Inflection Point in Medicine
This one’s for Daisy-Lee, will re edit with more relevant, less dense example.
Inflection Point Was a term used by Andy S. Grove, founder of Intel. “--- a strategic inflection point is a time in the life of a business when its fundamentals are about to change. That change can mean an opportunity to rise to new heights. But it may just as likely signal the beginning of the end.”
IP is a concept I find useful in the market indicating a fundamental shift in the company’s fortunes by virtue of product, market, management or a return to prior value after a prolonged hiatus.
In differential calculus, an inflection point, or point of inflection (or inflexion) is a point on a curve at which the curvature changes sign. ...
No matter the term, history reconstructs rare occasions when either some combination of events or some significant world event changes the course of history or the fundamental structure of the economy. We presently suffer such a combination of events and circumstances that will inevitably and irreversibly change the status quo.
The magnitude of the forces at play, suggest the end of an era and uncertain new beginnings. Like the market, it is easy to see the crisis, the change in direction, and the velocity, but it is not easy to see the significance or the future magnitude of the change, nor is it easy to see the point at which a fundamental change has taken place.
Today we have high fuel prices, environmental concerns, a ME crisis, high food prices, high fertilizer prices, a growing world population, significant starvation, water shortages, in the US a health care crisis and the US economy is faltering. Arguably some of these circumstances are beyond the point of no return.
History suggests that out of a slow and segmented collapse there will emerge an entirely new world of nations and of man. Those who are flexible and adapt will prosper. Those that remain inflexible and locked into the past will suffer and fail. The first requirement is for the leaders to identify this as a time of inevitable change and use their wisdom and vision to adapt.
Health care is but one crises out of the several; it is of immediate political concern.
In the US, health care challenges us, and hereto we are at an inflection point. The US by several metrics ranks something like in 8th to the 16th place in health care as seen from a public health viewpoint and measurements such as pari-natal mortality and immunization rates, no gold medals here. Leaders face difficult choices in securing health care for everyone, and they, with rare exceptions, know little about clinical medicine or public health; their decisions are late in the making and come just as the science of medicine undergoes a revolutionary breakthrough in basic knowledge. The breakthrough continues, however, and changes everything about the understanding and treatment of disease.
Beyond the genome, investigators can now look directly at the molecular structure and interactions of protein molecules. The desk-top microscope, once limited by the wavelength of the photon, now sees vividly at the nano-scale. Probes with imbedded chips and computer analysis identify the complex genetic molecules, and each new look seems to challenge us with a complete change in our understanding of what we see.
The extent of these new insights and the tools to see on a molecular level are exemplified by this article about a small thing from the inside wall of a fish tank. “As arguably the simplest free-living animals, placozoans may represent a primitive metazoan form, yet their biology is poorly understood.” Mansi Srivastava, et al, University of California, Berkeley, report the sequencing of the ~98 million base pair nuclear genome of the placozoan Trichoplax adhaerens. “Whole-genome phylogenetic analysis suggests that placozoans belong to a ‘eumetazoan’ clade that includes sponges. However, the genome shows content, structure and symmetry like human and other complex eumetazoan genomes. Despite the apparent cellular simplicity of Trichoplax, its genome encodes a rich array of transcription and signaling genes that are typically associated with diverse cell types and developmental processes in eumetazoans.” In other words this little thing adhering to the side of our fish tank is genetically way to complex to just be what it appears, but that is not the point.
The significance of this genetic observation, the result of instrumentation undreamed of a generation ago, prompted Nature to publish the report as its lead article in its 21 August 2008 edition. What might otherwise be considered merely a curious observation in the simplest of small flat animals (1-2 mm), has enormous allegorical implications for medical science, specifically: the fragility of our assumptions about human genetics, disease -- and physiology on a molecular scale. Quoting further, “With the genome in hand, renewed interest in this ‘simple’ animal with a complex genome will add to our appreciation of animal diversity and perhaps yield fundamental insights into early animal diversity,” and from Shakespeare, “There are more things in this world Horatio than are dreamed of in your philosophies,” but the point is diversity, and diversity is part of the scientific method!
The science and understanding of medicine today changes and accelerates at such a rapid pace that a decade may turn everything inside out. The same startling insights, as in the simple Trichoplax, alter our understanding of disease and offer new channels of intervention on nearly a daily basis. Keeping pace with new knowledge and treatment options while at the same time attempting to bring the benefits of new discovery to the patient and the public, frustrates both physicians and public health planners.
This inflection point, if you will, offers a choice of doing what we have always done, what England and Canada have done, or going to a diversified academic system more on the order of European health systems. Private insurance won’t go away but it cannot meet the demands of scientific investigation, education and innovative lines of intervention. Insurance privatizes a free choice of benefit from the fruits of academic medicine, research and education, but it is bureaucratically incapable of initiating research, education or change. And it costs a lot.
