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Why VCs and Healthcare Startup Founders are Struck in AI and Can AI Really Help Improving Health?

A VC is standing on a pile of paper and throwing money. Three healthcare AI Robot is seen around him. In the foreground a doctor is putting stethoscope to a happy child

Why people are saying that AI is the future of healthcare? Where VC are pouring money into healthcare AI? Can AI really solve the healthcare problems? Has technology helped in reducing diseases? Will AI make us healthier in the future?

A. What Roles Can AI Play in Healthcare?

  1. Screening and Anomaly detection from a set of parameters.
  2. Prognostics(The threat to life in a patient with acute diagnosis).
  3. Differential diagnosis(separating conditions in a complex syndrome and helping the clinician to know which one of the underneath conditions are most likely leading to current symptom and pathology).
  4. Medicine and Therapeutics recommendation for a given condition.
  5. Risk assessment.
  6. Anomaly detection and event triggers in monitoring.
  7. Evidence-based dosage adjustment.
  8. Assistive surgical treatment(Surgical robots).
  9. Learning from macro trends and data and providing additional insights to the clinical team.

B. Why Investment in healthcare is increasing?

a) Insufficient infrastructure to support a current increase in chronic disease prevalence

Post 2019 Covid-19 pandemic, people realized that the current healthcare infrastructure is insufficient to provide care to a large population where the average health of the population is slowly deteriorating. The deteriorating health can be understood from an increase in the prevalence of some of the common chronic diseases.

Cardiovascular disease prevalence in China.
Cardiovascular Disease Prevalence in China from the year 1960 to 2000 5Chen, Wei-Wei & Gao, Run-Lin & Liu, Li-Sheng & Zhu, Man-Lu & Wang, Wen & Wang, Yong-Jun & Wu, Zhao-Su & Li, Hui-Jun & Gu, Dong-Feng & Yue, Yang & Zheng, Zhe & Jiang, Li-Xin & Hu, Sheng-Shou. (2017). China cardiovascular diseases report 2015: A summary. Journal of Geriatric Cardiology. issn.1671-5411.2017.01.012.
Trends in the number of people with hypertension who reported a diagnosis, who used treatment, and whose blood pressure was effectively controlled, globally and by region, 1990–2019 <sup class="modern-footnotes-footnote " data-mfn="1" data-mfn-post-scope="000000004e6a857700000000588172b0_12025"><a href="javascript:void(0)"  title=""  role="button" aria-pressed="false" aria-describedby="mfn-content-000000004e6a857700000000588172b0_12025-1">1</a></sup><span id="mfn-content-000000004e6a857700000000588172b0_12025-1" role="tooltip" class="modern-footnotes-footnote__note" tabindex="0" data-mfn="1"></span>NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021 Sep 11;398(10304):957-980. doi: 10.1016/S0140-6736(21)01330-1
Trends in the number of people with hypertension who reported a diagnosis, who used treatment, and whose blood pressure was effectively controlled, globally and by region, 1990–2019 6NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021 Sep 11;398(10304):957-980. doi: 10.1016/S0140-6736(21)01330-1. Epub 2021 Aug 24. Erratum in: Lancet. 2022 Feb 5;399(10324):520. PMID: 34450083; PMCID: PMC8446938.
Trends in the number of adults with diabetes by region (A) and decomposed into the contributions of population growth and ageing, rise in prevalence, and interaction between the two <sup class="modern-footnotes-footnote " data-mfn="2" data-mfn-post-scope="000000004e6a857700000000588172b0_12025"><a href="javascript:void(0)"  title=""  role="button" aria-pressed="false" aria-describedby="mfn-content-000000004e6a857700000000588172b0_12025-2">2</a></sup><span id="mfn-content-000000004e6a857700000000588172b0_12025-2" role="tooltip" class="modern-footnotes-footnote__note" tabindex="0" data-mfn="2"></span>Zhou, B., Lu, Y., Hajifathalian, K., Bentham, J., Di Cesare, M., Danaei, G., ... & Gaciong, Z. (2016). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4· 4 million participants. The lancet, 387(10027), 1513-1530. DOI:https://doi.org/10.1016/S0140-6736(16)00618-8
Trends in the number of adults with diabetes by region (A) and decomposed into the contributions of population growth and ageing, rise in prevalence, and interaction between the two 7Zhou, B., Lu, Y., Hajifathalian, K., Bentham, J., Di Cesare, M., Danaei, G., … & Gaciong, Z. (2016). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4· 4 million participants. The lancet387(10027), 1513-1530. DOI:https://doi.org/10.1016/S0140-6736(16)00618-8
Trend in the number of cancer patients globally. <sup class="modern-footnotes-footnote " data-mfn="3" data-mfn-post-scope="000000004e6a857700000000588172b0_12025"><a href="javascript:void(0)"  title="Bray F, et al. CA Cancer J Clin 2018;68:394-424; Parkin DM, et al. CA Cancer J Clin 2005;55:74-108; Jemal A, et al. CA Cancer J Clin 2011;61:69-90; Torre LA, et al. CA Cancer J Clin 2015;65: 87-108. c American Cancer Society."  role="button" aria-pressed="false" aria-describedby="mfn-content-000000004e6a857700000000588172b0_12025-3">3</a></sup><span id="mfn-content-000000004e6a857700000000588172b0_12025-3" role="tooltip" class="modern-footnotes-footnote__note" tabindex="0" data-mfn="3">Bray F, et al. CA Cancer J Clin 2018;68:394-424; Parkin DM, et al. CA Cancer J Clin 2005;55:74-108; Jemal A, et al. CA Cancer J Clin 2011;61:69-90; Torre LA, et al. CA Cancer J Clin 2015;65: 87-108. c American Cancer Society.</span>
The trend in the number of cancer patients globally. 8Bray F, et al. CA Cancer J Clin 2018;68:394-424; Parkin DM, et al. CA Cancer J Clin 2005;55:74-108; Jemal A, et al. CA Cancer J Clin 2011;61:69-90; Torre LA, et al. CA Cancer J Clin 2015;65: 87-108. c American Cancer Society.

