My new medical research startup launches today: let me know what you think
metamed.com
metamed.com
That doctor was disbarred (http://w3.health.state.ny.us/opmc/factions.nsf/cd901a6816701...) for writing online pharmacy prescriptions.
Same guy?
Unfortunately, main site not working for me.
So, "at least two of our expert researchers will validate test results to rule out any errors"?
What does that mean, exactly? As a board certified pathologist, I have some idea what I mean by validation, but what do you mean?
Next, the featured testimonial from "Jerry W." sounds fishy - it may be genuine, but it seems like it was written by marketing, and lacks any detail to provide credibility to skeptical evaluators.
Next, when research is published, there is a p value, perhaps 0.04. When you provide your recommendations to patients, I'm sure you are smart enough to hedge appropriately. How do you communicate that? Do you guarantee follow-up if new research modifies the confidence of your previous recommendations?
Finally, research evaluating one treatment versus another typically are provided in the context of routine patient care for the average patient. Your clientele here, clearly, are not run of the mill patients. With the proposed fee structure, they are also not likely pursuing routine treatment. This suggests that routinely published research will be less applicable to your customers. This amounts to being a huge selection bias. How do you plan to adjust for this issue? (As a specific example for one class of these problems, for those not familiar with these kinds of issues: the reason we don't perform routine mammograms in women starting at age 20 is not just cost - the prevalence is so low in this age range that the false positive rate is very high. So, patients who obtain a mammogram at age 20 for "screening" are at higher risk of false positives.)
I see how that issue - name/history/etc. - would make it hard to provide credible success stories.
Site still not working for me, so this may be there:
Perhaps, someday, maybe include a patient story or two with medical history but no name? (With appropriate HIPAA waivers...)
Even better, it would be WAAY awesome if you posted, whenever possible, the results of your research on your site for review by anybody. It may not be in your current business model, but the "giving back" angle might be the edge that pushes you into popularity.
> We work with you and your doctor to figure out how advances in medical science apply to your personal health needs. Our team of researchers will do in-depth, personalized analysis to find new technologies, read scientific journals, talk to experts, and separate real medical breakthroughs from media hype. Whether it’s testing, prevention, treatment, or nutrition, if you have medical questions, we can help inform you about what the options are and what a rushed, ten-minute appointment might have overlooked.
Pricing:
> $5,000 (Surface); $25,000 (Depth); $250,000 (Comprehensive); $1,000,000 (Original Research)
"Concierge" for medical service feels a little cheesy to me, but I'm not in that income demo so I could be completely wrong.
The sample Surface report looks kinda thin to me for $5,000. http://www.metamed.com/static/Meta_Sleep.pdf
The Expanded report is a little better. http://www.metamed.com/static/Meta_H_Pylori.pdf
The Sample Concierge report is interesting. Though from an admittedly quick skim I'm not sure how much of it is truly personalized. There's a lot statistics in there, which I guess is unavoidable. http://www.metamed.com/static/Meta_Gout.pdf
In any case, I like the basic idea of this a LOT. It's an interesting direction to go in, bringing this kind of thing to semi-mass market.
By the way, the line "Our doctors are here to listen" in the call-or-chat box is brilliant. The couple of people I know who have problems they would need to take to this level are completely fed up with doctors that they feel aren't listening to them. This is the market. People who are in strong need of personal level attention.
No kidding. For three pages, effectively (with lots of whitespace).
In fact, for $5,000, your actionable items on the subject of "Difficulty Sleeping" are:
1. Get tested for sleep apnea. 2. Take melatonin. 3. Reduce caffeine intake.
Seriously? The first item is "get tested for thing you are complaining about"?
http://www.medicinenet.com/insomnia/article.htm - I typed in "Difficulty sleeping" into Google, and got this result as the first. It included all three items from the report and took somewhere under sixty seconds to find.
Don't get me wrong - this, and essentially anything medical - is ripe for innovation (I'm working on a almost polar opposite idea myself), and there are some good advances in expert systems for diagnosis that I've seen.
But if you're attempting to get $5,000 to $50,000 out of someone, the sample report you're showing isn't selling it, at all.
(I can send you a bunch of our more current research tonight if you're interested in this particular subject - email me at avance@metamed.com)
It's actually an accepted term, albeit in a clinical context: http://en.wikipedia.org/wiki/Concierge_medicine
Insurance providers will spend a lot of money telling you, advertising aimed at "taking better care of yourself" (that they should "need" to do so is a different, though sad, indictment).
