6 ms·

healthcare is a very hard problem. While we in the tech community may find it morbidly entertaining to watch Theranos burn to the ground. Someone out there nee

healthcare is a very hard problem. While we in the tech community may find it morbidly entertaining to watch Theranos burn to the ground. Someone out there needs to attack healthcare. The not dying motivation is fairly important.

ddorian43 10y ago
It's better to make photo-sharing apps and sell iphones. While healthcare is very hard, also needs alot of money. My idea would be: create photo-sharing app/telegram/iphones etc to make alot of cash and THEN try real-science-shit (like Elon Musk / ~Paypal Mafia).
467568985476 10y ago
The attacking part is great. It's the "fail fast" part that they messed up on. If the machines worked, would we be having this conversation about a company accused of lying to regulators and defrauding investors? Maybe it's a problem of Theranos setting investor expectations poorly, maybe the regulators are looking to make an example of someone for playing fast and loose in the traditionally tightly regulated healthcare industry, maybe both. Hopefully it's growing pains for a burgeoning biotech market and not actually fraud from the top.
toomuchtodo 10y ago
> Someone out there needs to attack healthcare. All the attacking that needs to be done is political/social, not technical. Want to attack healthcare? Strip middlemen out so that the money flows to providers and researchers (Single payer + pouring additional money into the NIH/NSF, with the results being public domain). All of these YC startups I see "hacking" healthcare (Dr Chrono, HealthSherpa, etc) are just bandaids on a patient bleeding out from the jugular. EDIT: Before you chime in to state that single payer can't be done, 58 countries [1] enable it just fine. Governments can be even more accountable than the current breed of private health insurance providers (I cannot replace the board at my insurance carrier, nor can I FOIA them). If you want to "hack" healthcare and fix the problem, get involved in government and get single payer done. [1] https://en.wikipedia.org/wiki/Universal_health_coverage_by_country https://en.wikipedia.org/wiki/Universal_health_coverage_by_c...
- BurningFrog 10y ago
  Here is a good factual overview of why Single Payer won't make health care cheap in the US: http://www.bloombergview.com/articles/2014-04-30/single-payer-would-make-health-care-worse http://www.bloombergview.com/articles/2014-04-30/single-paye...
  - toomuchtodo 10y ago
    My post never said it would be cheap. It would ensure 1) everyone was covered and 2) less funds were skimmed out by health insurance companies, leaving more funding to be used for health providers. It would also help if a republican Congress didn't require Medicare to _not_ negotiate on drug pricing with for-profit drug companies. Way to leach off the public teat "small government party".
    - eggy 10y ago
      I prefer to make the distinction between Corporatism vs. Capitalism in these type of discussions. Corparatism, the big companies and governments as a symbiotic unit, not Capitalism is the problem. I have lived in Montreal with its public health care system for a year, and I now live in a rice farming village in East Java, Indonesia with their public healthcare system, and I grew up in Brooklyn, NY, so I speak from my experience and what knowledge I have acquired. Sure, you can go to the doctors here in East Java, and pay $1 to $2, and walk away with 3 or 4 prescriptions, but I am not sure that is good for several reasons. People go without even a thought to thinking about their ailment or complaint. The doctor doesn't do more than listen, and possibly listen with a stethiscope, and then prescribe generic medications to treat the oral complaint. I have seen my father-in-law come back with 7 medications due to high blood pressure. I checked it with my portable monitor, and he does have high blood pressure. They prescribed a blood thinner, an antacid, and bunch of other meds you would see as possible prescriptions. My twelve year old niece had a blood test at school, and her cholesterol was a bit high. Result: 3 prescriptions, and not a lot about diet change or exercise. Lines are longer the closer to the city you get. Here people are there with sore elbows, headaches, etc... These are people who shake off a lot of hard daily work and bruises. They go at a whim when they are not working, and bored, and the simplest of ailments are perceived. I am anxious about the amount of prescriptions handed out, and the quality. In Montreal, in Spring or in stretches of good weather, there would be lines outside the emergency room. I went and inquired if it was for flu shots, or some other special day since they had setup folding tables and chairs to handle the patient load. The jaded healthcare worker explained this was typical, and made some comment about if somebody sneezes, is bored on unemployment, they head to the emergency room. My daughter needed surgery back in NJ, USA, while I was in SE Asia, and I thought it was going to cost me $16k to $20K, since my coverage had just expired. I asked how much to pay up front in cash to make sure she could get the surgery, and it turned out that if I paid the hospital, the anaesthesiologist and the surgeron each separately the cost would be and was $5k. I asked why, and I was told by all 3 offices, that this was their real price, and that when it goes through the insurance companies they spend up to a year or more trying to collect, and at a 40% rate or less. The gratitude of me pre-paying in cash, was shocking. They never have that, and it makes for less work for them. They were so thrilled. The hospitals and doctors charge a lot more to make sure they cover the administrative costs of tracking and chasing payments, and to cover the costs of the procedures themselves. I guess that's what you get when you let big companies and government intervention do their thing. I am sad at this Theranos thing. I do not know about the truth; I guess we shall soon know. I see the idea of disrupting the labs and innovation as a good thing. So I hope