Preventative Medicine

When I was a young associate in a VC firm in my mid 20s, one of the partners told me I should get an annual physical every year and if I did it in the fall, I should get a flu shot while I was having my physical.

I have done that every year since and this afternoon I will spend an hour with my doctor getting poked and prodded and a needle in my upper arm with whatever mixture of flu vaccine they are giving out this year.

Around the same time, my mother advised me that since I have her fair skin I should find a good dermatologist and have a full body scan twice a year. I have been doing that too ever since.

I have seen the statistics on the relative spending between preventative care and critical care but I don’t remember exactly what they are. I do recall that the vast majority of medical spending in the US is on critical care and a small amount is on preventative care.

That seems wrong to me. We should do more to make sure that we all make the effort and take the time to have regular check-ups, do the required scans (mammograms, prostate exams, etc), and get things that will prevent disease like vaccines.

I suspect that beyond good practice, there are startup and investment opportunities in preventative medicine. It is the kind of thing that personal mobile computing can make a big difference in.

#hacking healthcare

Comments (Archived):

  1. awaldstein

    I”m a believer. though took me longer to find the right mix.Have it for me now.Nutrition is key (pays to live with a wellness entrepreneur/hacker), variation in exercise/daily, test early for everything as needed, don’t have doctors who aren’t the very best and you can’t contact and get responses within a day.

  2. thinkdisruptive

    No doubt there is a big opportunity, especially if you can make prevention easy for people (path of least resistance, rather than a mindful additional thing to worry about). However the biggest impediment to this happening is the industry most likely to benefit from it — insurance. Most people are fearful of how punitive insurers are when they get their hands on more data, and the likelihood that startups would sell their data to insurers is about 99%.To make this, and most medical innovation really take off, we need to absolutely ensure that the patient and no one else owns their data, and that insurers in particular are prevented from using it. Today, it is exactly the opposite. I can’t see a doctor, or have anything noted on my record, that insurers aren’t evaluating and viewing with a jaundiced eye, ever ready to raise my premiums on the flimsiest of excuses.

  3. Tom Labus

    Did my annual mid October. Flu shot now given on shoulder more than arm. If you have fair skin find a good dermatologist/MOHS person early and go often. Dealing with the bad stuff is easier when caught early..

  4. sigmaalgebra

    Yes. After my move from NY, I went for a prescription renewal, and I ended up with blood test, urine test, blood sugar test (I’m not diabetic), a prostate digital exam, blood stool test, EKG, weight and blood pressure measurements, PSA (prostate specific antigen or some such) blood test, kidney function blood test, on and on, did get the flu shot and the prescription renewal, and finally an abdominal ultrasound exam.For the last, definite conclusion: Hurray, I’m not pregnant!

    1. Craig Calderone

      Might as well through the kitchen sink in there too! I think this is great that you were able to go through those preventive tests. I think a lot of these typically revolve around blood tests but what about a deeper look inside?What do you think of including a full body/Brain MRI scan or heart & lung ct scan in there, once a year to determine a baseline of healthy and see a trend over time, that can help balance out the false positives?

      1. sigmaalgebra

        Oh, they have more tests scheduled, some, yes, “deeper”.If they schedule a prostate biopsy (OUCH!!), I might be busy that day.If they went “deep” enough, they might discover what I think about what Tom Friedman of the NYT said about CO2 “absorbing sunlight” without even looking at, say,https://webbook.nist.gov/cg

  5. Marc Bush

    My wife’s employer – through whom we receive our health insurance – offers an incentive program where we receive a discount on our premiums in exchange for having a short health assessment and counseling session, and meeting basic health and fitness goals. Simple, easy, and aligned incentives for both sides. Not a replacement for an annual physical, but a good complement.

  6. DJL

    This notion has been in mainstream healthcare for years. That is why some private insurance companies pay 100% of certain preventative medical exams. (Not because they are generous – but because it makes sense.)However, that is where the fun stops. There is nothing in the current medical system that provides a financial incentive for taking care of yourself. It is up to each person to actually invest money in preventative healthcare. Hence, there is not nearly the uptake as their should be.For years I could get a 10% discount on my car insurance for taking drivers training. Last time I checked there was no discount for a colonoscopy.These are the types of incentives that COULD be inserted into private insurance if the government got out of the way.

    1. awaldstein

      As long as tests and processes are covered by insurance (and almost all are), what other incentives are needed?If taking control of your health isn’t ingrained, education is needed not financial incentives.

