Qualy #85 - The past, present, and future of medicine, hospitals, and healthcare
This Qualys episode features D.A. Wallach discussing the disruption of industries by technology, contrasting the music industry with the largely unchanged healthcare sector. He shares insights on healthcare economics, future technological impacts, and where he focuses his investment attention in biotechnology.
Deep Dive Analysis
6 Topic Outline
Internet Disruption in Various Industries vs. Healthcare
Reasons for Healthcare's Resistance to Technological Disruption
The Three Core Problems of Healthcare: Quality, Cost, and Access
Vision for Universal Access to Best Available Healthcare
Future Role of Technology in Medical Cognition and Procedures
Shifting Composition of the Healthcare Labor Market
3 Key Concepts
Healthcare Industry Disruption Resistance
Healthcare has been uniquely resistant to technological disruption compared to other industries because it is largely paid through labor, hospitals and payers operate on low, often legally capped margins, and pharmaceutical companies, despite high profits, undertake enormous risks in developing new solutions. Furthermore, the path for technology to deliver significant new dividends in human health is less clear, given the substantial progress already made in extending lifespan.
Three Pillars of Healthcare Challenge
Healthcare challenges can be categorized into three distinct yet interconnected problems: ensuring quality of care (ranging from preventing death to generating 'alpha' in health outcomes), managing the overall cost to the system (where government, employers, and payers bear the majority), and providing equitable access to care for all populations.
Future Healthcare Labor Shift
The future healthcare labor market is projected to see a rise in highly skilled nurses who focus on patient guidance, emotional support, and navigating complex decisions. Concurrently, the cognitive work of physicians (like interpreting data) will increasingly be handled by computational systems, and physical procedures like surgery will be performed by robotics, leading to fewer over-trained physicians.
4 Questions Answered
Healthcare's resistance to disruption stems from its labor-intensive payment structure, low margins for hospitals and payers, and the significant risk-taking by pharmaceutical companies. Additionally, the path for technology to deliver new dividends in human health is less clear, given the substantial progress already made in extending lifespan.
Peter Attia identifies three distinct but related problems: quality of care (from preventing death to optimizing health), the overall cost to the system (primarily borne by government, employers, and payers), and ensuring equitable access to care.
The ultimate goal is to achieve universal access to the current best available healthcare that anyone in the world receives, by leveraging technology to distribute the high-level, bespoke care currently only accessible to the wealthy.
Technology is expected to replace much of the cognitive work of physicians through computational systems and physical procedures through robotics. This will allow physicians to focus more on the 'touchy-feely' aspects, guidance, and helping patients navigate difficult decisions, potentially shifting their role to be more akin to highly skilled nurses.
2 Actionable Insights
1. Predicting Future Trends
To anticipate future developments in any field, observe what affluent individuals are currently doing, as these practices often become universally accessible in 20-30 years.
2. Annual Full-Body MRI Screening
If you are affluent, consider undergoing a full-body MRI annually for preventative screening to detect tumors or other potential issues early. This leverages advanced, currently expensive technology for proactive health management.
4 Key Quotes
It wasn't just the internet that disrupted, it was the desperation that followed the decimation that permitted the restructuring.
Peter Attia
The future is already here, it's just not evenly distributed.
D.A. Wallach
What is happening in your head when you look at a patient's blood tests and try to gel that with your biophysiological mental models is something that I believe computers will be able to do in the future.
D.A. Wallach
The cognitive work that physicians do will I believe largely be replaced by computational systems that can leverage the same types of theoretical frameworks that our minds are utilizing to make good decisions.
D.A. Wallach