This, and the fact that a sterilized robot is way less likely to transmit airborne pathogens than a dentist and an assistant wearing a surgical mask at best. Maybe not v.1.0b4, but I'd sign up for v.1.2.
Well your mucosa is more exposed than it normally is. Your mouth is acting like a receptacle, particularly when you're not wearing a dental dam. The probability that a larger pathogen-containing droplet will randomly fall in is much higher.
Larger droplets normally fall straight to the ground. Smaller droplets can be sucked in by breathing in no matter what, so the probability for those is equivalent to just being near someone. However, depending on the pathogen, risk can scale much more than linearly with droplet size. Overall risk is probably in the ballpark of an unmasked in-your-face shouting match with someone.
Then as someone else mentioned, any fomites can transfer from anything non-sterile that the dentist or assistant touches. There can also be aerosol-generating procedures in other rooms, though the robot wouldn't help there (they'd need a negative air pressure system.)
I think OP was wondering whether any studies have been done to demonstrate a correlation between dental operations and infections. It does seem needless to worry about it until you have some idea of effect size.
Those are likely to be pathogen-specific. The paper I linked for instance has a reference that dentists have a 10x risk of chronic Hep B than the rest of the population, but that doesn't translate to Hep C.
Every dentist I go to use single-use thin nitril or similar gloves. If they have to use any of the non-sterilisable equipment (like the mouse or kb), they take said glove off before use and put on a new one after.
Common sense would mean that my local butchers and fishmongers would not handover money and manipulate raw meat/fish with the same nitrile gloves and either employ an assistant or use a dedicated machine for that but they do not.
They do here but Norway has a functional balance of regulations and fines for this kind of stuff. Sometimes it’s too strict though but I certainly appreciate it.
Long ago (decades) the dentist would do a bunch of work, then pause to let me swish water in my mouth from the auto-filling cup, and spit into the water-circulating spitoon-thing before continuing.
On first blush, this is an interesting premise. And it would seem to make sense once there is no need for human attendants, nor any potential accommodation for them.
That's exactly what I was thinking, you can lay face down on a massage bed for a pretty long time, so they should just be able to put the robot in your mouth through the face hole lol
I imagine, particularly with V1, there's probably going to be human attendants for a good portion of the procedure. You'd want them for administering the numbing agent and positioning the machine for the procedure.
The suction tool is used to dry the area out and make it easier to see and work. A robot could be taught to see through water, but it still needs a dry environment for some work.
And the opposite for others. For example, getting cavities filled in the front of the mouth probably benefits from laying face up so that any saliva that's generated flows back down the throat instead of to the front of the mouth.
I'm guessing a lot of existing techniques and tools have an implicit bias for the patient being face up.
I'm sorry, but the thought of laying face down while allowing my drool to drip off my lips, moustache and beard onto machinery below sounds absolutely revolting.
All reusable dental tools have to go through a sterilization procedure after every use so would it matter? And they could have one-time use sleeves to put on the arms.
I think the main concern would be debris and drool getting on the camera but that is probably a concern for any position.
This sounds more like a systemic issue than a technological one. New tech will most likely only support the current system (profit over people, in your case), and not magically make things fairer or more social.
Doubly so if you are waiting for the Supreme Court to affirm your rights. Aside: After watching Biden win a rigged primary and be forced to resign with no vote just based on political pressure, my disillusionment with voting was complete. I’ll still do it, but just so I don’t have to lie to well intentioned people when they ask me if I did.
Probably it's both. If it would be really that easy to tell honest dentists (and society) would have no problem exposing the fake ones.
But in many cases dentists do protective/proactive treatment... that "brow spot looks like something, and maybe it's nothing, but let's make sure ..." ... which, yes, is reducing the number of cavities (by definition), but you have to get through the process. And if you have those spots for decades there's a good chance they would have continued to be nothing for more decades.
Even with Xray it's an educated guess. (I mean in cases when someone goes for a checkup.)
... but there's the non-tech aspect, meaning that the application of dental sealants seem to be spreading slower than warranted.
I had a stomach bug, and a Physician was insistent I get xrays. I put my symptoms into chatGPT, and it agreed that the xray was unnecessary.
I saved hundreds of dollars, I learned my doctor was corrupt, and tbh... I already knew what I had before going to the doctors. I only needed the doctor to write the prescription.
Have you considered that your doctor might have had an actual reason to want you to get an X-ray and that maybe chatgpt is wrong? Absolutely wild to me that you distrust a human but feel like a glorified autocomplete is somehow completely trustworthy. They can both lie, but at least the human knows they are lying.
EDIT: I should mention, literally every patient was offered an xray. We were in a communal area. It didn't help that their ads across the wall were full of pseudoscience too.
Whenever there's information asymmetry that financially benefits one party you have to be cautious. It's been shocking how many times people I know have sought second opinions on recommended dental work only to be given a completely different recommended treatment that's thousands of dollars cheaper.
Example from a friend: Dentist 1 - you need ten fillings today! Dentist 2 - You have a few risk spots but let's just keep an eye on it.
Went with the second recommendation and didn't have any issues and that was a decade ago.
Diagnosis is currently extremely subjective. I believe that GP is suggesting that robotic diagnosis will be more objective and determinant. Ostensibly, because financial considerations will not be part of the input to the diagnosis routine.
That said, financial considerations will probably still be a big part of the treatment routine.
> Ostensibly, because financial considerations will not be part of the input to the diagnosis routine.
Devices that overreport are likely to be more popular and more common than devices that underreport. That is in part due to the financial incentives associated with diagnosing.
To tie in the sibling threads: devices that underreport will also be popular, just with the insurance companies after the fact to help them deny covering procedures. Your lung biopsy come back benign? CignaAI says you shouldn't have had it in the first place so out of pocket for you!
> Devices that overreport are likely to be more popular and more common than devices that underreport.
I think you're on to something. I bet Henry Schein execs/shareholders haven't felt this much energy since patients first saw their dental issues on 36 inch TVs.
I'd like to see it change the way dental insurance works, so that e.g. an AI diagnosis will legally be fully covered by the insurance, and anything that can't be verified through that would be considered an elective procedure. In the US dental insurance works basically opposite of health insurance - they only cover the basic checkups and you have to pay for any real medical needs. It's like if car insurance only covered oil changes and tire rotations but not accidents
What makes you think that the robot won't have a financial interest? The company that makes it will want a profit. The dentist that buys it wants to make a profit. If there's an AI under the hood, it might decide that someone needs to pay for its electricity habit.
That being said, I agree that it's a difficult part of the fee-for-service model.
If the robot's decision-making process is transparent then 100% agreed. I just know, however, that (at least as long as state-of-the-art 'AI' consists of huge models trained on big data) the advice given by any free-on-the-internet bot will have built-in biases towards paid recommendations and similarly insidious things.
Fantastic development (I’m in the dental field) As a side note; a Chinese team already performed an implant surgery with a “fully automatic” robotic system in 2017.
I had an implant done recently and I got the impression that the device used to install the implant although being held by the dentist was actually monitoring its position & orientation very carefully.
Dental repair is really nothing. Automatic welders are very common e.g.
I've worked on automatic brain surgery robots, which really needs to be automatic. because 3d, tricky, and the doctor outside sees much less than the tiny sensors inside. but you can interfere and even invite remote specialists on remote duty to observe or handle the pedals.
That's interesting! Up to now, I've never seen automated surgical robots. They're just big swiss knives with stereo vision, usually. Are there automated robots on the market ?
> I've worked on automatic brain surgery robots, which really needs to be automatic. because 3d, tricky, and the doctor outside sees much less than the tiny sensors inside. but you can interfere and even invite remote specialists on remote duty to observe or handle the pedals.
Just curious.. Are these fully automatic/autonomous? I assume human supervision is required but are there steps that humans have to choose/decide such that the robot could not possibly work without any human supervision?
Sometimes the drill is necessary, but imagine how infrequently we'd need it if there were robots in our homes that could do an immaculate job with the daily cleaning.
That's a dropshipping site for AliExpress products shipping from China. You'll save money if you buy the product straight from AliExpress without a middleman in between.
However as you said, the toothbrush doesn't actually work.
Why is it now a trend to point this out? Marketing foreign-made inventory in your country is a long-standing legitimate business. Most individuals do not want to personally deal with a Chinese outlet.
I think you have misunderstood what dropshipping means.
In dropshipping the business won't have any foreign made inventory and neither will they have any in their country. Instead they will hook you up with a Chinese outlet without telling you.
The Chinese outlet will handle shipping, returns, etc with the dropshipping business just taking a cut for essentially spending money on Facebook Ads. This is the part where you'll deal with a Chinese outlet regardless of your preferences, because the dropshipping company basically did this to you without your knowledge.
