13 ms·

Cheap and simple medical devices have to overcome deeply rooted biases

217 points by theBashShell 8y ago

hirundo 8y ago
Hmm, why would an industry based on profiting from high margin expensive medical technology not sufficiently promote low margin inexpensive technology? It's a mystery.
- Consultant32452 8y ago
  A related mystery: what's stopping greedy practitioners from using the cheap device but still charging the old price increasing their margins even more?
  - hirundo 8y ago
    > But cpap machines, the standard device in a country like the U.S., are expensive and require uninterrupted electricity. In many countries, Burke says, doctors resort to using a makeshift solution: a Coke bottle filled with water and attached to some tubing There's a limit to what you can charge for a coke bottle attached to some tubing that's much lower than for a machine that blinks and beeps and goes whirrr with lots of knobs and buttons. Sometimes the solution is to hide the bottle and tubing in a complicated looking box. Of course not _all_ of it is theater.
    - bsder 8y ago
      Um, please, finish the quote: > "In many countries, Burke says, doctors resort to using a makeshift solution: a Coke bottle filled with water and attached to some tubing. The D.I.Y. approach can save an infant’s life but risks causing blindness." That NOT a better solution, thanks. The entire article is rife with this. Ketamine isn't a better anesthetic--it's acceptable if you don't have enough anesthesiologists. The condom with a catherer isn't better, but it is acceptable if you don't have a real UBT. It's disappointing to see the fact that the ethics really aren't clear until the whole way at the end rather than acknowledging it in a much more important manner earlier in the article. > "Kass, the bioethicist, is trying to puzzle out the ethics of what might be seen as lower-quality solutions." Doctors are also more likely to use these solutions with lower-socioeconomic groups--that is the whole point of them being cheaper, after all. And that opens an even bigger issue in places like the US.
gowld 8y ago
Because people don't keep track of all the buzzwords. FTA: > “reverse innovation”: taking a technology or solution born of the resource constraints in developing countries and adopting it in wealthier ones. Nothing "reverse" about it; the question is why rich countries don't import low-cost low-tech solutions from poor countries. I presume the answer is profit motive. The classic example that has been hiding in plain sight for decades is "so many expensive drugs that are about as good as cannabis, and cannabis still illegal."
- kiba 8y ago
  Presumably because wealthier nations are cost insensitive. They don't feel the need to reduce wastes in their healthcare system when they can 'afford' it.
  - aetherson 8y ago
    They may also feel that it's not actually lower-cost for them. For example: say your doctor uses a somewhat lower-tech, kitbashed uterine balloon on your wife during postpartum bleeding. And say she dies anyway (as someone surely will). There is going to be a real temptation to sue the pants off the hospital and say, "Look, they used some jury-rigged contraption instead of the gold-plated device that would have cost 10x." And, I mean, that's a bad look for the hospital in front of a jury, "Yes, well, this might be a little worse, but it might not, and it cost less money!" Everyone wants healthcare to cost less until it starts to look like hospitals or doctors are prioritizing "profits" versus people's lives.
    - WrtCdEvrydy 8y ago
      This is why we pay the most of any other country... we try for best outcomes. If something cheap is used in the UK with a 97% good outcomes, we will spend 3 million to ensure we get closer to 98% outcome.
      - TeMPOraL 8y ago
        Depending on the amount of patients, even a 1 percent point increase for $3M could be a baragin. If, e.g., everyone undergoes such procedure once in their lifetime, 1% times the population of UK is 660K people that could be saved for $3M, roughly $4.5 per life saved, which is a no-brainer.
kerkeslager 8y ago
What an awful headline.
toomuchtodo 8y ago
Entrenched interests, innovator’s dilemma. Orgs and people get addicted to their revenue stream.
TheRealPomax 8y ago
"People are not necessarily comfortable with the price of medicine dropping?" Sorry, which planet are you from? Earth, you say? The US even? People in your country would do anything (and have) for affordable medicine.
- afarrell 8y ago
  A world where people don't have a good way to judge the quality of medical services and so they use price as a proxy for quality. Here is a 2-minute video where a very popular speaker explains the position, to the agreement of a large crowd: https://www.youtube.com/watch?v=kPsfo8-FhB0 https://www.youtube.com/watch?v=kPsfo8-FhB0
- magduf 8y ago
  No, they won't. As comments above pointed out, Americans will sue when something goes wrong and it's found that the medical provider didn't use the most expensive option available. And Americans do NOT do what they can to obtain affordable medicine: if they wanted this, they'd be demanding laws to rein in costs, to provide socialized medicine, etc., just like most other developed nations have already done. Instead, we got ObamaCare, and half our population wants it to be repealed.
