
Why Are Medical Ultrasound Systems So Inexpensive? - skybrian
http://liesandstartuppr.blogspot.com/2016/12/why-are-medical-ultrasound-systems-so.html
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graeham
This is a great post, thanks for writing and sharing.

I'm a biomedical engineer and found both posts interesting.

There are really exciting things happening right now where the murky area
between expensive, slow medtech and fast-moving, lower cost consumer products
are being explored.

There have been some specatular implosions of approaches straying to far
towards the consumer tech-startup approach.

Like most things, the best path is probably somewhere in between. Medicine and
health is hard because the systems involved are complex and non-linear. There
is a higher burden for doing things right than other industries. That said,
people also suffer from innovation being slowed by red tape and leading to
increased costs.

One great but unlikely solution would be for an improved market for used
equipment, where the device loses its certification for medical use and
obsolete software becomes open source. Little incentive for manufacturers to
do this, but would be great for hobbiests, more 'wellness' rather than medical
applications, and improved use in developing countries (where used medical
devices like ultrasound machines often are donated but aren't used, because
they can't be adapted to local needs).

~~~
agumonkey
I trust the current post on the physics and EE side of things. That said I'm
also very curious about the computer graphics side nowadays. It seems to me
that historically, most of the complexity was handled through sophisticated
mathematical abstractions at the material level, making the research very
costly. How much post processing can be done to infer more information from
less costly inputs (I'm thinking ideas like Super Resolution used in spatial
imagery). Nowadays very very powerful GPU chips can be found for not much and
could be used at this part of the process. Maybe you heard about such ideas, I
don't know. I've seen NVidia involved in computer vision for the medical
field, but not a lots filter through to me.

~~~
graeham
There is work going on in this sort of arena, and I've wondered why there
hasn't been more. I think probably there are a few reasons.

First is medical imaging tends to have relatively low resolution and high
noise compared to optical images. So there is a danger of over-processing.

Second is, somewhat related, that I think there is distrust in clinical
practice and regulation of black boxes where processing happens in the
background. You're taking responsibility away from a doctor and putting it on
your system, so there is a greater burden of validation.

Third is cultural. Doctors get a ton of training to interpret the signal in
these images, and I think there is both a badge of honor in this as well as a
barrier to adjust to something new. In my Masters, one of the medical device
design instructors talked about a prototype of a digital stethoscope with huge
improvements to acoustics. Doctors hated it - even though the sound was
better, it wasn't the sounds they were used to. Although this was before the
Eko Stethoscope, which is a digital stethoscope and seems to be doing well.
Maybe an example of market timing.

------
Symmetry
The article seemed to be mostly an explanation of why any high quality
ultrasound has to be expensive and I'm sure the author is correct there. But
the original article was about the possibility of cheap, low quality
ultrasound.

