[HN Gopher] IBM's Watson Health is sold off in parts
___________________________________________________________________
IBM's Watson Health is sold off in parts
Author : alexmorley
Score : 501 points
Date : 2022-01-23 14:40 UTC (8 hours ago)
(HTM) web link (www.statnews.com)
(TXT) w3m dump (www.statnews.com)
| anm89 wrote:
| I don't know if I'm the only one, but I always felt like Watson
| was roleplaying being a relevant tech company. Something about
| the way they marketed it just seemed like it was a big PR
| campaign with no meat behind it. I always had a suspicion that
| most people agreed but was never really sure.
| hayesall wrote:
| Article is paywalled, but this story has evolved over the last
| few weeks:
|
| - 2022-01-05: "Scoop: IBM tries to sell Watson Health again"
| https://www.axios.com/ibm-tries-to-sell-watson-health-again-...
|
| - 2022-01-07: "IBM reportedly shopping Watson Health just as
| healthcare gets hot" https://techcrunch.com/2022/01/07/ibm-
| reportedly-shopping-wa...
|
| A lot of the hope seemed to be in document summarization from the
| latest medical literature, plus integrating patient data from
| electronic medical records.
|
| The autopsy of this could be interesting. Some of the critiques
| against using electronic health records previously was that many
| of them were designed for medical billing (I don't have a good
| link, but Eric Topol's "Deep Medicine" has some notes on this
| problem https://www.basicbooks.com/titles/eric-topol-md/deep-
| medicin...).
| whoopdedo wrote:
| The grand demonstration of Watson playing Jeopardy ended with the
| question to an answer about U.S. Cities being "What is Toronto?"
| [deleted]
| ogogmad wrote:
| What's the chances that we'll have robotic domestic servants
| before 2032? With AlphaZero, AlphaFold and sort-of OK machine
| translation, I think it's 50:50, no?
| Barrin92 wrote:
| as in physical android ones? More like 2:98. I'd be very
| astonished if we see a robot plumber by 2050.
| ogogmad wrote:
| Plumbing seems harder than loading and unloading a dish
| washer. Or doing laundry.
| BlueTemplar wrote:
| But none of this matters that much for the hardest part : the
| robotics of it. You probably need to instead follow what Boston
| Dynamics is up to...
| lettergram wrote:
| There were many, myself included, who called Watson vaporware
| since day one. Glad to see it go. It was almost as bad as
| Theanos, frankly.
| cube00 wrote:
| It will be interesting to see if self driving cars and the way
| they've been rushed to market with the same brute force marketing
| will meet a similar fate.
| mnd999 wrote:
| Self driving cars are just that, marketing. Tesla for all their
| hype have limited driver assist only and even Google who seem
| to have the most advanced offering only works in limited areas
| in good conditions and the dataset that drives it requires lots
| of maintenance. The general problem is too hard, and general
| practice has some of the same problems. Probably less
| adversarial data, but there's still litigation to be had from
| confusing an AI GP. Or narcotics.
| HiJon89 wrote:
| Limited driver assist? Are all the videos of people using
| Tesla full self-driving on YouTube fake?
| isx726552 wrote:
| What videos would those be, like this one?
|
| https://youtu.be/uClWlVCwHsI
|
| Tesla's safety claims are wildly overstated, as documented
| here:
|
| https://news.ycombinator.com/item?id=26855608
|
| In aggregate, Tesla's FSD is demonstrably not up to the
| task. "Limited driver assist" is a much more fair
| assessment of what their software is actually capable of
| than the "full self driving" branding.
| [deleted]
| sixQuarks wrote:
| Yeah I'm shaking my head as well.
| saltminer wrote:
| It's unpredictable enough that it should be considered just
| "limited driver assist". Only a fool would look at
| https://www.youtube.com/watch?v=2ub2F-UnXIU and go "yeah,
| that's _full_ self-driving, all right. " Slapping a "beta"
| label on it means nothing - you could be talking about how
| Gmail was in beta, or you could be talking about Fallout
| 76.
|
| Tesla's marketing is extremely disingenuous, IMO. The name
| of your product creates expectations in peoples' minds, and
| sure, you can absolve yourself of liability by putting in
| the fine print "this isn't anywhere close to true FSD and
| your car might not be powerful enough to support it by the
| time we get there, so you gotta keep your hands on the
| wheel," but that doesn't make it right.
|
| If they called it "advanced driver assist" or something
| similar, I'd be fine with it (it is more advanced than
| traditional driver assistance tools like cruise control and
| lane departure warnings, after all). But I doubt they could
| get people to pay $10k or whatever the current price is if
| they were more honest. Instead, they would prefer to earn
| more money by slapping that FSD label on it and letting
| people immediately turn their brains off.
| enragedcacti wrote:
| Tesla advertises their technology as being on the cusp of
| Level 4/5 applications but legally (when defending its
| actions to the California DMV) argue that it is and will
| continue to be a Level 2 (i.e. limited driver assist) into
| the future and that FSD beta should not fall under
| regulations concerning testing of L4/L5 autonomous
| vehicles.
|
| Perhaps most importantly, all legal responsibility falls on
| the driver, regardless of the fact that the car can cause
| accidents faster than a human can realistically react even
| if paying perfect attention.
|
| https://www.jurist.org/commentary/2021/09/william-widen-
| phil...
| cnlwsu wrote:
| Self driving cars are not made by IBM. I wouldn't consider
| their utter failure at everything they touch to be a sign that
| that AI field failed.
| laurent92 wrote:
| Yes. The IBM Rationale suite failed even though it wasn't AI.
| It's the IBM way they commercialize things by going to golf
| with execs which is the problem.
| echopurity wrote:
| jjcon wrote:
| Agreed, AI is just like any software. There are good, bad,
| scammy and brilliant examples of it. With AI somehow though
| people like to use one bad example as a referendum on
| everything.
|
| I think I understand why (because AI as a term is overloaded
| by marketing teams), but the inclination is to paint with a
| broad brush is still inaccurate here.
| 8note wrote:
| I expect roads to adapt to make self driving car's easier to
| run over time. Both in terms of handling people, other cars,
| signage, and obstructions.
| xnx wrote:
| Google started its self driving project 13 years ago. It
| doesn't seem like they're rushing anything.
| crispyambulance wrote:
| I wonder where the search engine Blekko ended up?
|
| It was acquired by IBM for use in Watson back in 2015. Blekko was
| an interesting attempt at addressing search engine problems using
| a thing called "slashtags" to better categorize searches.
| JCM9 wrote:
| Watson was mostly data science powered consulting pretending to
| have/be a product. They played heavily on the Jeopardy thing from
| a marking standpoint but what they were actually trying to sell
| was a hot mess.
|
| I do consider this a good milestone in getting past the latest
| "AI" hype cycle and focusing on what actually works in that
| space. Sat through too many meetings with non-technical execs
| saying "what if we apply Watson here?". The likes of McKinsey
| were pushing this stuff hard in what they were whispering into
| executives ears.
| hn_throwaway_99 wrote:
| Can we post a non-paywalled version of this news? TechCrunch has
| a better version of this IMO:
| https://techcrunch.com/2022/01/21/francisco-partners-scoops-...
| trollied wrote:
| They are a nightmare. I was part of a huge project to replace a
| large part of a telecom operators infrastructure. IBM global
| services ran the operators IT outsourced. The project failed
| after a year because of them. It was the 3rd such project to
| fail. The company in question couldn't bring themselves to
| realise it had been their outsourced operators fault once again.
| Even though they had again lost the bid to do said work.
|
| PwC/Accenture were worse. Hire arts graduates because they got a
| degree from a good university, chuck them on a 2 month
| coding/consulting course. Happy days $$$
| ogogmad wrote:
| I once went to a job interview at Accenture. I remember the
| recruiter told me they only considered me because I went to a
| prestigious university. When I got there, they practically IQ
| tested me, were rude to me, and never contacted me again even
| after they said they would. The job was to write GUIs in C#.
|
| Listen up Accenture, I will drink expensive champagne when you
| go bust, or get bought.
| 7thaccount wrote:
| Not getting contacted again was probably a blessing in
| disguise. They don't really do much, but kind of act like
| PMs, but aren't very effective as they don't know the
| business very well. I think they're generally only used when
| a company temporarily needs like 20 warm bodies to assist
| with a large project.
| alfiedotwtf wrote:
| > drink expensive champagne when you go bust
|
| You'll have to get in line
| formeribmer wrote:
| I worked at IBM Watson as one of the early engineers when they
| first started commercializing the product. It was a fucking joke
| - Ginni Rometty would go up on stage and said that Watson can
| help diagnose cancer from CT scans and we would just look at each
| other and be like "Dude, Watson is just a glorified Lucene index,
| wtf is she talking about." They started selling Watson as the
| end-all for everything from cancer diagnosis to customer service
| chat - they even had a stupid Watson Chef thing at SXSW one year
| - but none of that used the original Watson codebase - it was all
| built from the ground up and lots of it was just simple logistic
| regression
| dllthomas wrote:
| > they even had a stupid Watson chef thing at SXSW one year
|
| I loved Chef Watson, am sad that it's gone, and would pay a
| small amount for renewed access.
|
| It wasn't "smart", and its recommendations needed to be
| tempered with human understanding, but I wound up with some
| great recipes that I wouldn't have thought of otherwise.
|
| I think the best was goat milk mac & cheese with radishes and
| red miso.
|
| The funniest was when it told me to remove the connective
| tissue from tofu.
| mNovak wrote:
| I remember reading some very amusing Chef Watson cocktail
| recipes. Lots of savory concepts like putting chicken or meat
| into a drink.
| bilekas wrote:
| Is it possible to get a non paid link ?
| 0898 wrote:
| Watson was sold as being able to spit out answers without you
| having to think of the question.
|
| Could somebody more familiar with its capability reveal whether
| that was at all true?
| achow wrote:
| Non-Paywalled
|
| https://www.nytimes.com/2022/01/21/business/ibm-watson-healt...
|
| https://archive.fo/uFNnJ
|
| _The business is being sold for an undisclosed price to
| Francisco Partners, a private investment firm.. Watson Health was
| set up as a separate business in 2015. IBM then spent more than
| $4 billion to acquire companies with medical data, billing
| records and diagnostic images on hundreds of millions of
| patients._
| pettycashstash2 wrote:
| IBM has a large consulting business. They make a lot of money on
| Services.