      1. DJL

        Fair enough. However, we have seen the financial incentives do tend to motivate people. And from our discussion yesterday, nobody wants to pay for training.My point is that private insurance should be allowed to innovate. “Catastrophic care” was far more efficient for healthy people than tripling the cost of care and covering some tests 100%.

        1. awaldstein

          agree.the greatest aftereffect of the wellness revolution, through all the fluffiness is that people need to take ownership of their own health.that alone is a great aftereffect of the green revolution.

      2. MikeSchinkel

        Except that most health insurance plans these days have a high deductible and a significant percentage to be paid by the insured in what they euphemistically call “co-insurance.” (Can you tell I just signed up yesterday for a 2020 plan that cost almost $1000/mon for just myself, but covers very little?)

        1. awaldstein

          could be so, i’m not an expert in insurance beyond my own experience.I have always paid more to insure that I feel good about managing my health.that’s my priority.

      3. thinkdisruptive

        Human motivation is a lot more complex than monetary incentives, or inspiration from within.Why do people still smoke, or put all manner of illicit drugs into their bodies, or gamble away their life savings, or drive too fast, or eat too much? Insurance paying for tests and procedures isn’t motivating to do anything, even if it is 100% covered (which for most, it isn’t), and taking control of your health is such a long-term amorphous abstract idea, for most it’s less motivating than saving for retirement (and a very very small percentage of the population does that, or saves enough).Rather than asking what incentives are needed, it’s better to ask why people DON’T take care of their health or take preventative measures. Understanding that side of the equation, and providing nudges to make it the path of least resistance would be many times more productive than incentives of any kind. Unless, of course, you are purely motivated by money (which some are).If you aren’t already inclined to ‘do the right thing’, education is off-putting and elitist, and more likely to inspire people to take the tests grudgingly, but do the opposite (just as happens with most of the silly workplace training that hr insists on). Education only works with people who are already positively motivated, but don’t know what they should do.I don’t think those who read Fred’s blog are the demographic that we need to worry about. Consider that 40% of the adult population (over 20) is obese, and another 32% are overweight (and of those who are obese, almost 17% of those are morbidly obese). Add it up — more than 70% of us are fat. Or that 5% of the US population is addicted to opioids. Only one in three people get the recommended amount of daily exercise. 15% of the population still smokes. Last year, research was published showing that 40% of Americans drink too much, rising from 1 in 3 just 5 years ago. Name a vice — the data is shocking across the board. You can’t educate or financially incentivize these problems away.Putting it in perspective, getting a regular preventative colonoscopy (just one test) is so far removed from this reality, that we need to run an annual campaign with hundreds of millions spent on advertising , and we still have 1/3 of the population between 50 and 75 who’ve never had one.

    2. scottythebody

      You’re on to something there. I’m a big fan of both government health care AND private insurance. This is why I favor a healthcare system that has “catastrophic and basic” as a requirement, and an open market for supplemental insurance plans that can innovate, select target markets, provide incentives, etc.I think there are two sides to driving down the overall cost of healthcare. Taking care of the basic insurance and catastrophic care coverage to control costs and allowing a market to take care of the other side and provide either value or premium products.Remove employers as the value reduction role they currently provide and allow a more direct relationship between patients, doctors, and insurers.

      1. DJL

        Indeed. So now I am forced to disclose my “Unbama Care” solution. Back in the day, all we needed was this:The government is going to pay for basic, catastrophic care for anyone who needs it. Private insurance companies get to bid to provide that care for their state, market. etc. The total bill for all uninsured Americans would have been in the tens of billions. Case closed. Everyone has healthcare. Everyone gets to keep their plans and their doctors.It just shows that Affordable Care was more about politics that solving real problems.

        1. scottythebody

          the problem with doing it “by State” is that states like Louisiana and Mississippi did everything they could to make sure Obamacare sucked and made it as shitty as possible just because it was attached to Obama. That was part of getting it “passed”. So it just perpetuates bad habits and bad attitudes all the way around.

          1. DJL

            Hmm. Not sure how that was possible since the plans were mandated. In any case, you get my drift. There are ways to cover every American and still not tear down the entire system.

          2. scottythebody

            Refusing expansion of Medicare, for one, is how they did it.

