6 ms·

23andMe Anne Wojcicki Berates Stanford and Valley Med on Behalf of Sick Friend

42 points by hhhust 8y ago

writimov 8y ago
Glad Anne Wojcicki, CoveredCA and Legal Aid were able to step in and help. There are some specific problems highlighted in the article that could be fixed by software startups: 1) Problem: Difficulty to identify a Doctor for a second opinion. a) Possible solution: software that allows you to input the medical term (or possibly the medicare code for a disease or combos of diseases?) and find all the second opinion doctors located near you. The software needs things like sort by reputation or reviews, price estimates, speed to get second opinion, time window (with a button to click for life-threatening emergency). Also, why be local? Through telemedicine you could video chat with your second opinion after digitally transferring records. 2) Problem: Too long to transfer medical records 5-10 days instead of 10mins. a) Possible solution: HIPAA and GDPR compliant digital medical health platform that works with all hospitals. (Very difficult to solve this because of non-standardization.) b) Secondary solution: Biometric authorization (fingerprint and voiceprint ID or DNA scan) and quick digital download of medical record in plain text. Must complete in less than 10mins even with slower bandwidth. 3) Problem: Didn't have health insurance. Hospital was looking at a potentially very large unpaid bill. a) Single payer government health insurance is the best solution. b) SW Tech company solution is quick instant insurance signup with government or charity guarantee for some percentage of bill. The rest of the bill is dumped into CoveredCA or something else. And the patient is enrolled for 1 year after the fact and must pay premiums. ? There are probably better solutions. 4) Problem: Must rely on humans. a) IBM Watson for disease diagnosis and treatment recommendations combined with additional neural net or machine learning technologies could be used to created automated second opinions. Feed all the raw data into the system to determine the outcomes and probability of recovery for all treatment options.
- nradov 8y ago
  There are already standard protocols and data formats for transferring patient charts between providers within seconds. The standards actually work pretty well now and are supported by most major EMR applications. But many providers still haven't fully configured those features or linked their systems to existing nationwide health information exchange networks.
- bsder 8y ago
  > b) SW Tech company solution is quick instant insurance signup with government or charity guarantee for some percentage of bill. The rest of the bill is dumped into CoveredCA or something else. And the patient is enrolled for 1 year after the fact and must pay premiums. ? There are probably better solutions. CoveredCA kinda sorta does this already where if you get pulled into the system via a catastrophic diagnosis they will kick in and help spread the cost. However, I think that the hospital still winds up eating some chunk of the cost as well. The problem is that a doctor has to kick the process off and none of the doctors associated with the hospitals were going to do this.
- michaelpinto 8y ago
  The problem is that when you have a hammer (a software startup), everything looks like a nail: 1. There may be a shortage of Doctors to provide a 2nd opinion. The cost of a medical education is quite high, and the pay has been going down these past few years. This can't be solved by a software startup. 2. Hospitals have less funding than ever, and are trying to do more with less. So there may already be software out there, but they can't afford it (or the staff to to maintain it, never mind the staff to distribute it). This can't be solved by a software startup. 3. This is really a political problem, and again that can't be solved by a software startup. 4. A medical opinion may not be a binary option, and it could be a moving target where data changes by the day, and it could be a suggestion to collect more data, or even to talk to someone else. Opinions by definition are arbitrary, as where something like IBM Watson may just give you options based on probability (but that probability is only as good as the data you collect, which may not be all inclusive, and may be a moving target). So a startup might even make things worse as people base their options on incomplete data or dated options. The depressing reality is that there is a great deal of economic inequality in our society, and that's reflected in the quality of healthcare that many people receive. It should also be noted that poverty can prevent access to preventative healthcare strategies which include everything from diet to access to basic medication.
lopmotr 8y ago
Perhaps the problem is more that there exists expensive treatments. As long as they exist, people will be upset at not getting them. When they don't exist, people won't blame anyone for their death. Imagine if some miracle cancer cure is discovered but it genuinely costs a million dollars (not just due to patents). There'll be no option but to let uninsured poor people die. There might not be enough money in the country to actually save them all.
- eigenvector 8y ago
  Considering that the USA spent $1.9 trillion on the Iraq war, something that was quite literally not needed by anyone, I wouldn't be so sure that money couldn't be found to provide lifesaving treatment and research technological advancements to bring its cost down in the long term.
  - CobrastanJorji 8y ago
    In this scenario, that $2 trillion would prevent about a quarter of the deaths from cancer in one year, except that spending was over a decade, so assuming that we could spend at that same rate perpetually, replacing Iraq War spending with million dollar cancer cures would prevent about 2% of cancer deaths.
    - ShorsHammer 8y ago
      Do you have a source for that $2 trillion/ quarter of all deaths figure? I understand healthcare in the US costs far more than in the rest of the developed world, but those calculations seem quite wrong. http://ascopubs.org/doi/abs/10.1200/JCO.2016.34.15_suppl.6618 http://ascopubs.org/doi/abs/10.1200/JCO.2016.34.15_suppl.661... > In the EU in 2012 the estimated cancer incidence was 2.6 million cases. The estimated cancer mortality was 1.3 million deaths, accounting for 26% of all deaths. DHCC (direct health cost of cancer) in the whole EU increased from €79 to €86 billion during 2005-2014 (in 2014 prices) The population of the EU is over 500 million people. The annual taxation needed to afford this level of care ranges from 50-270 euros per person across the region.
- 8y ago
saagarjha 8y ago
It's nice that she was able to help out, but think about how many people aren't in a situation where they can call up the CEO of 23andMe to help.
- clay_the_ripper 8y ago
