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.)
This discusses some of the risks, but mostly from the standpoint of protecting the providers from the patients: https://www.ncbi.nlm.nih.gov/books/NBK589669/
I mean that’s just common sense, surely.
EDIT: hmm... a "dental engine"?
https://en.wikipedia.org/wiki/Dental_engine
better results searching for "dental spit sink"
Perhaps it could be combined with a back massage. Those chairs that you stick your face in would be tailor-made for this!
You'll have to ask when the time comes and report back.
I felt tooth pain thinking of it lol
I'm guessing a lot of existing techniques and tools have an implicit bias for the patient being face up.
Well, they have a bias for a human doing the dentistry. With all that entails.
But it could probably moisten your drying out lips so they don't crack
I think the main concern would be debris and drool getting on the camera but that is probably a concern for any position.
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.
Anyway, chatgpt was right, physician was wrong.
So... we are denying reality now?
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.
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.
That said, financial considerations will probably still be a big part of the treatment 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.
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.
That being said, I agree that it's a difficult part of the fee-for-service model.
https://time.com/4952886/china-world-first-dental-surgery-ro...
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?
;)
However as you said, the toothbrush doesn't actually work.
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.
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.
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.
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.
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.
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.
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. ;)
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.
https://cdn.shopify.com/s/files/1/0099/9525/5889/files/Sonic...
There’s really no way to do that to multiple teeth at once without something much much more complicated.
That's what I'd do as a billionaire anyway. I wonder how I'd solve peeing...
Shocking, I know.
The aristocracy doesn't even defecate.
I've met one adult that believed this.
I wouldn't call them a scam. They are pretty decent at polishing the exposed surfaces of your teeth.
Wouldn't it be better to get a dentist-grade cleaning every day in the the same amount of time?
Outside my skillset to comment on that claim, but I do keep hearing it.
I use the highest end sonicare and my dentist still wants me to brush with a normal brush, floss, and dental pick daily.
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.
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.
We all know this is not going to happen.
You'll just pay a premium for the novelty.
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.
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.
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.
https://www.practiceupdate.com/content/effectiveness-of-art-...
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.
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.
> 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.
Mouth pH and mouth biome make all the difference.
Also spacing between teeth.
I used to be friends with someone that ate bags of gummy bears a day.
Never flossed, brushed a couple of times a week.
Zero cavities well into his 30s, maybe longer.
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.
Anyway, it ends up being like you say, it's a largely out of pocket service that people shop around for.
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.
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.
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'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.
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.
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.
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.
Not just dangerous, but arduous, long and in extreme cold.
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.
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.
I was told you even need prescription to buy glasses, which is ridiculous.
Even many places online require it, but some just let you input the values.
When I said this to an overnight glasses website's customer care they basically said if I ordered without a prescription I'd be committing a crime.
You really can't make this up!
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.
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.
Forcing people to do it just to get a contact prescription is indeed a cash grab.
But yes, they will sell it to you as being for your own good.
Those sellers are incentivized not to look too closely at your prescription and whether the year has been altered.
Obviously breaking the rules doesn't make it less of a cash grab but at least one can work around it.
Thank you for your sacrifices, including to the oncoming ML "clinicians."
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.
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.
The front line primary care doctors and nurse practitioners dont make as much as IT people quite often.
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.
An OB/GYN or anesthesiologist is closer to $200k+
Of course, there is a typical shortage of doctors prying for this coveted physicianhood /s
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 have no clue if that's improved (with another decade of training, since I dropped out), but an even larger majority are miserable.
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.
It'd be nice to have this decision tree being built out in the open, ultimately everyone needs it.
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.
Grant the status of their profession to their opinions.
Even worse with lawyers. AI will never make a real difference in that field.
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.
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.
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.
Apologies if the link to that article is one mouse click too many for you.
[0]: https://med.stanford.edu/news/all-news/2024/04/ai-skin-diagn...
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.
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.
> The UK is bad at creating a pro-business/pro-investment environment
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.
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).
If you have enough time, read this 5-page article. Can this be explained by anything else but naked greed?
https://digitalsmiledesign.com/files/Old-Website-Assets/PDF/...
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?
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.
> cultural issues
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.
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.
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.
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.)
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)?
> 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.
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.
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.
https://www.who.int/data/gho/data/indicators/indicator-detai...
y'all know better than to get into this kinda thing.
I get your salty about the economics of it, but it's not like doctors are pencil pushers.
These are skilled people that will be saving your life one day whether you like it or not.
The only reason it is seen as a bad thing is that the economic system coerced you into proving you deserve basic necessities.
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.
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.
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 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.
That's sort-of what a NP is, but without the doctor in the room and only if she were reviewing their notes after.
(I know some doctors who this is a sensitive subject so I haven't asked them yet).
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 is higher than the 8% the NYTimes quoted in this 2021 article (which I was basing my argument on): https://www.latimes.com/opinion/story/2021-09-14/dont-blame-...
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,
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.
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.
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.
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.
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.
> 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.
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.
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.
as in losing jobs to ML algorithms ? What would the point of a union then :)
No. we are talking about doctors in specific.
Your original point won't stand if everyone in the world is replaced by AI.
> If only you guys had universal healthcare
There would be no private insurance through their employers if no one has a job in first place.
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].
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192917/ [2] https://www.whitecoatinvestor.com/how-much-do-doctors-make/
https://www.ama-assn.org/about/research/trends-health-care-s...
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.
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.
Cutting their salaries in half would have almost no perceivable impact on the cost of care.
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.
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've only read pop science articles on it but I think the gist is to use software (AI!) to make up for a much weaker magnet.
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".
You can say that again.
https://www.newscientist.com/article/dn5022-clubbers-choose-...
Otherwise very impressive.
Why be accurate when your goal is to make money, and suggest procedures, rather than be accurate?
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.
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.
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.
Why not?
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.
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.
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 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.
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.
He also noticed I had a breathing issue.
Pass.
I've been much happier about dental X-rays since they went digital. Substantially improves the diagnostic value to radiation ratio.
This seems unrelated to the fact that a robot is performing the procedure. Is there anything that prevents human dentists from using OCT instead too?
Also, I guess X-Ray usually isn't part of the process in a procedure like this - but IANAD.
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'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.
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 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.
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.
It's not rational, but that's us.
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.
Meanwhile we don't feel anything if the robot that killed someone gets decommissioned because machines Don't suffer.
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.
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?
Are we getting too old for this shit?
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.
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.
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.
For each step don't forget to collect the cash.
There I saved you 200k worth of training.
easy!