7 ms·

It’s going to become increasingly apparent in the US over time the degree to which doctors & the regulatory state are blocking us from getting cheap new care.

It’s going to become increasingly apparent in the US over time the degree to which doctors & the regulatory state are blocking us from getting cheap new care. Already ML algos are more accurate at diagnosing melanomas from an image than dermatologists - but we will never get that tech because doctors are fiercely protective of their salaries and have captured the arm of the state to help them do so.

marinmania 2y ago
And the lowest hanging fruit doesn't even necessarily have to do with AI or robotic tech. In the US you need a prescription within the last year to buy contact lenses. European countries do not require this. Not only does this mean contacts are more expensive and come from fewer suppliers, but demand for appointments with eye doctors would never go down, even though a test of vision could easily be done now by an automated machine where you choose a series of A/B options.
- slaymaker1907 2y ago
  Maybe for a basic eye exam, but they're also checking for things like glaucoma. Glaucoma in particular is tricky because you may not notice early on, but any damage done to your eyes before treatment is permanent. In my experience, the cost for glasses/contacts is mostly in actually buying them anyways. Therefore, I just go get my eye exam done and then just buy them online for much cheaper than any retail store. Supposedly the cheap online glasses aren't as good, but they're good enough in my experience and then I don't feel quite so bad when I inevitably lose them somewhere.
- bluGill 2y ago
  The vison test is to ensure your eyes are checked for things other than what correcion you need. Though machines do most of that.
  - tredre3 2y ago
    For healthy adults a yearly eye exam isn't necessary. Forcing people to do it just to get a contact prescription is indeed a cash grab. But yes, they will sell it to you as being for your own good.
    - margalabargala 2y ago
      You can get a paper copy of your contact lens prescription, which can be photographed and uploaded to online contact lens sellers. Those sellers are incentivized not to look too closely at your prescription and whether the year has been altered. Obviously breaking the rules doesn't make it less of a cash grab but at least one can work around it.
- shiroiushi 2y ago
  >In the US you need a prescription within the last year to buy contact lenses. European countries do not require this. Same here in Japan. I just buy my contact lenses from a shop online; I don't need a prescription at all. The only reason to go to the optometrist is when I feel my lenses are no longer the correct prescription (since your eyes change over time). And for the eye-health tests that eye doctors try to use to justify yearly visits, that's done for free at the annual health check that everyone gets. Unlike the US with its weird system that considers eyes and teeth to not be necessary for health, those are all covered by the same single health insurance that you normally get, either through your employer or from the government.
- 77pt77 2y ago
  >In the US you need a prescription within the last year to buy contact lenses. I was told you even need prescription to buy glasses, which is ridiculous. Even many places online require it, but some just let you input the values. When I said this to an overnight glasses website's customer care they basically said if I ordered without a prescription I'd be committing a crime. You really can't make this up!
deegles 2y ago
The issue is liability, just like self driving cars. Even if ML is more accurate, when it does get it wrong the buck has to stop somewhere. Those questions need to be answered first.
- whimsicalism 2y ago
  If ML is more accurate than doctors at the task, seems like the liability insurance should be lower. But yes, I agree that the US needs major tort reform regardless. I just don’t think tort is the major barrier compared to occupational licensing & the FDA though.
  - bluGill 2y ago
    Sure, but who pays for that insurance? It probably isn't someone currently buying it and that makes ubfront costs higher.
fred_is_fred 2y ago
For radiologists places in the US are already sending the images to India and other countries for analysis electronically. Is similar done with dermatology or do you need to be physically located there rather than sending an image?
- quadragenarian 2y ago
  I don't think this is true. Radiology imaging must be read by a physician holding a US Medical degree.
deleted 2y ago
[deleted]
BenFranklin100 2y ago
The medical establishment also artificially limits the number of doctors in order to keep salaries high. I live in Boston, arguably the top city for medical care in the US, and it is not uncommon to have a six month waiting list to see a specialist. People talk about prescription drugs being the cause of high medical costs in the US, but it’s really the hospitals and doctors that are driving the majority of the costs.
- rscho 2y ago
  Maybe I'm mistaken, but I don't think places like Boston are where docs earn the most ?
  - deleted 2y ago
    [deleted]
  - BenFranklin100 2y ago
    I made no claims regarding the geographical distribution of physician wages. I specifically claimed that wait times for specialists in Boston is on the order of months, which I speculate is due to the medical board artificially limiting the number of physicians.
    - rscho 2y ago
      But then, revenue does not correlate with scarcity anymore? To be clear, I think you're right up to a certain point, but it makes some sense to be very elitist about who can practice in what you'd like to be the medical 'pride of the nation'. Now, scarcity in other regions is another matter, where it makes sense to relax standards. How much you relax the standard is a matter of how low you accept to go in terms of quality.
- analyte123 2y ago
