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

http://thehealthcareblog.com/blog/2014/07/08/google-co-founders-thanks-but-no-thanks/

by tomhoward • 12 years ago

135 140 12 years ago

thehealthcareblog.com

gervase• 12 years ago

The site was extremely slow to load for me; here's the Google cache.

https://webcache.googleusercontent.com/search?q=cache:http:/...

jzelinskie• 12 years ago

The page isn't loading, but I assume it's referencing their response to the question about healthcare asked in this session: https://www.youtube.com/watch?v=Wdnp_7atZ0M

karzeem• 12 years ago

Do you have a timestamp?

ericd• 12 years ago

Basically, he's saying that it's too heavily regulated for them to want to dip their toe in. Seems reasonable, it's the same reason I never bothered with the healthcare ideas I've been interested in. Too many landmines, and not enough latitude to try creative things.

totoroisalive3• 12 years ago

The whole mining data on health has so many wonderful possibilities, but giving so much of my privacy it's a big no for me.

akozak• 12 years ago

Interesting. Is that an absolute position, or would you be more willing if the benefits (longevity, better health) were more apparent?

yawaramin3• 12 years ago

The data would be anonymised. No one would be connecting your records to _you._

Scoundreller2• 12 years ago

Although your health records may have some legal protections, health care is only one determinant of health.

Other determinants of health, like your gender, food choices, lifestyle, income, driving history, family history, physical environment, education, social network, etc. have all been heavily mined.

Much legally protected stuff can largely be inferred anyway. There aren't too many people without peanut allergies that haven't bought anything containing peanuts for the past 5 years.

lostcolony• 12 years ago

As a kind of note and response to all of your other responses, the issue isn't actually anonymization, but being able to correlate it with other data.

That is, if health data were anonymized, and was done right, and was made unable to be correlated with any other data, it likely would be sufficient. It's when you start allowing it to be correlated with personally identifiable things that it ceases to be anonymous.

That is, sure, let's take a case where you have a super rare genetic disorder. That, combined with the time in 2005 where you broke your leg, is sufficient to distinguish you from every other person in the country. In short, you have a unique health profile.

So what? Unless there is further information, that can't be traced to you. As an example, it's when we start saying "Ah, and the person is receiving treatment at (facility)" that we now know where you live. It's when we start correlating it with usernames that we start getting an internet trail. It's when we start correlating those with forum profiles that we get a real name, and now we know who you are.

The only other way someone could match that profile with you, is to have access to the profile, and to know you personally. Otherwise it links nowhere.

I agree the risk is huge; people don't do it right. But anonymous health profiles are -not- in and of themselves dangerous; it's when details linking them to further information leaks out that it's a problem.

But, pragmatically, while yes it would be incredibly hard...has anyone here read the rights they're signing away when they go to the doctor? Does everyone here trust every system a doctor uses, every system a health insurer uses, and every system used by marketers and researchers that the feds -do- allow to have access to this data? The real risk of Google would be that they could correlate it with so many other things about you; but the health insurers still have your medical history combined with all your PII.

retroencabulato• 12 years ago

Misleading title. It should be "Google Co-Founders on being a health company"

gph2• 12 years ago

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 being easily accessible, even if that would lead to better data-mining opportunities.

fd4gfdgfd2• 12 years ago

"Heavy regulation" doesn't just include HIPAA.

gph2• 12 years ago

True, but that was the one specifically mentioned in the article so I figured I'd address it.

kgarten3• 12 years ago

Why don't they just buy an island make their own country with their own rules?? ;)

muzz• 12 years ago

Not sure who downvoted you, but this is indeed the essence of one of the counterpoints against regulation-- that if we regulate an industry, the innovation in that industry will simply occur elsewhere in the world, outside of US regulation.

rmc• 12 years ago

To answer your question seriously, what makes you think your new country will be able to trade freely with every other country (e.g. USA & EU)? There's no point having an island with your own rules, if the only people you can get as customers are the inhabitants of your island.

Also, all land (more or less) is already in one country. Turning to split off a piece of one country into a new country is often quite deadly. Literally.

happyscrappy2• 12 years ago

They are just waiting for a spot on the map to open up. Something between Spain and Greece would be nice, it's much warmer there.

aestra• 12 years ago

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 be of interest

http://www.nytimes.com/2013/08/27/health/exploring-salines-s...

rayiner4• 12 years ago

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.

drcode2• 12 years ago

The problem with HIPAA is that it's supposed to look after my interests as a patient, but if I feel that it isn't, there's no way for me to opt out of it.

samirmenon• 12 years ago

Are you sure? I've seen waivers and "individual consent" forms that can supposedly release your health records.

dragonwriter2• 12 years ago

The problem with HIPAA is that it's supposed to look after my interests as a patient, but if I feel that it isn't, there's no way for me to opt out of it.