| nwsm wrote:
| That business was spun off into Kyndryl.
| [deleted]
| kumarvvr wrote:
| History will see our current decade of AI and only see over
| promises and under deliveries.
|
| I have decent amount of hope for AI, but corporate greed, hype by
| practitioners, a general explosion of various edTech companies
| hyping up the hype to drive online course sales and general
| excess of VC money is driving an embarrassing amount of AI
| failures.
|
| I am sure that any fad now and in the future, will have a similar
| cycle.
| bpiche wrote:
| Nothing to be afraid of
|
| https://en.wikipedia.org/wiki/AI_winter
| lvl100 wrote:
| The bigger and more interesting question for me right now is
| who's going to be this decade's IBM? I want to say Amazon.
| JohnJamesRambo wrote:
| You can count on it.
|
| https://en.wikipedia.org/wiki/Gartner_hype_cycle
| tomrod wrote:
| This is wholly unsurprising. IBM's big play was to integrate data
| science methods into the workflow. But they approached it from a
| "we will replace your labor costs" versus "we will augment your
| labor costs." Besides their AI models being fairly poor in
| quality, technology doesn't replace people very well where
| extrapolation is needed. So the quality of service Watson brought
| was significantly lower than what these businesses offered prior
| to adoption. So keeping Watson became an exercise in how well the
| business understands sunk costs and switching costs.
| lvl100 wrote:
| This so much. They basically let Snowflake (among others) eat
| their lunch. Back in 2015, IBM actually had a good chance but
| leadership just dropped the ball.
| 1024core wrote:
| Watson was a big PR machine wrapped around a little kernel of
| AI/ML.
| sdenton4 wrote:
| The American healthcare system is littered with the dead bodies
| of both startups and large tech companies...
| civilized wrote:
| Who could have seen it coming?
|
| IBM created a machine that could win at Jeopardy, not a universal
| expert or problem solver.
|
| Say what you want about Google, but they didn't claim to solve
| any practical problems by creating AlphaZero.
| ProAm wrote:
| Google is the next IBM.
| spookthesunset wrote:
| I don't know. Does google do consulting?
|
| IBM is its own category of tech company really... Oracle
| would fit the bill better.
| derwiki wrote:
| 60 years of prosperity before the wheels start coming off?
| Probably
| zwischenzug wrote:
| Tbf IBM didn't either when deep blue beat kasparov
| nwsm wrote:
| Meanwhile Google is unfolding Google Health.
| jonas21 wrote:
| Not sure what you mean by "unfolding". But, unlike Watson,
| Google Health seems to be building tools that may be useful
| for healthcare providers rather than just marketing hype.
|
| https://www.youtube.com/watch?v=71DVIWZnOho
| nickysielicki wrote:
| I do not understand how IBM stays in business.
|
| As far as I'm concerned the only cool engineering thing IBM does
| anymore is POWER, which has a sort of unique memory architecture
| but otherwise is well behind everyone else.
|
| What else did they do in my lifetime? They took a profitable
| RedHat and gutted it, they took the best Laptop line and sold it
| to Lenovo and almost ruined it, they tried to be a front runner
| in ML but blew their budget on marketing (remember Watson on
| Jeopardy?)
|
| The final straw for me was watching football with a techhy friend
| and a commercial for IBMs "hybrid cloud" came on. There's some
| executive mulling over whether to "go to the cloud" or whether to
| go with on premises, and they have a eureka moment where they
| learn about IBM hybrid cloud and they go into a board meeting and
| save the day. We both just burst out laughing.
|
| IBM doesn't make stuff anymore. That's the core problem.
| zitsarethecure wrote:
| > They took a profitable RedHat and gutted it,
|
| I know they bought Red Hat but I didn't hear that they gutted
| it. Can you expand on that?
| louniks wrote:
| I'm a Red Hatter, and I'm not sure what they mean either. I
| obviously only know my own little corner of engineering, but
| I've seen no signs whatsoever of being gutted. From where I
| stand, it's just a change of ownership that, at least for
| now, is completely transparent on the ground. I expect the
| situation to continue for as long as Red Hat keeps making
| money.
| frost_knight wrote:
| Traveling consultant-architect for Red Hat here.
|
| Before IBM purchase: Travel to clients, build and/or fix
| their things, suggest improvements.
|
| After IBM purchase: Travel to clients, build and/or fix their
| things, suggest improvements.
|
| At least from my side of Red Hat I've experienced zero
| changes in how I go about my work. In fact, my schedule is
| even more packed now, we can barely keep up with the demand.
| As far as I can tell IBM has left us alone to do our thing.
| Maybe it's different for other departments.
| dralley wrote:
| They haven't. I have no doubt that IBM has historically
| mishandled a great many acquisitions but thus far I haven't
| seen any changes that feel pushed by IBM.
|
| Source: I work at Red Hat.
|
| It's a bit of a strange comment considering it blames IBM for
| Lenovo's management of the Thinkpad line and a commercial
| that they later realized (but still haven't corrected
| themselves) was actually an HPE commercial [0].
|
| [0] https://news.ycombinator.com/item?id=30047062
| hackerbrother wrote:
| Was going to say, Red Hat seems to be doing fine/great. Very
| innovative Linux company.
| gigatexal wrote:
| Yeah ... My thoughts exactly.
| tmccrary55 wrote:
| Living off those mainframe MIPS bucks...
| blip54321 wrote:
| I was surprised by some companies too, until I worked outside
| of tech.
|
| The whole rest of the universe needs software too. Most
| companies are grossly incompetent to develop it themselves.
| Most are things that SWEs of the type which visit HN would
| never, ever want to work on. IBM does that adequately well.
| That's "services."
|
| If I need a tool built which will manage workflow at a
| management consulting firm, a custom tool for managing cases at
| a law firm, or some custom supply chain kludge -- the 99% of
| other "boring" software -- and I happen to know nothing about
| technology, who do I turn to?
|
| IBM isn't a bad choice. It's a major step up from Indian firms
| in terms of both price and quality. It has significant in-house
| technology to leverage. It's a safe choice. It will usually do
| better than in-house IT.
|
| I recently evaluated the business of a company which builds
| ships. They developed software in-house with an IT staff who
| weren't qualified to tie their own shoelaces. They had huge
| military contracts. They didn't subcontract to IBM, but it
| wouldn't have been a bad choice.
| [deleted]
| Aeolun wrote:
| Honestly, I'm not sure IBM is a step up from the Indian
| firms. It's certainly more expensive (like, ridiculously so)
| for not much more quality, if any.
| treis wrote:
| IBM is basically an Indian firm these days
| aquaticsunset wrote:
| Rational comes to mind
| scrubs wrote:
| Is it? Really? No. In fact it's not. Name one Indian
| company that ever reached 1/10th of what ibm had so that
| it's a candidate for seeing it on the way down.
|
| A serious insult because it'd be much more true would be
| to look at it's OD, culture and demise since Gerstner.
| Gerstner wasn't happy with a lot of IBM slop, paper
| pushers, and corporate BS either. That'd keep it on track
| rather than spurious comparisons.
|
| Gerstner layed of somewhere around 20% of work force,
| sold off tons of ibm art, real estate etc because IBM was
| lost ... And losing money. That says something. Spurious
| comparisons don't.
|
| Labeling IBM bad because it out sources to India is a
| vieled insult to indians and it's culture I guess. If
| that's the position -- not mine --- have the galiteantry
| and courage to just say so.
|
| I'm reminded of the Futurama line: do you idiots where
| you're from? Nobody nowhere can say no to that. American
| culture, OD, and common sense when it's not losing money,
| playing golf, splashing around shareholder cash on art or
| tieing up innovation in BS (all of which IBM did pre
| Gerstner and was called out for) expects problems fixed,
| brings out the best in all comers, and expects comers to
| be value add. Thosr that cant play that game are out.
|
| Regrettably this has one dark corner. Management isnt so
| good at overseeing itself. So in really bad situations
| they are good at shifting blame. Well nobody said it'd be
| easy. Let's start by not gossiping however.
| vidarh wrote:
| > Name one Indian company that ever reached 1/10th of
| what ibm had so that it's a candidate for seeing it on
| the way down.
|
| I'm not sure what your point is here, but based on Forbes
| 2000 for 2020 via Wikipedia [1], by market cap Tata
| Consultancy Services and Reliance are both _larger_ than
| IBM. Both have grown faster than IBM since 2020. In terms
| of companies overall a number of other Indian companies
| are larger than IBM.
|
| If you look at infotech alone, Tata Consultancy Services
| is the one bigger than IBM, and Infosys (>50% of IBM
| market cap), HCL Technologies and Wipro are all larger
| than 1/10th of IBM.
|
| [1] https://en.wikipedia.org/wiki/List_of_largest_compani
| es_in_I...
| relaxing wrote:
| IBM itself has large divisions in Southeast Asia that
| function basically the same as Indian IT firms.
| masalachai wrote:
| This assumes that IBM's core business is the same as
| their Services business. I doubt they have any overlap.
| They got onto the bandwagon after seeing how successful
| some of the early Indian services companies were (in
| terms of revenue) such as Infosys, Wipro, and TCS.
|
| I would put the IT services business of Accenture, Cap
| Gemini, and IBM in the same bucket as the rest of the
| Indian firms.
| yardie wrote:
| > IBM isn't a bad choice. It's a major step up from Indian
| firms in terms of both price and quality.
|
| Oh, my sweet child. You might be surprised to learn that IBM
| and those SWE boiler rooms like WiPro are basically the same.
| shakna wrote:
| Wasn't most of that spun out into Kyndryl last year? [0]
|
| [0] https://newsroom.ibm.com/2021-11-03-IBM-Completes-the-
| Separa...
| didip wrote:
| > It's a major step up from Indian firms in terms of both
| price and quality.
|
| Will it be? Don't they outsource a lot of their subcomponents
| to Indian firms?
| blip54321 wrote:
| There is a world of difference between a US ship building
| company outsourcing to India and a US tech firm
| intermediating that transaction:
|
| - A US intermediator can know the climate in India and
| navigate the cultural differences because they do this day
| in day out.
