Medsider: Learn from Medtech and Healthtech Founders and CEOs - Can This Service Solve the Problem of Information Overload in Healthcare?

Episode Date: August 5, 2013

Information overload is an issue that all of us face. Finding a decent signal in the midst of a very noisy world is a difficult challenge. Few are able to master it on a consistent basis. And that includes doctors. Check out some of these stats: 100,000 scientific journals are now in circulation. 30,000 new...[read more]Related StoriesSocial Media Best Practices for Marketing Medical DevicesCan Nurep Solve the Inefficiency Problem in Medical Device Sales?Substantial and Sustainable – 2 Words That Medtech Companies Should Get Used To 

Welcome to Medsider, where you can learn from experienced medical device and med tech experts through uncut and unedited interviews. Now, here's your host, Scott Nelson. Information overload is an issue that all of us face. Finding a decent signal in the midst of a very noisy world is a difficult challenge. Few are able to master it on a consistent basis, and that includes doctors. Check out some of these stats. 100,000 scientific journals are now in circulation. 30,000 new clinical trials are funded annually.

1,500 new articles are published every single day. In fact, if a general practitioner were to spend just five minutes reading each new article published on primary care, it would take 600 hours each month. Yes, that is information overload at its finest, but the end results are even more staggering. Misdiagnosis is the leading cause of medical error in outpatient facilities. and 40 million patients experienced delayed or poor care as a result of missing information,

including historical examinations, tests, and medication reports. In this interview was Zavie Maasiewicz, CEO of Medamed, we learn more about their second opinion service that is taking on the information overload challenge within health care by enhancing medical diagnosis through a robust team of researchers and data analysts. And if you're in the med tech space, as you listen to this conversation, think about how you could potentially partner with services like Metamed as we enter a new era of health care in which patients will be more empowered than ever before. Here are some of the points we're going to cover.

What is Metamed and why does personalized medicine matter? Specific examples of how Metamed has helped patients with both common and rare diseases. From initial consultation to end product, what does the metamid process entail? How much does the Metamed service cost? and will health insurance companies pay for it in two ways in which the Medamed personal health consultancy can scale. Of course, there's a lot more that we're going to cover in this interview, but before we dig in, listen to these brief two messages.

First, to get free email updates when another Medsider episode goes live, simply go to Medsider.com forward slash free. We don't send emails often, but when we do, they're full of valuable content. No spam ever. just go to medsider.com forward slash free to sign up. Second, Medsider is on iTunes. Just go to medsider.com forward slash iTunes and you can subscribe to the podcast for free.

That way all the new episodes will automatically download to your iTunes account. It's super easy. Also, if you like the podcast, don't forget to rate it. That really helps us out. Okay, for you ambitious doers, here's your program. Hello, hello, everyone. It's Scott Nelson. and welcome to another edition of MedSider,

the place where you can learn from experienced med tech and medical device thought leaders. And on today's program, we've got Zvi Moschwitz. He is the CEO of Metamed. He, Zvi was a world-class strategist and gamer and was a Magic, the Gathering, world champion, member of its Hall of Fame. After retiring from that, he founded a profitable startup

that was acquired, eventually acquired by Pidical Sports. Zvi holds a degree in mathematics from Columbia University. Obviously, that was a more formal intro, but without further ado, welcome to the programs. We really appreciate you coming on. Sure, happy to be here. Okay, so I'm going to start out our conversation with a quote from, I'm not sure if it's the founder or a founder of Medamed, Michael the Saar. Let me quote him first.

He states, we used to rely on doctors to be experts and we've gradually crowded them into being something like factory workers working in a constrained system where their job is to see one patient every eight to 11 minutes and implement a bi-evalian. the book solution. What I'm talking about is creating a new expert profession where doctors evolve into more patient focused and more caretaking profession and then scientists to evolve into a more argument and critical analysis and management of technology profession. And so that was kind of a long-winded quote, but it really stood out to me and it really piqued my interest. That's why I decided to reach out to you guys. But with that quote in mind, can you give us sort of

the thesis of MetaMed? And then we'll make it. maybe dig into where this idea was hatched and how you got involved. Right. That very much speaks to the core of what MetaMed is all about, which is, there is no way that one person, one doctor, can be all the things that we need from the system, can process all of the information, can master all of the different domains. It's impossible, right? I have the greatest respect for doctors, but most of the time they have a minimal amount of time to spend on the patients.