guilty completely, partially or not, it has at least challenged the status quo. I know their are smaller quantities of blood testing kits available, not as small as Theranos, but I sure never heard of them before this fiasco. The benefit of reading HN! The conspiracy side of me, urges me to look at big Lab and Pharma as not wanting this to happen, or at least outside of their walls. They will make a slightly more volume blood test work, and now reap the publicity and sell it to the public and government. My Uncle Victor, who upon seeing my drawing of a car running on water buy using a solar cell to perform electolysis on water and exhaust of water back in 1974 (I had just built a solar oven and purchased a small solar cell, too small) spurned the idea, said to me: The big oil companies, or (pardon the racist, parochial remark here relayed) the 'arabs will come after you'. We used to call him Archie Bunker from All in the Family. A very funny show that would cause many to protest if it were on the TV nowadays. Sweden is always held up as a model of public healthcare, but we forget their financial crisis in the 1990s that started with slow growth once the US ended the gold standard in August 1971. They didn't get out of the 1990s crisis until they started embracing more capitalistic practices, so their healthcare system should not be used as an argument for it to be applied in the US. Not to mention, costs of covering 9.5 million people in a smaller geography, vs. 310 million people in a much larger geography. It is not simply a scaling problem or application.
devonkim 10y ago
Healthcare like almost every major enterprise vertical is a wicked problem[1] and these problems are pretty much rife with far more than just technical problems. Most of the VC founded ventures are honestly quite terrible at attacking the Fortune 100 that dominates these verticals including reasons like collusion as well as regulatory capture. A $10M+ series A seems like big money to a lot of the people in tech, in the enterprise space of the Fortune 100, that's a rounding error resolved by just firing one or two middle managers. I can hardly afford good sales guys covering all the regions for long enough of a sales cycle that I could confidently ever make a single deal on that alone - the enterprise approach to relationship-focused sales and procurement cycles forces the necessity of well-networked, very expensive sales people, unfortunately. That's the kind of slow-moving, massive capital flows that are at play, and there won't be any company that can attack that problem head on because it's not a technical problem whatsoever. Even worse, because these industries are capitalized heavily as public companies, their board of directors appoint super risk averse leaders culturally and will not move forward without finding a business model that will not cannibalize existing sales. Even still, if such a technology and business model existed, it is simply very, very easy to torpedo these efforts politically within these companies because these companies are already so profitable (think Hollywood-style accounting for a second, not tech company or even i-bank style simplistic accounting) they'd rather get rid of emerging competitors than to actually innovate. After all, in the health insurance space, as long as people (and, more importantly, companies) are paying premiums and subsidizing a sufficient number of costly patients that need care, there's little reason to really try to innovate in terms of technology there. That becomes something up to healthcare providers to try to work at, but they're typically courted by a very, very well capitalized and networked cartel of healthcare companies typically founded by doctors first, not technology people. Doctors may be smart oftentimes, but they're just not technology people fundamentally after decades of practicing medicine. I agree that the problem must be attacked, but I have my doubts that it would come from a VC funded company in the same vein as most SV companies that have done so well. And as Theranos shows, I have my doubts that the highly kleptocratic cronyism driven private government contracting space will do it either. It may very well require a completely new model that incorporates the best ideas of both funding vehicles to avoid the common pitfalls of enterprise b2b companies. [1] https://en.wikipedia.org/wiki/Wicked_problem https://en.wikipedia.org/wiki/Wicked_problem
Mz 10y ago
Medical care and health care aren't actually the same thing. And the problem is that actually improving health for humans tends to be relatively cheap and culturally based. It is pretty much not a big money space. It involves things like inventing soap and getting people to wash their hands. And this is a thing most people do not want to hear. Better drugs and better surgeries are all ooh, shiny! but they really are not optimal. The optimal approach is boring and hard to even see. People who fail to get sick are incredibly hard to measure. Heroic interventions after the fact are far easier to measure and make for more interesting press. They also can be charged big bucks. The whole thing kind of sucks, frankly.
- nickpsecurity 10y ago
  Good summary. Especially the healthy people being hard to measure. Never heard anyone put it that way before. Now that I think of it, it's usually easier to tie data points to specific illnesses than to a lack of them. I have a feeling I'll be wondering about this in the future. Quick guess is that healthy relies on emergent behavior of locally interacting cells. Lots and lots and lots of complex behavior with few observable inputs and outputs into the body. The inputs might not have a direct correlation to healthiness. We'd have to have a model of all those processes before we'd see evidence of healthiness in the data points.
ThomPete 10y ago
It is and so it's kind of absurd that someone would create so much hype around their company before they even had something working. I would in fact call it irresponsible.
- TuringNYC 10y ago
  Given that patients relied on the faulty tests to drive healthcare decisions, one might even call it criminally negligent.

