13 ms·

I've long believed that once startups and tech companies get their hands on medical data (patient outcomes, medication treatment outcomes, mal practice rates, s

I've long believed that once startups and tech companies get their hands on medical data (patient outcomes, medication treatment outcomes, mal practice rates, surgery outcomes) that a reckoning will take place on the medical industry. The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor. Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are. Most prescription drugs do nothing, and the ones that do something are more so just covering the symptoms. HIPAA laws are hiding patient outcomes and holding this whole sham afloat.

sica07 7y ago
There were and are a lot of articles about the fact that many prescription drugs and many treatments are overrated and I totally belive that. But saying that "most" medical treatments & prescription drugs are worthless it's quite a radical view based on... pure speculation.
- rjf72 7y ago
  I think your statement sounds perfectly reasonable, but it actually holds a pretty interesting corollary! If he is wrong that "most" medical treatments and prescriptions are worthless then that would necessarily mean that "most" are valuable. The reason this is interesting is because the exponentially increasing rate of both the amount of medication out there and the amount people are using. For instance from 1997 to 2016 the number of prescriptions filled grew from 2.4 billion to 4.5 billion [1]. And an exponentially increasing number of people, across all ages and demographics, are also being medicated with all sorts of drugs for various reasons. So, if we assume that most medical treatments and prescriptions are not worthless we should see increases in healthfulness that are at least somewhat comparable with our increases in pharmaceutical usage. In reality we saw sharply diminishing returns on life expectancy that have now gradually shifted towards an ongoing decline in life expectancy over the past few years. By any standard of effectiveness, this is not looking good for pharmaceuticals. So I suppose I'd turn it around. I think the view that medicines (and especially their recent exponential growth) are providing a substantial social benefit could be true, but it would seem to be the statement that needs to be explained. E.g. perhaps our own increasingly unhealthy lifestyles are contravening the gains from the medical technology? No idea there, but I do think occam's razor would tend to simply suggest that the reason we're not seeing improvements is because we're not improving. [1] - https://www.webmd.com/drug-medication/news/20170803/americans-taking-more-prescription-drugs-than-ever-survey https://www.webmd.com/drug-medication/news/20170803/american...
  - sica07 7y ago
    I agree with you but in a different way :) (what follows its a long text written in bad English but I hope I'll manage to make my idea clear) Regarding your idea that "By any standard of effectiveness, this is not looking good for pharmaceuticals": This is a very complex topic and I don't think anyone has a clear and objective view/explanation about this. For example, we have a big problem with the antibiotics. We eat a lot of meat from animals that where treated with antibiotics. We "overuse" antibiotics. Etc. Because of this, new antibiotics-resistant bacteria appeared and classical antibiotics became less and less effective in fighting against them. How should we categorize this issue? Should we see it as a proof of the fact that medicines are not as effective as advertised? It's not a problem with antibiotics per se. Or as a proof that modern medicine is overrated? Medicine correctly identified the problem(bacteria) and the treatment(antibiotics). In reality it is a problem generated by mostly by the rising popularity of automedication, lack of basic medical/pharmaceutical education and urban myths (antibiotics are good for anything), medicines used on animals (which is not a problem of human medicine), and, I would say, only a tiny part of the problem is the treatments that unnecessarily include antibiotics and are prescribed by medicine doctors. But, let's say that we don't know anything about the above mentioned facts and we study some statistics. What would we think when seeing a clear correlation between the increase in the number of antibiotics and decrease of the effectiveness of the treatments? We could see it as a proof that "the quality of medicine drugs has decreased resulting in an increase of ineffective treatment". The point I'm trying to make is that the reason why the effectiveness of many treatments decreased and now we have a decline in life expectancy it's a very complex issue and it's not fair to see it as simple as a fact failure of pharmaceutics or/and medicine. Regarding your last statement, I think that we are not seeing improvements because our modern environment and life style has changed and is changing in such a rapid and unpredictable way that medicine can keep the pace. Medicine it's improving, but it's improving too slow. It is as out environment and lifestyle is traveling by plane while medicine and pharmaceutics are traveling by bus...