To the extent that the first part is true [1], the second part is not true in any substantive way -- the privacy protections restrict what can be disclosed without your consent. So, yes, you can effectively "opt out" of any of the restrictions by consenting to disclosures.

[1] HIPAA -- the Health Insurance Portability and Accountability Act -- exists, in terms of direct goals, mainly to look after your interests as a potential purchaser of health insurance, the as-a-patient privacy protections are secondary to that, and were put in place in HIPAA, and subsequent revisions, to mitigate political opposition to the incentives for automation and related standardization of electronic transactions provisions designed to make the health insurance system -- both in terms of enrollment and claims processing -- more efficient.

justinph• 12 years ago

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

taeric• 12 years ago

The regulations more exist to keep you from getting people discriminated against.

I mean, yes, we don't want folks to die. Nor do we want folks making bad decisions based on information they don't understand. However, to say that it is just "people could die" ignores the fact that they have technology entering in vehicles and whatnot.

balls1872• 12 years ago

The first time a Google car crashes and Google lawyers have to sit across from a now paralyzed child on the witness stand, Google will quickly think twice about the Vehicle market.

This was a huge problem we faced in Automotive. All big automotive companies are VERY cautious about safety, to what would seem like absurd levels.

ericflo• 12 years ago

Less regulation with respect to healthcare data would probably save lives, but increase discrimination.

jamra2• 12 years ago

As long as the laws continue to adapt in order to protect people from discrimination, we are on the right track.

fd4gfdgfd2• 12 years ago

Yes, because we all know heavily regulated VA hospitals haven't killed anyone.

Oh wait.

bluthru• 12 years ago

That's due to a lack of funding.

http://www.bloomberg.com/image/iFbqs_CCtc4k.png

The VA has asked for budget increases many times, but was denied by congress. The result is completely predictable.

tn132• 12 years ago

Where as the regulation has neither prevented people from fucking up nor dieing.

We do not even know how many people die every year because the increased cost of regulation and delayed time to market because of FDA.

zenbowman• 12 years ago

A lot of the regulation has allowed people to die when there was a chance they would have lived without it. Regulations on advertising and OTC drugs are absolutely needed, but stopping a doctor from prescribing a risky drug to a terminally ill patient who will die without it anyway is counterproductive.

The main reason people aren't healthy has nothing to do with the medical system or regulation. It has everything to do with lifestyle. Technology will not help at all in that regard. The mobile-device generation will be less healthy and even more physically disconnected than the current one, which is a horrifying thought given how bad the state of affairs is right now.

Man is a physical animal, and movement will always beat analysis when it comes to improving health outcomes. We already know how to improve health, we choose not to do it.

vacri• 12 years ago

stopping a doctor from prescribing a risky drug to a terminally ill patient who will die without it anyway is counterproductive.

And if the patient survives, but has a debilitating condition that was a side-effect of that risky drug, then claims he was going to survive anyway and now his life has a shattered quality because the doctor prescribed an drug that hadn't been fully cleared yet? It's not as black and white as you're painting it, and drugs are not always silver bullets that save your life and send you back to playing the violin like the virtuoso you once were.

Conversely, if you didn't have that regulation, you'd have medication with a much lower quality - more people dying, and more negative side-effects for the ones who survived. Plenty of drugs look promising at the outset, then turn out to have serious issues.

angersock2• 12 years ago

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 seems to be--it's not as far along as you might expect/hope.

fotbr• 12 years ago

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

TheCondor• 12 years ago

For profit medicine just seems rife with moral hazards.

Dengue kills poor people but we've got dick pills when you can't get it up. The regulations are just part of it...

What did an MRI cost 20 years ago, what does it cost today? No competition, no Moore's law, and that's on the technology side...

dragonwriter2• 12 years ago

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.

pinaceae• 12 years ago

didn't G+ out some transgender people? http://www.zdnet.com/google-outed-me-7000025416/

now imagine the same with Google having access to all medical records.

regulation around this exists for a very, very good reason.

gohrt• 12 years ago

By "outed", G+ exposed the user's public name to someone, connecting two public pieces of the user's data, that the user intended to keep separate.

