He watched his brother die from a cancer that no drug could cure. Now one of the world’s most renowned cancer researchers says it’s time for Plan B. ... The answers Bert Vogelstein needed and feared were in the blood sample. ... Vogelstein is among the most highly cited scientists in the world. He was described, in the 1980s, as having broken into “the cockpit of cancer” after he and coworkers at Johns Hopkins University showed for the first time exactly how a series of DNA mutations, adding up silently over decades, turn cells cancerous. Damaged DNA, he helped prove, is the cause of cancer. ... Now imagine you could see these mutations—see cancer itself—in a vial of blood. Nearly every type of cancer sheds DNA into the bloodstream, and Vogelstein’s laboratory at Johns ­Hopkins has developed a technique, called a “liquid biopsy,” that can find the telltale genetic material. ... The technology is made possible by instruments that speedily sequence DNA in a blood sample so researchers can spot tumor DNA even when it’s present in trace amounts. The ­Hopkins scientists, working alongside doctors who treat patients in Baltimore’s largest oncology center, have now studied blood from more than a thousand people. They say liquid biopsies can find cancer long before symptoms of the disease arise.

Nothing except a crazy experimental treatment never before given to a child: Blood was taken out of 6-year-old Emily’s body, passed through a machine to remove her white cells and put back in. Then scientists at the University of Pennsylvania used a modified HIV virus to genetically reprogram those white cells so that they would attack her cancer, and reinjected them. ... commercializing June’s cancer-killing cells would be like no drug development program ever. Scientists call them chimeric antigen receptor T-cells, or CARTs. T-cells are the immune system’s most vicious hunters. They use their receptors to feel around in the body for cells with particular proteins on their surface and destroy them, targeting infected cells and cancer. With CARTs scientists add a man-made receptor–the chimeric antigen receptor–assembled from mouse antibodies and receptor fragments. A gene code for the man-made receptor is inserted into the T-cell’s DNA with a virus, usually a modified HIV. If the receptor sees cancer, not only does it kill it, it starts dividing, creating a cancer-killing army inside the body. ... Downsides: “So far, it’s only blood cancer, it’s high technology, it’s customized therapy, it’s going to require major investment,” warns Clifford Hudis, president of the American Society of Clinical Oncology, who is nonetheless excited about the cells. The current CARTs kill not just cancer cells but any B-cell, the type of white blood cell that goes wrong in leukemia. Patients are likely to get injections of a protein that B-cells make, called gamma globulin, for the rest of their lives; if the treatment becomes popular there may not be enough gamma globulin to go around. ... “It’s a little early to know whether or not the remarkable results we’re seeing will show us whether these are the drugs we’ve been looking for or whether these are the first powerful signals that we’re headed in the right direction,” says Louis M. Weiner, the director of Georgetown University’s Lombardi Cancer Center . Though the cells are “amazing,” says Charles Sawyers, the past president of the American Association for Cancer Research and a Novartis board member, “what we don’t know is how broadly does this scale?”

Why thieves love America’s health-care system ... INVESTIGATORS in New York were looking for health-care fraud hot-spots. Agents suggested Oceana, a cluster of luxury condos in Brighton Beach. The 865-unit complex had a garage full of Porsches and Aston Martins—and 500 residents claiming Medicaid, which is meant for the poor and disabled. Though many claims had been filed legitimately, some looked iffy. Last August six residents were charged. Within weeks another 150 had stopped claiming assistance, says Robert Byrnes, one of the investigators. ... Health care is a tempting target for thieves. Medicaid doles out $415 billion a year; Medicare (a federal scheme for the elderly), nearly $600 billion. Total health spending in America is a massive $2.7 trillion, or 17% of GDP. No one knows for sure how much of that is embezzled, but in 2012 Donald Berwick, a former head of the Centres for Medicare and Medicaid Services (CMS), and Andrew Hackbarth of the RAND Corporation, estimated that fraud (and the extra rules and inspections required to fight it) added as much as $98 billion, or roughly 10%, to annual Medicare and Medicaid spending—and up to $272 billion across the entire health system.

