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Unless it's more expensive than existing treatments the medical industry will close the circles around you excluding you. That's why not one startup has hacked

Unless it's more expensive than existing treatments the medical industry will close the circles around you excluding you. That's why not one startup has hacked healthcare in America, not one. No breakaway successes making pharma cheaper. Like those incubators in Bangladesh, for premature babies not startups that is, those did OK. Some pill startups yes, but again that's an expensivification of medicine. If you can make medicine more expensive, they welcome you in! Jim Clark tried this, he was on a roll after Silicon Graphics and Netscape. Huge roll about as strong as Elon Musk as a serial entrepreneur. Then he targeted healthcare and couldn't do shit, just couldn't get anything to happen. He literally talked about getting "rid of all the assholes" by which he meant insurance and doctors and hospitals and middlemen and pharma and all the other "assholes" of that nature in his own words, but leave "only one asshole in the middle--us [paraphrased]." It's in a book. That book also talks about guys going on airplanes and chasing goats off cliffs, saying "Some people do this." Well the real structure of medicine isn't designed around the human body, it's designed around cornering the market. Market dominance. So of course it has this immune system against cost reduction and efficiencies--efficiencies especially--and you do know it lobbies, don't you? And can bribe the FDA like the Sacklers did? Or lobby the FDA, and then bribe underneath so when people see favoritism they think it's the over-the-counter placebo causing a placebo effect without suspecting an additional more potent under-the-table dosage of money. In case the administration has built up a tolerance to the over-the-counter stuff.

