Why Healthcare Is Stuck in the 19th Century and What to Do About It

Many of medicine's traditions date back to not just the prior century but the early 1800s, says prominent digital health investor Vinod Khosla. It's time for a reboot.

Brian Buntz

When you go to the doctor, the first thing that happens after your name is called is that you have your weight, blood pressure, and pulse measured. "Most of the things we measure in routine doctor visits happen to have been measurable in the early 19th century," said Vinod Khosla of Khosla Ventures at Health 2.0's WinterTech event in San Francisco on January 13. "It is surprising that we are still using things like that."

Just measuring heart rate by itself is not that useful and is rarely actionable, Khosla said. "Heart rate variability is an order of magnitude more useful, but nobody uses it because the way healthcare evolved," he added.

While there is a lot of talk about data-driven healthcare, so-called modern healthcare is actually archaic in his opinion. People shouldn't have to, for instance, wait until they have full-fledged flu symptoms and then go to a doctor to conclude they have the flu, he said. "I also find it shameful that most people with cardiac problems discover it by having a heart attack. There is probably a good way to detect it five to 10 years in advance," Khosla explained. "It is also dumb to see a cardiologist every six months. What do you do in between then?" he said.

Khosla says whole new approaches to categorizing human health are needed. "Medicine is too complex to do linearly," he said.

Khosla shared that he regularly has 900 biomarkers measured on himself. "Today, it is hard to make sense of 900 biomarkers," he admitted. But making sense of that volume of data is, based on today's norms, more of a math question than a medical question. "A few researchers are working on that math problem: understanding these kinds of networks," he said. If you analyze those variables thoroughly, patients can detect diseases much earlier.

Khosla shared that he once had a conversation with Obama administration technology adviser Todd Park, who made the comment that an average cancer patient is not getting the type of cancer care that is recommended in medical schools today. It is simply hard for doctors to keep up with changing recommendations for patient care. "People cannot do that well," he said. Machines are simply better at number crunching and keeping up with vast sums of data. "In the next 10 years, we'll see bionic supplementation," he predicted. "I should not rely on a doctor to diagnose my disease; there should be more data than a human can handle."

Khosla also railed against the Hippocratic Oath, which he said enables physicians to potentially make subjective recommendations for potentially ineffective treatment based on their own biases. "It is bad math," Khosla said. Instead of the Hippocratic Oath, we should use objectively accurate computation to determine the benefit-risk ratio for given treatments, he recommended.

Khosla concluded that he thought that the only way for healthcare to improve is to get much more consumerized and much less expensive. Entirely new types of companies will be needed to help make this happen, he said, because traditional institutions don't like change. "When you talk about reducing the cost of care, that means less revenue for somebody," he said. "Disruption is not easy, which is why it usually happens from the outside."

"Let me end with my dream: if you took a million people and took a thousand biomarkers for a year with continuous physiological variables such as blood pressure, blood glucose, etc., you could make medical discoveries that would make today's physicians obsolete," Khosla said. "And it would be relatively inexpensive."

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