ddorian43 10y ago

It's better to make photo-sharing apps and sell iphones. While healthcare is very hard, also needs alot of money. My idea would be: create photo-sharing app/telegram/iphones etc to make alot of cash and THEN try real-science-shit (like Elon Musk / ~Paypal Mafia).

467568985476 10y ago

The attacking part is great. It's the "fail fast" part that they messed up on. If the machines worked, would we be having this conversation about a company accused of lying to regulators and defrauding investors? Maybe it's a problem of Theranos setting investor expectations poorly, maybe the regulators are looking to make an example of someone for playing fast and loose in the traditionally tightly regulated healthcare industry, maybe both. Hopefully it's growing pains for a burgeoning biotech market and not actually fraud from the top.

toomuchtodo 10y ago

> Someone out there needs to attack healthcare. All the attacking that needs to be done is political/social, not technical. Want to attack healthcare? Strip middlemen out so that the money flows to providers and researchers (Single payer + pouring additional money into the NIH/NSF, with the results being public domain). All of these YC startups I see "hacking" healthcare (Dr Chrono, HealthSherpa, etc) are just bandaids on a patient bleeding out from the jugular. EDIT: Before you chime in to state that single payer can't be done, 58 countries [1] enable it just fine. Governments can be even more accountable than the current breed of private health insurance providers (I cannot replace the board at my insurance carrier, nor can I FOIA them). If you want to "hack" healthcare and fix the problem, get involved in government and get single payer done. [1] https://en.wikipedia.org/wiki/Universal_health_coverage_by_country https://en.wikipedia.org/wiki/Universal_health_coverage_by_c...