They have to master lots and lots of specific domain knowledge in the areas where they are true masters and experts. And there's no way that one person could also master all the complementary skills that could allow you to understand all the scientific problems involved in finding the best possible care. And the system just doesn't allow them to spend the kind of time required to do that. So MetaMed was founded with the idea that we're going to bring together all the complementary skills that allow you to combine what the doctors are masters of with all the other ways in which people process and understand information, figure out what's going to result in what, and make better decisions that result in better outcomes together with collaborating with physicians and the existing system.

Got it. So we're certainly going to get into more detail in regards to the kind of the processes and services that you have in place with in Medamed. But correct me if I'm wrong, but the idea there is that you've got a team of researchers that basically research certain diagnoses or disease states on behalf of patients and or, I guess, physicians. And you put together almost like an individualized report. for that particular, you know, customer, in this case, it would be most likely a patient.

Am I understanding that correctly? That's exactly right. It's almost, so far, it's usually been a patient. Yep. And so what they'll do is they'll come to us and they'll say, this is my situation. This is the decision I have to make. This is the problem or this is the medical problem that I have. And the existing system has either failed me, and the solutions people have offered me aren't working

or alternatively, the system is providing me you have more than one solution. I don't know what to choose. Or help me optimize the implementation of what the system wants to do. Find me the best place to go. Find me the best dosage, the best routine,

the best sequence, the best plans that I can do to maximize what's likely to happen to me. And then we assemble a research team. We have a team. So every time we have, a medical person to do the intake to provide initial information, another medical person to review what we found and approve it and make sure that we're doing the things that we found

to check out and make sense and will benefit the patient. And then we have a research team to complement them, which can also include more doctors, but also includes people who have been trained in complementary skills, especially statistics. and we think of the way it's to analyze research and read papers and evaluate that kind of information. And so I'm one of those team leaders, addition to being CEO. At first, I did all the cases.

Now I do about a third of them. And I will then prick a research team, generally between one and four other people. And then I will assign them areas instead of, We go locate the research. If we have enough budget, we go for primary literature. If not, we go for secondary literature. We read it.

We extract the information. We actually analyze their procedures. We figure out whether or not what they're doing, provide strong evidence for what they're claiming, and then provide a picture of what we believe the different options would actually do. Got it. Right? What their risks are, what their benefits are. And we provide all that information to the patient and their doctors,

so they can then make the decision. and we can't, nor we want to, tell them what to do. It's not our place to say, you should do this, or we recommend doing this. It's our place to say, this is what would happen. Got it. Okay. And there's a couple other questions I want to ask around that particular process. But before we get there, this idea is fascinating.

And I mentioned earlier, that quote from Michael really piqued my interest in what you guys are doing at Medamed, primarily because, you know, when I talk to friends or family members about what I do in the trenches within kind of the med tech space, I often, you know, call it sort of the unhidden benefit of being involved in healthcare, sort of be behind the curtain look, and that I get to work with physicians, especially specialist physicians on a daily basis. And even within a relatively small geography, they all practice and treat a disease state completely different, or what I would consider completely different. and most of the patients just think, you know, the doctor's word is golden. But they don't realize that those are humans too.

They suffer just like all of us. They suffer from information overload. And I think there's some really interesting stats on your website. Let me just name a few of them. The National Library of Medicine adds 34,000 new references every month. You know, there's 560,000 new articles are published annually. 100,000 scientific journals are now in search. circulation, et cetera, et cetera.

And so this is a really interesting concept because I think health care would really, really benefit from taking a step back and realizing that, you know, physicians, they too suffer from information overload. And so there's got to be a different way to sort of solve that problem. And that's what you guys are doing, in essence, correct? Yes, that's what we're doing. not information overload, requirement skill overload. Now, I thought about, you know, like many kids do, right,

whether or not I should look to be a doctor. And then I realized, but I just can't hold this many facts in my head. My memorization skills just aren't good enough. I can't do that job, and I have so much respect to people who can't. But at the same time, we're asking to do an impossible job, which is to, you know, have it their fingers, tips, all the information on everything could possibly go wrong with the human being, even if only in the specialty area. And so what ends up happening is, of necessity, the way that they learn what to do is through practical

interaction, through experience, through conversations with other doctors. And so what we find is that different doctors will think different procedures are the correct procedure for a given situation and won't even necessarily even know about the alternative It varies a lot by region. You'll see people in one area of the country will do things completely differently from another area of the country, and the people in other countries will do different things still, even when they all potentially have access to the same resources.

