Shostack + Friends Blog Archive


Cures versus Treatment

A relevant tale of medical survival over at The Reality-Based Community:

Three years ago a 39-year-old American man arrived at the haematology clinic of Berlin’s sprawling Charité hospital. (The venerable Charité, one of the great names in the history of medicine, used to be in East Berlin, but it’s now the brand for the merged university hospitals of the whole city.) He had both leukaemia and HIV; you wouldn’t have given much for his chances. Now he has neither. How?

The great cancer researcher and medical writer Lewis Thomas wrote this in 1983 (The Youngest Science, endnote to page 175). The context is his stint as an adviser on health policy in Lyndon Johnson’s White House in 1967:

We recognised three levels of medical technology:

(1) genuine high technology, exemplified by Salk and Sabin poliomyelitis vaccines, which simply eliminated a major disease at very low cost by providing protection against the three strains of virus known to exist;

(2) “halfway” technology, applied to the management of disease when the underlying mechanism is not understood and when medicine is obliged to do whatever it can to shore things up and postpone incapacitation and death, at whatever cost, usually very high indeed, illustrated by open-heart surgery, coronary artery bypass, and the replacement of damaged organs by transplanting new ones…

and (3) nontechnology, the kind of things doctors do when there is nothing at all to be done, as in the case of patients with advanced cancer and senile dementia.We suggested that the rising cost of health care was resulting from efforts to treat diseases of the halfway or nontechnology class, and recommended that basic research on these ailments be sponsored by NIH.

Thomas’ analysis still looks spot on to me. But his optimism has so far not proved justified: the billions poured into medical research ever since have led to many improved treatments but disappointingly few cures. The ideal state for Big Pharma is represented by the state of the art on diabetes and HIV: costly lifelong treatments. For most lethal conditions, we don’t have even that.

Information Security also seems to be stuck in the “halfway” technology mode.  We treat the symptoms by patching and deploying security products to prolong survival, but as of yet, there is no cure.

In most organizations, it’s even worse.  Lack of basic knowledge and awareness, lack of funding and/or misplaced risk tolerance produce more nontechnology, such as Business Acceptance of Risk Forms and Security Dashboards where vanity metrics provide CYA.

Even when we know what the Right Things to reduce a risk are, whether turning off the TV, eating right and getting some exercise or removing admin rights and keeping crapware off the machines, we as a society and as companies all-to-rarely seem to have the will to make it happen.

To twist a line from Dean Wormer, “Fat, dumb and pwned is no way to go through life, son.”