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The $250,000 Physical

MetaMed wants to give your doctor a shot of artificial intelligence.

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Illustration by Walter Green  

People suffer from the delusion that the one percent get decent medical care and everyone else is left out in the cold,” says Michael Vassar, leaning forward on the couch in a borrowed apartment on 23rd Street. “The reality is that really smart scientists and doctors get good health care and everyone else is left out in the cold.” Vassar, who’s done work in nano­scale physics and artificial intelligence, is explaining how he’ll bring the rest of us in—first rich people, then everyone else. Last year, with $500,000 from PayPal co-founder Peter Thiel, he helped launch a company called MetaMed, which, for fees ranging from $5,000 to (so far) $250,000, offers wealthy clients all the medical intelligence the smartest scientists and doctors can conjure.

Here’s his pitch. MetaMed’s founders have backgrounds not in medicine but in information theory. (Jaan Tallinn, the chairman of the board, also co-founded Skype.) Being able to think clearly about thinking is what puts the meta in the med: Doctors struggle to keep up with a vast and growing body of research, much of which is wrong in any case. The result is that patients have a fifty-fifty chance of getting the right treatment, and the health-care system itself has become a leading cause of premature death, by some reports ranking just behind cancer and heart disease. Doctors are ill-equipped to analyze failed methodology, much less to apply what good data there is to the needs of individual clients—so MetaMed will fill the gap. “People don’t normally hire domain experts in epistemology,” Vassar says. “And it turns out that those skills are useful.”

MetaMed’s actual process is itself somewhat meta. Clients provide personal data—medical records, blood workups, genetic profiles—via e-mail, then undergo a one-to-four-hour intake interview with a MetaMed doctor via Skype. After a few weeks, MetaMed’s analysts deliver a report based on their analyses of the primary and secondary literature. It might suggest obscure specialists, or point out risks associated with an unusual combination of genetic factors, or warn against rarely detected interactions in whatever cocktail of medications the client has accumulated. Sometimes it will note that all of the studies suggesting a particular drug were funded by that drug’s manufacturer. For bigger spenders, the analysts might offer to construct a statistically complex “Bayesian mathematical assessment of diagnosis,” or even conduct an original experiment—for $50,000, Vassar says, MetaMed could design a study particular to an individual patient’s physiology, which might then cost an additional few million dollars to carry out.

Some of the work is straightforward. Vassar describes one case where a client suffered from a condition that threatened to fully paralyze him within a few weeks, then kill him. Every last-ditch medication was failing, but Vassar’s analysts discovered a journal article from the seventies suggesting a treatment that had been forgotten by virtually everyone—including the article’s author, who had Alzheimer’s disease. The drug was still FDA-approved, and the researchers managed to find someplace where it was still being made. “And now you’re no longer at death’s door,” Vassar says. “Although you’re still in bad shape.”

Vassar says that he is creating something significantly more important than just another medical-concierge service. He is creating a better information system and a new class of people to manage it. “Almost all of the health care that people get is going to be done—­hopefully—by algorithms within a decade or two,” he says. “We used to rely on doctors to be experts, and we’ve gradually crowded them into being something like factory workers, working in a constrained system where their job is to see one patient every eight to eleven minutes and implement a by-the-book solution,” he says. “What I’m talking about is creating a new expert profession”—knowledge workers or medical quants, almost like hedge-fund managers, who could do the high-level analytical work of directing all of the information that flows into the world’s hard drive every year.

Doctors would still serve an important role, but they would be aided by Vassar’s new class of information experts, who would in turn be aided by advanced artificial intelligence. “I would like doctors to evolve into a more patient-focused, more caretaking profession,” he says, “and scientists to evolve into a more ‘argument and critical analysis and management of technology’ profession.”

Obviously, not everyone can go for a $250,000 workup, but Vassar argues that good medicine is a lot cheaper than bad medicine. He estimates that by directing just 10 percent of current U.S. medical spending to his kind of meta-analysis, he could produce such massively better health outcomes that the nation could cut health-care spending by two thirds.

This calls for some quick calculations. Total health-care spending makes up about 18 percent of the U.S. GDP. So is Vassar saying that MetaMed alone could some day single-handedly produce a Walmart-size 1.8 percent of the entire U.S. economy? He considers the idea. “I would be shocked if there are not three or four serious competitors,” he says, before mulling another possibility. “Bloomberg is the only player in its space. It’s possible we could hold the whole thing.”


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