Got it. And so, at the same time, it's not just the bare knowledge of the situation, it's that while doctors were learning this huge array of skills that eats away their entire young adult lives, I was studying a completely different set of skills that would not allow me to do their job but do allow me to do a much better job than their set of skills enables them to do

at evaluating the statistical strength of a claim, for example, or forming a Bayesian distribution over the possible situation of the world of what might happen based on a given set of information if certain actions were taken, Right. Right. So the idea is you need to complement them in time and complement them in skill and complement them in knowledge. Got it. So let's get into like the actual process that you folks follow there at MetaMed and your team, which I want to do ask about the, you know, sort of the team that you've built there because it's incredibly impressive. But before we go there, is it possible to maybe walk me through a case study or an example of a patient that you've helped?

and I certainly don't expect you to name names, but maybe just an example of a patient that's come to Medamed and said, I've got this problem or I'm dealing with this, and maybe how specifically you helped them with their challenge? Okay, I mean, obviously, you know, one of the big problems in medicine is confidentiality. So it's always tough to give specific examples. But so of the most recent, let's think about the most recent case

that I just finished, which was a mother came to me, and their child had an unknown condition. And she'd spent a long time going through the system, didn't know what it was, was trying a lot of different treatments, going through a lot of different tests, examining a lot of very long shots, and things were still progressive to getting worse.

And so I looked at the situation, and I said, well, there's so much, there's this giant heap of medical records and it's not something that I understand all of. But we looked through it and we came to the conclusion. First, I had my wife Laura Bauer talked to this person and we had an intake and found out the situation what had gone before, what had been made, what had been found.

And then we looked at the record and we said, okay, there's a lot of potential things that we know about. We know this isn't anything common. It would have been found already. but there's this unique aspect to the situation that isn't, you know, this thing that's unique about this person that looks like it's

the most efficient place for us to look because there's a good chance that this is what it is, there's a good chance this is what it is because what's the chance this would happen coincidentally. You know, without any into too much detail. So our researcher looked at it, found that when the same thing, there have actually been, for other reasons,

animal studies of the same thing, and they found that when this happens, very similar symptoms to what this child was reporting occur. Okay. So we said, okay, this obviously makes it vastly more likely, so we look into this in more detail. It all seems to make sense. This is actually in this case it had never been seen before.

So we, you know, it was not a hypothesis that hadn't been mentioned before, but it was more a case of like people thought it might be, as opposed to it probably is, or it had never illustrated to her exactly how this would be demonstrated, why this would be something to presume, and then was able to find a potential treatment that while a relatively long shot, due to the, you know, nature of the situation was worth exploring in more detail and was able to recommend, not recommend, but was able to note that there were certain things that were being done that if this was the case wouldn't do anything. They would only involve additional costs and additional inconvenience and additional side effects. There was no, you know, so the only reason to continue then would be if this, if this potential cause was incorrect. So this is, you know, one, of the different situations that we do. Another recent case was the client came to me and said,

I potentially have this, I have cancer. They're attempting to deal with it, but if they turned out that they have able to remove it and it's now stage three, what should I do? There's a lot of different drugs out there. There's a lot of different chemotherapies. And then I went through and I examined the literature and the evidence behind each of these different possibilities.

and I gave a likely effective survival benefit to each of the different potential treatments and treatments in combination and explain their potential side effects and gave a basis by which to make a decision depending on what was sound on how to choose between them. Got it. Okay. So taking a step back, so most of the time, and I like the fact that you brought up two sort of different spectrums in that you helped a page. and the family with a really rare, extremely rare sort of disease.

And then the other patient had cancer, dealt with probably quite a few different oncologists, which is quite common in our world today. So two different ends of the spectrum. But in terms of the process, usually it's a patient that comes to you with a certain medical record. Do they submit it via email? Is it via phone? And then what happens after you, is that where it usually starts with a medical record? And then talk to me a little bit about, like, the research part.

Are you looking at journals? Give me at least a little bit of an overview in regards to the actual research that goes on. Sure. So, kind of two different parts to consider. So the first part, we can say the process for us starts with the conversation that leads to the contract and the agreement to do things, which leads directly to the intake, where we will have one of our medical people talk to them, preferably in person, if not possible in person due to the location. We'll do it over Skype.

And this will generally take at least an hour. Often we'll take several hours. We'll talk to them, gather all the information. And a lot of what we're looking for in that conversation is not only what is the situation medically, what are the facts of your case, but also what do you, what is the patient really need? What are they from us? What do they want to know? What do they value? What are they looking for?