I can understand why, when you're dealing with human lives, you wouldn't want
anything but the best. But that wasn't the use case of the original article.

~~~
hwillis
Is he correct, though? Even a high quality ultrasound probe is only a few
thousand dollars. At best, <5% of the price goes towards the probe. The price
inflation is absurdly high regardless.

I don't like this post because it just plays up the difficulty of the
engineering without any context. Yes, making an ultrasound is hard and
complex, but its not as hard and complex as making a car, which is how much
they cost. He just presents the engineering like we should be able to
intuitively relate that to cost.

Hell, he also doesn't contextualize any of the engineering itself. At the end
he brings up the housing, and not making it cut or burn people. What? Not
making things sharp is not rocket science. The machine doesn't cost 30k-150k
because it isn't sharp. Most things aren't sharp. He's conflating details with
challenges.

Acoustic lenses, 100 micron precision? Injection molding produces surface
finish and repeatability to sub-micron levels without even trying. A 50 cent
plastic magnifying lens is more precise than the acoustic lens in an
ultrasonic machine, AND its made of more expensive plastic (it just so happens
the best acoustic matches between water and PZT are very cheap plastics).

He's completely dismissive of PZT buzzers, which is really unwarranted. A 2
cent PZT buzzer is actually the closest product to an ultrasound probe,
engineering wise. The transverse mode of a PZT buzzer is in the tens of MHz,
the surface finish is easily a few microns, and the performance across the
disk is very uniform- it just so happens the cheapest way to mass produce
buzzers creates those properties. Of course to get two disks that are similar
you need to pay more, but the price is still measured in cents.

Dice and fill is complex but not necessary, especially for lower frequencies.
It uses standard semiconductor tooling and while expensive, it doesn't mean
each transducer costs as much as a car. Splitting the elements is also
complex, but its a hell of a lot simpler. Also he keeps saying 100 micron- its
not a feature size except for dice and fill. It's an accuracy, and one that
can be achieved by hand with 2x magnifiction. For actual context: 127 microns
is your standard "sloppy" machinery tolerance. When you order something from a
machine shop and mark a dimension as not important, you'll get 127
microns/.005".

There are any number of ways to section the transducer. Laser would be one. It
would cost less than a dollar per, and worst case you have to repole the PZT
afterwards. Bonding is a pain but not complicated. You can just solder to
silver coated PZT, strain relieve the bond wire, and pot the whole thing in
plastic. Keeping that 100 micron accuracy just means making sure you don't get
hair all over it when you put it together, unless you're blond in which case
your hair is too fine to matter.

And then... a cable? That's his next example of complexity? Buy a bunch of
ground plane ribbon cables and roll em up. Crosstalk will be less than on a
PCB. This whole thing just gives off the impression he's stuck thinking about
things the way he's always done it and has never considered alternatives. He
talks about the challenges of building products.

>Ever made a protoype? Ever made 2 of them? 4? 100? 10,000? And made them all
the same? Yep, it's a different world when you have to start selling and
supporting products.

It's one thing to make a product that doesn't inject noise into the hospital
grid, is shielded to more than FCC standards, its waterproof and heat and
fireproof. It's quite another to just make a product. Yeah, making things is
hard, but literally every company that sells something knows how to do it.
It's built into cost. It's not an explanation.

~~~
LiesNStartupPR
A 2 cent PZT buzzer is ridiculously far from an ultrasound probe, engineering
wise, and your units are off by about three orders of magnitude. And soldering
depoles PZT.

A transducer does not cost as much as a car (well, not a well made car), but a
system does. That's the cart plus a number of transducers.

Yes, I only covered the transducer in that post, but as I noted, the systems
and software deserve their own Pt II. It takes time to write this kind of
stuff you know?

Your other points I try to answer in my updated blog post along with many
others here in this thread.

~~~
hwillis
What units? Thickness mode resonant frequency? The cost? injection molding
precision? The 100 micron thing? I have a PZT buzzer on my desk that I
measured the thickness resonance, which is 5 cents in units of 10k. Injection
molding accuracy is around a thou, but the precision and surface finish is
impeccable. I also have on my desk parts with 0402 resistors- 500 microns
wide, 350 microns tall. I soldered them by hand without magnification. 38 AWG
wire is 100 microns wide. 100 microns is wide enough to drive a truck through.

Soldering with silver-lead depoles PZT. Bismuth solder does not and regardless
repoling PZT is trivial- a couple hundred volts at most, and temperatures
below the melting point of plastics.

The transducer is the only part of the system that should concievably be
expensive, though. Doctors don't use special, medical-company made laptops-
they use thinkpads or dell or whatever. The cart is unnecessary! It shouldn't
be where the cost is coming from. The cart should add a few thousand dollars.
The electronics have no business costing tens of thousands of dollars. The
R&D, the software, and the transducers are the only plausible money sinks. If
making a monitor is expensive, the companies should buy a cheap laptop and
write an application to run on it.

I do really enjoy your posts but I am firmly in the camp that the price of
ultrasound machines is an order of magnitude too high. I also think it needs
to come down ASAP and that the future of cancer treatment really depends on
regular ultrasound screenings and machine learning.

Edit: also, to back up my statements about the electronics:
[https://news.ycombinator.com/item?id=13245998](https://news.ycombinator.com/item?id=13245998)

------
mtw
Philips is offering the Lumify at $199/mo
[https://www.lumify.philips.com/web/](https://www.lumify.philips.com/web/)

The device is used with a mobile and is portable anywhere. I found it has an
excellent value-proposition and potentially revolutionizing the space