|
| - A US tech company can properly vet whom they're
| subcontracting to because they have engineers in-house
|
| - A US tech company will have a contract in US
| jurisdiction. If there is e.g. a data leak, there is
| liability through US courts. A step down from that, a US
| company can have US-based oversight and escalation
| mechanisms
|
| - Social networks and relationships matter too. If you're
| working with Bob from the golf course, and his company
| messes up, you'll see Bob again next month at the golf
| course and chew him out.
|
| ... and so on.
|
| I'm not suggesting you or I (personally) should subcontract
| through IBM, but for a US-based non-tech firm, it can make
| a lot of sense.
|
| To flip this around, whom would you rather hire to do your
| accounting (presuming you're not an accountant and know
| nothing about accounting):
|
| - A US company which outsources to India
|
| - A random company in India
|
| I would go for the former, since I know there would be
| liability if they messed up, and they'd make sure the US
| tax code was properly complied with. There's nothing wrong
| with the latter, but I'd have no way to vet them, and if
| they messed up, no recourse.
| theduder99 wrote:
| https://www.zdnet.com/article/ibm-now-has-more-workers-in-
| in...
| ab_testing wrote:
| > IBM isn't a bad choice. It's a major step up from Indian
| firms in terms of both price and quality. It has significant
| in-house technology to leverage. It's a safe choice. It will
| usually do better than in-house IT.
|
| Having been there, I can say that IBM is no different than
| the other Indian tech firms like Infosys, Wipro, HCL and
| other. Infact, there is a rotating door of employees among
| IBM and other Indian firms.
|
| 1. Since the last 5 years, IBM has more employees in India
| than in the US or any other country [1]
|
| 2. Secondly IBM pays more that the Indian companies in India
| to poach employees but shortchange their US counterparts. [2]
|
| Infact, the only difference between IBM and other firms is
| that the initial sales procoess is handled by American
| counterparts. Once the sales piece is done and the actual
| project starts, it is replaced by the offshore team.
|
| [1] https://www.zdnet.com/article/ibm-now-has-more-workers-
| in-in...
|
| [2] https://www.postbulletin.com/opinion/ibm-to-give-raises-
| to-i...
| MattGaiser wrote:
| They will deal with all the crappy and lazy and incompetent
| clients. They bid on all the government work, the bank work,
| the insurance work, etc.
|
| The kinds of places where HN devs would say your career goes to
| die, along with your soul.
|
| They will do the stuff the internal teams at those companies
| pass on.
| newaccount2021 wrote:
| rwbaskette wrote:
| I don't suppose you remember the "IBM OS/2 Fiesta Bowl"?
| jessriedel wrote:
| The number 2 experimental quantum computing group in the world
| is at IBM Research.
| tinyhouse wrote:
| > I do not understand how IBM stays in business.
|
| I understand why you're saying this. I have no idea either.
| However, open their 10-K and you'll find out how they make
| money. In fact, while their revenue and profits are declining,
| they still make more than $70B in revenue a year with a profit
| of about $4-5B, so their ability to stay in business is higher
| than many tech companies that are not profitable.
| jiscariot wrote:
| I work in a role where half of our stuff is in IBM's cloud (for
| decisions made before my tenure). On a day in Mid-November, we
| started receiving alerts from our UAT and PROD environments.
| Logged in, all our stuff was gone. Opened a ticket and did some
| digging and found in our audit logs an IBM SRE had deleted all
| our stuff. They then told us there was no way to recover and
| we'd have to rebuild from scratch.
|
| They had apparently been doing some "cleanup" and somehow our
| site number got on to a list. All our servers, attached
| volumes, subnets, load-balancers were deleted.
|
| My boss and I spent the next 30 hours applying terraform and
| rebuilding anything not automated.
|
| Would not recommend IBM Cloud. We are moving off in next 6
| months.
| JediPig wrote:
| so I worked at IBM cloud, and can confirm this. They bought a
| cloud service, that by itself, and if left alone would been
| great. Soft(....something...) was the company... then IBM
| came and changed everything. I remember the SVP / President
| of ibm cloud showing up... talking 3 hours about how her son
| is so great and that we should 'follow' his example... after
| hour 3, man goes and interrupts and asks a question that was
| "please get to the point of talking about your son".
|
| Few weeks later, massive layoffs, that triggered the warn
| act. So now I know how IBM works, see first hand meeting,
| after meeting being totally worthless. I would say stay far
| away from anything the touch. Just be glad you could move off
| their platform and not stuck using their platform with their
| CICD ... else you would be in living hell.
| dangrossman wrote:
| I stopped using Softlayer after IBM took over. I still get
| emails about the daily "incidents" in "IBM Cloud", as well
| as monthly billing notices for my $0 bill. I don't know my
| "IBM Id" or "Softlayer Id" to log in any more as it's been
| almost a decade, so I can't unsubscribe from any of it.
| MerelyMortal wrote:
| Sounds like a violation of the U.S. CAN SPAM Act.
| dangrossman wrote:
| Relationship messages (like incident reports and bills)
| aren't typically covered by the CAN SPAM Act, but that
| law's never stopped anyone anyway. I don't have enough
| fingers to count the number of daily commercial emails
| from otherwise respectable US businesses that don't
| include a mailing address or don't honor opt-out
| requests. Cold sales mails from tech startups are a big
| offender...
| HollywoodZero wrote:
| Isn't this the typical corporate acquisition process?
|
| * Bring in Deloitte, McKenzie, or other consulting group.
|
| * Gut the acquired company to reduce costs.
|
| * Fold newly acquired divisions into existing mediocre
| division.
|
| * Service gets run into the ground without the original
| people who made it great.
|
| * Eventually the service degrades and customers leave,
| business line stops generating profits
|
| * Company goes through the process again.
| rileyphone wrote:
| Gives me the unpleasant thought of how much value is
| destroyed and lost in these mindless corporate
| acquisitions. Incentives are broadly misaligned with what
| we should want as a society, instead investors want a
| payday as well as founders, and the acquiring corporation
| wants a fresh coat of paint and has access to the finance
| that can make it happen and only hurts 10 years later. In
| the end promising human efforts are destroyed because the
| rewards for doing so are too great.
| jahewson wrote:
| OTOH the average startup is garbage held together with
| duct tape that naturally falls apart without the founding
| team who created it. By the time of acquisition it's
| usually reached a point of technical debt bankruptcy.
| This goes hand-in-hand with an over-heated sales team
| pushing hockey-stick growth that will crash back down
| when those brand-new customers churn at the next renewal
| - because the product, while nice-looking, is
| unmaintainable garbage.
|
| Nice payday for the founding team and the ticking time
| bomb is paid for out of bigcorp's wallet. They go on to
| great new things and the eventual demise of their garbage
| pile will be blamed on bigcorp.
|
| Not to say that large companies don't destroy value -
| they absolutely do, frequently - but that the main error
| they make is not being able to appraise which startups
| are smoke and mirrors and which are legit. The rest of us
| are not so great at it either.
| belter wrote:
| After being on the inside of many of these, can confirm
| 100%, this post could not be more accurate:-)
| thomasahle wrote:
| > This goes hand-in-hand with an over-heated sales team
| pushing hockey-stick growth
|
| This seems like just another argument for limiting
| startup acquires. Perhaps if a big exit wasn't the goal,
| the company would focus on more long term viability.
|
| Anyway, I don't think they big companies care as much
| about whether they destroy value, as long as they destroy
| a potential competitor.
| rtkwe wrote:
| It's not just the company internally that want (needs?)
| those big exits, the whole VC architecture is built
| around shot gunning out money for the occasional huge pay
| off.
| jahewson wrote:
| I see competition often being less about the startup and
| more about which other competing big tech company could
| buy the startup to consolidate an existing market
| strategy. I'd more charitably call it "revenue
| protection" to preemptively acquire them.
|
| Startup acquisitions, in the absence of astoundingly deep
| due-diligence should probably be placed in portfolios
| where a 5:1 failure rate can be tolerated. I'm not sure
| how such an acquisition would be compensated.
| Hokusai wrote:
| I have seen that with General Electric.
|
| It's not easy to know when is the right time to jump your
| old trusted provider. At the beginning of the acquisition
| not much happens. Things degrade slowly because employees
| take the burden of doing the job for two people. But
| nobody can be subjected to the stress for too many years.
|
| Big corporations create nothing, only abuse the good
| faith of employees and the cost of moving providers of
| small companies. I have seen that happening in tech. When
| small innovative companies grew they got enough economic
| power to not have to innovate anymore. Purchase small
| good companies and drain them is the new business model.
|
| And it's a shame, there was a time that liked IBM, and
| others.
| aunty_helen wrote:
| I've sat in an all hands like that before. Literally 50k$
| an hour being wasted listening to some guy we'll only ever
| see once talk about his sons 18th birthday.
|
| Weird experience.
| hacknews20 wrote:
| Same here- if they start talking about their kids, it's
| over for someone, possibly lots of someones.
| rch wrote:
| Yeah, I surround myself with people who have their stuff
| together but don't feel compelled to go around flexing
| about it.
| aunty_helen wrote:
| To be fair, it was the general manager's bosses boss. No
| body was surrounded by him and by the time we were due
| another visit by this position, he had been promoted on.
| Damogran6 wrote:
| Owner of the company spent half the meeting talking about
| how they take their grandkids anywhere in the world they
| want to go when they turn 16...I look at the audience
| paying rapt attention and I'm thinking 'this is a little
| odd'
|
| Then he mentioned the 'merger of equals' and I thought
| 'this isn't good news'
|
| Narrator: It wasn't.
| belter wrote:
| Also been on one of those. One of the employees raised
| the fact salaries had been on a freeze for the last two
| years. Answer from VP doing the all-hands meeting: "My
| wife also wanted me to buy a new boat this year but I
| could not"
|
| Started looking for a new job that same minute...
| hogrider wrote:
| It's about power, just like mandating going back to the
| office.
| borski wrote:
| There are lots of reasons other than power to want people
| on-site. This is a strawman.
| [deleted]
| daenney wrote:
| Mandating it is a power move. You can give folks the
| option to come back to the office if they so chose, and
| let others work from home if they want to.
| projektfu wrote:
| I think it's a power move. Nobody got up and said, "Fuck
| you, I have better places to be." So they win. You
| probably thought it was about the business or something.
| after_care wrote:
| I have 100% opened up a laptop and tuned out a meeting
| like that. Never go to a corporate meeting without a
| laptop.