It was a poor UI experience, but it wasn't a private-data leak.

stormbrew• 12 years ago

Connections aren't data?

dontmindifido2• 12 years ago

You're kidding yourself if you don't think that is a private data leak.

yawaramin3• 12 years ago

Google should take a look at https://news.ycombinator.com/item?id=7951019

Then buy Theranos.

zmmmmm2• 12 years ago

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 startup can be much more nimble and targeted and address a very specific niche in a clever way and be very successful.

wyager• 12 years ago

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.

That doesn't make any sense at all. Large companies are either A) already past any barriers to entry or B) have enough money to bust through any barriers to entry. There are probably very few real world situations where being "nimble" is enough to overcome onerous regulations. The reality of the matter is that you just need a lot of money to pay lawyers.

tn132• 12 years ago

It sounds very contradictory. In most of the heavily regulated industries such as healthcare or insurance, one of the economic efficiencies are a better understanding of the complex law, startups can not solve this inefficiency in their favor.

zmmmmm2• 12 years ago

I'm not saying you don't need to understand the regulations and law - you absolutely do. But you do have an advantage in being able to be less conservative and more innovative in how you interpret them. For examples, take Uber and AirBnb - they are both pushing the boundaries of highly regulated industries. An existing hotel chain couldn't do it because they have too much to lose, and target such broad markets. But a scrappy startup can.

mherdeg• 12 years ago

Well-loved YCombinator startup Stripe spent a bunch of its early time wrangling with the complexity of the payments industry precisely so that their customers wouldn't have to.

jeffbr13• 12 years ago

Legal frameworks are definitely tractable, and investing the time to navigate them more effectively can give you the same sort of competitive advantage as mastering a technology.

Same principle, different domain.

crazy1van• 12 years ago

Often times the regulations were designed in cooperation with existing businesses in the industry precisely to keep more competition out.

laurenstill5• 12 years ago

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 healthcare. The big take away is that healthcare specifically sets these rules with incredibly high barriers of entry, and then at the last minute does a complete 180. We've seen it every step of the way with the EHR incentive program, CEHRT, ICD-10, payment reimbursement, etc. https://www.youtube.com/watch?v=CekfvGDiab8

tallanvor• 12 years ago

How many people do you see posting all of their conditions and the medications they're taking on Facebook? I can't think of any friend who is THAT open.

Also, whether or not people care about their privacy doesn't mean it shouldn't be protected. Not just for themselves, but for their family as well. --Let's say I don't allow my medical information to be used, by my brother does. If he has a genetic disease and a potential employer finds out about it, they might decide not to hire me because there's a chance I may have it as well, which could cause problems if it ended up needing treatment. Laws that prevent discrimination are all well and good, but the problem can be proving the reason they decided not to hire you.

amirmc• 12 years ago

"Most people don't worry about their data privacy, or else they wouldn't be on FB, take those buzzfeed quizzes, etc."

The first part of the sentence is flawed, so the latter doesn't follow. It implicitly assumes that people even understand how things work (they don't, imho) and therefore can make a sound judgment, based on that knowledge.

For example, I could argue that people simply don't value their future selves (ie 30+yrs), otherwise they wouldn't be eating all this junk food now and never exercising. In some sense that's true, but it's mainly driven by ignorance.

rayiner4• 12 years ago

Frankly I'm okay with health data being illiquid. Everyone should be absolutely terrified of this data getting into the hands of the same people that try to predict if you are pregnant to sell you crap, or use your credit history or Facebook posts to deny you a job. The future in that direction is "Google Gattaca."

homulilly• 12 years ago

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.

Multics4• 12 years ago

Not bad for startups? So the merit of this is based on the value to startups, not society?

Another way to interpret what you said is: Google and other large companies can't apply large quantities of resources to health.

netcan2• 12 years ago

What is this?

This is a forum for/about startups. He made a statement relevant to startups. What exactly are you mad at?

dan_bk• 12 years ago

This may very well be the usual "we currently have no plans to enter the market of...", stated a few months or a year before some product/service is launched, in precisely that market.

chasb• 12 years ago

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.

asdfologist• 12 years ago

I'm surprised the blog post mentions nothing about Google Health. Basically, Google has already tried this and failed.

http://en.wikipedia.org/wiki/Google_Health

greggman• 12 years ago

Failed seems like an unfair characterization.

Another possibility is they thought it was a cool idea, then found out how regulated it was, how it would be nearly impossible to add any features without massive government oversight, and got out.

iskander• 12 years ago

I was an intern on the Google Health team and witnessed many problems unrelated to external barriers.