~~~
josinalvo
How does it compare to the ultrasound machines found in hospitals? (if that
question even makes sense)

~~~
centizen
It's not really intended to replace full scale machines but it is a big step
up from the cheaper imaging solutions available in the past. It is ideal for
"first aid" style situations, and will probably see widespread adoption in
ambulances soon enough.

------
legulere
> If you can really build an effective ultrasound system that people want to
> buy for significantly less than the currently available price when you've no
> expertise in the field, then why hasn't someone else with vast experience in
> the field gone and done exactly that?

If you just made a new effective ultrasound system that passes the FDA, why
would you sell it for a lower price when you also can make more money?

~~~
pulse7
You would sell it for a lower price to gain more customers than competition.

~~~
dogma1138
Medical equipment is more or less a fixed market unless you are going to sell
to developing nations and even then the cost of the machine might very well
not be the factor.

Hospitals, clinics and medical staff as well as the infrastructure required to
support the machines are your limiting factor.

With portable devices that can hook into a laptop or a tablet it's not much of
an issue but still there will be a hard limit for the market and it's
considerably lower than you would think.

You also need to understand that the lifespan of some of these machines can be
decades so in effect if you make it too cheap you either have to build in
planned obsolescence or you'll sell yourself out of the market.

------
nhebb
In case anyone is interested, there are low cost (< $10k) portable diagnostic
ultrasound machines. I used to work for a company that made interconnects for
medical devices, including ultrasound cables. Sonosite was developing their
portable systems back then - 15 years ago - so low cost systems aren't
something completely new. They don't have the same capabilities of full
ultrasound systems, but they do fit the needs that some people are discussing
here.

~~~
LeifCarrotson
I have used a similar machine. It was purchased used for about $3,000 for a
pregnancy resource center. And as a Test & Measurement EE experienced with
some high-density analog cables, I was extremely impressed with the quality of
the cable in that device.

But reading your post and this one:

> ... and then it's got to connect to the cables off to the system - all 100
> to 200 wires down a cable that's a couple meters long, and thin/light enough
> for someone to use 8 hours a day without getting repetitive strain injuries.
> Do you know how thin that makes each wire? Try calling a few cable vendors
> and ask for a small diameter cable with 200+ connectors that will actually
> conduct a signal without significant crosstalk and let's see where you end
> up on price.

It also mentions the system being mounted on a cart. This seems like an area
where technology can make some serious improvements. Mount your ADC (for which
speed, accuracy, power requirements, and channel counts have been steadily
improving) within the probe, and stick a high-speed
serialization/deserialization chip on the other end of it, and run power and
digital data over a much smaller, cheaper cable. That's the direction that
industrial I/O is going, at least.

I guess the point of all this is that there are opportunities to make
significant changes to the way these devices operate that will make them
easier to build. Switch out the ASICs for GPUs, the analog cable for digital,
the custom computer for commodity hardware, and so on because these
technologies are more capable than they were in the past.

~~~
temac
That advice is so good that people are already working on it... even in the
past!

Believe it or not, there is no plot for using outdated technology and keeping
the prices high. This is a quite competitive market, and engineers working in
the field are not stupid. There are already some machines using GPUs for the
signal processing. I think there might also be some machines with ADC in the
probe, although this is not simple (you also have to put the transmit side,
and the rx side has to be of good quality) and you can really benefit from
extremely high acquisition rates, so depending on what you want to do such a
digital link is not trivial + plus you basically duplicate a large part of the
machine in each probe if you do that, so I'm not even sure this will be better
in every cases...

Also; a new machine can take several years to design and bring on the market.