| TheCraiggers wrote:
| I used to do that too. Then I got accused of not being a
| team player or whatever. OK, fine.
|
| Turns out sitting on my ass and listening to something
| useless pays the same.
| twexler wrote:
| Softlayer is the name you're thinking of. They were pretty
| decent 10 or so years ago, but never touched them after the
| IBM acquisition.
| mrweasel wrote:
| Everyone wanted to be on Softlayer for a time. It was THE
| hosting provider. I don't know if they where any good,
| but the got great press coverage.
|
| Two years ago I had to help a customer debug some weird
| nginx behaviour, resulting in their traffic spiking at
| ten times the expected rate. The IBM/Softlayer VPN
| required that I used Internet Explorer, but it still
| failed to work. We spend three month with IBM and IBM
| Cloud consultants to make it NOT work.
|
| IBM destroy everything it buys. They have POWER, their
| mainframes and associated software left. How that keeps
| them afloat is a mystery.
| wrs wrote:
| Softlayer had the idea of API-driven bare-metal server
| hosting (as opposed to ticket-driven or phone-call-
| driven) early on, which was a big differentiator for a
| while. But AWS came along with an even more extreme
| version of API-driven hosting and they never caught up.
|
| As an example, most network or server changes you made
| through the API resulted in an automated email saying
| your sales representative would be in touch about your
| order, followed a minute later by an automated email
| saying the change was done at $0 charge.
| Operyl wrote:
| It had really gone to crap since then, we were softlayer
| customers before the acquisition and everything is beyond
| brittle now.
| zaidf wrote:
| Softlayer was solid at providing colo and dedicated
| servers. But they were never really architected with the
| cloud in mind. The pivot to cloud came later on. I always
| wonder why IBM didn't buy a provider like Linode.
| Operyl wrote:
| Likely because at the time (am unsure now) Linode did not
| own any actual data centers, they were all collocated.
| robk wrote:
| That seems negligent enough for your company to sue them
| jiscariot wrote:
| We're a pretty small org, and not sure we have the
| organizational heft or resources to do so. That being said,
| the $1k discount they gave us for Nov based on the broken
| SLA (resources down) was kind of a slap in the face. We had
| our minimal core services up in 16hrs, but recorded about
| 100-120 internal engineering hours for config, testing, and
| other fallout +1 month.
|
| When we opened the initial ticket, the IBM engineer kept
| saying "you should ask X why they deleted your stuff".
| Eventually after attaching the LinkedIn page for the IBM
| SRE in the audit logs, they realized something was screwed
| up on their side.
| Bombthecat wrote:
| Good luck suing ibm..
| Aeolun wrote:
| It may take a while, but you'll win.
| throwaway98797 wrote:
| pyrrhic victory is not good for business
| wussboy wrote:
| At what cost?
| jcranmer wrote:
| My guesstimate of the legal fees to try the case would be
| in the region of $100k.
| axiosgunnar wrote:
| In civilised lands the loser has to reimburse the
| winner's legal costs, so at no cost. If you don't live in
| civilised lands, well you have other problems.
| wussboy wrote:
| Does your civilized legal system also force the
| inevitable loser to front your legal fees while the case
| is ongoing? Or is it possible the plaintiff with deeper
| pockets can just stretch things out until the legal
| system has bled you dry and you must withdraw?
| jjeaff wrote:
| I'm not sure that is as civilized as you think it is.
| Loser pays discourages any small company or individual
| from suing because the cost is too great if they lose.
| axiosgunnar wrote:
| But the thread here was talking about a slum dunk case of
| contract breach.
| kortilla wrote:
| Even AWS contracts are vague enough to not make this a
| slam dunk. They pretty much explicitly say if you don't
| store stuff in multiple regions you are going to take
| outages/data loss.
| tomrod wrote:
| For material breach of contract and negligence? Easy
| peasy.
| rkk3 wrote:
| Reminds me of the IBM lawyer scene in _Halt & Catch Fire_
| shakna wrote:
| For breach of contract and negligence, IBM were
| successfully sued, and then banned from all future
| projects, by the Queensland government in 2013. [0] Which
| sets you up with a nice precedent and set of documents to
| see their angle of attack.
|
| > IBM will not be allowed to enter any new contracts with
| the State Government until it improves its governance and
| contracting practices.
|
| With that ban _still live today_, it astonishes me that
| any corporation would trust the organisation to actually
| carry through with their obligations. You have to really,
| really, royally screw up for a government body to
| consider you anathema.
|
| The old adage of "No one was ever fired for hiring IBM"
| is no longer true or reasonable.
|
| [0] https://statements.qld.gov.au/statements/72961
| acdha wrote:
| > For breach of contract and negligence, IBM were
| successfully sued, and then banned from all future
| projects, by the Queensland government in 2013. [0] Which
| sets you up with a nice precedent and set of documents to
| see their angle of attack.
|
| I mean, yes, but also think about how long a government
| can afford to have their lawyers pursue a case like that.
| If you don't have those kind of resources, it's a lot
| riskier.
| vidarh wrote:
| They also have a very significant _interest_ in pursuing
| it, in that they often have to follow procurement rules
| that prevent them from excluding vendors without good
| reason. If you think a vendor will be a problem in the
| future, getting a legal judgement in place may sometimes
| be necessary to save a _lot_ of grief that a private
| company can avoid by just privately and quietly
| blacklisting the vendor in question.
| themanmaran wrote:
| > Watson on Jeopardy
|
| Marketing aside. Lets not forget how cool that was. It was a
| great public demonstation that AI / ML is possible now.
| five82 wrote:
| csallen wrote:
| My stepdad manages a team in IT for a very large, very slow
| company in the banking/financial sector. The decisions about
| what software and hosting solutions they'll use are made by
| execs at the upper echelons, probably over games of golf by
| people who don't know that much. They just know, "I really like
| Jim over at IBM, he's got a real swagger to his step" and
| "other big companies are using them" and "hell they just bought
| a Super Bowl commercial." So a $2M deal gets done, and IBM
| stays in business.
| wussboy wrote:
| I spent 10 years at a small (<80 people) CX company that was
| full of intelligent, motivated employees. We were smart and
| quick and lean and did very good work. But we never dragged
| in big deals because no one at the company had that
| swagger/access to high-levels. The scenario you describe is
| dumb and ruinous and, unfortunately, true.
| Bayart wrote:
| I think a lot of engineers shoot themselves in the foot
| looking down on social networking skill and the ability to
| _speak corporate_ , as it were.
| wussboy wrote:
| 100% agree. I know many capable developers who will never
| do anything other than close tickets because they cannot
| build relationships. Some of them do not even understand
| why building a relationship might be fruitful.
| kitd wrote:
| Big corps tend not to do deals with small corps. They don't
| want the small corp to become dependent on them. Simple
| contract termination becomes costly and litigious
| otherwise.
|
| Let the big fish swim together.
| sangnoir wrote:
| Add counterparty risk to that too: if things go south and
| Big Corp decides to sue, small corp may go bankrupt in
| the process.
| rdtwo wrote:
| Big deals can really put a company in danger. If the
| company you work with closes or cuts the deal or whatever
| you could loose half your revenue. On top of that big
| clients can be really needy especially dinosaurs companies
| that aren't nimble. They take forever to pay, have lots of
| meetings and unreasonable expectations and expect lots of
| free stuff and service because they are incapable of
| processing Non standard invoices due to internal politics.
| It's a mixed bag to deal with the big guys
| andi999 wrote:
| Well, dont forget it takes 6-12 month for your company to
| be registered as a suplier in the ERP.
| 35fbe7d3d5b9 wrote:
| I saw this play out first hand: a local digital agency
| run by a friend essentially ended up "captured" by a
| major player in the aerospace industry, to the point that
| 65-75% of their business came from $BIGCO. They grew by
| 100%+, had employees flying all over the world to set up
| for trade shows, and were making money by the truckload.
|
| Then Covid hit, nobody wanted to fly, and $BIGCO took an
| earnings haircut and decided to cut back. My friend had
| to let dozens of people go. It ended up costing him his
| company because he'd neglected bringing other work into
| the pipeline.
| rdtwo wrote:
| Yep that's super dangerous especially cyclical industry
| like aerospace. Plus aerospace companies are notorious
| for paying late are having unreasonable demands.
|
| Coworker dad went from being a millionaire to living in a
| truck this way too.
| masalachai wrote:
| While that's true, the execs who make these decisions
| usually don't care about the actual implementation. Once
| the deal is done, it falls on their "IT division". And
| two things happen: Jim over at IBM still pampers the exec
| with a dinner or two. And the exec also suspects that
| some, if not most, of the problems are with his IT team.
| rdtwo wrote:
| Big companies have very strong anti kickback rules. You
| can get around them through board level connections but
| not much sort of That. Nobody Is risking 500k a year
| compensation over a dinner or 2.
| deagle50 wrote:
| I've worked as a sales engineer/architect in teams selling to
| people like your stepdad's execs for almost a decade. I can
| 100% guarantee the sales reps and their leadership constantly
| practice "swagger" and remind each other of its importance.
| It's hilarious.
| cycomanic wrote:
| I think what many people don't realise is the insane amount of
| research that is being done at IBM. In lots of areas, I know of
| quantum computing, silicon photonics, process development for
| integrated circuits, processors... They still file the most
| patents per year in the world by quite a margin (9000, the only
| one being remotely close is Samsung at 6000, for comparison
| apple and MS have 3000) and while I am not a big fan of
| patents, I do realise that one has to do significant research
| for getting this amount.
|
| They probably could just run much of the business just on the
| licencing fees they get. If you think they are not doing
| anything you're likely not their target customer.
| bastardoperator wrote:
| Easy. Governments, emerging countries, and heavy handed
| consulting. Once you're on their garbage it becomes near
| impossible to leave it.
| [deleted]
| riddleronroof wrote:
| Because people who make that fatal decision read Gartner magic
| quadrants.
| Joeri wrote:
| A former employer tried for years to get onto the magic
| quadrant, and never succeeded. Until they started paying
| gartner for access to their "specialist knowledge", and
| suddenly they were on the magic quadrant ... in the lower
| left, with gartner pushing them to pay more to get better
| access.