They don't have a local stock to replace items under warranty. They don't have a local warehouse to return your item to if you're unsatisfied. They might've never even seen the product themselves and thus cannot even provide support regarding it's use.
So that's why I think it's important to point out dropshipping. It's a completely different thing than keeping a foreign-made inventory. There isn't really any good reason to buy from a dropshipper, because you'll deal with the Chinese outlet behind it regardless.
> They don't have a local warehouse to return your item to if you're unsatisfied
Yeah well that's their problem and not yours. That's the value they are providing! The person who sold you something can't disclaim responsibility for selling it to you, at least under American law.
What value? What kind of logistics value could they possible provide if they don't have logistics in the first place?
It of course is problem of the consumer, as consumer is the one returning the item and the one who ultimately has to deal with a Chinese company that may not even speak English, not to mention the time the package takes to get there for a refund.
While it's the seller's responsibility in theory, yes, they make it very clear that you'll be dealing with a Chinese seller in their terms. Yes, it is your job to read the terms before you buy, however if you do read them, why wouldn't you just go buy from AliExpress after that? Absolutely no extra value buying from the dropshipper once identified.
Because it blew up as a get rich quick scheme / "hustle culture" trend recently as it became much more accessible via internet-based dropshipping facilitators, and there's a lot of people trying to make a buck on it, in sometimes nefarious ways.
Dropshipping is when you order from a merchant and all the merchant does is make an order with your name and address from someplace else. In other words, you could have simply made that second order yourself and saved yourself whatever margin the merchant added on top.
Do note that dropshipping is a very specific term, which does not mean "importing things from another country and then selling them locally", but rather "taking orders from customers and then just ordering a shipment from someone else directly to the customer". For example it would be dropshipping if I made an eBay listing for some product and, whenever someone bought the eBay listing, just ordered the product from Amazon to their address. I never touched or shipped the product; I just made another order posing as the customer.
It's not ethical for someone to clone a more expensive version of some Amazon listing onto another site, and then order stuff from Amazon to whoever buys the listing, pocketing the difference. It's just scummy. Sites like Alibaba really do help because otherwise importing stuff is a lot more manual of a process, but dropshipping on its own is just ugh.
> It's not ethical for someone to clone a more expensive version of some Amazon listing onto another site, and then order stuff from Amazon to whoever buys the listing, pocketing the difference
This is textbook marketing. You connect buyers and sellers and take a profit. You are bringing the product to the attention of a previously-unaware consumer. I can't imagine what you think is not ethical about this.
It's okay when the product they're selling is their own product. Say, Amazon fulfillment. The manufacturer sends their products to an Amazon warehouse and then Amazon handles shipping them out. But if a seller claims to have their own product but then just goes to another listing and buys it to the customer, that is what I think is unethical.
IMHO reselling is OK only if it's disclosed what the original brand of the product is... but even reselling doesn't necessarily imply dropshipping.
Alibaba has a "search by image" feature. It has been the BEST weapon to catch dropshipping.
As a bonus, if it's on Alibaba, you can either A: order a sample direct cheap or B: find the product on Aliexpress and order that way for cheap, too. I love catching scams and flipping the tables to buy it myself at their own price if I think it's nifty.
I built a homemade hot tub system around one of those "ice plunge" bath tubs that seem to be a thing going around these days. They're a rigid inflatable tub, but anyone selling them alongside a chiller sells the tub alone for $500-1000. I found the direct source (Shenzhen Gateo Sports - https://gateo.en.alibaba.com/) and bought one for $200 direct from the factory and love my unbranded tub. ;)
#1 is the website ships globally with no restrictions. A lot of Chinese businesses ship to any country. A local business with their own stock generally won't handle shipping to every single country around the globe. Sure there are exceptions to this rule, but in general it works well as your first sign.
Read the terms and conditions, privacy policy and other more "obscure" information like that. Dropshipping items always ship from China and returns are received to a warehouse in China.
In their Terms of Sale, Sonic Brush mentions that it is rebranding the following product "We are selling the following brand mark : W-White.". So this would be the dropshipping product they buy from AliExpress.
I've wondered if you could make something to floss multiple teeth at once. Maybe something that fits over a span of teeth such as all the top teeth and is custom fitted so that it fits on the same way each time. It would have holes that you can thread floss through so that when you put it on the floss ends up between the teeth. Then you can pull on the ends of the floss and it flosses between all the teeth that the device is covering.
You don’t want the floss just moving in and out between the teeth. The point of floss is to scrub the inside face of each tooth. So when the floss is between 2 teeth you want to press it against first one tooth and move it up and down several times and then press it up against the other tooth and do the same thing.
There’s really no way to do that to multiple teeth at once without something much much more complicated.
I actually had this thought one day. Do billionaires waste time brushing their teeth? If yes, why? If no, do they use a solution that they just stick their face in and it brushes for them?
That's what I'd do as a billionaire anyway. I wonder how I'd solve peeing...
I keep hearing that dentist-grade cleaning is a not-strictly-necessary way for dentists to make money now that their core service has been 95% resolved by fluoride in water and toothpaste.
Outside my skillset to comment on that claim, but I do keep hearing it.
I'm terrible at preventing it from occurring, and I don't see either a) a robot capable of dealing with me or b) my establishing comfort with said robot actually happening. So yea, I'd rather just introduce teeth that are more resilient to destruction than I am at constantly trying to fight the destruction.
But maybe, before we remove any amount of comfort with another human being we look at wether all of the dental practices are actually backed by science (which there is some scruitiny over).
But also going to the dentist already isn't exactly pleasant, the pokes, scrapes, drill noises, etc. Maybe we improve that first before sticking it in a robot?
People already have a ton of anxiety about going to the dentist. Removing humans will make that worse.
I realize this is early, but still. I feel like we skipped some things.
> But also going to the dentist already isn't exactly pleasant, the pokes, scrapes, drill noises, etc. Maybe we improve that first before sticking it in a robot?
From the article:
> The machine's first specialty: preparing a tooth for a dental crown. Perceptive claims this is generally a two-hour procedure that dentists will normally split into two visits. The robo-dentist knocks it off in closer to 15 minutes.
So this robot is actually improving the dental experience for the patient, which will hopefully reduce anxiety as well as reducing costs.
>But also going to the dentist already isn't exactly pleasant, the pokes, scrapes, drill noises, etc. Maybe we improve that first before sticking it in a robot?
Dentists are definitely trying. The drills have gotten smaller and gentler, my dentist (and many others) offers a headset so you can listen to music/podcasts while getting your cleaning, and overall they make an effort to be less scoldy and more encouragey.
The process itself is still kind of naturally unpleasant, and the billing sucks, but the people seem to have taken traditional criticisms to heart and made some moves to make it suck less.
There are a lot of fields like this, where they have mostly been reduced to refinements but ultimately are still very barbaric procedures. All we've done is upgrade the stick (in this case, a nice shiny pick), but the procedure hasn't changed much at all.
Too much of dentistry is still stuck on instant fix solutions. Take hard metal, scrape teeth. Something wrong on inside, just drill into it scrape it out and fill it. Dental implants were the last major invention and that was what, in the 60s? There really needs to be far more money and research in the field, because there is ample opportunity for major improvements here as it's lagging so far behind other health fields.
There's huge inertia to change in Dentistry, we know that drilling and filling is basically the worst way to fix teeth. It's firmly established that ART/HVGIC is a much simpler and superior method for 95% of issues. Could be nearly 100% with proper patient education. The ART proponents have been saying this for 30 years, but it's now too hard to deny the superiority. You don't hear Dentist advocating for it though, instead they push fillings, crowns and root canals. Because the majority of a dentist work is actually repairing the inevitable problems that drilling and filling will cause. Drilled teeth will almost certainly need to be refilled and at a larger portion each time.
Loads of studies that show the effectiveness of ART just as well as composites.
And the difference is Novocaine shots and drilling out a tooth vs no numbing need, minimal cleaning with a pick and toothbrush and then essentially placing a ball of putty in the cavity. A ball of putty which actually chemically bonds with the tooth and releases fluoride to rebuild enamel.
But it's hard to charge $350 for something anyone with two fingers can do in about 15 minutes. And then of course if it breaks or comes out the fix isn't drilling an even larger area, it's just filling a smaller hole with putty.
So what you're saying is, the dental industry is ripe for disruption by someone who can set up a fancy office and hire a half competent nurse? Come on, YCombinator, do your thing.
