Saturday, 8 August 2015

10Xing the management of MS

HOLIDAY DAY 6

I am currently reading the book 'How Google Works'. It is one of the most inspirational stories I have heard. In the chapter on innovation Eric Schmidt and Jonathan Roseneath discuss the strategy of 10Xing it. I want to do the same for managing MS in the digital age. Any ideas?

10 comments:

  1. Jolly good, rip it up and start again, to quote Orange Juice. I'm a bit clueless as to how this could apply to managing MS in the digital age, possible the 'internet of things' could play a role. It has to, if you are looking at the future and utilising technology to help manage MS. But finances and budgets are a lot tighter in the NHS than Google.

    PS I know two people who work for Google and on the whole their narratives are often very different to Schmidt et al

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  2. In January, Biogen Idec and Google X announce a partnership in order to collect and analyze data on why multiple sclerosis progress differently in each patient...I wish so much that the Ministry of Health here in Brazil, tried to collect general and genetic data, also creating a database that could aid research like this for example ... We are such a heterogeneous people, I think we would have much to contribute to the contribution of genetic and environmental factors in triggering MS ...

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  3. This is an excellent question.

    To 10x MS career we need to detect earlier, analyze and monitor more frequently.

    Recently on the blog NHS Scotland was mentioned; could we do something in Northern Scotland to aid earlier detection and prove that it works? I would like to know the minimum requirements for an MRI machine to detect suspect MS activity or an aneurism. Currently MRI manufacturers appear to be focused on making sharper imaging machines. As with the console wars between PlayStation and Xbox, is it possible that there might be a Wii like specification for MRI machines? The Wii was a much less powerful chip set but the intended use case for the Wii was different. Could we define the requirements for a good enough MRI machine? Just enough imaging power to determine either clear or further study recommended. Could existing old MRI machines be trailer mounted and driven to different locations? Could a lower spec machine be created at a price point that a GPs office would have one? Will the MSPrecise test work? Again could this be tested in Northern Scotland to prove that it works?

    I was at a technology vendor’s office recently, they were selling their big data tooling. The vendor mentioned that their tool was being used in cancer research to determine best treatment based on one’s genetic profile. Is there a similar effort in MS?

    Given the fact that medical monitoring is about to revolutionize; what could we do to put MS monitoring at the forefront? I am excited about the Google effort but a little concerned that they will target lifestyle rather than blood analysis. I research piece ‘Peripheral blood T cell dynamics predict relapse in multiple sclerosis patients on fingolimod.’ I priced a number of cytometers but couldn’t find one cheap enough. If we monitored patient's blood regularly would that help?

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  4. I'm glad you're thinking along these lines, but as a profession, neurology (i.e. your stick-in-the-mud colleagues at the ABN) aren't up to the job in an innovation/startup capacity. To get things moving at pace, you need to:
    a) Make it a free and open-market where patients can choose freely themselves which treatments they use
    b) Remove the ridiculous amount of regulation, red tape, and barriers to entry imposed currently
    c) Facilitate an environment of innovation based upon being able to test live, in market (rather than 10*15 years per iteration).

    To prove my point, as a bit of a thought experiment, what would the world be like if Google Search was MS...?

    1) There would be little/no freedom for users to decide which search engine to use. Instead, a group of self-proclaimed experts (we'll call them "The Internet establishment") would enforce upon users which search tools they were allowed to use. These experts would have never have themselves needed nor used these search tools, but nonetheless think they know best.

    2) The Internet Establishment would shamelessly accept substantial and widespread financial kickbacks, profit-shares and overseas trips from big, old-school corporations like The Yellow Pages, newspaper Classified ads, and Encyclopaedia manufacturers, to force people down those channels before they can try Google, stifling the birth of the Internet and perpetuating the way things have always been done whilst protecting their mutual profits.

    3) Before the Internet establishment would allow anyone to use Google for any specific search term, they would insist each and every search term was trialled a few thousand times against the weakest possible current alternative search method (eg trawling through every book in the world) - even if the superiority of google was patently clear beforehand, and even if that comparison would take over a decade to complete. In the interim, legislation would be passed to make it near-impossible for users to use Google.