| wussboy wrote:
| As a worker drone who has spent my career in Sector 7G, I'm
| continually amazed at how many business decisions seem to be
| based on these "magic" quadrants. We spend 12 months building
| a capable and flexible infrastructure on Product A, only to
| have our management ask us why we haven't moved everything on
| to Product B, which is slightly closer to the top-right
| corner in the magic quadrant.
|
| I always answer, "Sure, we could, if you're fine with not
| other progress getting made towards your business objectives
| for 6 months."
| bredren wrote:
| Magic quadrants are not kidding around.
|
| I set up briefings to Gartner Analysts seeking to get our
| consultancy on a quad early in the mobile era.
|
| One of them was on the earliest examples of hybrid HTML /
| native views in iOS. One of our engineers was implementing
| them in the Apple Store app.
|
| IIRC, Gartner was not ready to split out boutique mobile dev
| but getting an earworm into an analyst with influence over a
| quad is still valuable.
|
| I presume there is chatter on potential forming of quads
| before they make print.
|
| Working these executive-influential information sources, and
| our firm continuing to land major app dev contracts led to an
| acquisition by Deloitte Digital.
| rbobby wrote:
| Hmm... maybe the magic in magic quadrants is in how they
| attract the sorts of people that will act on the information
| conveyed by the grid. Way better than an Ouija board for IT
| recommendations. Ouija is very hit and miss, really depends
| on what spirit you get connected with. Magic quadrants just
| work.
|
| /lol
| beckingz wrote:
| They just work if you dont' care about money.
| Sharlin wrote:
| I don't think "doing cool engineering" has anywhere _near_ as
| much to do with staying in business than you think it does. And
| IBM of all tech companies is the one that always was more about
| suits and sales than technology.
| bproven wrote:
| you just need to think of IBM as a service and consultancy
| company - because that is what they are (and have been for
| quite a while).
| 300bps wrote:
| They're a public company. Here's how they make money:
|
| https://www.ibm.com/investor/att/pdf/IBM-2Q-Earnings-Press-R...
| stefan_ wrote:
| That's a joke. If you read that drivel prepared for the stock
| market, you would come away thinking IBM is the biggest Cloud
| operator in the world. In reality of course they have just
| rebranded all kind of cash flow streams as "cloud" - because
| they know "cloud" will make the stock go up whereas
| "mainframe" makes it go down.
| rbanffy wrote:
| They also provide mainframe-based Linux VMs for clients
| that require the encryption technology built into those
| machines. If you need to give certain assurances by law or
| contract, they may be a good option. Apart from that, if
| you need on-demand VMs for IBM i or AIX, they are one of
| your only options.
| thallium205 wrote:
| Although small in comparison, they also bought weather
| underground for a cool billion or so and completely ran it into
| the ground.
| duck_bacon wrote:
| I was part of that acquisition. To be fair, Weather Channel
| was already running Weather Underground into the ground when
| they acquired it first. IBM just came in and helped them
| finished the job.
|
| A huge part of it was the incompetence with which IBM pushed
| us to use Watson modules in our products, which I could see 6
| years ago were worse than open source AI options and had no
| application to Weather Underground's services. They were
| basically toy projects being advertised as ground-breaking
| AI. I'm not surprised at all to see Watson finally collapsing
| under the weight of its vacuous claims.
| sandworm101 wrote:
| >> They were basically toy projects being advertised as
| ground-breaking AI.
|
| They were media events that lead to powerful media events,
| which in turn lead to investors pumping money into the
| stock price. Shareholder value is the only real profit.
| Watson being on Jeopardy no doubt garnered investment
| dollars from thousands of wealthy retirees. Those toy
| projects earned their keep many times over.
| raincom wrote:
| This is a great insight. Even if execs know $x billions
| will be wasted on such trendy projects (toy projects to
| those who know what's going on), they will still go and
| spend $x billions. Why? Since it keeps the market cap
| going up. This positive delta in the market cap is almost
| 10 times more than $x billions.
| lotsofpulp wrote:
| Not for IBM.
|
| https://www.macrotrends.net/stocks/charts/IBM/ibm/market-
| cap
|
| It is even worse than it looks considering the
| opportunity cost of not sticking the money in basically
| risk free and cost free SP500 ETFs. Even Warren Buffett
| took a huge bath on IBM.
| KKKKkkkk1 wrote:
| > They were media events that lead to powerful media
| events, which in turn lead to investors pumping money
| into the stock price.
|
| That can't be the reason. Over the last 5 years, IBM
| underperformed the S&P 500 by 16%/year.
| deebosong wrote:
| I don't mean to inject cryptocurrency cynicism & NFT
| skepticism into this discussion about IBM Watson...
|
| But as someone who doesn't know the tech, but worked in
| the media side as a vendor at the tail end making
| marketing materials for IBM during their "Internet of
| Things" craze, I couldn't help but feel, as a laymen, so
| excited at what IoT (and other crazy developments like
| Watson) could be, because apparently IBM at the time was
| hitting up a buncha different vendors and just blanketing
| a certain sector of the marketing industry with jobs. Any
| colleagues I talked to were on some IBM marketing job or
| another.
|
| Fast forward to about 7 years later, and I still have no
| clue what IoT is or does, but I sure saw a buncha
| marketing material flood mainstream media for a minute,
| with IBM saying it'd be revolutionary!
|
| Just makes me think about web3/ crypto/ NFT's, how it's
| coming down hard with media campaigns, claims, yada yada.
| Definitely seems about hype & optics, just like IBM in
| their IoT media carpet bombing era.
| davidgerard wrote:
| IBM's Blockchain division was merged into the Watson
| division, so it's more on-topic than you might have
| thought. Put all the vapor together!
| spookthesunset wrote:
| They completely destroyed the iPhone app. It's been, what,
| more than a year at least and the new version's hourly
| forecast still shows the beginning of the day (1am) even if
| you look at it at 7pm. So many things about that app that
| made it great got ripped out.
|
| A shame...
| ravedave5 wrote:
| I used to use it as my sole source until the site became so
| slow that I couldnt handle it anymore.
| keewee7 wrote:
| They do "boring" IT like making ticketing systems for the
| railways and metros.
| acomjean wrote:
| I worked breifly at IBM research last century. The spent a lot
| of money on research (6 Billion). software, chip design and
| algorithms and a lot of just basic research.
|
| But when I left to go back to school "global services" a
| business to business consulting division was the big up and
| coming division. It seems that division is where IBM decided to
| go. Honestly they'll just sell to some big businesses so likely
| you'll never hear about what they're doing.
|
| I'll agree they seem to have lost their way. Its a shame
| really. They did some good things: I remember a lot of the
| engineers there would travel to schools and promote engineering
| careers.
| Spooky23 wrote:
| They have since pivoted again. IGS was just spun out into a
| new company whose name is gibberish. Lol.
| ferdowsi wrote:
| They coast on enterprise lock-in while pretending they are
| innovative by shoveling money into non-useful blockchain
| projects.
| spookthesunset wrote:
| Remember when they were all in on Second Life? They had some
| virtual town hall or something and there were flying penises
| everywhere?
|
| Those were the days...
| bobbob1921 wrote:
| And MARKETING, ofcourse.
| chefandy wrote:
| > I do not understand how IBM stays in business.
|
| I don't think they do either, judging by my experience working
| there as an upper-level-support technician 15 years ago.
|
| It seemed like the organization was book-ended with decent
| brains: engineers and front-line managers were decent to
| fantastic, and the upper-management seemed to be decent at the
| time. However, both ends seemed to be choking to death on a
| hundred layers of middle management. 7 years after Office Space
| was released and I actually had three(3) managers. Three! I had
| a technical manager with whom I had bi-weekly meetings where we
| talked about nothing, a non-technical manager with whom I had
| monthly meetings where we talked about nothing, and the head of
| my department who was the only one who meaningfully managed me
| in any way. (And he was absolutely fantastic.)
|
| For example-- they made some big announcements about their
| impending migration from windows to linux for everybody from
| admin assistants to sales to developers. Exciting! I loved that
| linux was getting more professional credibility, and my product
| ran on Solaris, so having a local UNIX environment would reduce
| some of the cognitive load for networking, scripting, etc. etc.
| There was no internal mandate to start the migration yet, but I
| was too eager to wait. I found the official image on the
| intranet and started writing documentation for my coworkers. It
| was pretty smooth! The complex GUI apps like the Lotus suite
| worked great! Well, as great as they did on windows, anyway.
| The installer was quite polished! I was excited!
|
| I had one more thing to install-- the ancient, internal defect
| and ticket tracking clients used by every technical worker,
| product designer, all of their managers, etc. Neither the
| intranet page for the clients nor the Linux image docs had any
| info. Hours later, I found a months-old internal note EoLing
| the Linux port, directing people to use the obtuse CLI instead.
| No problem-- we're all technical people here, right? Problem.
| The API used by the GUI client supported necessary
| functionality the CLI didn't. That alone rendered the Linux
| initiative dead-in-the-water for most technical workers who'd
| benefit most.
|
| I'm sure the manager who canned the Linux client was solving a
| very real problem, but a) a decision directly affecting
| company-wide strategy getting lost in the ether, and b) nobody
| checking to see if these big overtures were even basically
| feasible, embodies their organizational shortcomings. (I might
| have gotten some of the details wrong-- it was a long time
| ago-- but you get the gist.)
|
| That's almost certainly why they're getting sued for
| purportedly blatant age discrimination, too. Managers in the
| middle with too much sway to have that little top-level
| visibility solving their problems using means that end up
| screwing lots of people.
|
| That they style themselves as a technology-focused business
| consulting company rather than just a tech company is pretty
| rich.
| agumonkey wrote:
| IBM is old, it's good and bad (probably not the first time they
| made bad decisions). Let's see if they can wash off the last
| decade or two that were full of mistakes.
|
| They still do stuff but it's hard research and niche so
| business wise it won't make them short term success. You
| mention power but they also have a good hand in Quantum
| Computing.
| davidgerard wrote:
| > Quantum Computing
|
| which may take over the world, but is presently at the stage
| "call me when it can reliably factor 35"
| permalac wrote:
| IBM has acceptable tape systems. Would be nice if they did not
| keep changing tape buffer sizes/times and other conditions
| without properly advertising the changes, but LTO is bad at
| scale so they have that going for them.
