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Comment by vessenes | Hacker News Reader

I'd like a word for what is now the ritualized 'weirdo CEO anecdote' as a hook into why a company failed trope. Make no mistake: if Babylon were currently worth $20bn, Antigua standups and calling employees Babylonians would be the subject of business-school case studies.

That said, this is a puff piece in Wired for so many reasons, not least of which is the question of whether or not app-based diagnosis and triage is a good idea. It seems to me almost certainly the future, and while Wired notes that a UK physician thinks Babylon sucked at this, it makes no effort to review any recent literature on AI capabilities. My limited understanding is that AI capabilities for triage and diagnosis are pretty hopeful right now.

I guess: "IPOed too early, didn't preserve cash, got caught in the end of zero interest rate investing" is too short to deserve a full article.

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If you go to any startup founders gathering, I typically wonder "I am usually the biggest weirdo in the room. But in this crowd I feel among the most normal people ".

And it's still true for the later stage startups as well, but indeed it's the most prominent at the seed stage. There's really just a lot of weirdos among startup founders.

I think it was IBM that demonstrated in the 80s that a decision tree out performed doctors at diagnosis.

Given what inputs? Doctors don’t seem to be very competent at diagnosing things without a bunch of very expensive tests for unrelated things first and even then it’s just weeding out what it isn’t rather than accurately predicting what disease a person has.

I don't know if IBM created anything in this area back then, but the MYCIN expert system was developed in the 1970s at Stanford. MYCIN was shown to outperform infectious disease experts by 1979 in a blind testing:

>... Eight independent evaluators with special expertise in the management of meningitis compared MYCIN's choice of antimicrobials with the choices of nine human prescribers for ten test cases of meningitis. MYCIN received an acceptability rating of 65% by the evaluators; the corresponding ratings for acceptability of the regimen prescribed by the five faculty specialists ranged from 42.5% to 62.5%. The system never failed to cover a treatable pathogen while demonstrating efficiency in minimizing the number of antimicrobials prescribed.

https://jamanetwork.com/journals/jama/article-abstract/36660...

https://en.wikipedia.org/wiki/Mycin

I wish I had the link to the YouTube video where a researcher described one of the main reasons why MYCIN failed. Because when you optimize for number of patients per doctor, it is a lot more cost effective to prescribe a broad spectrum antibiotic that kills all pathogens and move on to the next patient than it is to spend time with one patient and MYCIN to narrow down to the exact pathogen.

And that worked out well! When you optimize for reducing costs, not outcomes, the outcome you get is antibiotic resistant bacteria!

Seriously though, if we take a "maximize outcomes" approach, then doctors don't actually need to spend any time with a patient - the computer can do it. Maybe this isn't optimal for wealthy first-worlders, but it will be better than what poor first-worlders and everybody else have now. Many people in the US simply do not go to the doctor, unless it's an unavoidable ER trip.

First line diagnosis is one of the hardest things we expect doctors to do. It's unlikely to fund a unicorn though, because it's also one of the least well paid activities for a doctor.

Good value for patients who can't find/afford a doctor, then.

Babylons was really basic and what they effectively mostly seemed to do was really basic.

Obvious shunt the really urgent stuff off to A&E without talking to a doctor first, and nudge less serious things to an Advanced Nurse Practitioner, who would be cheaper for them.

But I imagine there's a tricky tradeoff there where every ANP consultation that leads to a referral back to a doctor because the ANP couldn't address the issue ends up costing them their savings from multiple ANP referrals.

My Apple ][ came with a BONE TUMOR DIAGNOSIS program written in Applesoft on the contributed software floppies from Apple, "COPYRIGHT 1978 APPLE COMPUTER, INC." You might consider it Apple's earliest AI Powered Health App! You can run it in an emulator here:

https://archive.org/details/a2_Biology_19xx_

    Text found in Biology_19xx__.do/BONE TUMOR DIAGNOSIS.bas:

