I first spoke with Andy Kessler about his book plans at our alma mater's annual entrepreneurship event ("The Coming Revolution in Health and Wellness"), where The Medical Blog Network launched this January.

Now that the book is out ("The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor"), I caught up with Andy to dig into his vision of the future. A few words come to mind to describe it:

• Bold: What if the medical technology (chips, not IT) evolved according to Moore's Law of silicon?
• Provocative: How would such technology advances affect the nature of medicine and healthcare?
• Controversial: What effect would this have on the medical professionals and their careers?

While I am not an expert on medical instrumentation, I doubt we will see dramatic changes Andy talks about in the near term. But I do think he may have developed a viable investment theory for his upcoming (I am assuming here!) hedge fund. Here is his thinking:

Q1: How did you decide to take such a deep interest in medicine? Was there a specific encounter with our healthcare system that highlighted any problems and prompted you to look for answers?

I’ve spent the last 20 years studying Silicon Valley, as an engineer, Wall Street analyst and hedge fund investor. As silicon gets cheaper every year, I’ve watched it surround, strangle and change industry after industry. Kinda fun, actually. Computers, music, telephony, cameras, one by one they fall. I had no interest in medicine until a friend of mine was diagnosed with cancer by accident, after hitting his head on a mogul, a cocktail olive sized tumor showed up on an X-Ray. And then a brother-in-law had a heart attack in the middle of the night. I’m 47, got scared, and when my doctor got out a rubber hammer and banged my knee, I knew it wouldn’t be long until medicine was changed by ever cheaper silicon. The answer I found was to get doctors out of medicine.

Q2: "The End of Medicine" is a very provocative title and congrats on making Amazon's Top 10 List. But is this really the "End" or yet another transformation? Stethoscope used to be a revolution.

It’s not so much the end, more of the start of a 20 year transition from chronic care to early detection. We know that detecting disease early means that treatment is much simpler and we see much higher survival rates. Yet there are no good tools for early detection. We use cholesterol numbers and blood pressure to predict heart attacks. C’mon, those are lame, and we just get put on statins that we probably don’t need. PSA for prostate cancer and CA-125 for ovarian are not very effective biomarkers.

But silicon is about to invade medicine and bring early detection for cheaper and cheaper every year. That’s when things start to change. I should add that The End of Medicine is a bunch of fun stories, and hopefully entertaining to read. It’s not academic or dull prose, but some important issues get tackled (although with plenty of funny lines.)

Q3: Medicine has been imprecise science since the Dark Ages. Research and instrumentation have pushed the boundaries of unknown and changed the role of healthcare professionals many times over. But human bodies are just so complicated, compared to banks and cars. What defines life? Can we really expect perfection through technology?

Bodies are complex, which is why so many of the “cures” of today are not terribly effective. Pharmaceuticals work, sometimes. We push somewhere and things pop up elsewhere. Look at the problems with Vioxx and COX-2 inhibitors. Who knew? RNA interference, turning on or off RNA to increase good cholesterol, for example, is wonderful in concept, but what other parts of the body are affected? We don’t know.

Instead, technology can be used for visualization, finding arteriosclerosis, whose existence is only guessed at by cholesterol or blood pressure readings. Angiograms are pretty cut and dry to find heart disease, but are still invasive. Virtual angiograms via 256 slice CT scanners may be just as good and non-invasive. Actually, they may be better, since a 3D model of the heart can be built and manipulated on screen. This is better than any doctor can do from the outside.

Same with finding cancer. Looking for unique proteins using ELISA and eventually silicon chips with antibodies bound to nano-wires can test for 100’s or even 1000’s of unique cancer proteins in our blood. What doctor can do that?

The idea is to take the expertise of doctors and embed them into silicon and software so they can be delivered to patients cheaper and more efficiently.

Q4: Many people do not feel confident truly taking charge of their healthcare and making these decisions on their own. Yet a growing number of people use info from the Internet to question at least some calls of their doctors. How will these trends affect the overall care management continuum, from prevention and early detection through end-of-life?

The more information the better. There will certainly be a medical divide, those that want to know everything about their bodies and health and those that would just rather not know if they have cancer. But more information will always be better. If you can detect cancer 5 years early, then know you have it is no longer a death sentence. Treatment for finding a tumor 5 years early should be relatively simple, radiation, cut it, freeze it, heat it, melt it, etc. Once the simplicity of treatment is understood, care management and the cultural issues of those that want to know and those that don’t will certainly change.

It would be nice to get more information from doctors, but they don’t have much to tell us. A PSA number, cholesterol or blood pressure. I want data sets, a gigabyte flash memory filled with 3D models of my innards, a list of proteins swimming around in my blood. There is major concerns over false positives, but so what, I still want to know and will worry about the consequences, rather than missing some disease that will kill me.

Q5: Medicine is a highly regulated profession with its own elaborate governance, sponsored by the State. All past innovations to delivery systems, financing models and technologies had to either get blessing of existing institutions or circumvent / transform them through political process. What is the future of the "organized medicine"? AMA? Medical boards? Regulation of drugs and medical devices? What will be the role of government and politics in effecting the changes you discuss? 

Every licensed and regulated industry loves the government intervention. It is done in the name of patients’ interest or safety, but in actuality, keeps competition away. Limit the number of doctors, or drugs to take, or medical devices. Obviously, many of this is for the good, I don’t want a cab driver doing surgery, but it also limits what we as consumers of medicine can do. I think the FDA is taking a hard look at imaging, via a program called Critical Path, to bring more discover and information into the process. They are taking it slowly, and there are lots of vested interests in Washington to keep the status quo. But like the other over regulated business of telephony, as technology gets cheap enough, it could care less about regulations and marches forward year after year. Eventually, it affects change. The longer the incumbents wait, the harder the fall.