BurningFrog 10y ago
Here is a good factual overview of why Single Payer won't make health care cheap in the US: http://www.bloombergview.com/articles/2014-04-30/single-payer-would-make-health-care-worse http://www.bloombergview.com/articles/2014-04-30/single-paye...
- toomuchtodo 10y ago
  My post never said it would be cheap. It would ensure 1) everyone was covered and 2) less funds were skimmed out by health insurance companies, leaving more funding to be used for health providers. It would also help if a republican Congress didn't require Medicare to _not_ negotiate on drug pricing with for-profit drug companies. Way to leach off the public teat "small government party".
  - eggy 10y ago
    I prefer to make the distinction between Corporatism vs. Capitalism in these type of discussions. Corparatism, the big companies and governments as a symbiotic unit, not Capitalism is the problem. I have lived in Montreal with its public health care system for a year, and I now live in a rice farming village in East Java, Indonesia with their public healthcare system, and I grew up in Brooklyn, NY, so I speak from my experience and what knowledge I have acquired. Sure, you can go to the doctors here in East Java, and pay $1 to $2, and walk away with 3 or 4 prescriptions, but I am not sure that is good for several reasons. People go without even a thought to thinking about their ailment or complaint. The doctor doesn't do more than listen, and possibly listen with a stethiscope, and then prescribe generic medications to treat the oral complaint. I have seen my father-in-law come back with 7 medications due to high blood pressure. I checked it with my portable monitor, and he does have high blood pressure. They prescribed a blood thinner, an antacid, and bunch of other meds you would see as possible prescriptions. My twelve year old niece had a blood test at school, and her cholesterol was a bit high. Result: 3 prescriptions, and not a lot about diet change or exercise. Lines are longer the closer to the city you get. Here people are there with sore elbows, headaches, etc... These are people who shake off a lot of hard daily work and bruises. They go at a whim when they are not working, and bored, and the simplest of ailments are perceived. I am anxious about the amount of prescriptions handed out, and the quality. In Montreal, in Spring or in stretches of good weather, there would be lines outside the emergency room. I went and inquired if it was for flu shots, or some other special day since they had setup folding tables and chairs to handle the patient load. The jaded healthcare worker explained this was typical, and made some comment about if somebody sneezes, is bored on unemployment, they head to the emergency room. My daughter needed surgery back in NJ, USA, while I was in SE Asia, and I thought it was going to cost me $16k to $20K, since my coverage had just expired. I asked how much to pay up front in cash to make sure she could get the surgery, and it turned out that if I paid the hospital, the anaesthesiologist and the surgeron each separately the cost would be and was $5k. I asked why, and I was told by all 3 offices, that this was their real price, and that when it goes through the insurance companies they spend up to a year or more trying to collect, and at a 40% rate or less. The gratitude of me pre-paying in cash, was shocking. They never have that, and it makes for less work for them. They were so thrilled. The hospitals and doctors charge a lot more to make sure they cover the administrative costs of tracking and chasing payments, and to cover the costs of the procedures themselves. I guess that's what you get when you let big companies and government intervention do their thing. I am sad at this Theranos thing. I do not know about the truth; I guess we shall soon know. I see the idea of disrupting the labs and innovation as a good thing. So I hope guilty completely, partially or not, it has at least challenged the status quo. I know their are smaller quantities of blood testing kits available, not as small as Theranos, but I sure never heard of them before this fiasco. The benefit of reading HN! The conspiracy side of me, urges me to look at big Lab and Pharma as not wanting this to happen, or at least outside of their walls. They will make a slightly more volume blood test work, and now reap the publicity and sell it to the public and government. My Uncle Victor, who upon seeing my drawing of a car running on water buy using a solar cell to perform electolysis on water and exhaust of water back in 1974 (I had just built a solar oven and purchased a small solar cell, too small) spurned the idea, said to me: The big oil companies, or (pardon the racist, parochial remark here relayed) the 'arabs will come after you'. We used to call him Archie Bunker from All in the Family. A very funny show that would cause many to protest if it were on the TV nowadays. Sweden is always held up as a model of public healthcare, but we forget their financial crisis in the 1990s that started with slow growth once the US ended the gold standard in August 1971. They didn't get out of the 1990s crisis until they started embracing more capitalistic practices, so their healthcare system should not be used as an argument for it to be applied in the US. Not to mention, costs of covering 9.5 million people in a smaller geography, vs. 310 million people in a much larger geography. It is not simply a scaling problem or application.

