21 Comments
Oct 31, 2023Liked by Elliot Hershberg

Brilliant article summarizing cutting edge science. As a clinician what would be most exciting is if we can wrest this technology away from Pharma and make it easy, cheap and bedside so that we can treat our patients with cutting edge medicine. right now we can't treat most of our patients with best medication options, especially diabetics, because insurance plans won't pay for new medications.

Expand full comment
author

Totally agreed! I'd argue that it's less a problem of Big Pharma, and more a problem of making sure (potentially through regulation) that payers uphold their portion of the Biotech Social Contract by making branded medicines affordable for patients before they go generic.

Expand full comment

Agree! It is outrageous that insurance plans simply deny patients new medication coverage. currently patients are suing insurance plans to gain access to potent new medications for diabetes including the SGLT class of drugs. Patients should not have to sue insurance plans to receive the best treatment options created by science.

Expand full comment
Oct 31, 2023Liked by Packy McCormick, Elliot Hershberg

Very thorough article - thanks for writing this! And I appreciate the mention of Cellares - even though it might seem like a "crazy idea", a robotic factory to make cell therapies is now reality; you can come and see the Cell Shuttle in South San Francisco today

Expand full comment
author

Thanks Daniele, I'd love to come visit the Cell Shuttle!

Expand full comment
Nov 3, 2023Liked by Elliot Hershberg

Thanks, I don't understand it all but learned a lot and it was very approachable / a great launchpad!

Expand full comment
author

Thanks Andrew, glad to hear it!

Expand full comment

Thanks for this article. Learned a lot.

Expand full comment

Cancer is increasingly see as a metabolic dysfunction and not genetic in origin. The work of Thomas Seyfried seems indisputable toward starving it out. Silver-bullet cellular solutions may be the exception rather than the norm in future.

Expand full comment

Great article, thanks for unpacking

Expand full comment

“we can live in an Age of Miracles, but it’s going to take a lot of work to get there.”

Improving the clinical trial process would help:

https://bessstillman.substack.com/p/please-be-dying-but-not-too-quickly

Expand full comment

“I’m only one person, what can I do?” Said the whole world.

The root problem is the system itself. Fixing the system itself should be the one place we can all agree on. Medicine too, is broken by gatekeepers and centralized control.

We need to fix the entire system from being corrupted - government and all other related systems have lost all trust (government, media, medicine, big tech, science, academia, food, etc). The answer lies in building new trustworthy systems, migrating to them, then plugging them in to fix the existing corrupted ones. Like using a plug-in to fix a corrupted computer system.

It starts with understanding Swarm Theory and Human Swarm Intelligence. This is the beginning, but if everyone takes the time to understand this we can fix our corrupted systems and then fix everything else. Transparency + Decentralization + Human Swarm Intelligence = the answer.

Never heard of it? Here: https://joshketry.substack.com/p/human-swarm-intelligence-the-most

Expand full comment

Interesting tech, but yet another example of solving the lesser but more profitable problem.

The US spends roughly 18% of GDP on health care = $4.6 trillion per year.

This is roughly double, per capita, of any other nation in the entire rest of the world meaning at least $2 trillion of spending is excess to results.

Note we're not talking about Eastern Europe or Asia - this is even in comparison with high wealth nations like Luxembourg or Switzerland.

This $2 trillion of excess spending is the single biggest handicap to US society: families and companies alike.

In a fantasy world where the government and elites of the US focus on making life better for Americans, this issue would be addressed but in the actual world - this $2 trillion per year directly equals profits for a few. How many people are dying earlier due to this massive economic burden as compared to the cancers in question?

Expand full comment
author

This one is a stretch even for you!

Expand full comment

Oh?

Which part(s) are you disputing: the percentage of US GDP that is health care or the US overspend compared to other countries?

US health care spend 18.3% of GDP: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet#:~:text=NHE%20grew%202.7%25%20to%20%244.3,17%20percent%20of%20total%20NHE.

US per capital health care spend vs rest of world:

https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022#:~:text=In%202021%2C%20the%20U.S.%20spent,higher%20than%20in%20South%20Korea.

“ Health spending per person in the U.S. was nearly two times higher than in the closest country, Germany, and four times higher than in South Korea.”

Expand full comment
author

Not disputing either -- fully agree and have written about it before.

By stretch, I mean that practically no one in the world disagrees with you that that's an issue, but it's not super relevant here.

Expand full comment

Interesting - so a massive systemic health care problem across an entire large country of 330 million is known but literally ignored. Let's all talk about the cool new stuff instead.

Ok then.

Expand full comment
author

Who is ignoring it?

We should both fix the massive systemic health care problem and also continue to improve our technological toolkit.

Expand full comment

USA: 17.8%. Germany: 12.8%. Germany's spending is nowhere near "two times higher." There is a pretty close correlation between wealth and spending on healthcare. That said, we could do much to free the market in US healthcare and reduce costs without reducing innovation.

Expand full comment

Given that Germany has the highest GDP per capita percent spending for health care in Europe - your attempt at a strong point falls flat.

Actual EU average spending on health care as a percentage of GDP is under 10%.

Each 1% differential in health care spending as a percent of GDP represents more than $250 billion.

So if the US spent at "only" Germany's level - that's $1.25 trillion a year in excess health care spending waste.

If the US spent at the EU average - that's $2 trillion a year in excess health care spending waste.

Your quibble is irrelevant - both numbers are double digit percentages higher than the entire US military spending budget - which in turn is greater than the next 8 or 9 highest military budgets in the rest of the world combined.

$1.25 trillion a year = $9500 a year per household in the entire United States.

$2 trillion a year = $15000 a year per household in the entire United States.

Given US median household income is $74K - neither of the 2 numbers is a small amount.

Expand full comment

I wasn't trying to make a strong point. I was noting that the numbers quoted simply did not support the claim. Also, as wealth increases a growing percentage seems to go to healthcare. That may be simply be people's choice.

Expand full comment