7 ms·

Vinod Khosla says technology will replace 80 percent of doctors

36 points by pella 14y ago

pragone 14y ago
I look forward to the day that machines can practice art the way doctors do. One of the most underrated/underappreciated aspects of being in medicine is realizing it is a true amalgamation of art and science, relying heavily on both education, experience, wisdom, and instincts.
- guylhem 14y ago
  Being in medicine, I don't agree. Over 80% of the job could be done by properly designed algorithms - and 80% would be a conservative guess. The "interesting" cases are very rare, and mostly consist in easy-to-do diagnosis of unfrequent illnesses (I once diagnosed an insulinoma! hurrah!) Just look at the growing number of tasks given to non-MD- say RN. It's a trend that will go on. Human knowledge is nothing but the application of algorithms - deciding which symptoms are important, which are to be discarded, which require more investigation, etc. Education is building algorithms. Experience is machine learning. Wisdom is statistics. Instinct is prioritization. The faster we can implement all that in software, the better.
  - fl3tch 14y ago
    It seems to me that things like "intuition" and "instinct" are just subconscious algorithms that you can't articulate (example instinct: I pull my hand away from a fire; I can't tell you why, but it isn't magic; somewhere in the wiring of the brain there is an algorithm that makes that happen). Fundamentally, the brain processes information to make decisions, which machines can always in principle be designed to do. Thus as long is medicine is fundamentally about making diagnostic and treatment decisions, it can be solved by machines.
  - deleted 14y ago
    [deleted]
  - pragone 14y ago
    You present an excellent argument! Integration of software/computing with healthcare/medicine is what I hope to focus the rest of my life on, so I surely hope we can make significant progress in that area.
    - guylhem 14y ago
      If you do get involved in such projects, let me know where a double background as a clinician and a hacker might help (and that's open for anyone in the thread!) I see many topics where a proper mix of IT and medicine could make a real difference - for example, improving WorldVista, adding IA agents to mine the data and suggest things. Then I see the sorry thing that calls itself Health-IT and which is just a new way to put government stimulus money into dull uses and overpriced software.
      - dr1337 14y ago
        I'm actually involved in a project where having a hybrid background as a clinician and hacker is a synergistic advantage. I'm the founder, lead developer and clinical researcher behind StethoCloud - http://www.stethocloud.com/ http://www.stethocloud.com/ I find being a clinician helps me understand the problem when it comes to the diagnosis of pneumonia in children. I understand the scope of the problem, its current diagnostic hurdles and as a hacker, I know how to build the app and cloud backend for the project. Having exposure and knowledge in other fields of computer science, mathematics and engineering helps too. I'm glad I took the Stanford AI and Machine Learning courses that gave me a good understanding of what machine learning techniques are capable of doing given sufficient data to train on. I would say having knowledge of those fields was important in order for me to articulate the problems clinicians face with the diagnosis of pneumonia in children to data scientists in a way that they could understand how their skills could be helpful and thus convince them to help out with this project.
  - tomwalker 14y ago
    As a fellow doctor I agree with everything you say.
  - MaysonL 14y ago
    What's your take on checklists?
  - ippisl 14y ago
    hurrah for insulinoma diagnosis:) I think that even rare disease diagnosis can be done better by algorithms by using Isabel healthcare's diagnostic system[1] or Watson(in the future). The place where a human will contribute the most is the interpersonal stuff:motivating people, digging data from people(although computers compete there[2]) and administering placebo. And of course doing the physical stuff. But that seems very different from the job of a doctor and closer to the job of a nurse. [1]http://www.isabelhealthcare.com/home/default http://www.isabelhealthcare.com/home/default [2]There was some research that showed that people give more personal information to a computed form than via face to face chat with a doc.
    - guylhem 14y ago
      Agreed - algorithms won't just plainly discard rare diagnosis the way many physicians do. (especially at 3 am :-) Of course, it should never be top of the list - unless it becomes a possibility given the accumulation of negative results of other tests for more common diseases, or the positive results of DNA sequencing. Unfortunately, that's not the way it will happen with an human : rare almost means "ruled out" simply because "poorly taught" or even unknown, and for the best of us "get a second opinion with xxx who specializes in this very disease". DNA sequencing is at most used for a couple of diseases per specialty, and data mining/fishing expeditions are frowned upon (maybe rightly so given the human bias of trying to find meaning and correlation in what may be unrelated). I strongly believe the beginning of true e-medicine will make us look at the current medicine the way we look back at blood letting, holy waters, the four humors imbalances etc.