lukeschlather 7y ago
How would a startup make money by showing that treatments are worthless? Startups are going to have the same incentives as other pharmaceutical companies.
- drcode 7y ago
  Well, the hope I have (and OP probably as well) is that machine learning techniques properly applied to the raw data could uncover a lot of statistical errors in the historical literature, which could be both profitable and disruptive. ... Unfortunately, this may happen first in countries with poor human rights records (i.e. China) because there is likely a greater availability of patient data under those circumstances.
  - lukeschlather 7y ago
    ML doesn't fix bad statistics. ML is really just a sexier way of saying real-time statistics with lots of data.
    - drcode 7y ago
      I would agree that ML is just statistics, but I also kind of think that a median approach to statistics in medicine are currently at an even poorer level of quality than the low bar set by typical ML, so there could be an improvement nonetheless.
  - sidlls 7y ago
    ML is not in a state to be of much use in this context. Source: me, I work as a data scientist to apply ML and other techniques, with claims, EHR, and a bunch of other data, specifically for the purpose of identification of conditions, effectiveness of treatments and non-medical intervention. The tech world is very much in a condition of being unjustifiably arrogant about its ability to solve problems in this space. The problems are very hard, and the answers aren't gonna be found by some egotistical software eng who tries to shift his toy kaggle crap into this space, or the kinds of startups that are built up around that kind of thinking.
luckylion 7y ago
Anti-virus vendors have been doing great, what leads you to believe that medical tech startups won't just look to "disrupt" the market by funneling the money into a different (likely: their) direction?
BurningFrog 7y ago
Maybe you just described why this data will not become available...
pixelmonkey 7y ago
"The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor. Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are." I'm the spouse/partner of a recently-trained doctor, and I'm a programmer and startup founder with 2 decades of experience. With all respect, you have no friggen clue what you're talking about.
- mistermann 7y ago
  Would it be possible for you to be more specific about the ways in which the commenter is wrong?
  - SiempreViernes 7y ago
    Have tech solved the issues of a client changing their minds about what they want? Well, all the interesting bits of medicine are built on social interactions. You ask the patient where it hurts and they lie about where.
    - mistermann 7y ago
      I don't think this is relevant to my question, or am I missing something?
    - maximente 7y ago
      are those the same social interactions that explain why surgeons resisted using things like checklist because it was "beneath them", "they never make mistakes", etc.? because if so i agree, there's some real low hanging fruit there.
- mLuby 7y ago
  Would you kindly elaborate on that? I have enormous respect for the difficulty of the training that doctors like your spouse have gone through, and yet I share the quoted sentiment. We assume that difficulty is essential to the work, and I think that's an assumption worth questioning, as the dental profession has been recently.
patrick5415 7y ago
At a high level, I agree. My take is that for things like broken bones, and other accute trauma, doctors are great. For everything else, especially anything chronic, and they are completely worthless.
- radicalbyte 7y ago
  Any good doctor will advise you to get plenty of exercise and eat a health diet. That's easily the best thing you can do for your health. Only the vast majority of people ignore that advise. Also the combination of vaccinations and nutrient-fortified food have worked wonders for public health.
  - patrick5415 7y ago
    You can get the same advice from a crossfit website. Doctors aren’t the ones fortifying food and nurses seem perfectly capable of administering a vaccine.
deleted 7y ago
[deleted]
hannob 7y ago
> I've long believed that once startups and tech companies get their hands on medical data Honestly I think the last people that are going to improve anything in medicine are startups and tech companies. Quite the contrary. I know that quite a few people in evidence-based medicine are worried that Tech people who want to "disrupt" things come with their own poor scientific standards to undermine the minimum standards this field has (and has fought hard for to get).
- wolco 7y ago
  We've started with ubiome/23andme providing customers data previously not available. Another area is improving existing processes. We see techniques where photos are being read more accurately and quickly compared to manual processes. Medicine now resolves around tests. Those can be improved and automated. We will see tools that will empower personal medicine and shift the power balance away from the family clinics.
  - neural_thing 7y ago