| jeremyjh wrote:
| I think they still make a lot of money from their legacy
| business, z/OS & mainframes, DB/2 etc still run basically all
| large banks, insurance companies and many other types of
| businesses. IBM can charge whatever they want for the hardware
| and services to support these things because their customers
| have no alternative. So they have just been farming this for
| decades, and can afford not to succeed at anything else (so
| they don't).
| lokar wrote:
| They also run th backed for major airline booking systems,
| and charge outrageous amounts.
| sofixa wrote:
| The biggest airline booking system, Amadeus, can actually
| run on Kubernetes and some airlines are migrating to it.
|
| Fun fact: a few years back Amadeus employees were in the
| top 15 of k8s contributors by company.
| rbanffy wrote:
| I'd love to see their architecture. Do they publish much?
| ed25519FUUU wrote:
| Is airline booking software very complex? I don't see why
| that software would necessitate the updating of k8s.
| raverbashing wrote:
| > Is airline booking software very complex?
|
| If this is surprising to you, you have no idea.
|
| It's a 24/7 business as a start. Multiple flights,
| multiple fares, multiple ways of booking a flight,
| airline agreements, etc
| relaxing wrote:
| Yes, it is. Read up on the history of SABRE and you'll
| get pretty much the entire history of digital computing,
| post-UNIVAC, in the process.
| mbreese wrote:
| I'm not sure about the architecture, but airline booking
| is very complex. You basically need to support a
| traveling salesman algorithm. It's also one of the
| original use cases for large scale computers. The Sabre
| airline booking program dates back to the 60's so it's
| also very legacy. The Arstechnica article (below) has a
| good history of the original military program and how it
| helped to spin out airline booking.
|
| Modernization for these systems was probably long
| overdue.
|
| https://www.ibm.com/ibm/history/ibm100/us/en/icons/sabre/
|
| https://arstechnica.com/science/2022/01/the-most-
| important-c...
| lokar wrote:
| I recall talking to people who worked at a company that
| competed w/ Sabere/IBM
|
| There was a project they did not want to do. To avoid
| saying "no" and risking the relationship they quoted what
| they thought was an outrageous price, expecting to loose.
| The customer said yes. They had underestimated how much
| IBM had been gouging them for so long.
| spookthesunset wrote:
| Every single airline they ingest probably has a phone
| book sized list of special cases and edge conditions that
| are distinct and unique. Multiply that by every airline
| on the platform and every consumer of the dataset and
| yeah... it's incredibly complex.
|
| Not to mention the uptime requirements and other SLAs in
| place (which probably are all different for each contract
| they sign)... yup. It's probably a monster.
| virtue3 wrote:
| It's kind of similar in some ways to the traveling
| salesman problem. Which is not considered np-hard.
|
| "How do you get to tokyo from paris", the cheapest, the
| shortest time, the least layovers, add a stop in X, etc.
| Not that easy.
|
| Then you have to remember all the stuff under the hood
| like how are you caching all that information, how do you
| actually register the sales of all those tickets. Are
| they in your flight alliance? Are they goign through your
| regional airline systems too?
|
| I would never want to touch that stuff. Way too hard. Way
| too many legacy systems powering it too, probably.
|
| See also: https://franz.com/success/customer_apps/data_mi
| ning/itastory...
|
| Which is now owened by google and probably powering
| google flights lol
| HollywoodZero wrote:
| Just like Oracle.
|
| No one talks about Oracle. But they're still around. We did a
| major tech project to migrate off of Oracle after an
| acquisition of a large org that was running it.
|
| It was a year-long effort to migrate. But it was worth it
| since Oracle renewal costs were going to be nearly 50% of our
| IT budget.
| threeseed wrote:
| a) Oracle is proven at scale.
|
| b) Large global talent pool of Oracle experts.
|
| c) First-class professional support.
|
| Not everyone is looking to innovate on their database. Many
| just want something that is reliable and easily supported.
| jeltz wrote:
| Oracle is also arcane, buggy and poorly documented (the
| buggy really surprised me when I first started using it).
| And there are much less resources online compared to the
| other big databases.
| pmlnr wrote:
| >c) First-class professional support
|
| Ah, this was a sarcastic comment! It was, right?
| dean177 wrote:
| This is hilarious.
| narrator wrote:
| I did a similar year long migration off Oracle. What helped
| were all the automated integration tests that had been
| built previously. It made it so much easier to verify that
| everything would work after the migration.
| tormeh wrote:
| Afaik they're a consultancy now. That means all their other
| activities are more or less just lead generation
| gitfan86 wrote:
| They also do a lot of reselling. They will pitch some sort of
| cyber security upgrade to their client and after the client
| signs they will ask Akamai to onboard that client
| mathattack wrote:
| They are in the audit business. Large companies have pockets
| where outsourced engineering teams have installed or forgotten
| to delete their outmoded software. They send in an audit team,
| and come up with a massive payment due. Then they negotiate
| with their "customers" to have them buy new software for
| approximately half the cost of audit payment. IBM gets new
| revenue (and new products to audit) and companies pat
| themselves on the back for averting disaster. And the new
| software never gets used.
| colonwqbang wrote:
| Do you have a link to the commercial?
| nickysielicki wrote:
| Yikes, I misremembered, it's a Hewlett-Packard commercial.
|
| https://youtu.be/0EL3ZkcMNS4
|
| This commercial still makes me laugh. The way she finishes
| his sentence with "our digital transformation" is the kicker.
| jjnoakes wrote:
| It'd be nice if you edited your post with the correction.
| asveikau wrote:
| There's still a phenomenon in advertising where it
| increases your awareness of a category, but you don't
| correctly ascribe it to the correct advertiser in that
| category. So funnily enough, I could still see someone
| going to IBM based on this ad.
| axiosgunnar wrote:
| Or when Microsoft spent millions on giving NFL reporters
| tablets while in air, only for the reporters to refer to
| the tablets as ,,iPads"? :D
| rbanffy wrote:
| HPE is kind of even more baffling. They make generic
| servers while, at least, IBM can sell you a brand new POWER
| 10 (running AIX, Linux or IBM i) or a mainframe. A new
| generation of mainframes is due this year and the crazy
| cache architectures they have shown last year is quite
| unique.
| HollywoodZero wrote:
| I love these commercials that at the end everyone is
| sitting at their desks with their suit jackets still on.
| Who does this?
| pfraze wrote:
| That line really is the kicker. I compulsively muttered
| "god damnit" when I heard it.
| ThinkBeat wrote:
| They make awesome mainframes.
|
| Extremely reliable, and extremely good at what they do. They
| sure are expensive.
|
| A lot more companies should adopt them.
|
| Yet its going the way.
|
| They run at scale at a lot of companies.
|
| AS/400 / iSeries was awesome at least in the beginning.
|
| I think it may be discontinued now.
|
| Those machines were extremely reliable and well made.
|
| Often companies who had bought one had no idea where it was.
| Someone had set it up for them 7 years ago and after that
| nobody paid attention.
|
| Some places were better and did proper backups. Which means
| stuff the right tape of a rotation into the slot.
|
| They would also call home to tell IBM of a proper that is
| developing and they would send a tech out to switch the parts
| prior to anyone using it had any problem.
|
| (and that is when the machines were sometimes hard to find. One
| was buried in a closet, with tons of paper cases, paper
| archives. stack buttom up to the floor.
| Karunamon wrote:
| I wish there was a way to learn mainframes that were
| accessible to mere mortals. Some toying around with a (almost
| certainly illicit) emulated copy of z/OS revealed an
| extremely complex, no doubt powerful, but entirely alien
| system that I'd have loved to get my head around, but alas, I
| could find no good resources.
| relaxing wrote:
| Hiding that knowledge behind expensive certifications is
| part of the business proposition.
| streetcat1 wrote:
| You should read more about the history of IBM.
|
| IBM is a sale driven organization. I.e. sale first - tech
| after. so it cannot be judged as an high tech company, I.e. on
| the tech.
|
| A point of reference is SUN - which was tech first - sale
| after.
|
| Another point of reference is HP. HP was tech first, but turned
| into sales first.
| vishnugupta wrote:
| Last I heard they were dabbling in Blockchain. Atleast they
| were publicly making noise about it.
| NikolaeVarius wrote:
| https://www.ibm.com/blogs/blockchain/2021/05/why-digital-
| hea...
|
| NYC Covid pass was build on blockchain. Such a goddamn
| pointless waste of time
| jiscariot wrote:
| Marketed as Blockchain with Watson(TM) most likely.
| ta988 wrote:
| Same salesman, same lobbying, same results.
| reidjs wrote:
| They have a product called Hyperledger Fabric that is
| marketed as an enterprise-scale permissioned-blockchain. I've
| tried to get it working before with some free credits and
| couldn't figure it out.
| ta988 wrote:
| Oh my, I saw a presentation of that. Dabbling is not even the
| word.
| absoluteharam wrote:
| Most big tech companies got out of or significantly scaled
| back their blockchain business, it is solution chasing a
| problem. The web3 people apparently haven't caught on yet
|
| https://petri.com/blockchain-bust-microsoft-joins-ibm-
| with-b...
| Jansen312 wrote:
| I think secretly they are aiming for the digital currency
| aspect of blockchain, e.g. Bitcoin but couldn't understand
| how it works as MBA schools havn't mint out bitcoin
| graduates yet. Maybe in abother 10 years.
| wussboy wrote:
| > MBA schools havn't mint out bitcoin graduates yet
|
| Genius!
| samarama wrote:
| The problem is infinitely printable FIAT, controlled by
| corrupt and incompetent politicians that is very slow and
| very expensive to to transact overseas and mutable.
|
| The solution is 100x faster, cheaper, more secure,
| immutable, less prone to fraud and limited in supply.
|
| It's a very simple calculation.
| dymk wrote:
| > less prone to fraud
|
| whut
| californical wrote:
| Those are problems in theory, but I don't think most
| people are concerned or affected by them. I'm certainly
| not.
|
| I never need to transfer money quickly between accounts
| -- it's never once been a problem to wait a couple days.
| And sure there are real economic problems with printing
| money, but again, the government does a decent enough job
| at keeping the dollar stable that it doesn't affect me.
|
| And there's the fact that the US gov has tons of power to
| maintain the validity of the fiat dollar through
| legislation, and as a backup they have the use of force
| through police and jail (in the case of tax evasion, or
| avoiding the laws). Then there are international
| alliances, and there's the largest military in the world
| also with a strong interest in maintaining the dollar's
| value.