To the end of a workable solution, neither health care plan by the competing political parties will keep pace with the present scientific environment of medicine. They both rely almost exclusively on private insurance. The priority of private insurance is the stock holders. If the government subsidizes them they will raise the price. If the government regulates them, they will find a way around the regulation through complexity and exception and the cost goes up. Sound familiar? And there is the whole issue of employer paid insurance that got us the HMO.
The single payer English and Canadian programs work in a manner much criticized by patients who wait long periods of time for care. It is hard to criticize the quality; however, the treatments tend to be codified, which may lead to some inflexibility in education and progress in this fast moving environment. The European systems compete state by state and compete with private insurance by encouraging the continuation of a private segment of those who can afford it. From an academic standpoint the European approach is desirable in providing greater opportunity for research, education and innovation. Our, US, philosophical rejection of the so called two tiered system may have been a major mistake. Competition adds to the verve of scientific research, in the European case, competition between states and competition between the public system and the private insurance based and private pay systems.
A major argument against a two tiered system is that the costlier illnesses will migrate to the public system thus overburdening the budget. Countering that argument is the public responsibility not to bankrupt families unfortunate in experiencing major complicated medical problems. Furthermore, a public system burdened with a high proportion of complicated cases soon excels in competence rivaling the quality that heretofore was the claim of private medicine. That shift in competence to the public system seems to have taken place in Europe. I have seen this effect in France and I think it is the case in Germany as well. As leaders contemplate a solution to US healthcare problems, it will be wise to avoid a single structure and structured procedures lest they become obsolete even as they are codified.
Indeed the inflection point may go nowhere as in the past, try to build on the past or take a greater leap into academic and scientific medicine as is I believe the European model. We may be in for an interesting scrap.
A clade is a taxonomic group comprising a single common ancestor and all the descendants.
Eumetazoa is a clade comprising all major animal groups except sponges.
phylogenetics is the study of evolutionary relatedness among various groups of organisms
Phylogenetic analyses of DNA or protein sequences using maximum likelihood.
Placozoan A group of balloon-shaped marine organisms, of the phylum Placozoa, that are considered to be the simplest living animals ...
Genome: In modern molecular biology the genome of an organism is its whole hereditary information and is encoded in the DNA (or, for some viruses, RNA).
Signaling specificity depends on three principles of trascriptional control: (1) activator insufficiency, (2) default repression, and (3) cooperative activation. These interconnected transcriptional control principles place tight restrictions on the expression of target genes, but allow robust expression under appropriate stimulus.
Metazoan: Any member of the animal kingdom (Animalia or Metazoa)
Inflection Point Was a term used by Andy S. Grove, founder of Intel. “--- a strategic inflection point is a time in the life of a business when its fundamentals are about to change. That change can mean an opportunity to rise to new heights. But it may just as likely signal the beginning of the end.”
IP is a concept I find useful in the market indicating a fundamental shift in the company’s fortunes by virtue of product, market, management or a return to prior value after a prolonged hiatus.
In differential calculus, an inflection point, or point of inflection (or inflexion) is a point on a curve at which the curvature changes sign. ...
No matter the term, history reconstructs rare occasions when either some combination of events or some significant world event changes the course of history or the fundamental structure of the economy. We presently suffer such a combination of events and circumstances that will inevitably and irreversibly change the status quo.
The magnitude of the forces at play, suggest the end of an era and uncertain new beginnings. Like the market, it is easy to see the crisis, the change in direction, and the velocity, but it is not easy to see the significance or the future magnitude of the change, nor is it easy to see the point at which a fundamental change has taken place.
Today we have high fuel prices, environmental concerns, a ME crisis, high food prices, high fertilizer prices, a growing world population, significant starvation, water shortages, in the US a health care crisis and the US economy is faltering. Arguably some of these circumstances are beyond the point of no return.
History suggests that out of a slow and segmented collapse there will emerge an entirely new world of nations and of man. Those who are flexible and adapt will prosper. Those that remain inflexible and locked into the past will suffer and fail. The first requirement is for the leaders to identify this as a time of inevitable change and use their wisdom and vision to adapt.
Health care is but one crises out of the several; it is of immediate political concern.
In the US, health care challenges us, and hereto we are at an inflection point. The US by several metrics ranks something like in 8th to the 16th place in health care as seen from a public health viewpoint and measurements such as pari-natal mortality and immunization rates, no gold medals here. Leaders face difficult choices in securing health care for everyone, and they, with rare exceptions, know little about clinical medicine or public health; their decisions are late in the making and come just as the science of medicine undergoes a revolutionary breakthrough in basic knowledge. The breakthrough continues, however, and changes everything about the understanding and treatment of disease.
Beyond the genome, investigators can now look directly at the molecular structure and interactions of protein molecules. The desk-top microscope, once limited by the wavelength of the photon, now sees vividly at the nano-scale. Probes with imbedded chips and computer analysis identify the complex genetic molecules, and each new look seems to challenge us with a complete change in our understanding of what we see.
