5 ms·

I see a huge trend coming in “DIY Medicine”. Doctors, insurers, and the FDA are way too expensive for mere gatekeeping, and technology is developing new treatme

by jl2718 7y ago

I see a huge trend coming in “DIY Medicine”. Doctors, insurers, and the FDA are way too expensive for mere gatekeeping, and technology is developing new treatments and dropping equipment costs an order of magnitude faster than they can respond. For example, I can buy all of the equipment necessary for a PRP injection for less than the cost of a single treatment, and the doctor that does it knows no more about how to do it than any nurse that took a weekend course. There are also many simple drugs that aren’t used because they either can’t be patented or because the cost is too low. Many of these treatments obviate the need for much more expensive and dangerous treatments with questionable outcomes, like surgery and high-priced drugs. Doctors know that the price of the most effective treatments may not sustain their profession. So if we’re not there already, it’s coming to the point where the medical industry does more harm than good, and gray market treatments will give far better outcomes for an order magnitude lower cost.

tsmarsh 7y ago
I work in Pharma, we're not worried yet. We've done a few trials of nano-fabs, essentially 3D printed labs where you inject the raw materials and drugs pop out the end. They kind of work, but its still a lot of work and would mean consumers getting hands on a bunch of controlled substances. Being able to produce meth in a 'lab' that fits in your hand is not crazy... except you can clearly see how crazy that is.
- godtoldmetodoit 7y ago
  Ignore the legal aspect of this - if the technology gets good enough and cheap enough people will make their own nano-fabs and damn the laws. People would LOVE to pirate pharmaceuticals. It's an industry just begging for disruption.
  - zelly 7y ago
    A way to synthesize arbitrary chemicals in a printer is worth trillions of dollars. It goes well beyond pharmaceuticals, but for a start, it would drive healthcare costs down to basically free.
- jl2718 7y ago
  I’m not talking about nano-fabs. From a pharma perspective, I’m talking about moleculars that are produced in GMP facilities and sold like any other USP, not for human use. This is admittedly dangerous because the formulations could have contaminants. However, even in FDA-approved pharma, you get things like NDMA being used as a solvent and ending up as millimolar fractions, and the drugs don’t even get pulled for months after discovery by some random independent lab. There are thousands of moleculars that pharma will never push through the FDA because it’s a natural human protein fragment and therefore impossible to patent and profit from.
SkyPuncher 7y ago
I wish I could address everything that's wrong with this comment. The biggest thing is you seem extremely willing to take risks without understanding the gravity of what you're doing. Sure, you CAN give yourself PRP injections and LIKELY will have little to no side effects. Healthcare providers need extreme confidence that (a) a procedure will be effective (b) the risks are appropriate.
- reubens 7y ago
  I disagree. Some doctors will attempt new procedures with only a company promoting new tools. I once saw a surgeon try out new combined cut & staple hardware designed for bowel surgery on a patient's liver, because he had been told it would work. It didn't, and there was a ridiculous amount of staples in the patient's abdomen afterward. Doctors often become more risk prone the more power they have, and the hierarchy of human medical doctoring contributes to this.
  - alexanderdmitri 7y ago
    sailor: captain! there's a hole in the ship, if we don't do something quick we'll sink! captain: there's only one solution ... make the hole so big we can no longer call it a hole. sailor: aye aye captain, i'll go get the explosives.
- jl2718 7y ago
  PRP was a pretty extreme example, but I used it to prove a point that no matter how crazy it seems to do PRP in an underground or gray-market venue, 1. A lot of people are already doing it, and 2. absent blood contamination risk, the risk, benefit, and cost trade-off is still massively better than the surgery it may prevent. It’s not even close. Even if it’s not proven to be effective by statistical scrutiny, neither are the vast majority of orthopedic surgeries. Seriously, look it up, and be mindful that it is the surgeon himself that determines success in most studies.
Waterluvian 7y ago
This got me thinking about ideas for a product that would work internationally vs. just in one country and if that signal means much about the viability of a product. In terms of work being "promising", wouldn't I want to takle a global problem, not one unique to a specific country?
- jl2718 7y ago
  I see this trend strongest in Asia right now.
dr_ 7y ago
"Doctors know that the price of the most effective treatments may not sustain their profession." This is not really a fair assessment. The most cost effective treatments can be self administered. But if you are coming in to see me because of persistent knee pain, more often that not you have already tried tylenol and over the counter nsaids (ibuprofen, etc.), and your pain has been persistent. The next set of treatment options, aside from maybe some physical therapy, are more expensive, because they involve using drugs that are more expensive or treatment measures that are more expensive. With re: PRP, it is not covered by insurance, since the benefits of it over a placebo are still not entirely clear. Many doctors offer it however, and to insure accuracy of needle placement, they usually perform it under ultrasound guidance- not something most people would be able to do on their own, at least not yet. As more and more physicians offer it, and if it remains uncovered, market forces will drive the prices down (like Lasik), although I'm doubtful PRP is considered an effective treatment option in the future. I don't disagree with the notion that healthcare remains quite expensive in general. I see telemedicine, for certain conditions, reducing costs and maybe Direct Primary Care - bundling care into one package instead of serving it piecemeal could be a good way to go forward.
