Comment by DataDrivenMD | Hacker News Reader

Comment by DataDrivenMD | Hacker News Reader

A physician's $0.02 - The clinical relevance of FB's work is clearly stated in the blog post: "While state-of-the-art facilities today use 3 Tesla MRI machines, scanners with lower-strength magnets (1.5 Tesla, for example) are still commonly used around the world." Considering that a 1.5T MRI machine costs about $1M less than a comparable 3T model (+/- the cost of warranty, support, and installation), FB's work in this area has the potential to make a BIG positive impact on the lives of millions of patients. Which is why I will be cheering them on.

If they reproduce their results in other clinical settings, the immediate impact on patient care includes: 1) accelerating diagnosis (and treatment) for patients with traumatic brain injuries (by effectively up-scaling lower resolution scans) 2) healthcare providers in developing countries will effectively get a low-cost "upgrade" to their existing equipment 3) cancer patients in rural America could be monitored for treatment response in a setting that is closer to home (because rural communities tend to be resource-poor in terms of medical technology).

If we consider that a logical extension of their work could be to develop a compression algorithm for MRI data, then it's easy to see an even broader impact that includes: 1) connecting rural patients with high-quality radiologist services (i.e. remote MRI interpretations), and 2) decrease the cost of long-term storage, access, and retrieval for MRI data.

On the topic of FB's issues with privacy: I agree that FB has a long way to earn my trust as a doctor and a patient. That being said, it's important to give credit where credit is due. It seems that FB gained access to the imaging data by working collaboratively with NYU on this specific project. By comparison, it's an open secret among those of us in the biomedical informatics community that over the course of many years Google Cloud has quietly gained access to the personal health information of millions of Americans. So, when it comes to privacy concerns, it's important to avoid being myopic - the concern is valid, but the primary threat may not be as obvious as it first seems.

> 2) healthcare providers in developing countries will effectively get a low-cost "upgrade" to their existing equipment

I am VERY pessimistic about this. I don't know how well you know medical equipment providers but this will never be sold as a low-cost "upgrade" to existing machines. It will be sold with new equipment only and with a hefty surcharge as an option enabling higher patient throughput.

There is no real money in upgrades. Most equipment lasts only 8-10 years anyway.

Your point is well-taken. I agree that such an upgrade is unlikely to be sold as a standalone product. What is more likely to happen is that it will be included for a nominal fee as an add-on to a new purchase or service agreement.

To understand how this would work, we need to 1) understand the lifecycle of big-ticket medical equipment (ME) and 2) recognize that ME products are at the core of multiple revenue streams. The first point has to do with the renewed/refurbished market for used/last-generation ME. The second point has to do with the service agreements/warranties/support contracts that are needed in order to keep the ME operational. These factors combine to yield a sales process with multiple negotiating dimensions.

How these negotiations actually play out depends on whether you're a deep-pocketed healthcare system or not (it sucks, but it's true). If you can afford it, you'll have lots of ways to sport the latest and greatest ME without breaking the bank on any single purchase. Some of your old stuff will end up in the renewed/refurbished ME market, thereby offsetting your total cost of ownership (either directly or indirectly). Once used ME hits secondary markets, the customer profile changes: these customers are not looking to keep up with the Cleveland Clinics and Stanford's of the world. They're looking for long-term value, so reliability and longevity is top priority - and this is where I see software "upgrades" coming into play. Some of these customers may already have one or two MRIs, while others may not. In either case, the software "upgrade" becomes a differentiator that speaks directly to the priorities of these customers.

TL;DR - Today, healthcare providers with limited financial resources (e.g. those in developing countries, rural areas) are incentivized to purchase capital equipment through "discounts" on service/support. In the future, we're likely to see software "upgrades" (such as those made possible by FB's work) bundled/leveraged as an incentive. The net effect is the same: extend the clinically useful lifespan of medical equipment (MRIs in this case) and greater access to medical technology around the world.

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