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Comment by dave_sullivan | Hacker News Reader

Where do you see room for improvement, if any, for blood testing? As far as I can tell based on what I've read and what you've said, they've basically made certain types of blood tests easier, cheaper(?), and accessible via an app? Is that accurate? If so, even without any new technology, that seems like it could be interesting, if only as a business with a marketable product. Not sure about $10B interesting, but hey...

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The 10b valuation is nuts. That's more than LabCorp or Quest, two companies that already do lab actual lab tests on real instruments for hundreds of millions of people. Yes, it looks like you can get results online from Theranos, but you can do this for lots of labs, as well. Theranos' app is undoubtedly slicker...Silicon Valley can afford better software people than labs can. As for improvements in labs today.... Our financial structure is crazy. Fee for service drives more testing, when in fact the main problem in US medicine right now is that we do too much testing (overall...there are still some areas where we need to do more). The solution to test overutilization is not making tests cheaper so folks can get more tests at Walgreens. One answer could be the current ACO model (or it's logical extension, single payer or socialized medicine) in which the goal of care is the health of the patient, not the profit. Once hospitals and labs are payed by the person, not by the test, we're gonna find lots of surprising ways to stop letting folks get tests they don't need, since the answers to those tests will often be misleading, require expensive follow up, etc... To the folks on this discussion who think that they would prefer to be able to go and get frequent tests (or, god forbid, get frequent Lyme serologies, which borders on outright quackery), I would say this: you can't handle the truth. Really. There is a reason why we put doctors as gatekeepers between patients and medical services like MRIs, lab tests, and chemotherapy. It's called Bayes Theorem (it's on Wikipedia). If it's exceedingly unlikely that something is wrong with you before you get a test, then it's still exceedingly unlikely you have the condition even when you get a positive test for it. This breaks down when the doctor does a bad job, since it's the doctor's job to select tests only in those with higher pretest probabilities, but it is an inescapable issue. I realize also that suggesting that laypeople are too ignorant to take their own health into their own hands sounds not even a little elitist, but it is sorta true. One of the main concerns for healthy people should be staying OUT of the medical care system, because we hurt people sometimes, even when we help them. The lab is a gateway to the medical care system, so unless you want to go through the gate, stay away.

If you have tests that don't provide information, that's the problem of the test, not the person getting it. Doctors are still the people actually handing out prescriptions, so if they start telling people, "Look, this $10 test from Theranos isn't reliable as a predictor, stop doing it.", it will create a feedback loop that will stop people from doing those tests that, as you say "border on quackery".

Meanwhile, if I suspect that, for example, that my BMI veers into the obesity range when my TSH is high, it should be perfectly fine for me to try and get a $50 test to examine if there's a correlation. Better than spending that on a DVD of Keeping Up With the Kardashians, don't you think? Might even increase awareness about general health in the US.

You misunderstand Bayes. The point is that the test is the test, and the information value is all dependent on the person getting it, not the test.

>Silicon Valley can afford better software people than labs can.

LabCorp made (income) $600 million last year. Quest made $1.5 billion.

They can afford teams of very capable developers. They can have the best software, the best presentation, slick mobile apps, speedy information systems.

They don't not because they can't afford it, but because they don't want to afford it. As is the case with many of these companies that get disrupted by tech startups, they see it as a cost center and minimize it.

Software rules the world. Any business that doesn't adapt to this will see strange little upstarts steal all of their thunder.

Is there really an over-utilization of blood tests? MRIs, yes, but I'm not sure that right now we're really doing too many blood tests.

Regarding your point on Bayes Theorem, that's valid in some ways and invalid in some ways. Suppose someone gets a vitamin D test back at 8 ng/mL. There's not really a chance of a false positive. He's deficient and needs supplementation. Making the test cheaper, faster, and more accessible can really only improve the health of the population. It will likely also drive down the cost of healthcare overall, because vitamin D deficiency has all sorts of unpleasant effects.

Furthermore, the literature suggests that the vast majority of doctors do not understand Bayes Theorem. Source: http://yudkowsky.net/rational/bayes

You are demonstrably wrong about the vitamin d. What if it was a specimen swap, and the lab screwed up and tested someone else's blood instead of yours? This happens.

The cheaper and faster the tests, the easier it is to reorder a confirmation (or two or three).

And then what.... Rock Paper Scissors for which one is correct?

Let's be real, the vast majority, even much of what is and comes out of YC is barely more than what used to be snake oil salesmen and infomercial scam artists. (sorry, YCers, for causing that cognitive dissonance, but I would also like YC to focus on primary products that produce value in and of themselves and not just as, e.g., a dependency on something else)

There is maybe some marginal streamlining or process improvement possible, but you can already get blood drawn and a little while later have the results accessible on a mobile device. Sure, maybe the blood can be processed faster and those results should be available sooner and available to outside parties so you can use various apps and services; but that a policy and political problem, not really a technology challenge.

This company is just another one of those paper tiger companies... or maybe paper unicorn is a better metaphor ... who make something that is wholly unnecessary and the only thing they are good at is manufacturing buzz. Their technology solution seems to be an unnecessarily complex solution to a simple problem. We don't need to "know what your body is doing so you can live a healthier life", we just need to eat better and exercise far more. It's that focus on symptoms rather than causes that annoys the heck out of me. But I guess they have learned from the perpetual dependency model. You don't get to be a paper billionaire by telling people to stop being unhealthy, you become a paper billionaire by selling unnecessary stuff.

"make blood tests simple, timely, unalarming and cheap" sounds pretty valuable to me. I suspect there are billions of people who rarely, if ever, have blood tests (impoverished areas, children). And then in developed areas, I could easily see blood tests becoming a daily thing (or multiples daily). Athletes might do them every few minutes. Etc.

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