rdudekul 14y ago
I am not a doctor, but I have visited many. With machine learning and big data analytics, I can see why machines can be better than 80% of the doctors out there. It may be possible for simple iPhone compatible devices to take the vitals, send the data to a web service, which returns a diagnostic that is more accurate than what most doctors can come up with. It is necessary to stir up the industry with bold statements. Go Vinod Khosla!
- revelation 14y ago
  Vitals are for monitoring you are vital. I'd think they have very little to no meaning for the majority of diagnoses a GP makes daily. There are many diagnostical tools where computer analysis can be tremendously helpful (like EKG), but most of these are very much out of the iPhone-accessory league.
  - pragone 14y ago
    I know you were just giving an example, but any practitioner who relies on a computer to interpret an EKG is not one I would trust. Many times my own EKG interpretations are far, far more accurate than whatever the monitor thinks is wrong
    - neurotech1 14y ago
      Do you know a primary-care doctor who can properly interpret an EKG? Most can't beyond the basics. If it is for cardiac diagnostic purposes, then the recording is sent to a cardiologist for diagnosis. I have seen a room full of doctors with licenses and who are generally competent their in practice, who can't read an EEG either. They were not trained in medical school/residency to read an EEG and so their skill is limited. The neurologist with an EEG fellowship does the interpretation. This is after it is digitally processed by software that does the quantitative analysis. Note: I am not a physician, but I'm quite familiar with EEG technology including Quantitative EEG analysis.
      - robbiep 14y ago
fingerprinter 14y ago
The key word here is "eventually". Easy to prognosticate with no timeline. That being said, technology will likely eventually disrupt/replace many, many current industries/jobs/practices. This isn't news.
carbocation 14y ago
Challenge #1 is to get sufficient data. There are surprisingly few medical data available that have sufficient parameters to let you do any useful training.
rogerbinns 14y ago
The US healthcare "market" is completely distorted ranging from no one having any idea what anything actually costs, multiple layers of disintermediation from consumers to payments, a doctor's cartel that keeps numbers low thereby increasing compensation, but giving an incentive to replace them, income not based on outcomes, the government spending ~50% of all healthcare money but everyone ignoring it, and the list goes on. Atul Gawande's articles in the New Yorker are fascinating insight into how things really work - full list at http://www.newyorker.com/magazine/bios/atul_gawande/search?contributorName=atul%20gawande http://www.newyorker.com/magazine/bios/atul_gawande/search?c... Some highlights: Reliably delivering care (and cheaper) http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_... Pit crews http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-... Hot spots http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_... Costs http://www.newyorker.com/online/blogs/newsdesk/2010/12/the-cost-conundrum.html http://www.newyorker.com/online/blogs/newsdesk/2010/12/the-c...
- jbl 14y ago
  One thing I've been thinking of lately is whether there are technologies that could fundamentally change the incentive structure of the US healthcare market to be more in line with patient interests. Are there technologies or attitudes or approaches that could make feasible new business models that would accomplish such a change? I don't know, but it's something that's been on my mind.
  - protomyth 14y ago
    studying the process that resulted in https://questions.cms.gov https://questions.cms.gov could give you some insight into what makes up the health care costs of today. Lookup coding for a first look at why things are the way they are.
  - rogerbinns 14y ago
    It isn't just individual patient interests but rather everyone. For example providing sporting facilities at schools and exercise/active activity facilities for everyone would do a lot to improve overall group health. Making cities more walkable would do a lot too. But right now my primary care doctor (who is most valuable to me) gets paid zero when I am healthy and more the more tests and procedures she does. Other specialists only get paid when I am referred to them. Drug manufacturers only get paid when their items are prescribed. Essentially compensation is based on consumption not on wellbeing which is why the system is so messed up. The US market definitely needs to be split into two. A baseline coverage that is based on wellbeing, effectiveness and does take price into account, done by the government available to all residents. It is easiest to gather the money via taxes (which already happens to a large degree) and to provide the actual care via combinations of government employees/facilities and contractors. And a top up private system where the people who want to pay for or provide gold plated coverage and procedures can do so (in addition to the base). Most countries have different systems which amounts to running experiments in effectiveness and efficient. Heck worst case just do what the French do http://en.wikipedia.org/wiki/Health_care_in_France http://en.wikipedia.org/wiki/Health_care_in_France
