15 ms·
Google Co-Founders on Healthcare: “Thanks, But No Thanks”
- gervase 12y agoThe site was extremely slow to load for me; here's the Google cache. https://webcache.googleusercontent.com/search?q=cache:http://thehealthcareblog.com/blog/2014/07/08/google-co-founders-thanks-but-no-thanks/&strip=1 https://webcache.googleusercontent.com/search?q=cache:http:/...
- jzelinskie 12y agoThe page isn't loading, but I assume it's referencing their response to the question about healthcare asked in this session: https://www.youtube.com/watch?v=Wdnp_7atZ0M https://www.youtube.com/watch?v=Wdnp_7atZ0M
- karzeem 12y agoDo you have a timestamp?
- ericd 12y agoBasically, he's saying that it's too heavily regulated for them to want to dip their toe in. Seems reasonable, it's the same reason I never bothered with the healthcare ideas I've been interested in. Too many landmines, and not enough latitude to try creative things.
- totoroisalive 12y agoThe whole mining data on health has so many wonderful possibilities, but giving so much of my privacy it's a big no for me.
- akozak 12y agoInteresting. Is that an absolute position, or would you be more willing if the benefits (longevity, better health) were more apparent?
- duaneb 12y agoI highly doubt any data about my health could give me enough benefit to warrant such an intimate invasion of my privacy.
- _croz 12y agoWould you consider it an invasion of your privacy if the data was anonymized?
- gus_massa 12y agoIt’s very difficult to anonymize data, and prevent that someone deanonymize it. The bigger cases that I remember are the AOL searchs and Netfix data. More info: http://www.cnet.com/news/aol-netflix-and-the-end-of-open-access-to-research-data/ http://www.cnet.com/news/aol-netflix-and-the-end-of-open-acc...
- duaneb 12y agoAnonymized data is a myth.
- seanflyon 12y agoAnonymization is hard, not mythical
- totoroisalive 12y agoAbsolute position. The benefits are not that appealing to me.
- a3n 12y agoThere are only two changes that would make it very easy for me to accept revealing my medical data, for science, research or just about anything else. 1. No insurance companies involved as health care gatekeepers. At the moment, they are very much an adversary to me. 2. Strong, enforced laws against employers discriminating for health. I'm sure the letter of the law currently sounds strong, but I'm assuming you have to sue to right any wrongs. Advantage employer. Neither one of these will happen in my life time, because insurance companies make huge profits on throttling our healthcare, employers will always like flexibility to do what they want with the law, and both camps fund Congress.
- yawaramin 12y agoThe data would be anonymised. No one would be connecting your records to _you._
- totoroisalive 12y agoAccording to who?
- commandar 12y agoThe anonymization rules for PHI are strict enough that it would make a lot of the interesting mining you could do difficult if not impossible. Specifically the restrictions related to dates and locations.
- deleted 12y ago[deleted]
- shaggyfrog 12y agoWhen "anonymization" is done poorly, it has consequences. It was bad enough with Netflix recommendations getting de-anonymized; imagine what could happen with actual health records leaked. http://arstechnica.com/tech-policy/2009/09/your-secrets-live-online-in-databases-of-ruin/ http://arstechnica.com/tech-policy/2009/09/your-secrets-live...
- Goladus 12y agoIt's a lot trickier than this. Suppose you have a rare genetic condition that affects 0.005% of the population. It takes very little additional information to single out a person when the first thing you do is rule out 99.995% of the possibilities.
- Scoundreller 12y agoAlthough your health records may have some legal protections, health care is only one determinant of health. Other determinants of health, like your gender, food choices, lifestyle, income, driving history, family history, physical environment, education, social network, etc. have all been heavily mined. Much legally protected stuff can largely be inferred anyway. There aren't too many people without peanut allergies that haven't bought anything containing peanuts for the past 5 years.
