The $250,000 Physical

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.”

Vassar, who is 34, lives in California and crashes with friends when he is in New York. He has always thought about systems in the largest possible terms. Immediately prior to becoming MetaMed’s chief science officer, he was the president of a Berkeley nonprofit called the Singularity Institute (now called the Machine Intelligence Research Institute), which is largely dedicated to addressing the moment when machines become more intelligent than humans and decide, perhaps, to dispense with us. He says that eventually much of the analysis that happens at MetaMed will also be done with artificial intelligence, and in this sense, the company represents a natural career progression for Vassar.

In Vassar’s larger vision, very sick, very wealthy people spend fortunes on bespoke big-data solutions to their specific problems and the rest of us benefit from the things their analysts learn—creating a kind of trickle-down economy for better diagnosis and treatment.

“Right now, infinite money does not get you the health care that we say that everyone is entitled to,” Vassar says. “What I have created is a context where not merely infinite money but, you know, respectable amounts of money, 99th-percentile wealth, will get you the world that we say everyone is entitled to—where a middle class can afford much better health care than billionaires get today.”

MetaMed will continue to focus on wealthy clients—“That’s how capitalism works. Which of the technologies that we see around us would be here if we insisted that everyone has to have it before anyone can have it?”—but it will share the knowledge it gains. “If what we do works as well as I think it will, in ten years it will be disreputable for governments not to take our health standards.”

So far, MetaMed has twenty clients, and Vassar plans to open a permanent office soon in Red Hook. “I could totally imagine that no one would be taking a Wall Street quant job in five years if we were there as an alternative at the same pay scale,” he says, glancing up at his temporary home. “Practically everyone would rather help people. They just don’t want to be unable to live in nice neighborhoods.”

The $250,000 Physical