Google Co-Founders on Healthcare: “Thanks, But No Thanks”

Same principle, different domain.

Also, whether or not people care about their privacy doesn't mean it shouldn't be protected. Not just for themselves, but for their family as well. --Let's say I don't allow my medical information to be used, by my brother does. If he has a genetic disease and a potential employer finds out about it, they might decide not to hire me because there's a chance I may have it as well, which could cause problems if it ended up needing treatment. Laws that prevent discrimination are all well and good, but the problem can be proving the reason they decided not to hire you.

The first part of the sentence is flawed, so the latter doesn't follow. It implicitly assumes that people even understand how things work (they don't, imho) and therefore can make a sound judgment, based on that knowledge.

For example, I could argue that people simply don't value their future selves (ie 30+yrs), otherwise they wouldn't be eating all this junk food now and never exercising. In some sense that's true, but it's mainly driven by ignorance.

This is a forum for/about startups. He made a statement relevant to startups. What exactly are you mad at?

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.

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.

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.

Also, all land (more or less) is already in one country. Turning to split off a piece of one country into a new country is often quite deadly. Literally.

If you actually read the article, it happened due to the absence of regulation. Hospitals formed an entity (the GPO) to bargain collectively for lower prices from suppliers. This is a classic example of collusion. The GPO started negotiating with the suppliers for a cut of the contracts that they entered into on behalf of the hospitals. This is a classic example of the principal-agent problem. As a result, Retractable Technologies' couldn't break into the market.

Collusion and principal-agent problems arise naturally in free markets. Indeed, the usual response to them is regulation. Antitrust enforcement would've prevented the hospitals from colluding with respect to purchasing supplies, and as the article points out, Medicare's anti-kickback provision, had it been applied to the GPO, would have reduced the principal-agent problem.

To the extent that the first part is true [1], the second part is not true in any substantive way -- the privacy protections restrict what can be disclosed without your consent. So, yes, you can effectively "opt out" of any of the restrictions by consenting to disclosures.

[1] HIPAA -- the Health Insurance Portability and Accountability Act -- exists, in terms of direct goals, mainly to look after your interests as a potential purchaser of health insurance, the as-a-patient privacy protections are secondary to that, and were put in place in HIPAA, and subsequent revisions, to mitigate political opposition to the incentives for automation and related standardization of electronic transactions provisions designed to make the health insurance system -- both in terms of enrollment and claims processing -- more efficient.

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.

http://www.bloomberg.com/image/iFbqs_CCtc4k.png

The VA has asked for budget increases many times, but was denied by congress. The result is completely predictable.

And if the patient survives, but has a debilitating condition that was a side-effect of that risky drug, then claims he was going to survive anyway and now his life has a shattered quality because the doctor prescribed an drug that hadn't been fully cleared yet? It's not as black and white as you're painting it, and drugs are not always silver bullets that save your life and send you back to playing the violin like the virtuoso you once were.

Conversely, if you didn't have that regulation, you'd have medication with a much lower quality - more people dying, and more negative side-effects for the ones who survived. Plenty of drugs look promising at the outset, then turn out to have serious issues.

http://sunnyday.mit.edu/papers/therac.pdf

http://courses.cs.vt.edu/professionalism/Therac_25/Therac_1....

plenty of other reading: https://www.google.com/#q=therac-25

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.

While it seems to go against "do no harm" ,in reality many low cost products can start at low quality, but with time and experience improve while still offering much lower costs. So the logic can make sense.

Not sure it works for vaccines thought.

Also i wonder: what were the benefits of the vaccine you described ? were they weighted against the slight harm ?