10 ms·

I hear this sort of argument a lot in different fields. Usually it's because the IT guy doesn't really understand the business they are trying to automate or wh

I hear this sort of argument a lot in different fields. Usually it's because the IT guy doesn't really understand the business they are trying to automate or where the true pinch points or time savings are.

TuringNYC 5y ago
Could you provide some examples of fields where practitioners control both supply and standard of practice where automation is also shunned, perpetuating high costs? Also, note, the largest source of bankruptcy in the US is medical costs https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most... "They dont understand the business" is a great excuse for maintaining status quo. I'm an Engineer, a quant, and a computer scientist by training and I refuse to accept defeat w/o sound reason. I will if I'm given a good reason, but "go away you guys, you dont understand our business" is defeatist. If we all accepted such answers society would never progress. I'm sure horse carriages said the same thing when people tried to invent motor vehicles.
- xkjkls 5y ago
  As a question, why haven't any of these techniques made waves outside the US? Other countries don't have the same monopoly/monopsony powers in the medical industries that are prevalent in the US.
  - Isinlor 5y ago
    EU seems to have quite a lot of companies offering AI solutions in radiology: https://grand-challenge.org/aiforradiology/companies/ https://grand-challenge.org/aiforradiology/companies/
  - PeterisP 5y ago
    US is exactly the place where those techniques would make waves because of what the US is paying for radiology; in countries where radiologists don't have the same monopoly/monopsony powers it's not nearly as lucrative to replace them. For example, I'm distantly involved in a project with non-US-radiologists about ML support for automating radiology note dictation (which is a much simpler and much "politically cleaner" issue than actual radiology automation), and IMHO they and their organization would be happy to integrate some image analyis ML tools in their workflow to automate part of their work. However, the current methods really aren't ready, and the local market isn't sufficiently large to make the jump and make a startup to make them ready, that would have to wait until further improvements, most likely done by someone trying to get the US radiologists' money.
    - bradleyjg 5y ago
      If the entire rest of the world isn’t a big enough market to be worth developing for then maybe we don’t need ml radiology we just need medical reform.
      - PeterisP 5y ago
        The entire rest of the world isn't a market, it's many separate markets that need to be entered separately by overcoming different moats. Market fragmentation matters, especially in regulated industries like medicine. But yes, medical reform is definitely something that might be helpful - technological solutions almost always aren't the best way for solving social/political problems.
    - hik 5y ago
      There's not really a way to disambiguate the two though - the fact that there are lots of medical technology startups and new drugs coming out of the US is because of the costs involved and how much can be harvested by being a little better. This creates new technologies that the US can't really protect against proliferation - so all of the money has to be harvested from the US market. This isn't necessarily a bad thing - I for one happen to think it's great that our expensive medical system is financing all kinds of wonderful new technologies that benefit the world overall. However, the major problem here is that things that would be useful for other places simply don't have the market to support it, so most medical innovation exists in the context of the US medical system and it's problems - some of which are widespread, some of which are not. I do wish there were some other testbed healthcare systems out there for companies to try to disrupt, but I don't think it is (by itself) a call for medical reform. My preferred medical reform is to "legalize insurance markets" (ie: repeal laws that state that insurance companies operating in state Y cannot sell insurance to people in state X because state Y policies are not legally compatible) and try to break the monopoly that doctors and nurses enjoy....somehow. Telehealth? Maybe?
      - watwut 5y ago
        > I for one happen to think it's great that our expensive medical system is financing all kinds of wonderful new technologies that benefit the world overall. Does it factoring in situation of people unable to pay medical bills?
  - deleted 5y ago
    [deleted]
  - Fomite 5y ago
    Or the VA, which is a massive single-payer healthcare system that would love to cut costs.
- rayiner 5y ago
  So first of all, you’re incorrect about medical costs being the number one reason for bankruptcies: https://www.washingtonpost.com/politics/2019/08/28/sanderss-flawed-statistic-medical-bankruptcies-year/ https://www.washingtonpost.com/politics/2019/08/28/sanderss-... I’ll give you a concrete example in the legal field. Big firms might have reasons to avoid labor-saving automation, because they bill by the hour. But a large fraction of legal work isn’t billed by the hour, it’s contingency work (where the firm gets a certain fraction of a recovery) or fixed fee work. If you’re getting paid 1/3 of the amount you recover (a typical contingency fee) you have enormous incentives to do as little work to get a good result as you can. But those firms don’t use a lot of legal technology either, because it’s just not very good and not very useful. The bulk of legal practice is about dealing with case-specific facts and legal wrinkles. And machine learning tends not to be useful for that, at least in current forms.