Nope the regulation is too strict. You either must be a dentist or a hygienist to do any sort of dental work and there are strict limits on what a hygienist can do. To avoid regulation you must have an actual dentist doing everything. Now, the robot angle may open something up. There is already innovation in the manner you are thinking, but it's private equity basically buying the cheapest / worst dentist they can and scheduling them to do like 60 fillings a day in a different location each day of the week. Obviously the goal is extracting the most profit though. They will push all the most expensive procedures that non-dentist can do like periodontal debridement and measuring the gums etc.
At some point, you bottom out on the reality that we are all just big bags of meat and bones. No amount of technology or AI will change the fact that we are material objects who sometimes have problems with that composition and structure of that material.
That hasn't stopped other fields. You can get skin patches that utilize micro-needles to inject serum into your pimple, reducing the need to wait for pimples to "naturally" disappear. This was previously thought to be wildly unaffordable. Didn't we just get a new breakthrough for hair regeneration earlier this year using similar techniques?
Fact of the matter is, dentristry has lagged so far behind other fields because there's a lack of care for it. Dental is often not even considered "healthcare", despite how important oral health is to general health. It's also the easiest to hide, who cares about actual rotting teeth just sharpen them down and replace them with plastic. Whereas things like skincare and hair get far more priority due to being visible. Of course there's also the severity, people don't care if their teeth disintigrate, but a broken leg is a broken leg and gets handled appropriately.
Maybe it's because dermatology is much less risky since you're talking about a surface level treatment for a very small part of a very large organ. With dentistry, you're going into an orifice that humans must use to survive and directly interacting with the only place in the human body where bone is exposed to the outside environment. The risks are huge. You can die of heart failure if bacteria gets into your gums.
> a broken leg is a broken leg and gets handled appropriately.
Funny that you say that because I'm currently stuck on my couch with a broken ankle, unable to walk for the past two months. I'm very grateful for the quality of care I've gotten, but seeing the X-rays with three metal plates and 18 screws going into my bones sure as heck does look barbaric. But when chunks of bone snapped off and need to be put back in the right place and forcibly held there, maybe that's the best you can do.
Add decent calcium processing/distribution. I get too much calcium deposit and vit D+K basically fixed my dental issues. Unfortunately it took 30 years for a dentist to tell me about that.
This has not been the case in my experience. Dentists have always told me exactly how much I owe them, and the one time I forgot a payment, they called me and texted me to let me know and I resolved it in a matter of minutes.
Meanwhile a hospital visit sent me a bunch of bills in the mail ranging from $50 to $100, they refused to tell me the total sum even when I visited in person, and when I missed one $50 payment I was sent to collections a year later.
Perhaps they were referring to the idea that dental "insurance" doesn't cover more than a set amount which is far under the price of most dental surgeries. It is only intended to cover preventative maintenance. As far as I am aware, there is no way to get actual insurance for teeth in the US, even via medical insurance.
I don't know about US and it's healthcare system, but in many countries changing dentists is really easy because it's not tied to your healthcare, just pay out of pocket kind of situation. People discuss dentists, they give recommendations to friends, so it's a pretty efficient market. And people pay a lot of attention to how scary or not scary their procedure was.
In the US, dentists and optometrists are separate from our health insurance system, and have their own insurance. Dental insurance usually covers cleaning every six months, and some percentage of the minimum possible correction for things that need work. For example, they may cover 50% of having the tooth pulled but 0% of putting in an implant, because the implant is considered cosmetic and not necessary work.
Anyway, it ends up being like you say, it's a largely out of pocket service that people shop around for.
> and overall they make an effort to be less scoldy and more encouragey.
Oh, 100%. Yeah there has for sure been progress. I do also recognize that my anxiety is not just "oh I don't like the dentist", I was lied too. That breaks that trust.
I remember before I found my current dentist, I was having a ton of pain and I tried to find someone. I called them, explained the situation, explained the anxiety and where it was coming from. They reassured me, we have someone who knows how to help with that.
I went there, the dentist came in, I again explained the anxiety and where it came from. This was meant to be a, get comfortable thing. It wasn't a cleaning, just talking. He decides the entire time that he was feeling around my mouth with his fingers, he would hold the scraping tool inches from my face. And then, right at the end to purposefully do a quick little scrape as if, its not big deal see its not that bad.
I just got through telling you I was lied too, that is not the time to do something without telling me that you said you were not going to do to try to convince me that "its not that bad". And then he was like, yeah so we have time if you want to get a cleaning. I have not wanted to get up and leave as quick as I had in that situation in my life, never went back...
That is a rant, sorry about that. But that moment is burned into my brain.
I was so thankful to find my current dentist. When I told them, the dentist called me while I was at home to talk to me in my space that I am comfortable in. Then when I got there I just sat in the chair for a while talking, not laying back, my feet were at the side.
Only slightly related, I have a really bad thing with dental dams, clamps, and anything blocking my mouth - I get really paranoid im going to choke and die - and start overthinking swallowing my saliva and freaking out. Especially taking the moulds for my teeth, it really feels like the back of my throat is getting blocked up by the putty, and they just leave me sitting there with it in.
My dentist would always lie to me saying "just a little longer left" (even when there was about an hour remaining) which really didnt help, and after we finished about 5 teeth worth of treatments she said she "realised" I have 3 more places she wants to do as well..
It sounds hysterical I'm sure, but I dont think she realised that several times per each treatment I'm genuinely convinced I'm about to die - like making peace with god level. I got over myself and was in a really good cycle of going because I wanted to finally fix everything, and then that extra "reveal" of another 2 rounds of treatment just broke me, I couldn't do it.
It’s still along those same lines. It’s lying or stretching the truth.
And I do believe that for the most it comes from a good place. They are legitimately trying to reduce anxiety.
When the above happened an I was trying to find a dentist I talked with my therapist about this extensively. And then the dentist I found now, talking through it was a big way that helped me.
And both of them kinda said the same thing. That this was an old trick that dentists used. Particularly on kids, but clearly not limited. And it does come from a good place.
But they don’t think about the long term damage of that. Even on a subconscious level. It wasn’t until into my adult hood that I understood why I had a fight or flight moment when I got in that chair, but I still did.
And I feel you 100% on those tools and stuff. I have gotten better, but I remember early on after finding my current dentist I needed a root canal. I told her, if I am laying 100% back and that plastic film is covering my mouth fully I am going to have an anxiety attack. She listened and worked with me on how to make it work. It still made me anxious, but yeah.
I've had three dentists in my life. One lied to me, one stuck a toe over the line of informed consent and handed me an unexpected bill, the third half-assed his job leaving me with unnecessary work which ended up causing problems later in life.
I'm sure there are great dentists out there who are honest and empathetic but I haven't met one and don't plan on rolling the dice again anytime soon.
I originally had a good dentist, never had a cavity, ever. He retired, next dentist I had a cavity nearly every time. I stopped going, then one of the fillings came out. I went to a new dentist and they said ok, we can fix it. Then drilled my tooth off and literally while I was numbed up and after ~30 minutes of drilling, they freak out and are like.. OOOOOHHHH, you need a root canal, it's $2000, or the other option is extraction.
Haha, as a 3rd worlder; I'd much rather take my chances with a robot dentist than a dentist who's father has ties with the ruling class, who's father has bought their university sit, or who's father (allegedly) being a veteran of a war that was finished 34 years ago has gotten them a university sit.
As someone who 5 or 6 years ago was not going to the dentist since the very idea of it gave me anxiety after having a particularly bad and damaging dentist experience as a kid. When I would to to the dentist I would have a fight or flight moment just sitting in the chair. (TLDR, I was told they were going to do one thing as a kid, but they purposefully lied to me and did something else thinking I would be less anxious about it happening... yeah that went swimmingly)
The only way I got over that was being able to talk to the Dentist that I was working with, having them explain step by step what they are doing, they check in regularly, etc etc. I finally feel mostly comfortable going, to this specific dentist. The idea of switching has me anxious.
The idea of a robot, while great maybe it could have less human error and all that. No... just, no.
My friend swears his dog tooth paste was better at preventing plaque build up than human tooth paste and it got me thinking that big dentistry probably have incentive to not improve effectiveness of human tooth paste. Then I read the ingredients and it's pretty similar so what do I know.
I'm not bothered by any of these concerns, none of them are more important than cheap dental care because bad teeth and gums are agony that may lead to heart disease or cancers. The only thing I'm concerned about other than costs are failsafes. If the thing (or rather the 20th generation of the thing) can be absolutely guaranteed not to cause a disaster in someone's mouth (it should panic on the most minor confusion), and is cheaper than dentists (not hard) it should be made standard.
If somebody needs a dentist to hold their hand, they can go to a fancy clinic that has some sort of doula. But normal people used to get their dentistry done by the same guy who would cut their hair.