  Doctors don't seem to be driving the majority of the costs. After adjusting for inflation, doctors don't make much more than they did in 1984, yet the percentage of GDP spent on healthcare has almost doubled since then (and the real GDP has also doubled in that time). For example, see [1] where a general surgeon made an average of $118,689 in 1984 and a family practitioner $84,256. This would be $358k and $254k in 2024 dollars. Today in 2024 they make on average $423k and $272k respectively [2]. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192917/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192917/ [2] https://www.whitecoatinvestor.com/how-much-do-doctors-make/ https://www.whitecoatinvestor.com/how-much-do-doctors-make/
lovethevoid 2y ago
If only you guys had universal healthcare and therefore the state would prioritize cheap new care to minimize those costs.
- apwell23 2y ago
  Don't doctors have unions in those systems also.
  - lovethevoid 2y ago
    Yes they do! Unions though aren't the reason for the lack of cheap care, after all each party involved in a private system is incentivized to gouge as much as possible due to a lack of collective safety nets.
    - apwell23 2y ago
      > collective safety nets. as in losing jobs to ML algorithms ? What would the point of a union then :)
      - lovethevoid 2y ago
        Is this the hypothetical future where every job is replaced by a ML algorithm? In such case, you better hope there is some form of collective safety net for you ;)
        apwell23 2y ago
        > Is this the hypothetical future where every job is replaced by a ML algorithm? No. we are talking about doctors in specific. Your original point won't stand if everyone in the world is replaced by AI. > If only you guys had universal healthcare There would be no private insurance through their employers if no one has a job in first place.
15155 2y ago
> doctors are fiercely protective of their salaries A freshly-minted dermatologist isn't making that much, though they will be in the long term. As a whole, physicians aren't very organized to deal with these types of technological "invaders." The AMA and similar organizations' core competencies have traditionally been limiting supply and creating personnel exclusivity (limiting residency slots, limiting the usefulness of foreign-obtained credentials, etc.) I promise you can find an endless supply of freshly-minted dermatologists who will sign off on these ML-identified melanomas, bypassing the old guard with their rubber stamp. Once the tech is proven, that rubber stamp is worth nothing and may be removed. It's just too easy to chip away at these types of schemes where "assistance" can be rendered to a licensed professional and eventually completely relied upon.
- rscho 2y ago
  So, why hasn't it been done yet ?? (I'm a doc, BTW)
  - 15155 2y ago
    Every piece of breakthrough technology you use has followed this process to some degree, it takes time. As with any field, folks are resistant to new ideas and methods. Despite being poorly-organized, the medical field is collectively quite conservative and moves slowly - "first do no harm" is kind of the name of the game.
    - whimsicalism 2y ago
      > Despite being poorly-organized, the medical field is collectively quite conservative and moves slowly - "first do no harm" is kind of the name of the game. The medical profession seems to hold on too dearly to the action/omission distinction. Preventing life saving tech from becoming prevalent, arguing against challenge trials, advocating against NP responsibility expansion, etc. etc. -- all of these things do tons of measurable harm.
rscho 2y ago
Being a doc, I can confidently tell you you are totally incorrect as to why things happen the way they do in healthcare. That won't surprise you, I guess. I long tried to make outsiders, and especially tech people, understand what our job is, but discussions always lead to the same stereotypes.
- pegasus 2y ago
  I suspect you're right, and would be interested to hear more.
  - rscho 2y ago
    In a nutshell, no amount of lobbying will stop equivalent service for 100x cheaper. Tech does not permeate healthcare for 2 reasons: 1. mostly inapplicable. Everyone is focusing on ML model performance, but really information retrieval in healthcare is dismal and prevents the use of such new tech altogether except in very niche cases. 2. no integration in the workplace. Tech people and docs don't understand each other at all, so docs ask for impossible things, and tech people deliver perfectly functional, totally inapplicable tech.
    - robertlagrant 2y ago
      Me and my team made a piece of successful software for patients and clinicians. It is really difficult, mostly for the reasons you state, but it is possible. It's used in about half the NHS, and I personally know three people who've used our app to successfully manage their pregnancy complication, which is great.
      - whimsicalism 2y ago
        There is less political capture of this process in the UK.
        robertlagrant 2y ago
        My company/team is an unusual exception. The UK has a much bigger problem with creating tech than the US does. That's why almost all NHS trusts in the UK use US-created EHR systems: Cerner and Epic, mostly. The UK is bad at creating a pro-business/pro-investment environment, so we have to buy in stuff from elsewhere, even though it's not well-suited to our needs. Or best case we find US-based investment for our companies.
theGnuMe 2y ago
State licensing weeds out the cranks. But these AIs could go for FDA approval and direct to consumer. So I don't think doctors are the limiting reagent here in your example. If these AIs are good, they will reduce demand for dermatologists as some enterprising doctor will offer it as a service that scales. While I think doctors are paid handsomely and there are critical shortages, I don't think regulatory licensing requirements per se limit access to new and cheaper care.
Zenzero 2y ago
Doctor here. I know HN loves to hate on doctors, but your framing is just ridiculous. The medical world moves at a glacial pace compared to tech. Complaining that ML algos haven't swept the industry ignores all of the factors pushing it in that direction. "Best medicine" operates on a consensus model of the most prudent decision-making given present knowledge and evidence. That takes time. Pushing boundaries as a doctor outside of a research environment doesn't earn you brownie points. It increases your chances of getting sued. You also dramatically overestimate the amount of autonomy any given doctor has over the tools they are able to use. The vast majority are employees. It is like if you worked at Google as a SWE, and I came on HN ranting that you don't want to use the most recent release of Sonnet 3.5 to help you write features faster for Gmail, because you're "fiercely protective of your salary." You would laugh at how ignorant the complaint sounds.