          3. DJL

            Perhaps that is what happens when you pass a 100% partisan bill. There are states who (rightly) don’t believe medicare expansion is the correct solution. Oh well. The Obama team knew it would fail – it was designed to fail and collapse into government-single-payer when Hillary was elected. Oops.

      2. thinkdisruptive

        It is a fallacy that insurance reduces or controls the cost of healthcare. The cost of healthcare is increased by insurance, because it requires an intermediary to administer who needs to make a profit, and who ultimately insulates the end-user from knowledge of what things are really costing, and that is a problem because it’s the end-user who is the real cost controller. To drive down costs you need to attack the source of the costs — hospitals, insurers, healthcare providers, benefits administrators, pharmaceuticals, monopoly controls of sources at several levels, and ultimately as Fred has noted, prevention (i.e. the individual who needs the healthcare).Insurance mutualizes the cost (spreads it among a risk pool), but does absolutely nothing to reduce the total cost. Until we stop talking about insurance as a solution for healthcare costs, we won’t start actually figuring out how to reduce cost.

      3. JLM

        .With the advent of Obamacare, my company healthcare program — health, dental, vision, life — was classified as a “cadillac” program which if continued would no longer have been deductible as a business expense.The program included tons of preventive measures.As the CEO, I had built this program bit by bit and judiciously to favor my employees. I had an employee health insurance committee that did all the research and bidding. It worked like a charm as they owned it. I just wrote the checks.The financial formula is important — insurance is deductible to the employer as a benefit as long as it meets the ERISA non-preference rules, while it is simultaneously not income to the employee.Think about that for a second — employer deducts the cost while employee recognizes NO income.That formula is what Obamacare and all gov’t sponsored programs seek to eliminate. They want to pass the cost along directly to the employees who have to pay for it with after tax dollars. Big point — AFTER TAX DOLLARS, thereby making it way more expensive.Most of the healthcare insurance in the US was employer provided — an enormous percentage.These gov’t programs are based on wrecking that formula.We had somewhere about 30MM uninsured in the US and we wrecked the system — huge price increases, enormous deductibles, lower levels of care — to include these people. We wrecked the entire system to include this relatively small number who we should just have put on Medicare and called it a day.It was always about and is still — CONTROL.JLMwww.themusingsofthebigredca…

    3. MikeSchinkel

      No sure why private insurance would not be able to innovate in the manner you mention even given “Unbama Care,” as you called it.

    4. David Gobel

      umm – inserted used after paragraph mentioning colonoscopy. Oy!

  7. Ana Milicevic

    I’ve had many conversations with folks who skip the preventative stuff because they’re not sure how much it would cost to diagnose and follow up on an issue that’s potentially discovered (especially if it ends up being a false positive) that they forego care altogether. That’s something unique to the US health care “system” (perhaps the air quotes should be on the care part).I, too, am hopeful that accessible, out-of-pocket smartphone telemedicine can make a major difference here in the short term. The same solutions we’re looking at for addressing medical needs in poor and geographically hard to reach regions of the world will work here, too.

    1. Craig Calderone

      You make a great point around cost transparency which is under the gun lately in Washington and at the forefront of a lot of entrepreneurs minds. If we can go around the “system” and make healthcare a direct to consumer experience, don’t you think that would solve a lot of the issues you raised?Smartphones are great for some of the basic things, but also the scan machines mentioned aren’t getting any smaller any time soon which are crucial to see inside the body at a cellular level.What do you think of getting a full body MRI scan once a year to determine a baseline of healthy and see a trend over time, that can help balance out the false positives?

      1. Ana Milicevic

        I love the idea of regular, full diagnostic tests interspersed with more frequent readings of key metrics (eg the once a year measure your blood pressure at the dr’s office is unnecessarily archaic). A lot of the innovation here will be driven by folks who can afford to pay for stuff like that out of pocket; I think that’s a great start but don’t want to ignore that by far our biggest gap in health care right now is accessibility and cost (which heavily factors into accessibility).