> I'm not bothered by any of these concerns, none of them are more important than cheap dental care.
Is there really any indication that this will make any change to the cost of dental care? Is the dentists the problem or is it the other parts? There still has to be someone there to manage it.
Also this machine will not be cheap either, will require maintenance, etc. From what I have seen most robot operated medical things, are not to replace jobs but for precision that humans just can't do. Or to reduce human error.
> But normal people used to get their dentistry done by the same guy who would cut their hair.
I would strongly advise against saying "normal" when dental anxiety is very much a thing for many people. I would likely even say most people have some sort of dental anxiety.
There is a reason that a lot of people don't get their regular cleanings, and I am sure cost is part of that but not all of it.
I mostly agree with you, but note that “absolutely guaranteed” to not have a terrible outcome is not something human practitioners provide. The standard should be comparable.
But will it carry on a conversation with me that consists entirely of open mouthed vowel sounds? I'm not sure speech recognition has gotten quite that far.
I'm 100% positive that if you came up with something "first in the world", but the risk of death was 50% during the procedure, you would find people willing to do it.
It’s going to become increasingly apparent in the US over time the degree to which doctors & the regulatory state are blocking us from getting cheap new care.
Already ML algos are more accurate at diagnosing melanomas from an image than dermatologists - but we will never get that tech because doctors are fiercely protective of their salaries and have captured the arm of the state to help them do so.
And the lowest hanging fruit doesn't even necessarily have to do with AI or robotic tech.
In the US you need a prescription within the last year to buy contact lenses. European countries do not require this. Not only does this mean contacts are more expensive and come from fewer suppliers, but demand for appointments with eye doctors would never go down, even though a test of vision could easily be done now by an automated machine where you choose a series of A/B options.
>In the US you need a prescription within the last year to buy contact lenses. European countries do not require this.
Same here in Japan. I just buy my contact lenses from a shop online; I don't need a prescription at all. The only reason to go to the optometrist is when I feel my lenses are no longer the correct prescription (since your eyes change over time).
And for the eye-health tests that eye doctors try to use to justify yearly visits, that's done for free at the annual health check that everyone gets. Unlike the US with its weird system that considers eyes and teeth to not be necessary for health, those are all covered by the same single health insurance that you normally get, either through your employer or from the government.
Maybe for a basic eye exam, but they're also checking for things like glaucoma. Glaucoma in particular is tricky because you may not notice early on, but any damage done to your eyes before treatment is permanent.
In my experience, the cost for glasses/contacts is mostly in actually buying them anyways. Therefore, I just go get my eye exam done and then just buy them online for much cheaper than any retail store. Supposedly the cheap online glasses aren't as good, but they're good enough in my experience and then I don't feel quite so bad when I inevitably lose them somewhere.
Being a doc, I can confidently tell you you are totally incorrect as to why things happen the way they do in healthcare. That won't surprise you, I guess. I long tried to make outsiders, and especially tech people, understand what our job is, but discussions always lead to the same stereotypes.
Myself a med-school-dropout, I've found myself several times telling doctors how I really feel: "You aren't paid enough for the sacrifices you made just to be able to help people that probably aren't going to listen to your advice, anyways."
Thank you for your sacrifices, including to the oncoming ML "clinicians."
Come on, doctors are some of the most highly compensated wage earners.
Every working stiff at all income levels sacrifices disproportionately to their income, and if I were a high school teacher, I'd belly laugh at this doctor pity party.
Sure, but it's extremely hard to overcome the hole that medical school and residency puts you into. 4 years of tuition, then 4 years of pitiful wages is a long time. The top, most competitive fields have astronomical wages, but most doctors salary is closer to that of an engineer.
Anecdotally, I'm a software engineer. My wife is a physician. We'll be in our 50's before my wife's career out earns mine. That financial hole of med school and residency is so deep and the salaries on the other side just aren't _that_ much better than other paths. I didn't even pursue FAANG level salaries, either.
That being said, job security and availability is far, far better for my wife. We can basically live anywhere we want and she can find a job.
Lets not lump in nurse practitioners. I'm absolutely in favor of giving more responsibilities to NPs and paying them more than they currently are.
Data on doctor salaries is very difficult to come by publicly, however H1B salaries indicate the average pay for H1B PCPs is $200k [0]. These are the lowest paid physicians. If you look at the data, many many physicians are making much more than that - with many specialities averaging $300k+. Generally H1B workers make less than comparable native-born (even though that's illegal) so we should view this as a lower-bound.
That puts hourly pay for average PCPs lower than the top SWEs, but comparing average with average or specialty with average and you're already quickly outpacing large majority of SWEs.
From what I understand, the primary care physicians that work for a large medical company don't make much, but ones that run their own practice can make double or even triple, but then they take on enormous risk.
> Come on, doctors are some of the most highly compensated wage earners.
You mean it's not us tech workers? :P
Seriously though, I've seen the pay scales in some countries, they're nice and all, but they come with many extra years of training (expensive plus limited income while you do that), plus shift work and overtime that is bad for everyone (staff and patients) and which shouldn't be necessary — and wouldn't be necessary, if most nations all hired about twice as many of them… but that would require us to also train twice as many and politicians who do that get the budget shortfall today while their successors (possibly in other countries) get the reward for the benefit of their being more trained doctors and nurses.
I'd pay them the same for less hours. Mandatory less hours — go home and sleep, let someone else tend to this patient while you rest.
I will be honest, I've had better luck with google than most doctors. I've had doctors say things which were completely incorrect. I've had doctors prescribe unnecessary and not advised meds for what they diagnosed me with(incorrectly).
I have friends who are pharmacists and they agree with my opinion, and they interact with doctors daily.
I have had the opposite experience. I have had professionals find and treat problems in weeks after wasting years using books and the internet.
I am not saying it is impossible, but find good info on the internet, but it has its limits.
There's gotta be errors on both sides, now the question is if we are assessing their risks properly or not. Maybe giving a shot to a low risk thing you read on the internet is worth a try, and maybe booking a doctor visit and getting examined will be worth the time and money.
It'd be nice to have this decision tree being built out in the open, ultimately everyone needs it.
Doctors are people doing a job just like anyone else. The old joke, 'what do you call someone who graduated last in their med school class? Doctor.' Just like software, there are good ones, bad ones, and average ones. By definition, most are average.
I know a few surgeons who are nerds about surgery like many on HN are about technology. But they are also the first ones to tell you not all doctors are the same.
I had to fight with numerous doctors to finally get treated for scabies despite having extremely severe symptoms and despite my partner at the time having scabies. My immune system was apparently good enough to keep it from being easily detected under a microscope, but lo and behold, I had complete symptom remission once the dermatologist I saw went ahead and prescribed an antiparasitic anyways.
I would like to see RCTs on whether the current approach of care gatekept by doctors (ie. prescription for glasses, can't use this melanoma diagnosis tool unless you visit and pay for a derma) actually has any measurable impact on downstream health.
It's interesting that we have all these RCTs for drug interventions, but never conduct the RCTs on policy like letting NPs do more procedures, etc.
Ah, RCTs! The final truth, the end all of all arguments. I've been working for enough profs to know that the best thing to do with 90%+ medical papers is to transfer them directly to the wastebin, and that includes RCTs.
Yeah, what is a randomized controlled trial when we have your 'gut feel' to rely on. Great showing from the physicians in the comments here, now I can clearly see why we should have trust in your evidence-based practice.
X says "I would like RCTs on this subject", and you reply that most RCTs are worthless. Great, what do you want, a cookie? Presumably they want good RCTs, not low-quality ones.
Yeah, I'd like a cookie. I'd also like medicine to become real science. Unfortunately, you can't say by reading the paper, whether the paper corresponds to what's truly been done. In my experience, it often doesn't. What's your personal experience you wish to enlighten us with?
In a nutshell, no amount of lobbying will stop equivalent service for 100x cheaper. Tech does not permeate healthcare for 2 reasons: 1. mostly inapplicable. Everyone is focusing on ML model performance, but really information retrieval in healthcare is dismal and prevents the use of such new tech altogether except in very niche cases. 2. no integration in the workplace. Tech people and docs don't understand each other at all, so docs ask for impossible things, and tech people deliver perfectly functional, totally inapplicable tech.
If there are algos out there (and there are) that can accurately provide a strong heuristic on melanoma from a photo and this is being blocked by the state - that seems like an obvious instance of regulatory apparatus stopping an equivalent 100x+ cheaper service.
I've discussed with a number of people who work directly on DL for imaging at a major hospital system in Boston. They say that (outside of the doctors they work directly with) fear over competition and losing out on the pricier billings are one of the largest barriers to getting their (very accurate) tech deployed more widely.