    0 TEXT : GOTO 2000
    19 DIM PB(9,19)
    20 FOR I = 1 TO 9: FOR J = 0 TO 18: READ PB(I,J): NEXT : NEXT
    25 DATA 15,20,35,45,20,80,99,1,100,20,40,60,1,0,15 ,35,50,0,0
    26 DATA 5,75,20,5,20,80,100,50,75,0,90,10,0 ,30,50,35,15,0,0
    27 DATA 3,50,35,15,30,70,30,20,100,25,85,15,0 ,2,85,15,1,0,0
    28 DATA 17,25,25,50,35,65,40,1,85,65,20,80,5,65,15,20,25,25,15
    29 DATA 10,20,20,60,5,95,55,0 ,90,65,20,80,25,2,0 ,10,40,30,20
    30 DATA 25,65,25,10,10,90,30,05,95,75,15,85,98,05,0, 0,10,30,60
    31 DATA 5,20,35,45,0,100,30,1,100,50,25,75,100,5,15,25,55,5,0
    32 DATA 15,70,25,5,35,65,20,5,85,90,15,85,0,0,0,5,10,20,65
    33 DATA 5,10,25,65,20,80,50,1,85,80,15,85,0,0,0,0,20,30,50
    49 FOR I = 1 TO 10: READ Z$(I): NEXT I
    50 DATA I-A,I-B,I-C,II,III,"95-100%","40-95%","25-60%","15-35%","4-15%"
    55 IF NOT Q THEN NEW
    60 DATA GIANT CELL TUMOR,CHONDROBLASTOMA,CHONDROMYXOID FIBROMA,CHONDROSARCOMA
    62 DATA FIBROSARCOMA,OSTEOSARCOMA,PAROSTEAL SARCOMA ,EWING'S TUMOR,RETICULUM CELL
    70 FOR I = 1 TO 9: READ DIAGNOSIS$(I): NEXT
    80 FOR I = 1 TO 9:PB(I,19) = 1: NEXT
    90 HOME : PRINT " THIS PROGRAM USES A PRIOR PROBABILITY"
    92 PRINT "MATRIX PUBLISHED BY G.S.LODWICK M.D. IN"
    94 PRINT "THE RADIOLOGIC CLINICS OF NORTH AMERICA"
    96 PRINT "IN 1963."
    98 PRINT : PRINT "THE PROBABILITY OF THE DIAGNOSIS IS"
    99 PRINT "CALCULATED USING BAYES' RULE FOR THE"
    100 PRINT "PROBABILITY OF CAUSES"
    102 PRINT : PRINT "NINE DIAGNOSES ARE CONSIDERED"
    105 FOR I = 1 TO 9: PRINT I; TAB( 4);DIAGNOSIS$(I): NEXT
    106 PRINT : PRINT "THIS PROGRAM MAY NOT GIVE THE CORRECT DIAGNOSIS. FINAL DIAGNOSIS CAN BE OBTAINED ONLY BY BIOPSY"
    110 PRINT " HIT ANY KEY TO CONTINUE";: POKE -16368,0: GET A$

[...]

    2000 HOME : VTAB 5: PRINT " COPYRIGHT 1978 APPLE COMPUTER, INC."
    2010 FOR K = 1 TO 2500: NEXT K
    2050 VTAB 12
    2060 PRINT "THIS PROGRAM IS FOR PHYSICIANS ONLY!"
    2065 PRINT : PRINT
    2070 PRINT "IT IS DESIGNED TO BE USED AS A SINGLE"
    2080 PRINT "TOOL WHICH, ALONG WITH MANY, MANY":Q = 1
    2090 PRINT "OTHERS, CAN LEAD A QUALIFIED PHYSICIAN"
    2100 PRINT "TO A PROPER DIAGNOSIS."
    2105 PRINT
    2110 PRINT "ANY USE BY A NON-QUALIFIED PERSON TO"
    2120 PRINT "DIAGNOSE ANY CONDITION WOULD BE"
    2130 PRINT "GROSSLY MIS-LEADING AND DANGEROUS."
    2150 FOR K = 1 TO 18000: NEXT K
    2160 GOTO 19
    3000 REM BASED ON A PROGRAM BY JEFFREY DACH M.D.
    3010 REM 909 ROSCOE CHICAGO,ILL.60657
    3020 REM COPYRIGHT 1978 APPLE COMPUTER, INC.

What -- are you telling me that WIRED MAGAZINE does PUFF PIECES??!

You've Got Smell!

https://www.wired.com/1999/11/digiscent/

>But the orange peel is just the beginning, a humble hors d'oeuvre. Marc Canter, sometimes known as the father of multimedia, joins us to serve the multiscented main course.

With Marc Canter as boastful spokesman, biggest weirdo, proud maître d', and influencer under the influence of the munchies, it's more of a Puff Puff Pass piece.

>"You know, I don't think the transition from wood smoke to bananas worked very well." -Marc Canter

https://news.ycombinator.com/item?id=29225777

Babylons triage was a set of very basic questions. The problem here is there is only so much it helps you. They would try to use it to shunt you to Advanced Nurse Practitioners instead of GPs. Which is fine - I'd often pick one myself if I knew that'd likely be enough.

But it'll be rare they'd be able to safely tell people they don't need an appointment, and I'd have to imagine it doesn't take many ANP appointments leading to a referral to a GP before their savings from referring to a nurse first disappears.

I'm sure it'll eventually pay off, but I'm not sure just how many appointments they can avoid that way.

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