Broken Incentives in Medical Innovation

I recently listened to Mark Zuckerberg interviewing Tyler Cowen and Patrick Collison concerning their thesis that the process of using scientific research to advance major development goals (e.g. extending the average human lifespan) has stagnated. It is a fascinating discussion that fundamentally questions the practice of scientific research as it is currently completed.

Their conversation also made me consider more deeply the incentives in my industry, medical R&D, that have shaped the practices that Cowen and Collison find so problematic. While there are many reasons for the difficulties in maintaining a breakneck pace of technological progress (“all the easy ideas are already done,” “the American education system fails badly on STEM,” etc), I think that there are structural causes that are major contributors to the great slowdown in medical progress. See my full discussion here!

The open secrets of what medicine actually helps

One of the things that I was most surprised by when I joined the medical field was how variable the average patient benefit was for different therapies. Obviously, Alzheimer’s treatments are less helpful than syphilis ones, but even within treatment categories, there are huge ranges in actual efficacy for treatments with similar cost, materials, and public conception.

What worries me about this is that not only in public but within the medical establishment, actually differentiating these therapies–and therefore deciding what therapies, ultimately, to use and pay for–is not prioritized in medical practice.

I wrote about this on my company’s blog, but its concept is purely as a comment on the most surprising dichotomy I learned about–that between stenting (no benefit shown for most patients!!) vs. clot retrieval during strokes (amazing benefits, including double the odds of good neurological outcome). Amazingly, the former is a far more common procedure, and the latter is underprovided in rural areas and in most countries outside of the US, EU, Japan, and Korea. Read more here: https://about.nested-knowledge.com/2020/01/27/not-all-minimally-invasive-procedures-are-created-equal/.

Nightcap

  1. Can Francis change the Church? Nancy Dallavalle, Commonweal
  2. A Catholic debate over liberalism Park MacDougald, City Journal
  3. Why Hari Seldon was part of the problem Nick Nielsen, Grand Strategy Annex
  4. How not to die (soon) Robin Hanson, Overcoming Bias

There is no Bloomberg for medicine

When I began working in medical research, I was shocked to find that no one in the medical industry has actually collected and compared all of the clinical outcomes data that has been published. With Big Data in Healthcare as such a major initiative, it was incomprehensible to me that the highest-value data–the data that is directly used to clear therapies, recommend them to the medical community, and assess their efficacy–were being managed in the following way:

  1. Physician completes study, and then spends up to a year writing it up and submitting it,
  2. Journal sits on the study for months, then publishes (in some cases), but without ensuring that it matches similar studies in the data it reports.
  3. Oh, by the way, the journal does not make the data available in a structured format!
  4. Then, if you want to see how that one study compares to related studies, you have to either find a recent, comprehensive, on-point meta-analysis (which is a very low chance in my experience), or comb the literature and extract the data by hand.
  5. That’s it.

This strikes me as mismanagement of data that are relevant to lifechanging healthcare decisions. Effectively, no one in the medical field has anything like what the financial industry has had for decades–the Bloomberg terminal, which presents comprehensive information on an updatable basis by pulling data from centralized repositories. If we can do it for stocks, we can do it for medical studies, and in fact that is what I am trying to do. I recently wrote an article on the topic for the Minneapolis-St Paul Business Journal, calling for the medical community to support a centralized, constantly-updated, data-centric platform to enable not only physicians but also insurers, policymakers, and even patients examine the actual scientific consensus, and the data that support it, in a single interface.

Read the full article at https://www.bizjournals.com/twincities/news/2019/12/27/there-is-no-bloomberg-for-medicine.html!

Changing the way doctors see data

Over the past four years, my brother and I have grown a business that helps doctors publish data-driven articles from the two of us to over 30 experienced researchers. However, along the way, we noticed that data management in medical publication was decades behind other fields–in fact, the vital clinical outcomes from major trials are generally published as singular PDFs with no structured data, and are analyzed in comparison to existing studies only in nonsystematic, nonupdatable publications. Effectively, medicine has no central method for sharing or comparing patient outcomes across therapies, and I think that it is our responsibility as researchers to present these data to the medical community.

Based on our internal estimates, there are >3 million published clinical outcomes studies (with over 200 million individual datapoints) that need to be abstracted, structured, and compared through a central database. We recognized that this is a monumental task, and we therefore have focused on automating and scaling research processes that have been, through today, entirely manual. Only after a year of intensive work have we found a path toward creating a central database for all published patient outcomes, and we are excited to debut our technology publicly!

Keith recently presented our venture at a Mayo Clinic-hosted event, Walleye Tank (a Shark Tank-style competition of medical ventures), and I think that it is an excellent fast-paced introduction to a complex issue. Thanks also to the Mayo Clinic researchers for their interesting questions! You can see his two-minute presentation and the Q&A here. We would love to get more questions from the economic/data science/medical communities, and will continue putting our ideas out there for feedback!

My Startup Experience

Over the past 4 years, I have had a huge transition in my life–from history student to law student to serial medical entrepreneur. Essentially, I have learned a great deal from my academic work that taught me the value that we can create if we find an unmet need in the world, create an idea that fills that need, and then use technology, personal networks, and hard work to create novelties. While startups obviously tackle any new problem under the sun, to me, they are the mechanism to bring about a positive change–and, along the way, get the resources to scale that change across the globe.

I am still very far from reaching that goal, but my family and cofounders have several visions of how to improve not only how patients are treated but also how we build the knowledge base that physicians, patients, and researchers can use to inform care and innovation. My brother/cofounder and I were recently on an entrepreneurship-focused podcast, and we got the chance to discuss our experience, our vision, and our companies. I hope this can be a springboard for more discussions about how companies are a unique agent of advancing human flourishing, and about the history and philosophy of entrepreneurship, technology, and knowledge.

You can listen here: http://rochesterrising.org/podcast/episode-151-talking-medical-startups-with-keith-and-kevin-kallmes. Heartfelt thanks to Amanda Leightner and Rochester Rising for a great conversation!

Thank you!

Kevin Kallmes

Nightcap

  1. The gory, secret lives of NHL dentists David Fleming, ESPN
  2. Imam publicly caned for breaking adultery law he helped draft BBC
  3. The Chinese Communist Party on the worldwide protests Global Times
  4. Are countries like people? Niall Ferguson, Times Literary Supplement