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

thehealthcareblog.com

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

#131

Post by rayiner »

aestra wrote: post #101
gph wrote: post #6

Healthcare is heavily regulated, and I understand why some companies would be reluctant to branch out into it. But that doesn't mean the privacy and legal concerns surrounding HIPAA regulations are unwarranted. Yea, it would be nice if we lived in an ethical utopia where we wouldn't have to feel worried about people looking through our health records. But we don't. I would not feel comfortable with my health records…

It isn't just regulation, it is healthcare practically can't be entered in because of the established players and systems. Please read this http://www.washingtonmonthly.com/features/2010/1007.blake.ht... Guy made a company Retractable Technologies and made medical devices that prevented infections and saved lives. Hospitals won't buy it because of the system. Which happened partly due to regulation. This might also b…

> Hospitals won't buy it because of the system. Which happened partly due to regulation.

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.

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

#132

Post by k-mcgrady »

aianus wrote: post #129
k-mcgrady wrote: post #93

Earlier quoted context omitted.

Rightly so. If I recall correctly, instead of just providing the results to you they also included recommendations to try to prevent things their tests had shown you were at risk of. Their tests have never been vetted/proven accurate by anyone other than themselves so providing health advice based on them is reckless. If they were allowed to continue anyone could start their own 'DNA testing service' create bogus rep…

So what? I want to see my results. They make it clear it's not an exact science and they link to the relevant studies so you can make your own decisions. Why should the FDA prevent them from sharing that information with me? I'm not even American!

Did you read my comment? It wasn't about the results. You want your results - you got them. It was that they were providing recommendations based on the results which haven't been verified as accurate by anyone but 23andme.

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

#133

Post by chasb »

zmmmmm wrote: post #35

It's worth noting that highly regulated industries are not necessarily bad for startups to enter, exactly because they throw up particularly high barriers to large companies. Google can't enter health without accepting the full baggage that comes with that - people worried about their privacy, every random nutter looking to sue them and get a payday, FDA breathing down their neck every step of the way, etc. A small s…

This is a great point. Competitive advantages come from many places. Working in 1) an unsexy area, 2) a complex area, or 3) a regulated area can all be great advantages if you can manage it.

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

#134

Post by rwallace »

unethical_ban wrote: post #113
rwallace wrote: post #102

Earlier quoted context omitted.

So do I, but given the world as it is, wouldn't you much prefer some idiot marketing guy spamming you on the basis of your medical records, than a screwup in the chain of communication between your GP and spine specialist leaving you crippled or dead?

This is a false dichotomy. Can't we have secure, somewhat non-portable EHRs with super strong "Won't release without auth" procedures, or perhaps, as someone else implied, the data should be transfered via sneakernet on USB or similar? And how common, as a ratio, are crippling medical screwups related to multi-practice miscommunication? I'm sure the absolute number is non-zero, but risks must be weighed. If one perso…

Highly secure systems are possible in theory; we just don't have them today, and we aren't likely to have them tomorrow either.

Crippling medical screwups that could have been prevented by having the right information available at the right time are actually shockingly common. I don't remember the specifics, but I've seen claims to the effect of a five digit annual death toll in the US alone.

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

#135

Post by rwallace »

jerf wrote: post #106
rwallace wrote: post #102

Earlier quoted context omitted.

So do I, but given the world as it is, wouldn't you much prefer some idiot marketing guy spamming you on the basis of your medical records, than a screwup in the chain of communication between your GP and spine specialist leaving you crippled or dead?

Yes, of course. But "idiot marketing guy" isn't the worst case scenario, nor is it even the worst plausible scenario. Job loss and inability to get health insurance aren't hypothetical concerns... laws have been written about this because they happen, at scale. While I'm inclined to think the regulations as they stand today are heavy-handed and more expensive than they need to be to get the job done, that doesn't neg…

Job loss and inability to get health insurance are serious issues, granted. I will suggest the root causes of those need to be tackled for other reasons anyway, starting with the utterly insane practice of having employers involved in health insurance.

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

#136

Post by angersock »

fotbr wrote: post #104
angersock wrote: post #64

Earlier quoted context omitted.