Go ahead, then. Tell 90% of insurance carriers that you have committed to, documented yoga, gym attendance, walks every day. Ask them what premium reduction they're prepared to offer as a result. Be ready to hold the phone away from your ear as they laugh.
Ask them how much they'll contribute to your weight loss efforts.
Then ask how much they'll cover of your gastric bypass surgery.
The problem with health insurance in this country is that it's not "insurance" at all. It's amortized healthcare. And surprisingly enough, most insurance providers are not charities. They make a profit off of what you are charged.
Pre-existing conditions are a fun one. Actuaries have spend countless hours analyzing and modeling segments of the populace. Along comes John Smith. He's seeking healthcare. He happens to have a pre-existing condition, say, gout. But he's young, in his thirties. He gets a gout flare-up once, maybe twice a year, and a dose of OTC NSAIDs is enough to take care of it. He knows that in time, his condition is likely to worsen, and that he'll need more active management.
But right now? He doesn't care. He's not seeking out health insurance as a result of his condition. He's just looking out for his general health.
The preponderance of a population to have this condition, and ergo this average healthcare cost, hasn't increased by virtue of him wanting insurance. But you watch, as a carrier will deny him (or at least subject him to extensive waitlisting).
I don't know how widespread it is, but the two major insurance carriers in my area (Rochester, NY) both have plans where can earn credits (up to ~$500) for healthy behaviour - gym memberships, yoga, etc.
> The preponderance of a population to have this condition, and ergo this average healthcare cost, hasn't increased by virtue of him wanting insurance. But you watch, as a carrier will deny him (or at least subject him to extensive waitlisting).
This, definitely. I know at least one person denied health insurance due to seeing a therapist for three months while having a rough spot in high school. It was nearly a decade ago and the therapist wrote a letter along the lines of "situational, no ongoing issue, no condition remains". No dice.
Also, as someone who spends a lot of time working with doctors, the current medical system does not train people to look at things in detail and connect subtle dots - it trains people to run around doing everything as quickly as they possibly can. (Ask anyone who's in residency if you don't believe me.) A significant part of our advantage is that we can spend much more time on a single patient than a standard ten-minute consultation.
The way I'm reading the site, it feels more like a one-shot "we'll run a bunch of tests and give you a single comprehensive analysis" which seems like a good idea in theory, but scares me in practice.
Most of us have diseases that are horses not zebra - and you have a strong financial incentive to encourage hypochondriacs to keep hearing zebra.
If my condition has Gregory House stumped, sure ill pay you but otherwise that lump on your skin is a cyst not a tumour and that shortness of breath is lack of fitness not a heart failure.
That said, here are a couple things which make me skeptical about this:
1) They make claims involving rounded numbers without sources, such as "50% of second opinions contradict the original diagnosis." That's a red flag for me. Would be nice for me to see some sources for claims like that on a site wishing to sell medical research services.
2) Several of the medical researchers do not have a background in anything medical. In fact, one of the senior health researchers' area of expertise includes herbal medicine and Naturopathy (which is a bit anti-vaccination: http://en.wikipedia.org/wiki/Naturopathy). I would not be happy If I got suggested any alternative medicine remedies for my disease at the cost of $5,000.
Side effects of digitalis (the active component) toxicity include but are not limited to DEATH
Saying take foxglove instead of digitalis is kind of like saying take willow bark instead of aspirin, but potentially MUCH MORE DANGEROUS.
If what you mean to say is 'we shiuldnt give profits to the pharmaceutical-medical-industrial complex because I believe it is acting against my best interests' then go ahead and say so; however if thr best example of an 'alternative' medicine being efficacious or safer is foxglove you are woefully underinformed
As the saying goes, alternative medicine that works becomes medicine. That is digoxin
So, we have its derivative, digoxin, available as a prescription medication. And many people do take it. It's helpful for some symptoms of heart failure. One thing it doesn't do, quite notably, is reduce mortality. Anyway, this is an available, commonly prescribed treatment
Not to belabor the point, but I was hoping to hear about alternative medicines that are not accepted but have evidence supporting them.
[1] = http://www.accessdata.fda.gov/scripts/plantox/detail.cfm?id=...
The vast majority of patients have routine problems. Though these might be distressing to the individuals, the "standard of care" (assuming correct diagnosis) is established practice, and this service would not affect that.
For the few with very rare conditions, or with useless primary care physicians, this service might be useful, however the price is very high for what is essentially a diagnostic/referral service.
Nevertheless, I think it could be commercially successful, given the number of people who think they know more about medicine and medical practice than their doctors do.
