August 26th, 2011

.. that wears the crown.

The brave few commenters who struggled to the end of my post blaming admired medical researchers for the long-term crisis in health costs  didn’t like it much. We would all much rather blame parasitical insurance companies and greedy plastic surgeons; but how do they account for the same trends in Britain, Switzerland and Japan? Or Big Pharma: which does operate everywhere, but whose marketing excesses are only allowed to flower in the USA? The slowing down of Pharma’s innovation into incremental plodding does drive costs higher everywhere – but that also is basically a failure of research.

I’m not required to offer solutions, but here goes. Suppose, in the flames and chaos of the collapsing Bachmann Administration, an act of spite by the fleeing President makes me by accident head of the luckless NIH. What would I do in the interval before the Mounties and the UN peacekeepers restore order and the Committee of Public Safety gets round to replacing me?

A successful conservative institution is bound to resist my ideas. So I’ll quickly set up an in-house MARPA – Medical Advanced Research Projects Agency. Like its Pentagon model, it would operate on a venture-capital rather than peer-review paradigm. accepting high failure rates, backing people and ideas rather than neatly packaged proposals, and exploiting unorthodox mechanisms like open prizes and competitions. The mandate will include cost reduction as well as innovation.

As an example let’s look at the apparently glowing health of European royalty.

The evidence for health and longevity is anecdotal but strong.


Queen Elizabeth of the UK – age 85, working. Photo 2010. Keyhole surgery on both knees.

Queen Beatrix of the Netherlands – age 73, working. Photo 2011. Operation for cataracts.


King Harald V
of Norway – age 74, working. Heart and cancer surgery.


King Carl Gustav of Sweden – age 65, working, Photo 2011. Only publicly known health problem is dyslexia.


Queen Margrethe of Denmark – age 71, working. Photo 2011. Arthritis; both knees replaced.

and two consorts:

Prince Philip – age 90, semi-retired.  Photo 2011. Heart condition.


Queen Elizabeth the Queen Mother – died age 101, working into her 80s. Photo at age 100. Appendectomy, two operations for colon cancer, cataracts, hip replacement.

The Queen Mum’s alcohol consumption, 70 units of alcohol a week, was about ten times the recommended level. It was apparently outweighed by regular physical exercise (walks and dancing) and mental (party games, waspish conversation, horse racing), as well as a rugged Scottish constitution.

The sample is of course biased. These are the survivors. How many royal Johnnies  died young, or Katherines and Nerissas spent their lives in institutions?

The project aims are (a) to confirm this anecdotal picture of rosy health and (b) to find out how much it costs.

The first is straightforward and, if true, easily explained. Royalty have nice jobs, so they keep working into their 80s; healthy lifestyles, with sport, sociability, and a requirement to look presentable; and lifelong access to state-of-the art medicine. The strange millinery isn’t a job requirement. They are also, conveniently, a near-random genetic sample, unlike selective cohorts like university professors and international civil servants. (European royalty used to be inbred, but for two generations now they’ve been mating with commoners.) It’s a reasonable stretch to assume that under universal health care they represent the future of the whole population. Which makes question (b) important. Does this health depend on greater health care resources?

My guess is no. Royals don’t have to wait and their physicians spend more time with them at each consultation. But they don’t have access to mythical super-doctors, just reliably good ones. Queen Elizabeth II was advised to breast-feed her children in the 1950s, no doubt as an example to the poor.  To get a fair comparison with the average patient, I think you would want to convert the royals’ actual out-of-pocket costs for private doctors (a luxury good in these countries) to standard costs.

Batty you say? More so than DARPA’s synaptic chips? Find a better idea that actually addresses the health costs trend, the only real external driver of the US deficit, unlike rubbish like cutting Social Security.

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