~~~
LiesNStartupPR
Exactly, thanks for putting this so succinctly.

------
wink
I mostly agree with this author's post but I think the 'I just want to play
around with this' vibe of the original post mostly missed.

So yes - those things are "expensive" (in the 'it's a lot of money' sense) but
"inexpensive" in the (stuff is hard to build and takes some knowledge and
parts).

But I feel reminded of those cheap 60 bucks tablets that are not high end and
fail all the time for various reasons, but if you just want a wall-mounted
touchscreen why would you buy an ipad instead of one of these.

~~~
skynetv2
Good point but i don't think it applies in the context of a medical device.

------
dfox
The transducer is one thing, also the electronics are highly non-trivial, to
the extent that it is in my opinion the most complex of the big three medical
imaging techniques used.

With CT you have some large mechanical thing, pretty much straightforward
X-ray source and image sensor, slight issue with interconnect between the
stationary and rotating part (that only has to carry power and digital data)
and bunch of software.

With MRI you have large superconducting magnet (which is expensive, but not
that complex), few power amplifiers for various coils and relatively low
bandwidth RF receiver and then bunch of software.

With ultrasound you have the transducer head, which is connected with
specialist flexible multi core RF cable with the frontend. Frontend has to be
able to both supply large (essentially RF) power to said transducer and listen
back for reflected energy with as little dead time as possible and with as low
SNR and wide dynamic range as possible (and typically using the same physical
wire to the transducer for both Tx and Rx path), with this whole frontend
being replicated few dozen times.

~~~
LiesNStartupPR
And all for ~1/10th of the cost of a CT or MR system.

------
bayesian_horse
It would be nice to have cheaper ultrasound devices, and yes, it can't be that
hard to develop something which is useful to a certain hobbyist niche.

Especially with pet breeders, I could see a use for devices around a couple
hundred Dollars, though there may not be enough demand to warrant commercial
development, especially not from players interested in selling more expensive,
over-engineered (for this purpose) devices to the same market.

It's clearly not easy to break into the market for USI, both at the low and
the high end. But with patents expiring, and electronics becoming cheaper,
more customizeable, more performant, the bigger players may have another think
coming.

------
DanielBMarkham
This was good. It's good to be reminded of the complexity of things we might
overlook.

However the answer to any question around why something is expensive or not is
economics, specifically supply and demand, marketing and distribution
channels, and barriers to entry.

This is the technology sector. We have made a cottage industry out of taking
things that used to be at the maximum level of complexity and turning them
into household items. You could write a similar article about how web servers
work -- there's an amazing amount of complexity in there, but we've
commoditized all of it. Ultrasound tech will follow the same trajectory,
although I have no idea how long that will take. In addition, ultrasound
providers are marketing towards large, rich, healtchare providers who are
operating in a tightly-regulated market. If I had a $1,000 ultrasound that
only worked for a year, was quirky, might scald me or my patient, but was good
for quick diangoses in the field in third-world countries? It might be all I
would need. There is no universal "ultrasound" device that has to meet a ton
of specs. That's just the way the market is configured currently.

Good article. Lots of cool stuff in there.

~~~
phpnode
Why is it ok to scald patients in third world countries? What if the quirks
lead to misdiagnosis etc? If there was a way to produce this technology safely
and cheaply people would be doing so

