pulp (2006-52)

Gonzo Healthcare

The End of Medicine tries hard to rev a boring subject’s engine, but spins its tires

by Jonathan Frey

Maybe hedge fund managers shouldn’t take up the pen, or at least not in service of explaining the U.S. healthcare industry, irrespective of how passionate they are about the subject. And Andy Kessler, former hedge fund manager, Wall Street impresario, and author of Wall Street Meat among other titles, definitely has passion: “Health care in America is like Saturn—it’s incomprehensibly big and made out of lots of moving parts, yet far enough out of our reach that we can’t truly understand how massive it really is. Depending who you ask, around $1.8 trillion was spent on health care in 2005. That’s ‘t’ as in trillion. Carl Sagan talked about billions and billions of stars. That’s bubkes. With the U.S. economy at $12 trillion, that’s 15 percent of the entire economy spent on doctors, hospitals, and aspirin.”

These facts provide the context for Kessler’s new book, The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor (Collins, $25). Unfortunately, this context doesn’t lead anywhere but to wondering how such a disastrous book could ever get published by anything other than a vanity press.

In its essence, End of Medicine is a bildungsroman , a diary of Kessler’s search for “scale” in the healthcare industry. Along the way, he intends to “entertain” the reader with his bon mots concerning economic forces understood from his Wall Street experiences, how the lessons of Silicon Valley can be applied to medicine, and what he learns of medical imaging and a selection of diagnostic tests during his trawl through the U.S. healthcare system.

The result is a kind of travel writing, rich in pseudo-gonzo, shoot-from the-hip asides with haute frat-boy stylings. While he intends to employ his boyish, innocent affect as a lever in uncovering the inner workings of this very complicated industry, in fact he fails to convey much of anything clearly—even subjects that one would expect him to understand well—meantime sinking even his more interesting conclusions in so much twaddle to be near impenetrable.

Part of the problem is the sheer number of subjects that grab Kessler’s interest. For Kessler, it’s all about “[s]cale, scale, scale. Push costs down and some new business that does things cheaper and better pops up faster than a Whac-a-Mole… Every year, the cost of every chip, gate, transistor, function drops by 30 percent—it halves every two years… Put simply, every time costs decline, some new application opens up to take advantage of the cheaper functionality, and you sell three times as many… And just like that, because of new technology entire careers disappear like trolley car conductors of old—phone operators, tellers, stock traders, librarians… Were doctors next? I secretly hoped so.”

As a result, each new shiny symptom of scale—declining costs, new applications, job loss—grabs his attention, and like a canary he darts from one to another, fascinated briefly until another shiny surface presents itself. Along the way, Kessler inevitably name drops Moore’s Law—the observation by Intel co-founder Gordon Moore that transistor density doubles every 24 months, a phenomenon that apparently has held for the past four decades—but never bothers actually to define the concept or fully examine its possible implications for healthcare technology. Rather, the law serves as just another bauble to riff on, another billboard on his tourist travels, never to be actually visited or understood.

And on it goes, as Kessler giggles his way through an intimidating diversity of subjects, including but not limited to a friend’s cancer, the U.S. healthcare reimbursement system, heart disease, radiation therapy, in vitro diagnostics, LASIK eye surgery, nuclear medicine, computed tomography, magnetic resonance imaging, cancer screening, computer-aided diagnosis, mapping the human genome, and molecular imaging research, all the while dropping names like highway litter.

Moreover, rather than actually taking a moment to explain any one of these subjects, Kessler instead issues a steady stream of ad nauseam adolescent patter, e.g., “I walked out to the parking lot, turned to look at the building and did what I should have done inside—I flipped [the doctor] the digitus in medio ,” or “staring at huge vats behind glass made me think of chemicals, especially C3H8O, our good friend Al K. Haul,” or “I had somehow neglected to tell my wife I was going to be checking out women’s breasts all morning,” or “staring at mammograms with a 70-year-old radiologist is probably not considered, er, titillating,” etc.

Unfortunately, Kessler neglects the opportunity to reveal what Silicon Valley might actually offer U.S. healthcare, which spends roughly twice per capita as any other country and provides a life expectancy and infant mortality ranking in the mid-20s, behind most of Europe and parts of Asia. Instead, The End of Medicine is a 350-plus page ersatz keg party, filled with lots of chat and light-hearted banter, illuminating nothing.