- godtoldmetodoit 7y ago
  Telemedicine is pretty cool. I was pretty amazed when I had a pretty nasty rash on my leg, went to my insurance site looking for a nearby doctor, and saw the "talk to a Doctor in 5 minutes option". Filled in some basic info and was talking to a Doctor who prescribed me the appropriate medication all within 30 minutes. Seems likely it will just be a matter of time until little storefronts pop up in strip malls with various user friendly diagnostic equipment to give the remote Doctor more data to treat more conditions (maybe this already exists)?
- JabavuAdams 7y ago
  Robo-medicine! Every upgrade is a fleet upgrade.
- jl2718 7y ago
  I was including the price of the ultrasound imaging machine. And I’m not talking about Tylenol either, which is a harmful and oversubscribed drug anyway. Example: I’ve been given a choice: surgery that includes removal of hip cartilage, or nothing. But there are many natural growth factors that have shown excellent cartilage regeneration. PRP wouldn’t be among my first choices, but as an example, it’s better than nothing, better than surgery, and the FDA can’t make my own blood illegal. The two surgeries I did get elsewhere were terrible and didn’t really solve the problem. There are other cheap options for regenerative injections, and they are extremely common among elite and professional athletes. They are also used extensively by large animal vets, and it turns out that there’s nothing I need that a race horse doesn’t, but it’s legal for him and not for me. Diagnostics also, a huge area for free market expansion. The cost of an MRI is dropping below the cost of a copay. And most of all, it’s a question of value added by doctors, which is mostly informational, and as with all information commodities, rapidly dropping to zero. In my vision of the future, I decide what I want, and I pay for it. Simple.
ameister14 7y ago
Much like the massive opportunity in "DIY Civil Engineering" - those engineers deciding how a bridge should be built don't know that with a couple of two by fours and some selective welding the gray market can give far better outcomes for an order magnitude lower cost
- munchbunny 7y ago
  I'm having trouble telling whether this is satirical.
  - ameister14 7y ago
    I figured 'selective welding' would give it away
TurkishPoptart 7y ago
I would like to see something like tele-medicine that works internationally with local pharmacies. Why should I pay for an insurance plan I don't want to see doctors I can't afford? If I am an English speaker, I should be able to connect with any English-speaking physician in the world via a Skype-like system. And if they prescribe me medications, they should be sent to my pharmacy (and if my insurance or lack thereof makes it too expensive, have the system order the generics from India or Mexico). I think the health industry giants have already seen this coming, but your idea with "doctors, insurers, and the FDA" as arbitrary and overpaid gatekeepers jibed with me.
JMTQp8lwXL 7y ago
What a future we would live in, if you were able to create prescriptions at home with FDA-levels of tolerance. I stumbled upon DIY instructions on GitHub once. In reality, I know someone who works in an environment where pharmaceuticals are manufactured. He can't even lift a ceiling tile (steam fitter) without getting approval. Maintaining FDA quality-level may not be possible in a DIY-context. These are clean rooms where the manufacturing occurs. High up-front costs. But it would certainly be incredible for people who pay $1,000 per pill for some life-saving medication today, if they could totally roundabout the pharmaceutical industry.
JabavuAdams 7y ago
Funny that you mention PRP. Was about to get one, then decided to do more research. The evidence is not good. Just saw a surgeon today who says he doesn't get good results with it for sub-patellar tendon tears, but has seen promising results for arthritis. I dunno there are a lot of medical conspiracy theories, but the average person doesn't know crap about how we know their bodies work. A couple of years of biophysics has taught me that biology is waaaaaaay more complicated than the nastiest distributed computer system you've ever heard of. When I hear civilians trying to talk about health or bio, or why cancer is a hoax ... it's like being a car mechanic who knows a thing or two about cars and having someone come up to you to tell you they need their banana wipers replaced because the windshields don't roll properly when they put their foot on the cigarette lighter. Like ... I have no idea what you're even saying beyond some medieval animist notions of good stuff and bad stuff. /rant
zelly 7y ago
I love this. If we have an alternate route for healthcare directly marketed to end users, that's a way around the insufferable healthcare monopoly. Healthcare piracy. The average person who reads the first 10 pages of search results for their disease definitely knows more about it than their doctor. Doctors are smart, but medicine is huge and they aren't polymaths. The obvious obstacle is that you legally cannot prescribe medicines without a medical license but hey who said the doctor has to physically be present or can't be a desperate Carribean med school graduate.
Wh1skey 7y ago
I think you hit the nail right on the head. Gartner's recent post on technology trends for 2020 points out democratization of tech and business expertise. More domains like medicine and law will follow. Gartner's Top 10 Trends of 2020: https://www.gartner.com/smarterwithgartner/gartner-top-10-strategic-technology-trends-for-2020/ https://www.gartner.com/smarterwithgartner/gartner-top-10-st...