|
| So I'm not worried about the value of the US dollar in
| the long term -- at least I certainly trust it more than
| a purely technical solution with none of the US Gov
| benefits.
|
| Faster: I don't have any problem with speed of USD
| transactions. In fact, most transactions are faster than
| crypto via credit cards or cash.
|
| Cheaper: there are $0 transaction fees for cash, and low
| fees for credit.
|
| Secure: US laws do a decent enough job
|
| Fraud: crypto exchanges get hacked and there is often no
| recourse -- if my credit card is stolen, there are laws
| that protect me
|
| Limited supply: by definition, that makes the currency
| deflationary, which is horrible for a growing economy.
| And it's obvious in bitcoin. Nobody spends money today if
| it'll be worth more tomorrow -- that's why everyone just
| buys and holds bitcoin as an investment, not uses it as a
| currency
| Edman274 wrote:
| I thought shilling operations don't operate on Sundays.
| Do they not give you the day off?
| amelius wrote:
| How does any IT person stay in business if they do not create
| cool stuff?
|
| There's your answer.
| Tade0 wrote:
| > I do not understand how IBM stays in business.
|
| They make money on those who have more than they know what to
| do with.
|
| Case in point: I spent six months in a project, which at its
| peak had about forty people working on it. Eventually it was
| scrapped and replaced with a solution from IBM, which in turn
| ended up... not being used at all.
|
| Overall it was a hilarious waste of everyone's time, but
| somehow that was okay.
| twistedpair wrote:
| Similar. Worked on a project where there were 50+ contractors
| to automate simple biz workflows. Run that for a few years @
| their rates and you'll see how much enterprises spend on
| relatively simple software projects.
| seanp2k2 wrote:
| I'm guessing that governments are keeping them afloat,
| especially on long-term contracts and with bespoke projects.
| throwaway4good wrote:
| They have a very big consultancy business. Probably has a much
| better brand name than say Tata consulting. Plus their products
| like db2, websphere or openshift have thousands of businesses
| locked in.
| tsywke44 wrote:
| The tech sector prints money. Large companies can leech off
| past heroics built by former employees for decades, even if the
| current employees are incompetent. A zombie company if you
| will.
| ibmfud wrote:
| IBM identified back in the 70s their core asset and were very
| explicit about what it was. "No one gets fired for buying IBM."
| Their key strategy since then has been to monetize this asset
| in a variety of creative, and mainly very effective ways.
|
| Thinkpads were a great example of this. Laptops which promised
| decent quality and support for a high price. When the laptop
| market was demystified and commodified, IBM correctly got out
| of it - for a decent price.
|
| If some random start-up, or even Google, had built Watson, it
| would have correctly been seen as a gimmick. Instead it sold
| literally billions of software consulting to people who thought
| they needed AI but actually just needed a search box with
| dynamic autosuggestion. Would you rather get some junior guy to
| hack something together using open source tools, or would you
| rather pay IBM 50 times as much? If you chose the former,
| you're simply not in the target market.
|
| The hybrid cloud is exactly the same game - as is made quite
| clear in that ad, it's pitched at middle management who don't
| want to look like chumps for ignoring the cloud, but don't want
| to fuck up by moving to it.
|
| Reputation is a difficult asset to monetize - effectively you
| make money from it by degrading and then destroying it. After
| all, if you carry living up to your good reputation, you're not
| extracting any advantage from it. IBM can't sell their
| reputation or their name to the highest bidder. All they can do
| is keep trawling for business lines where it gives them a
| comparative advantage.
|
| It's easy to see this as unscrupulous - but their customers
| genuinely do get a benefit from the confidence they have in
| IBM.
| hintymad wrote:
| Another insult to the injury: they were doing e-commerce with
| WebSphere Commerce series as early as 1998, yet they could not
| even go beyond the limited presentation-controller-db tiered
| architecture, and could never imagine something like shopify.
| dvh wrote:
| IBM is current record holder for largest number factored of
| quantum computer using Shor's algorithm: 21. And in 2019 they
| almost succeeded for 35.
| czbond wrote:
| What was the deal with this? Was it that the internal management
| team just mis-managed the product they had?
| max_ wrote:
| On a long enough time horizon, everyone's survival rate goes to
| zero.
|
| [0]: [Why Cities Keep on Growing, Corporations Always Die, and
| Life Gets Faster] https://www.youtube.com/watch?v=jOnWowd-7HQ
| lotsofpulp wrote:
| It was just IBM throwing stuff at the wall to try and keep up
| with big tech companies. They have been in decline for a long
| time, and I assume this marketing stunt did not fool anyone
| actually involved in the businesses of healthcare or tech.
| DebtDeflation wrote:
| It wasn't a product. It was a business unit created by the
| acquisition of (at least) 4 separate companies that had wildly
| disparate products, data sets, and consulting teams. The only
| thing they had in common was the focus on healthcare (and even
| that could mean anything vaguely related to providers, payers,
| or life sciences). "Watson" in general evolved into little more
| than a branding that was applied to anything remotely related
| to AI, analytics, or data management.
| fault1 wrote:
| It kind of sounds like a cautionary tale for other tech
| companies wading into the health space or medicine (e.g,
| calico, deepmind).
| raverbashing wrote:
| "billed as a revolution in medicine" by whom? IBM's marketing
| department?
|
| Anything "Watson" (together with 95% of that company -
| optimistically) is marred too deep in bureaucracy and yes men to
| do anything productive and innovative.
| RotaryTelephone wrote:
| Heh, imagine a comma "and yes, men, to do anything productive"
| m2f2 wrote:
| Better still, no comma and no space.
| ezconnect wrote:
| ramphastidae wrote:
| I imagine IBM quantum computing will go to same route. IBM has
| become a husk of its former self -- mostly marketing, and
| generally 5-10 years behind the cutting edge.
| cantrememberpw8 wrote:
| I'm excited by this.
|
| I recently left Red Hat for greener pastures. From where I sat,
| IBM was slowly turning toward wisdom again, having been run
| aground by its previous few CEOs. I was skeptical when IBM bought
| Red Hat, but after several years of not screwing it up, I'm
| pretty hopeful. Now, Krishna is working on streamlining the
| business and making the rest of IBM more like Red Hat. Splitting
| off the low performing Kyndryl, and selling Watson, are part of
| this by cutting obsolete sectors; focusing on getting Red Hat the
| resources it needs to rapidly accelerate, and on building the
| talent pool by hiring more junior engineers, are the positive
| changes working to turn IBM back into a powerhouse.
| kumarvvr wrote:
| Curious, what does RedHat actually do ?
| cantrememberpw8 wrote:
| Red Hat is the premier organization doing open source
| development. They optimize the experiences for enterprises:
| lots of support and a goal of helping it be easy to use so
| enterprises can focus on their business logic.
|
| Lots of well-hated projects come from Red Hat: systemd,
| wayland, ... but they have also contributed well to some
| other projects which are much less controversial.
| leokennis wrote:
| They make sure enterprises can run Linux that doesn't
| "suddenly" (read: with less than 2-3 years notice) break
| their critical workflows because some component loses support
| or some dependency reaches EOL - they do this by extended
| maintenance, backporting (security) patches to old versions,
| providing tailored support etc.
|
| This is very valuable to enterprises and so they pay a lot
| for it.
|
| For example, you can still run Red Hat 6 safely and securely
| until 2024; by that point Red Hat 8 will have been out for 5
| years already.
| staz wrote:
| To save you a web search : Red Hat 6 was relased 6 November
| 2010. Roughly 1 year after Window 7, which ended support 2
| weeks ago.
| KindOne wrote:
| Windows 7 went EOL in on Jan 14, 2020.
|
| Are you talking about the Extended Security Update? That
| ends Jan 10, 2023.
|
| https://docs.microsoft.com/en-
| us/lifecycle/products/windows-...
| ako wrote:
| Services/products of a company usually bring one of the
| following to customers: 1) improve revenue, 2) lower costs or
| 3) manage risks. RedHat is probably mostly about the last
| one, manage the risks of running linux.
| haltingproblem wrote:
| Often I see projects like Watson, Libra, Wave... which makes a
| very insistent voice say, the chance of this being real is really
| really small. This is completely anti-thetical to agile.
|
| What is the chance that this makes it through the gauntlet of
| product-market fit in-spite of the massive marketing dollars
| behind it and actually becomes a useful thriving product?
|
| I wish there was some way to _short_ individual product or
| initiatives at tech companies. Perhaps it could create a feedback
| loop of sorts and actually be useful rather than just being a
| ego-validation mechanism for the shorters.
| mromanuk wrote:
| There should be a way to bet (short) against "projects" or
| products, not the whole company. When they hyped about Watson
| Health, I "knew" it will fail.
| cuteboy19 wrote:
| Sometimes companies use their failed or loss making products to
| help promote their successful products. YouTube is a prime
| example
| frosted-flakes wrote:
| What failed/loss-making products is Google using to promote
| YouTube?
| donkarma wrote:
| you think YouTube is profitable?
| colinmhayes wrote:
| Yes, I think youtube is making billions of dollars a
| year. Youtube's revenue was $25 billion last year. It's a
| mature product. You don't think it's making money?
| baobabKoodaa wrote:
| Revenue is not profit.
| mardifoufs wrote:
| Google still doesn't release the profit figures for
| youtube, only revenue. Even the revenue figure was a
| secret until 2--3 years ago, so it was probably not that
| high. If youtube was very profitable, I'm not sure why
| Google would hide it in its earnings since they almost
| always try to show how they aren't exclusively dependent
| on their search ad business. I'm not saying youtube does
| not make any profit at this point, but if it wasn't tiny
| there's no reason for them not to talk about it.
| brendoelfrendo wrote:
| I mean, the opposite is also true, isn't it? If Google's
| search ad revenue was going down while YouTube ad revenue
| was going up, I feel like Google would want to keep that
| a secret so that people don't realize that search ads are
| shrinking in relevance.
|
| Basically, I don't see that Google has any incentive to
| break out its profits by line of business unless someone
| forces them to. They're better off if you just look at a
| black box of ad revenue and say "yeah it's all
| profitable, so ads are as strong as ever."