tompccs 8y ago
The answer to the headline is astoundingly obvious yet the article doesn't mention it once. The reason is regulation: you can't use a medical device that you've hacked together unless it has been cleared by the relevant authorities as being safe. Sometimes it's a matter of simply getting a cheaper alternative through regulatory approval, but other times its just not worth the cost to prove a cheaper alternative is as safe as the more expensive one. Very annoying article about an interesting subject.
- EamonnMR 8y ago
  The agonizing part is that having incredibly expensive medical tools isn't safe either - it leads patients to avoid medical treatment because of the cost.
  - jstanley 8y ago
    It's not meant to improve patient outcomes, it's meant to avoid liability.
    - aetherson 8y ago
      I wish people didn't phrase things this way. There's no single "meaning" to all of this. It's a bunch of different people with different priorities making different cost-benefit tradeoffs. I mean, what would you do if a loved one died at least in part because someone was trying to save $1,000 on their treatment? How would you feel? What if you were permanently disabled or put in months of agonizing pain, and there were more expensive options that would have had a lower chance of doing that? Or just might have had a lower chance of doing that? From the 10 miles up view, it's easy to say, "Holy shit, the US has such a high health care cost, we could get 97% of the same care at 50% of the cost," and that seems like a great idea. When you're personally looking at tragedy to save an amount of money that is not that significant for your specific medical case (the waste comes when it's applied to 50 more people who don't really benefit from it), the calculus looks very different. It may still be the right decision. But can we be compassionate about the victims of that decision? Then layer in that it is not in fact uncontroversially the case that this is what drives the costs of the US healthcare system. And layer in that there is unavoidable uncertainty about when a higher-cost procedure or device or medicine is really higher quality and when it's not, because we have well-founded limitations on how many experiments we can do on people. I don't think it serves anyone to take such a moralizing tone. Liability exists for a reason. These cost-benefit decisions are tough ones. Information is not perfect.
myself248 8y ago
Years ago, a friend of mine was in med school, and headed off for a semester in the rainforest of Ecuador, performing basic medicine and stuff for people who rarely got to the city to see a doctor. He called me up, on a Sunday afternoon, with this question: "Our dentist in the group just realized she doesn't have a source of suction, you know, like the vacuum that slurps saliva out of the way during a procedure. We're in Houston and our flight leaves in 6 hours. Any solution needs to work off-grid for a month. Got any ideas?" I thought for a moment, and said "Hit an auto parts store. Get a brake-bleeder kit. This has a hand-pump vacuum with a clear collection jar. Aim for one with a glass jar if possible, since it'll be easier to clean. Should set you back about thirty bucks." And we didn't speak again for a few months. When he was stateside again, he said the brake bleeder kit had worked so well and was so simple to operate, they'd often just hand it to the patient. Not only did this free up a physician, it also gave the patient something to do during what's often a nervous and fidgety time, and may have thus decreased the need for sedation in some procedures. Sometimes it really is that simple. He had numerous stories of doctors in hospitals picking the brains of janitors -- they called it a "facilities consult" -- to see if they could MacGuyver a solution to a problem that the medical industry hadn't packaged yet. PTFE plumber's tape apparently comes in a medical grade too, but sometimes you need to toss around ideas with some other hands-on maker-fixer sort of people before you figure out how to apply it.
- asdf9ij 8y ago
  You really are a genius aren't you?
- WrtCdEvrydy 8y ago
  In a pinch, I've seen third world doctors use super glue to seal cuts. American culture doesn't allow for anything better than the best outcome in medicine.
  - dotancohen 8y ago
    American culture allows for exactly two possible types of medical care: 1. The best 2. None at all Often the choice between the two is financial.
subcosmos 8y ago