  - nonfamous 5y ago
    That WP article doesn’t support your claim. It’s about the number of bankruptcies, not the leading cause. Nonetheless it does cite a survey that found medical bills contributed to 60+% of bankruptcies, and that it doesn’t really make sense to talk about a single cause.
    - bhupy 5y ago
      It's a stat that requires a lot of contextualization. To your point, you're absolutely correct that the number of bankruptcies is important, because over the last couple decades, 1) bankruptcies in general have been falling, 2) medical bankruptcies have also been falling in absolute terms; but because the denominator has dramatically fallen relative to the numerator, the numerator looks larger than it actually is. https://www.theatlantic.com/business/archive/2009/06/elizabeth-warren-and-the-terrible-horrible-no-good-very-bad-utterly-misleading-bankruptcy-study/18826/ https://www.theatlantic.com/business/archive/2009/06/elizabe... In other words, medical bankruptcies have fallen in absolute terms, but you wouldn't know that by just looking at the %age of bankruptcies.
      - 5y ago
- FredPret 5y ago
  I wonder if you can replace a GP with a decision tree. You could update the tree as new research is done. If you could collect reliable diagnostic data locally, you could serve this globally and for free. It would also be a treasure trove of data about how we respond to various treatments.
  - deleted 5y ago
    [deleted]
  - rscho 5y ago
    > I wonder if you can replace a GP with a decision tree. No, you can't. > If you could collect reliable diagnostic data And there's the reason. You can't do that either. There is a reason why GPs go through medical school.
    - FredPret 5y ago
      > No, you can't. Any sound reason, or are you either a) a defeatist, or b) a GP? >There is a reason why GPs go through medical school The input data would be basic things like: - blood pressure - weight - images of the ear canals and throat - blood, urine, saliva samples, perhaps analyzed in a regional centre You don't need a ton of training to get the above from a patient and into a computer, and to ship the samples.
      - rscho 5y ago
        > Any sound reason The job of a GP is actually probably one of the top hardest to automate, because the GP's main (and often only) job is to extract information. And that _does not_ consist in performing plenty of tests, but in speaking to and most importantly listening to the patient. > You don't need a ton of training to get the above from a patient and into a computer, and to ship the samples. Great! And you know what good that would do to improve diagnostic accuracy? Zilch. Zero. There's a saying that '90% of diagnoses are done on history'. Now tell me why that would be different for an algorithm given identical information? If there was a simple answer to that, we'd already be running statistical models over patient labs all day long, which we're not. > are you either a) a defeatist, or b) a GP? I'm an epidemiologist and also a practicing anesthesiologist, which is why the statistical theories of people who have never set foot in the clinics to see what's the job really about make me want to jump off a bridge.
- ghaff 5y ago
  > the largest source of bankruptcy in the US is medical costs That's not what the article says. "Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall." Those issues can absolutely include direct costs, but they also include things like not being able to work, needing a lot of day to day help, and other things that increase costs and reduce income even if the actual medical costs were largely covered.
- deleted 5y ago
  [deleted]
- tinomaxgalvin 5y ago
  I don't really know of one.. I don't think automation is ever shunned as long as it is useful and known to be useful. Everyone likes things that save time. There is an essentially an unrestricted demand for healthcare across the world.. they will use the time to either talk to their patients more (or start to if they don't already).. or they will move into other medical fields.. or increase the volume of screening.. (may be harmful, but that's another matter). They probably don't want to do it as it won't really save them much time. OR it will save them time and they have been burnt before. For example, early voice recognition was very poor and over promised. Stopped me using it for ages after it became fairly good. It's still not actually better than typing, but it is closer now. Let's all focus on voice recognition that works before moving on to grander plans....
- WalterBright 5y ago
  > examples The taxi system, until Uber and Lyft kicked their ant hill.
joe_the_user 5y ago
The thing about Health Care is most efforts to automate it have failed. Arguably that's because no one "understands" the field, in the sense that no one can give, codified summary of the way they operate; each professional who's part of a health care pipeline takes into account twenty different common variabilities in human body/health/behavior/etc. It's similar to the situation of self-driving cars, where the ability to do the ordinary task is overwhelmed by the existence of many, many corner cases that can't be easily trained-for. Except in health care, corner cases are much more common. Just seeking health care is an exceptional relative to something in ordinary life.

