health future

i love vinod khosla's report entitled "20% doctors included - speculations and musings of a technology optimist". it gives us a picture of the future of healthcare that is rooted in current developments. let me begin with the summary he opens with:

1.   Healthcare today is often really the “practice of medicine” rather than the “science of medicine”. In the worst cases of the practice of medicine, doctors just take moderately educated shots in the dark when it comes to patient care. Physicians should be much more scientific and data-driven. That’s hard for the average physician to pull off without technology, because of the increasing amount of data and research released every year. Next-generation medicine will be the scientific arrival at diagnostic and treatment conclusions and real testing of what’s actually going on in your body. And, it will be much more personalized than your physician can provide. Data science will be key to this.

2.   Technology makes up for human deficiencies and amplifies strengths – MDs and even other less trained medical professionals can do much more than they do now. By 2025 more data-driven, automated healthcare will displace up to 80% of physicians’ diagnostic and prescription work. It will AMPLIFY physicians by arming them with more complete, synthesized, and up-to-date research data, all leading to better patient outcomes. Computers are much better than people at organizing and recalling information. They have larger and less corruptible memories, remember more complex information much more quickly and completely, and make far fewer mistakes than a hot shot MD from Harvard. Contrary to popular opinion, they’re also better at integrating and balancing considerations of patient symptoms, history, demeanor, environmental factors, and population management guidelines than the average physician.

3.   The healthcare transition will start incrementally and develop slowly in sophistication, much like a great MD who starts with seven years of med school and then spends a decade training with the best practitioners by watching, learning, and experiencing. Expect many laughing-stock attempts by “toddler MD computer systems” early in their evolution and learning. These systems will grow with the help of the top MDs and AMPLIFY them so everyone can have the best, most researched care, not the average, overburdened, and rushed doctor the average person gets today!  In fact, the very best MDs will be an integral part of designing and building these advanced systems.

4.   The systems of 10-15 years from now (which is the time frame I am talking about) will overcome many of the short-term deficiencies of today’s technologies. By analogy, using today’s technology then would be like our carrying the multi-pound phones from 1987 (they were floor mounted cell phones with big handsets and heavy cords) in our pockets rather than iPhones. There will be point innovations that seem immaterial, but, when there are enough of them, they will integrate with each other and start to feel like a revolution. In the meantime, expect these early systems and tools to be the butt of jokes from many a writer or MD. Early printers, typically “dot matrix”, did not exactly cut it for business correspondence, let alone replace traditional means. Early medical systems will be used in non-critical roles or under physician supervision. Eventually, this shift in how healthcare is delivered will allow for less money to be spent on capital equipment, cutting health care costs. It will allow us to provide care to those who don’t have it now. And, it will prevent simple things from getting worse before being addressed.

5.   The human element of care, provided by humane humans, not rushed, overloaded MDs, will still be around. These people may have MDs anyway, but they won’t need ten or twenty years of medical school training. Or, when they have the training, they will become much better diagnosticians and caregivers. Beyond diagnosis and treatment, there are many things doctors do that won’t be replaced.

6.   The problem in healthcare is not with doctors, many of whom are accomplished, caring, honest, and compassionate providers. The problem is the incredible increase in complexity of the newly enabled data (some extrinsic), vast amounts of research, longitudinal health records, and histories without the self-reporting inaccuracies of the patient that allows for the much more integrative analysis that is now possible.  The problem is also the misalignment of incentives in medicine, where organizations try to maximize revenue (extra surgeries anyone?) at the expense of optimizing care. This is why innovation will most likely happen from the outside. It is also important to realize that I refer to the “AVERAGE GLOBAL doctor” or healthcare concern, not every doctor or company. The standards of performance in some parts of the world and in some parts of this country are very different than those in the best metropolitan hospitals in the United States. I also note that 50% of MD’s are below average though every doctor most people  know is above average!

a case for replacing doctors (in their current form) altogether is emerging, though - as you can see - he treads carefully on this issue. he goes on to mention several new start-ups that are actually beginning to create this new healthcare future:

ZocDoc - allows patients to check in for an appointment and provide basic information ahead of time.
AliveCor - makes an iPhone case to take an ECG after every workout. 
CellScope - which produces low-cost iPhone attachments for imaging skin moles, rashes, ear infections, and (in the future) your retina or throat.
SkinVision - uses the fractal nature of patterns in a skin image to determine more accurately than most general physicians whether you have skin cancer.
Eyenetra - makes a device that can give you an eye test and fit you for eyeglasses at little cost or hassle.
Adamant - is a very risky startup that’s attempting to produce a chip that can detect hundreds of gases in your breath. If you’re asthmatic, it can measure the level of nitrous oxide and predict whether you’re at risk of having an attack. If you’re diabetic and have ketones in your breath, it can detect that too and tell you that your body is undergoing ketosis. It can detect if you have lung cancer and even tell you what type of lung cancer. It will even detect whether you’re burning fat or sugars during exercise, because each results in different component concentrations in your breath. This little chip will do all this inexpensively, for far less than a big, expensive CT scanner that’ll just tell you that you have a nodule in your lungs but can’t tell you what kind of lung cancer you have. Eventually, you won’t have a doctor stare at you and tell you that you look well; instead, your doctor will be able to look at the levels of hundreds of compounds in your breath and know whether you’re well.
Ginger.io - determines patients’ mental health based on a variety of metrics. It can monitor your rate of emailing, tweeting, texting, and calling to gauge your social activity. Using motion sensors and your phone’s GPS, it can even know if you’re hiding in your bedroom, eating in your kitchen, or just staying in bed. By watching for changes in your behavior, it can tell how you’re doing far better than a psychiatrist could possibly determine and actually calls your psychiatrist if you’re in the danger zone of an episode. For example, detecting a behavioral pattern change that’s indicative of bipolar disorder could help us prevent shooting sprees of the type we’ve seen recently.
Proteus - is helping address drug non-compliance, one of the biggest problems in medicine. They’ve designed a clever system that combines a pill sensor, a body patch, and a mobile app. They attach a tiny, ingestible sensor to pills that gets activated by stomach acids. When a patient takes the pill, the sensor sends a signal to the body patch, which then relays the signal to the app. This system will allow caregivers to remotely monitor patient adherence by individual, time-stamped pill consumption events. This is a far better solution than having your doctor base a diagnosis on the one-time blood test done in the clinic. 

Empatica - uses sensors on patients’ wrists to measure bio-signals that correlate with emotion. Imagine having a continuous and, more importantly, accurate and objective measurement of your emotions for a month instead of only the latest, biased description that you might give (or forget to give) to your hurried physician.  

AirStrip Technologies - provides real-time vital signs to physicians’ mobile devices. 

Sotera Wireless - provides a battery-powered mobile device for monitoring vital signs. 

Agile Diagnosis/Lifecom - are improving clinical decision-making by providing decision trees with probability-based outcomes for physicians at the point of care. These and other startups are forcing us to rethink healthcare from diagnostics to treatment. 

dr. daniel kraft's talk - appended below - reinforces and animates khosla's views. khosla, kraft and other people connected with the cutting edge of medicine are alerting us to myriad new technologies - but as they all say - the real advantages will flow from their convergence. development - maturation - convergence - maturation will take at least a decade. the era of systems medicine begins in 2020...