Array
(
    [content] => 
    [params] => Array
        (
            [0] => /forum/index.php?threads/the-ability-of-chips-to-leverage-talent-and-time-drive-progress.16283/
        )

    [addOns] => Array
        (
            [DL6/MLTP] => 13
            [Hampel/TimeZoneDebug] => 1000070
            [SV/ChangePostDate] => 2010200
            [SemiWiki/Newsletter] => 1000010
            [SemiWiki/WPMenu] => 1000010
            [SemiWiki/XPressExtend] => 1000010
            [ThemeHouse/XLink] => 1000970
            [ThemeHouse/XPress] => 1010570
            [XF] => 2021071
            [XFI] => 1050270
        )

    [wordpress] => /var/www/html
)

The ability of chips to leverage talent and time drive progress

Arthur Hanson

Well-known member
The ability of semis of all types from sensors to communications to processes is what is driving the semi sector. We are about to see an "Automation of Everything" revolution if special interests of all types can be worked around. Doctors spend forty percent of their time on diagnostics and in no way can a human even come close to a platform in this area in speed and accuracy and also be kept up to date in real time. Much of the diagnostics have the ability to be automated and special interests that drive high medical costs driven by special interests are standing in the way. This is now true of many professions and represents an area of staggering gains in speed, accuracy, and lowering cost. The ability to automate almost everything and integrate active data bases will represent a true revolution in how things are executed. The ability to combine massive databases with low cost per unit memory and unparalleled computational powers at ever lower costs will only be prevented by special interests. This will apply to medicine, law, engineering, and just about everything we engage in. Low-cost memory, processing, sensors, and communications together have brought us to the tipping point of a true revolution in the history of mankind. I only hope we have the wisdom and fortitude to override the special interests to make this happen. Any thoughts or comments appreciated. The tipping point is here and now.
 

Arthur Hanson

Well-known member
Special interests?
US medical ranks 37th in quality(they have since employed web masters to manipulate this figure since I published a similar forum in Barron's) and the world's highest cost. US medical has done much to operate in the most inefficient manner possible such as the individual or very small practice in major cities which doesn't have the economies of scale in expertise or finance to provide professional service at a reasonable cost.
 

tooLongInEDA

Active member
Special interests?
Absolutely.

One example. In the UK, we have a persistent shortage of home-trained doctors - and a large part of the reason is that the BMA (the doctor's trade union in the UK) limits the number of degree places for doctors. Whilst the absolute numbers of students going into higher education has increased by about 4x in the last 35 years, the number of trained doctors has not.

The results are less than satisfactory. Junior doctors remain overworked and work excessive hours which would be deemed unsafe in many professions - but oddly the medical profession has never addressed this, preferring to gain exemption from 48 hour maximum working week directives. That and the continued asset stripping of doctors from poorer countires (with the training costs not even reimbursed to those countries).

Yes, the healthcare industry is riven with this sort of thing. Much of what doctors do does not require fully trained doctors to do it. But the career structure and job demarcation in healthcare has been largely frozen for around 100 years.

We should ask ourselves how it is that the "more for less" gains from semiconductors and software made in so many industries have not not been achieved in healthcare (or education) and costs continue to rise and productivity not advance. Are there real technical reasons or is it human and organisational obstruction ? My money's on the latter.

Of course, we shall hear a lot about "safety" and "putting the patients first". But I remember hearing exactly the same from airline unions in the UK 20 years ago when trying to defend their excessive pay (we had a lot of bloated state-owned airlines in Europe charging 3x the actual cost of flights). Then the low-cost airlines came along - and miraculously safety did not suffer at all.
 

Arthur Hanson

Well-known member
Medical should be the next area for the tech sector to attack several fronts in an industry that has crossed so many lines and killed so many people by offering low quality at staggering cost. Waste, inefficiency, and outright fraud dominate, and where things are very poorly run light the greatest opportunities. Semis in both sensors and diagnostics offer real competition if they can get around the relationship of the special interest with a government totally corrupted by medical that has given us the over priced low quality mess in the US.
 

jms_embedded

Active member
Semis in both sensors and diagnostics offer real competition if they can get around the relationship of the special interest with a government totally corrupted by medical that has given us the over priced low quality mess in the US.

Do you have any specific evidence of "special interests" blocking the use of technology in medicine?

I agree that medical care is a mess in the USA but my understanding is that it is the role of insurance companies / hospitals / law firms / etc. and all about issues involving coverage and costs and liability --- for example the RaDonda Vaught case now poses some chilling disincentives for nurses to admit mistakes or even to enter the nursing industry --- and nothing to do with technology.

