
Google Co-Founders on Healthcare: “Thanks, But No Thanks” - tomhoward
http://thehealthcareblog.com/blog/2014/07/08/google-co-founders-thanks-but-no-thanks/
======
zmmmmm
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.

~~~
laurenstill
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](https://www.youtube.com/watch?v=CekfvGDiab8)

~~~
tallanvor
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.

~~~
laurenstill
Never said privacy shouldn't be protected, only that it's not exactly valued
by BOTH sides of the equation (and of course, YMMV). Up until recently
(Omnibus rule), HIPAA had little practical power in that department from both
an audit perspective and a fine/mediation perspective. The largest fine
levied? It was for inadequate patient access to their own health information,
not a security breach.

And even with the new rule, there are currently no regulations surrounding de-
identified PHI being used for marketing purposes, research, or sold for
whatever other purposes. So now you have data wharehousers like IMS spinning
up software dev depts with the specific goal of harvesting patient data.

As far as identity vs membership vs attribute disclosure, I linked to a good
study below.

I find it interesting that there are more comments in the average HN
healthcare-related thread than on any of the recent NPRM. Hell, there are more
comments here than people who actually showed up for FDASIA.

I support regulation in a lot of cases, and feel that that FDA took a
reasonable approach to the recent mobile medical device guidelines. What I,
and pretty much everyone else (other than the AMA) rails against is the
indiscriminate flip flopping of what regulations, standards, etc will be
required, and on what time horizon.

------
ericd
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.

~~~
totoroisalive
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.

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

~~~
shaggyfrog
When "anonymization" is done poorly, it has consequences.

It was bad enough with Netflix recommendations getting de-anonymized; imagine
what could happen with actual health records leaked.

[http://arstechnica.com/tech-policy/2009/09/your-secrets-
live...](http://arstechnica.com/tech-policy/2009/09/your-secrets-live-online-
in-databases-of-ruin/)

------
asdfologist
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](http://en.wikipedia.org/wiki/Google_Health)

~~~
greggman
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
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.

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

[https://webcache.googleusercontent.com/search?q=cache:http:/...](https://webcache.googleusercontent.com/search?q=cache:http://thehealthcareblog.com/blog/2014/07/08/google-
co-founders-thanks-but-no-thanks/&strip=1)

------
gph
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.

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

~~~
muzz
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.

~~~
AnthonyMouse
That is generally true for things like minimum wage laws or regulations on
manufacturing. If it is expensive to manufacture in the US then companies can
easily manufacture in China.

It doesn't really work for healthcare because you can't remove it from the
jurisdiction. It isn't practical to fly to another country to receive
emergency medical services or if all you need is to fill a prescription.
Meanwhile the customers with the wealth to sustain research into novel health
products are in the countries that impose heavy regulatory burdens on anyone
who wants to service them.

~~~
kgarten
Actually a lot of people do ... I know people who get their eyes lasered in
Turkey for example (in this case it's because the treatment is cheap). Larry
Page suggested the Island idea in last year's google IO.

------
jzelinskie
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](https://www.youtube.com/watch?v=Wdnp_7atZ0M)

~~~
karzeem
Do you have a timestamp?

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

~~~
zenbowman
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
_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.

~~~
TeMPOraL
> _stopping a doctor from prescribing a risky drug to a terminally ill patient
> who will die without it anyway is counterproductive._

It's also about balancing incentives. If there were no such regulations
whatsoever, you'd find yourself in a situation, where a patient with a mild
cancer and a broken arm is potentially "terminally ill" and needs the New
Risky Drug. It could degenerate to regular, systematic experimentation on
humans in the guise of "doing everything we can".

------
micro_cam
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.

~~~
paletoy
> 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.

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

~~~
k-mcgrady
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.

~~~
aianus
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!

~~~
k-mcgrady
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.

~~~
aianus
AFAIK they're not showing health results at all anymore because of the FDA
decision.

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

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

~~~
thejdude
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.)

------
tempodox
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.

------
yawaramin
Google should take a look at
[https://news.ycombinator.com/item?id=7951019](https://news.ycombinator.com/item?id=7951019)

Then buy Theranos.

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

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

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

------
trhway
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

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

