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Meet Dr. Robot, Coming to a Clinic Near You

Badly needed wholesale change is coming to American medicine – Via Meadia has long predicted it – and the Washington Post’s Ezra Klein is also on the bandwagon. Between Robo-Doc prostate surgeons and ever-shrinking super computers, technology is changing how and who (or what) does medicine. Klein writes in the WaPo:

… Most doctors right now are thinking about robots built for diagnostics. They’re thinking about a version of IBM’s Watson that can cross-check symptoms with medications with a patient’s history and come up with an array of possible diagnoses ranked by likelihood. They’re thinking about that so much that, on Tuesday, the famed Cleveland Clinic is hosting an innovation conference in which clinicians will be competing against Watson.

There’s precedent for this. Librarians, for instance, now work with the public to find information on computers. Loan officers now speak with eager borrowers and plug their financial system into a computer program. Accountants now plug their client’s income information into tax-preparing software. There are plenty of professions that used to mix technical skills and conversational skills and now mix conversational skills and computers. Eventually, medicine will be one, too.

This is all encouraging news. America’s health care costs are completely out of hand and unless something changes they will literally bankrupt the country. In time we’ll either ration health care costs more aggressively or preferably find much more efficient ways to provide health care. Klein’s piece points to the good news: innovative technology is beginning to come on line.  This needs to happen, fast, or no matter how we structure it or what laws we write,  good quality American health care will soon be only for the rich.

Not all doctors will like this. John Henry didn’t like his encounter with the steam drill.  The Luddites didn’t like the mechanical looms.  Blacksmiths hated the car.

But using technology to cut costs in health care delivery isn’t an option; it’s a must.  There is simply no other way to resolve this country’s health care mess.  It is Dr. Steam Drill or Dr. Death Panel, and of those two physicians I think I can predict which one most Americans prefer.

Better diagnostic software will mean that the entry point into the health care system for most people will be a less thoroughly trained (and much less expensive) human being with a ‘smart box’.  Once we get individual health records fully online (with proper protections for individual privacy) many health problems could be dealt with by stopping off, say, at a McDoc booth in the local Walmart.  Cases that the box and the booth can’t handle would move up the line to fully trained human physicians, but routine health care would be available at dramatically lower prices.

However the American health care debate evolves in the coming months and years, much more needs to be done to promote innovative health care delivery models.  Technology makes it possible to get better results at a lower cost; future efforts at health care reform in this country need to be aimed at creating a marketplace where producers and consumers have incentives and the freedom to innovate and experiment.

Our poorly constructed and chaotically regulated health care system is a bit like JFK’s description of Washington DC: a city of northern charm and southern efficiency.  American health care combines the high costs of the private sector with the low efficiency of government management.  Partly as a result, health care is one of the few fields where progress in technology leads almost always to cost increases: expensive and elaborate new treatments come on line, creating new demand for government and insurance companies to pay for these treatments whatever the price.

We need a system in which the cost-saving and efficiency-enhancing aspects of technology are as free to operate as the cost-increasing ones.  In Via Meadia‘s view, this is the central challenge of health care today and it is one that both liberals and conservatives should leap to address.  This is the only way to have a health care system that meets the needs of all Americans.

Dr. Robot can’t come on line too fast for me.

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  • Gerald Owens

    Watson??? My goodness, Artificial Intelligence Expert System technology is DECADES old, and now they’re resurrecting it? Happily, human disease doesn’t innovate at the same rate, so I suppose the older codes are still adequate.

    By the way, research has shown that the liklihood of a doctor being sued for malpractice is inversely proportional to the amount of time s/he spends interacting with the patient in discussing diagnoses and treatment options. The more likable and friendly a doctor is, the less people want to sue them in the event of an honest mistake. I got this reading Malcom Gladwell’s latest book, “Blink!”, so I hope that whoever is helping the machine diagnose the patient takes some time interacting with them, otherwise it’ll be lawsuit-time.

  • MarkE

    This could create a real bonanza for the trial lawyers. The owners of these machines, which are likely to be very expensive, will probably have very deep pockets. Also, the defense will have a hard time arousing any empathy from the jury for their machine.

  • WigWag

    “Between Robo-Doc prostate surgeons and ever-shrinking super computers, technology is changing how and who (or what) does medicine.” (Walter Russell Mead)

    The problem is that robotic assisted prostate surgery represents everything wrong with American medicine. It makes prostate surgery more expensive but it doesn’t improve outcomes.

    Compared with conventional prostate surgery, there is no evidence that robotic assisted surgery improves five year survival rates, post surgical erectile function or reduces incontinence. The only benefit of the robotic surgery that rigorous peer reviewed research has been able to discover is that it does somewhat improve surgical recovery times. Unfortunately it does that by increasing cost.