  I think this situation shows how ludicrous our current situation is. You shouldn’t need to know the CEO of a billion dollar company to get healthcare. And good for her fiend, when your life is on the line no one shoood feel bad about using every option available to them.
  - pebers 8y ago
    You obviously don't need to know the CEO just "to get healthcare" - her friend was already being treated. It only seems to be necessary as a means of getting access to expensive private treatments that were otherwise unaffordable.
darawk 8y ago
Um, you're a millionaire. Why don't you put up the money? Someone is paying for it. This is literally an ultra-wealthy person complaining that someone else won't pay for her friend's million dollar medical treatment. It's fine if you want to argue for single payer healthcare. But where do you get off berating a non-charitable institution about covering their costs? They have their longevity to think about. If they simply gave everyone infinite treatment for free they wouldn't exist anymore.
- bsder 8y ago
  You are defending the position that we should let someone die because they don't have enough money to pay for medical treatment. Are you really sure you want to go there? Now, if you want to argue I would argue that why is this CEO letting a "friend" go without healthcare when CoveredCA has platinum plans at about $7000/year for an individual?
  - icebraining 8y ago
    Are you really sure you want to go there? This is just bullying, regardless of how disagreeable you find someone's position.
  - candiodari 8y ago
    And she is defending that effectively tax money should pay for medical treatment. ANY medical treatment, with the only limitation that it prolongs life. It is already the case that millions people lost ~20% of their disposable income because of insurance increases. In many cases it is lower a LOT of people who would normally be comfortably above the poverty line back down to the poverty line (those are the people losing the most in the individual mandate and subsidy system). And we all know that anything less than 2x the poverty line definitely feels like poverty and already cannot be escaped through savings and/or good financial sense. So there is a choice to be made. A choice between the cost of the individual mandate and coverage on families and the fact that we want everyone to be "saved" from health problems. This is further complicated by the fact that anyone saved from a health problem increases healthcare demands both linearly (very few health treatment really fixes things, so future demands on healthcare by the same patient will on average be higher), and exponential (a LOT of health problems are inheritable), because people demand the genetics of their kids be "respected" even when known problems exist. Afterwards, of course, it is unfair to blame the kids or the parents, even in entirely predictable problem cases. And then you have 5 kid families, where the parents were warned long before anything happened, which all have severe genetic problems resulting in brain defects. 2 cannot survive a single day without medical care and only 1 will ever live independently. But 3 would like to marry and have kids themselves (I don't blame the kids, however the parents should have known better, also we need to figure out the very sane policy of 100% refund of fertility treatments for couples without fertility problems for this reason) ... At what point is it not reasonable anymore ?
deleted 8y ago
[deleted]
cncrnd 8y ago
The larger point of this article is about the need to advocate for your own medical care. It really hit me hard, due to my own and family experiences with hospitals and doctors who simply didn't care or recognize the effect of their everyday behaviors on the lives of others. The example given in the article is Valley Med requiring 5-10 days to serve patient medical records. These 5-10 days can be the the difference between LIFE and DEATH when it comes to medical care. There exists an inefficiency, which can lead to wrongful death, and there is a clear path to remove the inefficiency. Why is nothing done and why does society accept it, despite paying ridiculous amounts for healthcare? The fact is that doctors are perfectly adept at handling 95% of cases which they see often, but outside of that they seem to lack the drive to 'connect the dots.' When I go to the doctor, I do my research before I step foot into the office and I tell them what I am thinking. Sometimes I am wrong and cede to the doctor's explanation, other times it results in different tests taken/treatment paths.
- sjg007 8y ago
  There's one problem with this.. for emergent care, the records can be faxed over immediately. At least PAMF does that. They can also get the doctor on the phone. Always remember your doctor's name. It's on the discharge sheet.
  - cncrnd 8y ago
    Requests for medical records should not take 5-10 business days period. When someone requests medical records it is for some purpose related to health. A hospital taking 5-10 business days to make medical records available can only hurt patients.
    - sjg007 8y ago
      I agree. Nothing I said disagrees with that. His care was emergent. and I also agree that medical records should be ready the same day.
jonhendry18 8y ago
"Such assertiveness came in handy when Wojcicki was visiting her grandmother in a Palm Springs care home several years ago and couldn’t find a doctor in the building." The nursing homes I'm familiar with have nurses and a doctor who comes in one day a week, and takes calls from staff. If anything significant comes up the resident is taken to the ER. A care home with a doctor on staff full time (let alone 24 hours) would likely be significantly more expensive. I suspect Wojcicki's grandmother couldn't afford that. And it's probably overkill.
- weeks 8y ago
  You think the CEO of 23andMe and ex-wife of Sergey Brin can't afford the best nursing home for her grandmother?
  - icebraining 8y ago
    That depends on many "several years" ago that was. She's only been that for about a decade.
- sjg007 8y ago
  It's standard of care to send a patient to the ER from the nursing home... We may not "know" this but it's also fine to call 911 and get an ambulance especially if the staff on hand is not cooperative. Some nursing homes have a clinic attached to them for daily and urgent care but even if you had a hospital next door they would still have to be wheeled or taken by ambulance. So this specific part of the article is overly sensational.
  - jonhendry18 8y ago
    If the issue was really urgent enough for an ambulance, then "a doctor" probably wasn't what was needed. The doctor would just call for an ambulance - they probably wouldn't have much in the way of emergency treatment equipment on hand anyway. If the issue wasn't urgent enough for an ambulance, and she just wanted to escalate the issue because she didn't trust the nurses or wasn't happy with the quality of service she felt she was getting, then it would be irresponsible to call 911. 911 is not for the use of impatient rich people. She could have just called her grandmother's doctor.