~~~
snovv_crash
If risk of scalding means the price can be reduced to a point to where every
ambulance or high-speed paramedic car can have one, then it is worth it. If it
means that every back-water third-world doctor can have one, great. Sometimes
knowing if a patient has internal bleeding, and where, is worth the risk.

~~~
DanBC
Don't forget to balance that advantage with the risks and harms of over
testing.

------
frozenport
Curiously, cheaper ultrasound is at the heart of the proposition of a "new"
player in the field : Butterfly Network.

------
bearsnowstorm
I'm a doctor who is qualified in echocardiography and other ultrasound
techniques, teaches ultrasound to other doctors, and who uses machines from
multiple manufacturers regularly. I've also been computer programming, and
generally interested in comp sci, for 30 years.

My 2 cents worth on differences between more expensive vs cheaper ultrasounds,
how ultrasound has changed over time, etc is: * ultrasounds are getting
cheaper and better. Harmonic imaging was probably the biggest advance for me.
* because of cheaper, better machines, many more doctors are using ultrasound
than before. A real challenge is making sure they are appropriately trained to
use ultrasound to get the most useful images, that they appropriately
interpret what they see, and recognise their own limitations. The results you
get from ultrasound are _highly_ dependent on the training and experience of
the operator, more than most other imaging modalities. Although some
techniques are easy to learn, many require substantial training and
experience. Putting ultrasound in the hands of someone who doesn't know how to
interpret the findings is not risk free. * there is a significant increase in
image quality and the modalities available with more expensive machines
(although this does not seem to be a linear relationship over the range of
price; once you get into the top echelon of machines, differences in cost
between them doesn't _necessarily_ correlate with their capabilities). * With
more challenging assessments, these differences in image quality and
modalities can mean the difference between a diagnostic and a non-diagnostic
scan, and change management and outcomes for patients. However, there are some
techniques (e.g. vascular access) where entry level machines are usually
adequate, particularly if you have access to a better machine for challenging
cases.

Although I'd love to see the quantum leap in imaging quality that some
startups are apparently aiming for, I'm not holding my breath. That doesn't
mean I don't see a lot of potential for technology to improve though - some
things I expect or hope to see over the next decade or two are:

the application of computer vision and machine learning techniques to assist
with the interpretation of scans. This is already happening a bit (e.g. strain
imaging, automated 3D ejection fraction) and it's an active area of research.
It has the potential to improve reproducibility of assessments. Maybe, just
maybe it will get good enough to help mitigate the problem of less experienced
operators using ultrasound.

multimodality fusion for interventional procedures - already, you can do a TEE
(a kind of heart ultrasound) and fluoroscopy (video version of X-ray) and fuse
the two images in real time to guide cardiac interventions. Maybe this will
extend into other areas: e.g. guiding vascular access by fusing accelerometer
/ gyro / magnetic positioning / video camera data with ultrasound

virtual reality or augmented reality applications to accelerate the
acquisition of ultrasound skills. There are already simulators but they're
expensive; as they become cheaper and more doctors have access I'm hopeful we
can improve the learning curve for image acquisition a bit!

------
franciscop
This kind of description can be made of any hardware piece. We came from a
whole room, slow computer to an iPhone that can make billions of operations
per second. I see the previous post as complaining about this not happening on
the industry.

Of course making an iPhone (or a OnePlus phone if you want to get into low-
scale) is not easy, but the technology has advanced and standardized enough to
be considered "cheap" for what they offer, and really cheap compared with
10-20 years ago.

Why hasn't that happened with ultrasounds? Certainly most of the components
have been around for a while and the process of making a "simple one" (in the
way the average smartphone is _simple_ ) should be a solved problem.

~~~
guitarbill
I came here to make exactly the same argument. Or cars, if we pick something
that also needs certifying (from a purely manufacturing perspective). I get
that most people would rather have a car, so more cars get made, so they're
cheaper. (Athough roughly comparable, and there's different models. To me, it
seems a car is _more_ complicated than an ultra-sound system).

The author of the original article made a good point that there may be a
market for cheaper, non-medical ultrasound. The author of this article totally
ignores this. Of course he's going to say they ought to cost as much as they
do.

> but for now take my word [...] seriously, you don't want to use these things
> without strong safety regulations.