    To be fair, ubiome is a fraud, and (anecdote) 23andme made a mistake in reading my genome and their data showed that I had an incredibly deadly cancer predisposition (Li-Fraumeni), which a reputable medical lab showed to be false.
    - wolco 7y ago
      ubiome is a ycombinator company. Why would you call them a fraud. I've done a number of tests over a period after antiobiotics and I definately saw the change into diversity correlate with the foods I introduced.
      - detaro 7y ago
        They've been raided by the FBI for insurance fraud, they reportedly conducted "tests" using samples that hadn't been stored properly, their CEOs/founders have resigned, they've let half their staff go recently and currently are not capable of actually doing testing ... That's not saying that they never produced useful data, but ...
agumonkey 7y ago
It's a deep, wide and sensitive subject. White coats give people extreme social powers. But they are far from perfect.
jcranmer 7y ago
The health supplement industry is still alive and kicking. And that's an industry that's so sleazy many companies can't be bothered to even put their claimed active ingredients in their products. Yet it's a very healthy industry that has very cushy anti-regulation protections. So even if you were right on the lack of efficacy of modern medical treatment (and I strongly suspect you are not), I highly doubt that its exposure would lead to a collapse in the industry.
klenwell 7y ago
> Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are. Most prescription drugs do nothing, and the ones that do something are more so just covering the symptoms. I've read Bad Pharma (and will recommend it to anyone interested in this subject). And one way to summarize (perhaps oversimplify) it is: pharmaceutical corporations manipulate data to justify expensive drugs of questionable effectivness. But to think "startups and tech companies" are going to help solve this problem... man, that's optimistic. And as Bad Pharma demonstrates, the data is already available. There's just not a lot of interest (economically or politically, especially where those two are strongly correlated) to seek it out or listen to it. Also I don't think it was HIPAA's intention to hide data from well-meaning startups. That's just an unintended consequence perhaps. I'd like to think its primary motivation was to protect patient data from predatory insurance companies and unscrupulous marketing forces. (Does it succeed in doing that? I don't know. Are startups and tech companies going to help with that if it doesn't? Hmmm.)
- bdamm 7y ago
  I briefly worked for a startup back in 2005 that was doing data analysis on prescriptions to reverse analyze a patient's conditions. The customers were the insurance companies.
  - lonelappde 7y ago
    How does that work? Insurance companies have access to all the prescription purchase and tests ordered,but not the diagnoses?
cryptowizard69 7y ago
Didn't a big Silicon Valley startup already get their hands on a bunch of money and data and try to disrupt the medical industry? Can't quite remember... Themanos? Therablos? Wonder whatever happened to them...
marcinzm 7y ago
>I've long believed that once startups and tech companies get their hands on medical data (patient outcomes, medication treatment outcomes, mal practice rates, surgery outcomes) that a reckoning will take place on the medical industry. Startups have been going at this problem for years and years already and have had the data. I've worked at them. You know what the goal of most of those startups was? To make money. Patients were a means to an end. If they helped people, it was a thing that happened but not the actual goal. See, actually trying to help patients and do so responsibly and not just cause a bigger mess is hard. Medicine is complicated, people are complicated, the health system is complicated. Easier to just ignore all that, make some money and sell out before people realize all you did was funnel some money around. >Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are. There's plenty of existing literature that notes various medical treatments are worthless. Yet they still happen and are still prescribed and are still paid for. Knowledge doesn't change behavior. >HIPAA laws are hiding patient outcomes and holding this whole sham afloat. You can easily get medical billing data for a massive percentage of the US population which includes doctors, dates, procedures, diagnoses and aggregated costs. De-identified but that doesn't matter for these sorts of things. edit: Also, what is probably the biggest hurdle for health care startups isn't data. It's the fact that AB testing, the cornerstone of how every tech company iterates, is considered unethical except in very constrained forms. Something about there being a difference between crashing the web page of 1% of your customers versus literally killing 1% of your customers.
- disqard 7y ago
  Thank you for articulating these points so well. Possibly preaching to the choir here, but you should check out "Geek Heresy" by Kentaro Toyama.
rscho 7y ago
Oh yeah, of course! Startups and tech are so much more honest than big pharma and clinicians... The reckoning will not go the way you think it will.