Because it's all too often that the medical system is forced by its nature to make presumptions that everyone wants what instinctively they, you know, quote, quote, unquote, should want, and to focus primarily on the same measures of health for everyone. And some people have very different preferences. That's a great point. Yeah. And so we say, you know, what one thing we have to push back with our medical people all the time, is they will always try to go after instinctively whatever the big glaring health threat is with the patient, the big concern. And we have to sometimes say, no, that's not where our comparative advantage is.

That's not what the patient came to us for, right? That's something that the patient has to deal with, but that's just, that's not our task here. And, you know, maybe they want something else. We have to give them that. That's what's going to help them. Got it. Right? We let the patient run the show in that sense.

So then once that happens, once that's done, they'll brief me generally. Sometimes they'll brief Sarah Constantine, who was our other current case, who's our other active case manager who does a lot of cases. We are branching out to add Sohan Fahn and Adam Winmar as we scale up as additional managers. And then often I'll learn what the case is, and then based on what the cases, I'll choose even a manager that's appropriate. it has more area background knowledge of the case who has more specialty. I'll shoot the team based on the specialty area.

So you want, like, you know, one person to handle a lot of different cases of cancer, even a particular type of cancer, because all the research they've done before, they already have it at their fingertips. Got it. Right? Everything they've done before. Like specialists are important to the medical system for a reason. We're creating our own specialists as we go as well.

Okay. So I'll assemble a team with the specialist for, the particular situation. And then, so then we'll scour the literature. And generally, this involves hacking on PubMed

as the primary way to do that slash, you use then references to and from the initial things that you find and from the initial things that experts you ask questions about

refer to as these things are important. These are the key things that people are talking about. These are the key things that reflect, you know, the development in the field very recently.

And then the great thing about the literature is that if something is important, people will reference it all the time. Okay. Unless it's very recent. So you know that even if your initial searches don't turn up everything, if it's not very, very new, it will be found because it will be referenced by any reasonable set of things that you find, you use that to find the rest of them. As long as you do a careful search of things that are recent, you also, you know, if you have

sufficient time and budget for this. You find an expert in the field, and you ask them, you're trying to keep up with this particular, you know, this area you are keeping up, you know, as best you can. What's going on? What's the new hotness here? Right? What's the recent developments that we should be sure to cover? And then we have our literature, and then we'll look through that literature.

If we have a lot of time, we'll be looking for primary stuff only, and we'll read it all cover-to-cover, and we'll extrapolate based on everything. If we have a limited time, we'll try to use determine value of information. We'll say, it was very important during the intake to figure out exactly what matters to this client, this patient, this situation. And then you say, okay, this patient situation says, we need to find out the effectiveness of the various treatment options, so we're only going to look at things that bear on these treatment options.

Sure. Or offer alternate treatment options that show enough promise quickly to be worth examining. And then we would look at those things and then one by one, gather enough information to either rule them out or make it clear that it should be part of the decision tree, right? Something that we should look into in more detail, those we would narrow in. And then the most of, so there's, when you're reading the literature, there's two things that are, the two things that are most important.

in evaluation are you're watching out for the statistical methodology of what's being done in any study. Because there's different statistical methodologies that are done, sometimes because people intentionally choose very robust systems and sometimes choose less robust systems because either it would cost too much money to do it the other way or be too dangerous. If it would put too many people at risk, they can't do it in a more robust fashion. They have to use very small sample sizes or they can't do double-blosses. or they can't do double blind or anything like that. So you have to look at the study design,

which can be better or worse, not affecting those things, and then figure out, okay, how likely is this to give the right result? How much evidence does this result signify? And you also have to look out for bias. Got it. Because it's a huge problem in medicine that, you know, studies don't happen at random. Studies happen because someone decided to do them,

and that person often, or that corporation especially, is looking to give off a certain impression. If looking for a certain finding, you have to keep that in mind as well. You have to say, well, you know, there are no negative results from studies like this. Would there be? Would they have been published even if they had happened? You know, are these engineered to find that? Would they have tried various different things of similar types until they found one that succeeded?

And you make room in your sort of in your research to allow for that sort of bias? Absolutely. Wow. You would never, it's inherently what you do when you read a research paper. Like, whenever you're looking at any source of information, in fact, in the back of your mind should always be, who's telling me this? Why are they telling me this? Why? How do they go about getting this information?

Does this actually reflect on what's going on? the very fact that someone is telling you something at all, was choosing to tell you that thing is often as interesting as the content of the message. And this is sort of, you know, a lot of the people involved in this company came from the community that was grown out of the less wrong and overcoming bias websites.