    4) The Internet Establishment would disregard the results of any such trial unless the user and assessor had been blinded as to whether they were typing a 2 second search into google, or trawling through the world's libraries for a decade, despite the obvious impossibilities of doing so. This would be regarded as an acceptable status quo.

    5) The Internet Establishment would stifle innovation/competition from startups by imposing a range of pointless tariffs. Like £30,000 to even speak to the EU branch of the Establishment about testing a new search technology. And a testing/trial process would be imposed costing a few hundred million dollars and a decade of time investment, before anything could go to market. As such, innovative startups like Google, Apple, Facebook and Microsoft would collapse before they even got started, and the Yellow Pages would rule the world for a thousand more years, whilst it's CEO became a multibillionaire for peddling shit.

    6) Only the most common (profitable) search terms would be catered for by Google. If you happen to have a search term that is less common (10%), there would be not a single search engine in the world available to help you.

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  5. 7) If you had a time-urgent search (eg Will Hurricane Zelda hit my city tonight?), you would be advised by the Internet Establishment to await the outcome of a ten year+ trial (which likely has not even started, or even be planned to start yet due to lack of funding) of Google versus Michael Fish, despite the fact that, in doing so, the answer to the question would no longer be relevant to you by the time it was reached. In the interim, the Internet Establishment would deem it to be perfectly acceptable for you to die/be permanently maimed by the hurricane as a result.

    8) Due to the ridiculous system of testing/tariffs imposed by the Internet Establishment, in order to protect the profits of Yahoo, AltaVista, and AskJeeves, they are permitted to patent particular search terms for decades at a time, so that those terms can only be found through their company. They are then allowed to charge whatever they want for the results. Many impose "search fees" of a couple of hundred thousand dollars a hit upon users, the cost of which has to be picked up by their National Search Service.

    9) As a result, the NSS limits what can be searched, by whom and when - and insists that the need for each search is comprehensively proven, and that they have first failed all (archaic) first line search methods, like scouring the world's libraries, Yellow Pages, Classified ads first. The people entrusted with managing/assessing this will be the self-regulated Internet Establishment, who take kickbacks from said archaic search companies (see #2). This would not be deemed in any way a conflict of interest.

    10) Even if another, off-label search engine offered to carry out your search for cheaper/free, with the same/better results, this would be comprehensively legislated against where there is a paid search already in place - even if this results in users paying hundreds of thousands of dollars more for an inferior search result - because the profits of the Search Giants must be protected at all costs, even if this involves sacrificing the lives of users.

    11) The majority of the Internet Establishment's education on which search engine is best would come from all-expenses-paid jollies organised by AskJeeves. By pure coincidence, AskJeeves remains the search engine of choice for the Internet Establishment. These two facts are deemed to be entirely unrelated.

    12) The Internet Establishment make money by setting up their own businesses which provide the only access to searches, in once-monthly sessions, thereby sending themselves a place in the food chain. The search engines R&D dept find a way to make these sessions only required once yearly, but the Internet Establishment refuse to provide access to users as it would impact the profits of their monthly sessions.

    13) For reasons unknown, there is almost no centrally tracked data on ongoing use of search engines. Google Analytics shares only the data it deems favourable to itself, suppressing that which is not (to the detriment of users, and the Internet in general).

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  6. To summarise, the truth is that if there was a genuine desire and commitment by the establishment to 10x it, they could easily do so. But, let's face it, there isn't. And nobody in the establishment has the balls or financial inclination to do anything about it.

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  7. Prof G - I don't' want to go and read this book, so could you please post a nice simple explanation of what "10Xing" means, and explain the context in which you would like to see this applied to MS.

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  8. Great post, Matt. Using your analogy, the MS world sounds totally ludicrous/behind the times... what to do about it? There are safety considerations to adhere to (if the person using 'Google' chooses to.

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  9. http://www.wired.com/2013/02/moonshots-matter-heres-how-to-make-them-happen/

    This is a short 10X description from a wired article.

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    Replies
    1. Thank you Aidan - that explained it very well.

      I'd still love to know Prof G's thoughts on how this type of thinking could be applied to MS - I can already hear people muttering darkly about all the effort and dosh that's already gone into research over many many years. And, although we are much advanced on where things were MS-wise 30 odd years ago, we still need so much more to prevent/reverse/stop what this disease costs patients with MS, their families, and society overall - in both human and monetary ways.

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