Glowing Puppies, Monkies, and Babies (and Mice with "Human Ears")

When I read the headlines about glowing green monkeys I immediately recalled other recent news articles about glowing red puppies. There is, of course, a key difference between the two developments.  While the glowing dog story involved gene-splicing, it did not involve a key aspect of the marmoset gene-splicing.  With the marmosets, after the gene-splicing was complete the "recipients" reproduced and actually passed on the new DNA sequence.  This is being considered a significant milestone and rightfully so.  The implications for research and medicine are tremendous (researching treatments for human diseases is just one benefit) and the ethical implications are possibly broader - especially when you wonder how far away human gene-splicing is and the potential effects on future generations.  It is important to keep in mind how quickly science is moving along.  It's moving even more quickly than I thought.  I mistakenly thought back to what I thought was another example of genetic manipulation around 12 years ago.

The mouse with the human ear, however, really had to do with cow cartilage being placed under the skin of a mouse, and not genetic manipulation as such.  More closely related to the marmosets is the story of baby Jessica.

Also just a little over decade ago, scientists successfully selected a gender of a human baby named Jessica.  Some raised concerns over the future of so-called "designer babies."  Even that technique however, was really a technique using selection during artificial insemination.

The marmoset gene-splicing is a completely different twist and, as its terminology suggests, really does involve splicing in DNA from a different species - in this case a jellyfish - and from now on babies of those marmosets can inherit the DNA the same way they can inherit marmoset DNA! 

Okay, so how DID health care become so expensive?

I am happy to see that a leading publication such as Reuters has mentioned a rarely-discussed turning point in the cost of health care.  The article discusses the effects of folks being "tied" to their employee health plans.  The turning point I mention is that during World War II the federal government instituted a cap on wages which meant that employers could not pay more than a predetermined amount (I think this was done in an attempt to stifle inflation and was possibly considered by some as a way to support high production of war time industry).  When employers wanted to attract workers and couldn't do so by raising wages, they came up with the idea of offering health insurance which was not considered "wage" and was therefore permissible.

This was a turning point because it marked the large scale shift towards a society with a third-party payer for health care.  Today, in fact, the majority of people with health coverage are covered by an employer-provided plan.  Under the "old system" well before World War II folks usually paid for physician and hospital services out-of-pocket.  This meant that they had a great deal of incentive to reduce their use of services.  This low-demand situation was necessarily met with lower prices by physicians and hospitals who had to attract consumers.

The big change came on a large scale during World War II when the third party payer system began en masse and lifted the burden on the consumer.  The patient could then obtain more services which in turn enabled physicians, hospitals, and the like to both perform those services and gradually raise prices knowing that they would get paid by the third party.

This is just a simple explanation of the beginnings of the third-party payer system and, as such, yields the opportunity for many future posts discussing the costs of health care today.

Standard and Poor's UK Rating (yes, it's relevant)

Whenever people talk about the state of health care it is highly likely that cost and financing will be discussed.  Whether you believe it or not a discussion of economics - even global economics - is relevant to the cost of health care.

According to Bloomberg, Standard and Poor's has indicated a negative outlook for U.K.'s credit rating.  Historically, U.K., United States, and other leading nations have held AAA credit ratings which is the highest possible rating.  The announcement of Standard and Poor's outlook is of particular interest to me because I remember that several months ago, U.K.'s central bank lowered its target interest rate to the lowest since the 1600s.  Its near-zero rate raised the issue of what would happen if it didn't work (the U.S. near-zero rate raises the same question).  The connection between the target inerest rate and the credit rating is this: governments acheive their target interest rates by buying their own bonds (in the U.S. the Federal Reserve Bank purchases Treasuries on the open market as well as directly from the Treasury).  Two observations can be made from this process: 1) The government is borrowing more money (A LOT more during this crisis) 2) This process can also be thought of as "printing money" - that is, the money the Treasury borrows didn't really exist before it sold bonds (and paid them off).  When you print money, you inflate the money supply, which causes devaluation pressure, and possibly lowers your credit rating.

The relevance for medicine is that in the U.S. government spends (depending on the year) close to half of all money spent on health care.  One might be tempted to think devaluation of the dollar won't really affect health care so much then because government won't be willing to pay dollars to compensate for the fact that the dollar is worth less, and then people working in health care will just have to take what the government gives them.  Actually, they won't.  If people working in health care get paid less and less because of a devalued dollar, they will find other places to work where the pay can better help them survive.  One can imagine what would happen to the state of health care then.

On the other hand, if health care spending becomes more federal and the government just prints more and more money to put into health care and other sectors the cycle continues until the government can't print money fast enough to keep up (I suppose eventually people would just value the dollar so much less than say, a Canadian dollar, that people would tend to work in fields where they can get paid in Canadian dollars.)  In that case, for the most part the U.S. government would no longer be able to finance health care as we know it - instead it would be financing a backwards and possibly unsafe health care system where only a fortunate few will have anything resembling reasonable access to the decreasing numbers of physicians and facilities.  If you don't "believe in inflation" and its ill effects consider the extreme example of Zimbabwe which was recently calculated at a 231 million percent inflation rate.  I don't think we'll see that rate any time soon but inflation doesn't have to get to that point before most of us suffer its effects.

So what's the solution?  It depends on who you are, and it depends what kind of time frame you're talking about.  If you're at a good job with good coverage you might not need a solution right now.  If you don't have coverage you might try to find a way to get covered and stay covered by a government program (although if you're an "average" adult male you might find this is impossible).  If you are interested in medicine as an innovator, researcher, or developer - the world needs you - we need you to find a way to do an "end-run" around the system - kind of like the way fax and e-mail did an end-run around the post office.

Iressa (by AstraZeneca) - A Good Example of PGx

A new trend in medicine goes by several names: Personalized Medicine, Pharmacogenomics, Pharmacogenetics, and more. The names are often given similar yet different meanings depending on who you ask. It is probably most accurate to say that the broad concept of Personalized Medicine includes several concepts - among them Pharmacogenomics appears to be the largest and most significant

Pharmacogenomics combines the words pharmaceuticals and genomics to describe medicine based on the link between genetic patterns and the way an individual will metabolize types of drugs, as well as to precise types of diseases. I recall reading that there are now thought to be 5 different types of asthma with genetic markers for each. New developments in this field are made frequently.

Lung cancer patients, who might receive a prescription for standard chemotherapy drugs or an alternative drug, can be tested for a mutation of gene EGFr to determine whether they should be presribed Iressa or receive standard chemotherapy if they do not have the mutation. This and similar recent research was recently reported on by Marilyn Chase for Bloomberg.