Because stupid people demonize managed care, and the standardization benefits can thus not be reaped across the board.
2015-07-11: Coding is crazy.

I was not able to verify the existence of an ICD-10 code for falling from a non-military spacecraft, but there certainly is an ICD-10 code for being burned due to water-skis on fire

2015-07-23: Until this is fixed, we can’t have nice things. The recent progress with open access journals is a tiny first step, but it’s still not common to attach your raw data to your study for easy replication, or to to publish negative results.

So some of the results of this individual trial shifted, under closer examination, and that is definitely problematic. But fundamentally there is only one thing different about this deworming trial and the rest of social science and medicine: Miguel and Kremer had the decency, generosity, strength of character, and intellectual confidence to let someone else peer under the bonnet.

This kind of statistical replication is almost vanishingly rare. A recent study set out to find all well-documented cases in which the raw data from a randomized trial had been reanalysed. It found just 37, out of many 1000s. What’s more, only 5 were conducted by entirely independent researchers, people not involved in the original trial.

2015-10-25: Epic is benefiting greatly from the lock-in it has created.

instead of ushering in a new age of secure and easily accessible medical files, Epic has helped create a fragmented system that leaves doctors unable to trade information across practices or hospitals. That hurts patients who can’t be assured that their records—drug allergies, test results, X-rays—will be available to the doctors who need to see them. This is especially important for patients with lengthy and complicated health histories. But it also means we’re all missing out on the kind of system-wide savings that President Barack Obama predicted nearly 7 years ago, when the federal government poured billions of $ into digitizing the country’s medical records.

2020-04-20: And then we have the usual problems with IRB / EMR

If you want to report the number of times a patient has cut her nails in the last week, you would need approval. And it’s not easy at all to search the EMR for any of this information. You’d have to hire someone specifically to look through it.

“Why are nearly all notes in Epic . . . basically useless to understand what’s happening to patient during hospital course?” Another doctor’s reply: “Because notes are used to bill, determine level of service, and document it rather than their intended purpose, which was to convey our observations, assessment, and plan. Our important work has been co-opted by billing.”

2020-04-22: The software is only designed for billing, not evidence.

Electronic health record software in the US is not set up to make clinical research faster and easier. We have billing claims as, absurdly, our only reliable and easily integratable national source of raw patient data. What we don’t have is anything useful to produce evidence-based medicine.

2020-04-27: EMR might not capture what matters

Is this loose, informal transmission of anecdotal findings—call it chatter, call it rumor—part of medicine? It isn’t what anyone is taught in medical school; it doesn’t fit in with the professional’s image as a purveyor of rigorously tested interventions. But continuous, iterative clinical knowledge—the kind that can be updated minute by minute—is invaluable during this tumult, when time is of the essence and there’s scant research to fall back on.

2023-07-30: Clinical trials keep getting more expensive due to regulatory capture, lack of competition, and luddite tendencies. Vial might do an end run around this if they don’t get stopped by the enemies of progress

Instead of dealing with the difficulty of collecting data on new medicines, both society and government sidestepped it by focusing on treatments for much rarer illnesses: relatively rare cancers, rheumatoid arthritis, and multiple sclerosis to name a few, not to mention very rare illnesses such as cystic fibrosis or paroxysmal nocturnal hemoglobinuria. The North Star for Vial is to drive a 10x improvement in both the speed and cost of clinical trials. This can sound hyperbolic, but it is likely not impossible, given the massive inflation of trial costs over the last 50 years. In the bull case for Vial, the development of TrialOS would enable companies to pursue 10x as many drug candidates in parallel. This would open the aperture for drug development, giving emerging companies more breathing room in pursuit of their first clinical success.

Vial has now had a front-row seat to 10s of trials. They’ve seen the product features that trial sponsors have adopted and shied away from. Their electronic tablets and eSource solutions have been welcomed with open arms. On the other hand, their remote data capture solutions—which could make the difference between a 2-3x cost reduction and a 10x cost reduction—have been less widely adopted so far.

What if they could aggressively dogfood the most cutting-edge features of their platform? This could further accelerate reductions in trial speed and costs and open the door to massive value capture. Taken individually, no part of their stack is groundbreaking. There is fierce competition to innovate within in silico drug discovery. Organoids are not new technology. Faster chemical synthesis won’t spark a revolution on its own. The fundamental insight is that integrating each part together will give Vial a chance to exploit their true advantage: faster and cheaper trial execution.

2023-07-31: HIPPA is one of the enemies of civilization.

The path forward is therefore clear. We should be doing more to get more data into the hands of more researchers. Unfortunately, we have laws and regulations surrounding privacy that make that extremely difficult. Reform in this area would do a great deal to advance progress in the fields of science, medicine, and health. Privacy concerns also stand in the way of attempts to make healthcare more affordable. The privacy advocates have 2 arguments:

1. Someone might make a profit while they’re curing disease
2. We shouldn’t even try to achieve any more medical progress until we achieve socialism

These objections are almost too silly to refute, but I’m including them because it’s useful to understand the irrational motivations of many privacy advocates.