I spent the weekend dissassembling a hematology analyzer capable of measuring 17 parameters of the immune system from a large drop of blood. Nabbed it on ebay for cheap. Was able to unclog a few of the lines and get it running, learning how it works by shooting cells past a laserbeam and looking at scatter. Overall, the complexity of the machine is far simpler than that of a simple laser printer, but its retail value is $10k as a veterinary instrument. Machines for human patients are way more expensive. My dissappointment however was discovering that it refuses to run unless its barcode scanner can see manufacturer-validated reagent bottles. The chemicals needed to make it run are simple salt-waters that can be easily made for $10 of various powders, but the manufacturer sells reagent sets for $1000k each. Now its clear that getting any useful data out of it will require hacking the ARM embedded system onboard. Why am I doing this? Certainly not for any kind of regulated medical treatment, but I personally want to know how my immune system changes on a day to day basis. Datasets like this dont exist on such a high frequency sampling rate. What I find however, is that the decades-old tech that powers this relatively simple machine is being held back by an overly restrictive regulatory environment and price gouging of chemical reagents. Why the artificial construction of a $100 lab test, when the actual value to perform such a test is much much lower? Why can't we live in a world where such self-experimentation is allowed outside of the strict guidelines of diagnostics?
- mschuster91 8y ago
  I happen to do some IT field support for my vet - she has one of these machines too, with the same problem of expensive reagents. The problem space here is: of course anyone can mix the fluids together from powder... but under what conditions? Tested for impurities, contaminants or unevenly mixed/clumped powder? For a clean water source? Regular batch checks to ensure the stuff is up to spec? Mess up one of these things, the system doesn't work/produces false results, a pet or a human dies and the payout sums can be enormous. The latter risk and the insurance premiums as well as mitigation risks are why medical stuff is so insanely expensive. And another thing: at least when someone dies, it's over. Bit of a lump sum to relatives of the deceased, funeral cost, that's it. Now, when someone does not die, but gets stuck with brain damage, in an awake coma or bedridden for life, the costs of keeping that person alive can well run into double-digit millions of euros whereas 50 years ago that person would simply die sooner or later. Midwifes in Germany are retiring in droves because insurance premiums have skyrocketed - due to exploding costs for newborns requiring extensive care after e.g. being stuck in the vaginal canal during birth.
intrasight 8y ago
Just don't call it a medical device. Call it a "dietary supplement"
- Symmetry 8y ago
  To be used inside a hospital an innovation needs official blessing. There are a lots of examples of everyday things like fish oil being rebranded and put through FDA trials so that they can be used by doctors. https://slatestarcodex.com/2014/06/15/fish-now-by-prescription/ https://slatestarcodex.com/2014/06/15/fish-now-by-prescripti... Something called a dietary supplement just isn't going to be used. Both because they sound sketchy and because nobody is going to use expensive food to bribe doctors to sit through a 2 hour training course in some cheap dietary supplement.
  - intrasight 8y ago
    >Something called a dietary supplement just isn't going to be used. I have more faith in humanity
LoSboccacc 8y ago
Like Theranos'? Medical science is slow but steady for a reason.
dublo7 8y ago
I just want to say the title on yc is so much better than the original. Making something cheaper and simple is innovation. Reverse innovation is ambiguous and confusing.
BeetleB 8y ago
I've come across the ORT (ORS in other countries) problem in the US. They're often hard to find, and incredibly overpriced. In the past, many pharmacies simply did not carry them. I was sometimes told to buy Gatorade instead.
- titanomachy 8y ago
  Buy them online and keep them on hand just in case? https://www.amazon.com/Rehydration-Organization-Poisoning-Electrolyte-Replacement/dp/B00OG8G9U2/ref=sr_1_5?keywords=oral%2Brehydration&qid=1549915449&s=gateway&sr=8-5&th=1 https://www.amazon.com/Rehydration-Organization-Poisoning-El...
noobermin 8y ago
Why would Americans physicians stand for this when they can make loads of profit off of backroom deals with device manufacturers and their expensive doctors?
fxfan 8y ago
As per my understanding- sophisticated and expensive medical devices have sophisticated algorithms for processing raw data. I would love it if cheap devices just exposed raw data and I could use my own algorithms, arguably newer and better, to process them. I don't know if cheap devices are much worse as far as raw data is concerned.
itissid 8y ago
Root cause analysis: 1. Developed world: Profit motive(i.e. greed). 2. Developing world: Profit motive(i.e. greed) and Bureaucracy(greed, but oft times incompetence). Greed and incompetence are deeply rooted creations of concentrations of economic incentives in the hands of a few. Capitalism and Socialism are just two ways creating those things, just by slightly different routes. One needs true democratization of technology and its distribution to succeed. Its the only reason why the internet is so powerful and empowering.
shanecleveland 8y ago
> "People in emergency medicine often joke “that you can figure out a solution with a couple of popsicle sticks." But that wouldn't be covered by insurance without a going through a bunch of red tape. But the approved $1000 alternative is.
kwhitefoot 8y ago
This reminds me of Victor Papanek's Design for the Real World.