A new book reveals the moment the NFL could no longer ignore concussion science … THERE HAS NEVER been anything like it in the history of modern sports: a public health crisis that emerged from the playing fields of our 21st-century pastime. A small group of research scientists put football under a microscope -- literally. What they found was not the obvious, as many people later would claim. We all knew that football was violent and dangerous, that one hit could break your neck or even kill you. No, what the researchers were saying was that the essence of football -- the unavoidable head banging that occurs on every play, like a woodpecker jackhammering at a tree -- can unleash a cascading series of neurological events that in the end strangles your brain, leaving you unrecognizable. … The researchers who made this discovery -- you could count them on one hand -- thought NFL executives would embrace their findings, if only to make their product safer. That is not what happened.

Elizabeth Holmes founded her revolutionary blood diagnostics company, Theranos, when she was 19. It’s now worth more than $9 billion, and poised to change health care. ... In the fall of 2003, Elizabeth Holmes, a 19-year-old sophomore at Stanford, plopped herself down in the office of her chemical engineering professor, Channing Robertson, and said, “Let’s start a company.” ... Robertson, who had seen thousands of undergraduates over his 33-year teaching career, had known Holmes just more than a year. “I knew she was different,” Robertson told me in an interview. “The novelty of how she would view a complex technical problem–it was unique in my experience.” ... Holmes had then just spent the summer working in a lab at the Genome Institute in Singapore, a post she had been able to fill thanks to having learned Mandarin in her spare hours as a Houston teenager. Upon returning to Palo Alto, she showed Robertson a patent application she had just written. As a freshman, Holmes had taken Robertson’s seminar on advanced drug-delivery devices–things like patches, pills, and even a contact-lens-like film that secreted glaucoma medication–but now she had invented one the likes of which Robertson had never conceived. It was a wearable patch that, in addition to administering a drug, would monitor variables in the patient’s blood to see if the therapy was having the desired effect, and adjust the dosage accordingly. ... “I remember her saying, ‘And we could put a cellphone chip on it, and it could telemeter out to the doctor or the patient what was going on,’ ” Robertson recounts. “And I kind of kicked myself. I’d consulted in this area for 30 years, but I’d never said, here we make all these gizmos that measure, and all these systems that deliver, but I never brought the two together.” ... Still, he balked at seeing her start a company before finishing her degree. “I said, ‘Why do you want to do this?’ And she said, ‘Because systems like this could completely revolutionize how effective health care is delivered. And this is what I want to do. I don’t want to make an incremental change in some technology in my life. I want to create a whole new technology, and one that is aimed at helping humanity at all levels regardless of geography or ethnicity or age or gender.’ ” ... “Consumerizing this health care experience is a huge element of our mission,” Holmes says at our first meeting in April, “which is access to actionable information at the time it matters.” In our conversations over the next two months, she comes back to that phrase frequently. It is the theme that unifies what had seemed to me, at first, a succession of diverse, disparate aspects of her vision. ... Though she has now raised more than $400 million, she says she has retained control over more than 50% of the stock.

A Ghanaian entrepreneur thinks he has the answer to Africa’s fake medicine problem ... Drug Lane runs through a market in the heart of Accra, Ghana. It’s past the office towers going up to the east of the central business district, past the pushy vendors with fake Louis Vuitton luggage, and past the women selling trays of raw beef under the midday sun. The alley bristles with signboards for pills, powders, and other substances. One store is packed to the rafters with boxes of painkillers and antibiotics. On the wall are two posters: One is for Coartem, a malaria treatment made by the Swiss drug company Novartis, and the other advertises something called Recharger, supposedly made from the male silkworm moth. ... Like 85 percent of the people selling medicine in Ghana, he isn’t a pharmacist. Most of his stock comes from China, India, and Malaysia, imported by Ghanaian distributors who supply everyone from “licensed chemical sellers” like him to actual pharmacies and hospitals. It’s a system so porous that as many as one in three medicines sold on Drug Lane could be counterfeit, according to the U.S. Centers for Disease Control and Prevention, compared with about 1 percent in the U.S. and Europe. The fake drugs often have no active ingredient at all, or just enough to pass quality-control tests, and visually they can be indistinguishable from the real thing. ... MPedigree sells software that manufacturers use to label individual packs of medication with a random 12-digit code hidden under a scratch-off panel on the packaging. When a person buys medicine, she can text the code to MPedigree for free and get an instant reply telling her whether the product is authentic.

