Diagnosis Futures
From ’97 to ’99 I was a RWJF Health Policy Scholar (at UC Berkeley), and my final project and presentation was on what I called “treatment futures”, i.e., the idea of using decision markets to forecast treatment-conditional health outcomes for individual patients. I proposed:
At major treatment decision point, post sanitized medical record & options to web.
Subsidize [betting] markets estimating treatment-conditional outcomes (e.g. lifespan).
Anyone can trade or add treatment options.
Market estimates inform treatment choice.
Outcome determines market asset values.
I also posted on this in ’07. Yesterday I learned that a new startup, CrowdMed, is spending $1.1M to try a related idea. They will have ordinary people “bet” on particular patient diagnoses. I put “bet” in quotes because they only bet donations, and they don’t tell users how individual predictions, individual winnings, and consensus estimates on patients are related. That is apparently part of their patented secret sauce – you’ll just have to trust them.
A patient pays $200 to post their problem, and promises to eventually declare a “correct” diagnosis. Each player is given $5 to start, and can only spend winnings on donating to Watsi patients. So if after several years hard work, you do much better than average, and end up with $20, you might donate that much – woo hoo! Player incentives to diagnose correctly are diluted further by the fact that they only predict what the patient will say is their diagnosis, not the true diagnosis. And players don’t get to look at a full medical history, just a few paragraphs of description.
Patients mainly pay for possible diagnoses to suggest to their doctor to consider, diagnoses that players believe might find supporting evidence, if only the patient’s doctor would consider them. So patients have to believe that their doctor will believe that these volunteer amateur detectives have useful diagnosis suggestions to pursue, ones the doctor would not have otherwise considered. Seems a pretty high bar to me.
My conditional forecasting concept could help patients even if patient doctors don’t believe in it, but it does require players to wait longer to find out if they win. And I think that players deserve a much higher fraction of the patient payments than this startup seems willing to give them — I expect CrowdMed incentives are way too weak. Many seem to have decided that the big idea in “crowd-sourcing” is getting amateurs to do for free what you’d otherwise have to pay professionals to do. Me, I think you usually need to pay good money to get good info, even when you do it right.
Added 3p: The CrowdMed founder replies in the comments; I respond also.
I used to create elaborate, high quality mods for videogames that I shared online for free and I know plenty of useful programs that were created 100% for free by everyone involved. Believe, me, free software works. What it doesn't do is work all the time, at any place, in any culture and at any scale, that is something we have to keep in mind and it's why someone like you would generally (and most of the time rightfully so) advice against betting on it. It cannot be commercialized, generalized, or reproduced on demand, just like memes and virals can't. CrowdMed can work, just don't expect it to work for a 100.000 employee company in China 20 years from now, but that's not a problem, it will help some people in the here and now (which is the goal) and gather data that can be used for future diagnostics software.
IMASBA - you are right. I regret being so outspoken in my criticisms. The team is doing their best and I wish them well. The point I was attempting to make is that to build a business of scale, one needs to have strong incentives at every point in the delivery chain. These incentives are usually financial, but they can also be status, altruistic, entertainment, etc. The evidence suggests that free/low paying/altruistic prediction markets don't work and structures that supply enough incentives to scale have yet to be discovered.
Your point about free software needs further analysis. Little software is truely "free" i.e nobody pays ... these companies usually have a business model where somebody is paying, (the economic buyer/true customer) while users use it for "free." There is a clear difference between users and customers. Google is a good example of that, users use it for free, but advertisers pay. There is also the fremium approach whereby users get a "free" version of the software, but for it to be useful, they need to upgrade and pay for premium versions. Open source is built on consulting, value added services, and upgrades. RedHat, mySQL etc are not free if you want to use them in any meaningful way. Its the old gillette story of giving away the razors but charging for the blades. So software tends not really free in the full sense of the word, its free to some, but somewhere money is usually changing hands.