217 points by theBashShell 8y ago

Hmm, why would an industry based on profiting from high margin expensive medical technology not sufficiently promote low margin inexpensive technology? It's a mystery.

Consultant32452 8y ago
A related mystery: what's stopping greedy practitioners from using the cheap device but still charging the old price increasing their margins even more?
- hirundo 8y ago
  > But cpap machines, the standard device in a country like the U.S., are expensive and require uninterrupted electricity. In many countries, Burke says, doctors resort to using a makeshift solution: a Coke bottle filled with water and attached to some tubing There's a limit to what you can charge for a coke bottle attached to some tubing that's much lower than for a machine that blinks and beeps and goes whirrr with lots of knobs and buttons. Sometimes the solution is to hide the bottle and tubing in a complicated looking box. Of course not _all_ of it is theater.
  - bsder 8y ago
    Um, please, finish the quote: > "In many countries, Burke says, doctors resort to using a makeshift solution: a Coke bottle filled with water and attached to some tubing. The D.I.Y. approach can save an infant’s life but risks causing blindness." That NOT a better solution, thanks. The entire article is rife with this. Ketamine isn't a better anesthetic--it's acceptable if you don't have enough anesthesiologists. The condom with a catherer isn't better, but it is acceptable if you don't have a real UBT. It's disappointing to see the fact that the ethics really aren't clear until the whole way at the end rather than acknowledging it in a much more important manner earlier in the article. > "Kass, the bioethicist, is trying to puzzle out the ethics of what might be seen as lower-quality solutions." Doctors are also more likely to use these solutions with lower-socioeconomic groups--that is the whole point of them being cheaper, after all. And that opens an even bigger issue in places like the US.

gowld 8y ago

Because people don't keep track of all the buzzwords. FTA: > “reverse innovation”: taking a technology or solution born of the resource constraints in developing countries and adopting it in wealthier ones. Nothing "reverse" about it; the question is why rich countries don't import low-cost low-tech solutions from poor countries. I presume the answer is profit motive. The classic example that has been hiding in plain sight for decades is "so many expensive drugs that are about as good as cannabis, and cannabis still illegal."

kiba 8y ago
Presumably because wealthier nations are cost insensitive. They don't feel the need to reduce wastes in their healthcare system when they can 'afford' it.
- aetherson 8y ago
  They may also feel that it's not actually lower-cost for them. For example: say your doctor uses a somewhat lower-tech, kitbashed uterine balloon on your wife during postpartum bleeding. And say she dies anyway (as someone surely will). There is going to be a real temptation to sue the pants off the hospital and say, "Look, they used some jury-rigged contraption instead of the gold-plated device that would have cost 10x." And, I mean, that's a bad look for the hospital in front of a jury, "Yes, well, this might be a little worse, but it might not, and it cost less money!" Everyone wants healthcare to cost less until it starts to look like hospitals or doctors are prioritizing "profits" versus people's lives.
  - WrtCdEvrydy 8y ago
    This is why we pay the most of any other country... we try for best outcomes. If something cheap is used in the UK with a 97% good outcomes, we will spend 3 million to ensure we get closer to 98% outcome.
    - TeMPOraL 8y ago
      Depending on the amount of patients, even a 1 percent point increase for $3M could be a baragin. If, e.g., everyone undergoes such procedure once in their lifetime, 1% times the population of UK is 660K people that could be saved for $3M, roughly $4.5 per life saved, which is a no-brainer.

kerkeslager 8y ago

What an awful headline.

toomuchtodo 8y ago

Entrenched interests, innovator’s dilemma. Orgs and people get addicted to their revenue stream.

TheRealPomax 8y ago

"People are not necessarily comfortable with the price of medicine dropping?" Sorry, which planet are you from? Earth, you say? The US even? People in your country would do anything (and have) for affordable medicine.

afarrell 8y ago
A world where people don't have a good way to judge the quality of medical services and so they use price as a proxy for quality. Here is a 2-minute video where a very popular speaker explains the position, to the agreement of a large crowd: https://www.youtube.com/watch?v=kPsfo8-FhB0 https://www.youtube.com/watch?v=kPsfo8-FhB0
magduf 8y ago
No, they won't. As comments above pointed out, Americans will sue when something goes wrong and it's found that the medical provider didn't use the most expensive option available. And Americans do NOT do what they can to obtain affordable medicine: if they wanted this, they'd be demanding laws to rein in costs, to provide socialized medicine, etc., just like most other developed nations have already done. Instead, we got ObamaCare, and half our population wants it to be repealed.

tompccs 8y ago

The answer to the headline is astoundingly obvious yet the article doesn't mention it once. The reason is regulation: you can't use a medical device that you've hacked together unless it has been cleared by the relevant authorities as being safe. Sometimes it's a matter of simply getting a cheaper alternative through regulatory approval, but other times its just not worth the cost to prove a cheaper alternative is as safe as the more expensive one. Very annoying article about an interesting subject.

