Reviews Book

The End of Medicine: How Silicon Valley (and Naked Mice) will Reboot your Doctor

BMJ 2006; 333 doi: (Published 05 October 2006) Cite this as: BMJ 2006;333:760
  1. David Woods, president (dwoods{at}
  1. Healthcare Media International, Philadelphia

    Andy Kessler, who made millions of dollars in the Silicon Valley technology boom of the 1990s, focuses in this book on how that technology might be applied to health care to weed out disease in its earliest stages and significantly reduce costs. Kessler says that “doctors use ancient tools, memorize symptoms and solutions, and a halfway decent search engine can leave them in the dust.”

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    Andy Kessler

    Collins (New York), $24.95, pp 354 ISBN 006113029X

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    Sticking to what he calls “the big three”—heart disease, stroke, and cancer—Kessler says that we spend huge amounts of money treating these diseases when what we should be doing is stopping people getting sick in the first place. In a tone that is a curious mix of lowbrow (“colonoscopies are a pain in the ass”) and scholarly, he conducts a series of interviews with scientists about how sophisticated technology can achieve this. One example is high resolution computed tomography that can quickly and cheaply provide “a decent entry-level image of your heart and arteries… enough to identify deadly plaque that can be rooted out.”

    Kessler gets very excited about the fact that half of the million heart procedures now done annually in the United States might no longer be necessary because some sign was detected early enough to treat the illness in other ways. “That's a lot of hospital beds and cardiologists and nurses with nothing to do,” he declares.

    The naked mice of the book's subtitle are the hapless hairless creatures on which experiments are conducted to test that approach, an effort that could teach us about prevention and cost savings, through cheap, mass screening by such means as biomarkers that can accurately predict cancers and heart diseases.

    As far as the possible redundancy of doctors is concerned, Kessler notes that some radiologists are being replaced by computer aided detection and interpretation of images. Ophthalmologists are being shut out by laser eye surgery, and “physical-peddling physicians will be replaced by multislice scanning machines.”

    Is all this science fiction? Alvin Toffler, author of the 1970s blockbuster Future Shock, said in a recent interview in the Financial Times, “[We] will be using new technologies from self diagnosis to… self administered therapies delivered by nanotechnology so patients can do for themselves what doctors used to do.”

    The end of medicine? Hardly. But it is perhaps the beginning of the end. For now, though, doctors should not give up their day jobs.


    Items reviewed are rated on a 4 star scale (4=excellent)

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