ghshephard 14y ago
The last three times I've contacted Kaiser (In California) to get a doctors appointment, (Once, when I had stabbing chest pains and my left arm had gone completely numb - I seriously thought I was having a heart attack) - their expert system (staffed by a human, still - but that will change) - asked me a series of questions, and came to the conclusion that I didn't really need to see a doctor. "Drink some tea with honey for a cough", "Stretch your arm, and take breaks from the keyboard" for the numb arm. Oh, and "Stress Pains" So - some significant number of doctors are already starting to be replaced by the experts systems at Kaiser right now.
- ippisl 14y ago
  Kaiser is a rare gem in the u.s. healthcare system, and the reason is that they are integrated system: they integrate insurance with treatment. Since Kaiser if payed a fixed sum and not a fee for service it has motivation to reduce costs, hence the expert system. Patients at Kaiser also stay for the long haul(who wants to switch doctors?), so it makes sense for Kaiser to invest in prevention, and they do. Finally, Kaiser is an NGO, which i'm sure helps to keep they're priorities straight. Maybe Kaiser is a good target for startups ?
dmk23 14y ago
Healthcare technology has always been a siren song for the Silicon Valley. The thinking repeats over and over: 1) It is an antiquated industry 2) There has to be a better way to do it with IT 3) My company has the magic solution that will save everyone and make me rich While it is hard to argue with points #1/2 the real problem is finding viable entry points and building large, growing, sustainable businesses around them. Regulation, government and professional, is a huge reason healthcare is what it is. You can make the best ML algorithm to diagnose and treat disease and doctors will spend decades arguing about why it is unsafe and they should always be the final authority. You won't be able to get a diagnosis and a prescription without them. You might think otherwise, but they have real power in denying you medical choice via setting professional guidelines through medical boards and lobbying politicians who are simply not brave enough to pit themselves against doctor's medical judgement. It is harder to think of a more counter-productive and self-defeating way to market any healthcare solution then by saying it is going to "replace doctors". Here is a great example (DNA testing) of how doctor lobby can restrict innovation: http://www.nytimes.com/2010/03/20/business/20consumergenebar.html http://www.nytimes.com/2010/03/20/business/20consumergenebar... EDIT: I actually believe Vinod Khosla knows better and he just made a troll statement on purpose. It worked, we are talking about it!
- arjunnarayan 14y ago
  These constraints are US-specific. Have you heard of Narayana Hrudalaya? http://knowledge.wharton.upenn.edu/india/article.cfm?articleid=4493 http://knowledge.wharton.upenn.edu/india/article.cfm?article...
- elemeno 14y ago
  Don't forget number 4 - sheer hubris on the part of people who think that just because they've been to a doctor that they know what a doctor does.
  - scarmig 14y ago
    Misdiagnose your hypothyroidism for months, only testing you once you've done your own research and pointed it out to them, and then signing their name to a piece of paper and getting you to sign your name to a large check? </bitter>
vineet 14y ago
As an investor, Vinod Khosla's job is to make such bold statements. But his statement will never come true. Even if you assuming that 'doctors' and 'humans' are old technolgy, whenever a disruptive technology has come to market the old technology has not gone away -- it is still used and is often a part of a growing market (this is partly why incumbents are often so slow to move). Regardless, I think the right way of phrasing the above is that in the future 80% of medical needs will be met by technology. This statement is actually different from implying that 80% of doctors will loose their jobs, it is more that technology will help them do their jobs - either to service more people or to service more complex situations.
elemeno 14y ago
I'm always somewhat leery about these sort of predictions since to my mind they seem to miss that being a doctor is often more than just making diagnoses and deciding on a treatment - it's also about having a relationship with the patient, especially when it comes to primary care practitioners (like GPs in the UK) and specialists for long term conditions (such as my father, an oncologist, who has patients he's been seeing for ten or fifteen years since their initial diagnosis and treatment). Not withstanding that people are generally more comfortable and willing to submit personal information to a fellow human who they know and trust, there's also things like how does a computer tell the difference between a little old lady with a problem, and a little old lady who's just lonely and uses going to her GP as a way to get some human contact every few weeks. Her GP will likely know the difference though, because she's known the little old lady for the last five years and has realised that her visits aren't about the vague symptoms she's presenting, but the ten minute chat she has with the doctor.
- ippisl 14y ago