And we dedicated a lot of our study to the questions of, as it says in the title, overcoming bias, how to locate these types of biases and how to account for them, how to adjust such that we're not making the cognitive mistakes that humans always make because that's how we're wired. One great source for this is thinking fast and slow,

came out recently, which is a great illustration of how the human brain just doesn't work properly in these senses because it has to use heuristics and shortcuts and biases in order to make good decisions in general, but those decisions fail you in situations the human brain, doesn't evolve to DLS, which are things like scientific double-blind studies.

Right. Right. That would never have happened. So I'm going to stop you right now and ask you a question. So I can imagine there's a clinician or physician that's listening to this and it's going to ask. I like the idea that you guys try to eliminate the bias. But how would you respond to two issues? And they're kind of on two different sides of the coin.

and that one, the overwhelming majority of these studies would never actually be published if they weren't funded by industry. So that's one side. And the other side of the coin is the specialist physician that practices in his or her particular area and says, you know, I know that there's a lot of studies that point to this. But in my experience, with my base of patients over the course of treating, you know, a thousand different patients, my algorithm is actually quite different than, you know, what most of the studies would point to.

How do you respond to those two sort of statements? So those are two very different objections, obviously. So you have to deal with them on their own terms separately. So the first objection is a very good point, right, which is that you need to get the money from somewhere, you know, random, a scientist or a doctor who comes up with someone like novel idea doesn't just have $100 million long around. They have to go to a corporation.

And the answer is you don't throw out information because it's coming from someone who has a motivation. but you do give special care to whether or not they've done things in the proper fashion, whether or not they have provided a structure that protects you from the fact that they wanted you to find a certain result. And sometimes this study is not being done by someone who has a financial interest in the situation or a particular outcome. And those cases you can give it a lot more weight than you would normally give it. when a corporation is funding a trial on their own drug, you don't discount it entirely.

You just keep that in mind that these choices were made with an eye towards sending the message that they want you to hear, and the method was written in a way to give off the impression that they want you to have. Got it. Right. So you're not saying don't throw the baby out with the bathwater. You're saying just perhaps there's a little bit more skepticism warranted

with some of these maybe well-known studies. and the biases that kind of come along with those. You have to be very much more careful, right, to watch out for these problems. And you have to assume that, you know, all the choices that were made were made such that they were the best choices they could have made, given their motivations. Got it. And you look at these studies, you have to, like, make sure to even undo the framings that they make. you know, people will use different ways of stating the same statistical fact

because they give off different impressions. And this can fool, you know, even the most advanced statistical minds and the best doctors. Because unless they've specifically been trained to avoid it, they don't even know what's happening. Even if you have, it still happens, you have to fight it. Now, in terms of, in my experience, so this is obviously the difference between anecdotes, anecdotal evidence, both look over time, and statistical evidence that comes from studies. So a doctor's anecdotal evidence is still valuable, but it's very easy to get caught by that type of information because we don't naturally process it properly into getting the wrong

idea. It's also very possible for a doctor to have a situation that because of who they are and what they're dealing with differs greatly from the cases being described in the studies. So often the quality of implementation of a given type of care or the attention to the details of the situation and the ability to make the right decisions based on exactly who the patient is and manage all these problems matters greatly. So, you know, some procedures are relatively easy and carry very little risk, and you can do them pretty much anywhere and you'll see more or less the same results others highly you know are

highly sensitive to the skills of the especially the surgeon performing the procedure and so sometimes someone will in fact just be that good and will have the ability to get results that can't otherwise be gotten and so you do need to keep that in mind that you know any pilot program right any anything where you pay a lot of close attention to one specific thing you get better results and you can make things work that don't then aren't you aren't able to replicate. This is true across the board. This is not just medicine. And we also know, for example, that the more times a given surgeon has done the same procedure, the better their results are.

Right. Right. Absolutely. It's a skill set. Yeah. Yeah. So you would give a different set of possible outcomes for someone who is capable of going to the best. you know, who can step outside of, you know,

doesn't have to worry about their insurance network, who doesn't have to worry about where they are and how much time they can allocate and so on, and can search out the very best, the special of the special in this particular thing. And we can help, and we can and do help with that. We have to find, okay, here's the person who is the best, whose expectations would be different

than if you just went to someone else. And that can change what the best action is for someone. often it will change the outcome when it's otherwise going to be close. So I would say, you know, sometimes he says, well, I've done a thousand of these and I do something different. And, you know, my response, if I was talking to him, would be yes, but that doesn't necessarily mean that someone else should do it too, especially if it hasn't been tested and replicated. Yeah, that's a fantastic point. Yeah.