quickthrower2 4y ago
What about the NHS in the UK? They should be more aligned to wanting cheaper cancer diagnosis and also anything to help people. If America has dysfunctional healthcare there is still the rest of the world. Which might be good for Americans eventually as the tech will come across one way or another.
- anamax 4y ago
  > If America has dysfunctional healthcare there is still the rest of the world. Which might be good for Americans eventually as the tech will come across one way or another. Which raises the question - why does the vast majority of healthcare tech development come from the US? (I included "development" to get around the out-sourcing of testing to China.)
  - quickthrower2 4y ago
    It is probably much much better for the wealthy and well insured, but on average not as good for all people. With that skew the high end is going to be better. That is my guess.
  - danielheath 4y ago
    It’s hard to understand how much more available capital is in the states. Getting 100 million together is drastically easier there than anywhere else. Similar to silicon valley’s tech scene, you get migration of people who want to work at a level where that sort of capital is required.
    - anamax 4y ago
      I was reacting to "Which might be good for Americans eventually as the tech will come across one way or another."
- londons_explore 4y ago
  I believe it's too small a market. Modern treatments are hugely expensive to develop, and they also tend to be very specific (ie. only 1 in 5,000 people might get the exact right kind of brain tumour for your treatment to be an option). With only about 1 million all-cause deaths per year in the UK, that means your treatment for a specific terminal brain tumour might only have 200 patients per year. The 'we just saved 4 hours of clinician time by using fancy AI' just isn't worth it if it only saves 800 hours of clinician time per year, yet costs millions to develop. The fix is to roll this out somewhere with more patients (eg. China) and where trials are cheaper (ie. China).
  - daniel-cussen 4y ago
    Use rugged AI like coolwulf. That's what's up. He hauled ass, be like coolwulf. No don't be like coolwulf, be coolwulf. Be him, do what he did, make the algorithms from your brain protect the algorithms that make up your brain. You know they're symbiotic right? Transistor and neuron fighting together against destruction. Symbiosis. EDIT: coolwulf might as well be John von Neumann, the last line of defense against brain cancer and brain surgery, those neurons reaching beyond the skull to make a change in the World for some part of that World to then reach inside that skull and protect it. The chip as the final garrison of the biological human brain. Ghost in the Shell. Ghost retreating from the Shell and regrouping, no ruling out whether it can triumph when it returns to reconquer its damaged Shell.
- daniel-cussen 4y ago
  Shell game. Money moves too many times, like the pebbles under the shells. So that's a deflection so people don't see who's serving whom. Every time someone thinks they can remember what's under a shell before it's shuffled, they move it really fast, and like with feints. And of course this doesn't work for real, hands aren't fast enough, so you gotta layer it with like something to injure their eye with a flash while they're looking, say a laser to the pupil, or maybe... You could make a little trapdoor for the pebble provided the guy will not ask which shell the pebble was actually in. So deflect all questions. But the end outcome is servitude comes from all over the world to an American banker, an American doctor, and an American executive. There's a few others. But the long tail of the American middle class? That was only necessary because those bankers, doctors and executives would never themselves (or with their sons) man the nuclear ballistic submarines, dogfight jets, aircraft carriers, CIA undercover agents, and especially infantrymen--never never never infantrymen. I've only heard of a single lonely guy becoming an enlisted man in a high-bullets-flying environment, when he could have gone anywhere--from Philips Exeter in fact. Anecdotal. Yeah undercover agents get wrapped up and tortured, but infantrymen are bullet sponges. Riflemen, holy shit. WW2 riflemen, no let's not talk about that. At least spies there's a whole song and dance to the whole thing, part two of 1984, and speaking as someone who's stood up to torture, there's not the immediacy of the infantry where the brain surgery is much messier. Well on second thought it's not that different from getting rocks thrown at you, like I have this year... Listen. So this is what's up. There's these guys, they eat all this work and don't do anything. Doctors don't do anything. They only use 5% of what they learned, the rest being a masochistic filter the elders imposed on the youngers to keep them from bringing them down to human reality with competition. So morally a doctor should only study for 1 year, not 20 (if not less, because of retention). That's five percent! Don't argue with that part, argue with something else! And then plus surgeons, spesh brain surgeons which is what every medical student "wants to be when he grows up" as elder doctors put it, so the thing there is younger surgeons have much better manual dexterity than older surgeons, you can't do it past your fifties generally. What does that mean? Learn it faster! But no, they have to say "I studied for 20 years to tell you my bullshit" like come on, that's masochism. You spent 1 year learning worthwhile things and 19 years in the medical school "slammer" learning to be a good bitch, that's the whole game in medicine, hazing. Because otherwise people would say hey just pump out more doctors then the doctors have to say "nonono, you can't because it's soooooo expensive to make a doctor and America loses money [pretends to lose money] on training doctors and you have to be the absolute best of the best of the best to learn how to multiply 3-digit numbers". It's so so stupid, especially because of this: it's all multiple choice. All of it. It's all multiple choice. No essays or explanations, just filling in black circles. I have contempt for using that form of testing alone because I'm so good at it with no effort. Like not even doing the reading. Show up "naked", a good enough mathematician should be able to learn from the test itself, from NOTHING, NOWHERE, and NOBODY. Destroy the integrity of these measurements. Get the test to leak the answers. Like I could do it in Chinese [I don't read Kanji, I can only make out Oracle Bones from 2600 BC] and be measurably better than a monkey. I don't generally brag about it because I have no respect for it, like not having respect for torture. But if that's the underlying reason some doctor claims to be better than me? If such a doctor says he's better than me, then let us agree we are not equal.
idiotsecant 4y ago
>That's why not one startup has hacked healthcare in America, not one. This post makes a lot of points, but in general I think they boil down to the above statement : the belief that large, complex systems are just run by stupid and/or malicious people and that a sufficiently clever 'hack' will fix all the problems. I think that is an attitude that is common on HN, but wrong. Most big problems are not technology problems, they are People problems with a capital P. Technology problems can be fixed with 'one simple hack they don't want you to know about!!!' People problems are complex and messy and cause and effect can be intermingled vertically and horizontally with other seemingly unrelated factors as well as temporally with things that don't even exist yet or used to exist but don't anymore! The way we fix these messy, complex People problems is by respecting that they are real problems, that the people acting on those systems are (mostly) reasonable people just doing what reasonable people do, and slogging through solutions a day at a time with the oldest technology around - political power. These problems resolve if you can get enough people to agree they need solved.
- emteycz 4y ago
  I think you basically agreed with the GP.
throwaway122385 4y ago
lhl 4y ago
While the US health care system as a whole is mess, I don't think it's intractable if you can attack it from the right directions. GoodRX did with pharmaceuticals, and Mark Cuban seems to be doing a good job with CostPlus Drugs. (Valisure is also pretty interesting, doing in-house validation of generics). Marty Makary wrote a book a couple years back, The Price We Pay on the wicked knot of a problem that is US health care. For those mildly interested, there was a Peter Attia Podcast inteview a while back that covers the gist of it: https://peterattiamd.com/martymakary/ https://peterattiamd.com/martymakary/ For those that want to get some color from some of the biggest problems from a clinician/practioner's perpective, I found some of these podcast episodes to be pretty great/eye opening: https://zdoggmd.com/podcasts/ https://zdoggmd.com/podcasts/