  >> people are generally more comfortable and willing to submit personal information to a fellow human who they know and trust There was some research(can't find it now) , that show that filling an automated form is a good way to make patient elicit personal embarrassing info that they wouldn't offer via chat. >> difference between a little old lady with a problem, and a little old lady who's just lonely First that's a nurse can easily do. And maybe, hopefully we'll find ways to solve the loneliness issue.
- fl3tch 14y ago
  Proper care of the elderly is another problem that society should address without racking up insane health care costs just so a little old lady has someone to chit chat with. There are certainly more fruitful (and cheaper) ways to solve that.
neurotech1 14y ago
No Vinod. Technology will make doctors more efficient so they can handle 3x-5x the workload and serve more patients. I've known doctors/nurses who answer emails both between other health professionals, and between patients. Sometimes a 2-minute email can take the place of a regular checkup for somebody with a chronic condition. Where technology can make drastic improvements is detecting problems when they are minor, and not becoming major. If a primary-care doctor can only do 5 minute consults, and that results in missing a major diagnosis like cancer, which is then treated at a later stage, then they've blown out any cost saving by rushing consults.
malandrew 14y ago
Thinking of innovation as coming from people outside the industry or people inside the industry is a false dichotomy. I reckon that one of the catalyzing factors will be smart people who naively go into school to study medicine thinking that is the career for them, but drop out of that career path just before, during or just after their residency, either because they can no longer imagine living the medical lifestyle or because they realize how backwards it is. Those that drop out will know more enough about what is wrong with the industry but not have the horse blinders that those immersed in the industry for years will have. These people and those who work with the medical industry but are doctors are the people the medical industry discounts.
kamaal 14y ago
This is because your average doctor is no match to a Google search. In my own case it has been true. I lost around 35 kgs rapidly to tropical sprue around 3 years back(By God's grace- I'm healthy now). None of the doctors could diagnose it. In fact most of them so badly managed my situation, I had to finally decide to work on it myself. Needlessly to say simply researching the topic on Google gave me far more perspective than they ever had. There were even a few days when I could tell them straight on their face, why they weren't going with a particular medication with existing ones. I even described to a doctor how a particular anti biotic works, and why the one he is giving regularly to patients is not working. I showed them their flaws in diagnostics, results and clinical procedures. Nothing that I did was magic. It was all decision procedures, if-else scenarios with some careful reading and analysis. The point is no doctor hears to your problems completely. They have preconceived ideas of what your problem might be and go with that. They cut you off while you are speaking and that is all it. You are their mercy now. Many of them just experiment with trial and error methods. Some just prescribe what the salesman from the pharmacy company sells them. This is what your ordinary doctor down the lane is. He is not god/super human who can do miracles to save your life. 10 years into practice your ordinary doctor knows nothing more than what you would know if you read Merck Manual of diagnosis and therapy: http://en.wikipedia.org/wiki/Merck_Manual_of_Diagnosis_and_Therapy http://en.wikipedia.org/wiki/Merck_Manual_of_Diagnosis_and_T... If you can code up that Manual as software- I am not sure if 80% of them can be replaced. But I can tell you the number will pretty close to more than 50%.
bfrs 14y ago
Here's a recent anecdote: A few months back I got a stomach ulcer and before going to the doctor, I decided to do some research. I came to realize that the primary cause is not stress or excess spicy food, but a particular stomach bacteria, H. Pylori, going rogue and attacking the mucus lining of the stomach that protects underlying tissue from the strong acid [1]. For this discovery, Drs. Marshall and Warren were awarded the 2005 Nobel prize in medicine [2], as it meant that ulcers were curable with the use of suitable antibiotics. However, my doctor (and good friend) insisted that there was no permanent cure for stomach ulcers and they could only be managed by taking acid reducing medication (Prilosec) everyday for as long as I lived. I couldn't help wondering if his information was corrupted by big pharma, who always want to keep you hooked onto some drug or the other. So, I had to use extra persuasion and tact to get him to prescribe antibiotics for H. Pylori elimination (and thus permanently curing the ulcer). I'm a bit skeptical that big pharma's tentacles will NOT reach Watson's doctor successors [3]. [1] http://en.wikipedia.org/wiki/Peptic_ulcer#History http://en.wikipedia.org/wiki/Peptic_ulcer#History [2] http://en.wikipedia.org/wiki/List_of_Nobel_laureates_in_Physiology_or_Medicine http://en.wikipedia.org/wiki/List_of_Nobel_laureates_in_Phys... [3] http://www-03.ibm.com/innovation/us/watson/watson_in_healthcare.shtml http://www-03.ibm.com/innovation/us/watson/watson_in_healthc...