Even though it may be a very valid treatment algorithm, that physician that's in a different part of the country or world, for that matter, may not have that particular skill set that... Yeah, these rely on so much on tacit knowledge. Sure. Things that the doctor doesn't necessarily know. They might know that they know them, but they don't necessarily know how to articulate them properly, or they just haven't done so.

Okay. Before we move on to some other ideas outside of the typical process that you folks follow, what does the end product typically look like for most of your patient customers? Is it a report, or do you go beyond that? direct in to certain to certain physicians. What is sort of the, what is, what is that end? One second. Just, uh, someone came in. Yep.

Right back. Um, I'm on the phone doing a phone interview or a broadcast. Yeah. Sorry, um, my wife got home. My wife got home early. Edit that short brief. Uh-huh. We'll, we'll leave it in there.

That's the, uh, that's the transparent. Oh, sure. No, no, no. That's, that's fun too. Yeah. Yeah. Yeah. Yeah, it's great to see her.

Yeah, always. That's right. That's right. Yeah, she works with a company as well. So, so. So... The end product. Right, the end product.

So the end product, at its core, right, the end product that you're buying is a report where we write down, we say here's the sources that we used, here's the reasoning behind what we've found, here's what we've found, and then we organize it in a way designed to give you the information you need to make your decision, right? One question we're all... The question I'm always asking when looking after these. the researcher comes back with an alpha version is what in this draft, you know, what do I need, put myself in the mind of the patient.

I need to make a decision, does this information help me? Does this tell me what I need to know? What's left? You know, am I actually being given the necessary information to make the decision and know how to implement it? You know, often people will give people, often people will give advice and won't provide the necessary steps and there will still be, you know, mysterious portions of the implementation, right?

Because the person saying it will know how to do it, but the person hearing it won't know. And often those details, especially in medicine, can be very important. So the first thing you do is you go off the report. So, but in addition to the report, especially for larger cases, more complex situations, bigger budgets, you will also speak to them. you will do an interview with the manager of the case or the medical of the case as appropriate. And this person will sit down with you

and will explain the contents of the report and their practical implications to you, answer your questions. And we get clear, you know, how this carries forward. If you need more from us, you know, we talk about whether or not we might want to continue, if there's things that, in addition, would still be helpful to you,

you, we explain that there's something that doesn't make sense to the client, the patient, doesn't know, sometimes they're two different people. You know, often you have a family member who comes to us, right, and they're not the patient. And so it's important to keep that separate, and often they have different concerns and somewhat different needs. Keep that in mind, too. And, you know, you sit down, and they'll often grill you, and they'll go through the report sentence by sentence, and they'll say, what does that mean?

You know, are you sure about that? Like, how do you know that? and then you'll explain it. And then, you know, some cases it's relatively straightforward because we've been asked a relatively simple question. You don't need to talk to them that much or some, you know, a quick email will suffice to explain what's happening. Other times, you sit down for hours.

Got it. Both of these things have happened to me. So I imagine those listening to this would think, you know, this idea of a very robust second opinion is what health care really should be. right? Right now, it's usually very difficult to have a candid sit-down conversation with a specialist physician. But this is ideal. However, it seems like it would be really expensive. And I know if you go to medammed.com, your website, there's the free consultation. Certainly this process

isn't free. But can you explain sort of what the costs typically entail? And obviously, I presume insurance companies are not paying for this right now. What is a, is there a typical cost that you allow or is it all over the board? So you are correct that insurance companies do not cover this. And we do not deal in any way, shape, and form with insurance companies. And that has allowed us to provide our service at all. So the range of costs, we have had cases as big as $250,000. We have had this small as $5,000, which is the minimum that we accept.

due to the cost of doing the intake process, memorizing ourselves with a situation, acquiring and digitizing medical records, briefing everybody, and so on. Then it makes sense to do, you know, the intake process itself essentially costs $5,000 plus familiarization with the case an initial lookover. So there's no more reason to do less. Most cases that come to us, certainly the majority, are worthy of, you know, sort of have enough. problems involved in them for 10,000. So, I mean, no, this process is obviously not cheap. That's a lot of money for a lot of people. But, you know, for some people, it's not that much money,

certainly relative to their health and also relative to their health care and their health care costs. So if you're deciding between very expensive procedures or the procedures that could potentially, you know, cause major effects on your life, you end up saving money rather than sending money when you make sure you get it right. right, getting these things wrong is ridiculously expensive.