I could not find a publication supporting that assertion after a brief pubmed search. Can you provide one?
http://link.springer.com/article/10.1007%2Fs10902-011-9257-7
Claims that have some truth to them, but which are not correct, are both endemic to and hazardous in healthcare. I will argue that in this type of conversation, claims of fact that are disputed but ultimately unsupported must be taken to be false until shown otherwise.
(The fulltext of the article that you found doesn't use the terms "SSRI", "medication", "drug", or "therapy", but I haven't read it in depth to see if they're using some unusual synonyms.)
The site is down so I have to go from the headline, but I'd ask the same question: how would this service affect clinical management? Can you offer an example?
Yet, a lot of unnecessary tests are run daily at every hospital I've seen. But what's worse is that often times doctors are reluctant to find out more about a patient's illness simply because they believe "it wouldn't affect treatment and it's not worth it anyway". It doesn't take a scientist to figure out why this approach can be disastrous. At the same time, high-paying private patients are often considered to be worth finding out the specifics.
The whole system of clinical knowledge and action is broken from this point on. Doctors often do not keep current with advances in medical research, and I encountered a few who are actively opposed to it, asserting that medicine should not go any further than it does today because it's considered "unnatural".
Medicine is in danger of becoming scientifically bankrupt. This startup, while I think it's a great concept, is a symptom of this disease. Practitioners, even in the odd case they're interested in advanced knowledge that is not being passed down from whoever the resident rockstar surgeon is, generally do not have proper access to current knowledge and statistics.
It seems to me this system, where a life is more often than not considered ephemeral and expendable (except if you're a small child or a pregnant woman), this system is broken and cannot in its current form provide the services we will need as our civilization advances. As it is, this system plays into the hands of religion and pseudo science (a trend which doctors are generally comfortable with), and it is one of the dehumanizing factors that make our hospitals places of desperation instead of regeneration.
Some tests will not change management (just get a chest ct? no chest x-ray needed); other tests could change management but are unlikely to have an unusual result (have appendicitis? skin biopsy is probably not indicated). So without context it's possible to both agree and disagree with you equally emphatically.
> At the same time, high-paying private patients are often considered to be worth finding out the specifics.
More often, it seems that people who can pay push for and get unnecessary services, finding out specifics in a way that does not affect management.
I am still very curious to hear from the creators of this company how they think it will affect management, and whether they have an example.
Medicine needs a huge amount of change. Whether or not this affects management basically determines whether this has utility or is simply high-end entertainment.
That's got some rationality to it, but how do you value the impact to the patient of simply having an answer? I know people who've broken down and cried with relief when they finally knew what was wrong and the search was over, even though it just meant a lifetime of living with the disease for them.
In other posts I offer examples of tests that would not change management, and surely experienced clinicians could offer myriad other examples. (A lot of it depends on the clinical context.)
But thank you for bringing this up; I agree that a diagnosis is, in itself, valuable for patients (and care providers).
It's not everyday medicine where you work on simple problems following a statistical approach - an appendicitis is more likely than a Meckel diverticulum, and a simple overeating is even more likely than both.
But there are complicated cases - not very often, but that's the one I like, and that most of the passionated doctors do too. Hell - I love such cases.
A quick story - I once had the chance to make a one-in-a-million diagnosis while working in the ER of a small hospital, around 2004.
A patient presented with a psychiatric history and a psychiatric diagnosis, but somehow it didn't feel right. I had this odd feeling when talking to the patient - no psychiatric symptoms of no kind. It seemed wrong. I ordered basic blood tests (checking for hyponatremia, etc), X-rays - all normal.
It was a bit late so I asked for the patient to be served a lunch before being discharged, deeply unsatisfied. Around 10 minutes later, the patient had a new episode - but this time it was in an hospital and I did not have to rely on eyewitnesses - it looked a lot like neurological problem, not a psychiatric problem.
After another round of blood tests (I don't like it when I don't know what's happening), brain scan, etc. everything was normal. I noticed the glucose was normal - it should not be, since the patient had had an hospital lunch (in my hospital it included marmelade, and all kind of sweet things!)
So I ordered a test to check for insulinoma (I'm weird, I know - its incidence is like one-in-a-million) because it made sense - and the test was negative.