by jl2718 7y ago

tsmarsh 7y ago

I work in Pharma, we're not worried yet. We've done a few trials of nano-fabs, essentially 3D printed labs where you inject the raw materials and drugs pop out the end. They kind of work, but its still a lot of work and would mean consumers getting hands on a bunch of controlled substances. Being able to produce meth in a 'lab' that fits in your hand is not crazy... except you can clearly see how crazy that is.

godtoldmetodoit 7y ago
Ignore the legal aspect of this - if the technology gets good enough and cheap enough people will make their own nano-fabs and damn the laws. People would LOVE to pirate pharmaceuticals. It's an industry just begging for disruption.
- zelly 7y ago
  A way to synthesize arbitrary chemicals in a printer is worth trillions of dollars. It goes well beyond pharmaceuticals, but for a start, it would drive healthcare costs down to basically free.
jl2718 7y ago
I’m not talking about nano-fabs. From a pharma perspective, I’m talking about moleculars that are produced in GMP facilities and sold like any other USP, not for human use. This is admittedly dangerous because the formulations could have contaminants. However, even in FDA-approved pharma, you get things like NDMA being used as a solvent and ending up as millimolar fractions, and the drugs don’t even get pulled for months after discovery by some random independent lab. There are thousands of moleculars that pharma will never push through the FDA because it’s a natural human protein fragment and therefore impossible to patent and profit from.

SkyPuncher 7y ago

I wish I could address everything that's wrong with this comment. The biggest thing is you seem extremely willing to take risks without understanding the gravity of what you're doing. Sure, you CAN give yourself PRP injections and LIKELY will have little to no side effects. Healthcare providers need extreme confidence that (a) a procedure will be effective (b) the risks are appropriate.

reubens 7y ago
I disagree. Some doctors will attempt new procedures with only a company promoting new tools. I once saw a surgeon try out new combined cut & staple hardware designed for bowel surgery on a patient's liver, because he had been told it would work. It didn't, and there was a ridiculous amount of staples in the patient's abdomen afterward. Doctors often become more risk prone the more power they have, and the hierarchy of human medical doctoring contributes to this.
- alexanderdmitri 7y ago
  sailor: captain! there's a hole in the ship, if we don't do something quick we'll sink! captain: there's only one solution ... make the hole so big we can no longer call it a hole. sailor: aye aye captain, i'll go get the explosives.
jl2718 7y ago
PRP was a pretty extreme example, but I used it to prove a point that no matter how crazy it seems to do PRP in an underground or gray-market venue, 1. A lot of people are already doing it, and 2. absent blood contamination risk, the risk, benefit, and cost trade-off is still massively better than the surgery it may prevent. It’s not even close. Even if it’s not proven to be effective by statistical scrutiny, neither are the vast majority of orthopedic surgeries. Seriously, look it up, and be mindful that it is the surgeon himself that determines success in most studies.

Waterluvian 7y ago

This got me thinking about ideas for a product that would work internationally vs. just in one country and if that signal means much about the viability of a product. In terms of work being "promising", wouldn't I want to takle a global problem, not one unique to a specific country?

jl2718 7y ago
I see this trend strongest in Asia right now.

dr_ 7y ago

"Doctors know that the price of the most effective treatments may not sustain their profession." This is not really a fair assessment. The most cost effective treatments can be self administered. But if you are coming in to see me because of persistent knee pain, more often that not you have already tried tylenol and over the counter nsaids (ibuprofen, etc.), and your pain has been persistent. The next set of treatment options, aside from maybe some physical therapy, are more expensive, because they involve using drugs that are more expensive or treatment measures that are more expensive. With re: PRP, it is not covered by insurance, since the benefits of it over a placebo are still not entirely clear. Many doctors offer it however, and to insure accuracy of needle placement, they usually perform it under ultrasound guidance- not something most people would be able to do on their own, at least not yet. As more and more physicians offer it, and if it remains uncovered, market forces will drive the prices down (like Lasik), although I'm doubtful PRP is considered an effective treatment option in the future. I don't disagree with the notion that healthcare remains quite expensive in general. I see telemedicine, for certain conditions, reducing costs and maybe Direct Primary Care - bundling care into one package instead of serving it piecemeal could be a good way to go forward.