Yes, so as usual it's so superior but it's never used. And the people building it say it's stellar, promise! Here's a clue: instead of building a tool, and try teaching people already practicing how and why they should use it, maybe we could actually go see what practitioners are doing and try to integrate into that without requiring 30 additional mouse clicks and the use of a new soft that nobody understands ?
You can find the studies on the recent melanoma classifiers. There are tons showing in various settings that they pretty clearly outperform physicians.
If 'additional mouse clicks' is a major barrier to physicians using a tool that leads to far better diagnosis outcomes of a fast-progressing and deadly disease, I'm not sure why that is an argument for why things should continue to be as physician-gated as they are.
I will happily perform the 30 extra clicks myself if it is my potential melanoma. But if I were to offer it as a self-serve app ($2 for melanoma diagnoses too cheap to meter), I would be thrown in jail.
Yes, we have so many models that completely outclass docs. It's really strange, they're not more widely available don't you think ? Providing so much value, one would think there would be a black market for those, at this point. Or maybe, just maybe, the setting necessary to make things work in large-scale realistic practice is more difficult than what the paper authors would have you believe? No, they would never do that...
I'm being very specific about melanoma because this is one of the cases with very compelling evidence. You can broaden the discussion if you want - but that is not what I'm discussing. Here's a study of this technology with 67k real-life practitioners showing obvious increases in accuracy. [0]
Apologies if the link to that article is one mouse click too many for you.
I never denied the performance. Now make it usable to the average doc. That's where we disagree. You believe it's usable, but you've never seen clinicians handle computer stuff.
exactly… this is tech that could be used by literally anyone if it were legal but I am supposed to believe it is just too difficult to bring into practice
I doubt that measurements outside a standardized environment would grant satisfactory performance. But, perhaps. I don't know.
You're just too sour, man. I'm not saying it won't work, not even saying with certainty it doesn't work now. I'm not refuting protectionism plays a role either. What I'm saying is just that clinical integration of new tech, especially involving computers, is much more difficult than you seem to believe. And that the primary reason for that is not the greed of docs, which in my experience holds far less political influence than you think. I'm all for new tech, so chill out a bit.
Last I heard, they were very sensitive to things like imaging equipment, so they could diagnose well if imaging was done by the same gear that provided the training data. It worked fine in the hospital that developed it, but unable to deploy widely. If that issue has been fixed, I look forward to an online service running from a less regulated region. It would be a money printer, even if the US blocked it.
Me and my team made a piece of successful software for patients and clinicians. It is really difficult, mostly for the reasons you state, but it is possible. It's used in about half the NHS, and I personally know three people who've used our app to successfully manage their pregnancy complication, which is great.
My company/team is an unusual exception. The UK has a much bigger problem with creating tech than the US does. That's why almost all NHS trusts in the UK use US-created EHR systems: Cerner and Epic, mostly.
The UK is bad at creating a pro-business/pro-investment environment, so we have to buy in stuff from elsewhere, even though it's not well-suited to our needs. Or best case we find US-based investment for our companies.
Can you explain why optometrist is necessary to buy glasses? Eye exam is already automated to a large extend, and it shouldn't be hard to make it 100% automated by having machine ask questions instead of optometrist. Optometrist already follows a well defined algorithm to come up with prescription by putting a series of lens pairs in phoroptor and asking patient which one is better.
It's not entirely required. You can go on Zenni (and other online stores) and buy a pair of glasses with whatever correction you want.
Though, I do largely agree that the actual assessment by an optometrist is literally unnecessary. I've personally had to adjust my prescriptions because the optometrist pushes me to something that strains my eyes.
> That won't surprise you, I guess. I long tried to make outsiders, and especially tech people, understand what our job is, but discussions always lead to the same stereotypes.
You can explain all you want, but the US is the only country that has exorbitant bills for healthcare culturally normalized for some reason, despite outcomes being roughly the same as other developed countries.
Unless your explanation sufficiently addresses that (which I doubt, since you are not an economist), no one will care to listen.
So maybe a little less confidence and a bit more humility and empathy (for those that need healthcare and can't afford it).
So, if I tell you: 'I'd like help, but when I ask for it I get something worse than what I had at the start', that's me being a typical insufferable doctor, I guess ? We both fit our stereotypes really well, then !
Most docs are overworked for many, mostly bad reasons. Clinical overload is one thing, but healthcare is more like drowning in admin work, these days. So mostly yes, but the true answer is more complex than I can write about in a comment.
The US has 26.1 doctors per capita, while Germany has 42.5, which is a middle-of-the-road number for the developed West.
Do you accept the criticism that the US simply artificially limits the supply of doctors, which leads to overwork for physicians, and worse health outcomes for patients?
Do you think most doctors would take less hours for a somewhat lower salary if you it was possible?
All countries control rather strictly who can practice medicine. Yes, there is some amount of protectionism, but that happens almost everywhere. The reason is not only money, but also cultural issues. So yes, I expect that to be a valid criticism, but I don't think opening the floodgates would have the result you expect either. Access to care is a complex problem, and IMO not primarily limited by doc counts in the US.
Young docs would absolutely work less for less if possible, I think. Old docs wouldn't. IMO, that's reflected in the rise of big network providers such as Kaiser and friends.
In Europe, access to care is better IMO mainly because both patients and docs are far less aggressive, and often quite happy just doing nothing. Which is in fact the true problem about US healthcare: the culture of absolutism.
There is always a strong sense of national pride in medicine. Many people both inside and outside healthcare believe their nation has the best care, and make it an institution of sorts. It really seems stupid and insignificant, but the fact that foreigners are not feeling welcome has consequences. For example, US people often compare to german docs. Except I'm from Europe and having worked in the US, I can tell you I wouldn't go back to the US even for a million bucks. Why go somewhere you do 1.5x the hours, have a miserable quality of life and be treated like s##t, just to earn a little more ? So, if the US was to open the floodgates to foreign grads, I don't think the 'brain drain' would go the way people expect.
Within the US, the limitation of admission of US students into med school is another matter. And I think people are probably right to call out protectionism in this case. But I have no first hand experience, being a foreign graduate myself.
I'm just a random bloke having worked in Boston, though. So YMMV.
> All countries control rather strictly who can practice medicine
To pretend that the restrictions in other countries like Germany are at all comparable to the restrictions in the US is laughable. Just look at the work involved for a German doctor to legally practice in the US vs the reverse if the controls are so similarly strict (they're obviously not).
You are very clearly engaging in motivated reasoning in this thread.
I agree the US is especially restrictive. But that's just the US doing its usual thing: treating everywhere else as a 3rd world country. Docs from developing countries also have a hard time in Europe. You clearly have an axe to grind with MDs.
The comparisons between countries is hard because roles, processes and existence of other practitioners will vary a ton.
High doctor-per-capita could be a sign of inefficient use of resources rather than being a good thing.
Examples: Do you need a prescription for stuff that's otherwise over-the-counter elsewhere?
Is over-the-counter stuff paid by (state) insurance if you get a prescription for people that don't value their time?
Do people go to the doctor anyway for every possible matter (e.g. cough/cold/flu in otherwise healthy people)?
Do you have to make a pointless appointment with your GP every year to confirm you still have that incurable disease in order to keep seeing your specialist? Or renew that allergy med prescription every allergy season? Or go once for a lab test, and then again in-person just to find out the results, even if they're negative?
Who puts in most IV lines? In some places it’s a doctor, other places, nursing staff.
If we're going to talk about inefficient use of resources, maybe we could start with the education requirements. In the US and Canada, doctors spend years getting useless degrees before they are allowed into medical school.
In Europe, they somehow get through medical school without them.
(Not that any of this would matter because the incentives of the residency system are perfectly set up to make it impossible to train any more doctors.)
100%. The US/Can approach also limits/compresses the potential career length. Make it ~6 years and out, straight from high school (if you so please). It kinda works like this already in Quebec: you can enter medical school straight out of CEGEP.
It's also a meritocratic matter: you have to take a lot of risk to make a go for medical school, and the best candidates may not be able to afford the risk of failing to achieve their med school goal and ending up with a degree with ??? value, so the best may not take that path.
Or worse, taking an easier degree program (to beef up their grades and have time for other application-enhancing activities) and not getting themselves educated to their full potential.
> Do people go to the doctor anyway for every possible matter (e.g. cough/cold/flu in otherwise healthy people)?
I lived in Hong Kong for many years and observed this habit amongst local staff with private insurance. (If they did not have private insurance, I highly doubt this behaviour would persist.) It was bizarre. And the "doctor" would happily prescribe medicines for a common cold!
