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I came here to make exactly the same argument. Or cars, if we pick something that also needs certifying (from a purely manufacturing perspective). I get that mo

I came here to make exactly the same argument. Or cars, if we pick something that also needs certifying (from a purely manufacturing perspective). I get that most people would rather have a car, so more cars get made, so they're cheaper. (Athough roughly comparable, and there's different models. To me, it seems a car is more complicated than an ultra-sound system). The author of the original article made a good point that there may be a market for cheaper, non-medical ultrasound. The author of this article totally ignores this. Of course he's going to say they ought to cost as much as they do. > but for now take my word [...] seriously, you don't want to use these things without strong safety regulations. Why? Instead of being a condescending asshat and lording his career achievements over us, this guy could have explained if and why it might be dangerous to build one yourself, again for non-medical use. Wouldn't a good article with great arguments be more convincing than a list of credentials? (edit: I'm reasonably convinced that devices in hospitals probably should cost that much, but this article didn't change that significantly. some of the details about impedance matching were interesting)

Xylakant 10y ago
Cars, iphones and laptops are sold in quantities that are magnitudes larger than ultrasounds. Even if every school bought one for students to experiment with, you'd still only have all schools and doctors in the world as potential market. On top of that, medical devices are supposed to work in comparatively harsh environments (strong disinfectants etc.) for a long long time. Iphone lifetimes are measured in years, not decades and don't you dare and try to get a spare part for a 10 year old macbook. All of that means that evolution is much slower in that market - more small steps rather than big disruptive changes. I'd also challenge that cars are more complicated than ultrasounds. They do have more moving parts, but allowed tolerances are magnitudes larger than a few microns in all places.
- ChicagoBoy11 10y ago
  ... but the "magnitudes larger" that they are sold is also endogenous to the regulatory framework around them. Suppose you had to get a PhD in physics to be able to get a drivers license. All of a sudden we would see a lot fewer buying -- and therefore far fewer people selling -- cars since it is so expensive to actually be able to drive them. With these ultrasounds, there is such a heavy regulatory framework at work -- from regulations impacting the device itself to regulations preventing hospitals from being built to regulations preventing hospitals from having as many of these as they want -- that they make the actual quantity demanded of these things artificially small. Your point about evolution of the technology also falls trap to this same fallacy: Again, if all of a sudden you are artificially making something much more expensive to produce, it should be no surprise to you that the refresh rate on the device would be smaller. Here you also have the added effect that since we rarely pay for our own medical care and instead rely on insurance, many of the incentives that would exist for companies to make cheaper, faster, better equipment also disappear. Lastly, I fully concede that it is quite possible that there is some basic, inherent quality of ultrasounds that make them more complicated than cars or any other pieces of tech. But that isn't important. The importance is realizing that the derivative of the state of these machines looks very different from other technology industries where competition and the free market are much more of a factor.
  - temac 10y ago
    Ultrasound systems is probably the cheapest modality, there is quite a lot of competition in this market, there is a lot of innovations in this market, the machine are getting cheaper and more compact, and at least in the developed world there is no penury of ultrasound systems, the regulation are there to prevent somebody to build a shitty machine that for example burns you with and endoscopic probe (you would not like that), and the interpretation of ultrasound images requires to be highly trained (you won't even understand the basic physical features you have before your eyes if you are not trained, due to various artifacts that are intrinsical to the technology), which limit the potential for delivery machines to a significantly larger market, because all those machines would be of no use.
temac 10y ago
A car is not necessarily more complicated than an ultrasound system. Now the definition of "complicated" can be subject to debate, but you could be surprised if you compare the production prices of simple/high-end cars and simple/high-end ultrasound systems. Really high volumes help a lot for all components. There are more and more components in ultrasound system that can be reused OTS from other markets, but even then, those larger markets are not necessarily larger than the cars market! And it is not too dangerous to build one yourself for non-medical use, although it might be a little harder than you seem to think. But if you are reasonably skilled, I believe it is doable to design a toy system reasonably cheaply (but simply, do not expect to be able to use a raspberry pi GPIO and obtain something non-shitty). Go on if you want!
LiesNStartupPR 10y ago
I do appreciate being called a "condescending asshat", I might get a t-shirt with that on it, thanks. I though my credentials were one paragraph instead of many, but maybe I need to count again. As for lording it over you with qualifications - I just needed to make it clear that I actually do have a huge amount of experience in this area, otherwise instead of being a "condescending asshat" people would be asking who the hell do I think I am commentating on this. I make no apology for knowing what I'm talking about, there's too many articles written by people with no idea about the topic. And don't take it personally, I've something of a reputation in ultrasound for being blunt.

