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Did you know that 50% of second opinions from doctors contradict first opinions? And did you know that 80% of the findings in medical literature are wrong?

I'm fascinated by a new company called Metamed that offers to be your personal medical researcher. For a fee of $200 per researcher per hour, with a $5K minimum, you can make sure the full force of science is on your side. Metamed analyzes the medical literature and tells you which study results about your condition are reliable and which are not. They assess the value of various diagnostic tests, and create a map of all possible medical correlations. It's the sort of thing your doctor would love to do for you if he had the resources.

Metamed's service is pricey, but the cost will probably come down as the process gets more automated. And objectively speaking, the service is already a bargain if your alternative is death by ignorance.

I saw in the news recently that the rate of growth for healthcare costs in the United States was slowing and no one is entirely sure why. I assume there are a number of reasons for the unexpected change, but my hypothesis is that the Internet is already unlocking the power of healthcare information for consumers. Personally, my healthcare process looks like this now:
  1. Observe symptoms
  2. Search Internet for diagnosis and treatment.
  3. If I'm not confident in what I find on the Internet, I email my doctor in the Kaiser Permanente system to describe my symptoms. Kaiser encourages email.
  4. My doctor often replies in an hour with a prescription that has already been sent to my nearest pharmacy, some self-care instructions, or a request to come in for tests.
  5. If I need to book an appointment, Kaiser's website does an automated interview to advise me whether I should treat the problem myself or schedule a doctor.
For the bigger problems, you want as much expert brainpower on your side as you can get. That's what Metamed provides. It makes me wonder how much healthcare costs can drop if we get better at picking the right treatment the first time. My gut feel is that 20% of healthcare costs are directly attributable to ignorance.

My healthcare provider, Kaiser Permanente, operates for the benefit of the members, so they are super-aggressive about preventative healthcare. I would think preventative medicine can take another 20% off of healthcare costs in the long run. And preventative medicine is mostly about getting the right information to the right people.

The Adams Law of Slow-Moving Disasters observes that whenever a massive threat to humanity can be identified far in advance, we always find a way to sidestep it. At the moment it seems that healthcare costs will grow to the sky and bankrupt us, especially as the population of oldsters increases. But I think better information might someday cut healthcare costs by as much as 50%. That better information will come from a variety of sources. Metamed is part of that solution, as is Google, as is Kaiser's extraordinarily effective use of the Internet. And we're nearing a point at which your smartphone will test you for all sorts of problems.

I can also imagine a time in which Google Glasses TM will observe all of your food choices during the day and keep a running record of your nutrition. When you stray from a healthy diet, your glasses might start suggesting a salad. When you don't exercise all day, the glasses might suggest using the stairs instead of the elevator. For all practical purposes, a human with Google Glasses and a smartphone is already a cyborg. And your future cyborg half will do a better job of keeping your organic parts functioning than you are doing on your own.

In the long, long run your healthcare provider will fix both your organic parts and your cyborg parts because it will all be part of the same system. You'll go to the doctor complaining of a headache and he'll update your smartphone software to track your daily habits and look for what triggers the headaches.

Anyway, my point is that better information will solve the problem of increasing medical costs. It's already happening.

Disclosure: I don't have a financial interest in Metamed, nor do I have any firsthand knowledge of their service. The Chairmam of Metamed is Jaan Tallin, one of the founding engineers of Skype, and one of the more important futurists of our time. I know Jaan because of our mutual interest in the so-called singularity.

 
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Apr 1, 2013
http://www.youtube.com/watch?v=sxnlvwprf_c

So I watched this TED talk a little while ago and felt that doctor made a persuasive point in the need for human interaction in medicine. Then I read Scott's post about Metamed and emailing Kaiser to get a prescription. So I had some thoughts about the different ways of doing healthcare:

Option 1) Doctors see patients and are able to diagnose through long practice, training and treating the patients throughout their life. Because of the doctors knowledge and relationship with the patient they are able to make an accurate diagnosis and begin a therapy to treat to condition/ ailment.

The reason this works has a few assumptions: Doctors are knowledgeable, we appreciate our relationship with our doctors, co-pays are such that is more economical to visit a doctor early rather than later.

The reason that this doesn't work: Doctors are overworked having many patients to treat, we are afraid of letting someone know face to face our ailment and doctors have to spend countless hours dealing with insurance companies to get paid. Also, the cost of medical malpractice insurance as well as dealing with various insurances including Medicare and Medicaid make it cost prohibitive to have a private practice. So instead many doctors are relegated to being part of hospitals which means that they spend less time with patients and work more for less.

Option 2) Doctors, researchers etc. take a patients health profile using the latest in gene research, studies and lab results are able to make a tailored prognosis for each individual patient. Having many doctors and researchers working on each case they can divide the issues into specialties and make a treatment plan for the patient's ailment/ condition.

The reasons that this works assumes: Patients don't like waiting rooms, keeping appointments or feeling like they have to pay to ask their doctor "simple" questions that they can find answers to on the internet. Also, face to face relationships are becoming more of an inconvenience in a busy society with a large amount of social apps that capture a person's mind share.

The reasons that this doesn't work: Having multiple people dividing a patients symptoms across specialties can mean that something would be missed. No one is accountable if something is missed or misdiagnosed. Most insurance companies are not yet willing to pay for these virtual doctors. Patients no longer have a relationship with a single doctor and therefore lose the personal experience that a doctor would have with each individual patient.

I'm sure that there are more positive and negatives for each scenario but the question is, which is better for the patient, healthcare and the nation. From my standpoint it seems that in health care we are moving toward an Industrial revolution idea of medicine, where instead of having one specialized doctor you have many people dividing up that doctors tasks into smaller tasks which take less training to do. By being it virtual it means that that you can treat patients in high tax states from low tax states or countries. Therefore it means that virtual practices like Metamed are probably the future because there is greater profit. However, if this is where healthcare is heading, is this the best solution?
 
 
Apr 1, 2013
Hi Scott - If you want to know where the $ in healthcare is going, read the lead article in Time Magazine from a few weeks back - we have some -very- rich "not-for-profit" hospitals in this country (I'm simplifying though - but read the article - it's quite detailed and thorough, albeit sad). Your healthcare process works well for you, because you can clearly articulate your symptoms and condition in an Email. Many can't (not even in person). I agree that more Dr's should work via Email, but perhaps many can't deal with it (spam, and people who can't explain themselves well).

If the Medical Insurance providers were smart they would negotiate contracts with Metamed and cover (at reduced cost) their service. A few grand is nothing against the costs of unneeded or incorrect procedures. I wonder if this is in process.

/j

(soapbox) - what's happening in healthcare is what's happening elsewhere in the economy. Regulated capitalism can be a good thing, but in an environment of unfettered capitalism, most of the money finds its way to the top of the pyramid. The people at the top get better at collecting more and there's nothing to stop them (soapbox off).



 
 
Apr 1, 2013
A few things Id like to say about this but first, Scott, would you mind denying that this is a hoax? Normally I wouldnt ask as it mostly seems serious enough, but it IS April Fools day, the 50% and 80% error rates seem damn high and...well, this IS you we're talking about here, Scott.
 
 
 
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