US supply is artificially limited. There's literally no arguing this. There are essentially a fixed number of residency spots and that's basically the only way to become a physician.
> Do you think most doctors would take less hours for a somewhat lower salary if you it was possible?
It is possible. Lots of doctors work fractionally. It's one of the easiest fields to do it in. Given the artificial shortage, hospitals essentially have to accept it.
The reality is many doctors are simply driven people. They don't really mind the hours, but they do mind the type of work. A lot of it is just terribly unfun.
> US supply is artificially limited. There's literally no arguing this. There are essentially a fixed number of residency spots and that's basically the only way to become a physician.
Isn't this true in all highly developed countries?
I was under the impression that the limitation is a bit different in other countries. There is no hard, fixed limit. However, there is still practical limitations around how many institutions want to go through the accreditation process and support the education system. "Anyone" (hand waves a little bit) can start a program, as long as they meet the requirements.
In the US, it's a hard limit set by Congress. Even if you want to run a residency program, you can't.
Technically, there are ways around the hard limit, but they're extremely challenging to implement.
How is a 26.1 per capita calculated? Various unrelated sources state that there are 1.1M physicians (MD and DO) in the US. The US has a population of 360M?
It's per capita * 10,000. 26.1 doctors per citizen would definitely be a surprising standard of care.
26.1 / 10000 * 336M Americans = 876960 active physicians, and the error is probably a measurement artifact (how do you define 'active physician') and the fact that both the population and number of doctors vary over time.
I could probably automate hugging my children, but I sure as hell wouldn't want to.
We should try to build a world where people get to live with as much safety, dignity, meaning, and reward as we can. We should build a world where if people were given the choice between it and some other world with different parameters, they would choose the former.
Automation is a piece of that, but absolutely not an end goal. Often people are happiest when doing things that are not automated.
Physician salaries are less than 10% the cost of healthcare. You could eliminate their salary entirely and it'd have no meaningful difference on the cost of healthcare. There is _absolutely_ an artificial supply limitation, but that's increasingly being worked around by the use of PA and NP providers. Doctors essentially become managers for PA and NPs.
My wife is a physician. Actual, scientific diagnosis is a ridiculously small part of her job.
Most of her time is taken up on "soft problems". Writing notes for continuity/quality of care. Justifying medical decisions for billing purposes. Advocating with insurance and healthcare administrators. Discussing treatment plans and options with patients. More notes. Well, really, most of her time is taken up with notes. It's really the only way for her to capture all of the soft variables.
Writing notes is a bit like coding. LLM/AI can help solve the problem, but ultimately you still need to go through them piece-by-piece to ensure they're correct.
Unlike the other comment defending current medical practice, this one I absolutely agree with. I do not think that physician salaries are the major drivers of healthcare cost. I do think that occupational licensing reform would help bring down cost, but agree it is only a relatively small factor.
However I do think that in the process of engaging in wage protectionism (and there is absolutely no question that doctors do this) there is a ton of consumer surplus that is being lost and not captured by either patient or provider. For instance, in the case of the melanoma AI, that is a casualty of the wage protectionism (+ medical conservatism + FDA failure) - the value there isn't being captured by doctors, it is just disappearing into thin air and tons more people will just have undiagnosed melanomas.
> I do think that occupational licensing reform would help bring down cost
I actually think this is the only way to bring costs down. Most providers, equals more competition. More competition leads to innovation and all around better outcomes.
Interestingly, a lot of states are starting to express their frustration with physician supply shortages by expanding rights for NPs and PAs. I think over the next 20 years, we're going to see MD/DO roles transition to largely supervisory roles with NPs and PAs doing most of the work. Much more akin to manager/IC type of roles we see in STEM type fields.
Notes are kind of a poor term for what these documents actually are. To the lay person, notes are what you take during a meeting or lecture. A sort a annotation of what happened. Notes in medicine are essentially a treatment plan that includes justification and context for that treatment plan. It's essentially the physician's thinking on how they're treating a patient.
A lot of patient care centered specialties (as opposed to surgery or technical specialties, like radiology) are seeing a shift towards NP and PAs. The physician will be legally responsible for the actions of one or more NPs. They'll review their work and ensure their plans are correct.
That AMA-ASSN article has a nice pie chart breaking down the high level categories of total health care spending. Though, this isn't particularly useful for understanding why your individual healthcare might cost so much. This article is looking at nation-state level trends, including things like public health activities and nursing home costs.
Labor does make up a massive part of healthcare costs (I've seen it quoted as much as 60%), but that includes every person in the healthcare field. Physicians, nurses, techs, administrators, billing, construction/maintenance staff, security, etc, etc, etc,
Part of the problem is quackery. Remove the regulatory state and all the sudden you have people claiming bleach enemas as a cure all (We have that with the regulatory state, but those people get prosecuted).
I don't think that some regulations ensuring the tooth drilling robot isn't going to explode teeth is unwarranted even though that drives up cost of development.
> doctors are fiercely protective of their salaries
A freshly-minted dermatologist isn't making that much, though they will be in the long term. As a whole, physicians aren't very organized to deal with these types of technological "invaders." The AMA and similar organizations' core competencies have traditionally been limiting supply and creating personnel exclusivity (limiting residency slots, limiting the usefulness of foreign-obtained credentials, etc.)
I promise you can find an endless supply of freshly-minted dermatologists who will sign off on these ML-identified melanomas, bypassing the old guard with their rubber stamp. Once the tech is proven, that rubber stamp is worth nothing and may be removed. It's just too easy to chip away at these types of schemes where "assistance" can be rendered to a licensed professional and eventually completely relied upon.
Every piece of breakthrough technology you use has followed this process to some degree, it takes time. As with any field, folks are resistant to new ideas and methods.
Despite being poorly-organized, the medical field is collectively quite conservative and moves slowly - "first do no harm" is kind of the name of the game.
> Despite being poorly-organized, the medical field is collectively quite conservative and moves slowly - "first do no harm" is kind of the name of the game.
The medical profession seems to hold on too dearly to the action/omission distinction. Preventing life saving tech from becoming prevalent, arguing against challenge trials, advocating against NP responsibility expansion, etc. etc. -- all of these things do tons of measurable harm.
The issue is liability, just like self driving cars. Even if ML is more accurate, when it does get it wrong the buck has to stop somewhere. Those questions need to be answered first.
If ML is more accurate than doctors at the task, seems like the liability insurance should be lower.
But yes, I agree that the US needs major tort reform regardless. I just don’t think tort is the major barrier compared to occupational licensing & the FDA though.
Doctor here. I know HN loves to hate on doctors, but your framing is just ridiculous.
The medical world moves at a glacial pace compared to tech. Complaining that ML algos haven't swept the industry ignores all of the factors pushing it in that direction.
"Best medicine" operates on a consensus model of the most prudent decision-making given present knowledge and evidence. That takes time. Pushing boundaries as a doctor outside of a research environment doesn't earn you brownie points. It increases your chances of getting sued.
You also dramatically overestimate the amount of autonomy any given doctor has over the tools they are able to use. The vast majority are employees. It is like if you worked at Google as a SWE, and I came on HN ranting that you don't want to use the most recent release of Sonnet 3.5 to help you write features faster for Gmail, because you're "fiercely protective of your salary." You would laugh at how ignorant the complaint sounds.
I'm blaming the regulatory apparatus more for that one. These image based algos are ones that could be DTC but of course the FDA (with a side of lobbying) would never ever allow that.
> You also dramatically overestimate the amount of autonomy any given doctor has over the tools they are able to use.
I'm not saying that doctors are mostly choosing not to use these tools - but that lobbying organizations involving collectives of doctors would lobby against it if it ever tried to do a DTC approach or something like that. Please, steelman what I'm saying - I am very aware that doctors who don't own their practice (vast majority of them) cannot simply choose their tools and even those with their own practice are often limited by what they can bill. I know lots of doctors personally.
For radiologists places in the US are already sending the images to India and other countries for analysis electronically. Is similar done with dermatology or do you need to be physically located there rather than sending an image?
State licensing weeds out the cranks. But these AIs could go for FDA approval and direct to consumer. So I don't think doctors are the limiting reagent here in your example. If these AIs are good, they will reduce demand for dermatologists as some enterprising doctor will offer it as a service that scales.
While I think doctors are paid handsomely and there are critical shortages, I don't think regulatory licensing requirements per se limit access to new and cheaper care.
There's very few, if any doctors, that are saying we shouldn't use ML or algos to diagnose cancer. This is a wild accusation and hilariously conspiratorial. What most are saying is we should evaluate all of this new tech, but be careful of the rollout because medical practices shouldn't operate like a hot startup where we pivot every 6 months.