- whimsicalism 2y ago
  I'm blaming the regulatory apparatus more for that one. These image based algos are ones that could be DTC but of course the FDA (with a side of lobbying) would never ever allow that. > You also dramatically overestimate the amount of autonomy any given doctor has over the tools they are able to use. I'm not saying that doctors are mostly choosing not to use these tools - but that lobbying organizations involving collectives of doctors would lobby against it if it ever tried to do a DTC approach or something like that. Please, steelman what I'm saying - I am very aware that doctors who don't own their practice (vast majority of them) cannot simply choose their tools and even those with their own practice are often limited by what they can bill. I know lots of doctors personally.
blackeyeblitzar 2y ago
Their professional organizations have prevented us from having lower cost healthcare independent of technology. For example limited supply (from schools) of various specialties, resistance and FUD about less qualified care (like dental therapists), etc. Their lobbying and influence is all over the system.
jorblumesea 2y ago
There's very few, if any doctors, that are saying we shouldn't use ML or algos to diagnose cancer. This is a wild accusation and hilariously conspiratorial. What most are saying is we should evaluate all of this new tech, but be careful of the rollout because medical practices shouldn't operate like a hot startup where we pivot every 6 months. Healthcare, similar to government, shouldn't be a move fast break things situation. If your service breaks, you just roll back. False or incorrect cancer diagnoses...that's a huge deal. Imagine your tumor getting missed because of a bug in software, one which a human might have caught. Peoples' lives are on the line here. It's not a game.
HanClinto 2y ago
For another example of this, see the tooth decay vaccine (that is currently only available in Honduras): https://news.ycombinator.com/item?id=39819248 https://news.ycombinator.com/item?id=39819248
- throwaway2037 2y ago
  Honduras medical care? Scary! Why did they choose Honduras?
ChumpGPT 2y ago
I know very little about the regulatory system but, what is stopping an app to scan your skin via mobile camera to try and determine melanoma. As long as there is a disclaimer to see your physician and this is not medical advice. It would be the same as taking your blood pressure or blood sugar test at home.
- whimsicalism 2y ago
  The FDA would absolutely not permit that, you cannot just 'disclaimer this is not medical advice' for an actual diagnosis service.
  - stubish 2y ago
    The FDA does not regulate most of the world. There is some other issue, but I can only make guesses what that is.
deleted 2y ago
[deleted]
SkyPuncher 2y ago
Physician salaries are less than 10% the cost of healthcare. You could eliminate their salary entirely and it'd have no meaningful difference on the cost of healthcare. There is _absolutely_ an artificial supply limitation, but that's increasingly being worked around by the use of PA and NP providers. Doctors essentially become managers for PA and NPs. My wife is a physician. Actual, scientific diagnosis is a ridiculously small part of her job. Most of her time is taken up on "soft problems". Writing notes for continuity/quality of care. Justifying medical decisions for billing purposes. Advocating with insurance and healthcare administrators. Discussing treatment plans and options with patients. More notes. Well, really, most of her time is taken up with notes. It's really the only way for her to capture all of the soft variables. Writing notes is a bit like coding. LLM/AI can help solve the problem, but ultimately you still need to go through them piece-by-piece to ensure they're correct.
- whimsicalism 2y ago
  Unlike the other comment defending current medical practice, this one I absolutely agree with. I do not think that physician salaries are the major drivers of healthcare cost. I do think that occupational licensing reform would help bring down cost, but agree it is only a relatively small factor. However I do think that in the process of engaging in wage protectionism (and there is absolutely no question that doctors do this) there is a ton of consumer surplus that is being lost and not captured by either patient or provider. For instance, in the case of the melanoma AI, that is a casualty of the wage protectionism (+ medical conservatism + FDA failure) - the value there isn't being captured by doctors, it is just disappearing into thin air and tons more people will just have undiagnosed melanomas.
  - SkyPuncher 2y ago
    > I do think that occupational licensing reform would help bring down cost I actually think this is the only way to bring costs down. Most providers, equals more competition. More competition leads to innovation and all around better outcomes. Interestingly, a lot of states are starting to express their frustration with physician supply shortages by expanding rights for NPs and PAs. I think over the next 20 years, we're going to see MD/DO roles transition to largely supervisory roles with NPs and PAs doing most of the work. Much more akin to manager/IC type of roles we see in STEM type fields.
cogman10 2y ago
Part of the problem is quackery. Remove the regulatory state and all the sudden you have people claiming bleach enemas as a cure all (We have that with the regulatory state, but those people get prosecuted). I don't think that some regulations ensuring the tooth drilling robot isn't going to explode teeth is unwarranted even though that drives up cost of development.
- willmadden 2y ago
  You don't need preemptive regulation over the entire medical industry to arrest people for quackery.

