SCIENCE-WEEK / 26 March 1999
Many economists and policy-makers believe that one of the most serious problems to face the US health care system and the US economy in the 21st century will be the demographic shift caused by the aging of persons born between 1946 and 1963 (the "baby boom" population) ... H. Pardes et al (6 authors at 6 installations, US) present a proposal that progress in biotechnology may seriously reduce the magnitude of the problem of health care in the next century by rapidly altering medical knowledge and practice, health delivery and outcomes, and total health costs. The authors identify the following factors:
1) Declining disability among people over 65 years of age: The age-adjusted chronic disability prevalence rate has been declining 1.3 percent annually over the past 13 years, and this is consistent with the introduction of new biotechnologies, e.g., better drug treatments of osteoporosis, stroke, Parkinson's disease, and congestive heart failure.
2) Changing paradigms of medicine: Technological advances are defining new paradigms for medicine to which traditional economic theory may not apply. Improved understanding of human biology at the molecular level may make invasive surgery, intensive care units, and long-term nursing home care far less necessary.
3) Reduced health care cost at later ages: Health costs in the last 2 years of life in fact decline in persons dying at later ages (e.g., persons dying at age 90 as opposed to persons dying at age 67. The cost ratio is 1:3)
4) The developing revolution in pharmaceutical methods: Savings resulting from new medical knowledge will be multiplied by the ability to screen promising compounds at rates unimaginable a few years ago. Miniaturization and robotic chemistry, allied with genetics and high-throughput screening and bioinformatics, both provide a clearer picture of drug efficacy before clinical trials and may reduce certain pretrial development costs by a factor of 100.
5) An increase in public expectations about health at later ages: A better-educated older population will be driven by rising health expectations, resulting in behavioral changes identified by biomedical research as improving health.
6) Labor productivity as a function of improved health: Decreased morbidity will increase the productivity of the labor force and extend such productivity to older populations. This will make feasible the raising of the age of Medicare and Social Security eligibility.
7) Growing importance of biotechnology to the economy: Beyond its impact on individual health, biotechnology is an important engine of US economic growth, and biotech industries could experience growth similar to that experienced by the computer industry during the past 20 years, with a resulting significant increase in the gross domestic product.
The authors conclude: "Looking at health care as a multicomponent dynamic subsystem of the US economy allows us to appreciate the multiplier effects biotechnological innovations may produce to control future costs. However, there may by a 15- to 20-year lag between a scientific observation and its clinical implementation. We must increase investment heavily in biomedical research to realize benefits in time to control the impact of Medicare costs."
H. Pardes et al: Effects of medical research on health care and the economy. (Science 1 Jan 99 283:36) QY: H. Pardes hp2@columbia.edu