On the seventh floor of a building overlooking the Federal Reserve Bank in lower Manhattan, two medical clinics share an office. One is run by a podiatrist who’s outfitted the waiting room with educational materials on foot problems such as hammer toes and bunions. The other clinic doesn’t have pamphlets on display and offers a much less conventional service: For the advertised price of $525, severely depressed and suicidal patients can get a 45-minute intravenous infusion of ketamine—better known as the illicit party drug Special K. ... Patients receive a low dose of the drug: about one-tenth of what recreational abusers of ketamine take or about one-fifth of what might be used as a general anesthetic. ... During the infusions, which are gradual rather than all at once, patients often experience strange sensations, such as seeing colors and patterns when they close their eyes. ... The U.S. Food and Drug Administration hasn’t approved ketamine for the treatment of mood disorders, but dozens of medical studies show that it can quickly alleviate severe depression.

Everyone at the Napa meeting had access to a gene-editing technique called Crispr-Cas9. The first term is an acronym for “clustered regularly interspaced short palindromic repeats,” a description of the genetic basis of the method; Cas9 is the name of a protein that makes it work. Technical details aside, Crispr-Cas9 makes it easy, cheap, and fast to move genes around—any genes, in any living thing, from bacteria to people. ... Using the three-year-old technique, researchers have already reversed mutations that cause blindness, stopped cancer cells from multiplying, and made cells impervious to the virus that causes AIDS. Agronomists have rendered wheat invulnerable to killer fungi like powdery mildew, hinting at engineered staple crops that can feed a population of 9 billion on an ever-warmer planet. Bioengineers have used Crispr to alter the DNA of yeast so that it consumes plant matter and excretes ethanol, promising an end to reliance on petrochemicals. Startups devoted to Crispr have launched. International pharmaceutical and agricultural companies have spun up Crispr R&D. Two of the most powerful universities in the US are engaged in a vicious war over the basic patent. Depending on what kind of person you are, Crispr makes you see a gleaming world of the future, a Nobel medallion, or dollar signs. ... It brings with it all-new rules for the practice of research in the life sciences. But no one knows what the rules are—or who will be the first to break them. ... As it happened, the people who found it weren't genome engineers at all. They were basic researchers, trying to unravel the origin of life by sequencing the genomes of ancient bacteria and microbes called Archaea (as in archaic), descendants of the first life on Earth. Deep amid the bases, the As, Ts, Gs, and Cs that made up those DNA sequences, microbiologists noticed recurring segments that were the same back to front and front to back—palindromes. The researchers didn't know what these segments did, but they knew they were weird. In a branding exercise only scientists could love, they named these clusters of repeating palindromes Crispr. ... Pick your creature, pick your gene, and you can bet someone somewhere is giving it a go.

Meet the iChip, a plastic block that helped scientists discover a new antibiotic that kills superbugs. Will it be enough to save humankind from the coming bacterial apocalypse? ... Even more exciting is the innovation used to discover teixobactin: the unassuming plastic blocks. Each one is called an iChip, short for isolation chip, so-named because of how it captures microbes from soil. Until now, scientists hunting for antibiotics haven’t been able to study 99 percent of the world’s microbial species because, when ripped from the outdoors and encouraged to grow under desolate laboratory conditions, the vast majority of bacteria die. The iChip overcomes this problem by keeping things dirty: Burying soil microbes in their natural habitat during the culturing process preserves the organic compounds they need to thrive, enticing previously stubborn microorganisms to multiply under human supervision. ... An investigation by a U.K. government task force estimates that the global toll of antibiotic resistance is 700,000 deaths per year—and that it could soar to 10 million by 2050. In the United States, at least 2 million people are infected with antibiotic-immune bacteria annually; some 23,000 die. (The director of the Centers for Disease Control and Prevention has called the estimate “a bare minimum.”) All that illness and death exacts substantial economic losses, too: The U.K. task force projects that resistance will sap between 2 and 3.5 percent of the world’s GDP—about $100 trillion—over the next 35 years. ... The iChip could prove an essential tool for warding off bacteria’s looming assault on humans, but it’s not a cure-all. ... Rather than trying to determine what biological compounds soil bacteria need to flourish—science still doesn’t have a precise answer—he focused on the simple fact that many microbes are happy in dirt.