Capital always follows the market. As the market opportunity particularly in healthcare is increasing with more number of patient percentage in the population, capital is invested into the sector for levaraging the market opportunity.

b) Population across the globe is getting older with a decreased fertility rate

Worldwide fertility rate by year <sup class="modern-footnotes-footnote " data-mfn="4" data-mfn-post-scope="000000004e6a857700000000588172b0_12025"><a href="javascript:void(0)"  title="(https://ourworldindata.org/fertility-rate)"  role="button" aria-pressed="false" aria-describedby="mfn-content-000000004e6a857700000000588172b0_12025-4">4</a></sup><span id="mfn-content-000000004e6a857700000000588172b0_12025-4" role="tooltip" class="modern-footnotes-footnote__note" tabindex="0" data-mfn="4">(https://ourworldindata.org/fertility-rate)</span>
Worldwide fertility rate by year 9(https://ourworldindata.org/fertility-rate)

The fertility rate is the number of children per woman in a population. The critical fertility rate is 2.1, which means if on average every woman gives birth to 2 children, the old population can be replaced by a newer population.

Fresh and young pair of legs are important to maintain the GDP, productivity, and other services in a society. As the population across the globe is getting older, and there appears to be no near-term reversal in the trend of effective replacement of the world population, in another 10-30 years, we are going to see an ill and old population with not many youths to take care of the old.

As the manpower in the care will be less with every passing day, we are expected to be left at the mercy and efficiency of the machines to take care of the aging population.

So, there is not only an increased market opportunity but also humans appear to have no opportunity to compete in this market with the machines. Machines appear to be the only caretakers of us when we become old.