Right. And I think that that's such a unique aspect of health care in that if the physician or the hospital where you go or whatever setting it is, if they do something wrong or something goes bad and it's potentially their fault, well, yeah, maybe there's a lawsuit down the road. But in the immediate term, the patient is responsible for paying for that. You know, if it means multiple days in the hospital, et cetera, it's not that, you know, the hospital or the physician that pays for it, it's the patient. And so you bring up a very good point that, you know, maybe there's an upfront, a higher upfront expense, but it could potentially be rewarding down the road for sure. So, so in a typical case example, is it, is it almost like a, there's, do you give a quote up front or is it as you, as the case unfolds, then you bill out a certain hourly rate?

How does that work? So we do charge for our time, right? The resource that we are spending is people's time, primarily. Got it. There are some minor expenses that we charge whatever we pay, but beyond that it's mostly our time. However, we do work on the contract, choose the amount up-front basis,

because that is what people are comfortable with. Different people have different budgets they can afford to spend on their care or they're comfortable with. So we talk to you first about what you'd like from us. We tell you what we believe this will cost, and then we do the best job we can with that amount available. Because one of the problems in healthcare is that these problems

can always dig deeper. You can always say, I'm going to leave no stone unturned. In theory, you could even fund your own labs, your own experiments, you know, advance the cost of science. but you have to stop somewhere. So the way that people are almost always most, the way people are almost always most comfortable is this is the problem at hand, and then we say, okay, in order to give you the type of help that you want,

we estimate that this is, we think this is the appropriate budget for that, and then we'll rerun that budget, and it will work to that budget. Got it. And then, you know, in general, you know, if it costs somewhat more than that, you know, in terms of what we were doing, otherwise, Bill, we will do what we can to make sure that we go the extra mile. Okay. But, and if we have extra, then we'll look in more detail at places that we would otherwise

have looked in less detail and or we'll examine more issues that you have of the remainder of the budget. Got it. Because there's always more to do. Okay. So almost like a, you know, a personal health consultancy, I guess, to a certain extent. With that said, this current model, do you see it, I mean, do you see it, I mean, do you see evolving over time, and maybe the better question is, is can you scale this up where maybe that

price can begin to lower a little bit? Maybe speak to that. Right. So there's two types of scaling that can and need to be done. The first type of scaling is simply, can we teach enough other people to do what we are able to do? And this is very hard. To be able to properly evaluate the medical literature in this fashion and to work with all these problems requires a large number of skills that are rare. And so we have been slowly attempting to find the people who have what it takes to do that, and we've been instructing them, and we believe that we will, this is our biggest test going forward, in my opinion, is that we need to prove that we can scale in this sense.

and so far, you know, we have myself and Sarah who have handled most of the cases, we have several people, I'm confident, you know, have been trained and can take, can and will in the process of taking on cases themselves, can we keep doing that as we need to reach out farther and farther into the world and with people we've had less and less contact with and who share less and less of our mean space?

And I am confident that we can do this, but it is the most likely problem that will ensue for us. The other type of scaling is can we make this process faster through the fact that we've done in enough times and we've systematized it? And we've created automated assistance and pre-existing knowledge such that we can bring the price down. And the answer to that is absolutely yes. Not right away. But every case we do, we bring the knowledge of every case we've already done. and it means we get to start at a farther off point,

we get to have better, more efficient procedures. We are innovating in this realm as we go. So every time we do a new case, we're learning about the best way to do these cases. The best way to track down the right studies quickly and efficiently and not miss anything. The right way to differentiate where the highest value of information is and the right way to do all of these things.

So we'll get better. at it and will also be able to design systems and have pre-existing findings. Okay. And so with that said, do you, I mean, I could almost potentially see this becoming almost a, almost like a human-powered, you know, sort of Google for health. Maybe similar to what, you know, Ben Haywood and their team is doing with patients like me, but could you somewhat pool all of this data and knowledge from the case studies that you, that, you know, that you're doing at Metamed, where someone could potentially pay for a service and almost do the research within Medamed themselves? Do you see where I'm going with that? Is that viable? Is that a viable?

Well, so in my experience, right, with my family and my community, whenever anybody has had it, their own medical problems and they do the work themselves, they will do what Medaned does, but they will do it on their own behalf, or if they're too sick to do it, their friends will do it, their family will do it on their own behalf because it's so important to consider this information and to get it right. And so this is one of the inspirations for it is, well, people who have more training athletes

who have more practice, more experience, can obviously do it better or can supplement. But it's absolutely true that even now, without men and meds help, you are very much incentivized by the system to do this yourself, and if you are capable of it, then you'll be better off.

if you do it, then if you don't do it, it's well worth your time. You know, because it's your health you're dealing with. You need to do this. It'll make you better informed, and you'll often get information that you can pass along. So we can almost certainly provide, you know, both advice on how to do this, you know, guidelines for how to go about doing this yourself, and provide some parts of the process for people who otherwise, you know, couldn't afford the depth of attention that their case deserves.

