Intel and others are aggressively pursuing technologies for the aging boomer
market which, in facilitating patient self-care, could
bring down the cost of care and improve quality at the same time. To Intel, it
is not just a commercial no-brainer: it is a societal no-brainer. The trend to
self-care will be helped by legislation that would facilitate public access to public-funded medical research.

The fruits of publicly-funded academic research may
be susceptible to ethical decay if not distributed rather more equitably between
the paying public and the well-paid private beneficiaries. Bayh-Dole or no
Bayh-Dole, the fruits of publicly-funded embryonic stem cell (ESC) research in
the United States are not likely to be plump enough to feed anyone, given the
severe limitations on such funding imposed by the present Administration. Even a
parthenogenic method of obtaining ESCs from blastocysts has
just been put off limits by an NIH assessment that a blastocyst, however
created, is an embryo.

In noting that a recent major U.S. government study’s predictions of
longevity may not be valid 20 years from now because of the epidemic of obesity,
diabetes, and heart disease among middle-aged Americans, and that lifespan could
soon be well over 100 for healthier senior citizens, experts are implicitly
recognizing that given the accelerating pace of change, current long range
predictions of healthcare costs are not very firm ground on which to build major
policy edifices.

HFD urges that long-term-policy-oriented studies as a matter of course
include a study of all conceivable futures, not just one. For example, cost
predictions need to factor in futures in which major diseases (1) are and (2)
are not eliminated by a given target date. As medical technology accelerates,
making unilateral “common sense” assumptions is no longer remotely reliable.
Assumptions are unavoidable, but we need to apply available methodologies to
deal with multiple assumptions — to treat as conceivable things (such as living
to 150, the elimination of cancer) that until recently were inconceivable.

Reference: Johnson, Linda A. (2003). “Longevity’s
Health Care Costs Reassessed.” Associated Press/Washington Post, September
10.

See also “Longevity” article in the
Acceleration section of this issue of HFD.

Cost of High Tech Health

The HeartMate, a left ventricular assist device approved last year as
a permanent solution for people with chronic heart failure who are ineligible
for a transplant, costs $150,000 to $200,000 to purchase and install. That is
between $95,000 to $145,000 more than what Medicare will reimburse. If everyone
who needed a HeartMate got one, it could cost Medicare $15 billion to $20
billion a year.

The device itself costs between $60,000 and $65,000, and the small company
that developed it has begun reporting a profit. If a competitor’s device gains
approval as expected by the end of the year, the price could come down somewhat.

The problem may get worse as other expensive technologies and procedures are
developed, and as the wave of ailing boomers grows — many with “only” an
additional 6-12 months of life to gain from a device such as the
HeartMate. “Technology is being created faster than our ability to put in
any kind of a financial, ethical and moral framework,” said the Blue Cross and
Blue Shield Association’s chief medical officer. A medical ethicist added: “We
are headed for a big political debate about rationing health care.” A Brigham
and Women’s physician noted: “The fact that resources are finite is something
the U.S. is waking up to very late,” Stevenson said. “We ration care all the
time.”

Reference: Agovino, Theresa (2003). “Price
of Heart Device May Mean Rationing.” Associated Press/Yahoo News, September
1.

See also “Heart Pumps” article in the
Devices section of this issue of HFD.

Med Tech and the Cost of Healthcare

A Kaiser Permanente Northwest official believes medical innovation will
continue to raise the cost of healthcare, saying that drugs, medical devices and
medical advances constituted 22 percent of healthcare cost increases in 2001 and
2002, and that these costs will likely jump another 19 to 25 percent in 2003.

Yet, he implied that expensive new drugs are not always safer or more
effective than cheaper alternatives, and blames aggressive drug marketing for
adding to costs. Two insurance executives seemed to imply that health systems
and individuals were to blame for consuming technology at “an alarming rate.”

It seems to us that innovation that brings real health benefits and lowers
costs is in danger of being confused with pharmaceutical price manipulation that
adds to costs without conferring additional benefit.

Reference: Moody, Robin J. (2003). “As
long as medicine advances, costs will increase.” Business Journal of
Portland, September 19.