marinmania 2y ago

And the lowest hanging fruit doesn't even necessarily have to do with AI or robotic tech. In the US you need a prescription within the last year to buy contact lenses. European countries do not require this. Not only does this mean contacts are more expensive and come from fewer suppliers, but demand for appointments with eye doctors would never go down, even though a test of vision could easily be done now by an automated machine where you choose a series of A/B options.

slaymaker1907 2y ago
Maybe for a basic eye exam, but they're also checking for things like glaucoma. Glaucoma in particular is tricky because you may not notice early on, but any damage done to your eyes before treatment is permanent. In my experience, the cost for glasses/contacts is mostly in actually buying them anyways. Therefore, I just go get my eye exam done and then just buy them online for much cheaper than any retail store. Supposedly the cheap online glasses aren't as good, but they're good enough in my experience and then I don't feel quite so bad when I inevitably lose them somewhere.
bluGill 2y ago
The vison test is to ensure your eyes are checked for things other than what correcion you need. Though machines do most of that.
- tredre3 2y ago
  For healthy adults a yearly eye exam isn't necessary. Forcing people to do it just to get a contact prescription is indeed a cash grab. But yes, they will sell it to you as being for your own good.
  - margalabargala 2y ago
    You can get a paper copy of your contact lens prescription, which can be photographed and uploaded to online contact lens sellers. Those sellers are incentivized not to look too closely at your prescription and whether the year has been altered. Obviously breaking the rules doesn't make it less of a cash grab but at least one can work around it.
shiroiushi 2y ago
>In the US you need a prescription within the last year to buy contact lenses. European countries do not require this. Same here in Japan. I just buy my contact lenses from a shop online; I don't need a prescription at all. The only reason to go to the optometrist is when I feel my lenses are no longer the correct prescription (since your eyes change over time). And for the eye-health tests that eye doctors try to use to justify yearly visits, that's done for free at the annual health check that everyone gets. Unlike the US with its weird system that considers eyes and teeth to not be necessary for health, those are all covered by the same single health insurance that you normally get, either through your employer or from the government.
77pt77 2y ago
>In the US you need a prescription within the last year to buy contact lenses. I was told you even need prescription to buy glasses, which is ridiculous. Even many places online require it, but some just let you input the values. When I said this to an overnight glasses website's customer care they basically said if I ordered without a prescription I'd be committing a crime. You really can't make this up!

