Sunday, April 10, 2011

It Only Looks Easy

There’s a certain touching naiveté about this TED talk:

I suppose like much tech-related naiveté it might end up being more accurate prophecy than utopian thinking, but there are certain reasons to believe it won’t be. Structurally, health care economics looks completely different than computer economics and engineering, which is where he (apparently) draws his mental model from—a citation of Moore’s Law being the visible sign that he believes that.

The question to ask is this: if you expect healthcare technology to become both more effective and cheaper—just like the computers you imagine power the enterprise—why has healthcare technology proven remarkably unresponsive to this idea previously? As we know health care has become steadily more expensive while delivering very uncertain returns, and it’s not as if nothing was invented technologically during this time period.

Indeed, much of the available inventions for health care are more expensive than their forebears—digital mammography is 45% more expensive in Massachusetts than film mammography despite being faster and not requiring physical storage. Hip replacement joints don’t seem to work much better either (anecdotal). Some of the trends the speaker identifies have yielded very uncertain results: for example, with personal genomics leading to personalized drugs—well, drug companies have researched the matter and found it a dry well so far. (Drugs, by the way: also something getting more expensive with uncertain improvements. And, again, something that a technological perspective alone isn’t equipped to solve: one of the big problems, of course, is intellectual property law; also the we-want-results-NOW shareholder culture.) In this, health care technology looks a lot like defense technology, where stuff just gets more expensive all the time.

I wouldn’t say all of the ideas identified by the speaker are useless or without potential. (I'm excited about 3D printing of organs, for example.) I would say, however, that it’s a very narrow perspective on a problem that is so entangled in so many fields. The technologist, having seen so much of media disrupted by the computer revolution, and knowing the inefficiency and illogic that pervades much of it, thinks that the entire economy can be so easily swept away. It’s the same mentality that led to the seemingly-failed GoogleTV, for example. But the rest of the economy is so entangled: it has laws and physical infrastructure and loyalty that the media doesn’t. You can switch media at nearly the speed of thought, without barriers to block you. It’s not so easy to root out an entrenched system.

(Late Add: To be perfectly clear--since I'm not sure if I have been--the fundamental problems are the payment system and our health care culture, neither of which I'm entirely sure will be fixed technically. Certain problems--the speaker seems very enthusiastic about electronic medical records, which theoretically have a high ceiling--you can just claim that we haven't invented the right fancy device, which I suppose is narrowly true but doesn't exactly inspire confidence that we're heading to some virtuous circle of continuously improving technical prowess, as we are with Moore's Law. Which, by the way, may be running out of predictive power.)

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