Comment by dmk23 | Hacker News Reader

Comment by dmk23 | Hacker News Reader

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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...

EDIT: I actually believe Vinod Khosla knows better and he just made a troll statement on purpose. It worked, we are talking about it!

This is pretty spot on ( and I would not discount Vinod trolling ). We know healthcare can be done for less because folks like Doctors without Borders provide health care on a much smaller budget. But it is very hard to reconcile health care providers, health care insurers, and health care outfitters which have such a cozy relationship. Breaking all of those bonds at once is political suicide and thus not often embraced.

Its not spot on.

This debate is similar to debates about computer automation taking away jobs. The final result is, automation is inevitable. The biggest losers are those who resist it, the winners are those who learn before time and move to something else more productive. The same argument about unions, suppliers, OEM's etc can be applied to manufacturing industry. But delta improvements in robotics have been replacing humans and will continue to. There is little you can do against bit by bit delta automation happening every day. You can't protest against it, you can't stop it. But when look at it in a decades scale timeline you will see it is likely to be changing the whole scenario like never before.

Heck in our own industry IDE's have decreasing barrier to entry rapidly. The quality of skills required to write programs today is far lesser compared what it was two decades back.

You could argue every point in the world about why the doctors say in a judgement must be final. But that point is true if you prove doctors themselves don't make mistakes. Doctors make mistakes all the time. In fact ordinary down-the-lane doctors years into their practice aren't anymore helpful than what vinod describes them to be.

The point he is trying to is not that there would be a massive change tomorrow and doctors will be out of jobs. But automation in this area is inevitable. How many testing labs have lost blood sugar testing business to glucometers? That sort of innovation is inevitable. There is no point fighting it. Human beings will inevitably move to a higher levels in the productivity curve endlessly.

If the doctors don't want that to happen, they have to work to be better than machines. Not expect machines to be dumber than them.

I think a better strategy than to "replace 80% doctors" is to help doctors "replace 80% of their tasks". So focus on a business that makes a doctor's job much easier by identifying or confirming a diagnostic, or helping him reach a diagnostic much easier. The point is to get doctors to want this technology, rather than fight against it.

There are worse sources of waste in the health sector. In Sweden, and most other developed countries I imagine, the introduction of IT has resulted in less patient time simply because doctors are now legally required to work on filling out forms, documentation and other acts of IT powered bureaucracy. What's astonishing is that we don't know if all this documentation is doing any good, it's just assumed that it does.

So startups don't have to work on hard AI problems to make it big in the health sector. Removing the bureaucracy caused by IT is a much more attainable goal provided you're ready to fight policy makers who have created the regulations in the first place.

But we do know that good IT implementation do help:

"There is significant evidence that CDSS can positively impact healthcare providers' performance with drug ordering and preventive care reminder systems as most clear examples." (from a literature review)[1]

[1]http://jamia.bmj.com/content/18/3/327.short

The other 20% of the tasks that aren't easily automatable or done by a computer ironically are often the tasks that doctors have already delegated to nurses (RNs and NPs).

Personally I see a future of healthcare with more nurses and fewer doctors. Technology bridges the knowledge gap between nurses and 80% of doctors.

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.

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>

The computer has decided you don't have hypothyroidism either, the doctor you can at least persuade otherwise.

I've read my chart. It's full of the doctors' logic based on facts. Computers are good at that. Medicine isn't magic.

I've read my charts as well, they're made up of a mix of facts, intuition and conjecture. The later two being things which computers aren't very good at.

Medicine isn't magic, but it's also more than a checklist which gives you a definitive answer at the end, that's why the process of becoming a doctor is as much an apprenticeship as it is rote learning.

What is conjecture besides probability, which computers are great at? Intuition is creating new information from an understanding of how things work, and is therefore rarely needed when enough information is available. Doctors need intuition because they don't have detailed knowledge of thousands of individual cases in their heads. Computers will.

People keep trying to describe what makes medicine non-automatable, but they're using descriptions that apply just as well to driving. Non-creative work will be automated, and my understanding is that the vast majority of medicine doesn't break any new ground.

You don't have to go through doctors to improve the healthcare system. You can around them, to the health insurance companies that pay their checks.

Insurance companies are much more interested in statistics than doctors are, especially predictive models. If someone can find out how to use technology to make health insurance companies more money, the doctors will follow.

That is what IBM is trying to do with Watson initially.

These constraints are US-specific. Have you heard of Narayana Hrudalaya?

http://knowledge.wharton.upenn.edu/india/article.cfm?article...

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