Xylakant 10y ago

Cars, iphones and laptops are sold in quantities that are magnitudes larger than ultrasounds. Even if every school bought one for students to experiment with, you'd still only have all schools and doctors in the world as potential market. On top of that, medical devices are supposed to work in comparatively harsh environments (strong disinfectants etc.) for a long long time. Iphone lifetimes are measured in years, not decades and don't you dare and try to get a spare part for a 10 year old macbook. All of that means that evolution is much slower in that market - more small steps rather than big disruptive changes. I'd also challenge that cars are more complicated than ultrasounds. They do have more moving parts, but allowed tolerances are magnitudes larger than a few microns in all places.

ChicagoBoy11 10y ago
... but the "magnitudes larger" that they are sold is also endogenous to the regulatory framework around them. Suppose you had to get a PhD in physics to be able to get a drivers license. All of a sudden we would see a lot fewer buying -- and therefore far fewer people selling -- cars since it is so expensive to actually be able to drive them. With these ultrasounds, there is such a heavy regulatory framework at work -- from regulations impacting the device itself to regulations preventing hospitals from being built to regulations preventing hospitals from having as many of these as they want -- that they make the actual quantity demanded of these things artificially small. Your point about evolution of the technology also falls trap to this same fallacy: Again, if all of a sudden you are artificially making something much more expensive to produce, it should be no surprise to you that the refresh rate on the device would be smaller. Here you also have the added effect that since we rarely pay for our own medical care and instead rely on insurance, many of the incentives that would exist for companies to make cheaper, faster, better equipment also disappear. Lastly, I fully concede that it is quite possible that there is some basic, inherent quality of ultrasounds that make them more complicated than cars or any other pieces of tech. But that isn't important. The importance is realizing that the derivative of the state of these machines looks very different from other technology industries where competition and the free market are much more of a factor.
- temac 10y ago
  Ultrasound systems is probably the cheapest modality, there is quite a lot of competition in this market, there is a lot of innovations in this market, the machine are getting cheaper and more compact, and at least in the developed world there is no penury of ultrasound systems, the regulation are there to prevent somebody to build a shitty machine that for example burns you with and endoscopic probe (you would not like that), and the interpretation of ultrasound images requires to be highly trained (you won't even understand the basic physical features you have before your eyes if you are not trained, due to various artifacts that are intrinsical to the technology), which limit the potential for delivery machines to a significantly larger market, because all those machines would be of no use.

temac 10y ago

A car is not necessarily more complicated than an ultrasound system. Now the definition of "complicated" can be subject to debate, but you could be surprised if you compare the production prices of simple/high-end cars and simple/high-end ultrasound systems. Really high volumes help a lot for all components. There are more and more components in ultrasound system that can be reused OTS from other markets, but even then, those larger markets are not necessarily larger than the cars market! And it is not too dangerous to build one yourself for non-medical use, although it might be a little harder than you seem to think. But if you are reasonably skilled, I believe it is doable to design a toy system reasonably cheaply (but simply, do not expect to be able to use a raspberry pi GPIO and obtain something non-shitty). Go on if you want!

LiesNStartupPR 10y ago

I do appreciate being called a "condescending asshat", I might get a t-shirt with that on it, thanks. I though my credentials were one paragraph instead of many, but maybe I need to count again. As for lording it over you with qualifications - I just needed to make it clear that I actually do have a huge amount of experience in this area, otherwise instead of being a "condescending asshat" people would be asking who the hell do I think I am commentating on this. I make no apology for knowing what I'm talking about, there's too many articles written by people with no idea about the topic. And don't take it personally, I've something of a reputation in ultrasound for being blunt.