Things you should know about medical care, medical research, stock options, etc.

I'm 42 and recently learned this stuff. Others older than I am didn't know it either and had to pay the price. If you are reading this, this may save your life, or it may save you a lot of grief.

HOW TO GET THE HIGHEST QUALITY MEDICAL CARE
Don't let this happen to you! If you can afford it financially, take charge of your own medical care. NEVER assume your medical condition is "normal."

Infoseek's COO, Les Wright, recently felt his back "go out" while digging a ditch. The doctors ordered some drugsto relax his muscles, but delayed an MRI until he had symptoms of losing feeling in one of his legs, since an MRI isn't normally warranted based on the symptoms. As a result of this delay to find out what was really going on, he now can walk only on one leg.

The word "normally" is key here. Doctors aren't going to order an "unnecessary" medical procedures unless there is evidence that the procedure is warranted. There are a couple of reasons for this: 1) your insurance company won't pay 2) it reduces strain on the facilities (e.g., even after Les exhibited loss of feeling, it still took a day before he could be booked on the MRI because of the demand).

But it's even worse than that! When the surgeon read the MRI, he wanted to operate immediately (but again, the soonest they could schedule a surgery was the next day). When the doctor called the insurance company for approval to operate, the insurance company said they would not cover the surgery until he had gone through a 7 day evaluation to see if he got better. The surgeon operated anyway and told our COO to argue with the insurance company later.

Moral of the story: If you aren't destitute, don't screw around trying to save money on medical care. Get several opinions, always assume you are the 1% case where the external symptoms don't show the full nature of an injury, explain to the doctors that you'd rather be safe than sorry and that cost is no object. If your situation warrants an immediate MRI to be safe, don't wait. Call around. Offer to pay overtime to the MRI operator. An ounce of prevention is worth a pound of cure here.

In the case here, if Les had the MRI right after experiencing a tingling sensation in his thigh, it might have been caught early enough that no significant nerve damage would have occurred.

Les is in his mid 40s and very smart, and he got good medical advice. But it wasn't good enough. Don't let this happen to you.

Here's what a doctor at Stanford had to say about Les' case.

Bottom line is that if you can afford it, take charge. Get the best treatment and the best doctors. There is effectively a two-tier medical system in this country. Many people cannot afford to get premium care. But if you can afford it, it's up to you to get it for yourself. Don't expect it to be handed to you.

MEDICAL RESEARCH  IS  INEFFICIENT
We spend billions of dollars a year on medical research in universities and industry. But contrary to what I used to think, I've now learned that those dollars are inefficiently spent. Anyone in the research community will validate this, but it isn't something that people talk about, or our proud of. Here's the scoop...

University researchers are no different than companies; they are always trying to compete with each other. So you rarely see university groups working in the same area collaborating. The only collaborations you see are cross-departmental, because there is no competition.

As a result, rather than always building on the research of others, or helping to prove promising ideas, researchers focus on their own unique ideas so they will get the "credit." In fact, it's often worse; people try to discredit your work. Certainly there is some value in this if the work is legitimately poor. But if the work is poor, but still has a good scientific basis, our researchers should be helping other researchers make new discoveries, rather than criticizing them.

So that's why researchers working in many fields work so hard to make sure their formulations and protocols are well documented before going public. For example, look what happened to Judah Folkman when he didn't do this and nobody could replicate his work.

This slows progress because it means people are less likely to publish results sooner.

NIH has realized this and the "center" grants are an attempt to foster cooperation between groups. It's a move in the right direction, but still is not enough to foster cooperation within a field (as opposed to cross-fields).

Oddly, the most promising ways of creating collaboration is through industry. Since academics don't see themselves in "competition" with industry, you can have a hub-spoke model where one type is the hub, and the other types are the spokes.

All things considered, the system works pretty well -- better than in any other country in the world. Academics are motivated by fame, glory, and career. Commercial researchers are motivated by profits. Both are highly motivated. But I believe there is an opportunity to do better still with a more collaborative system.

University research vs. Commercial research
In general, universities are good at inventing. Companies are good at commercializing. That's why Targesome is a company, rather than a research project, for example. The technology could have been licensed to a drug company, but often, licenses often fail due to "not invented here" problems. And by using "stock options," Targesome can get help from experts everywhere, something that university researcher cannot do.

WHY MOST NEW DRUGS FAIL TO GET TO MARKET
I've heard stats like for every 100 drugs that makes it to Phase 3 clinical trials, only one gets approved. Why is the failure rate so high?

The answer appears to be that most drugs that get tested are not understood or non-specific.

For example, take Minoxidil, which was approved for baldness. Does anyone know why it works? No. Only that it does in "some" cases. And that's a big time drug (until recently when Propecia stole all it's market share since it is much more effective).

Another example, is tetracycline for acne. Sure it reduces acne, but it doesn't stop it.

The problem is that the science is so complicated, and the interactions so mysterious, that often you just have to try a lot of things and see what works (i.e., empirical results).

KNEE SURGERY
See my Knee Surgery Q&A.

THINGS TO KNOW ABOUT STOCK OPTIONS
Buy your stock if you are in a startup company. The stock is cheap so there's virtually no downside. If you instead take an option and don't exercise it immediately, you can get hit with a lot of taxes when you exercise and sell. Buying early gives you the best chance at long term capital gains treatment.

SLEEP
Research by Cornell psychology professor James B. Maas shows that if you get less than 8 hours of sleep a night, you are operating impaired; your alertness, productivity and creativity, and general health are all affected. He has a new book out called Power Sleep. The book details the enormous costs to individuals and society of sleep deprivation, then explains the "architecture and functions" of sleep and offers a practical guide to balancing a personal sleep budget while coping with those who can't. One-third of all Americans get six hours of sleep a night or less when they should be getting nine or 10.

"If we can get people sleeping eight hours, that would be wonderful, although still not optimal," Maas said and explained the significance of that number. "Between the seventh and eighth hour is when we get almost an hour of REM (rapid eye movement) sleep, the time when the mind repairs itself, grows new connections and puts it all together. REM sleep occurs about every 90 minutes, and the periods of REM sleep get longer as the night progresses. If you're a six-hour sleeper, you're missing that last, important opportunity to repair and to prepare for the coming day."

HEART DISEASE
Purple grape juice has the same heart benefits as wine, but without the alcohol.   Check out these articles:

http://www.tamnet.com/leisure/stories/98121002l.html

Links
Steve Kirsch home page

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