- lostcolony 12y agoAs a kind of note and response to all of your other responses, the issue isn't actually anonymization, but being able to correlate it with other data. That is, if health data were anonymized, and was done right, and was made unable to be correlated with any other data, it likely would be sufficient. It's when you start allowing it to be correlated with personally identifiable things that it ceases to be anonymous. That is, sure, let's take a case where you have a super rare genetic disorder. That, combined with the time in 2005 where you broke your leg, is sufficient to distinguish you from every other person in the country. In short, you have a unique health profile. So what? Unless there is further information, that can't be traced to you. As an example, it's when we start saying "Ah, and the person is receiving treatment at (facility)" that we now know where you live. It's when we start correlating it with usernames that we start getting an internet trail. It's when we start correlating those with forum profiles that we get a real name, and now we know who you are. The only other way someone could match that profile with you, is to have access to the profile, and to know you personally. Otherwise it links nowhere. I agree the risk is huge; people don't do it right. But anonymous health profiles are -not- in and of themselves dangerous; it's when details linking them to further information leaks out that it's a problem. But, pragmatically, while yes it would be incredibly hard...has anyone here read the rights they're signing away when they go to the doctor? Does everyone here trust every system a doctor uses, every system a health insurer uses, and every system used by marketers and researchers that the feds -do- allow to have access to this data? The real risk of Google would be that they could correlate it with so many other things about you; but the health insurers still have your medical history combined with all your PII.
- laurenstill 12y agoYou both may be interested in this paper: Publishing data from electronic health records while preserving privacy: A survey of algorithms http://webcache.googleusercontent.com/search?q=cache:1gHT-y0g9rwJ:www.j-biomed-inform.com/article/S1532-0464%2814%2900140-3/pdf+&cd=2&hl=en&ct=clnk&gl=us http://webcache.googleusercontent.com/search?q=cache:1gHT-y0...
- watwut 12y agoAnother interesting write up about anonymization https://freedom-to-tinker.com/blog/randomwalker/no-silver-bullet-de-identification-still-doesnt-work/ https://freedom-to-tinker.com/blog/randomwalker/no-silver-bu... tl;dr: it does not work much.
- Dakuan 12y agoWe had a big old flap about this in the UK recently http://www.theguardian.com/society/2014/jun/17/nhs-patient-data-audit-significant-lapses-confidentiality-hscic http://www.theguardian.com/society/2014/jun/17/nhs-patient-d...
- retroencabulato 12y agoMisleading title. It should be "Google Co-Founders on being a health company"
- gph 12y agoHealthcare is heavily regulated, and I understand why some companies would be reluctant to branch out into it. But that doesn't mean the privacy and legal concerns surrounding HIPAA regulations are unwarranted. Yea, it would be nice if we lived in an ethical utopia where we wouldn't have to feel worried about people looking through our health records. But we don't. I would not feel comfortable with my health records being easily accessible, even if that would lead to better data-mining opportunities.
- fd4gfdgfd 12y ago"Heavy regulation" doesn't just include HIPAA.
- gph 12y agoTrue, but that was the one specifically mentioned in the article so I figured I'd address it.
- niels_olson 12y agoI think the most illuminating thing about HIPAA is the fact that it lays bare just how poorly doctors and lawyers and healthcare administrators actually understand logical security in the computer science sense. I will point to the use of fax machines as a superb example. The law essentially considers PGP and a fax machine to be security equivalents. And I say that as a doctor.
- rayiner 12y agoI think that ignores a lot of the technology involved. A fax van be intercepted, but an email is guaranteed to be recorded by intermediate servers. In most cases, e-mail will be data mined in a webmail system. So while PGP is clearly better, I think its reasonable to say fax is, in practice, better than email. Unless you want patients suddenly getting Valtrex ads because someone sent their health records over webmail.
- kgarten 12y ago
- justinph 12y agoWhen you fuck up in health, people can die. Regulation exists for a reason.
- taeric 12y agoThe regulations more exist to keep you from getting people discriminated against. I mean, yes, we don't want folks to die. Nor do we want folks making bad decisions based on information they don't understand. However, to say that it is just "people could die" ignores the fact that they have technology entering in vehicles and whatnot.
- balls187 12y agoThe first time a Google car crashes and Google lawyers have to sit across from a now paralyzed child on the witness stand, Google will quickly think twice about the Vehicle market. This was a huge problem we faced in Automotive. All big automotive companies are VERY cautious about safety, to what would seem like absurd levels.
- yawaramin 12y agoLike GM? http://www.nbcnews.com/storyline/gm-recall/lawsuit-says-gm-hid-ignition-defect-recalled-cars-n53221 http://www.nbcnews.com/storyline/gm-recall/lawsuit-says-gm-h...
- Scoundreller 12y agoThe rest of the world will welcome the Google car with open arms. The US will have to make do with their automobile deathtraps and continue to live suboptimal lifespans (35th worldwide) for a country with such a high GDP per capita (6th).
