Why Computers Work and Health Care Doesn't
by Bill Walker
by Bill Walker
Computers work. We complain about them, but that's because most of the time they work so fast that we don't even notice them in the background. And they get cheaper by the second. They get cheaper so fast that we can see the prices of memory and processor speed falling even without adjusting for inflation.
Health care, on the other hand, gets more expensive all the time, even for techniques that were invented decades ago. Computers get twice as fast every two years, but technology for carbon-based organisms improves at a snail's pace. Why? Biology isn't all that complex. After all, our cells only have the equivalent of about 2.8 gigabytes of (very slow) DNA memory storage. The viruses that kill us often get by with 12 kilobytes. Your cellphone has more memory than most pathogens, and cellphone design mutates more over the course of a year than the flu.
A Thought Experiment: The Federal Data Administration
Let's put medical research and biotech under the Federal computer regulatory agencies… oh, that's right, there aren't any. Meanwhile, let's see how Steve Jobs and Bill Gates would fare under… the FDA!
Yes, the FDA; the Federal Data Administration. Every processor, peripheral, program, printer, and power cord will now need FDA approval. This will take about 19 years of trials on lab rats and human nerd volunteers, at an average cost of $802 million dollars per item (according to a Tufts University study on drug approval back in 2001; the time and cost is probably less than twice that now, right?). Any change of any kind to any chip, peripheral, or line of code will of course require a complete re-approval.
And what about those guys who run the computer industry? They're… dropouts! Steve Jobs, Bill Gates, Larry Ellison… the whole industry is dominated by billionaire dropouts. How have we gotten along so long without credentialed professionals?
To make the computer industry run like the health care industry, state licensing boards will require American Mainframe Association (AMA) membership for all computer professionals. Every programmer will have to pass a four-year pre-mainframe undergraduate degree, four years of Mainframe School, then internships, residencies, and so on until they are gray enough to program responsibly (or die of old age).
Now when you have a computing need, you will have to go to one of these AMA professionals and sit in a cold waiting room full of computer viruses. Then you will receive a prescription to receive FDA-approved hardware and software (within the prescribing and cost regulations of an HMO, see below).
The IRS will make buying computers tax-deductible for employers, but not for you. Employees will be forced to buy computers through Hardware Maintenance Organizations (HMOs) run by their employers. To lose your job will mean to lose your computer, your ISP, and your primary-care AMA programmer.
The Data Enforcement Agency (DEA) will combat the smuggling of illegal data-processing paraphernalia, such as that used in so-called "video games" or "iPods." The DEA would also have the responsibility of ensuring that no unapproved data crosses our borders.
And then there would be the National Institute of Hardware (NIH), which would pour billions into the academic study of advanced vacuum tube designs…
OK. No one would really be stupid enough to try to run the computer industry like this. We love our computers too much, so we don't let government regulate them. We leave our computers to the free market, even though they control nuclear weapons, air traffic control, our cars' antilock brakes, and lots of other stuff that's more immediately dangerous to our health than medicine. The free market isn't perfect, but it's constantly driven to improve. With all its imperfections, freedom is still safer than stagnation.
Can Market Medicine Be Safe?
Most people can see that the market works best for computers. There are few calls for nationalization of Apple or Intel. But when it comes to health care, it is just assumed that only government can provide safety… in spite of its record of both approving dangerous drugs and stalling valuable therapies.
Of course we need impartial testing of drugs and medical protocols. Do we really think we get that under the current system? Is the FDA somehow exempt from the law that every regulatory agency is captured by the industry it "regulates"? I'd feel a lot better if the next Celebrex or Thalidomide were also going to be tested by competing companies and nonprofits, instead of essentially by the prospective manufacturer under the "supervision" of the FDA. Maybe Underwriters' Laboratories, the AMA, a few universities, etc. could expand into the job.
In any case, even if you think the FDA is exempt from the evolutionary laws that govern bureaucracies, there is no advantage to preventing competition. If some people wish to use only the FDA approval system, fine. That shouldn't restrict anyone else with an incurable disease from using a medicine approved by the AMA, or UL, or the Mayo Clinic. Any group should be allowed to make lists of "approved" drugs and protocols, and patients and doctors should be allowed to choose.
The FDA and the patent office have created a medical system that is driven by drug companies. Do drug companies have all the right incentives to find the downsides of their patented product pipelines? I'm not at all anti-drug-company; they do good work, but wouldn't medical systems driven by (say) life insurance companies, or hospital chains, or academic research, each have their own advantages? Again, competition is the key to progress.
Then there's biological terrorism. If the survival of our nation depends on the speed at which we develop new cures for artificially engineered viruses… do we want to bet on our current system of government agencies and committees, or on the market?
February 19, 2008
Bill Walker [send him mail] works in HIV and gene therapy research in Rochester, Minnesota.
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