        1. Craig Calderone

          I’m working through some of this now in positioning a direct to consumer preventive health radiology screening service. Would you be open to chatting via phone? Here’s the site we’d love to get your feedback on if you’d be open: http://alfiehealth.com/

          1. thinkdisruptive

            Hi Craig,Thought I’d throw in my two cents about direct to consumer and your services.a) I absolutely believe that direct to consumer is a better model than what we currently have, for quality of experience, cost control and empowerment.b) cost is still a huge issue, especially for preventative tests which are by their nature discretionary expenses.I had a look at your site. It’s obviously pretty new and sparse.The problem is that your costs are so high that only the wealthiest or most hypochondriac would sign up for these, and we already have a population that is largely under-served because of cost and lack of knowledge. Extrapolating, one could easily create a tab of many 10s of thousands of dollars to run all the tests that might be of benefit, and still end up with no positive outcome other than peace of mind (although if i had spent that much money for tests, I wouldn’t have a lot of peace of mind).At this price point, these measures are not preventative — they are only something I would do if there was evidence or reason to believe there was a problem that needed to be addressed. Putting it in perspective, given a choice between a new iPhone and full body MRI, 99% of average people would choose a new iPhone.If your service was integrated into a holistic direct to consumer model, rather than as an a la carte offering, it would be more appealing, but there was absolutely nothing on your site that made me think “I have to have this”.My suggestion to you is to focus on desired outcomes — why is someone going to do this, and why is this a reasonable price? You may have internalized the expected benefits, and have greater knowledge of costs and where the most likely problems for which these tests are useful. I don’t have this knowledge, and I suspect most are far less aware than I am.

  8. David A. Frankel

    Preventative healthcare is really about prioritizing self care. People and companies don’t do it enough, and you can find it at the very core of so many issues we are dealing with in society. Proper, lifelong health education and regular physical and mental healthcare BEFORE a crisis can save money and, more importantly, save lives.While I do agree that there are entrepreneurial opportunities here, ultimately I think we have to correct a very real cultural problem that one could say is almost as big as climate change — self care not only needs to be easy and affordable, it also needs to be encouraged and embraced from the top down.

  9. Hemi Weingarten

    From the nutrition angle, prevention simply isn’t profitable.If everyone ate healthfully, multiple 100B$ industries would collapse: junk food, fast food, soft drinks – one one hand, and weight loss, healthcare, pharma – on the other.All these industries are essentially anti-prevention.Additionally, health insurance companies don’t really care about prevention, a long term payoff, because average member churn is every few years. More people getting sick? No problem, insurers simply raise the premiums as needed.Employers (in the US insurance model) are one area of hope, but employee incentives have proven to be effective only for short spurts, after which people go back to their old, unhealthy habits.As much as Fred prefers market forces and hates government / regulatory solutions, I think public health measures by the government may be the fastest, most effective means of preventing and reducing the burden of chronic disease related to nutrition. See past success with the cigarette industry for reference.

  10. Bob

    Unfortunately, epidemics like Type 2 diabetes are largely lifestyle-driven. Everyone (even healthy adults) can start taking a more proactive role in their own health by simply getting an inexpensive glucose meter and begin to understand the effects of things like diet, exercise, and sleep on your blood sugar – https://www.quantifiedbob.c

  11. Souraya Eid

    One of the areas I love most about healthcare is functional medicine, which is a form of preventive care and basically revolves around not letting people get sick rather than treating them when they’re sick. Parsley Health, a NY-based company, has launched in that space and I think it would be interesting for you to check out their services. Cheers!

    1. awaldstein

      Yup know them.I agree, though great functional medicine doctors are really scarce as it takes not only the special study and intuition from the functional side, but also deep connections with the western experts and practitioners to know when to use them.Rare.I’ve been lucky to find great ones.

      1. William Mougayar

        But is this the trend? Something directional to where it is going?

        1. awaldstein

          i think the market demand for functional/integrative doctors of quality grows but the supply is not great.True for nutritional expertise as well.

    2. William Mougayar

      Can’t some of the GP’s become versed into these additional factors or is this a core healthcare practice that you learn specifically?You are an investor in Parsley it seems?

      1. awaldstein

        you can take additional certification in functional medicine though in my experience the cert while helpful is not an indicator of excellence, as certainly it is not with a medical degree.the very best functional medicine doctor are invariably the best GPs and very much part of the system and as well, the ones who know the cutting edge advancements.

      2. Matt A. Myers

        Where did you see she’s an investor ?

  12. Michael Blend

    I have been wanting to start a mobile annual physical company. It makes sense for everyone, employees don’t have to leave work for half a day fortheir physical, and everyone at the office has the same insurance so billing would be simple. Next company!

