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I was at TEDMED in San Diego last week listening to Stanford physician and entrepreneur Daniel Kraft run through a dizzying array of medical devices, apps, discoveries. They do everything from nano-repairing cells to regenerating damaged tissue in our brains.

Eythor Bender of Berkeley Bionics also talked about exoskeleton technology that is allowing the paralyzed to walk. Catherine Mohr of Intuitive Surgical, Inc. described surgical robots that precisely excise very small tumors.

As Peter Diamandis of the X-Prize said on stage, “we are entering a period of explosive innovation.”

It’s a nascent world of miracles large and small that will be nice when - and if - it happens.

Counterpoised with this brilliant world was a talk the night when TEDMED opened by economist and entrepreneur Juan Enriquez. The world he described - the real world of today’s overpriced, dysfunctional healthcare system - was a dystopic counterpoint to Kraft’s bright and shiny world.

“Our system is operating as an anti-Moore’s Law,” said Enriquez, meaning that innovation in the real world of biomedicine is actually declining. Investments in drugs are in decline as the costs and timelines for developing new meds increases and the number of approved drugs goes down.

Enriquez described cases where drugs were delayed for years by regulatory hurdles, and by an academic environment that is hugely risk adverse. One example: he said a seven year delay in approving beta-blockers resulted in 119,000 deaths of patients that would have benefited from these drugs. And Interleukin-2 was okayed as a treatment for kidney cancer in nine European countries, he noted, but the FDA took 3 1/2 years to grant its approval.

Next year the new owner of TEDMED, Jay Walker, plans to move the meeting to Washington, DC, in part to see if the energy and buzz of excitement over innovation that one often hears about on the west coast can penetrate the dystopia Enriquez described.

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