Why? Instead of being a condescending asshat and lording his career
achievements over us, this guy could have explained if and why it might be
dangerous to build one yourself, again for non-medical use. Wouldn't a good
article with great arguments be more convincing than a list of credentials?

(edit: I'm reasonably convinced that devices in hospitals probably should cost
that much, but this article didn't change that significantly. some of the
details about impedance matching were interesting)

~~~
Xylakant
Cars, iphones and laptops are sold in quantities that are magnitudes larger
than ultrasounds. Even if every school bought one for students to experiment
with, you'd still only have all schools and doctors in the world as potential
market. On top of that, medical devices are supposed to work in comparatively
harsh environments (strong disinfectants etc.) for a long long time. Iphone
lifetimes are measured in years, not decades and don't you dare and try to get
a spare part for a 10 year old macbook. All of that means that evolution is
much slower in that market - more small steps rather than big disruptive
changes.

I'd also challenge that cars are more complicated than ultrasounds. They do
have more moving parts, but allowed tolerances are magnitudes larger than a
few microns in all places.

~~~
ChicagoBoy11
... but the "magnitudes larger" that they are sold is also endogenous to the
regulatory framework around them. Suppose you had to get a PhD in physics to
be able to get a drivers license. All of a sudden we would see a lot fewer
buying -- and therefore far fewer people selling -- cars since it is so
expensive to actually be able to drive them.

With these ultrasounds, there is such a heavy regulatory framework at work --
from regulations impacting the device itself to regulations preventing
hospitals from being built to regulations preventing hospitals from having as
many of these as they want -- that they make the actual quantity demanded of
these things artificially small. Your point about evolution of the technology
also falls trap to this same fallacy: Again, if all of a sudden you are
artificially making something much more expensive to produce, it should be no
surprise to you that the refresh rate on the device would be smaller. Here you
also have the added effect that since we rarely pay for our own medical care
and instead rely on insurance, many of the incentives that would exist for
companies to make cheaper, faster, better equipment also disappear. Lastly, I
fully concede that it is quite possible that there is some basic, inherent
quality of ultrasounds that make them more complicated than cars or any other
pieces of tech. But that isn't important. The importance is realizing that the
derivative of the state of these machines looks very different from other
technology industries where competition and the free market are much more of a
factor.

~~~
temac
Ultrasound systems is probably the cheapest modality, there is quite a lot of
competition in this market, there is a lot of innovations in this market, the
machine are getting cheaper and more compact, and at least in the developed
world there is no penury of ultrasound systems, the regulation are there to
prevent somebody to build a shitty machine that for example burns you with and
endoscopic probe (you would _not_ like that), and the interpretation of
ultrasound images requires to be highly trained (you won't even understand the
basic physical features you have before your eyes if you are not trained, due
to various artifacts that are intrinsical to the technology), which limit the
potential for delivery machines to a significantly larger market, because all
those machines would be of no use.

------
ChicagoBoy11
The fallacy this author makes in his response is unfortunately very
symptomatic of our society's poor grasp of fundamental economic principles.
Worth noting that despite failing to see some of the larger forces at work
that the previous post mentioned the author nevertheless acts condescendingly
towards that other post, which is also very similar to how society-at-large
operates.

The one factor the author completely fails to engage in is the fact that the
state-of-the-art of ultrasound production and the resources devoted to its
development is entirely endogenous to the regulatory and market structure
around it. He spends a great deal of time justifying the price based on the
technical challenges involved in building the device, but this completely
misses the point. The market doesn't reward innovators or companies because
their product is "complex."

The matter-of-fact is that we have crazy regulations in the medical space that
sharply distort both the demand and supply of these machines. On the demand
side, there's bat-shit crazy things like the fact that in order to open up a
new hospital, in certain regions the existing hospitals in the area have to
all agree that they are okay with that. Imagine what the technology landscape
would look like if every time Apple wanted to open a store it would have to
seek approval of the Best Buys that had already been there.

We also rarely pay directly for our own medical treatments. The fake prices we
see in medicine (I was once hospitalized for < 1 day and the "bill" came out
to > $40k; a juice-box in an itemized hospital list could cost $12, etc.) are
a great indication of the lack of competitiveness in that space. The truth is
these fake prices reveal the fact that no one actually pays them, and instead
are like that so insurance companies can negotiate individually with treatment
providers. Now, given all of this, who could possibly enter this space and try
to sell you on the idea that they could make an ultrasound that is 10%
cheaper?

10% cheaper, that is, on top of an already highly-inflated price. Elsewhere in
medicine, the INCREDIBLY high cost of FDA drug approval is extremely well
documented, costing in the billions of dollars to bring a new drug to market.
I hope it wouldn't shock the author of the post to learn that, with that
incredibly high cost to play ball, the default scenario is for young medical
startups to quickly sell to pharmaceutical giants, as that is really the only
way to bring drugs to market. At a smaller scale, this too happens in the
ultrasound arena, thus also making their price artificially high.

Speaking more broadly, the author's post is symptomatic of a view of much of
our society which ends up treating prices as exogenous things. "College is
expensive," "medicine is expensive." are things you hear all the time, and
said with the intent that this reveals some fundamental truth about these
things. That's garbage. College is expensive simply and only because colleges
have been charging that much and people have been paying for it. Full-stop. In
fact, the "free college" would be wise to understand that much of the increase
in the price tag can be explained by the artificially low rates that you can
borrow to attend them in the first place. I lived overseas for many years, and
despite having Harvard Medical School-trained doctors and frequenting world
class hospitals there, the actual, full cost of those treatments -- which I
paid individually -- were a fraction of what they would have cost me in the
U.S.