deegles 2y ago

The issue is liability, just like self driving cars. Even if ML is more accurate, when it does get it wrong the buck has to stop somewhere. Those questions need to be answered first.

whimsicalism 2y ago
If ML is more accurate than doctors at the task, seems like the liability insurance should be lower. But yes, I agree that the US needs major tort reform regardless. I just don’t think tort is the major barrier compared to occupational licensing & the FDA though.
- bluGill 2y ago
  Sure, but who pays for that insurance? It probably isn't someone currently buying it and that makes ubfront costs higher.

fred_is_fred 2y ago

For radiologists places in the US are already sending the images to India and other countries for analysis electronically. Is similar done with dermatology or do you need to be physically located there rather than sending an image?

quadragenarian 2y ago
I don't think this is true. Radiology imaging must be read by a physician holding a US Medical degree.

deleted 2y ago

[deleted]

BenFranklin100 2y ago

The medical establishment also artificially limits the number of doctors in order to keep salaries high. I live in Boston, arguably the top city for medical care in the US, and it is not uncommon to have a six month waiting list to see a specialist. People talk about prescription drugs being the cause of high medical costs in the US, but it’s really the hospitals and doctors that are driving the majority of the costs.

rscho 2y ago
Maybe I'm mistaken, but I don't think places like Boston are where docs earn the most ?
- deleted 2y ago
  [deleted]
- BenFranklin100 2y ago
  I made no claims regarding the geographical distribution of physician wages. I specifically claimed that wait times for specialists in Boston is on the order of months, which I speculate is due to the medical board artificially limiting the number of physicians.
  - rscho 2y ago
    But then, revenue does not correlate with scarcity anymore? To be clear, I think you're right up to a certain point, but it makes some sense to be very elitist about who can practice in what you'd like to be the medical 'pride of the nation'. Now, scarcity in other regions is another matter, where it makes sense to relax standards. How much you relax the standard is a matter of how low you accept to go in terms of quality.
analyte123 2y ago
Doctors don't seem to be driving the majority of the costs. After adjusting for inflation, doctors don't make much more than they did in 1984, yet the percentage of GDP spent on healthcare has almost doubled since then (and the real GDP has also doubled in that time). For example, see [1] where a general surgeon made an average of $118,689 in 1984 and a family practitioner $84,256. This would be $358k and $254k in 2024 dollars. Today in 2024 they make on average $423k and $272k respectively [2]. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192917/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192917/ [2] https://www.whitecoatinvestor.com/how-much-do-doctors-make/ https://www.whitecoatinvestor.com/how-much-do-doctors-make/

lovethevoid 2y ago

If only you guys had universal healthcare and therefore the state would prioritize cheap new care to minimize those costs.

apwell23 2y ago
Don't doctors have unions in those systems also.
- lovethevoid 2y ago
  Yes they do! Unions though aren't the reason for the lack of cheap care, after all each party involved in a private system is incentivized to gouge as much as possible due to a lack of collective safety nets.
  - apwell23 2y ago
    > collective safety nets. as in losing jobs to ML algorithms ? What would the point of a union then :)
    - lovethevoid 2y ago
      Is this the hypothetical future where every job is replaced by a ML algorithm? In such case, you better hope there is some form of collective safety net for you ;)
      - apwell23 2y ago
        > Is this the hypothetical future where every job is replaced by a ML algorithm? No. we are talking about doctors in specific. Your original point won't stand if everyone in the world is replaced by AI. > If only you guys had universal healthcare There would be no private insurance through their employers if no one has a job in first place.