  13. William Mougayar

    For years, it’s been known that early detection (hence preventative care) leads to better outcomes, yet it is not widely practiced. I think education has a role to play here, whether it’s mobile solutions, home self-tests, wellness practices, lifestyle changes, regular visits to primary care physician, etc.. are the steps taken.

  14. kidmercury

    fred, i hope you have considered/will consider the adverse impacts of the flu vaccine, especially as you get older, and critically ask yourself whether the rewards are worth the risks. the flu vaccine’s own insert warns it can cause encephalomyelitis (link). that’s a serious injury that can result in many disorders that none of us would like to have. the flu vaccine has the largest payout in vaccine injury court settlements (sources).

  15. JLM

    .At your advanced age, you may want to consider a heart cat scan, a total body MRI, and some cognitive testing to create base lines for future assessment. Also get pics of your skin if you are prone to skin issues.The cognitive testing — a series of simple tests administered by a health pro — is particularly illuminating. One cannot see or feel their cognitive powers — one’s super powers — deteriorating, but they do. It is surprising how fatigue can impact one’s cognitive results.There are also a number of exercises that you can do to delay the inevitable deterioration. I do these all the time and they work. [I suspect that your disciplined blogging has a very favorable impact on cognitive skills.]You are an old fart and can afford to take care of yourself. [For the record, I am 10 years older and do all this stuff regularly.]JLMwww.themusingsofthebigredca…

    1. Matt A. Myers

      You know as well as any, old farts don’t listen to most advice given, offered to them; maybe a higher possibility if is old fart sharing with another old fart.

      1. JLM

        .One of the advantages of older age — unfortunately some are old men at 40 and thankfully others are young men at 80 — is the ability to discern the difference between chicken salad and chicken excrement.If I had sought or taken advice from some young whippersnappers who knows what kind of a monumental blunder I might have embraced.I might have become convinced to support, say, Andrew Yang in the impending US national elections. Eeegads!Youth is wasted on the young. Too late we achieve wisdom.The other day I had coffee with a guy in NYC even older than me who is still active in entrepreneurial business. We concluded that we had lived an aggregate total of 5.2 lifetimes and had the scars to prove it.JLMwww.themusingsofthebigredca…

        1. Matt A. Myers

          Haha – got an audible laugh from me.And as you suggest, youth is determined by experience and therefore potential for maturity – not simply time passing of time, still many people trust based on the wrong metrics.P.S. Yang raised $10mm Q3 in ~$30 contributions, and $1 million last week alone. #YangGang

          1. JLM

            .Yang is like an essential spice in a delicious concoction. His presence may make the taste more savory, but he is not the main ingredient.IAW Dem orthodoxy, Yang needs to find some stuff to apologize for. You can’t be an attractive Dem candidate without an apology tour or two. Witness Brother Bloomberg.Maybe Yang can apologize for being a calculus terrorist?It is not the passing of time. It is the times themselves. Some men fill every minute of every day with “sixty seconds of distance run” and some sit on their asses and watch the runners go by.Each year is not valued the same.JLMwww.themusingsofthebigredca…

