Startup Ideas

> A smart contract that auto-pays upon (phased) delivery, etc.

That's a solid idea in theory. We tried something similar but had a tough time getting companies to be comfortable with the autopay feature (e.g. like your comcast or cell phone bill) because most people think that the role of accounts payable is to pay as slowly as possible without pissing off your vendors. That means that the squeaky wheel gets the grease, but to nag politely is a nuanced art. The folks who do it the best manage the relationships with the people that actually cut the checks super carefully. They view it as the last step in their customer engagement cycle. Happy to chat more about what we've learned or how we're approaching this: carlos[at]tesorio.com

I'm an MD, practicing in the US.

I don't know the actual legality. But here's what I do know from attempting to implement multiple projects within the US for clinical care and for clinical research: most providers, hospitals, and pharmaceutical companies we have worked with have balked at the ability to have high resolution data fed into their medical record or research data systems. In most cases, they are worried that if they had the data, they would have to act on it were something to be concerning. And they do not want that responsibility.

Example: we were in talks to feed in near-realtime blood glucose, activity, and blood pressure measurements from patients on a clinical trial. Surely that would be useful for better sussing out the effects of a research drug than the current process (patient comes in every few months to get measured or have their log data entered or meter data downloaded)? Nope, multiple top 5 pharma companies didn't want the responsibility and liability of seeing their data that often, because what if a patient had super low or super high glucose and they later died? You had the ability to act on it but didn't.

They'd rather just not have it at all. It sounds ridiculous. And again, I don't know the actual legal/liability issues, but based on my experience with malpractice cases, I could see a viable case to be made. And there are certainly institutions out there who believe the benefit is worth the cost of that responsibility for certain use cases. But my experiences have definitely made me reconsider some of these things.

All that said, I am definitely in favor of collecting more health data (somehow), because until we have more data we won't know its utility. So far, in general it has been shown that more testing and more information often doesn't lead to better outcomes, but the cost of data is getting lower -- aside from aforementioned liability cost/fear.

I find something unsettling about the idea of a social network for children. But social media is not going away. There should be a way to introduce people to it in a way that maximizes the value to the entire network.

It would be cool if there were a network where children can interact only with people close by IRL (school, neighborhood, etc.) Other participants are either simulated or are a filtered sample of the wider internet. Privilege to interact with a wider group and content is based on achievement in gamified lessons specific to understanding social media:

etiquette / discourse

    politeness
    avoiding negativity
    supporting others
    how to communicate for respect
    how not to argue a point

critical thinking

    determining the credibility of content
    political and commercial motivations for fake content
    recognizing specific trolling techniques

being aware of dangers

    bullying
    brigading
    doxing
    herd mentality
    to name a few

... would it be possible to also gamify teaching the difference between your and you're, or TO versus TOO, etc. I mean, what does it take.

Not sure about the systems you maintain, but mine page for false positives all the time. They're annoying, sometimes they wake me up, but in general they're not a big deal.

A false positive from a medical test is much more costly, both in money for a doctor (or doctor's staff member's) time, and anxiety for the patient.

That said, your brother's case makes some sense. It's targeted, and I imagine the action you want to take after getting an alert would be pretty well defined.

Okay, I really don’t want the data. I don’t want the data because:

(1) if I see something, I have to act on it, despite not actually having the knowledge of whether it means anything in this information-rich context. I just love things that -look- like information but that don’t actually tell me anything.

(2) we have a LOT of data suggesting that we do more harm than good when we try to intervene or investigate everything. For Pete’s sake, hospice patients outlive those who are actually pursuing life extension! Turns out every treatment has harms, and when you’re applying those harms to no benefit (because the patient is asymptomatic, or the anomalous event was never destined to progress to clinical disease), you just accrue harm that -looks- like care.

3) It is not likely to result in useful diagnosis, because catching shit pre-clinically offers little indication of what will or won’t become clinical. We see this in helical CT: a lot of people became “cancer patients” when helical CT came out, before we realized a LOT of growths recede forever without intervention - we just hadn’t seen them before, on the less sensitive tech.

If I see the data I have to act on it to cover my (American) ass, and I know I will do net harm to my patients. Thanks but no thanks. Do your due diligence: collect the data, analyze it, stick it in a properly randomized prospective study to see if you just trawled your way into an overfitted model, and prove that the intervention for it does more good than harm. THEN I’ll be delighted to use that specific data to pursue that specific intervention. Don’t just measure everything, throw it at my wall like hot spaghetti, and expect me to turn it into dinner.

-my blunt anonymous opinion, since it was asked for