sica07 7y ago

There were and are a lot of articles about the fact that many prescription drugs and many treatments are overrated and I totally belive that. But saying that "most" medical treatments & prescription drugs are worthless it's quite a radical view based on... pure speculation.

rjf72 7y ago
I think your statement sounds perfectly reasonable, but it actually holds a pretty interesting corollary! If he is wrong that "most" medical treatments and prescriptions are worthless then that would necessarily mean that "most" are valuable. The reason this is interesting is because the exponentially increasing rate of both the amount of medication out there and the amount people are using. For instance from 1997 to 2016 the number of prescriptions filled grew from 2.4 billion to 4.5 billion [1]. And an exponentially increasing number of people, across all ages and demographics, are also being medicated with all sorts of drugs for various reasons. So, if we assume that most medical treatments and prescriptions are not worthless we should see increases in healthfulness that are at least somewhat comparable with our increases in pharmaceutical usage. In reality we saw sharply diminishing returns on life expectancy that have now gradually shifted towards an ongoing decline in life expectancy over the past few years. By any standard of effectiveness, this is not looking good for pharmaceuticals. So I suppose I'd turn it around. I think the view that medicines (and especially their recent exponential growth) are providing a substantial social benefit could be true, but it would seem to be the statement that needs to be explained. E.g. perhaps our own increasingly unhealthy lifestyles are contravening the gains from the medical technology? No idea there, but I do think occam's razor would tend to simply suggest that the reason we're not seeing improvements is because we're not improving. [1] - https://www.webmd.com/drug-medication/news/20170803/americans-taking-more-prescription-drugs-than-ever-survey https://www.webmd.com/drug-medication/news/20170803/american...
- sica07 7y ago
  I agree with you but in a different way :) (what follows its a long text written in bad English but I hope I'll manage to make my idea clear) Regarding your idea that "By any standard of effectiveness, this is not looking good for pharmaceuticals": This is a very complex topic and I don't think anyone has a clear and objective view/explanation about this. For example, we have a big problem with the antibiotics. We eat a lot of meat from animals that where treated with antibiotics. We "overuse" antibiotics. Etc. Because of this, new antibiotics-resistant bacteria appeared and classical antibiotics became less and less effective in fighting against them. How should we categorize this issue? Should we see it as a proof of the fact that medicines are not as effective as advertised? It's not a problem with antibiotics per se. Or as a proof that modern medicine is overrated? Medicine correctly identified the problem(bacteria) and the treatment(antibiotics). In reality it is a problem generated by mostly by the rising popularity of automedication, lack of basic medical/pharmaceutical education and urban myths (antibiotics are good for anything), medicines used on animals (which is not a problem of human medicine), and, I would say, only a tiny part of the problem is the treatments that unnecessarily include antibiotics and are prescribed by medicine doctors. But, let's say that we don't know anything about the above mentioned facts and we study some statistics. What would we think when seeing a clear correlation between the increase in the number of antibiotics and decrease of the effectiveness of the treatments? We could see it as a proof that "the quality of medicine drugs has decreased resulting in an increase of ineffective treatment". The point I'm trying to make is that the reason why the effectiveness of many treatments decreased and now we have a decline in life expectancy it's a very complex issue and it's not fair to see it as simple as a fact failure of pharmaceutics or/and medicine. Regarding your last statement, I think that we are not seeing improvements because our modern environment and life style has changed and is changing in such a rapid and unpredictable way that medicine can keep the pace. Medicine it's improving, but it's improving too slow. It is as out environment and lifestyle is traveling by plane while medicine and pharmaceutics are traveling by bus...

lukeschlather 7y ago

How would a startup make money by showing that treatments are worthless? Startups are going to have the same incentives as other pharmaceutical companies.