~~~
bluejekyll
I definitely get this argument that regulations decreases competition, but
they are there for protecting the consumer. I don't believe they were created
to skew the marketplace, but they have indeed done this. It's a tough
question, because self-policing doesn't work, we need organizations designed
to protect the consumer.

The recent fight between CA, SF and Uber around the "self-driving car" tests
is interesting to me personally, because I ride my bike in San Francisco
almost every day, and sometimes with my kids. I do believe that self-driving
or driver assisted cars will be safer than people alone, but I also want to
know that there have been some amount of testing requirements met so that I
know my family and I are safe.

So I ask this question, if your premise is that regulations are overly
burdensome, and there is evidence to support this, what do we replace it with
to get the same or better oversight of industries?

~~~
ChicagoBoy11
As cliché as my answer might be, I really believe in it: competition. There is
no force quite as good as keeping companies from shafting consumers quite like
competition.

Now, I'm also not knocking safety requirements. I'm fully aware that some of
those structures exist for a very good reason -- I just feel like we have gone
way overboard in virtually every industry. For a great piece discussing the
medical industry specific, I highly recommend this essay:
[https://faculty.chicagobooth.edu/john.cochrane/research/pape...](https://faculty.chicagobooth.edu/john.cochrane/research/papers/after_aca.pdf)

------
mongol
Really eye-opening to read in order.

------
LiesNStartupPR
Original blog post author here. Thanks to everyone for their comments, I've
tried to answer as much of the issues raised as I can in a new blog post,
here.

[http://liesandstartuppr.blogspot.com/2016/12/medical-
ultraso...](http://liesandstartuppr.blogspot.com/2016/12/medical-ultrasound-
systems-pt-ii-where.html)

TL;DR summary - ultrasound engineers are not stupid, are adding capabilities
as they can, and driving costs down, but demands keep rising as new
applications are found, and there is not yet the "killer app" demand for
ultrasound that will drive smartphone sized economies of scale to lower prices
massively. Regulation is not a huge cost driver (and you seriously do not want
no regulation), and there is no cartel action in ultrasound conspiring to keep
prices high, it's actually an incredibly competitive industry.

