How Doctors Die (2011)

I'm an American who typically values choice and being able to shop around, but I agree that it ends up creating this sort of unpleasant situation in healthcare. Lots of reasons, but two big ones are: 1) lots of buyers who cannot say no, e.g. someone in an ambulance on a way to a hospital is not in a strong negotiating position; and 2) the insurance model doesn't work that well, because incidents are strongly correlated within an individual's lifetime (hence the notion of "preexisting conditions" and the need for employer-tied group plans to pool risk without adverse selection), not independently insurable.

I live in Denmark currently, and I do find the healthcare system here a lot more sane. I have some choice; for example, I can choose a doctor. On that angle I actually have more choice: I can choose any doctor, and keep him/her, whereas in the U.S. I had to give up the doctor I liked when I was a kid, because my dad's company changed insurance plans and my doctor wasn't covered by the new one. And I don't have a huge bureaucratic mess of insurances and plans and bills to deal with, or worry about how changes in my employment will affect my coverage.

Respectfully I disagree. This level of understanding is not necessary.

Metaphor: if you are fighting a fire, you don't kneed to understand the full composition of th various fuels and the exact molecular characteristics of the fire at every point, it is enough to know that water will quench it.

- I realise that many on HN have an aversion to metaphors so please forgive me and let me continue to elaborate.

Wole cell emulation is certainly not necessary, although it would no doubt be interesting to be able to do this at some long-distant point.

We don't need to do this because it really does seem as though it is enough to understand the mechanisms of unconstrained cellular proliferation through genetic analysis and surface protein characterisation.

This will allow targeted therapies through:

1) Find the genes that are Broken, or allow the final common pathway of cell proliferation to be stuck in the 'on' position, and work out how to block them.

-Initially this will be done by designed drugs following the model of glivec but one day soon (i hope) it seems likely that siRNA technologies will make it a lot easier and faster

2) characterise the surface molecules that are different in the cancerous cells and design targeted therapies for them,

- as with Trastuzamab for HER2 in receptor positive breast cancers; in the future it seems more likely that we will be able to achieve good efficacy with musing camel antibodies (smaller, high affinity), and by combining the antibodies to substances to deliver targeted radiation, chemotherapy and upregulate the immune response against the cells

3) immune system-boosting therapies which prime the immune system against specific cancers

- already shown in proof of concept for various leukemias, see New England Journal of Medicine 'Chimeric Antigen Receptor–Modified T Cells in Chronic Lymphoid Leukemias' , doi://10.1056/NEJMoa1103849

You say we need to understand the mechanics of cells down to a molecular level; in a very many cases we do:'we understand huge areas of cellular biology down to the atomic and molecular level. There are of course many things we don't understand or know yet, but emulation is not necessary for knowing them and it seems quite clear that proliferation pathways are very well characterised indeed, and have been for around 20-25 years; since all cancerous cells must proliferate by this pathway it is simply (I know, it is very difficult, but still, I say again, simply) a matter of determining which pathway is being used and blocking it, whilst also destroying the cell.

Not easy work, but I believe something that we are making good progress on.

- my 2c given a background in molecular biology and as a final year med student

If, as a US citizen, you're going to have (or need) serious treatment done for which you will have to pay a considerable amount of money it might be an option to go overseas. I can highly recommend going to Thailand. They have great medical centers in Bangkok with very professional and highly skilled doctors and specialists AND you're treated like a patient who needs care.

I can't comment on Sweden, but in Canada, you essentially go to any doctor you want. It was in the US, where the insurance company more-or-less assigned a doctor, that I lacked freedom of choice.

I dont know. Its one thing when you are 65 and all your kids are grown up. Its a whole other thing when you are 50 and have young children at home. I have a friend with 4 young kids. He has stage 4 cancer requiring constant chemo and pain, but he is going to fight it with everything they have in order to be there as long as possible with his kids - and maybe beat it.