TuringNYC 5y ago

Could you provide some examples of fields where practitioners control both supply and standard of practice where automation is also shunned, perpetuating high costs? Also, note, the largest source of bankruptcy in the US is medical costs https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most... "They dont understand the business" is a great excuse for maintaining status quo. I'm an Engineer, a quant, and a computer scientist by training and I refuse to accept defeat w/o sound reason. I will if I'm given a good reason, but "go away you guys, you dont understand our business" is defeatist. If we all accepted such answers society would never progress. I'm sure horse carriages said the same thing when people tried to invent motor vehicles.

xkjkls 5y ago
As a question, why haven't any of these techniques made waves outside the US? Other countries don't have the same monopoly/monopsony powers in the medical industries that are prevalent in the US.
- Isinlor 5y ago
  EU seems to have quite a lot of companies offering AI solutions in radiology: https://grand-challenge.org/aiforradiology/companies/ https://grand-challenge.org/aiforradiology/companies/
- PeterisP 5y ago
  US is exactly the place where those techniques would make waves because of what the US is paying for radiology; in countries where radiologists don't have the same monopoly/monopsony powers it's not nearly as lucrative to replace them. For example, I'm distantly involved in a project with non-US-radiologists about ML support for automating radiology note dictation (which is a much simpler and much "politically cleaner" issue than actual radiology automation), and IMHO they and their organization would be happy to integrate some image analyis ML tools in their workflow to automate part of their work. However, the current methods really aren't ready, and the local market isn't sufficiently large to make the jump and make a startup to make them ready, that would have to wait until further improvements, most likely done by someone trying to get the US radiologists' money.
  - bradleyjg 5y ago
    If the entire rest of the world isn’t a big enough market to be worth developing for then maybe we don’t need ml radiology we just need medical reform.
    - PeterisP 5y ago
      The entire rest of the world isn't a market, it's many separate markets that need to be entered separately by overcoming different moats. Market fragmentation matters, especially in regulated industries like medicine. But yes, medical reform is definitely something that might be helpful - technological solutions almost always aren't the best way for solving social/political problems.
  - hik 5y ago
    There's not really a way to disambiguate the two though - the fact that there are lots of medical technology startups and new drugs coming out of the US is because of the costs involved and how much can be harvested by being a little better. This creates new technologies that the US can't really protect against proliferation - so all of the money has to be harvested from the US market. This isn't necessarily a bad thing - I for one happen to think it's great that our expensive medical system is financing all kinds of wonderful new technologies that benefit the world overall. However, the major problem here is that things that would be useful for other places simply don't have the market to support it, so most medical innovation exists in the context of the US medical system and it's problems - some of which are widespread, some of which are not. I do wish there were some other testbed healthcare systems out there for companies to try to disrupt, but I don't think it is (by itself) a call for medical reform. My preferred medical reform is to "legalize insurance markets" (ie: repeal laws that state that insurance companies operating in state Y cannot sell insurance to people in state X because state Y policies are not legally compatible) and try to break the monopoly that doctors and nurses enjoy....somehow. Telehealth? Maybe?
    - watwut 5y ago
      > I for one happen to think it's great that our expensive medical system is financing all kinds of wonderful new technologies that benefit the world overall. Does it factoring in situation of people unable to pay medical bills?
- deleted 5y ago
  [deleted]
- Fomite 5y ago
  Or the VA, which is a massive single-payer healthcare system that would love to cut costs.
rayiner 5y ago
So first of all, you’re incorrect about medical costs being the number one reason for bankruptcies: https://www.washingtonpost.com/politics/2019/08/28/sanderss-flawed-statistic-medical-bankruptcies-year/ https://www.washingtonpost.com/politics/2019/08/28/sanderss-... I’ll give you a concrete example in the legal field. Big firms might have reasons to avoid labor-saving automation, because they bill by the hour. But a large fraction of legal work isn’t billed by the hour, it’s contingency work (where the firm gets a certain fraction of a recovery) or fixed fee work. If you’re getting paid 1/3 of the amount you recover (a typical contingency fee) you have enormous incentives to do as little work to get a good result as you can. But those firms don’t use a lot of legal technology either, because it’s just not very good and not very useful. The bulk of legal practice is about dealing with case-specific facts and legal wrinkles. And machine learning tends not to be useful for that, at least in current forms.