36 points by pella 14y ago

I look forward to the day that machines can practice art the way doctors do. One of the most underrated/underappreciated aspects of being in medicine is realizing it is a true amalgamation of art and science, relying heavily on both education, experience, wisdom, and instincts.

guylhem 14y ago
Being in medicine, I don't agree. Over 80% of the job could be done by properly designed algorithms - and 80% would be a conservative guess. The "interesting" cases are very rare, and mostly consist in easy-to-do diagnosis of unfrequent illnesses (I once diagnosed an insulinoma! hurrah!) Just look at the growing number of tasks given to non-MD- say RN. It's a trend that will go on. Human knowledge is nothing but the application of algorithms - deciding which symptoms are important, which are to be discarded, which require more investigation, etc. Education is building algorithms. Experience is machine learning. Wisdom is statistics. Instinct is prioritization. The faster we can implement all that in software, the better.
- fl3tch 14y ago
  It seems to me that things like "intuition" and "instinct" are just subconscious algorithms that you can't articulate (example instinct: I pull my hand away from a fire; I can't tell you why, but it isn't magic; somewhere in the wiring of the brain there is an algorithm that makes that happen). Fundamentally, the brain processes information to make decisions, which machines can always in principle be designed to do. Thus as long is medicine is fundamentally about making diagnostic and treatment decisions, it can be solved by machines.
- deleted 14y ago
  [deleted]
- pragone 14y ago
  You present an excellent argument! Integration of software/computing with healthcare/medicine is what I hope to focus the rest of my life on, so I surely hope we can make significant progress in that area.
  - guylhem 14y ago
    If you do get involved in such projects, let me know where a double background as a clinician and a hacker might help (and that's open for anyone in the thread!) I see many topics where a proper mix of IT and medicine could make a real difference - for example, improving WorldVista, adding IA agents to mine the data and suggest things. Then I see the sorry thing that calls itself Health-IT and which is just a new way to put government stimulus money into dull uses and overpriced software.
    - dr1337 14y ago
      I'm actually involved in a project where having a hybrid background as a clinician and hacker is a synergistic advantage. I'm the founder, lead developer and clinical researcher behind StethoCloud - http://www.stethocloud.com/ http://www.stethocloud.com/ I find being a clinician helps me understand the problem when it comes to the diagnosis of pneumonia in children. I understand the scope of the problem, its current diagnostic hurdles and as a hacker, I know how to build the app and cloud backend for the project. Having exposure and knowledge in other fields of computer science, mathematics and engineering helps too. I'm glad I took the Stanford AI and Machine Learning courses that gave me a good understanding of what machine learning techniques are capable of doing given sufficient data to train on. I would say having knowledge of those fields was important in order for me to articulate the problems clinicians face with the diagnosis of pneumonia in children to data scientists in a way that they could understand how their skills could be helpful and thus convince them to help out with this project.
- tomwalker 14y ago
  As a fellow doctor I agree with everything you say.
- MaysonL 14y ago
  What's your take on checklists?
- ippisl 14y ago
  hurrah for insulinoma diagnosis:) I think that even rare disease diagnosis can be done better by algorithms by using Isabel healthcare's diagnostic system[1] or Watson(in the future). The place where a human will contribute the most is the interpersonal stuff:motivating people, digging data from people(although computers compete there[2]) and administering placebo. And of course doing the physical stuff. But that seems very different from the job of a doctor and closer to the job of a nurse. [1]http://www.isabelhealthcare.com/home/default http://www.isabelhealthcare.com/home/default [2]There was some research that showed that people give more personal information to a computed form than via face to face chat with a doc.
  - guylhem 14y ago
    Agreed - algorithms won't just plainly discard rare diagnosis the way many physicians do. (especially at 3 am :-) Of course, it should never be top of the list - unless it becomes a possibility given the accumulation of negative results of other tests for more common diseases, or the positive results of DNA sequencing. Unfortunately, that's not the way it will happen with an human : rare almost means "ruled out" simply because "poorly taught" or even unknown, and for the best of us "get a second opinion with xxx who specializes in this very disease". DNA sequencing is at most used for a couple of diseases per specialty, and data mining/fishing expeditions are frowned upon (maybe rightly so given the human bias of trying to find meaning and correlation in what may be unrelated). I strongly believe the beginning of true e-medicine will make us look at the current medicine the way we look back at blood letting, holy waters, the four humors imbalances etc.