Inside the 50-year quest to build a mechanical organ ... each year, only about 1 in 10 patients that need a transplant worldwide receives the life-saving surgery. ... Fewer than 2,000 patients have received an entirely artificial heart in the device's three decades of existence, and most patients haven’t used the machines for long. As with Williams, mechanical hearts are typically just a bridge to an eventual transplant. ... It’s unclear whether plastic and metal hearts can ever truly replicate their biological counterparts, which pump 2,000 gallons of blood every day, service 60,000 miles of blood vessels (more than double the circumference of the world), and work without a hitch year after year.

Elizabeth Holmes rarely slips out of character. When she responds to questions in an interview or on a conference stage, she leans forward, leg crossed ankle over knee in a half-lotus manspread power pose. She lowers her voice an octave or two, as if she’s plumbing the depths of the human vocal cord. Although she hates it being remarked upon, her clothing, a disciplined all-black ensemble of flat shoes, slacks, turtleneck, and blazer buttoned at the waist, is impossible not to notice. She adopted this uniform, as she calls it, in 2003, when she founded Theranos, a company seeking to revolutionize the medical diagnostics industry by doing tests using only a few drops of blood. ... “I wanted the focus to be on my work,” she says slowly and deliberately. “I don’t want to go into a meeting and have people looking at what I’m wearing. I want them listening to what I’m saying. And I want them to be looking at what we do.” ... She was only too willing to let that propel her through the business media’s star chamber, though she refused to let photographers use a wind machine to blow her hair. ... After several years of Holmes telling the largely unchallenged story of how Theranos intends to change the world, a blast of cold air came ... Most blood work in the U.S. is run on analyzer machines made by companies such as Siemens, Roche Diagnostics, and Olympus. The labs that buy these machines don’t need the FDA’s OK to use them, but the manufacturers need it to sell them. ... FDA clearance alone may not be enough to convince physicians that the tests can be used for all patients, according to John Ioannidis, a professor of medicine at Stanford who’s best known for his criticism of the way scientific research is conducted, in particular for a 2005 paper titled “Why Most Published Research Findings Are False.”

The tech for surgeons to operate on patients from hundreds or even thousands of miles away has been possible for over a decade. But will it ever become commonplace? ... real benefits, though, are for the patient. Thin, dexterous tools are precise over a large range of motion. For example, Tewari used the forceps to tie a series of knots with thin string to suture up his incisions, which makes it easier for surgeons to spare healthy tissue when cutting out an unwanted mass. Tewari says that at his hospital, the use of robots has cut the recovery time for prostate surgery from four days to just one or two. No surprise, then, that robotic procedures are more popular than ever. In 2010, 86 percent of prostatectomies were done with robots, and they are used to operate on hearts, kidneys, gallbladders, and ovaries. In 2012, 450,000 operations were done with robots, according to the Wall Street Journal. ... Some optimistic experts says it's only a matter of time until researchers fix the technical challenges that prevent doctors from operating from another state or country. But from cyber security to connection speeds to legal gray areas, there are a host of potential problems with remote surgery. Under the wrong conditions or in the wrong hands, surgical tools can do more harm than good. ... researchers found that the surgeons didn't notice if the lag time was less than 250 milliseconds. Higher than that, though, and their performance suffered no matter their level of surgical experience

Patrick Soon-Shiong wants to turn cancer treatment upside down. On January 12, Soon-Shiong and a consortium of industry, government, and academia announced the launch of the Cancer MoonShot 2020, an ambitious program aiming to replace a long history of blunt trial-and-error treatment with what amounts to a training regimen for the body’s own immune system. That system, Soon-Shiong argues, is perfectly adept at finding and eliminating cancer with exquisite precision—if it can recognize the mutated cells in the first place. Helping it to do so could represent a powerful new treatment for the disease, akin to a flu vaccine. ... Soon-Shiong has hit home runs before. This past July, one of his firms underwent the highest-value biotech IPO in history. A cancer drug he developed, called Abraxane, is approved to fight breast, lung, and pancreatic cancers in more than 40 countries. Soon-Shiong’s path from medical school in South Africa through residency in Canada, to UCLA professor, NASA researcher and corporate CEO has given him the bird’s-eye view necessary to take on a project this ambitious, as well as the resources to marshal the world-class computing and genome-sequencing facilities that it requires.