At this time, I was just a medical resident - the seniors were a bit mad at me for having spent so much time (and costly diagnostic procedures) on what was proven wrong, and what should be wrong in the first place - because it is so unfrequent. And that's not what one is expected to do in the ER (fortunately, it was late at night)
Yet I wasn't satisfied, so I asked the patient to be transferred in the university hospital neurological department for further tests. Something was happening, we didn't know what, someone had labelled the patient "crazy" (not politically correct, but truth is psychiatric patient issues are usually less investigated) but there was something.
Guess what- weeks later I got a letter, they found it was a rare variant of insulinoma that our basic test did not detect.
That's one of my best moment in life !! That day I made a difference - I removed a wrongful psychiatric diagnosis and gave the proper diagnosis. Patients with insulinoma should not get institutionalized in a psychiatric hospital.
That's the medicine I love. Fixing basic problems is the job a mechanic.
The kind of medicine I love is unfortunately not possible with the current healthcare setup - and even with usual patients, because most people don't care. They want a quick fix.
This startup idea is just great, to take care of people who want the real deal. I wish you luck!!
I'm sure you will find great clinicians who will take going as deep as the rabbit hole goes to give excellent care.
Where those tests really expensive though or do you mean what you could have charged?
In the ER in France, it's more or less a flat rate that gets charged - which incentivizes cost reduction. There is an exception if the patient is admitted, but with the billing rules of the time, it reverted to a flat rate if the patient was transferred to another hospital.
Considering this was not the patient first contact with an hospital and that the last times they had found nothing (it didn't seem to me they looked very hard), I just couldn't pass the bucket and hope this time they did things right - the last few times they didn't, so why now?
Working in hospitals taught me at least one thing - never trust other people work. You want something done well, you do it yourself.
Sorry if that doesn't make me a team player, but I've seen so many bad things happen :-(
[Another thing I learnt today - when one remember work stories 9 years later, it usually does not speak well about the work environment]
1) Pricing- even the most basic package is ridiculous. For $5000 I would not only fly to your city to spend as much time with you in a face-to-face meeting discussing your medical problems, but I would give you my personal cell phone number for any questions or concerns at a later date.
2) Chart reviews- I don't know the credentials of the people doing the reviews, but I am highly suspect of anyone other than a board certified physician in a given specialty providing medical advise or in any way guiding diagnostic decisions.
Having said that, I think there is real opportunity here. I wish you the best of luck.
It seems that the Singularity Institute also reads James Altucher: http://www.jamesaltucher.com/what-is-the-quickest-way-to-mak....
My guess is that your "productize step" is to also use your researchers to train a specialized medical search engine you'll keep on the back-end (sort of a Mahalo+Watson).
If that isn't what you're doing, let me know. Maybe I can help get you there.
I'd have more comments, but the site appears to have gone for now...
Health Researcher: Justin Alderis is an Eagle Scout who co-chaired the Princeton Philosophical Society for four years while he earned his BS degree from Princeton University, with a focus on the philosophy underlying cognitive science.
Edit: 38 minutes later, we're up.
But I feel pricing model needs a revisit.
For patients with some serious ailments this is all fine but what about less serious issues like..a person with allergies, thyroid, migraine etc. These are kinds of things which bother people but still not enough to spend 5000 for analysis.
Probably a profile based pricing is a good idea? Just a thought.
So my point was to pay more that 20 but less than given minimum 5000.
$5,000 would buy me consultations with 250 allergists, who'd likely be basing their conclusions on the same sort of research available to the health researchers at MetaMed, as well as it being their actual medical specialty.
Good luck.
As someone with a 1000 moles who have been diagnosed with melanoma (luckily early stage and now removed) would this service be of any good for me?
Been quite interesting (and scary) to go through the US healthcare system coming from Denmark.
Unsurprisingly I suppose, you're not that rms.
Don't be that guy.
Pardon my skepticism, but that sentence and the rest of your not-functioning-very-well website smell of nothing more than an attempt to ripoff very vulnerable people, and other marketing bullshit.
But do please prove me wrong - kindly link to the world-class research your docs and researchers have done thus far.
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econ BA/finance (labeled researcher)
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Starting a company like this with med students (I'm sure she's nice, but the VP of Biology hasn't even finished her MD yet), is not the way to do this. It's a way to get sued.
So while the goals may be good, this is not the way to do it.
Also, why the rudeness? In terms of the disagreement hierarchy (http://www.paulgraham.com/disagree.html), you're using DH1 through DH3 - attacking credentials and tone rather than facts.
I think you've got things turned around a bit here. He's not using claims of authority to spuriously attack an argument that you're making. You are the one asserting authority, and he's asking for proof. Since you are basing some of your credibility on authority, it seems like a reasonable request.