42 points by hhhust 8y ago

Glad Anne Wojcicki, CoveredCA and Legal Aid were able to step in and help. There are some specific problems highlighted in the article that could be fixed by software startups: 1) Problem: Difficulty to identify a Doctor for a second opinion. a) Possible solution: software that allows you to input the medical term (or possibly the medicare code for a disease or combos of diseases?) and find all the second opinion doctors located near you. The software needs things like sort by reputation or reviews, price estimates, speed to get second opinion, time window (with a button to click for life-threatening emergency). Also, why be local? Through telemedicine you could video chat with your second opinion after digitally transferring records. 2) Problem: Too long to transfer medical records 5-10 days instead of 10mins. a) Possible solution: HIPAA and GDPR compliant digital medical health platform that works with all hospitals. (Very difficult to solve this because of non-standardization.) b) Secondary solution: Biometric authorization (fingerprint and voiceprint ID or DNA scan) and quick digital download of medical record in plain text. Must complete in less than 10mins even with slower bandwidth. 3) Problem: Didn't have health insurance. Hospital was looking at a potentially very large unpaid bill. a) Single payer government health insurance is the best solution. b) SW Tech company solution is quick instant insurance signup with government or charity guarantee for some percentage of bill. The rest of the bill is dumped into CoveredCA or something else. And the patient is enrolled for 1 year after the fact and must pay premiums. ? There are probably better solutions. 4) Problem: Must rely on humans. a) IBM Watson for disease diagnosis and treatment recommendations combined with additional neural net or machine learning technologies could be used to created automated second opinions. Feed all the raw data into the system to determine the outcomes and probability of recovery for all treatment options.