        2. Pete Griffiths

          Youth is wasted on the young. Too late we achieve wisdomNever a truer word

        3. sigmaalgebra

          ForYouth is wasted on the young. Too late we achieve wisdom. The way I heard it, attributed to Mark Twain, was “Youth is such a wonderful time of life. Too bad it’s wasted on young people.”Yup, I picked up a LOT of really important lessons about life, often paid “full tuition” as in “experience is the great teacher and some will learn from no other”.I believe that nearly all of those lessons I could have learned plenty well enough when I was, say, 12 (I’m not talking mostly just about puberty topics) without the “experience” or “full tuition”. I believe that Dad could have taught me a lot of those lessons, but he didn’t — there was a lot he knew that he just didn’t much try to teach me.But apparently it is nearly standard that sons later regret that they didn’t get more from their fathers. E.g., apparently the writer of Indiana Jones and the Last Crusade believed that movie audiences were prepared to believe that the scene at the little table in the Hindenburg airship where Indiana told his father “we never talked” was realistic.I STILL believe that there are a 100 or so such lessons that are nearly universal and really important, commonly take decades to learn even if then, and COULD be easily enough taught to boys of 12. I concentrate on boys because the lessons for girls will be quite different (sorry ’bout that feminists), and I have too little insight into what girls should be taught.The techniques and talents of Hollywood could do a TERRIFIC job. Since a lot of the lessons are common but commonly unspoken and politically incorrect, no major organization would dare to make the lessons explicit.Essentially all the lessons could be presented in a book, but for a boy of 12 a good Hollywood presentation would be important to essential.So, right, such a book might have title What I Wish Dad Had Explained to Me When I Was 12, and I suspect that occasionally going way back there have been such books; still, apparently, the problem remains very poorly solved.One way to write such a book or script for a Hollywood production and avoid the attacks from being politically incorrect would be to explain clearly up front that one of the main lessons to learn is that for nearly any situation in life, there can more than one, several, to many common approaches and that the script will display many of them — some of the common approaches are politically incorrect or worse, but it is important to understand lots of the common approaches, maybe for own use but at least to better understand others and just reality.I’ve long thought that once my startup works (making good progress today, getting big steps forward on Windows 7 system management, writing some code, fun time!) I would produce such a movie.Ah, did Howard Hawks, Alfred Hitchcock, etc. have a child who could be the director???? Hitchcock could do some darned subtle stuff, e.g., Olivier and Fontaine in Rebecca — right, we don’t know that any such thing did happen or very realistically ever could happen; it’s definitely fiction as in not true; but there is subtlety that could be important for skits of some of the more difficult lessons that are about reality/ For the nastiness and sex life of Rebecca and the devotion and bitterness of Danvers, again we don’t know how realistic, but one of the lessons I’ve learned is that for such things even worse versions CAN be real. I WOULD have in the movie essentially, “Look out, guys, such stuff and worse really can happen; watch for it; if there is some evidence, then take it seriously and don’t reject it as obviously just impossible — worse things along those lines ARE possible.”I believe that a gold mine of solid descriptions of such possibilities, and a very wide range of more, can come, like rivers, from the clinical psychology practitioners. E.g., in the movie, Fontaine does a terrific job showing low self-esteem until some of the events near the end: Low self esteem is very common, especially in girls and young women, and boys NEED to understand this, be able to detect it, and respond to it at LEAST sympathetically and gently. Dad never explained female low self-esteem to me. For that one, big chunk of full tuition; totally unnecessary; it’s super easy to teach, and BEAUTIFULLY illustrated by Fontaine in that movie. A boy of 12 really could learn that lesson, if nowhere else than just in that movie IF someone would POINT it out. Sure, Hitchcock believed, apparently at least assumed, that everyone in the audience would understand right away; NOPE, a LOT of boys 12 to … have yet to learn that lesson. With high irony, in the story, de Winter himself married Rebecca without understanding hardly even the first thing about the severely ugly points about her.So, Rebecca put on one heck of an act: Yup, that’s one of the lessons, i.e., some people actually can do that. I paid full tuition for that lesson. Dad never warned me that there are some REALLY good actresses, maybe actors, out there. Similarly for something like Rebecca’s sex life — I’ve had solid evidence of worse although that lesson I didn’t have to pay for.And there are lots more such lessons. Boys should be taught that stuff, and with good materials can learn it at 12.

    2. Richard

      Over 55….For the heart – a calcium score (not a heart scan) and a stress test.For the Bone – bone density ScanFor the nerves – Nerve conduction test

      1. JLM

        .A heart scan is a “coronary calcium scan” which measures calcium-containing plaque and can be used to set a trend line when done over time. It is a first rate preventive measure.A heart stress test determines how well your heart handles work — performance under load. It is normally used when there is some evidence of cardiac dysfunction as to rhythm, speed or irregularity. It is a diagnostic tool that can determine whether a heart valve might require replacement. It is also a way to test the efficacy of a regimen of treatment. It is typically not a preventive measure.Bone scans are typically prescribed when there is some unexplained bone problem like pain or in the aftermath of a broken bone or associated with cancer spread. It is typically not a preventive measure.NCV (nerve conduction velocity) is typically related to specific testing for things like ALS, carpal tunnel, Guillain-Barre and peripheral diabetic neuropathy. In the absence of such conditions, it is hard to imagine what the efficacy of the test might be. It is typically not a preventive measure.I have some nerve damage in my feet from the Army and my values haven’t changed in more than forty years.JLMwww.themusingsofthebigredca…

      2. Richard

        The name of the game is to prevent the fall.

      3. awaldstein

        useful.