15155 2y ago

> doctors are fiercely protective of their salaries A freshly-minted dermatologist isn't making that much, though they will be in the long term. As a whole, physicians aren't very organized to deal with these types of technological "invaders." The AMA and similar organizations' core competencies have traditionally been limiting supply and creating personnel exclusivity (limiting residency slots, limiting the usefulness of foreign-obtained credentials, etc.) I promise you can find an endless supply of freshly-minted dermatologists who will sign off on these ML-identified melanomas, bypassing the old guard with their rubber stamp. Once the tech is proven, that rubber stamp is worth nothing and may be removed. It's just too easy to chip away at these types of schemes where "assistance" can be rendered to a licensed professional and eventually completely relied upon.

rscho 2y ago
So, why hasn't it been done yet ?? (I'm a doc, BTW)
- 15155 2y ago
  Every piece of breakthrough technology you use has followed this process to some degree, it takes time. As with any field, folks are resistant to new ideas and methods. Despite being poorly-organized, the medical field is collectively quite conservative and moves slowly - "first do no harm" is kind of the name of the game.
  - whimsicalism 2y ago
    > Despite being poorly-organized, the medical field is collectively quite conservative and moves slowly - "first do no harm" is kind of the name of the game. The medical profession seems to hold on too dearly to the action/omission distinction. Preventing life saving tech from becoming prevalent, arguing against challenge trials, advocating against NP responsibility expansion, etc. etc. -- all of these things do tons of measurable harm.

rscho 2y ago

Being a doc, I can confidently tell you you are totally incorrect as to why things happen the way they do in healthcare. That won't surprise you, I guess. I long tried to make outsiders, and especially tech people, understand what our job is, but discussions always lead to the same stereotypes.

pegasus 2y ago
I suspect you're right, and would be interested to hear more.
- rscho 2y ago
  In a nutshell, no amount of lobbying will stop equivalent service for 100x cheaper. Tech does not permeate healthcare for 2 reasons: 1. mostly inapplicable. Everyone is focusing on ML model performance, but really information retrieval in healthcare is dismal and prevents the use of such new tech altogether except in very niche cases. 2. no integration in the workplace. Tech people and docs don't understand each other at all, so docs ask for impossible things, and tech people deliver perfectly functional, totally inapplicable tech.
  - robertlagrant 2y ago
    Me and my team made a piece of successful software for patients and clinicians. It is really difficult, mostly for the reasons you state, but it is possible. It's used in about half the NHS, and I personally know three people who've used our app to successfully manage their pregnancy complication, which is great.
    - whimsicalism 2y ago
      There is less political capture of this process in the UK.
      - robertlagrant 2y ago
        My company/team is an unusual exception. The UK has a much bigger problem with creating tech than the US does. That's why almost all NHS trusts in the UK use US-created EHR systems: Cerner and Epic, mostly. The UK is bad at creating a pro-business/pro-investment environment, so we have to buy in stuff from elsewhere, even though it's not well-suited to our needs. Or best case we find US-based investment for our companies.

theGnuMe 2y ago

State licensing weeds out the cranks. But these AIs could go for FDA approval and direct to consumer. So I don't think doctors are the limiting reagent here in your example. If these AIs are good, they will reduce demand for dermatologists as some enterprising doctor will offer it as a service that scales. While I think doctors are paid handsomely and there are critical shortages, I don't think regulatory licensing requirements per se limit access to new and cheaper care.

Zenzero 2y ago

Doctor here. I know HN loves to hate on doctors, but your framing is just ridiculous. The medical world moves at a glacial pace compared to tech. Complaining that ML algos haven't swept the industry ignores all of the factors pushing it in that direction. "Best medicine" operates on a consensus model of the most prudent decision-making given present knowledge and evidence. That takes time. Pushing boundaries as a doctor outside of a research environment doesn't earn you brownie points. It increases your chances of getting sued. You also dramatically overestimate the amount of autonomy any given doctor has over the tools they are able to use. The vast majority are employees. It is like if you worked at Google as a SWE, and I came on HN ranting that you don't want to use the most recent release of Sonnet 3.5 to help you write features faster for Gmail, because you're "fiercely protective of your salary." You would laugh at how ignorant the complaint sounds.

whimsicalism 2y ago
I'm blaming the regulatory apparatus more for that one. These image based algos are ones that could be DTC but of course the FDA (with a side of lobbying) would never ever allow that. > You also dramatically overestimate the amount of autonomy any given doctor has over the tools they are able to use. I'm not saying that doctors are mostly choosing not to use these tools - but that lobbying organizations involving collectives of doctors would lobby against it if it ever tried to do a DTC approach or something like that. Please, steelman what I'm saying - I am very aware that doctors who don't own their practice (vast majority of them) cannot simply choose their tools and even those with their own practice are often limited by what they can bill. I know lots of doctors personally.