nradov 8y ago
There are already standard protocols and data formats for transferring patient charts between providers within seconds. The standards actually work pretty well now and are supported by most major EMR applications. But many providers still haven't fully configured those features or linked their systems to existing nationwide health information exchange networks.
bsder 8y ago
> b) SW Tech company solution is quick instant insurance signup with government or charity guarantee for some percentage of bill. The rest of the bill is dumped into CoveredCA or something else. And the patient is enrolled for 1 year after the fact and must pay premiums. ? There are probably better solutions. CoveredCA kinda sorta does this already where if you get pulled into the system via a catastrophic diagnosis they will kick in and help spread the cost. However, I think that the hospital still winds up eating some chunk of the cost as well. The problem is that a doctor has to kick the process off and none of the doctors associated with the hospitals were going to do this.
michaelpinto 8y ago
The problem is that when you have a hammer (a software startup), everything looks like a nail: 1. There may be a shortage of Doctors to provide a 2nd opinion. The cost of a medical education is quite high, and the pay has been going down these past few years. This can't be solved by a software startup. 2. Hospitals have less funding than ever, and are trying to do more with less. So there may already be software out there, but they can't afford it (or the staff to to maintain it, never mind the staff to distribute it). This can't be solved by a software startup. 3. This is really a political problem, and again that can't be solved by a software startup. 4. A medical opinion may not be a binary option, and it could be a moving target where data changes by the day, and it could be a suggestion to collect more data, or even to talk to someone else. Opinions by definition are arbitrary, as where something like IBM Watson may just give you options based on probability (but that probability is only as good as the data you collect, which may not be all inclusive, and may be a moving target). So a startup might even make things worse as people base their options on incomplete data or dated options. The depressing reality is that there is a great deal of economic inequality in our society, and that's reflected in the quality of healthcare that many people receive. It should also be noted that poverty can prevent access to preventative healthcare strategies which include everything from diet to access to basic medication.

lopmotr 8y ago

Perhaps the problem is more that there exists expensive treatments. As long as they exist, people will be upset at not getting them. When they don't exist, people won't blame anyone for their death. Imagine if some miracle cancer cure is discovered but it genuinely costs a million dollars (not just due to patents). There'll be no option but to let uninsured poor people die. There might not be enough money in the country to actually save them all.

eigenvector 8y ago
Considering that the USA spent $1.9 trillion on the Iraq war, something that was quite literally not needed by anyone, I wouldn't be so sure that money couldn't be found to provide lifesaving treatment and research technological advancements to bring its cost down in the long term.
- CobrastanJorji 8y ago
  In this scenario, that $2 trillion would prevent about a quarter of the deaths from cancer in one year, except that spending was over a decade, so assuming that we could spend at that same rate perpetually, replacing Iraq War spending with million dollar cancer cures would prevent about 2% of cancer deaths.
  - ShorsHammer 8y ago
    Do you have a source for that $2 trillion/ quarter of all deaths figure? I understand healthcare in the US costs far more than in the rest of the developed world, but those calculations seem quite wrong. http://ascopubs.org/doi/abs/10.1200/JCO.2016.34.15_suppl.6618 http://ascopubs.org/doi/abs/10.1200/JCO.2016.34.15_suppl.661... > In the EU in 2012 the estimated cancer incidence was 2.6 million cases. The estimated cancer mortality was 1.3 million deaths, accounting for 26% of all deaths. DHCC (direct health cost of cancer) in the whole EU increased from €79 to €86 billion during 2005-2014 (in 2014 prices) The population of the EU is over 500 million people. The annual taxation needed to afford this level of care ranges from 50-270 euros per person across the region.
8y ago

saagarjha 8y ago

It's nice that she was able to help out, but think about how many people aren't in a situation where they can call up the CEO of 23andMe to help.

clay_the_ripper 8y ago
I think this situation shows how ludicrous our current situation is. You shouldn’t need to know the CEO of a billion dollar company to get healthcare. And good for her fiend, when your life is on the line no one shoood feel bad about using every option available to them.
- pebers 8y ago
  You obviously don't need to know the CEO just "to get healthcare" - her friend was already being treated. It only seems to be necessary as a means of getting access to expensive private treatments that were otherwise unaffordable.

darawk 8y ago

Um, you're a millionaire. Why don't you put up the money? Someone is paying for it. This is literally an ultra-wealthy person complaining that someone else won't pay for her friend's million dollar medical treatment. It's fine if you want to argue for single payer healthcare. But where do you get off berating a non-charitable institution about covering their costs? They have their longevity to think about. If they simply gave everyone infinite treatment for free they wouldn't exist anymore.