I worked for a company for over 15 years that primarily designed medical electronics. I worked a little bit on the medical side, sometimes on other projects --- but for all that time I was exposed to how the medical electronics industry works. It is slow and expensive in large part because, quite frankly, the companies in this space have to ensure that their products are safe, and will be available for a long product lifetime. That is not trivial. It involves a lot of careful design, planning, analysis, and testing. Consumer electronics can take shortcuts and just ship the damn product, putting out a new widget every year. So it stops working if a drop of water gets into the USB connector or one of the ICs fails? Oh well. Too bad. That kind of approach doesn't work in medical. FMEA (failure mode effect analysis) are used to scrutinize large numbers of possible failures. We had to document what could happen if any pair of adjacent pins on every IC shorted together, or if any pin experienced an open circuit, and make sure that failures could be detected and mitigated. People can die and have died because of engineering failures in medicine --- read up on the Therac-25 --- and the only way around it is taking proper engineering precautions, which takes time and effort and money.

Hearing accusations of "special interests" in medicine, without some examples to back it up, is just disappointing to me.

Medical should be the next area for the tech sector to attack several fronts

Medical has already been something the tech sector is focusing on. The next time you get an X-ray and the results show up instantaneously on a computer screen, instead of waiting for films to be developed, think about how that was made possible.

What people should be complaining about is the drain of engineering talent for entertainment companies, because we like our Facebook and Netflix and Apple and Google and TikTok and Instagram, and the dozens of smaller "fun" companies, and so the tech industry effort goes there instead of more mundane problems important to society, like medical technology or designing better software for programming microcontrollers.
 
Last edited:

Arthur Hanson

Well-known member
The special interests are the doctors and dentists themselves. Many operate out of small offices and cannot offer the benefits that scale provides in everything from diagnostics to corrective actions, devices, and skill sets. The individual dentist or doctor's office is of low quality and high cost just by not having the scale to offer the diverse skills, equipment, and software needed to offer high quality services. It is the ego that drives much of this that delivers high costs and low quality. Many skills and professions need scale to achieve great products at reasonable cost and TSM has fully demonstrated this in the semi sector. Canadian medical at seven steps better in quality at half the cost demonstrates many methods the US could easily adopt such as banning advertising of drugs which many doctors and almost all individuals are not even close to the skill set needed to pick the the best drugs. Canada uses formulary boards of specialists to pick the best drugs for particular conditions.
 

tooLongInEDA

Active member
Do you have any specific evidence of "special interests" blocking the use of technology in medicine?

I agree that medical care is a mess in the USA but my understanding is that it is the role of insurance companies / hospitals / law firms / etc. and all about issues involving coverage and costs and liability --- for example the RaDonda Vaught case now poses some chilling disincentives for nurses to admit mistakes or even to enter the nursing industry --- and nothing to do with technology.

I worked for a company for over 15 years that primarily designed medical electronics. I worked a little bit on the medical side, sometimes on other projects --- but for all that time I was exposed to how the medical electronics industry works. It is slow and expensive in large part because, quite frankly, the companies in this space have to ensure that their products are safe, and will be available for a long product lifetime. That is not trivial. It involves a lot of careful design, planning, analysis, and testing. Consumer electronics can take shortcuts and just ship the damn product, putting out a new widget every year. So it stops working if a drop of water gets into the USB connector or one of the ICs fails? Oh well. Too bad. That kind of approach doesn't work in medical. FMEA (failure mode effect analysis) are used to scrutinize large numbers of possible failures. We had to document what could happen if any pair of adjacent pins on every IC shorted together, or if any pin experienced an open circuit, and make sure that failures could be detected and mitigated. People can die and have died because of engineering failures in medicine --- read up on the Therac-25 --- and the only way around it is taking proper engineering precautions, which takes time and effort and money.

Hearing accusations of "special interests" in medicine, without some examples to back it up, is just disappointing to me.



Medical has already been something the tech sector is focusing on. The next time you get an X-ray and the results show up instantaneously on a computer screen, instead of waiting for films to be developed, think about how that was made possible.

What people should be complaining about is the drain of engineering talent for entertainment companies, because we like our Facebook and Netflix and Apple and Google and TikTok and Instagram, and the dozens of smaller "fun" companies, and so the tech industry effort goes there instead of more mundane problems important to society, like medical technology or designing better software for programming microcontrollers.
I don't think Arthur or I are disagreeing with you on these points, which you make very well.

In some ways, medical sounds a bit like defense (where I started my career). It used to be more leading edge and exciting, but the big rewards (and you can get to these much, much faster) have been in the mass consumer/entertainment area for a long time now. And all - as you note - without the tougher engineering discipline of safety, reliability, etc to worry about so much.

Certainly, medical technology innovation does not get the recognition it deserves (perhaps someone should fund a Nobel prize type award for this ?).

Where we see things differently (likely both as outsiders so we may be optimistic about what is practically possible) is that we would challenge some of the conservatism of the processes. The fact that a certification process works and has done for [let's say] 50 years does not mean that this is the only (or best) certification process that we can achieve. We saw that demonstrated (at least to my satisfication - I don't want to start a vaccines debate on here !) on the cycle time reduction of Covid-19 vaccine approval in the UK. I think we at least need to ask such questions.