- nonfamous 5y ago
  That WP article doesn’t support your claim. It’s about the number of bankruptcies, not the leading cause. Nonetheless it does cite a survey that found medical bills contributed to 60+% of bankruptcies, and that it doesn’t really make sense to talk about a single cause.
  - bhupy 5y ago
    It's a stat that requires a lot of contextualization. To your point, you're absolutely correct that the number of bankruptcies is important, because over the last couple decades, 1) bankruptcies in general have been falling, 2) medical bankruptcies have also been falling in absolute terms; but because the denominator has dramatically fallen relative to the numerator, the numerator looks larger than it actually is. https://www.theatlantic.com/business/archive/2009/06/elizabeth-warren-and-the-terrible-horrible-no-good-very-bad-utterly-misleading-bankruptcy-study/18826/ https://www.theatlantic.com/business/archive/2009/06/elizabe... In other words, medical bankruptcies have fallen in absolute terms, but you wouldn't know that by just looking at the %age of bankruptcies.
    - 5y ago
FredPret 5y ago
I wonder if you can replace a GP with a decision tree. You could update the tree as new research is done. If you could collect reliable diagnostic data locally, you could serve this globally and for free. It would also be a treasure trove of data about how we respond to various treatments.
- deleted 5y ago
  [deleted]
- rscho 5y ago
  > I wonder if you can replace a GP with a decision tree. No, you can't. > If you could collect reliable diagnostic data And there's the reason. You can't do that either. There is a reason why GPs go through medical school.
  - FredPret 5y ago
    > No, you can't. Any sound reason, or are you either a) a defeatist, or b) a GP? >There is a reason why GPs go through medical school The input data would be basic things like: - blood pressure - weight - images of the ear canals and throat - blood, urine, saliva samples, perhaps analyzed in a regional centre You don't need a ton of training to get the above from a patient and into a computer, and to ship the samples.
    - rscho 5y ago
      > Any sound reason The job of a GP is actually probably one of the top hardest to automate, because the GP's main (and often only) job is to extract information. And that _does not_ consist in performing plenty of tests, but in speaking to and most importantly listening to the patient. > You don't need a ton of training to get the above from a patient and into a computer, and to ship the samples. Great! And you know what good that would do to improve diagnostic accuracy? Zilch. Zero. There's a saying that '90% of diagnoses are done on history'. Now tell me why that would be different for an algorithm given identical information? If there was a simple answer to that, we'd already be running statistical models over patient labs all day long, which we're not. > are you either a) a defeatist, or b) a GP? I'm an epidemiologist and also a practicing anesthesiologist, which is why the statistical theories of people who have never set foot in the clinics to see what's the job really about make me want to jump off a bridge.
ghaff 5y ago
> the largest source of bankruptcy in the US is medical costs That's not what the article says. "Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall." Those issues can absolutely include direct costs, but they also include things like not being able to work, needing a lot of day to day help, and other things that increase costs and reduce income even if the actual medical costs were largely covered.
deleted 5y ago
[deleted]
tinomaxgalvin 5y ago
I don't really know of one.. I don't think automation is ever shunned as long as it is useful and known to be useful. Everyone likes things that save time. There is an essentially an unrestricted demand for healthcare across the world.. they will use the time to either talk to their patients more (or start to if they don't already).. or they will move into other medical fields.. or increase the volume of screening.. (may be harmful, but that's another matter). They probably don't want to do it as it won't really save them much time. OR it will save them time and they have been burnt before. For example, early voice recognition was very poor and over promised. Stopped me using it for ages after it became fairly good. It's still not actually better than typing, but it is closer now. Let's all focus on voice recognition that works before moving on to grander plans....
WalterBright 5y ago
> examples The taxi system, until Uber and Lyft kicked their ant hill.

joe_the_user 5y ago

The thing about Health Care is most efforts to automate it have failed. Arguably that's because no one "understands" the field, in the sense that no one can give, codified summary of the way they operate; each professional who's part of a health care pipeline takes into account twenty different common variabilities in human body/health/behavior/etc. It's similar to the situation of self-driving cars, where the ability to do the ordinary task is overwhelmed by the existence of many, many corner cases that can't be easily trained-for. Except in health care, corner cases are much more common. Just seeking health care is an exceptional relative to something in ordinary life.