Right, but unless you fuck up pretty badly software is not going to kill a patient directly (barring, say, pacemaker software). We had to do a risk analysis review recently, and figured that unless you physically dropped one of our servers onto a patient you couldn't directly cause harm. Anyways, you'd be a lot less concerned with regulation if you knew how brainfucked and unscientific the whole field of medicine see…

It does happen. I refer you to the Therac-25. 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

Yeah, I'm familiar with that--note again that that was a combination of hardware and software, and that the perhaps leading cause of actual damage was the omission of a mechanical safety interlock that existed on earlier models; with that interlock, the buggy software wouldn't have mattered.

There is a difference between embedded systems or devices (pacemakers, imaging devices, etc.) and EMR/records/data mining software.

The regulations are all calibrated to defend against a Therac-25 (well, sort of) and seemingly not to deal with modern software development or deployment.

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

#137

Post by dragonwriter »

justinph wrote: post #8

When you fuck up in health, people can die. Regulation exists for a reason.

The reference to HIPAA and how it restricts things they'd like to do with health information -- and the fact that Goolge is investing in Calico, which is more about health technology -- suggests that the concern is more with the regulations that are designed to prevent financial fraud, exploitation of health information for scams and discrimination purposes, etc., that affect the market for health information technology, and less about the kind of regulations that are designed around the safety of health care technology.

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

#138

Post by moe »

yebyen wrote: post #117
moe wrote: post #109

Earlier quoted context omitted.

If only we had a technology to physically carry around data in our pocket, and selectively share it without uploading it to remote servers...

Great... now your doctor can read the news in your patient file only once/after and while you're in the room. I'm sure that won't affect his or her bill rate. As it is, I only get to see my doctor for three and a half minutes when I need help, after 5 minutes with a PA, and I don't know if the PA has even had a chance to communicate any of what I told her to the physician, so I have to write everything down lest I fo…

How about handing it to their receptionist as you check in?

Who can of course store the data on their network, for the duration of your treatment?

Not everything has to be put into global data-silos.

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

#139

Post by homulilly »

laurenstill wrote: post #57
zmmmmm wrote: post #35

It's worth noting that highly regulated industries are not necessarily bad for startups to enter, exactly because they throw up particularly high barriers to large companies. Google can't enter health without accepting the full baggage that comes with that - people worried about their privacy, every random nutter looking to sue them and get a payday, FDA breathing down their neck every step of the way, etc. A small s…

Most people don't worry about their data privacy, or else they wouldn't be on FB, take those buzzfeed quizzes, etc. The P in HIPAA stands for Portability. At it's heart, the act was supposed to guarantee patients have access to their health information, not bring health data liquidity to it's knees. This is Jonathan Bush, of Athena, testifying (read: ranting) a couple weeks ago about regulations and innovation in hea…

Most people don't understand how data privacy works. A huge number of people don't even realize their Facebook posts can be viewable to the public let alone how that data can be collected, analyzed and shared with third parties. Besides, even the most completely oblivious Facebook users generally don't throw their entire medical history on their wall.

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

#140

Post by thejdude »

XorNot wrote: post #78
micro_cam wrote: post #55

Earlier quoted context omitted.

I've heard Bill Gates state this as one of his philanthropic goals; to fund things with a cost/benefit analysis that doesn't make sense in the developed world but does elsewhere. I've worked with people involved in HIV vaccine trials overseas and, in fact, things really don't change as much as you might think. The basic tenant "first do no harm" is ingrained at an many different ethical, institutional and legal level…

Also because the history of unethical research is long and storied enough already. It's pretty well appreciated where that path leads.

You could say research is well researched.

Unfortunately, the same doesn't apply to unethical treatment. More and more patients get certain treatments or recommendations by doctors or hospitals not because they need them but because they're profitable for the doctors or hospitals.

This is the insurance/financial product salesman's spirit at work, and it needs to be stopped. Right now.

I think part of the problem is the "insurance" mentality - if you don't pay for the treatment yourself, but the insurance just pays for everything, you aren't interested in an economical solution (and maybe the minimally-invasive treatment), but you take what's recommended. If you have to pay for treatment yourself, you begin asking questions. (Disclaimer: I live in Germany, a country with "free" health insurance, which I pay for with an effective 15% tax on my income.)

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