

The Velluvial Matrix - spydez
http://www.newyorker.com/online/blogs/newsdesk/2010/06/gawande-stanford-speech.html

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caffeine
What he's saying applies to research nowadays too, especially biology-related.
People in e.g. my lab (neuroscience) come from EE, Bio, Physics, Medicine,
Stats, CS ...

It's working, though. Care _is_ getting better than ever. Science _is_
progressing faster than ever. We just need more. More funding, more education,
more scientists, more talent. Especially in biology, we need a lot more
computer scientists, especially the theoretical kind. A probabilistic pi-
calculus would do wonders for dealing with the sorts of errors that cost Duane
Smith his digits. We need more mathematicians to help us handle systems of
vast and irreducible complexity, and we need more truly excellent
experimentalists to pull off what was thought impossible.

That's what will help medicine the most, I think. More and better science, and
intelligent people thinking rigorously about process. It costs money. My "one
wish" would be to redirect the resources we've wasted in our War on Drugs, and
the War on Terrorism / the Middle-East, and throw it all at the War on Human
Ignorance. In truth, it's amazing how cheap progress is. The cost of
developing a new cancer drug is _way_ less than the cost of invading Iraq.
It's actually _cheaper_ to save lives rather than kill people!

This post doesn't really have a point. I just wanted to express my vote of
total optimism for science in these days of rampant pessimism. It works, it's
actually pretty cheap, and it gives back a thousand times more than what we
put in. If you're in college and you're reading this, please become a
scientist (or a doctor) :)

~~~
nkassis
I fully agree with you here, I work in your field currently and noticed the
wide range of skills that are employed. For example my lab director is a
Physicist working in brain imaging research.

All the math I learned in school (I have a BS in math) seemed so small
compared to the stuff I see used in the research the folks in my lab are
doing. There is a great need of skilled mathematicians and comp sci folks in
these bio based fields, as you pointed out. Biologist are smart people but
when it comes to comp sci their cs skill sets are not always large enough for
their need. That's where p eople like us fill in the blanks.

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sanj
The interesting part to me is that Atul Gawade is one of the few doctors who
is willing to say

"I don't know."

What worries me are those that attempt to fake it instead.

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megablast
I think it is an incredibly ridiculous system of training we have for these
people.

Why are we not using expert systems?

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aero142
Malcolm Gladwell covered a great story in Blink about the success of decision
trees in diagnosing Chest Pain at Cook County Hospital in Chicago. The doctors
were very resistant to using the tools. I wonder if we will just have to wait
for the old guard to die off before new innovations in technology can be
integrated into medicine.

Imagine a Netflix challenge for catching medication problems using customer
case files. "Your patient had his spleen removed but is not receiving
medication to compensate." should be displayed along side the case so every
reviewer would see these recommendations.

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acon
What we need is the francise model they are starting to explore in India.
Repeatable processes encoded in easy to follow three-ring binders; checklists
and procedures that anyone can follow. This will take care of the basics and
free up resources for the gourmet care we all need from time to time.

~~~
wazoox
I remember reading an article (or mayba was it in a book?) about that; a
parallel was made with the checklists in airplanes, after the crash of the B17
prototype in the '30s. If only I could find a link...

~~~
billswift
Google - gawande checklist and you will get this article
[http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_...](http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande)
and a whole page of links to Amazon and reviews of his new book _The Checklist
Manifesto_ .

~~~
wazoox
Right on! It's from 2007, unsurprisingly I didn't remembered all of the
details :) Really great article.

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nkassis
This article was extremely interesting. I remeber wired reporting on a system
which would allow doctors to give a list of symptoms and have the most likely
diagnostics listed by probability. Not sure of the name but technology like
that has incredible potential. I also remember the article mentioning the
reluctance of doctors to use it.

This kind of problem seems more widespread than only in the medical field.
This stuff just reminds me of what Doug Englebart was trying to do with his
NLS system. Augmenting Human intelligence. Were reaching the limits of what
single humans are cable of retaining and processing in their daily jobs. I
think that it's time for stuff Englebart did in the 60s to be rediscovered.
While the internet is great, it's potential hasn't been maximised in area like
this. Englebart's vision went much further than just google. Wolfram alpha is
getting close to this in a way but still not far enough. I'm sure someone is
already starting to develop this stuff (post some links if you have any).

I can just imagine an iPad application (preferably android table app ;p) for
doctors which implements the system I talked about at the beginning of this
post. Giving doctors on the go access to a database of diseases and medical
records of the patients and a way for the computer to anylisze the data and
return the info right there (powered by a huge hadoop cluster). Typing a few
symptoms, getting the list of possible diagnostics and viewing some checklist
of things to do. This would in no way replace doctors, I don't believe that we
have reached a point where you don't need a human person to judge the validity
of the computer guesses. In fact, assessing the symptoms is probably going to
require a trained professional for ages but, at the same time I think there is
massive potential for this kind of AI in these information intensive fields.

There is definitively lots of startup potential in all this.

I see a lot of startups solving easy problems (for good reasons) but this is
worth a 10 twitters in value.

If I wasn't doing stuff in the medical imaging field (Brain imaging
specifically) I'd go out and build this.

~~~
Dove
_a system which would allow doctors to give a list of symptoms and have the
most likely diagnostics listed by probability_

Oh, good. Seems every episode of _House_ I watched would contain a scene that
began with, "Differential diagnosis for shoulder pain, go!" And then they'd
spend ten minutes listing off all the diseases that could cause it. And I'd
spend ten minutes thinking "You people really need a _database_."

~~~
hugh3
I'm not sure that House is an entirely accurate depiction of how diagnostic
medicine works. For instance, I'm pretty sure real diagnosticians have to look
something up in a book every now and then.

~~~
Dove
Indeed. I hoped that something like what I imagined either existed or was
actively being built. Until this comment, though, my faith in the medical
industry was insufficient to justify the belief.

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acgourley
What incentives are there for engineering a better process? Seems like PPOs
and HMOs would both want this. But I guess only HMOs are the only ones who
have a chance of making progress here.

Kaiser does seem to be making progress here, but I'm not sure how fast it is.

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jodrellblank
Incidentally, for the recent "what problems need solving?", this is one.

Interperson coordination. I want it for small team IT project work, they want
it for multiteam medicinal work.

We have decent task schedulers in computers at the kernel level, multiple
processes, multiple threads, RPC, yet in people terms we're still on email,
shared docs, waves, CRUD-dy database frontends with no central driver.

And I don't want to be the central project manager myself, tracking lots of
data and sorting it into order - that's machine work.