So I'd say absolutely, and I want to encourage everyone out there to do this themselves to the extent that their case is something they can handle or something that they can't afford to have handled by someone like us when there's enough high value. When you have to make a decision about your health, you have to make a decision about your health. You should gather as much information as you can't. Got it. I know we're running, we're running short on time here, but before I ask you a little bit about your background, do you see what do you see the competition looking like in another couple years? Do you see Metamed competing against another similar service? So there are similar services that offer similar services that are out there today.

but as far as I can tell, they are vastly weaker. They charge more money at the bottom end and offer much less. But I certainly expect as Metamed grows, as MetaMed succeeds and paves the way for this, that others will attempt to follow us, and some of them will succeed.

And I think that's great. I think that competition is good for all involved and that we will make them better and they will make us better and they will show us new things and we will show them new things and together we'll lead to that clear improvements

and we'll look into the results the patients that get our reports are free to share them and we encourage them to share them with whoever they want it's their choice it's their information they don't have to if they don't want to

for privacy reasons or any other reason but we hope that more people benefit from what we found. And if someone else is out there doing the right thing, benefiting people, we think that's great. We think that we bring a lot of unique human capital and skills to the table that will be remarkably hard to duplicate. And so we do think that we can maintain our edge over the course of a long time

and not just because we're first movers effectively. But, yeah, but someone beats us. That's great. I could almost see some of the larger health systems, at least across the United States anyway, almost either setting up their own medameds or acquiring a med-a-med-like shop within their own health system to really add more value to their, you know, to their patients that they would, they could potentially reach. But anyway, that's a whole other conversation. Last question before we conclude here, because like I mentioned, we're running short on time. I gave a little bit of an intro, or I should say, I provided a short bio when we first started this conversation. But you went from sort of the gaming space and then your startup that sold to Pinnacle Sports to health care. Why? Why that transition?

Because so I started out, you know, as a gamer, I majored in mathematics. I love solving interesting problems. I love figuring things out, figuring out proper procedures, optimizing rules sets. That stuff really appeals to me. And people who it appeals to are people that appeal to me as well. So I'm drawn to those communities. I'm drawn to those activities. And I excelled at those activities.

But there's a problem with those activities, which is at the end of the day, when you develop a great strategy for playing a game and you prove it in competition, against other people. You know, everyone's had a great time, but what have you done? What have you accomplished, right? It's not like you haven't saved lives. You haven't changed the world.

And so at some point, you have to take the skills that you've created and the connections that you've made and all the knowledge that you have out of the realm of a game, right, or a sport, and into a realm where you can really make a difference. And a difference in a realm where you can play on a larger stage where you have a chance

to work on problems that matter. And so, you know, Vassar was questioned, when we thought, Vasor and I, when we, especially he came up with the idea for the company himself and then brought me in the co-founder, he asked the question, you know, where can people with our types of skill sets, he comes from a rationality,

the Singular Institute and a rationality style background, which has a lot of the same problems, where can we really take our skills and make a difference and impact the world? And he said, well, you know, medicine is a place where people can see the value that we can provide and where we can provide a lot of value

so that we can get, you know, people to agree to give us, us, the equipment, the ability to go out there and do our work. And then where we can make a huge impact and save lives and help a lot of people. And so that's why I'm here. Okay. Well, I'm going to leave at that because I think that's fantastic. The idea that it sounds cliche, especially in the startup community, to go after something

where you can make a dent in the universe or make a dent in the world. but you guys are certainly doing it with a very unique set of, a unique set of skills and applying it to, you know, a space that desperately needs it, at least in my opinion. So, V, thanks a ton for doing this interview. I'm going to leave it at that. Can you hold on the line real quick? Absolutely. Yeah. And for those listening that have made it all the way through, thanks for your listening attention. Remember, you can subscribe to all these podcasts for free. Just go to iTunes or Stitcher Radio or whatever podcast that you have. type in MedTech or MedSider and the podcast will come up for free, download it and you'll find that way with every new episode that's published, it'll be downloaded to your smartphone

with ease. So anyway, that's it for now. Until the next episode of Medsider, everyone, take care.