- balls187 12y agoWait, isn't Google a US company?
- ericflo 12y ago
- pinaceae 12y agodidn't G+ out some transgender people? http://www.zdnet.com/google-outed-me-7000025416/ http://www.zdnet.com/google-outed-me-7000025416/ now imagine the same with Google having access to all medical records. regulation around this exists for a very, very good reason.
- gohrt 12y agoBy "outed", G+ exposed the user's public name to someone, connecting two public pieces of the user's data, that the user intended to keep separate. It was a poor UI experience, but it wasn't a private-data leak.
- stormbrew 12y agoConnections aren't data?
- dontmindifido 12y agoYou're kidding yourself if you don't think that is a private data leak.
- yawaramin 12y agoGoogle should take a look at https://news.ycombinator.com/item?id=7951019 https://news.ycombinator.com/item?id=7951019 Then buy Theranos.
- zmmmmm 12y agoIt's worth noting that highly regulated industries are not necessarily bad for startups to enter, exactly because they throw up particularly high barriers to large companies. Google can't enter health without accepting the full baggage that comes with that - people worried about their privacy, every random nutter looking to sue them and get a payday, FDA breathing down their neck every step of the way, etc. A small startup can be much more nimble and targeted and address a very specific niche in a clever way and be very successful.
- wyager 12y ago>It's worth noting that highly regulated industries are not necessarily bad for startups to enter, exactly because they throw up particularly high barriers to large companies. That doesn't make any sense at all. Large companies are either A) already past any barriers to entry or B) have enough money to bust through any barriers to entry. There are probably very few real world situations where being "nimble" is enough to overcome onerous regulations. The reality of the matter is that you just need a lot of money to pay lawyers.
- tn13 12y agoIt sounds very contradictory. In most of the heavily regulated industries such as healthcare or insurance, one of the economic efficiencies are a better understanding of the complex law, startups can not solve this inefficiency in their favor.
- zmmmmm 12y agoI'm not saying you don't need to understand the regulations and law - you absolutely do. But you do have an advantage in being able to be less conservative and more innovative in how you interpret them. For examples, take Uber and AirBnb - they are both pushing the boundaries of highly regulated industries. An existing hotel chain couldn't do it because they have too much to lose, and target such broad markets. But a scrappy startup can.
- pwnna 12y ago
- asdfologist 12y agoI'm surprised the blog post mentions nothing about Google Health. Basically, Google has already tried this and failed. http://en.wikipedia.org/wiki/Google_Health http://en.wikipedia.org/wiki/Google_Health
- greggman 12y agoFailed seems like an unfair characterization. Another possibility is they thought it was a cool idea, then found out how regulated it was, how it would be nearly impossible to add any features without massive government oversight, and got out.
- deleted 12y ago[deleted]
- iskander 12y agoI was an intern on the Google Health team and witnessed many problems unrelated to external barriers. 1) The original codebase was a nightmarish mess of Java/GWT code that did very little (my first real-life encounter with a FactoryFactory). Most of the developers from this first version drifted away from the project and by the time I arrived there was a second team who were talented, but, unfortunately spent much of their time slowly refactoring other people's crappy code. 2) I didn't observe very much clear product vision. Instead, we had a paranoid obsession with matching the features of Microsoft Health Vault (which was equally meandering & useless). 3) There was a huge top-down pressure from Marissa M and other high level managers to make Google Health into something astoundingly successful, suffocating any possibility of incremental progress and disempowering the actual developers. 4) We had one MD on staff and very little other experience with medicine or healthcare. The developers were very far from the problem domain and relying on a game of managerial telephone to ascertain what the current state of medical record management is and what improvements are possible. Anyway, in short, my experience was that Google screwed up.
- throwwit 12y agoWhy doesn't google innovate regulation first then? :)
- dontmindifido 12y agoI'd love to see them take an altruistic approach and shift the focus to countries like Africa where health projects would provide a lot more utility and have a lot less regulatory burden. Once a product is visibly working in one country it's more difficult to make cases against it elsewhere.
