Thursday, October 10, 2019

A Pox on Us

                                                          

            The first scam that affected me personally was the call to arms to fight in the Vietnam War. LBJ masterminded that. I spent seventeen months on aircraft carriers in the Gulf of Tonkin, never directly in harm’s way, but close to pilots, air crewmen, and ship crewmen who died from enemy action and accidents.
            Richard Nixon was a crook. He is probably the patron saint for the CEOs of today.
            I get multiple scam calls per day about extended warranties for my car, the IRS, and my credit card.
            Garmin, having sold me two lifetime updates for the maps on my GPS devices, has decided they made a bad business decision. Apparently, the fact that maps are available for free on most cell phones has hurt their pocketbook. They disabled both of my devices, and now want me to pay them to update the software that allows me to download those maps for which I already paid.
            Insulin and epinephrine, both discovered over a hundred years ago, are now so expensive that patients in need have to decide whether to eat, pay rent, or buy their medicine. Epinephrine has been manufactured for a hundred years; human insulin has ben manufactured for forty years.
            Razor blades are so expensive that growing beards make more sense.
            DirecTV and DISH scam customers with come-ons and bait and switch tactics. DirecTV offered me one service, signed me up for another because the first was unavailable. The DISH sales representative neglected to tell me that if I paused my account that all incentives would be null and void, and to restart the account would cost 50% more than the price he quoted me.
            CEOs make thousands of times what their average worker makes, more than they could spend in a lifetime.
            The tax rate on the richest people in the U.S. and successful companies doesn’t cover their cost to the country: for infrastructure use, the rule of law, the freedoms guaranteed by the Constitution, or protection of the country and citizens by the military.
            I am retired now. I was an adequate physician. I worked many, many different jobs because of one fault: I didn’t feel obligated to prescribe unneeded medication to patients just because they wanted it (antibiotics and narcotics, usually). Most clinic directors and hospital CEOS desire that patients go home happy, so they will return in the future. They don’t care if there is a national crisis, or two, with antibiotic resistance or opioids. I usually lasted a year or two before the number of complaints by patients made moving on a good option.
            Big Pharma bribes hospital CEOs and physicians with free meals, clinic presentations, continuing education, kickbacks, etc.
            Congress and local politicians line their pockets with lobbyists’ money. The Supreme Court sees no conflict with PACs or the corruption brought on by donations to political campaigns without controls by rich citizens and wealthy corporations.
            Software vendors statements about privacy and use of their products are so long and so full of legal jargon as to be unreadable and worthless.
            Scientific American recently published a study about bribery. People who think bribery exists tend to want to participate. That attitude is contagious. People who see speeders and aggressive drivers tend to assume that is normal and copy that style of driving. Corruption and selfishness breed more of the same.
            Until a sense of integrity is restored in the U.S., we are stuck with this mentality. 
            


Sunday, April 21, 2019

Medicine & AI:


I just finished reading a really good book, “The Space Barons” by Christian Davenport. In it Elon Musk and Jeff Bezos, rocket rivals, are doing their best to bring down the cost of space flight and reprise the role of D. D. Harriman in Robert Heinlein’s novel, “The Man Who Sold the Moon.” By utilizing advanced technology they propose to deploy relatively inexpensive, reusable rocket boosters. I like the idea of applying advanced engineering and computers to bring down the costs of things.

Some wag once said if aviation or automobile development had mirrored the evolution of the computer, you would now be able to drive to California from New York for a quarter, in six hours. Or, you could fly to the moon for $1 in a day. Or something like that.

Computers make a huge difference. We need to apply them to the practice of medicine to lower the costs. And to the automobile and aviation industries, too, apparently.

But let’s start with medicine. MRI studies are way too expensive. Well, everything in medicine is way too expensive. It’s a for profit industry now, not a calling. It was a calling back when there really was no way to help a patient except to hold his hand and console him, or to make her comfortable while she passed away from an untreatable disease. Today, people can actually be cured! Epidemics of infectious diseases or Type II diabetes can be prevented!

As a result some people think there is a vast conspiracy to immunize them or starve them. Many have become hypochondriacs. They expect to die from that gas pain, which resulted from the CardiacArrestBurger they downed with a six pack of their favorite local brew or energy drink. Unnecessary measles outbreaks, obesity, diabetes, and visits to the ER help drive the cost of medicine upward.

No politician wants to try to balance the budget when everyone who might receive free medical care will expect to live to be 105. Well, no politician wants to try to balance the budget. At one time, the Republicans did, until they they realized they could vote themselves a huge tax refund and still get to complain about the ‘loafers on welfare’ at the same time. Besides, who knows if our trillions of dollars in debt mean anything?

Where would free market competition and technology help with the expense of medical care? Suppose the government, some individual, or group sponsored several contests, like the Ansari X Prize for first reusable spacecraft. This ignited the free market space race of which Bezos and Musk are only the tip of the iceberg. A similar prize by Raymond Orteig sent Charles Lindberg to Paris, and is widely blamed for the cramped seating in present day airliners. The first maker of a portable, handheld, cheap MRI would win $20 million dollars. MRIs don’t produce radiation and are thus probably safe in the layman’s hands, as is ultrasound imaging. The spin-off technology would be exciting, even if every household could afford their own MRI.

MRIs by themselves won’t solve the problem. We would also need contests to develop an artificial intelligence (AI) to interpret the information obtained by the machine. Radiologists are paid too well to read every MRI or ultrasound image taken. The radiologists should be called upon when the AI is stumped. Later, when the AI is sufficiently trained, the radiologists will likely consult it when they are flummoxed. They could help each other, and lower costs.

We’ll also need a contest to help develop a diagnostic AI. Not everyone needs an MRI. People have infectious diseases, inheritable syndromes, autoimmune diseases, cancers, and other problems that only good diagnosticians can solve, or at least diagnose. A third AI may be needed to determine the best treatment for each individual.

Once these advanced technologies are in place, I would envision the interaction of an injured weekend athlete with a private MRI and Cloud AI to go something like this:

“Doctor Alexa.”

“Yes, John.”

“I fell playing Pickleball today and hurt my wrist.”

“Please scan your wrist with the MRI wand.”

“Done.”

“You have sprained radialulnar and ulnarcarpal ligaments in your left wrist. Ice and elevate it. Take two aspirin, and use the wrist support I just printed in the 3D printer. They might take a couple weeks to heal.”

“Thanks. Can’t we do anything about the pain right now?”

“If you do what I said the pain will diminish greatly.”

“But that might take twenty minutes….”

“Grow a pair, John. This is a minor injury.”

“What did that cost me?”

“Three cents in electricity and $1.51 in Cloud AI time.”

“Thanks.”

“No problem, wimp.”

Similar interactions would take place with sick individuals.
“It’s a virus, idiot. You don’t need an antibiotic.”
“A bland diet does not include jalapeƱo peppers, pizza, and beer.”

Some people might even be cured. Even though only a small percentage of the population has difficulty understanding scientific principles, they account for an inordinate amount aggravation for the rest of us.  The next step would be an AI with which preschoolers would interact to help prevent stupidity and the development of conspiracy theories that plague humanity.

If you do print this opinion, please add:
Bill Yancey is a retired physician and the author of two recently published novels: “Abandoned: MIA in Vietnam” and “An Autopsy of Vultures: Murder and Mayhem in an Active Adult Retirement Community.”

Bill Yancey
735 Copperhead Circle
St. Augustine, FL 32092
904-466-1003
wmbyancey@bellsouth.net