Healthcare, similar to government, shouldn't be a move fast break things situation. If your service breaks, you just roll back. False or incorrect cancer diagnoses...that's a huge deal.
Imagine your tumor getting missed because of a bug in software, one which a human might have caught. Peoples' lives are on the line here. It's not a game.
I know very little about the regulatory system but, what is stopping an app to scan your skin via mobile camera to try and determine melanoma. As long as there is a disclaimer to see your physician and this is not medical advice. It would be the same as taking your blood pressure or blood sugar test at home.
Their professional organizations have prevented us from having lower cost healthcare independent of technology. For example limited supply (from schools) of various specialties, resistance and FUD about less qualified care (like dental therapists), etc. Their lobbying and influence is all over the system.
Yes they do! Unions though aren't the reason for the lack of cheap care, after all each party involved in a private system is incentivized to gouge as much as possible due to a lack of collective safety nets.
Is this the hypothetical future where every job is replaced by a ML algorithm? In such case, you better hope there is some form of collective safety net for you ;)
The medical establishment also artificially limits the number of doctors in order to keep salaries high. I live in Boston, arguably the top city for medical care in the US, and it is not uncommon to have a six month waiting list to see a specialist. People talk about prescription drugs being the cause of high medical costs in the US, but it’s really the hospitals and doctors that are driving the majority of the costs.
Doctors don't seem to be driving the majority of the costs. After adjusting for inflation, doctors don't make much more than they did in 1984, yet the percentage of GDP spent on healthcare has almost doubled since then (and the real GDP has also doubled in that time).
For example, see [1] where a general surgeon made an average of $118,689 in 1984 and a family practitioner $84,256. This would be $358k and $254k in 2024 dollars. Today in 2024 they make on average $423k and $272k respectively [2].
Thanks for the datapoint about physician inflation adjusted salaries, but I said ‘hospitals and doctors are driving the majority of the costs’. In 2023, hospitals and physician and clinical services made up just over half of costs:
Nursing care added another 4.3%, and other personal health care expenditures (dental, medical equipment, and other professional services) added another 16.5%, or about 2/3 of total costs when all taken together.
By the way, an average salary of $423K is pretty good, and a six month wait to see a specialist amounts to denial of medical care. Serious reform is needed.
If doctors are not a major part of the cost, then saying "hospitals and doctors are a major part of the problem", while technically true, is disingenuous. It's like saying "Stalin and and his cat killed more than twenty million people" - technically true, but it assigns the cat an unwarranted part in this problem.
Two separate points were made. The first is that the numbers of doctors is limited in order to keep salaries. Which is true. The second is that hospitals and physician/clinical services were the majority of health care costs in the US. Which is also true. See link.
All the rest of the logic you supplied yourself.
Since you seem intent on sticking words in my mouth, I don’t think doctor are necessarily paid too much, and don’t think limiting their salaries will substantially affect health care costs. I do think doctor salaries probably will go down if their ranks weren’t artificially limited, but society would benefit, and doctors might too with a reduced workload. In fact, the overall proportion of medical costs given to physician salaries will likely go up if their ranks weren’t limited, albeit with each individual doctor making less.
I made no claims regarding the geographical distribution of physician wages. I specifically claimed that wait times for specialists in Boston is on the order of months, which I speculate is due to the medical board artificially limiting the number of physicians.
But then, revenue does not correlate with scarcity anymore?
To be clear, I think you're right up to a certain point, but it makes some sense to be very elitist about who can practice in what you'd like to be the medical 'pride of the nation'. Now, scarcity in other regions is another matter, where it makes sense to relax standards. How much you relax the standard is a matter of how low you accept to go in terms of quality.
This is great news. Many people, even in developed countries, suffer a lack of quality dental care because of the cost. Once these devices become widespread, costs should start to drop significantly.
Why do you think that? MRI scanners are still terribly expensive machines, for example. And in most countries, the hourly wage for a dentist need not be high.
It is more likely that some robot company is going to make a fortune. Whether other people profit from that is an open question.
I would be more comfortable with this technology if it had saw-stop like behavior. If I sneeze it has to be fast enough to safe the dental tool before I impale myself on it.
> Remarkably, the company claims the machine can take care of business safely "even in the most movement-heavy conditions," and that dry run testing on moving humans has all been successful. There sure are some brave guinea pig types out there.
There is something about the "moving humans" part in the article that doesn't hold water.
From what I noticed, dentists use fingers 4 and 5 to track the movement of the head or jaw. I saw no such tracking in this robot, with the article simply making a handwavy "trust AI" argument.
In general, I think if robots are to overdo humans, they should do that with improved sensors and actuators, not just "enough AI".
There is no mention of a feedback mechanism for the patient to express that the pain level is too high and something should be changed in method and/or anesthetic.
And what about soft tissues? Does the robot image those so it knows there is a tongue in the way?
From the pictures, it looks like the dentist is positioning the machine so I'm guessing the administration of the anesthetic and ensuring the area is clear will be on them.
Hair cut actually seems like it would be more complex than dental surgery. You only have about 32 teeth, they are large, and they shouldn't move around much. Compare that to 100,000 extremely thin strands of hair in varying length moving about all willy-nilly.
Yes, it is extremely impressive, especially considering it was made by one guying trying to come up with a hair cutting solution during the pandemic. Like you said in regards to trimming, more work would need to go into it to fully replace a hair stylist, and I was just pointing out that weirdly enough that might be more difficult than the dental surgery robot.
At least 20 years before you get to see one in an office doing very limited procedures. The dental association isn’t gonna give this an easy path to replace human dentists
SO is a dentist. They laughed and said 90% detection leaves a lot to be desired, and there's rarely a good reason to not have an X-ray.*
In addition, there's some things a human dentist does that I doubt this does - early detection of oral or skin cancer on the face being one of them. If you have the same dentist you'd be amazed at what they remember about your face and what's different from last time.
General vibe is that even if it can technically do a drill 'n' fill, it has a long way to go before it can substitute for a trained medical professional.
* Edit: I'm actually going to go further and say that calling an X-ray "harmful" should constitute disinformation and therefore wariness towards the attitude or motive of the author, since it's patently not true. The fraction they use at the dentist's isn't going to hurt anyone. The comparison point I've heard (and can't personally verify) is 6 dental X-rays is equivalent to 1 trans-Atlantic flight; alternatively 1 x-ray to a weekend in Cornwall.
> there's some things a human dentist does that I doubt this does - early detection of oral or skin cancer on the face being one of them
I'm sure this can happen, but that's different to every dentist doing it. And a dentist doing harder to automate stuff while the 15 minutes go on instead of 2 hours means way more patients treated in the same time period, which means costs can hopefully come way down for some dentistry.
It's definitely what I'd like to see for the future, in the same way that calculators improved the capability and throughput of professional mathematicians; as a tool that assists to enhance and augment delivery of a service.
CNC milling already exists for crown prep. The drilling of the tooth itself is not a long operation. The reason that a crown is split into 2 sessions is (depending on your local health board's practice guide) to ensure that the tooth is still viable for a crown; bleeding to stop, inflammation to go down.
This revolutionises nothing... But it is a step towards a revolution. It can only be a good thing. However, in the same way that there's technically a lab-grown hamburger out there, it's not going to be commonplace for a while.
I should add that my perspective is based in secondhand UK dental experience; in a hospital setting this would be used to improve care. In a private practice I have no doubt that it wouldn't affect the price handed to the customer.
> there's rarely a good reason to not have an X-ray
I'd much rather have a 90% detection rate without an X-ray than 100% with. Destists are very trigger-happy with X-rays, in part because of the extra billing, but mostly because it makes their job easier and prevents mistakes.
The estimates of the hidden costs of radiation risk are tentative at best. Some people have inherently higher risk and many are not aware of it. Either way, it can take years or decades before the effect plays out. By then, no one is going to implicate the original providers who pushed for an elective X-ray.
Also, note that not all ionizing radiation is alike. The exact spectra are different and the exposure intervals are very different, so the comparisons to environmental sources don't necessarily hold.
Absolutely correct, and my examples given are unsubstantiated and anecdotal at best; I'm not in the medical physics field.
Honestly, I'd take both. If standard light imaging is 99% efficient then it adds additional triage and diagnostic capability.
As regards the billing situation, that may partially be a locale issue rather than an all-dentists thing, but even within the UK it's disappointingly nonstandard and subject to manipulation by the dentist.
Despite all that, you say that X-rays are pushed because it "prevents mistakes". And my response would be along the lines of "well... yeah..." because a mistake turns a simple filling into a more complex (and expensive) operation that could cost a tooth and £x,000.