godtoldmetodoit 7y ago
Telemedicine is pretty cool. I was pretty amazed when I had a pretty nasty rash on my leg, went to my insurance site looking for a nearby doctor, and saw the "talk to a Doctor in 5 minutes option". Filled in some basic info and was talking to a Doctor who prescribed me the appropriate medication all within 30 minutes. Seems likely it will just be a matter of time until little storefronts pop up in strip malls with various user friendly diagnostic equipment to give the remote Doctor more data to treat more conditions (maybe this already exists)?
JabavuAdams 7y ago
Robo-medicine! Every upgrade is a fleet upgrade.
jl2718 7y ago
I was including the price of the ultrasound imaging machine. And I’m not talking about Tylenol either, which is a harmful and oversubscribed drug anyway. Example: I’ve been given a choice: surgery that includes removal of hip cartilage, or nothing. But there are many natural growth factors that have shown excellent cartilage regeneration. PRP wouldn’t be among my first choices, but as an example, it’s better than nothing, better than surgery, and the FDA can’t make my own blood illegal. The two surgeries I did get elsewhere were terrible and didn’t really solve the problem. There are other cheap options for regenerative injections, and they are extremely common among elite and professional athletes. They are also used extensively by large animal vets, and it turns out that there’s nothing I need that a race horse doesn’t, but it’s legal for him and not for me. Diagnostics also, a huge area for free market expansion. The cost of an MRI is dropping below the cost of a copay. And most of all, it’s a question of value added by doctors, which is mostly informational, and as with all information commodities, rapidly dropping to zero. In my vision of the future, I decide what I want, and I pay for it. Simple.

ameister14 7y ago

Much like the massive opportunity in "DIY Civil Engineering" - those engineers deciding how a bridge should be built don't know that with a couple of two by fours and some selective welding the gray market can give far better outcomes for an order magnitude lower cost

munchbunny 7y ago
I'm having trouble telling whether this is satirical.
- ameister14 7y ago
  I figured 'selective welding' would give it away

TurkishPoptart 7y ago

I would like to see something like tele-medicine that works internationally with local pharmacies. Why should I pay for an insurance plan I don't want to see doctors I can't afford? If I am an English speaker, I should be able to connect with any English-speaking physician in the world via a Skype-like system. And if they prescribe me medications, they should be sent to my pharmacy (and if my insurance or lack thereof makes it too expensive, have the system order the generics from India or Mexico). I think the health industry giants have already seen this coming, but your idea with "doctors, insurers, and the FDA" as arbitrary and overpaid gatekeepers jibed with me.

JMTQp8lwXL 7y ago

What a future we would live in, if you were able to create prescriptions at home with FDA-levels of tolerance. I stumbled upon DIY instructions on GitHub once. In reality, I know someone who works in an environment where pharmaceuticals are manufactured. He can't even lift a ceiling tile (steam fitter) without getting approval. Maintaining FDA quality-level may not be possible in a DIY-context. These are clean rooms where the manufacturing occurs. High up-front costs. But it would certainly be incredible for people who pay $1,000 per pill for some life-saving medication today, if they could totally roundabout the pharmaceutical industry.

JabavuAdams 7y ago

Funny that you mention PRP. Was about to get one, then decided to do more research. The evidence is not good. Just saw a surgeon today who says he doesn't get good results with it for sub-patellar tendon tears, but has seen promising results for arthritis. I dunno there are a lot of medical conspiracy theories, but the average person doesn't know crap about how we know their bodies work. A couple of years of biophysics has taught me that biology is waaaaaaay more complicated than the nastiest distributed computer system you've ever heard of. When I hear civilians trying to talk about health or bio, or why cancer is a hoax ... it's like being a car mechanic who knows a thing or two about cars and having someone come up to you to tell you they need their banana wipers replaced because the windshields don't roll properly when they put their foot on the cigarette lighter. Like ... I have no idea what you're even saying beyond some medieval animist notions of good stuff and bad stuff. /rant

zelly 7y ago

I love this. If we have an alternate route for healthcare directly marketed to end users, that's a way around the insufferable healthcare monopoly. Healthcare piracy. The average person who reads the first 10 pages of search results for their disease definitely knows more about it than their doctor. Doctors are smart, but medicine is huge and they aren't polymaths. The obvious obstacle is that you legally cannot prescribe medicines without a medical license but hey who said the doctor has to physically be present or can't be a desperate Carribean med school graduate.

Wh1skey 7y ago

I think you hit the nail right on the head. Gartner's recent post on technology trends for 2020 points out democratization of tech and business expertise. More domains like medicine and law will follow. Gartner's Top 10 Trends of 2020: https://www.gartner.com/smarterwithgartner/gartner-top-10-strategic-technology-trends-for-2020/ https://www.gartner.com/smarterwithgartner/gartner-top-10-st...