devonkim 10y ago

Healthcare like almost every major enterprise vertical is a wicked problem[1] and these problems are pretty much rife with far more than just technical problems. Most of the VC founded ventures are honestly quite terrible at attacking the Fortune 100 that dominates these verticals including reasons like collusion as well as regulatory capture. A $10M+ series A seems like big money to a lot of the people in tech, in the enterprise space of the Fortune 100, that's a rounding error resolved by just firing one or two middle managers. I can hardly afford good sales guys covering all the regions for long enough of a sales cycle that I could confidently ever make a single deal on that alone - the enterprise approach to relationship-focused sales and procurement cycles forces the necessity of well-networked, very expensive sales people, unfortunately. That's the kind of slow-moving, massive capital flows that are at play, and there won't be any company that can attack that problem head on because it's not a technical problem whatsoever. Even worse, because these industries are capitalized heavily as public companies, their board of directors appoint super risk averse leaders culturally and will not move forward without finding a business model that will not cannibalize existing sales. Even still, if such a technology and business model existed, it is simply very, very easy to torpedo these efforts politically within these companies because these companies are already so profitable (think Hollywood-style accounting for a second, not tech company or even i-bank style simplistic accounting) they'd rather get rid of emerging competitors than to actually innovate. After all, in the health insurance space, as long as people (and, more importantly, companies) are paying premiums and subsidizing a sufficient number of costly patients that need care, there's little reason to really try to innovate in terms of technology there. That becomes something up to healthcare providers to try to work at, but they're typically courted by a very, very well capitalized and networked cartel of healthcare companies typically founded by doctors first, not technology people. Doctors may be smart oftentimes, but they're just not technology people fundamentally after decades of practicing medicine. I agree that the problem must be attacked, but I have my doubts that it would come from a VC funded company in the same vein as most SV companies that have done so well. And as Theranos shows, I have my doubts that the highly kleptocratic cronyism driven private government contracting space will do it either. It may very well require a completely new model that incorporates the best ideas of both funding vehicles to avoid the common pitfalls of enterprise b2b companies. [1] https://en.wikipedia.org/wiki/Wicked_problem https://en.wikipedia.org/wiki/Wicked_problem

Mz 10y ago

Medical care and health care aren't actually the same thing. And the problem is that actually improving health for humans tends to be relatively cheap and culturally based. It is pretty much not a big money space. It involves things like inventing soap and getting people to wash their hands. And this is a thing most people do not want to hear. Better drugs and better surgeries are all ooh, shiny! but they really are not optimal. The optimal approach is boring and hard to even see. People who fail to get sick are incredibly hard to measure. Heroic interventions after the fact are far easier to measure and make for more interesting press. They also can be charged big bucks. The whole thing kind of sucks, frankly.

nickpsecurity 10y ago
Good summary. Especially the healthy people being hard to measure. Never heard anyone put it that way before. Now that I think of it, it's usually easier to tie data points to specific illnesses than to a lack of them. I have a feeling I'll be wondering about this in the future. Quick guess is that healthy relies on emergent behavior of locally interacting cells. Lots and lots and lots of complex behavior with few observable inputs and outputs into the body. The inputs might not have a direct correlation to healthiness. We'd have to have a model of all those processes before we'd see evidence of healthiness in the data points.

ThomPete 10y ago

It is and so it's kind of absurd that someone would create so much hype around their company before they even had something working. I would in fact call it irresponsible.

TuringNYC 10y ago
Given that patients relied on the faulty tests to drive healthcare decisions, one might even call it criminally negligent.