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6/ Blockbuster drugs (with no value judgments on whether they are for HIV, ED, or heart disease) and super-advanced surgery with augmented reality are not "good" or "bad" outside of a societal health condition and simple possibility.
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7/ But the kinds of leading-edge innovation delivered by the US "advanced" system tells you where the frontier is: in biochemistry labs and extremely advanced treatment facilities (for people with weird and rare kinds of cancer for example). This was not always the case.
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8/ Healthcare innovation used to depend on learning rate delivered by number/variety of care episodes so care correlated with advances. The frontier, in other words, used to coincide with the world of care delivery. Public health WAS the field laboratory.
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9/ Today, public health and epidemiology connect a healthcare "market" to a healthcare "innovation" sector via a set of prioritization choices that reflect profit-making potential rather than incidence rates. Again, just an observation, not a judgment.
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10/ Ie, the health conditions that get prioritized are efficiently privatizable ones. Healthcare evolves by corporations deciding for instance that "diabetes" is a better market, and more worth privatizing, than some other condition which offers weaker margins.
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11/ Goes without saying that the efficiently privatizable conditions may not be the ones that represent the greatest societal burden. Social and moral of course, but in the US, we mean primarily economic burden.
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12/ Condition A that represents say a -1% drag on the GDP (ie fixing it would add 1% to growth) goes unaddressed because there is no way to privately make a sweet profit off it.
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13/ While Condition B, that is a 10th place rounding error in GDP terms gets a huge amount of attention/resources because it has efficient private market development potential. Call these "charismatic diseases."
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14/ A charismatic disease/condition is 3 things: a) Easy to market (strong "brands" in symptom terms) b) Easy to dramatize via relateable life narratives ("the American dream, but with diabetes") c) Most importantly: good for drive-by interventions instead of open-ended care
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