1) The original codebase was a nightmarish mess of Java/GWT code that did very little (my first real-life encounter with a FactoryFactory). Most of the developers from this first version drifted away from the project and by the time I arrived there was a second team who were talented, but, unfortunately spent much of their time slowly refactoring other people's crappy code.

2) I didn't observe very much clear product vision. Instead, we had a paranoid obsession with matching the features of Microsoft Health Vault (which was equally meandering & useless).

3) There was a huge top-down pressure from Marissa M and other high level managers to make Google Health into something astoundingly successful, suffocating any possibility of incremental progress and disempowering the actual developers.

4) We had one MD on staff and very little other experience with medicine or healthcare. The developers were very far from the problem domain and relying on a game of managerial telephone to ascertain what the current state of medical record management is and what improvements are possible.

Anyway, in short, my experience was that Google screwed up.

throwwit• 12 years ago

Why doesn't google innovate regulation first then? :)

dontmindifido2• 12 years ago

I'd love to see them take an altruistic approach and shift the focus to countries like Africa where health projects would provide a lot more utility and have a lot less regulatory burden. Once a product is visibly working in one country it's more difficult to make cases against it elsewhere.

micro_cam2• 12 years ago

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 levels that it isn't like you can, say, justify a more risky vaccine in an area with a higher risk for HIV or whatever.

In fact trials have been cut short and research into entire vectors (ie the cold virus used as a transport for the HIV related material) cut off when trials in Africa started to appear (statistically) to be slightly harmful in any way.

I feel this is a good thing. Scientists and medical people holding themselves to this high standard is the reason the anti-vaccine crowd really doesn't have a leg to stand on.

XorNot• 12 years ago

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

paletoy2• 12 years ago

to fund things with a cost/benefit analysis that doesn't make sense in the developed world but does elsewhere.

While it seems to go against "do no harm" ,in reality many low cost products can start at low quality, but with time and experience improve while still offering much lower costs. So the logic can make sense.

Not sure it works for vaccines thought.

Also i wonder: what were the benefits of the vaccine you described ? were they weighted against the slight harm ?

micro_cam2• 12 years ago

Bringing a healthcare product to market is really hard. A friend just had a good one with a proven product and sales fail simply because institutional hospitals take to long to really implement a decision to the point they will actually pay for a piece of software they want to use even if it isn't something regulated.

Google certainly has the cash to sit this sort of thing out, hire sales and support people etc. Microsoft and others are doing so, see Microsoft Amalga for example.

However a more intriguing area, to me, is doing some more basic research without becoming a health company. Google is doing this with the glucose contacts and things. These are novel ideas with significant IP that could be spun off into an independent company and/or licensed to to an existing drug company to push through clinical trials and bring to market.

paletoy2• 12 years ago

Bringing a healthcare product to market is really hard.

I think this is the place that google might enter and play well. If google can develop a very high-level , fda certified development tool/operating-system ,such that developing fda certified products become much easier , they could have a very big win on their hands.

I've seen some research on such systems ,so it's a clear possibility. And since it's a new thing , it might need some changes in the fda, which google has the tools to push.

trhway• 12 years ago

Google seems to avoid enterprise/gov, and especially highly regulated, business. One can see the advantage of it - that allows the company and the products to avoid bloat and culture corruption endemic to doing enterprise/gov/highly regulated business

RoryH• 12 years ago

Brin's partner co-founded https://www.23andme.com/ and that got it's nose cut off by the FDA IIRC.

k-mcgrady2• 12 years ago

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 reports and bogus recommendations and people could get hurt.

fixermark4• 12 years ago

... which is not nearly as big a risk these days as it was in the days of snake-oil salesmen; there isn't a "new town to set up shop in" for a bad DNA testing service in the days of the Internet.

I'm in favor of protecting people from bad medcine, but I think the current regulatory structure is an overly-restrictive tool for the job. Either that, or (given that it steps on the neck of 23andme but lets GNC and homeopathic practitioners continue to operate) it's mis-tuned for modern technologies and tools.

aianus2• 12 years ago

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!

tempodox• 12 years ago

I tend to believe that Goog won't do it. Imagine going from kingpin of the Internet, making the rules as it suits you, to an area where you're subject to laws made by others, just like everyone else. They wouldn't be that special any more. Methinks, they're too spoilt for that.

BrainInAJar• 12 years ago

Waah... we can't let advertisers trawl through your health records because privacy rules won't let us

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

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