Arthur's last point about drug advertising in the US is also a good one. Drug advertising direct to consumers is probably almost unknown outside the US. And I think for very good reasons (I've seen the documentary about OxyContin). Also things like excessive patent protection and patients needlessly demanding more expensive "brand name" drugs when identical generics would do the job.
 
S

smeyer0028

Guest
I do not think automation works for medicine. It is a clinical
science that depends on complex pattern recognition where
computers run into combinatorial explosion. Just the area human
experts excel at. I had a minor skin cancer problem. Dermatologists
at Mass General (one of the world's best hospitals) do not trust
the supposedly better than human skin cancer recognition
programs.
 
M

mgoldsmith1979

Guest
Canadian medical at seven steps better in quality at half the cost demonstrates many methods the US could easily adopt such as banning advertising of drugs which many doctors and almost all individuals are not even close to the skill set needed to pick the the best drugs. Canada uses formulary boards of specialists to pick the best drugs for particular conditions.
Personal anecdote: Canadian healthcare management is not exactly as good as what is available in the US. Most records are still paper (including childhood vaccines, which you need to get when say, emigrating to the US), you have no real idea of the cost of care, because it is paid through taxation (except prescription meds), and you have no visibility if the doctor is committing fraud when they bill services on your behalf. In the US I have an app on my phone that lets me track every interaction with a Dr for my entire family, manage my payments, see all my health records etc. Some of the software used in this space is developed in Canada, but not used there. :/
Quality of care, I would put them on par, except in the US there is a definite "Quality of Service" element that Canada just doesn't have. Hospitals in the US compete for your business, and are responsible for both positive and negative outcomes - in Canada, they are a wing of the government and provide a minimum-but-equal standard of care to everyone. They are monopolistic and don't much care if you are happy with results or wait times or if they commit malpractice, because you have no recourse or alternatives. Also since the payments are part of the Government's annual budget, they hit 'annual caps' on certain forms of care, and so waiting lists can be extremely long (years for hip replacement surgeries, deemed 'non critical', for ex), or scheduling for certain procedures occur at odd times (MRI at 3am anyone?)
Visible costs of care are a mixed bag; Canada you still have to pay out of pocket for vision / dental / prescriptions, and company insurance covers that same as you might expect in the US; cost of prescriptions in the US is orders of magnitude higher due to no aggregate single-buyer negotiating drug costs. However, if your corporate insurance provider elects to not cover your prescriptions, because "reasons", then you again have little or no recourse other than out-of-pocket. My experience, for example was one specific drug costs 8x in the US what I was paying in Canada, but in the US it is subject to annual maximums through my insurance, whereas in Canada it was not, and net-net I pay less for the drug in the US. That is a direct reflection on my employment and corporate bargaining power on health insurance though, and I recognize that this is not the case with most Americans.
 

benb

Active member
Here's the instrument that detected when I had COVID, in 15 mins: https://www.lumiradx.com/. The instrument is smaller than a Kleenex box. The different "chips" do different tests: COVID antigen, COVID antibody, D-DIMER.

Illustration of the semiconductors in medicine.
 

Attachments

  • Screenshot 2022-06-30 at 06-47-10 Point-of-Care Diagnostics.png
    Screenshot 2022-06-30 at 06-47-10 Point-of-Care Diagnostics.png
    145.8 KB · Views: 12

Arthur Hanson

Well-known member
Medical consuming twenty cents of every dollar while offering low quality is the greatest single danger to the US, far greater than any external threat. Reforming US medical to make it a world leader could also open a world wide massive market that would benefit everyone. Mark Cuban has taken a large step in this area by having a drug company that sells some drugs for less than ten cents on the dollar compared to the so called competition. US medical is also the greatest threat to the US by making us uncompetitive cost-wise in many areas by the medical expense added to everything. Automating and using new technologies to lower costs and improve results in medical is among the largest market in the world and offers a staggering opportunity economically and in the health of people around the world.
 

jms_embedded

Active member
Medical consuming twenty cents of every dollar while offering low quality is the greatest single danger to the US
I don't buy it, particularly the "low quality" aspect. I agree that medical policy is a mess in the US, but that's not a technical issue we (as semiconductor people) can solve.

(Off-topic, but I would argue that our political crises --- gerrymandering and election challenges and disinformation --- are the greatest single danger to the US.)
 

Arthur Hanson

Well-known member
I don't buy it, particularly the "low quality" aspect. I agree that medical policy is a mess in the US, but that's not a technical issue we (as semiconductor people) can solve.

(Off-topic, but I would argue that our political crises --- gerrymandering and election challenges and disinformation --- are the greatest single danger to the US.)
The waste and inefficiency is staggering and I have seen it first hand as Industrial and Systems Engineers in the field I knew that found massive inefficiency and waste.
 
Top