Vinod Khosla on A.I., Health, and the Future of Working (or Not)

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you want to try something radically better? It has to come with something else that is a big problem today—accessibility. You know medicine, especially in the U.S., has gone down a path of increasing inaccessibility. Hey, if I get cancer, touch wood I don’t, but I can get proton beam therapy. But the damn machine costs $200 million dollars to install. How many people can access that? And that’s the wrong direction to go in. I want this damn device to do most of my diagnosis, and it can’t.

The data science, if it’s computing-based, can be very low cost. Anything that’s computing-based is near zero cost eventually. Which is why we spend way more compute cycles on a two-cent ad on Google than $10,000 medical decisions like ‘Do you need a meniscus repair?’ It’s silly. It makes no sense to me. So I started just saying, ‘How would you do it better?’ And then I took it to a bunch of friends of mine who knew medicine. I got a lot of critique. And, basically, I took every critique as a way to collect questions I should answer. And over time, as I collected more and more questions and could answer them plausibly, I said ‘Hey, this is the way medicine needs to go and should be reinvented. It was and still is speculation, but at least it is possible.’

X: It seems from your writings that you believe outsiders—especially entrepreneurs—can do this better than the medical industry.

VK: The auto companies are never going to lead driverless cars, they’re never going to lead electric cars. There was a 2010 DOE [U.S. Department of Energy] report that predicted in the year 2035, and their number for 2035 was smaller than the number of electric cars Tesla shipped last year. Why? Because they talked to Volkswagen, GM, and Ford. The car companies were thinking incrementally, and Elon [Musk] said, ‘Hey, how would you do this from scratch?’ He had no auto expertise. I think the same can be done in medicine. It just takes a great entrepreneur. I’m not going to do it, but great entrepreneurs I want to back will do it. It does eventually have to fit back into the system, but radically innovative ideas will likely come from outside the industry.

X: Tell me what you think is the difference between the data science and the A.I., because the data science, presenting it to doctors so they can make a decision, that’s one thing, but that’s not A.I.

VK: Today, you do your test results, you’re given 30 numbers at most, and the doctor looks at your blood test and says your iron’s low, your NK [natural killer immune cells] are high, your mean corpuscular volume is low. It means a few things. He can remember a few simple relationships. But let’s say you’re dealing with something serious like colon cancer. Does he know what each of the thousands of mutations could be? No, he doesn’t. So when he’s sitting down with the patient and saying, ‘You’ve got this cancer mutation,’ does he remember the 5,000 papers published in oncology journals recently? No, he doesn’t, he can’t. He’d be inhuman if he did that.

So machines have to do that. Can [the doctor] do the human element of care? Yes. But to be honest, a nurse would do that better. Three years ago I told the dean of Harvard Medical School, if you believe this is the future of medicine, and he sort of said he did, then you should change your admissions criteria to not look like an IQ test—just use the admissions criteria the USC film school uses, because they’re looking for people who can put themselves in other people’s shoes, be empathetic, have lots of mirror neurons. I know you laugh, everybody laughs, but I actually think it’s serious. If you want humans to do the human element of care, pick the most emotive humans, the most humane humans.

X: So machines have to take the data and interpret it?

VK: Look, every person should have a personal physician they can consult on every single day. If it’s an A.I. bot, that’s 10 bucks a month, max. And they would save you more than a few bucks a month by saying, ‘Buy this generic brand of aspirin, not this fancy non-steroidal anti-inflammatory. For your situation, it’s going to be better.’ The pharma companies wouldn’t love it. The doctors may or may not love it. The notion is medicine can be reinvented. Everything that can be reinvented doesn’t always get reinvented, but could get reinvented if the right entrepreneurs go after it and they get lucky.

X: Well, do you see that happening?

VK: I think we are well on our way. It isn’t yet visible. Another story I’ll tell you is a friend of mine is Marc Tessier-Levine, who’s president of Stanford now. He was the chief scientific officer of Genentech. After that he became president of Rockefeller University. So we were just talking about it – and he said, ‘Why don’t you give a talk at Rockefeller?’ And he said, ‘But here’s what I want to do. You can talk for an hour, but then I want you challenged for an hour.’ So he took very traditional experts, the CEO of Memorial Sloan-Kettering, and the CEO of New York Presbyterian. I said, ‘Perfect. I love this.’ And by the end, we all sat there, and I said, ‘So what do you think?’ Their only comment, and I remember this vividly: ‘Well, it’ll take longer.’

I said, ‘Then it’s a win for me. I’ve gone from impossible to it will take longer.’

X: Longer is faster than never.

VK: Longer is much faster than never. If the right entrepreneurs take it up, then it goes from improbable to possible, with a little luck and sometimes more than one attempt. And we know from our technology world, this happens. It’s only a matter of time.

X: What do you think will be the most impactful short-term applications?

VK: Talk about accessibility. There’s a company in … Next Page »

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