There are a lot of directions in which to point fingers. There is Holmes, of course, who seemed to have repeatedly misrepresented her company. There are also the people who funded her, those who praised her, and the largely older, all-white, and entirely male board of directors, few of whom have any real experience in the medical field, that supposedly oversaw her. ... But if you peel back all of the layers of this tale, at the center you will find one of the more insidious culprits: the Silicon Valley tech press. They embraced Holmes and her start-up with a surprising paucity of questions about the technology she had supposedly developed. They praised her as “the next Steve Jobs,” over and over (the black turtleneck didn’t hurt), until it was no longer a question, but seemingly a fact. ... The system here has been molded to effectively prevent reporters from asking tough questions. It’s a game of access, and if you don’t play it carefully, you may pay sorely. Outlets that write negatively about gadgets often don’t get pre-release versions of the next gadget.

The DNDi is an unlikely success story in the expensive, challenging field of drug development. In just over a decade, the group has earned approval for six treatments, tackling sleeping sickness, malaria, Chagas' disease and a form of leishmaniasis called kala-azar. And it has put another 26 drugs into development. It has done this with US$290 million — about one-quarter of what a typical pharmaceutical company would spend to develop just one drug. The model for its success is the product development partnership (PDP), a style of non-profit organization that became popular in the early 2000s. PDPs keep costs down through collaboration — with universities, governments and the pharmaceutical industry. And because the diseases they target typically affect the world's poorest people, and so are neglected by for-profit companies, the DNDi and groups like it face little competitive pressure. They also have lower hurdles to prove that their drugs vastly improve lives. ... Now, policymakers are beginning to wonder whether their methods might work more broadly. ... If successful, the work could challenge standard assumptions about drug development, and potentially rein in the runaway price of medications.

In a searing investigation into the once lauded biotech start-up Theranos, Nick Bilton discovers that its precocious founder defied medical experts—even her own chief scientist—about the veracity of its now discredited blood-testing technology. She built a corporation based on secrecy in the hope that she could still pull it off. Then, it all fell apart. ... At Theranos, Holmes preferred that the temperature be maintained in the mid-60s, which facilitated her preferred daily uniform of a black turtleneck with a puffy black vest—a homogeneity that she had borrowed from her idol, the late Steve Jobs. ... Holmes had learned a lot from Jobs. Like Apple, Theranos was secretive, even internally. Just as Jobs had famously insisted at 1 Infinite Loop, 10 minutes away, that departments were generally siloed, Holmes largely forbade her employees from communicating with one another about what they were working on—a culture that resulted in a rare form of executive omniscience. At Theranos, Holmes was founder, C.E.O., and chairwoman. There wasn’t a decision—from the number of American flags framed in the company’s hallway (they are ubiquitous) to the compensation of each new hire—that didn’t cross her desk. ... And like Jobs, crucially, Holmes also paid indefatigable attention to her company’s story, its “narrative.” ... In a technology sector populated by innumerable food-delivery apps, her quixotic ambition was applauded. ... she is often surrounded by her security detail, which sometimes numbers as many as four men, who (for safety reasons) refer to the young C.E.O. as “Eagle 1”—and headed to the airport. (She has been known to fly alone on a $6.5 million Gulfstream G150.) ... it is impossible to get a precise result from the tip of a finger for most of the tests that Theranos would claim to conduct accurately. When a finger is pricked, the probe breaks up cells, allowing debris, among other things, to escape into the interstitial fluid. While it is feasible to test for pathogens this way, a pinprick is too unreliable for obtaining more nuanced readings. Furthermore, there isn’t that much reliable data that you can reap from such a small amount of blood.

Fifteen years after the U.S. declared drug-resistant infections to be a grave threat, the crisis is only worsening, a Reuters investigation finds, as government agencies remain unwilling or unable to impose reporting requirements on a healthcare industry that often hides the problem. ... Even when recorded, tens of thousands of deaths from drug-resistant infections – as well as many more infections that sicken but don’t kill people – go uncounted because federal and state agencies are doing a poor job of tracking them. The Centers for Disease Control and Prevention (CDC), the go-to national public health monitor, and state health departments lack the political, legal and financial wherewithal to impose rigorous surveillance. ... As America learned in the battle against HIV/AIDS, beating back a dangerous infectious disease requires an accurate count that shows where and when infections and deaths are occurring and who is most at risk. Doing so allows public health agencies to quickly allocate money and manpower where they are needed. But the United States hasn’t taken the basic steps needed to track drug-resistant infections.