  16. Benoit

    I agree, but with one important caveat people often don’t realize: incidental findings for which we just don’t exactly know the outcome/impact yet. I have been doing research in mathematics and brain MRI for more than 10 years now. We routinely image healthy volunteers for our studies. The documented rate of incidental finding is about 10%, and we do see this rate in our studies. This means that in every 10 subjects, we have one subject with something not completely normal. This is a lot of incidental findings. Many times it is not a big deal at all, or it just need to be monitored but it’s probably ok. And yet I can assure you that it causes so much stress and emotional pain that can last. I’m honestly a little worried of these startups doing MRI for ~$2000. Do you want to know early if you have any disease, so that therapy can be introduced early and therefore be more effective? Yes. But this is also going to cause a lot of useless suffering and pain. This is something we need to be aware of and try to manage the best as we can.

    1. Pete Griffiths

      And every time the scans up the resolution the radiographers go thru a new learning curve trying to figure out which of the new things they can now see might be dangerous.

  17. olegious

    The discrepancy between spending on preventative and critical care is simple- many people don’t have health insurance, or have poor coverage so they can’t afford preventative care so they they avoid going to the doctor until they HAVE to go to the doctor because their issue is critical.As a point of comparison- I have excellent insurance in the US and my basic annual checkup and blood tests cost $700 (covered by insurance). When I lived in France, I got a far more comprehensive checkup and blood work done for $200 without insurance.

  18. MikeSchinkel

    > That seems wrong to me.For a large segment of the population β€” especially given the increasing inequality where so many people are just struggling to get by on a day-to-day basis β€” preventative medicine is a “luxury” they just cannot afford when compared to paying for food, clothing, shelter and the outrageous modern-day costs of health care so they can live another day.Sadly.#justsaying

  19. Vendita Auto

    The UK has the NHS free at point of delivery part of which is free flue jabs wellman clinics and blood tests if required because the UK plc workforce is our most important asset.Personally I noted my blood test results warned me my cholesterol was bordering on high six months before a mild stroke. I became my own experiment, cut out all dairy and only eat line caught fish my blood cholesterol is now 2.9. was 6.9 thank you Dr Google for all the “China study” advice. I and a small group of friends around the same timeline share our yearly test results.One has to smile when discussing health while many I am sure were / are looking atin vaping or tobacco ROI …

  20. Harald Steltzer

    Completely agree! NoMo Diagnostics is working on an helmet embedded diagnostics aid for concussion detection where 70-80% are currently unrecognized. We are in a new space of Medical Devices as a Service combining hardware with a detection algorithm plus longitudinal tracking with cloud service. The challenge will be who absorbs the cost for the remote monitoring in a system where you need to be diagnosed first. It is a new space for investors, entrepreneurs, and regulators alike. Skins sensors are a big part of the future of healthcare. Let’s keep the conversation going.

  21. JLM

    .”preventive” works as well as preventative, but I love the word invention aspectWhere are the spelling goons? Come on, y’all.JLMwww.themusingsofthebigredca…

    1. fredwilson

      Made up words are my specialty (ie freemium)

      1. JLM

        .Huge fan of made-up-words.Didn’t realize you were the author of “freemium” — hattipper to you, amigo.The Investopedia slang dictionary attributes the word to Jarid Lukin who worked for Alacra at the time.I once, erroneously, thought I had invented the word “beclowned” to find out it was archaic English and had been around for a long time. Still, I love it.JLMwww.themusingsofthebigredca…

        1. jason wright

          Jarid Lukin?

      2. pointsnfigures

        I can’t pronounce them, but dats cauze I speak Chicago.

  22. jason wright

    Phew. At first i thought this post was heading in the direction of an alien abduction recollection.Preventive medicine and the preventive lifestyle. 1+1=2. 1+-1=0.

  23. Ian Cruz

    I, personally, also like to order my bloodwork and request additional tests like C reactive protein (inflammation), an advanced lipid panel (NMR) for LDL particle count, HOMA-IR for insulin resistance, omega 3-6 ratio’s etc. I geek out over this stuff, and like to see how my results differ as I alter my diet and lifestyle. I’ll time the tests with an athletic endeavor or nutrition/lifestyle change. But I remember my physician asked me why I was asking for these tests if “my past results weren’t bad”. It’s as if I’m only supposed to go to the doctor when it’s too late. I think this attitude needs to change. Regarding functional health, I’d recommend the book “Unconventional Medicine” by Chris Kresser or “Ultramind Solution” by Mark Hyman. I’ll share an article written by Mark Hyman back in 2008 on the application of Functional Medicine: https://experiencelife.com/