Hence the investment in healthcare in general, and healthcare technologies in particular is increasing with a hope to get benefitted from the current market and population trends.

C. Why machines can not provide healthcare, irrespective of how effective and obvious they appear?

a) Human well-being is Directly proportional to Human empathy, love, care, and relationships

Even though the trends appear obvious, it is not possible for any machines or technology to provide us with any form of care, and certainly not healthcare.

In the 1970s, scientists carried out an experiment to understand the effect of Carb food on rabbits. Out of the test group, where Rabbits were fed junk food, one subset of Rabbits appeared to not have been affected by the junk food. Upon detailed investigation, scientists found out that the caretaker who was feeding the rabbits of this subset was feeding them with love, and care, rather than just throwing the food to their cages as were done by the others. Remaining disease free is therefore a function of human love, care, empathy and touch.

Depression Percentage in US 12 Grade students10https://www.thecut.com/2016/03/for-80-years-young-americans-have-been-getting-more-anxious-and-depressed.html

The above trend provides us a valuable insight into major depressive disorder in US teenagers.

When we look into the loneliness global trend among adolescents, we see similar trends.

Increase of loneliness amongst teenagers by factor. (so 2 means 200% increase)
11Jean M. Twenge, Jonathan Haidt, Andrew B. Blake, Cooper McAllister, Hannah Lemon, Astrid Le Roy,
Worldwide increases in adolescent loneliness, Journal of Adolescence, Volume 93, 2021, Pages 257-269,
ISSN 0140-1971,https://doi.org/10.1016/j.adolescence.2021.06.006.(https://www.sciencedirect.com/science/article/pii/S0140197121000853)

The above graph presents a factual representation of the Rabbit experiment. We understand that the more humans are disconnected from each other, the more they feel lonely, the more they become depressed, and the more diseases will increase.

b) Technology can not improve health, it needs humans

There has been a significant technological advancement in medical and healthcare technologies since 1950 till date. If population well-being was dependent on technological advancement, then we would already have far fewer patients in the population.

However, technology can certainly increase the expected lifespan.

Life expectancy development in some big countries of the world since 1960 12https://en.wikipedia.org/wiki/Life_expectancy

However, even though life expectancy has improved till now since 1960, the trends from 2015 onwards again is presenting evidence of increasing mortality due to fewer human interactions and increased loneliness.

In India, a 6% reduction in mean life expectancy is observed. This not only debunks the improvement of health and life with the advancement of technology but also the quality of life’s association with the mean income of a country. The Indian economy has grown sustainably over the last decade to place India among the world’s top five economies of the world today.

Economic growth and technological advancement have always put an inverse effect on the quality of life, not only today but also over the course of history.

D. If machines, technology, and financial growth doesn’t improve human lives then why everyone is talking about AI in healthcare?

Most of the so-called founders and Venture Capitalists who are talking about “AI is the future of Healthcare” have never cleaned a patient’s stool, never seen a human life dying, never had to go and give the bad news to the relatives, and none of them have a diary with confessions from patients in their end days.

Because if they did, one that did would know healthcare is not about good diagnosis, treatment, facilities, or money, and certainly not about AI, it is about care.

Care is not scalable. Because humans can’t care those, whom they don’t have to care. Care is not an industry, it’s an emotion.

And because the founders, the VCs, and the so-called industry doesn’t care, they did not care to read history either, and none have read the history of medicine and philosophy of medicine.

Medicine is a philosophy, not technology.

If Humans understood Philosophy, Diogenes wouldn’t live for 90 years, and Alexender wouldn’t have died at age 32.

E. Why AI is the future of Healthcare is simply a noise to justify irrationality

Humans are irrational animals. We always try to justify our irrationality. Because “technology and the economy improve health” is an irrational myth, we need to repeat this myth over and over again to convince people about this claim is a fact.