Intrigued by the promise of an easier way to make money, he enrolled as a guinea pig in a four-week study testing the effects of alcohol on a painkiller drug. ... For studies looking for healthy subjects, the screening process generally comes in two steps. The first is over the phone, when guinea pigs call to express their interest. ... The second step is in person, where clinic staff will check blood, urine, and vital signs to determine whether subjects’ claims are true. Some studies, the well-paying ones, are competitive, and clinics will often admit more people than they need from the phone screen, expecting to cull the herd after the round of physicals. Pros know to avoid alcohol and drugs in the days leading up to the screening. Some of the more cautious ones will also abstain from exercise, out of worry that an increased creatinine level will make it appear as though they’ve been drinking. ... In chronological order, the phases of drug testing work like this: Phase 1 studies, which test for safety, typically use between 20 and 80 healthy subjects to determine a drug’s side effects and how it’s metabolized in the body. Assuming the drug proves safe, it then advances into Phase 2, which measures its effectiveness against another treatment or a placebo; this time, the study participants are patients with whatever condition the drug was developed to treat, usually somewhere between a few dozen and a few hundred. Phase 3, the last phase before the drug is submitted to the FDA for approval, can include hundreds or thousands of patients and measures both safety and efficacy, as well as how the drug behaves in different types of patients or in conjunction with another therapy.

In the industries where there’s rapid productivity growth, everybody is freaked out, because what are people going to do after everything gets automated? In the other part of the economy, that second part, health care and education, people are freaked out about, "Oh my God, it’s going to eat the entire budget! It’s going to eat my personal budget. Health care and education is going to be every dollar I make as income, and it’s going to eat the national budget and drive the United States bankrupt!" And everybody in the economy is going to become either a nurse or teacher. It’s really funny, both sides of the economy get polar opposite emotional reactions.  ... We are very much not present, in what we would consider to be a healthy way, in education, health care, construction, childcare, senior care. The great twist on that is that second category — that’s most of the GDP. Most of the spending is most of the GDP, and these are the areas where we have not yet been able to crack the code. ... How audacious or insane is it to think that you could bring tech to health care or education? It’s probably 50/50. ... What’s interesting is there are probably more new computer companies in the valley today than there were probably since 1982 — it’s just that the products are all these different shapes, sizes, and descriptions. ... Basically, the entire way we live today is a consequence of the invention of the automobile. Because, before that, people just never went anywhere. Therefore, everything that you travel to is a consequence of the automobile.

At home, before he gave the present to his wife, Muruganantham took out one of the pads and tore it open. As a kid, he had always been driven by an extraordinary curiosity to find out how things worked; he would compulsively dismantle any new thing he could lay his hands on — toys, bicycles, radios. Muruganantham expected to see something interesting inside the pad, especially because of how furtively the shopkeeper had handed him the pack, but the innards seemed to be nothing but compressed cotton. He wondered why 10 grams of cotton — costing barely a 10th of a rupee — was being sold for a price that was beyond the reach of 90 percent of Indian women. ... economic constraints have driven India’s government and industries to create cheaper versions of many Western products and technologies. India’s pharmaceutical companies have for many years been a major supplier of cheap generic drugs domestically as well as in other developing countries. In 2014, when the Indian Space Research Organization’s Mangalyaan spacecraft entered into orbit around Mars, a few days after a NASA probe did the same, the most-talked-about difference between the two missions was that Mangalyaan had cost about a 10th of what NASA had spent.

And, as human birthrates fell, pets took the place of children in some families. In 2014 there were 179 million cats and dogs in the U.S., up from 98 million in 1980. Today, according to the American Animal Hospital Association (AAHA), more than 80 percent of pet owners think of themselves as their pets’ moms and dads. Americans love their pets so much, they spent $35 billion on veterinary care in 2015. ... In contrast to human medicine, in which everything from the nurse-patient ratio to the caloric count of injections is mandated and overseen by a web of government agencies, veterinary medicine is largely unregulated. And pet owners pay cash: Vets don’t deal with insurers haggling for better prices or questioning whether that vaccine or ultrasound or blood panel is really necessary. ... when veterinarians make fatal mistakes, they face no real financial consequences. The law hasn’t changed to reflect the attitudes of the average pet owner; courts still treat pets as property. ... a typical medical malpractice insurance policy for a veterinarian costs less than $20 a month. ... Corporations now own 15 percent to 20 percent of America’s 26,000 pet hospitals, and consolidators, copying the model pioneered by VCA, are buying them fast. ... The cost of veterinary care has risen even faster than the cost of human health care, more than doubling since 2000, according to the U.S. Bureau of Labor Statistics.

