The Best of Times, the Worst of Times for Medicine in America
Our medical tools and techniques are rapidly improving but our system for delivering health care is a source of widespread frustration.
WE ARE LIVING THROUGH a remarkable revolution in the life sciences, with more on the way as researchers begin to juice already exceptional progress with explosive advances from artificial intelligence.
Yet the actual experience of healthcare in America is often terrible—and seems to be getting worse.
Our collective challenge in the United States will be productively channeling our simmering frustration. As we strive to reimagine healthcare delivery, we must find ways to sustain, and not undercut, the tremendous momentum of American biomedical science.
Healthcare, as experienced in America today, is miserable for just about everyone. It’s awful for patients who must navigate a fiendishly Byzantine system to receive even the most basic care, and to figure out whether costly treatments will be covered by insurance. It’s awful for loved ones who are increasingly pressed into service to advocate for patients—such as when they are left languishing for days in the hall outside emergency departments waiting for a hospital bed to become available.
It’s awful as well for exasperated and overburdened health care professionals. Doctors like those I trained with face escalating administrative burdens, including constant negotiation with insurance companies; they’re experiencing unprecedented professional dissatisfaction and career burnout. Competing, ever-expanding armies of administrators—and more recently, AI tools—from provider and insurer organizations engage in fierce daily battles over reimbursement. These relentless bureaucratic skirmishes sap time, money, and empathy from everyone involved.
YET WE ARE ALSO LIVING THROUGH a time of remarkable progress in biomedical science, “a Golden Age for medicine” as columnist David Wallace-Wells has called it. Genetics and other tools have provided critical insights into new disease targets to attack. We have added an impressive array of approaches to our therapeutic armamentarium, including traditional small molecules, biologics, nucleic acid therapeutics, cell and gene therapies, and imaginative combinations.
Consider the remarkable results: We have improved treatments for many cancers, and developed therapies that now afford most children born with cystic fibrosis a good chance to live a nearly-normal life. Hepatitis C infections, which can lead to liver failure as well as liver cancer, can now be cured. An injectable medicine, lenacapavir, was shown to protect recipients from HIV infection for six months with 100 percent efficacy—an accomplishment recognized by Science magazine as the 2024 Breakthrough of the Year. And a powerful new class of medications, the GLP-1 receptor agonists (think Ozempic and Wegovy), has proved phenomenally effective in staunching appetite, helping patients reduce excess weight and meaningfully improve their health.
Better measurement technologies, including wearable digital devices, enable researchers to understand both disease and treatments with unprecedented precision. Over coffee in Cambridge, Massachusetts, an enthusiastic physician-scientist recently explained to me how a lightweight headset produced by his startup enables clinicians to monitor brainwaves and assess sleep disorders, attracting the interest of multiple pharmaceutical companies.
Life science is also poised to benefit from the revolution in artificial intelligence; two recipients of the 2024 Nobel Prize in Chemistry developed an AI-enabled tool, AlphaFold, to predict protein structures. AI will also play a critically important role in managing drug development’s exploding complexity—a happy consequence of biology’s remarkable progress.
AT THIS TRANSFORMATIVE MOMENT in life science, it seems astonishing some would spend our time and treasure looking backwards and relitigating some of medicine’s most impactful and well-established successes, like the vaccinations that eliminated smallpox and saved millions of children from the scourge of dreadful diseases like polio and other preventable conditions. This regressive thinking is at once distracting and terribly misguided.
Instead, we should look forward, and support our nation’s powerful life-science engine, including both the foundational, enabling science so often funded by the National Institutes of Health as well as our vibrant biotech ecosystem that translates promising early-stage science into rigorously validated medicines.
As we contemplate how to improve access to medicines—a vitally important consideration—let us remember that no one can access therapies that haven’t yet been discovered. Effective treatments are still urgently required for Alzheimer’s disease, pancreatic cancer, brain tumors, and a vast array of rare, devastating conditions that collectively affect millions.
It is essential that we aggressively challenge our conspicuously dysfunctional model of healthcare delivery, since great biomedical science means very little if it doesn’t translate to better care and improved health. But amid our zeal to fix what’s so obviously broken, we must do our best to preserve, refine, and build upon what’s already working.
 | A guest post by
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