    More information can be found here,

    Professor Mead is right that we need to find a way to harness technology to make medical care more efficient and less expensive rather than less efficient and more expensive. But until we do, there are many steps that can be taken to make medical care less expensive without causing deterioration in outcomes.

    Using pretty much the same technology that we do, nations as diverse as Canada, Switzerland, France and Germany spend far less on medical costs per capita than we do and they manage to achieve comparable results. Based on parameters such as fetal mortality, longevity, hospital acquired infections, hospital falls, etc. those nations actually do better than the United States despite the fact that we spend so much more than they do. While the United States does have marginally better survival rates for some forms of cancer and cardiac surgery, the differences are minute especially compared to the costs.

    What accounts for the superior performance of Canada, and the European nations compared to the United States? It’s simple really; those nations don’t have tens of millions of citizens worshipping at the altar of a deity named “the market.” By eschewing the private market for the delivery of medical care, those countries have achieved comparable results for far less expense; technology has little or nothing to do with it.

    But there are some things that the Europeans and Canadians can be blamed for; their worst offense is that they are freeloading on the back of American consumers. Until recently the pharmaceutical industry was a major factor in reducing medical costs. Even when they are still “in patent,” statins to reduce cholesterol, antibiotics to fight bacterial infections and anti-hyperglycemic agents to reduce blood sugar associated with diabetes, dramatically reduce long-term medical costs. The problem is that discovering these new agents is an enormously expensive undertaking. For every thousand compounds that are developed only a tiny fraction proves efficacious. The drug discovery business is very high risk, high reward. Right now, Americans, for whom drug prices are unregulated, pay 100 percent of the research and development costs for these new medicines while the Canadians and Europeans pay prices based on the manufacturing costs of the medicine (which are tiny). This blatantly unfair system means that a destitute American on Medicaid has the American government pay 2 or 3 times as much for the medicine he needs as a wealthy European who takes the same medicine.

    Unfortunately, this is only likely to get worse. As drug companies turn to developing medicines for the multitudinous forms of cancer and various autoimmune diseases, we are about to enter a period of “personalized medicine.” Instead of drugs whose costs can be amortized over millions or even tens of millions of patients, new drugs are likely to be “cocktails” brewed for the specific and sometimes almost unique genetic alteration causing disease in an individual patient. The bad news is that the cost of these new drug “cocktails” is likely to be enormous; the good news is that they will likely make it possible to cure some of the most intractable and deadly diseases.

    Unless a way is discovered to make the rest of the developed world shoulder a fair portion of drug discovery costs, the American medical system is likely to implode and the world-wide pharmaceutical industry that has saved so many lives is likely to collapse right along with us.

    So Professor Mead is right; technological innovation to reduce costs is important, but it is only one small piece of a very complicated puzzle.

  • Stephen St. Onge

    The big problem with medical costs is that everyone wants “price no object” medical care, but they all want someone else to pay for it. Until we face the fact that it isn’t possible, we’ll continue to stumble.

  • Jacksonian Libertarian

    It’s the feedback of competition that makes for improvements in Price, Quality, and Service, in the free enterprise system. The Health Insurance industry as it is now with third parties paying for it, with either the employer or government as the third party, will never be able to deliver the McDoc described. Until the Patient is spending his own money, the patient has no incentive to shop for better prices, quality, and service, and so no competition.
    It will have to be made illegal for employers to pay for health insurance. And all health insurance will have to be high deductible ($2,000+) with tax free Heath Savings Accounts, and full coverage low deductible health insurance made illegal (HMO’s must also be illegal). This will have to include Medicare and Medicaid, only with the Heath Savings Accounts modified so that the elderly can keep any left over money deposited there by Medicare (it’s the elderly that have the time and just need the motivation to shop). This would create the incentive for the entire medical industry, to compete for the patient’s health dollar. It’s only with this competition that we will ever see a McDoc’s or something even better.
    Think about the improvements in Lasik from radial keratotomy and all because it’s not covered by insurance. The entire medical industry would have been advancing just as fast if it weren’t for third party paid health insurance.
    Where would medical science be today, if we had not taken this full coverage third party paid health insurance road? Would we already have reach the TIPPING POINT, where for every year which passes the average life span increases by one year? Would we already be IMMORTALS?

  • lhf

    Sooner or later, people have to take some responsibility for maintaining their own health. That is the only way the cost of medical care can be reduced. Rationing care WILL be necessary and better it be done by each individual than by some so-called “panel of experts.”

    Banking on technology has only increased the cost of medical care. Why visit a doctor to get a computer diagnosis when you can do your own research at home and come up with the same or more likely, better, results?

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