quickthrower2 4y ago

What about the NHS in the UK? They should be more aligned to wanting cheaper cancer diagnosis and also anything to help people. If America has dysfunctional healthcare there is still the rest of the world. Which might be good for Americans eventually as the tech will come across one way or another.

anamax 4y ago
> If America has dysfunctional healthcare there is still the rest of the world. Which might be good for Americans eventually as the tech will come across one way or another. Which raises the question - why does the vast majority of healthcare tech development come from the US? (I included "development" to get around the out-sourcing of testing to China.)
- quickthrower2 4y ago
  It is probably much much better for the wealthy and well insured, but on average not as good for all people. With that skew the high end is going to be better. That is my guess.
- danielheath 4y ago
  It’s hard to understand how much more available capital is in the states. Getting 100 million together is drastically easier there than anywhere else. Similar to silicon valley’s tech scene, you get migration of people who want to work at a level where that sort of capital is required.
  - anamax 4y ago
    I was reacting to "Which might be good for Americans eventually as the tech will come across one way or another."
londons_explore 4y ago
I believe it's too small a market. Modern treatments are hugely expensive to develop, and they also tend to be very specific (ie. only 1 in 5,000 people might get the exact right kind of brain tumour for your treatment to be an option). With only about 1 million all-cause deaths per year in the UK, that means your treatment for a specific terminal brain tumour might only have 200 patients per year. The 'we just saved 4 hours of clinician time by using fancy AI' just isn't worth it if it only saves 800 hours of clinician time per year, yet costs millions to develop. The fix is to roll this out somewhere with more patients (eg. China) and where trials are cheaper (ie. China).
- daniel-cussen 4y ago
  Use rugged AI like coolwulf. That's what's up. He hauled ass, be like coolwulf. No don't be like coolwulf, be coolwulf. Be him, do what he did, make the algorithms from your brain protect the algorithms that make up your brain. You know they're symbiotic right? Transistor and neuron fighting together against destruction. Symbiosis. EDIT: coolwulf might as well be John von Neumann, the last line of defense against brain cancer and brain surgery, those neurons reaching beyond the skull to make a change in the World for some part of that World to then reach inside that skull and protect it. The chip as the final garrison of the biological human brain. Ghost in the Shell. Ghost retreating from the Shell and regrouping, no ruling out whether it can triumph when it returns to reconquer its damaged Shell.
daniel-cussen 4y ago
Shell game. Money moves too many times, like the pebbles under the shells. So that's a deflection so people don't see who's serving whom. Every time someone thinks they can remember what's under a shell before it's shuffled, they move it really fast, and like with feints. And of course this doesn't work for real, hands aren't fast enough, so you gotta layer it with like something to injure their eye with a flash while they're looking, say a laser to the pupil, or maybe... You could make a little trapdoor for the pebble provided the guy will not ask which shell the pebble was actually in. So deflect all questions. But the end outcome is servitude comes from all over the world to an American banker, an American doctor, and an American executive. There's a few others. But the long tail of the American middle class? That was only necessary because those bankers, doctors and executives would never themselves (or with their sons) man the nuclear ballistic submarines, dogfight jets, aircraft carriers, CIA undercover agents, and especially infantrymen--never never never infantrymen. I've only heard of a single lonely guy becoming an enlisted man in a high-bullets-flying environment, when he could have gone anywhere--from Philips Exeter in fact. Anecdotal. Yeah undercover agents get wrapped up and tortured, but infantrymen are bullet sponges. Riflemen, holy shit. WW2 riflemen, no let's not talk about that. At least spies there's a whole song and dance to the whole thing, part two of 1984, and speaking as someone who's stood up to torture, there's not the immediacy of the infantry where the brain surgery is much messier. Well on second thought it's not that different from getting rocks thrown at you, like I have this year... Listen. So this is what's up. There's these guys, they eat all this work and don't do anything. Doctors don't do anything. They only use 5% of what they learned, the rest being a masochistic filter the elders imposed on the youngers to keep them from bringing them down to human reality with competition. So morally a doctor should only study for 1 year, not 20 (if not less, because of retention). That's five percent! Don't argue with that part, argue with something else! And then plus surgeons, spesh brain surgeons which is what every medical student "wants to be when he grows up" as elder doctors put it, so the thing there is younger surgeons have much better manual dexterity than older surgeons, you can't do it past your fifties generally. What does that mean? Learn it faster! But no, they have to say "I studied for 20 years to tell you my bullshit" like come on, that's masochism. You spent 1 year learning worthwhile things and 19 years in the medical school "slammer" learning to be a good bitch, that's the whole game in medicine, hazing. Because otherwise people would say hey just pump out more doctors then the doctors have to say "nonono, you can't because it's soooooo expensive to make a doctor and America loses money [pretends to lose money] on training doctors and you have to be the absolute best of the best of the best to learn how to multiply 3-digit numbers". It's so so stupid, especially because of this: it's all multiple choice. All of it. It's all multiple choice. No essays or explanations, just filling in black circles. I have contempt for using that form of testing alone because I'm so good at it with no effort. Like not even doing the reading. Show up "naked", a good enough mathematician should be able to learn from the test itself, from NOTHING, NOWHERE, and NOBODY. Destroy the integrity of these measurements. Get the test to leak the answers. Like I could do it in Chinese [I don't read Kanji, I can only make out Oracle Bones from 2600 BC] and be measurably better than a monkey. I don't generally brag about it because I have no respect for it, like not having respect for torture. But if that's the underlying reason some doctor claims to be better than me? If such a doctor says he's better than me, then let us agree we are not equal.

