More Phones, Fewer Doctors

Famous as the founding CEO of Sun Microsystems, Vinod Khosla has spent the past 28 years as a venture capitalist. As a partner at Kleiner Perkins Caufield & Byers, he was involved in some of the technologies underpinning the Internet. Now 59, he is currently head of Khosla Ventures, where he sees a similar opportunity in medicine and is investing in digital health ventures that he predicts will reinvent the field. In June, he spoke to editor in chief Jason Pontin at the MIT Technology Review Digital Summit in San Francisco. Making no apologies for having picked some losers, including some of his high-profile bets on clean tech, he declared, “I don’t mind failing, but if I am going to be successful, it better be consequential.”

Here is an edited version of the full interview.

What surprised you the most when you turned your attention to health care?

What surprised me initially was how bad it was. Researchers gave the same data to 40 cardiologists and asked the same question: “Should this person have cardiac surgery or not?” Half said yes and half said no. Whether you get surgery depends on which doctor you happen to pick? That is pretty bad. And that’s not the worst part. Two years later they took the same data to the same cardiologists, and 40 percent changed their mind. I could give you 100 examples like that.

You have concluded that about 80 percent of what doctors do can be replaced by machines. So tell me which things we can replace, which things probably should remain human, and why.

Atul Gawande is one of the most famous surgeons. He said machines are much better at the cognitive parts of medicine: diagnosis, writing the right prescriptions. On purely ethical questions, or comforting, humans can do much better. That raises a question that I always ask and that pisses the physicians off. If you want the human element of care, shouldn’t we use the most humane humans?

Doctors don’t always qualify.

It’s hard to get into good medical schools. You select for IQ and hard work. You don’t select medical school students for compassion. I think the role has yet to be defined. I’m not saying humans have no role. If you ask people in the burn unit of the hospital, do we need doctors there? Absolutely. Whether human plus computer is better—whether in certain parts of the world where there is no doctor for 50 miles, the machine will do much better—it’s hard to predict.

You have invested in a number of mobile health companies like CellScope, the maker of a smartphone attachment which allows you to peer into the ear, that place the responsibility for health care on the individual. Do people really want that?

Yes. I’ve often said our goal in medicine should be to make the consumer the CEO of his own health. By that I don’t mean the consumer should do his own diagnosis. But every home should have a digital first aid kit that has half a dozen to a dozen devices that let you take your ear image like CellScope, or let you take your EKG like AliveCor [another Khosla investment], or a dermatology image if you have a mole.

With the result being better medicine?

Much more precise medicine is possible. And I for one want it.

Because our smartphones are on us 24/7, we can start to do much more. Take psychiatry. We have a company called Ginger.io that monitors your cell phone with your permission. They collect thousands of data points a day. They figure out over a period of time what day of the week you call your mom. What you do on Thursday evening. Do you call your friends to make plans for the weekend? It figures out that this week you didn’t eat. You didn’t go from your bedroom to your kitchen. Your cell phone can tell that. They’ve discovered hundreds of new microbehaviors that can actually be predictive [of mental state]. If you can monitor people 24/7, you can move them from whatever stage of illness to be more healthy. I think that will become possible.

Wellness will become the point of health care. Today it’s just sick care.