The extent of these new insights and the tools to see on a molecular level are exemplified by this article about a small thing from the inside wall of a fish tank. “As arguably the simplest free-living animals, placozoans may represent a primitive metazoan form, yet their biology is poorly understood.” Mansi Srivastava, et al, University of California, Berkeley, report the sequencing of the ~98 million base pair nuclear genome of the placozoan Trichoplax adhaerens. “Whole-genome phylogenetic analysis suggests that placozoans belong to a ‘eumetazoan’ clade that includes sponges. However, the genome shows content, structure and symmetry like human and other complex eumetazoan genomes. Despite the apparent cellular simplicity of Trichoplax, its genome encodes a rich array of transcription and signaling genes that are typically associated with diverse cell types and developmental processes in eumetazoans.” In other words this little thing adhering to the side of our fish tank is genetically way to complex to just be what it appears, but that is not the point.
The significance of this genetic observation, the result of instrumentation undreamed of a generation ago, prompted Nature to publish the report as its lead article in its 21 August 2008 edition. What might otherwise be considered merely a curious observation in the simplest of small flat animals (1-2 mm), has enormous allegorical implications for medical science, specifically: the fragility of our assumptions about human genetics, disease -- and physiology on a molecular scale. Quoting further, “With the genome in hand, renewed interest in this ‘simple’ animal with a complex genome will add to our appreciation of animal diversity and perhaps yield fundamental insights into early animal diversity,” and from Shakespeare, “There are more things in this world Horatio than are dreamed of in your philosophies,” but the point is diversity, and diversity is part of the scientific method!
The science and understanding of medicine today changes and accelerates at such a rapid pace that a decade may turn everything inside out. The same startling insights, as in the simple Trichoplax, alter our understanding of disease and offer new channels of intervention on nearly a daily basis. Keeping pace with new knowledge and treatment options while at the same time attempting to bring the benefits of new discovery to the patient and the public, frustrates both physicians and public health planners.
This inflection point, if you will, offers a choice of doing what we have always done, what England and Canada have done, or going to a diversified academic system more on the order of European health systems. Private insurance won’t go away but it cannot meet the demands of scientific investigation, education and innovative lines of intervention. Insurance privatizes a free choice of benefit from the fruits of academic medicine, research and education, but it is bureaucratically incapable of initiating research, education or change. And it costs a lot.
To the end of a workable solution, neither health care plan by the competing political parties will keep pace with the present scientific environment of medicine. They both rely almost exclusively on private insurance. The priority of private insurance is the stock holders. If the government subsidizes them they will raise the price. If the government regulates them, they will find a way around the regulation through complexity and exception and the cost goes up. Sound familiar? And there is the whole issue of employer paid insurance that got us the HMO.
The single payer English and Canadian programs work in a manner much criticized by patients who wait long periods of time for care. It is hard to criticize the quality; however, the treatments tend to be codified, which may lead to some inflexibility in education and progress in this fast moving environment. The European systems compete state by state and compete with private insurance by encouraging the continuation of a private segment of those who can afford it. From an academic standpoint the European approach is desirable in providing greater opportunity for research, education and innovation. Our, US, philosophical rejection of the so called two tiered system may have been a major mistake. Competition adds to the verve of scientific research, in the European case, competition between states and competition between the public system and the private insurance based and private pay systems.
A major argument against a two tiered system is that the costlier illnesses will migrate to the public system thus overburdening the budget. Countering that argument is the public responsibility not to bankrupt families unfortunate in experiencing major complicated medical problems. Furthermore, a public system burdened with a high proportion of complicated cases soon excels in competence rivaling the quality that heretofore was the claim of private medicine. That shift in competence to the public system seems to have taken place in Europe. I have seen this effect in France and I think it is the case in Germany as well. As leaders contemplate a solution to US healthcare problems, it will be wise to avoid a single structure and structured procedures lest they become obsolete even as they are codified.
Indeed the inflection point may go nowhere as in the past, try to build on the past or take a greater leap into academic and scientific medicine as is I believe the European model. We may be in for an interesting scrap.
A clade is a taxonomic group comprising a single common ancestor and all the descendants.
Eumetazoa is a clade comprising all major animal groups except sponges.
phylogenetics is the study of evolutionary relatedness among various groups of organisms
Phylogenetic analyses of DNA or protein sequences using maximum likelihood.
Placozoan A group of balloon-shaped marine organisms, of the phylum Placozoa, that are considered to be the simplest living animals ...
Genome: In modern molecular biology the genome of an organism is its whole hereditary information and is encoded in the DNA (or, for some viruses, RNA).
Signaling specificity depends on three principles of trascriptional control: (1) activator insufficiency, (2) default repression, and (3) cooperative activation. These interconnected transcriptional control principles place tight restrictions on the expression of target genes, but allow robust expression under appropriate stimulus.
Metazoan: Any member of the animal kingdom (Animalia or Metazoa)
posted by Clancy Hughes | 9/05/2008 04:56:00 PM
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