bsder 8y ago
You are defending the position that we should let someone die because they don't have enough money to pay for medical treatment. Are you really sure you want to go there? Now, if you want to argue I would argue that why is this CEO letting a "friend" go without healthcare when CoveredCA has platinum plans at about $7000/year for an individual?
- icebraining 8y ago
  Are you really sure you want to go there? This is just bullying, regardless of how disagreeable you find someone's position.
- candiodari 8y ago
  And she is defending that effectively tax money should pay for medical treatment. ANY medical treatment, with the only limitation that it prolongs life. It is already the case that millions people lost ~20% of their disposable income because of insurance increases. In many cases it is lower a LOT of people who would normally be comfortably above the poverty line back down to the poverty line (those are the people losing the most in the individual mandate and subsidy system). And we all know that anything less than 2x the poverty line definitely feels like poverty and already cannot be escaped through savings and/or good financial sense. So there is a choice to be made. A choice between the cost of the individual mandate and coverage on families and the fact that we want everyone to be "saved" from health problems. This is further complicated by the fact that anyone saved from a health problem increases healthcare demands both linearly (very few health treatment really fixes things, so future demands on healthcare by the same patient will on average be higher), and exponential (a LOT of health problems are inheritable), because people demand the genetics of their kids be "respected" even when known problems exist. Afterwards, of course, it is unfair to blame the kids or the parents, even in entirely predictable problem cases. And then you have 5 kid families, where the parents were warned long before anything happened, which all have severe genetic problems resulting in brain defects. 2 cannot survive a single day without medical care and only 1 will ever live independently. But 3 would like to marry and have kids themselves (I don't blame the kids, however the parents should have known better, also we need to figure out the very sane policy of 100% refund of fertility treatments for couples without fertility problems for this reason) ... At what point is it not reasonable anymore ?

deleted 8y ago

[deleted]

cncrnd 8y ago

The larger point of this article is about the need to advocate for your own medical care. It really hit me hard, due to my own and family experiences with hospitals and doctors who simply didn't care or recognize the effect of their everyday behaviors on the lives of others. The example given in the article is Valley Med requiring 5-10 days to serve patient medical records. These 5-10 days can be the the difference between LIFE and DEATH when it comes to medical care. There exists an inefficiency, which can lead to wrongful death, and there is a clear path to remove the inefficiency. Why is nothing done and why does society accept it, despite paying ridiculous amounts for healthcare? The fact is that doctors are perfectly adept at handling 95% of cases which they see often, but outside of that they seem to lack the drive to 'connect the dots.' When I go to the doctor, I do my research before I step foot into the office and I tell them what I am thinking. Sometimes I am wrong and cede to the doctor's explanation, other times it results in different tests taken/treatment paths.

sjg007 8y ago
There's one problem with this.. for emergent care, the records can be faxed over immediately. At least PAMF does that. They can also get the doctor on the phone. Always remember your doctor's name. It's on the discharge sheet.
- cncrnd 8y ago
  Requests for medical records should not take 5-10 business days period. When someone requests medical records it is for some purpose related to health. A hospital taking 5-10 business days to make medical records available can only hurt patients.
  - sjg007 8y ago
    I agree. Nothing I said disagrees with that. His care was emergent. and I also agree that medical records should be ready the same day.

jonhendry18 8y ago

"Such assertiveness came in handy when Wojcicki was visiting her grandmother in a Palm Springs care home several years ago and couldn’t find a doctor in the building." The nursing homes I'm familiar with have nurses and a doctor who comes in one day a week, and takes calls from staff. If anything significant comes up the resident is taken to the ER. A care home with a doctor on staff full time (let alone 24 hours) would likely be significantly more expensive. I suspect Wojcicki's grandmother couldn't afford that. And it's probably overkill.

weeks 8y ago
You think the CEO of 23andMe and ex-wife of Sergey Brin can't afford the best nursing home for her grandmother?
- icebraining 8y ago
  That depends on many "several years" ago that was. She's only been that for about a decade.
sjg007 8y ago
It's standard of care to send a patient to the ER from the nursing home... We may not "know" this but it's also fine to call 911 and get an ambulance especially if the staff on hand is not cooperative. Some nursing homes have a clinic attached to them for daily and urgent care but even if you had a hospital next door they would still have to be wheeled or taken by ambulance. So this specific part of the article is overly sensational.
- jonhendry18 8y ago
  If the issue was really urgent enough for an ambulance, then "a doctor" probably wasn't what was needed. The doctor would just call for an ambulance - they probably wouldn't have much in the way of emergency treatment equipment on hand anyway. If the issue wasn't urgent enough for an ambulance, and she just wanted to escalate the issue because she didn't trust the nurses or wasn't happy with the quality of service she felt she was getting, then it would be irresponsible to call 911. 911 is not for the use of impatient rich people. She could have just called her grandmother's doctor.