Reinventing Healthcare

Comparison of US and UK healthcare costs per capita

A lot of the political effort in the UK appears to circle around a government justifying and handing off parts of our NHS delivery assets to private enterprises, despite the ultimate model (that of the USA healthcare industry) costing significantly more per capita. Outside of politicians lining their own pockets in the future, it would be easy to conclude that few would benefit by such changes; such moves appear to be both economically farcical and firmly against the public interest. I’ve not yet heard any articulation of a view that indicates otherwise. But less well discussed are the changes that are coming, and where the NHS is uniquely positioned to pivot into the future.

There is significant work to capture DNA of individuals, but these are fairly static over time. It is estimated that there are 10^9 data points per individual, but there are many other data points – which change against a long timeline – that could be even more significant in helping to diagnose unwanted conditions in a timely fashion. To flip the industry to work almost exclusively to preventative and away from symptom based healthcare.

I think I was on the right track with an interest in Microbiome testing services. The gotcha is that commercial services like uBiome, and public research like the American (and British) Gut Project, are one-shot affairs. Taking a stool, skin or other location sample takes circa 6,000 hours of CPU wall time to reconstruct the 16S rRNA gene sequences of a statistically valid population profile. Something I thought I could get to a super fast turnaround using excess capacity (spot instances – excess compute power you can bid to consume when available) at one or more of the large cloud vendors. And then to build a data asset that could use machine learning techniques to spot patterns in people who later get afflicted by an undesirable or life threatening medical condition.

The primary weakness in the plan is that you can’t suss the way a train is travelling by examining a photograph taken looking down at a static railway line. You need to keep the source sample data (not just a summary) and measure at regular intervals; an incidence of salmonella can routinely knock out 30% of your Microbiome population inside 3 days before it recovers. The profile also flexes wildly based on what you eat and other physiological factors.

The other weakness is that your DNA and your Microbiome samples are not the full story. There are many other potential leading indicators that could determine your propensity to become ill that we’re not even sampling. The questions of which of our 10^18 different data points are significant over time, and how regularly we should be sampled, are open questions

Experience in the USA is that in environments where regular preventative checkups of otherwise healthy individuals take place – that of Dentists – have managed to lower the cost of service delivery by 10% at a time where the rest of the health industry have seen 30-40% cost increases.

So, what are the measures that should be taken, how regularly and how can we keep the source data in a way that allows researchers to employ machine learning techniques to expose the patterns toward future ill-health? There was a good discussion this week on the A16Z Podcast on this very subject with Jeffrey Kaditz of Q Bio. If you have a spare 30 minutes, I thoroughly recommend a listen:

That said, my own savings are such that I have to refocus my own efforts elsewhere back in the IT industry, and my MicroBiome testing service Business Plan mothballed. The technology to regularly sample a big enough population regularly is not yet deployable in a cost effective fashion, but will come. When it does, the NHS will be uniquely positioned to pivot into the sampling and preventative future of healthcare unhindered.

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