drcode 7y ago
Well, the hope I have (and OP probably as well) is that machine learning techniques properly applied to the raw data could uncover a lot of statistical errors in the historical literature, which could be both profitable and disruptive. ... Unfortunately, this may happen first in countries with poor human rights records (i.e. China) because there is likely a greater availability of patient data under those circumstances.
- lukeschlather 7y ago
  ML doesn't fix bad statistics. ML is really just a sexier way of saying real-time statistics with lots of data.
  - drcode 7y ago
    I would agree that ML is just statistics, but I also kind of think that a median approach to statistics in medicine are currently at an even poorer level of quality than the low bar set by typical ML, so there could be an improvement nonetheless.
- sidlls 7y ago
  ML is not in a state to be of much use in this context. Source: me, I work as a data scientist to apply ML and other techniques, with claims, EHR, and a bunch of other data, specifically for the purpose of identification of conditions, effectiveness of treatments and non-medical intervention. The tech world is very much in a condition of being unjustifiably arrogant about its ability to solve problems in this space. The problems are very hard, and the answers aren't gonna be found by some egotistical software eng who tries to shift his toy kaggle crap into this space, or the kinds of startups that are built up around that kind of thinking.

luckylion 7y ago

Anti-virus vendors have been doing great, what leads you to believe that medical tech startups won't just look to "disrupt" the market by funneling the money into a different (likely: their) direction?

BurningFrog 7y ago

Maybe you just described why this data will not become available...

pixelmonkey 7y ago

"The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor. Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are." I'm the spouse/partner of a recently-trained doctor, and I'm a programmer and startup founder with 2 decades of experience. With all respect, you have no friggen clue what you're talking about.

mistermann 7y ago
Would it be possible for you to be more specific about the ways in which the commenter is wrong?
- SiempreViernes 7y ago
  Have tech solved the issues of a client changing their minds about what they want? Well, all the interesting bits of medicine are built on social interactions. You ask the patient where it hurts and they lie about where.
  - mistermann 7y ago
    I don't think this is relevant to my question, or am I missing something?
  - maximente 7y ago
    are those the same social interactions that explain why surgeons resisted using things like checklist because it was "beneath them", "they never make mistakes", etc.? because if so i agree, there's some real low hanging fruit there.
mLuby 7y ago
Would you kindly elaborate on that? I have enormous respect for the difficulty of the training that doctors like your spouse have gone through, and yet I share the quoted sentiment. We assume that difficulty is essential to the work, and I think that's an assumption worth questioning, as the dental profession has been recently.

patrick5415 7y ago

At a high level, I agree. My take is that for things like broken bones, and other accute trauma, doctors are great. For everything else, especially anything chronic, and they are completely worthless.

radicalbyte 7y ago
Any good doctor will advise you to get plenty of exercise and eat a health diet. That's easily the best thing you can do for your health. Only the vast majority of people ignore that advise. Also the combination of vaccinations and nutrient-fortified food have worked wonders for public health.
- patrick5415 7y ago
  You can get the same advice from a crossfit website. Doctors aren’t the ones fortifying food and nurses seem perfectly capable of administering a vaccine.

deleted 7y ago

[deleted]

hannob 7y ago

> I've long believed that once startups and tech companies get their hands on medical data Honestly I think the last people that are going to improve anything in medicine are startups and tech companies. Quite the contrary. I know that quite a few people in evidence-based medicine are worried that Tech people who want to "disrupt" things come with their own poor scientific standards to undermine the minimum standards this field has (and has fought hard for to get).

wolco 7y ago
We've started with ubiome/23andme providing customers data previously not available. Another area is improving existing processes. We see techniques where photos are being read more accurately and quickly compared to manual processes. Medicine now resolves around tests. Those can be improved and automated. We will see tools that will empower personal medicine and shift the power balance away from the family clinics.
- neural_thing 7y ago
  To be fair, ubiome is a fraud, and (anecdote) 23andme made a mistake in reading my genome and their data showed that I had an incredibly deadly cancer predisposition (Li-Fraumeni), which a reputable medical lab showed to be false.
  - wolco 7y ago
    ubiome is a ycombinator company. Why would you call them a fraud. I've done a number of tests over a period after antiobiotics and I definately saw the change into diversity correlate with the foods I introduced.
    - detaro 7y ago
      They've been raided by the FBI for insurance fraud, they reportedly conducted "tests" using samples that hadn't been stored properly, their CEOs/founders have resigned, they've let half their staff go recently and currently are not capable of actually doing testing ... That's not saying that they never produced useful data, but ...