rdudekul 14y ago

I am not a doctor, but I have visited many. With machine learning and big data analytics, I can see why machines can be better than 80% of the doctors out there. It may be possible for simple iPhone compatible devices to take the vitals, send the data to a web service, which returns a diagnostic that is more accurate than what most doctors can come up with. It is necessary to stir up the industry with bold statements. Go Vinod Khosla!

revelation 14y ago
Vitals are for monitoring you are vital. I'd think they have very little to no meaning for the majority of diagnoses a GP makes daily. There are many diagnostical tools where computer analysis can be tremendously helpful (like EKG), but most of these are very much out of the iPhone-accessory league.
- pragone 14y ago
  I know you were just giving an example, but any practitioner who relies on a computer to interpret an EKG is not one I would trust. Many times my own EKG interpretations are far, far more accurate than whatever the monitor thinks is wrong
  - neurotech1 14y ago
    Do you know a primary-care doctor who can properly interpret an EKG? Most can't beyond the basics. If it is for cardiac diagnostic purposes, then the recording is sent to a cardiologist for diagnosis. I have seen a room full of doctors with licenses and who are generally competent their in practice, who can't read an EEG either. They were not trained in medical school/residency to read an EEG and so their skill is limited. The neurologist with an EEG fellowship does the interpretation. This is after it is digitally processed by software that does the quantitative analysis. Note: I am not a physician, but I'm quite familiar with EEG technology including Quantitative EEG analysis.
    - robbiep 14y ago

fingerprinter 14y ago

The key word here is "eventually". Easy to prognosticate with no timeline. That being said, technology will likely eventually disrupt/replace many, many current industries/jobs/practices. This isn't news.

carbocation 14y ago

Challenge #1 is to get sufficient data. There are surprisingly few medical data available that have sufficient parameters to let you do any useful training.

rogerbinns 14y ago

The US healthcare "market" is completely distorted ranging from no one having any idea what anything actually costs, multiple layers of disintermediation from consumers to payments, a doctor's cartel that keeps numbers low thereby increasing compensation, but giving an incentive to replace them, income not based on outcomes, the government spending ~50% of all healthcare money but everyone ignoring it, and the list goes on. Atul Gawande's articles in the New Yorker are fascinating insight into how things really work - full list at http://www.newyorker.com/magazine/bios/atul_gawande/search?contributorName=atul%20gawande http://www.newyorker.com/magazine/bios/atul_gawande/search?c... Some highlights: Reliably delivering care (and cheaper) http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_... Pit crews http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-... Hot spots http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_... Costs http://www.newyorker.com/online/blogs/newsdesk/2010/12/the-cost-conundrum.html http://www.newyorker.com/online/blogs/newsdesk/2010/12/the-c...

jbl 14y ago
One thing I've been thinking of lately is whether there are technologies that could fundamentally change the incentive structure of the US healthcare market to be more in line with patient interests. Are there technologies or attitudes or approaches that could make feasible new business models that would accomplish such a change? I don't know, but it's something that's been on my mind.
- protomyth 14y ago
  studying the process that resulted in https://questions.cms.gov https://questions.cms.gov could give you some insight into what makes up the health care costs of today. Lookup coding for a first look at why things are the way they are.
- rogerbinns 14y ago
  It isn't just individual patient interests but rather everyone. For example providing sporting facilities at schools and exercise/active activity facilities for everyone would do a lot to improve overall group health. Making cities more walkable would do a lot too. But right now my primary care doctor (who is most valuable to me) gets paid zero when I am healthy and more the more tests and procedures she does. Other specialists only get paid when I am referred to them. Drug manufacturers only get paid when their items are prescribed. Essentially compensation is based on consumption not on wellbeing which is why the system is so messed up. The US market definitely needs to be split into two. A baseline coverage that is based on wellbeing, effectiveness and does take price into account, done by the government available to all residents. It is easiest to gather the money via taxes (which already happens to a large degree) and to provide the actual care via combinations of government employees/facilities and contractors. And a top up private system where the people who want to pay for or provide gold plated coverage and procedures can do so (in addition to the base). Most countries have different systems which amounts to running experiments in effectiveness and efficient. Heck worst case just do what the French do http://en.wikipedia.org/wiki/Health_care_in_France http://en.wikipedia.org/wiki/Health_care_in_France

ghshephard 14y ago

The last three times I've contacted Kaiser (In California) to get a doctors appointment, (Once, when I had stabbing chest pains and my left arm had gone completely numb - I seriously thought I was having a heart attack) - their expert system (staffed by a human, still - but that will change) - asked me a series of questions, and came to the conclusion that I didn't really need to see a doctor. "Drink some tea with honey for a cough", "Stretch your arm, and take breaks from the keyboard" for the numb arm. Oh, and "Stress Pains" So - some significant number of doctors are already starting to be replaced by the experts systems at Kaiser right now.