EamonnMR 8y ago
The agonizing part is that having incredibly expensive medical tools isn't safe either - it leads patients to avoid medical treatment because of the cost.
- jstanley 8y ago
  It's not meant to improve patient outcomes, it's meant to avoid liability.
  - aetherson 8y ago
    I wish people didn't phrase things this way. There's no single "meaning" to all of this. It's a bunch of different people with different priorities making different cost-benefit tradeoffs. I mean, what would you do if a loved one died at least in part because someone was trying to save $1,000 on their treatment? How would you feel? What if you were permanently disabled or put in months of agonizing pain, and there were more expensive options that would have had a lower chance of doing that? Or just might have had a lower chance of doing that? From the 10 miles up view, it's easy to say, "Holy shit, the US has such a high health care cost, we could get 97% of the same care at 50% of the cost," and that seems like a great idea. When you're personally looking at tragedy to save an amount of money that is not that significant for your specific medical case (the waste comes when it's applied to 50 more people who don't really benefit from it), the calculus looks very different. It may still be the right decision. But can we be compassionate about the victims of that decision? Then layer in that it is not in fact uncontroversially the case that this is what drives the costs of the US healthcare system. And layer in that there is unavoidable uncertainty about when a higher-cost procedure or device or medicine is really higher quality and when it's not, because we have well-founded limitations on how many experiments we can do on people. I don't think it serves anyone to take such a moralizing tone. Liability exists for a reason. These cost-benefit decisions are tough ones. Information is not perfect.

myself248 8y ago

Years ago, a friend of mine was in med school, and headed off for a semester in the rainforest of Ecuador, performing basic medicine and stuff for people who rarely got to the city to see a doctor. He called me up, on a Sunday afternoon, with this question: "Our dentist in the group just realized she doesn't have a source of suction, you know, like the vacuum that slurps saliva out of the way during a procedure. We're in Houston and our flight leaves in 6 hours. Any solution needs to work off-grid for a month. Got any ideas?" I thought for a moment, and said "Hit an auto parts store. Get a brake-bleeder kit. This has a hand-pump vacuum with a clear collection jar. Aim for one with a glass jar if possible, since it'll be easier to clean. Should set you back about thirty bucks." And we didn't speak again for a few months. When he was stateside again, he said the brake bleeder kit had worked so well and was so simple to operate, they'd often just hand it to the patient. Not only did this free up a physician, it also gave the patient something to do during what's often a nervous and fidgety time, and may have thus decreased the need for sedation in some procedures. Sometimes it really is that simple. He had numerous stories of doctors in hospitals picking the brains of janitors -- they called it a "facilities consult" -- to see if they could MacGuyver a solution to a problem that the medical industry hadn't packaged yet. PTFE plumber's tape apparently comes in a medical grade too, but sometimes you need to toss around ideas with some other hands-on maker-fixer sort of people before you figure out how to apply it.

asdf9ij 8y ago
You really are a genius aren't you?
WrtCdEvrydy 8y ago
In a pinch, I've seen third world doctors use super glue to seal cuts. American culture doesn't allow for anything better than the best outcome in medicine.
- dotancohen 8y ago
  American culture allows for exactly two possible types of medical care: 1. The best 2. None at all Often the choice between the two is financial.

subcosmos 8y ago

I spent the weekend dissassembling a hematology analyzer capable of measuring 17 parameters of the immune system from a large drop of blood. Nabbed it on ebay for cheap. Was able to unclog a few of the lines and get it running, learning how it works by shooting cells past a laserbeam and looking at scatter. Overall, the complexity of the machine is far simpler than that of a simple laser printer, but its retail value is $10k as a veterinary instrument. Machines for human patients are way more expensive. My dissappointment however was discovering that it refuses to run unless its barcode scanner can see manufacturer-validated reagent bottles. The chemicals needed to make it run are simple salt-waters that can be easily made for $10 of various powders, but the manufacturer sells reagent sets for $1000k each. Now its clear that getting any useful data out of it will require hacking the ARM embedded system onboard. Why am I doing this? Certainly not for any kind of regulated medical treatment, but I personally want to know how my immune system changes on a day to day basis. Datasets like this dont exist on such a high frequency sampling rate. What I find however, is that the decades-old tech that powers this relatively simple machine is being held back by an overly restrictive regulatory environment and price gouging of chemical reagents. Why the artificial construction of a $100 lab test, when the actual value to perform such a test is much much lower? Why can't we live in a world where such self-experimentation is allowed outside of the strict guidelines of diagnostics?