Industry Forming Around Self-care

Wireless networks, broadband Internet connections, and smart kitchen
appliances are slowly being adopted by the elderly, allowing them to continue to
live at home and relieving the burden of family caregivers. General Electric’s
Home Assurance project is field-testing among seniors simple motion
detectors to watch for abnormal behavior and send alerts over the Internet to
professional or family caregivers. With no video or audio, and no access for
people other than those the senior citizen chooses to let in, the system does
not invade privacy and assuages the patient paranoia often associated with
dementia and other problems of aging. GE hopes to commercialize the Home
Assurance system next year.

Intel plans to start installing prototypes of a system that will collect
environmental, behavioral and biological data on victims of cognitive decline,
cardiac disease, and cancer through a network of wireless sensors in the home.
The system will eventually become intelligent and interactive, prompting
patients to lie down, eat, drink, take their medicine, and so on, through a
radio or television.

The enabling technologies — broadband cable or DSL Internet connections,
Wi-Fi within the home, and wireless sensors — seem to have come almost out of
nowhere in just a few years, and the artificial intelligence necessary for the
more sophisticated systems is not far behind.

The article in Wired News quotes an Intel researcher as saying that
society has no choice but to aggressively develop such technology in the face of
an age boom. We agree.

Reference: Unknown (2003). “Caregiver Tech
Slowly Evolves Associated Press.” Wired News, September 14.

See also articles in the September issue,
on the same topic.

Self Care: Access To Medical Research

The US House of Representatives last month passed a spending bill (H.R. 2660)
that would help provide free public access to federally funded medical
research. Another bill (H.R. 2613)
would provide free public access to papers in scientific and medical journals
based on research funded largely by the federal government.

In the ongoing trend to self-care, more laypeople seek and use scientific and
medical literature.

Reference: Unknown (2003). “Bill
would expand free access to medical journals.” iHealthBeat, August
15.

Technology Transfer

University “technology transfer” programs to commercialize academic research
discoveries are a good investment. Emory University made $30 million in
royalties and licensing fees last year, much of it from two AIDS drugs developed
at the university. Emory is now finalizing a collaborative agreement with the
Centers for Disease Control and Prevention (CDC) to commercialize their joint
research discoveries.

The 1980 Bayh-Dole Act allowed federally funded research to be licensed
exclusively and commercialized, and there is no questioning its efficacy in
turning research into “actual products, such as life-saving drugs.”
Nevertheless, in the present climate of corporate scandal and attendant focus on
ethics, it seems to us at least possible that the ethics of Bayh-Dole and of
drug and biotech company executives — many of them still holding academic
appointments — who get exceedingly rich off taxpayer-funded products that many
taxpayers cannot afford, are open to question. The practice seems not different
in principle from insider trading and the pre-allocation of IPO blocks to
investment bankers and their friends. As with bloated executive salaries,
bloated private profits generated from public capital may need to be moderated,
but without losing the incentives to turn research into products for the public
good. 

Reference: Bryant, Julie (2003). “From
lab to market.” Atlanta Business Chronicle, September 19.

Parthenogenic ESCs Off Limits to Research

Hopes of major progress in stem cell therapy resulting from the ability to
harvest ESCs from artificially-engendered human blastocysts (the beginning of an
embryo) reported in our June
issue appear to have been dashed by an NIH fearful of crossing the present
administration’s pro-Right to Life rules.

A group of researchers from several US universities recently succeeded in
“tricking” primate egg cells into behaving parthenogenetically — i.e., as if
they had been inseminated — and forming blastocysts, a hundred or so stem cells
that in normal reproduction would become embryos. They then harvested the stem
cells, proving that it is possible to obtain embryonic stem cells without
recourse to the ethically debated use of actual embryos, and proceeded next to
coax the stem cells into becoming two types of neurons, smooth muscle and
beating cilia, proving that their artificially induced stem cells have the same
pluripotent potential as natural embryonic stem cells to repair many types of
damaged tissue.

Unfortunately, taking its cue from President Bush’s televised address on Aug.
9, 2001, in which he announced strict limits on the use of federal funds for ESC
research, the National Institutes of Health have lumped parentless, non-viable,
parthenogenetically induced blastocysts in the same category as normal, viable
embryos, making any research that uses them ineligible for federal funding.
There is no question that researchers are right in saying that this “will
significantly slow progress toward medical treatments,” as the reference article
puts it mildly; but that is not true of countries such as China, that hold a
different ethic.

Reference: Philipkoski, Kristen (2003). “Definitions Impede Stem-Cell Work” Wired News, September
23.