ippisl 14y ago
Kaiser is a rare gem in the u.s. healthcare system, and the reason is that they are integrated system: they integrate insurance with treatment. Since Kaiser if payed a fixed sum and not a fee for service it has motivation to reduce costs, hence the expert system. Patients at Kaiser also stay for the long haul(who wants to switch doctors?), so it makes sense for Kaiser to invest in prevention, and they do. Finally, Kaiser is an NGO, which i'm sure helps to keep they're priorities straight. Maybe Kaiser is a good target for startups ?

dmk23 14y ago

Healthcare technology has always been a siren song for the Silicon Valley. The thinking repeats over and over: 1) It is an antiquated industry 2) There has to be a better way to do it with IT 3) My company has the magic solution that will save everyone and make me rich While it is hard to argue with points #1/2 the real problem is finding viable entry points and building large, growing, sustainable businesses around them. Regulation, government and professional, is a huge reason healthcare is what it is. You can make the best ML algorithm to diagnose and treat disease and doctors will spend decades arguing about why it is unsafe and they should always be the final authority. You won't be able to get a diagnosis and a prescription without them. You might think otherwise, but they have real power in denying you medical choice via setting professional guidelines through medical boards and lobbying politicians who are simply not brave enough to pit themselves against doctor's medical judgement. It is harder to think of a more counter-productive and self-defeating way to market any healthcare solution then by saying it is going to "replace doctors". Here is a great example (DNA testing) of how doctor lobby can restrict innovation: http://www.nytimes.com/2010/03/20/business/20consumergenebar.html http://www.nytimes.com/2010/03/20/business/20consumergenebar... EDIT: I actually believe Vinod Khosla knows better and he just made a troll statement on purpose. It worked, we are talking about it!

arjunnarayan 14y ago
These constraints are US-specific. Have you heard of Narayana Hrudalaya? http://knowledge.wharton.upenn.edu/india/article.cfm?articleid=4493 http://knowledge.wharton.upenn.edu/india/article.cfm?article...
elemeno 14y ago
Don't forget number 4 - sheer hubris on the part of people who think that just because they've been to a doctor that they know what a doctor does.
- scarmig 14y ago
  Misdiagnose your hypothyroidism for months, only testing you once you've done your own research and pointed it out to them, and then signing their name to a piece of paper and getting you to sign your name to a large check? </bitter>

vineet 14y ago

As an investor, Vinod Khosla's job is to make such bold statements. But his statement will never come true. Even if you assuming that 'doctors' and 'humans' are old technolgy, whenever a disruptive technology has come to market the old technology has not gone away -- it is still used and is often a part of a growing market (this is partly why incumbents are often so slow to move). Regardless, I think the right way of phrasing the above is that in the future 80% of medical needs will be met by technology. This statement is actually different from implying that 80% of doctors will loose their jobs, it is more that technology will help them do their jobs - either to service more people or to service more complex situations.

elemeno 14y ago

I'm always somewhat leery about these sort of predictions since to my mind they seem to miss that being a doctor is often more than just making diagnoses and deciding on a treatment - it's also about having a relationship with the patient, especially when it comes to primary care practitioners (like GPs in the UK) and specialists for long term conditions (such as my father, an oncologist, who has patients he's been seeing for ten or fifteen years since their initial diagnosis and treatment). Not withstanding that people are generally more comfortable and willing to submit personal information to a fellow human who they know and trust, there's also things like how does a computer tell the difference between a little old lady with a problem, and a little old lady who's just lonely and uses going to her GP as a way to get some human contact every few weeks. Her GP will likely know the difference though, because she's known the little old lady for the last five years and has realised that her visits aren't about the vague symptoms she's presenting, but the ten minute chat she has with the doctor.