mschuster91 8y ago
I happen to do some IT field support for my vet - she has one of these machines too, with the same problem of expensive reagents. The problem space here is: of course anyone can mix the fluids together from powder... but under what conditions? Tested for impurities, contaminants or unevenly mixed/clumped powder? For a clean water source? Regular batch checks to ensure the stuff is up to spec? Mess up one of these things, the system doesn't work/produces false results, a pet or a human dies and the payout sums can be enormous. The latter risk and the insurance premiums as well as mitigation risks are why medical stuff is so insanely expensive. And another thing: at least when someone dies, it's over. Bit of a lump sum to relatives of the deceased, funeral cost, that's it. Now, when someone does not die, but gets stuck with brain damage, in an awake coma or bedridden for life, the costs of keeping that person alive can well run into double-digit millions of euros whereas 50 years ago that person would simply die sooner or later. Midwifes in Germany are retiring in droves because insurance premiums have skyrocketed - due to exploding costs for newborns requiring extensive care after e.g. being stuck in the vaginal canal during birth.

intrasight 8y ago

Just don't call it a medical device. Call it a "dietary supplement"

Symmetry 8y ago
To be used inside a hospital an innovation needs official blessing. There are a lots of examples of everyday things like fish oil being rebranded and put through FDA trials so that they can be used by doctors. https://slatestarcodex.com/2014/06/15/fish-now-by-prescription/ https://slatestarcodex.com/2014/06/15/fish-now-by-prescripti... Something called a dietary supplement just isn't going to be used. Both because they sound sketchy and because nobody is going to use expensive food to bribe doctors to sit through a 2 hour training course in some cheap dietary supplement.
- intrasight 8y ago
  >Something called a dietary supplement just isn't going to be used. I have more faith in humanity

LoSboccacc 8y ago

Like Theranos'? Medical science is slow but steady for a reason.

dublo7 8y ago

I just want to say the title on yc is so much better than the original. Making something cheaper and simple is innovation. Reverse innovation is ambiguous and confusing.

BeetleB 8y ago

I've come across the ORT (ORS in other countries) problem in the US. They're often hard to find, and incredibly overpriced. In the past, many pharmacies simply did not carry them. I was sometimes told to buy Gatorade instead.

titanomachy 8y ago
Buy them online and keep them on hand just in case? https://www.amazon.com/Rehydration-Organization-Poisoning-Electrolyte-Replacement/dp/B00OG8G9U2/ref=sr_1_5?keywords=oral%2Brehydration&qid=1549915449&s=gateway&sr=8-5&th=1 https://www.amazon.com/Rehydration-Organization-Poisoning-El...

noobermin 8y ago

Why would Americans physicians stand for this when they can make loads of profit off of backroom deals with device manufacturers and their expensive doctors?

fxfan 8y ago

As per my understanding- sophisticated and expensive medical devices have sophisticated algorithms for processing raw data. I would love it if cheap devices just exposed raw data and I could use my own algorithms, arguably newer and better, to process them. I don't know if cheap devices are much worse as far as raw data is concerned.

itissid 8y ago

Root cause analysis: 1. Developed world: Profit motive(i.e. greed). 2. Developing world: Profit motive(i.e. greed) and Bureaucracy(greed, but oft times incompetence). Greed and incompetence are deeply rooted creations of concentrations of economic incentives in the hands of a few. Capitalism and Socialism are just two ways creating those things, just by slightly different routes. One needs true democratization of technology and its distribution to succeed. Its the only reason why the internet is so powerful and empowering.

shanecleveland 8y ago

> "People in emergency medicine often joke “that you can figure out a solution with a couple of popsicle sticks." But that wouldn't be covered by insurance without a going through a bunch of red tape. But the approved $1000 alternative is.

kwhitefoot 8y ago

This reminds me of Victor Papanek's Design for the Real World.