Q6: To expand on the prior question, ethical arguments have been always raised regarding any new technology. How do you envision these issues influence the changes you discuss? New technology tends to challenge the boundaries of what is acceptable and pose ethical questions that have no consensus answers. Stem cells, cloning, abortion, assisted suicide are only a few. What about genetic screening and things not even on the radar yet?

There will always be ethical questions. I’m not sure I have any good answers on how to handle them. Cheap silicon will enable things far beyond my imagination today of early detection from heart, stroke or cancer. When it reaches into reproduction or genetic issues, a can of worms will open up and those smarter than I will worry about how to find the balance between saving lives and deep seated religious and or ethical concerns. Caution must be taken by those that introduce these technologies as fears of cultural change can kill a new technology faster than anything else.

But, you can’t stop change. It is going to happen. Imaging and screening and early detection are going to happen in the next decade. How the market handles them and even question like “what do we do with all these people who will live longer” are great questions to debate.

Q7: Next onto healthcare financing. The largest slice of healthcare spending is "end-of-life" care. Here is the paradox. The more technology we invent, the more we prolong life, the more things break in our bodies, the more demand for technology, the ever rising cost. Whether this is Medicare or private insurance or single payor systems the cost is in the end rationed. Do you think silicon and chips can keep up with rising demand for healthcare, created by success of solving "simpler" healthcare issues?

90% of Medicare dollars are spent on chronic care. 5% of patients use almost half of our healthcare dollars. The Big Three in spending are heart disease, stroke and cancer. My view if you can move the needle even a little bit on lowering the rate of these diseases (especially cancer which has huge end-of-life expenses), you can arrest the runaway growth in healthcare spending. Will it go down? I doubt it. People will get sick from something. But if we can keep both middle age folks and seniors healthier longer, then perhaps this notion of “rationing” healthcare can change.

I think it is insurance companies that will drive change. Assume 1% of adults have heart attacks each year (plus or minus, don’t quibble with the exact number). If heart imaging via 256 slice CT scanners costs $1000, then each 100 people screened would cost $100,000 vs. the $30,000 to patch up and put stents in the one unlucky person who had the heart attack. $100,000 vs. $30,000. Not going to happen. But when the scans are $250? Perhaps. At $100? Absolutely. Insurance companies will not only want customers to be imaged, they may insist on it to screen for disease and the inevitable ever increasing expense of hospitals and procedures. Its economics in healthcare, what a change!

Q8: To expand on the prior question. How will technology affect the future of healthcare financing system? Will the industry's slice of GDP stop at 15%, keep growing or drop off? Say if average lifespan rises to 100 years, how will this affect Medicare and Social Security? Would our public institutions need an extreme makeover? Of what sort? Who will win, who will lose? Will we even recognize the society we live it? Brave New World comes to mind.

It’s still early to tell how this change will take place. Extreme makeover? Over time, yes, but the changes will be in small steps. 20 years ago, cell phones were the size of bricks, expensive and 100,000 were sold. Today they are tiny, $100 and almost a billion will ship. Think about the profound change to institutions and society because of this. But it happened over time and we now take what we have for granted. Same with medicine. The change will be slow, not overnight. Silicon gets cheaper by 30% per year and then permeates into industries. It will eventually save lives by making early detection cheaper. 20 years from now we will look back and note how much of a change has taken place. With double digit growth in healthcare spending, I think the change is much needed. Who will win or lose? Too early to tell. New companies not even in existence will be huge winners, much as Microsoft and Compaq and a huge number of PC related companies grew out of the chaos of the PC industry starting in the mid ‘80’s. But it is still early to pick winners in the coming transformation of medicine from chronic care to early detection. Take my book The End of Medicine as a set of signposts for what to look for and you’ll be the first on your block to note the change as it takes place!

Q9: What is your advice to physicians on adapting to this Brave New World? How does this differ by specialty? What should they do today vs. plan for in 10, 20, 30 years? Any advice for pre-meds and medical school students?

The end game is embedding the expertise of doctors into silicon and software, much as ATMs did to tellers, or switches did to operators or electronic trading did to specialists at the NY Stock Exchange. I would rather be on the side of those affecting the change than fight the change. There will be enormous career opportunities for those that understand the changes ahead. The days of the family physician aren’t over, but will be radically different. Think of the change that took place with cardiac surgeons once stent procedures became the norm vs. bypass. Then multiply that by 1000 to cover the rest of the industry. You can ride the wave or get knocked over by it.

Q10: What is your advice to modern healthcare consumers, who have to navigate the system as it exists today, cannot count on the future to be here now and may not have infinite means.

Take control of your own information. Get scanned. Ask your doctor what new tests are available. Bug your insurance company to get reimbursed for new tests and procedures. Eventually, many of these tests will be at the local Walgreens or RiteAid, much as pregnancy tests are today. Avoid getting sick by focusing on early detection. A lot less folks should have a heart attack or stroke again. Same for cancer over the next decade. Get over the hump of not wanting to know.

Whether or not you agree with Andy, I think the evolution of "medical silicon" would be interesting to watch. I doubt the medicine and clinical judgement will go away anytime soon, but the book could help you make better stock picks!