ippisl 14y ago
>> people are generally more comfortable and willing to submit personal information to a fellow human who they know and trust There was some research(can't find it now) , that show that filling an automated form is a good way to make patient elicit personal embarrassing info that they wouldn't offer via chat. >> difference between a little old lady with a problem, and a little old lady who's just lonely First that's a nurse can easily do. And maybe, hopefully we'll find ways to solve the loneliness issue.
fl3tch 14y ago
Proper care of the elderly is another problem that society should address without racking up insane health care costs just so a little old lady has someone to chit chat with. There are certainly more fruitful (and cheaper) ways to solve that.

neurotech1 14y ago

No Vinod. Technology will make doctors more efficient so they can handle 3x-5x the workload and serve more patients. I've known doctors/nurses who answer emails both between other health professionals, and between patients. Sometimes a 2-minute email can take the place of a regular checkup for somebody with a chronic condition. Where technology can make drastic improvements is detecting problems when they are minor, and not becoming major. If a primary-care doctor can only do 5 minute consults, and that results in missing a major diagnosis like cancer, which is then treated at a later stage, then they've blown out any cost saving by rushing consults.

malandrew 14y ago

Thinking of innovation as coming from people outside the industry or people inside the industry is a false dichotomy. I reckon that one of the catalyzing factors will be smart people who naively go into school to study medicine thinking that is the career for them, but drop out of that career path just before, during or just after their residency, either because they can no longer imagine living the medical lifestyle or because they realize how backwards it is. Those that drop out will know more enough about what is wrong with the industry but not have the horse blinders that those immersed in the industry for years will have. These people and those who work with the medical industry but are doctors are the people the medical industry discounts.

kamaal 14y ago

This is because your average doctor is no match to a Google search. In my own case it has been true. I lost around 35 kgs rapidly to tropical sprue around 3 years back(By God's grace- I'm healthy now). None of the doctors could diagnose it. In fact most of them so badly managed my situation, I had to finally decide to work on it myself. Needlessly to say simply researching the topic on Google gave me far more perspective than they ever had. There were even a few days when I could tell them straight on their face, why they weren't going with a particular medication with existing ones. I even described to a doctor how a particular anti biotic works, and why the one he is giving regularly to patients is not working. I showed them their flaws in diagnostics, results and clinical procedures. Nothing that I did was magic. It was all decision procedures, if-else scenarios with some careful reading and analysis. The point is no doctor hears to your problems completely. They have preconceived ideas of what your problem might be and go with that. They cut you off while you are speaking and that is all it. You are their mercy now. Many of them just experiment with trial and error methods. Some just prescribe what the salesman from the pharmacy company sells them. This is what your ordinary doctor down the lane is. He is not god/super human who can do miracles to save your life. 10 years into practice your ordinary doctor knows nothing more than what you would know if you read Merck Manual of diagnosis and therapy: http://en.wikipedia.org/wiki/Merck_Manual_of_Diagnosis_and_Therapy http://en.wikipedia.org/wiki/Merck_Manual_of_Diagnosis_and_T... If you can code up that Manual as software- I am not sure if 80% of them can be replaced. But I can tell you the number will pretty close to more than 50%.

bfrs 14y ago

Here's a recent anecdote: A few months back I got a stomach ulcer and before going to the doctor, I decided to do some research. I came to realize that the primary cause is not stress or excess spicy food, but a particular stomach bacteria, H. Pylori, going rogue and attacking the mucus lining of the stomach that protects underlying tissue from the strong acid [1]. For this discovery, Drs. Marshall and Warren were awarded the 2005 Nobel prize in medicine [2], as it meant that ulcers were curable with the use of suitable antibiotics. However, my doctor (and good friend) insisted that there was no permanent cure for stomach ulcers and they could only be managed by taking acid reducing medication (Prilosec) everyday for as long as I lived. I couldn't help wondering if his information was corrupted by big pharma, who always want to keep you hooked onto some drug or the other. So, I had to use extra persuasion and tact to get him to prescribe antibiotics for H. Pylori elimination (and thus permanently curing the ulcer). I'm a bit skeptical that big pharma's tentacles will NOT reach Watson's doctor successors [3]. [1] http://en.wikipedia.org/wiki/Peptic_ulcer#History http://en.wikipedia.org/wiki/Peptic_ulcer#History [2] http://en.wikipedia.org/wiki/List_of_Nobel_laureates_in_Physiology_or_Medicine http://en.wikipedia.org/wiki/List_of_Nobel_laureates_in_Phys... [3] http://www-03.ibm.com/innovation/us/watson/watson_in_healthcare.shtml http://www-03.ibm.com/innovation/us/watson/watson_in_healthc...