idiotsecant 4y ago

>That's why not one startup has hacked healthcare in America, not one. This post makes a lot of points, but in general I think they boil down to the above statement : the belief that large, complex systems are just run by stupid and/or malicious people and that a sufficiently clever 'hack' will fix all the problems. I think that is an attitude that is common on HN, but wrong. Most big problems are not technology problems, they are People problems with a capital P. Technology problems can be fixed with 'one simple hack they don't want you to know about!!!' People problems are complex and messy and cause and effect can be intermingled vertically and horizontally with other seemingly unrelated factors as well as temporally with things that don't even exist yet or used to exist but don't anymore! The way we fix these messy, complex People problems is by respecting that they are real problems, that the people acting on those systems are (mostly) reasonable people just doing what reasonable people do, and slogging through solutions a day at a time with the oldest technology around - political power. These problems resolve if you can get enough people to agree they need solved.

emteycz 4y ago
I think you basically agreed with the GP.

throwaway122385 4y ago

lhl 4y ago

While the US health care system as a whole is mess, I don't think it's intractable if you can attack it from the right directions. GoodRX did with pharmaceuticals, and Mark Cuban seems to be doing a good job with CostPlus Drugs. (Valisure is also pretty interesting, doing in-house validation of generics). Marty Makary wrote a book a couple years back, The Price We Pay on the wicked knot of a problem that is US health care. For those mildly interested, there was a Peter Attia Podcast inteview a while back that covers the gist of it: https://peterattiamd.com/martymakary/ https://peterattiamd.com/martymakary/ For those that want to get some color from some of the biggest problems from a clinician/practioner's perpective, I found some of these podcast episodes to be pretty great/eye opening: https://zdoggmd.com/podcasts/ https://zdoggmd.com/podcasts/