Speaking from personal experience, if the dentist wasn't concerned about anything on my teeth and I didn't ask for an x-ray, I didn't get one.
I keep seeing this template response/attitude but I think it’s generally flawed. Here’s why.
You judge a prototype / instance of a technological field that’s otherwise in full swing, cranking on releasing next version long before you see the current one
You assume this will be isolated from the rest of advancements, but in reality once you have the mechanics to automate imagery and drilling 100x more technologies can be composed. Memory in particular is something tech has always surpassed humans.
The combination of these two, particularly in the context of AI is much faster than most people can perceive.
So saying yes but x, is irrelevant for the most part.
I’m optimistic about AI but if you know anything about dental procedures and then look at what this does, it’s the simplest and done in extremely filtered patients. While in 100 years there will be a robot that can do most cases but it is very justified to write this off in the near future and in the current form.
A reasonable take, but one that I don't think lessens my point.
I can't speak to the other responses from which you've identified this yes-but-x template, and can speak really only from the 2 bits of knowledge I have: IT/infrastructure stuff is my primary knowledge, and my SO's dental training and practice, which is not "my" knowledge, but from this I have access to more knowledge than would the average person.
Now, the IT stuff. Automation has come a long way and quickly, but if I break something, it's just a service. Worst case scenario a customer can't buy something, or maybe a couple thousand customers can't. Big deal, one a minute, etc. I don't need to preach on this, I'm sure.
The medical field is significantly slower to adopt new practices, with the reasoning that their customers' custom is not an item in a cart, it's their health or life. New technology comes in slowly, with trials for wide population application taking decades in some cases.
The stakes are so much higher that safety demands caution.
This does not of course mean never. I've said this in another reply also, but I think tooling like this augments service delivery at the very least (provided it meets safety standards) and could be the start of a boom of up-tooling practitioners. And I will be surprised if I see one in the flesh before 2050.
The problem with your observation is this is what can be done TODAY with a robot. Current dentists are indeed safe as you point out.
But after 20 years of iteration it might be able to do most or all of what you describe. This means that my 8 year old should maybe not, when he grads from college in the future, decide to go to dental school and rack up $200K of debt (actually that’s conservative) for a profession that won’t disappear but will likely face tremendous downward pressure (ability to perform more operations==fewer dentists needed==greater competition among dentists). And that is the problem.
And since that was published, the widespread uptake of digital dental X-rays brought the dental x-ray dose down to the (roughly, depending on how you count, how many, etc) 1 uSv range.
I've been much happier about dental X-rays since they went digital. Substantially improves the diagnostic value to radiation ratio.
Dental cases are deep and wide, I can see these robots doing the simplest and less complicated case of a single procedure and there are 100s of procedures
I think what's being overlooked here by some commenters is the speed of this machine.
A normal cavity filling can take 20/30 minutes. Imagine if that could be cut down to 1 minute with a perfect filling at the end? Even if we are talking about the dentist messing up the pain killing application it'll all be over pretty damn fast.
The freezing doesn't always work for me. If I say "hey, I can feel that" the second dose might work, and it might not.
What happens next is that they slow down, and while this sounds like compassion, it also lengthens the time they're drilling into my head while I can feel it.
Just building up a resistance to physical torture. Bring it on, movie CIA guy.
I think a quick, very intense filling might be better than a long, slow one.
I may be weird about this, but for me when I've been drilled (or even cleaned) and experienced tooth pain the level is 100%. I can't feel more pain.
I'm certainly not advocating that dentists don't do their best to numb patients before drilling. What I'm saying is it's fairly likely that by the time they can stop the machine in the case of pain the procedure will be nearly complete and the pain over.
The actual drilling can be quiet fast. The limiting factor is making sure it isn't so fast that it shatters the tooth. What will take time is bonding the filling.
My assumption is that for a regular cavity fill, the drilling will be a much smaller portion of the time than the filling bonding. You can see that in the crown placement video in the article, almost no time is spent removing the outside tooth. The actual spent time is building up the crown.
I’m simply too old and seen too many BSOD to ever allow this to be done on me. Also I just watched the Fallout episode with the Mr. Handy in it. The picture in the article of the robot hand moving a drill into his mouth fills me with intense dread. Maybe the younger generation would feel differently. I didn’t let my Tesla drive either.
I know how bad humans are at driving. I don't have a Tesla, so I don't know if I'd let one drive, but they only need to be better than humans not perfect. I just wish there was some unbiased source of data as to how good they are - the only numbers I can find come from those who have reason to lie (mostly Tesla, but other self driving car companies as well).
There are rules around how medical software is developed and so if this is property approved by the FDA or equivalent I'm not worried - it may not be perfect, but human dentists are not either.
You must not have any experience working with medical software.
This is lawyers checking boxes, nothing more. The people that actually wrote the software likely are outside the jurisdiction of the FDA and have zero incentive to treat the software any different than any other hastily organized project. After all, why would any of these people care beyond their paycheck -- it's extremely foolish to assume others hold the same priorities and values as you do.
My experience with the recent tesla supervised-but-still-full self drive beta was largely positive. I have a cameras only Y with hw4. I think John Carmack will win his bet. I do think they need regional model modifications though. The way you drive in different places is different. In some places you can't signal that you want to change lanes or people close ranks. In others people make room. It did two stops at each stop sign in places that had no crosswalks, picking some arbitrary distance before the intersection to watch for pedestrians, then it pulled up to look for road traffic. Perhaps not a horrible idea, but humans around here don't do that so it confuses other drivers and pedestrians both.
At least this is actual CNC software using math and geometry that somebody can find the bugs in. What terrifies me is “software” that is really just black boxes filled with floating point numbers and no one knows how it works, or when it won’t.
IDK. Logically you are right, but humans are emotional.
Just a day or so ago, here on HN, full of IT guys, there was a discussion about some Tesla autopilot crash. People were absolutely livid and demanded the impossible. Now - generic Musk hate might have something to do with it, but I suspect that it is not just Musk. We really react very unfavorably to machines wreaking havoc, while our tolerance for humans fessing up is somewhat higher.
Because we feel better when those humans can go to jail as a form of Justice since now that person gets to suffer in exchange for the suffering caused.
Meanwhile we don't feel anything if the robot that killed someone gets decommissioned because machines Don't suffer.
> We really react very unfavorably to machines wreaking havoc, while our tolerance for humans fessing up is somewhat higher.
Yup.
Over 100 people die in car crashes in the USA every day. When a fatal car crash happens, it MIGHT make it to the local news. But a single car crashes while driving autonomously and it's national news for MONTHS.
Now, I'll acknowledge that there will be statistical bias here. There percentage of cars driving autonomously at any given moment is likely less than 1%. But autonomous cars make different kinds of mistakes. They'll fail to identify the lines in the road correctly, or fail to recognize an obstacle. Meanwhile, humans will drive drunk, drive distracted, or have massive egos and drive dangerously because they think they own the road and everyone else is just in their way, or just simply be bad drivers that don't even look around themselves before changing lanes.
But you're letting your device auto update even though you might come from a period where you had to voluntarily and manually install a service pack or start manually your internet session by dialing up your provider... Like I did.
I even remember manually mowing my parent's lawn when I was a teenager while there are now many mowing robots that wander around with several spinning blades.
And what about having 2 tons Waymo's car wandering around without a driver?
Have you switched dentists recently? I have little trust in the profession (though I like my current dentist).
Around 2008 every time I went in to the dentist she found cavities. I moved states between a bad diagnosis and getting any fillings and when I went to a new dentist I came out with a clean bill of health.
I moved back and had a dentist that I trusted, she sold the practice and the new dentist started finding cavities every single visit. I switched dentists and magically those cavities were gone.
Not only did I likely get drilled and filled superfluously, the first dentists fillings fell out or broke and needed to be replaced after a few years.
If a machine was doing the work, economies of scale also create a large enough class that if the treatment is not effective the class can sue. Against a one-off terrible dentist with a small sample size, the chance of compensation for terrible work is almost non-existent.
Last time I went to see my US dentist, he said I needed another filling. I wasn't feeling it for some reason, I told him not now, and he looked at it again, and said "I agree". Now I sort of regret getting my other "small" fillings.
I've had a dentist in Europe who laughed and said there's no need to come here every year, that's an American thing.
In the end dentist offices are businesses, and often dentists have small practices.
I've recently listened to a podcast of a dentist turning consultant to increase numbers. Dude literally applied a lot of marketing tricks, tested them and analyzed the results. He did things like naming teeth cleaning, a "clinical teeth cleaning" or something along those lines. This resulted in an increase in cleanings. I guess he could be lying as he is now selling his services but the whole podcast felt disgusting.