agumonkey 7y ago

It's a deep, wide and sensitive subject. White coats give people extreme social powers. But they are far from perfect.

jcranmer 7y ago

The health supplement industry is still alive and kicking. And that's an industry that's so sleazy many companies can't be bothered to even put their claimed active ingredients in their products. Yet it's a very healthy industry that has very cushy anti-regulation protections. So even if you were right on the lack of efficacy of modern medical treatment (and I strongly suspect you are not), I highly doubt that its exposure would lead to a collapse in the industry.

klenwell 7y ago

> Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are. Most prescription drugs do nothing, and the ones that do something are more so just covering the symptoms. I've read Bad Pharma (and will recommend it to anyone interested in this subject). And one way to summarize (perhaps oversimplify) it is: pharmaceutical corporations manipulate data to justify expensive drugs of questionable effectivness. But to think "startups and tech companies" are going to help solve this problem... man, that's optimistic. And as Bad Pharma demonstrates, the data is already available. There's just not a lot of interest (economically or politically, especially where those two are strongly correlated) to seek it out or listen to it. Also I don't think it was HIPAA's intention to hide data from well-meaning startups. That's just an unintended consequence perhaps. I'd like to think its primary motivation was to protect patient data from predatory insurance companies and unscrupulous marketing forces. (Does it succeed in doing that? I don't know. Are startups and tech companies going to help with that if it doesn't? Hmmm.)

bdamm 7y ago
I briefly worked for a startup back in 2005 that was doing data analysis on prescriptions to reverse analyze a patient's conditions. The customers were the insurance companies.
- lonelappde 7y ago
  How does that work? Insurance companies have access to all the prescription purchase and tests ordered,but not the diagnoses?

cryptowizard69 7y ago

Didn't a big Silicon Valley startup already get their hands on a bunch of money and data and try to disrupt the medical industry? Can't quite remember... Themanos? Therablos? Wonder whatever happened to them...

marcinzm 7y ago

>I've long believed that once startups and tech companies get their hands on medical data (patient outcomes, medication treatment outcomes, mal practice rates, surgery outcomes) that a reckoning will take place on the medical industry. Startups have been going at this problem for years and years already and have had the data. I've worked at them. You know what the goal of most of those startups was? To make money. Patients were a means to an end. If they helped people, it was a thing that happened but not the actual goal. See, actually trying to help patients and do so responsibly and not just cause a bigger mess is hard. Medicine is complicated, people are complicated, the health system is complicated. Easier to just ignore all that, make some money and sell out before people realize all you did was funnel some money around. >Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are. There's plenty of existing literature that notes various medical treatments are worthless. Yet they still happen and are still prescribed and are still paid for. Knowledge doesn't change behavior. >HIPAA laws are hiding patient outcomes and holding this whole sham afloat. You can easily get medical billing data for a massive percentage of the US population which includes doctors, dates, procedures, diagnoses and aggregated costs. De-identified but that doesn't matter for these sorts of things. edit: Also, what is probably the biggest hurdle for health care startups isn't data. It's the fact that AB testing, the cornerstone of how every tech company iterates, is considered unethical except in very constrained forms. Something about there being a difference between crashing the web page of 1% of your customers versus literally killing 1% of your customers.

disqard 7y ago
Thank you for articulating these points so well. Possibly preaching to the choir here, but you should check out "Geek Heresy" by Kentaro Toyama.

rscho 7y ago

Oh yeah, of course! Startups and tech are so much more honest than big pharma and clinicians... The reckoning will not go the way you think it will.