blackeyeblitzar 2y ago

Their professional organizations have prevented us from having lower cost healthcare independent of technology. For example limited supply (from schools) of various specialties, resistance and FUD about less qualified care (like dental therapists), etc. Their lobbying and influence is all over the system.

jorblumesea 2y ago

There's very few, if any doctors, that are saying we shouldn't use ML or algos to diagnose cancer. This is a wild accusation and hilariously conspiratorial. What most are saying is we should evaluate all of this new tech, but be careful of the rollout because medical practices shouldn't operate like a hot startup where we pivot every 6 months. Healthcare, similar to government, shouldn't be a move fast break things situation. If your service breaks, you just roll back. False or incorrect cancer diagnoses...that's a huge deal. Imagine your tumor getting missed because of a bug in software, one which a human might have caught. Peoples' lives are on the line here. It's not a game.

HanClinto 2y ago

For another example of this, see the tooth decay vaccine (that is currently only available in Honduras): https://news.ycombinator.com/item?id=39819248 https://news.ycombinator.com/item?id=39819248

throwaway2037 2y ago
Honduras medical care? Scary! Why did they choose Honduras?

ChumpGPT 2y ago

I know very little about the regulatory system but, what is stopping an app to scan your skin via mobile camera to try and determine melanoma. As long as there is a disclaimer to see your physician and this is not medical advice. It would be the same as taking your blood pressure or blood sugar test at home.

whimsicalism 2y ago
The FDA would absolutely not permit that, you cannot just 'disclaimer this is not medical advice' for an actual diagnosis service.
- stubish 2y ago
  The FDA does not regulate most of the world. There is some other issue, but I can only make guesses what that is.

deleted 2y ago

[deleted]

SkyPuncher 2y ago

Physician salaries are less than 10% the cost of healthcare. You could eliminate their salary entirely and it'd have no meaningful difference on the cost of healthcare. There is _absolutely_ an artificial supply limitation, but that's increasingly being worked around by the use of PA and NP providers. Doctors essentially become managers for PA and NPs. My wife is a physician. Actual, scientific diagnosis is a ridiculously small part of her job. Most of her time is taken up on "soft problems". Writing notes for continuity/quality of care. Justifying medical decisions for billing purposes. Advocating with insurance and healthcare administrators. Discussing treatment plans and options with patients. More notes. Well, really, most of her time is taken up with notes. It's really the only way for her to capture all of the soft variables. Writing notes is a bit like coding. LLM/AI can help solve the problem, but ultimately you still need to go through them piece-by-piece to ensure they're correct.

whimsicalism 2y ago
Unlike the other comment defending current medical practice, this one I absolutely agree with. I do not think that physician salaries are the major drivers of healthcare cost. I do think that occupational licensing reform would help bring down cost, but agree it is only a relatively small factor. However I do think that in the process of engaging in wage protectionism (and there is absolutely no question that doctors do this) there is a ton of consumer surplus that is being lost and not captured by either patient or provider. For instance, in the case of the melanoma AI, that is a casualty of the wage protectionism (+ medical conservatism + FDA failure) - the value there isn't being captured by doctors, it is just disappearing into thin air and tons more people will just have undiagnosed melanomas.
- SkyPuncher 2y ago
  > I do think that occupational licensing reform would help bring down cost I actually think this is the only way to bring costs down. Most providers, equals more competition. More competition leads to innovation and all around better outcomes. Interestingly, a lot of states are starting to express their frustration with physician supply shortages by expanding rights for NPs and PAs. I think over the next 20 years, we're going to see MD/DO roles transition to largely supervisory roles with NPs and PAs doing most of the work. Much more akin to manager/IC type of roles we see in STEM type fields.

cogman10 2y ago

Part of the problem is quackery. Remove the regulatory state and all the sudden you have people claiming bleach enemas as a cure all (We have that with the regulatory state, but those people get prosecuted). I don't think that some regulations ensuring the tooth drilling robot isn't going to explode teeth is unwarranted even though that drives up cost of development.

willmadden 2y ago
You don't need preemptive regulation over the entire medical industry to arrest people for quackery.