Silicon Valley Bank. (2021). US Healthcare Venture Capital Fundraising 2011–1H 2021. Healthcare Investments and Exits: Healthcare Investments and Exits Accelerate in 1H 2021. 13https://www.svb.com/industry-insights/healthcare-life-science/healthcare-investments-latest-trends-show-a-spike-in-capital-funding

Money speaks! We can see that investment in healthcare AI has been increasing steadily since 2018, and by multiple folds since Covid. Humans have always believed that access to more money automatically makes them wiser and more knowledgeable, which is far from the truth.

The fact that economic growth and wealth don’t improve health can be seen from the historical population graph of Rome. Rome was the first city-state to start a Census. As Rome became the capital of the empire, within a couple of hundred years it started getting depopulated.

The way Romans justified their expansion, and invested heavily in roads, infrastructures, and technology advancement in mass-production, trade, and mining, to eventually lose it all, Silicon Valley is going in no different direction than Rome of yesteryears.

E. Conclusion

Any youngster reading, go out and serve real patients, experience death, smell urine, blood, formalin, Tincher, see death, and then talk about AI in health.

Life is about death, and health is about defying death, neither of them is about tech, it’s about emotions.

References

  • 1
  • 2
  • 3
    Bray F, et al. CA Cancer J Clin 2018;68:394-424; Parkin DM, et al. CA Cancer J Clin 2005;55:74-108; Jemal A, et al. CA Cancer J Clin 2011;61:69-90; Torre LA, et al. CA Cancer J Clin 2015;65: 87-108. c American Cancer Society.
  • 4
    (https://ourworldindata.org/fertility-rate)
  • 5
    Chen, Wei-Wei & Gao, Run-Lin & Liu, Li-Sheng & Zhu, Man-Lu & Wang, Wen & Wang, Yong-Jun & Wu, Zhao-Su & Li, Hui-Jun & Gu, Dong-Feng & Yue, Yang & Zheng, Zhe & Jiang, Li-Xin & Hu, Sheng-Shou. (2017). China cardiovascular diseases report 2015: A summary. Journal of Geriatric Cardiology. issn.1671-5411.2017.01.012.
  • 6
    NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021 Sep 11;398(10304):957-980. doi: 10.1016/S0140-6736(21)01330-1. Epub 2021 Aug 24. Erratum in: Lancet. 2022 Feb 5;399(10324):520. PMID: 34450083; PMCID: PMC8446938.
  • 7
    Zhou, B., Lu, Y., Hajifathalian, K., Bentham, J., Di Cesare, M., Danaei, G., … & Gaciong, Z. (2016). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4· 4 million participants. The lancet387(10027), 1513-1530. DOI:https://doi.org/10.1016/S0140-6736(16)00618-8
  • 8
    Bray F, et al. CA Cancer J Clin 2018;68:394-424; Parkin DM, et al. CA Cancer J Clin 2005;55:74-108; Jemal A, et al. CA Cancer J Clin 2011;61:69-90; Torre LA, et al. CA Cancer J Clin 2015;65: 87-108. c American Cancer Society.
  • 9
    (https://ourworldindata.org/fertility-rate)
  • 10
    https://www.thecut.com/2016/03/for-80-years-young-americans-have-been-getting-more-anxious-and-depressed.html
  • 11
    Jean M. Twenge, Jonathan Haidt, Andrew B. Blake, Cooper McAllister, Hannah Lemon, Astrid Le Roy,
    Worldwide increases in adolescent loneliness, Journal of Adolescence, Volume 93, 2021, Pages 257-269,
    ISSN 0140-1971,https://doi.org/10.1016/j.adolescence.2021.06.006.(https://www.sciencedirect.com/science/article/pii/S0140197121000853)
  • 12
    https://en.wikipedia.org/wiki/Life_expectancy
  • 13
    https://www.svb.com/industry-insights/healthcare-life-science/healthcare-investments-latest-trends-show-a-spike-in-capital-funding

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