Monday Note

Regard the horrified looks on the faces of the attendees at a California Council on Science and Technology meeting in Irvine six or seven years ago. I’m the only member from the Dark Side, from the venture capital milieu, inside an institution “designed to offer expert advice to the state government and to recommend solutions to science and technology-related policy issues”. The other members are scientists and scholars.

The question of the day is electronic medical records: How do we computerize, standardize, store, secure, exchange our corpus info with a reasonable assurance of privacy?

My answer: Give the job to Google. And thus follows the politely alarmed reaction…and the objections.

Our records won’t be secure! Google will exploit our most personal history to make money on our backs (or other organs)! They’ve digitized books, is this yet another step towards a privately-controlled but overly powerful public utility/institution?

Years later, what do we know?

First, doctors and patients still have trouble finding and exchanging records. I have, as attorneys are fond of saying, “personal knowledge” of this fact. The exchange of records between my politically-incorrect internist, the Palo Alto Medical Foundation and the Stanford Hospital—organizations within a mere mile of one other—takes multiple phone calls, visits in person, fax machines.

Now try one of the blood-sucking medical insurance companies. To gain access to your own record, they send you, by fax, an authorization form for your signature…but there’s no return number, there’s no way to return the fax. It’s not personal, it’s systemic, an obstacle course to minimize claim payments.

Second, the current system, notwithstanding HIPAA regulations, leaves our records open to outsourcing subcontractors in the US and elsewhere, to poorly qualified claim adjudicators inside insurance companies and to employers’ HR personnel. In theory, there are walls. In practice, expediency: there’s “cost containment”, there’s an astounding number of people, “trusted” or not, who get to look at your records. Compared to this, Google looks pretty good. Yes, they have security breaches, people occasionally lose their password or get their accounts hacked, but these events are statistically insignificant. Add penalties for such incidents, weigh them against what we’d pay Google for the service, and we’d have a decent level of protection, an SLA for our medical records.

Few companies have dealt with size, with what we call “scalability” as successfully as Google has. They have the human expertise and the computer systems to store and index “everything”, this is what they do for a living, with more than 2.5 million servers that keep their data intact.

As to Google’s exploitation of our records… Of course Google cares, they can wring billions from our personal health history? All we have to do is write a contract to share the loot, we call this “revenue-sharing”. Think of what a relentless crawl through billions of medical records will garner them… Take a transversal look at all the patients who take high blood pressure (antihypertensive) drugs, look at morbidity (how often, when, and how severely they get sick) and mortality (when and how we die) rates. Or look at the more subtle but important combinations such as ancestry (the best way to get low cholesterol is to choose your parents well), other drugs, lifestyle (a.k.a. good and bad exercise, food intake, alcohol, tobacco and other substances soon to be legal in California).

This would be much better than the current and deeply corrupt system of medical studies. You think I exaggerate? I wish. See this sobering David H. Freedman story in the November issue of the Atlantic (a treasure of literate America).

Since that CCST meeting, Google’s founders have demonstrated an interest in DNA decoding. Handing them our records would promote progress in areas such as individual sensitivity to drugs, or predicting the onset of diseases. We would get real data, valuable information on the scale we need to fight the ever escalating percentage of GDP that’s we sink into healthcare with little to show for it–other than being ranked 37th in the world in medical quality, according to this World Health Organization report.
We would benefit individually and collectively from a permanent large-scale mining of health records. Anonymized if we so dictate. Personalized if/when we think it’ll help.

Imagine what that lousy #37 ranking would become if we used the #1 computer system, Google’s.

Lastly, the horror of giving too much power to Google. It’s a fantasy. Haven’t we done this already, and worse? We vote and send our solons to Washington where they promptly sell us to a collection of lobbies: healthcare, Big Pharma, telecom, financial services, agribusiness… I’d rather deal with Google than with Washington.

We’re lucky. Just when we thought Google was becoming too powerful, Facebook emerged and could become bigger and even more pervasive than the search giant.

Should we make them regulated monopolies? We had Ma Bell, will we have Ma Goog or Ma Face?

But…we know what will happen: Nothing. We don’t have what it takes for such a bold step. Proud as we might be of our Valley’s achievements, we can’t even get a high-speed train through the Peninsula. How can we expect to have the political will to take really bold steps?

—JLG@mondaynote.com

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