you do have this tumor the size of a martini olive sitting on the top of your spine.' He knew a doctor at Stanford he would put me in touch with, and then he discharged me." Brad sighed. "Then the nightmare started."

"Oh, jeez."

"Yeah, you don't want go through the rest of this. The good news is that I kicked it."

"Kicked what?" I asked.

"Well, I had this tumor on my clivus, at the base of my skull. It's inoperable, too much in the way. It turns out that I had multiple myeloma-bone marrow cancer. It's one of those autoimmune things, your body generates lots of white blood cells, which basically eat your bones away from the inside. In the 1800s, people would sneeze and break ribs, that kind of stuff. It's rare-and misdiagnosed all the time-because other things can kick up your white blood cell count."

"So you had to almost break your neck skiing to find it?" I asked.

"Yeah, it's just a fluke, but luckily, it happened early enough."

"Chemo, I assume?"

"First thing, I had to find a doctor. Stanford led to USF, which did some focus radiation on the tumor to try to stop its growth. But bone marrow is messy stuff. Dana Farber at Harvard is the leading clinician in multiple myeloma. But they pointed me to M. D. Anderson in Houston, Fred Hutchinson in Seattle, which was full, and ACRC, the Arkansas Cancer Research Center in Little Rock. So off to Little Rock, every four to six weeks, 15 months start to finish."

"For what?" I asked.

"Four rounds of VAD cocktail, two rounds of DT-PACE, which has thalidomide-"

"No plans on getting pregnant any time soon?" I kidded.

The foregoing is excerpted from The End of Medicine by Andy Kessler. All rights reserved. No part of this book may be used or reproduced without written permission from HarperCollins Publishers, 10 East 53rd Street, New York, NY 10022.