- micro_cam 12y agoI've heard Bill Gates state this as one of his philanthropic goals; to fund things with a cost/benefit analysis that doesn't make sense in the developed world but does elsewhere. I've worked with people involved in HIV vaccine trials overseas and, in fact, things really don't change as much as you might think. The basic tenant "first do no harm" is ingrained at an many different ethical, institutional and legal levels that it isn't like you can, say, justify a more risky vaccine in an area with a higher risk for HIV or whatever. In fact trials have been cut short and research into entire vectors (ie the cold virus used as a transport for the HIV related material) cut off when trials in Africa started to appear (statistically) to be slightly harmful in any way. I feel this is a good thing. Scientists and medical people holding themselves to this high standard is the reason the anti-vaccine crowd really doesn't have a leg to stand on.
- XorNot 12y agoAlso because the history of unethical research is long and storied enough already. It's pretty well appreciated where that path leads.
- thejdude 12y agoYou could say research is well researched. Unfortunately, the same doesn't apply to unethical treatment. More and more patients get certain treatments or recommendations by doctors or hospitals not because they need them but because they're profitable for the doctors or hospitals. This is the insurance/financial product salesman's spirit at work, and it needs to be stopped. Right now. I think part of the problem is the "insurance" mentality - if you don't pay for the treatment yourself, but the insurance just pays for everything, you aren't interested in an economical solution (and maybe the minimally-invasive treatment), but you take what's recommended. If you have to pay for treatment yourself, you begin asking questions. (Disclaimer: I live in Germany, a country with "free" health insurance, which I pay for with an effective 15% tax on my income.)
- micro_cam 12y agoBringing a healthcare product to market is really hard. A friend just had a good one with a proven product and sales fail simply because institutional hospitals take to long to really implement a decision to the point they will actually pay for a piece of software they want to use even if it isn't something regulated. Google certainly has the cash to sit this sort of thing out, hire sales and support people etc. Microsoft and others are doing so, see Microsoft Amalga for example. However a more intriguing area, to me, is doing some more basic research without becoming a health company. Google is doing this with the glucose contacts and things. These are novel ideas with significant IP that could be spun off into an independent company and/or licensed to to an existing drug company to push through clinical trials and bring to market.
- paletoy 12y ago> Bringing a healthcare product to market is really hard. I think this is the place that google might enter and play well. If google can develop a very high-level , fda certified development tool/operating-system ,such that developing fda certified products become much easier , they could have a very big win on their hands. I've seen some research on such systems ,so it's a clear possibility. And since it's a new thing , it might need some changes in the fda, which google has the tools to push.
- trhway 12y agoGoogle seems to avoid enterprise/gov, and especially highly regulated, business. One can see the advantage of it - that allows the company and the products to avoid bloat and culture corruption endemic to doing enterprise/gov/highly regulated business
- RoryH 12y agoBrin's partner co-founded https://www.23andme.com/ https://www.23andme.com/ and that got it's nose cut off by the FDA IIRC.
- k-mcgrady 12y agoRightly so. If I recall correctly, instead of just providing the results to you they also included recommendations to try to prevent things their tests had shown you were at risk of. Their tests have never been vetted/proven accurate by anyone other than themselves so providing health advice based on them is reckless. If they were allowed to continue anyone could start their own 'DNA testing service' create bogus reports and bogus recommendations and people could get hurt.
- fixermark 12y ago... which is not nearly as big a risk these days as it was in the days of snake-oil salesmen; there isn't a "new town to set up shop in" for a bad DNA testing service in the days of the Internet. I'm in favor of protecting people from bad medcine, but I think the current regulatory structure is an overly-restrictive tool for the job. Either that, or (given that it steps on the neck of 23andme but lets GNC and homeopathic practitioners continue to operate) it's mis-tuned for modern technologies and tools.
- aianus 12y agoSo what? I want to see my results. They make it clear it's not an exact science and they link to the relevant studies so you can make your own decisions. Why should the FDA prevent them from sharing that information with me? I'm not even American!
- k-mcgrady 12y agoDid you read my comment? It wasn't about the results. You want your results - you got them. It was that they were providing recommendations based on the results which haven't been verified as accurate by anyone but 23andme.
- tempodox 12y agoI tend to believe that Goog won't do it. Imagine going from kingpin of the Internet, making the rules as it suits you, to an area where you're subject to laws made by others, just like everyone else. They wouldn't be that special any more. Methinks, they're too spoilt for that.
- BrainInAJar 12y agoWaah... we can't let advertisers trawl through your health records because privacy rules won't let us