We have a certain heroic expectation of how medicine works. Following the Second World War, penicillin and then a raft of other antibiotics cured the scourge of bacterial diseases that it had been thought only God could touch. New vaccines routed polio, diphtheria, rubella, and measles. Surgeons opened the heart, transplanted organs, and removed once inoperable tumors. Heart attacks could be stopped; cancers could be cured. A single generation experienced a transformation in the treatment of human illness as no generation had before. It was like discovering that water could put out fire. We built our health-care system, accordingly, to deploy firefighters. Doctors became saviors. ... But the model wasn’t quite right. If an illness is a fire, many of them require months or years to extinguish, or can be reduced only to a low-level smolder. The treatments may have side effects and complications that require yet more attention. Chronic illness has become commonplace, and we have been poorly prepared to deal with it. Much of what ails us requires a more patient kind of skill. ... Observing the care, I began to grasp how the commitment to seeing people over time leads primary-care clinicians to take an approach to problem-solving that is very different from that of doctors, like me, who provide mainly episodic care.

Hrusovksy’s pitch to me is roughly the same as the one he just gave Jeff Miller, the NFL’s senior vice president for health and safety—skittering from drones, to driverless cars, to Tesla, to heart attacks and diabetes. “I’m still addicted to pastries at night,” Hrusovsky says before circling back to his thesis: Quanterix’s machines are on the brink of delivering a revolution in medicine, as scientists use them to detect diseases earlier, target them more precisely, and create breakthrough treatments for cancer, heart disease, diabetes, and Alzheimer’s, to name a few. ... Discovering, for instance, that half its linemen show signs of CTE could starve the league of talent or force changes that make it unrecognizable to fans. And football isn’t alone: CTE presents similarly dire questions for hockey, soccer, and ultimate fighting, among other contact sports. ... The method is a thousand times more sensitive than the Elisa, capable of detecting molecules in concentrations as low as 30,000 per drop—the equivalent, Hrusovsky says, of finding a grain of sand in 2,000 swimming pools.

Whether it takes the form of a touch of the Holy Spirit at a Florida revival meeting or a dip in the water of the Ganges, the healing power of belief is all around us. Studies suggest that regular religious services may improve the immune system, decrease blood pressure, add years to our lives. ... Religious faith is hardly the only kind of belief that has the ability to make us feel inexplicably better. ... just as a good performance in a theater can draw us in until we feel we’re watching something real, the theater of healing is designed to draw us in by creating powerful expectations in our brains. These expectations drive the so-called placebo effect, which can affect what happens in our bodies as well. Scientists have known about the placebo effect for decades and have used it as a control in drug trials. Now they are seeing placebos as a window into the neurochemical mechanisms that connect the mind with the body, belief with experience. ... How does a belief become so potent it can heal? ... Most astonishingly, placebos can work even when the person taking them knows they are placebos.

The building that houses the Heritage Foundation, on Massachusetts Avenue near the Capitol, stands as an eight-story monument to plain-faced perversity. It was here, in 1989, that the intellectual framework was first developed for what would become the Affordable Care Act. And it is here where Needham has spent the last six years trying to exterminate what he sees as the Frankenstein’s Monster that Heritage inadvertently set loose upon the land. ... premiums have been rising because of a variety of structural reasons, and because federal assistance to recipients to offset the costs has been in many cases inadequate. ... it is also because unit costs have continued to soar — like the price of prescription drugs, thanks to the sweetheart deal that the pharmaceutical industry cut with the Democrats in exchange for being an early supporter of the law. Some rural states like Alaska have seen very little competition among insurers — something that a public option might have addressed, had the insurance lobby not spent a fortune to defeat that provision. ... To make Obamacare economically feasible for insurers, the program needed to attract a large pool of young and healthy recipients to offset the costs of providing care for the older and less healthy. That ratio has yet to prove satisfactory for many insurance companies ... Collectively, those groups spent close to $273 million on lobbying during the height of the Obamacare debate. They will surely spend a similar sum haranguing Congress to pass a replacement that favors them.