  24. Joel Fichera

    While I absolutely believe there are startups in this space doing interesting things, globally there are generally structural funding issues that exist that make it difficult for the business models of preventative medicine startups to be attractive. This holds particularly for the US where the current spending per capita is comparatively high to per capita GDP (https://www.healthsystemtra….To expand on this I’ve provided an article talking about the NHS specifically, but it is many ways funadmentally similar to other models of healthcare in developed countries.Some key excerpts from the article (https://www.theguardian.com…- “NHS made an error from the start: building services around treatment rather than prevention. We see the ramifications of this today. By seeking to treat ill health rather than tackling its causes”- “GPs spend taxpayers’ cash more efficiently than any other part of our NHS; more investment in the training of GPs and cash for surgeries would reduce pressure on the acute sector.” -> GPs need to be part of the solution, they are the key touchpoint prior to hospitals- “The [introduction of additional] funds will do nothing to alleviate pressure on GP services and A&E departments. For now, we rely on the heroic efforts of six million unpaid carers to maintain a flailing social care system.- The major stakeholder not addressed in the article are insurers, who are also able to shape individual behaviours and have the financial incentive to improve outcomes (but this is difficult without a system that facilitates the change)

  25. pointsnfigures

    got to get my flu shot…..

  26. Pete Griffiths

    I’m not sure we should all be doing mammograms and prostate exams.

  27. Pete Griffiths

    Preventative care is like technical debt. Nobody wants to pay for refactoring.

  28. Dror Ceder

    I couldn’t agree more. I recently saw a CB insights report of the top 150 digital health companies in the world. More than $16B were invested in these companies yet none of them deals with prevention. It seems to know one has found a super profitable business model that makes sure people don’t get sick in the first place which is shocking. Healthcare today is more Medical care which is solving medical issues after they happen, real healthcare is when you take care of your health while you are still healthy.

  29. Amar

    I suspect we are one of the reasons this is not prevalent. The advice often given to product managers and entrepreneurs is “build a pain killer not a vitamin”.Preventative care is big into vitamins while critical care is all about pain killers. As @joelfichera:disqus says below, the business model for scaling vitamins is not as easily blessed πŸ™‚

  30. Mike

    Good discussion. One thing I might add is chronic disease management. I recall there are a few chronic conditions (Hypertension, CHF, Diabetes etc.) that account for a significant portion of healthcare costs. Within the Medicare population over 50% of recipients have two or more chronic conditions. I think this is an area that many companies, large and small, are working to address – to help people better manage their chronic conditions. From a healthcare economics perspective the basic idea is that through proper management you can reduce expensive acute, inpatient episodes (ER visits, hospitalizations etc.). This folds into the larger strategy of managing the health of an aging population and pursuing solutions, including technology, that will enable age in place and home health delivery models.

  31. cavepainting

    There are many startups addressing preventative healthcare selling to employers and payers. (See Welltok as an example). But few are experiencing significant growth or success.Why? The healthcare ecosystem is incredibly complicated. Payers’ members churn constantly, Average tenure of employees is declining, and hospitals make money on the sick, not the healthy. Generally speaking, there is little incentive for anyone to invest money in bending the cost curve for the long term.But.. employers, payers, and CMS are starting to realize that sick care is not health care and starting to dabble with preventative measures and reward programs. Whether these will go mainstream is not clear. We need more awareness among all stakeholders. CMS (Center for Medicare and Medicaid Services) should take the lead for they are the largest payer and the entity most invested in reducing total cost of care over the long term.

  32. Richard

    Fred .. The Forest Gump of Healthcare Analysis

  33. Kenneth Goldman

    I’ve worked with Dr. Mike Nichols of Saratoga, CA for about 9 years. By tracking the results of many more tests than would typically be ordered (blood, bone mineral density, coronary calcium, etc., as well as exercise data, e.g., from a heart rate monitor), he has saved my life where standard medical practice would have failed me. He uses a patient’s own data and risk profile (rather than those of typical populations) to detect problems *much* earlier and to motivate them to take the actions that ensure better heatlh. There’s a short video on his websites that explains the approach:http://whenyouareserious.com/http://quantitativemedicine…He’s also an excellent short form (blog) writer, which is how he first got my attention.I would commend him to anyone who is indeed serious about their health.Feel free to contact me offline if you’d like more details about my own experience.