| emilsedgh wrote:
| Being profitable is only one angle though. Youtube is the
| biggest media network right now. I wouldn't be surprised
| if it beats Spotify as a music streaming service and a
| host of other unrelated sectors as well.
| mromanuk wrote:
| That's true. Definitively this was on the plus side for IBM
| PR and Marketing.
| politician wrote:
| Prediction markets are one of those things that
| cryptocurrencies are good for.
| todd8 wrote:
| Why?
| politician wrote:
| Good question. Prediction markets [1] allow people to bet
| on outcomes and benefit financially if they are correct.
|
| However, many jurisdictions ban them outright claiming that
| they a form of gambling and challenging the unregulated
| nature of questions leading to misaligned incentives ("When
| will that building burn down?").
|
| Yet despite these issues, the scheme can offer a neutral
| ground for betting against overhyped technologies or
| registering dissent against the policies of authoritarian
| regimes.
|
| Cryptocurrency based prediction markets further protect the
| participants by masking or hiding their identities.
|
| The combination of these features makes prediction markets
| an effective way to deliver global-scale censorship-
| resistant voting to the masses.
|
| [1] https://en.m.wikipedia.org/wiki/Prediction_market
| listenallyall wrote:
| So all you're saying is that cryptocurrencies can be
| deployed to facilitate illegal behavior. We've known that
| for quite a while.
| cuteboy19 wrote:
| Neutral ground is useless if the blockchain doesn't have
| an oracle to know what happens in the real world.
|
| The blockchain only knows about things on the blockchain
| itself. So someone has to do the actual data entry into
| the blockchain, and that person is the weakest link in
| any 'prediction' scheme.
| projektfu wrote:
| I'll give a different answer, which is that a blockchain-
| based prediction market can be used as an oracle for other
| blockchain-based contracts. So there can be both a final
| answer and a mark to market for the contract which should
| approximate reality in some way. However, being
| unregulated, there's always the possibility of cornering
| the prediction market and causing the derivative contracts
| to end with unreality. So you may need another kind of
| oracle to finalize the market price of the prediction
| market.
|
| Probably could be accomplished without crypto, but it can
| also be accomplished on some blockchains with minimal
| additional investment.
| phphphphp wrote:
| being cynical is easy because most things fail, the challenge
| is in identifying winners early or identifying losers after
| they've had some measure of success.
| draw_down wrote:
| hindsightbias wrote:
| Watson Health and Watson are not synonymous. Who gets to use the
| name, idk, but there are a hundred Watsony things in consulting.
| nickdothutton wrote:
| Watson is a great example of what happens when your marketing is
| better than your product, or to be more accurate technology
| toolkit.
|
| IBM will probably send RH the same way as they sent Softlayer.
| user3939382 wrote:
| I could be mistaken because it's been a while, but I read that
| Watson's diagnostic capabilities turned out to be mostly
| marketing and that eventually IBM ended up hiring teams of
| doctors to process the diagnosis requests that were coming into
| Watson.
| MattGaiser wrote:
| > that eventually IBM ended up hiring teams of doctors to
| process the diagnosis requests that were coming into Watson.
|
| Sounds like another health care company where the exec just got
| convicted.
| gexla wrote:
| So, they invented a Mechanical Turk?
| ta988 wrote:
| One that lost games yes.
| absoluteharam wrote:
| Watson became a marketing term after the company spent hundreds
| of millions to brand Watson to be synonymous with AI. The term
| Watson then got appended to existing businesses as it allowed
| them all to benefit from the brand equity and Watson ads. This
| unfortunately happened even if there wasn't any AI
| capabilities, so it eventually backfired.
|
| Watson Health seems to have been focused on selling the
| narrative of AI in healthcare, even though the technology
| wasn't there.
|
| The divestiture is only for IP also, and it seems most people
| in the group will be laid off.
| deelowe wrote:
| As someone with no inside knowledge, it seemed to me that
| watson started as a technology (or maybe solution/set of
| solutions) and as time went on, it was pivoted to be a brand?
| Hard to tell for sure with how difficult it is to get IBM to
| answer questions about what they actually do...
| HumanReadable wrote:
| Worked for IBM for three years, this is accurate. To solve
| some clients problem we would build an ML solution from
| scratch just like everyone else, and then try to shoehorn
| some Watson service into it so we could use the Watson
| Brand to distinguish our product.
|
| The solutions we built were generally pretty good and our
| clients were happy, but the Watson part was never anything
| more than marketing,
| [deleted]
| pram wrote:
| Sounds like what happened at Theranos! I read the analysis
| Watson was generating was ultimately just ignored by doctors
| because it came to inaccurate conclusions, so that makes sense.
| sixdimensional wrote:
| I personally feel Watson was an extremely clever marketing
| boondoggle. If you think of it, machine learning, neural
| networks and AI were just making a return into the public mind
| around the time they announced Watson.
|
| I think somebody thought if they "humanized" AI by making it
| seem like it was a character, it would make AI seem all that
| much more closer to the dream.
|
| On the face of it, not a horrible idea, but applied to what was
| essentially a bunch of separate algorithms.. pretty misleading,
| but that's just an opinion.
| cgearhart wrote:
| Worth noting that Jeopardy Watson had very little ML and
| absolutely no deep learning (it was a few years pre-AlexNet).
| I don't even think it used any neural networks; certainly not
| in any major way because they're not a major topic anywhere
| in the press releases, working group notes, or the papers
| published by the Watson research group. Watson was an
| incredibly complex mixture of bespoke implementations of
| "classical" AI and NLP techniques to handle questions of
| different classes by transforming them into search &
| information retrieval problems. They were able to make it
| work pretty well for the very limited domain of questions
| that arise in Jeopardy, but it was also obviously a Herculean
| task to generalize that approach. I can totally believe that
| as executives started to grok what Watson really was they
| realized that it had more value as a brand than as a
| technology.
| kgin wrote:
| This has real shades of Theranos
| perardi wrote:
| I worked for one of the companies that IBM acquired to make this
| non-product.
|
| https://www.reuters.com/article/us-merge-healthcare-m-a-ibm/...
|
| I have no idea what they got for the money they spent. Merge
| Healthcare was the most miserable work experience I have ever
| had. They had patents, I guess, but the actual technology was
| garbage. And the owner was...a piece of work, let's say that.
|
| https://www.npr.org/2018/12/12/675961765/tribune-tronc-and-b...
| jackcosgrove wrote:
| > Merge Healthcare was the most miserable work experience I
| have ever had.
|
| Was it the orange ties?
| perardi wrote:
| Ha, in a way.
|
| Because they were indicative of Ferro's "leadership": flashy
| branding gimmicks, with nothing to back them up.
|
| Like when he bought an orange Tesla roadster to bring to
| trade shows. He'd just pop an orange car in the middle of the
| booth. What's that got to do with health care? I dunno.
|
| _(And this was all a while ago, but this job just always
| stuck in my craw, because it made "Silicon Valley" feel like
| an understated documentary and not a parody.)_
| lvl100 wrote:
| Healthcare IT is all garbage. It's as if the people who
| invested in the space specifically did not want any of the
| inefficiencies to go away.
| goodluckchuck wrote:
| The inefficiencies are where all the money is made. After
| all, patients don't pay and they certainly don't pay for
| results.
|
| Patients may pay for insurance, and buy the right to not
| worry. Insurance delivers peace of mind by with appointments,
| papers, and pills. Look at all the bureaucracy and money, it
| must be fancy and effective. In the course of producing these
| papers are human doctors, nurses, coders, etc. They sometimes
| feel a sense of human decency and help people pro bono.
| morpheuskafka wrote:
| As someone doing a CS degree now, I seem to be the only one who
| doesn't want to have anything on my resume to do with "AI",
| blockchain, ML, NFT, chatbots, etc... all I see is overhyped
| product after product, one-size-fits all solutions that frustrate
| customers and create problems for humans to clean up, hugely
| valued companies that have very little real improvement over
| conventional technology, etc.
|
| An "AI chatbot" is far inferior to a real user interface. A real
| user interface allows discoverability (looking through menus to
| notice functions that may be useful later), experimentation, and
| puts the user in control of the program.
|
| For example, my bank apparently only supports viewing the reason
| for card declines through the chatbot--something I never knew,
| because I took the time to go through the menus when I first got
| the app and learn what functions existed.
| kkjjkgjjgg wrote:
| Searching movies to watch with Alexa works better than with the
| clumsy TV keyboard. I think for some applications or some
| people chatbots may be better than traditional UIs. Also they
| should be getting better over time.
| fsloth wrote:
| Most solutions to real-world problems offer tons of deliciously
| complicated CS issues to chew through.
|
| Just find problems to solve that are interesting _to you_ ,
| hype is irrelevant in finding a worthwhile thing to do (i.e.
| that a thing is hyped does not make it worse than something
| else - it does not make it better, either, though).
| alar44 wrote:
| You're missing the trees for the forest. I'm implementing a
| slack chatbot right now for our customer service team. Our
| customers ask for updates on jobs and these simple questions
| clog up the pipes for people who actually need to talk to a
| real person. It's likely going to reduce the number of CS reps
| we need by half. Figuring out whether a customer needs to be
| put in the phone queue or not is the perfect job for a chatbot
| AI. Maybe you should like, learn about CS and get some real
| world experience before you toss out edgy takes on things you
| literally know nothing about.
| jonas21 wrote:
| Since you're still a student, I feel like maybe I can offer
| some advice:
|
| First, I think you're getting the wrong lesson from this. The
| key takeaway is stay to away from IBM. Almost everyone in the
| field has known that Watson is a bunch of marketing hype since
| day one. It's no surprise that Watson Health didn't work out.
| That doesn't mean that everything is overhyped, and it's
| important to develop a good sense for what is and what isn't
| when deciding where to work.
|
| Second, every technology looks stupid when it's new. Airplanes,
| computers, the Internet, mobile phones -- they all had
| drawbacks that made them vastly inferior to the alternatives
| for most tasks for the first years/decades of their existence.
| It takes a lot of iteration and improvement to make something
| that's useful for everyone. Chatbots will probably get there
| some day - but it will take some big improvements in NLP.
| Perhaps this is the time to be working on them since we have a
| good idea of what we'd like them to do, and we just need to
| solve the challenges to get there.
|
| Finally, realize that you're not the typical user. I doubt if
| very many people take the time to go through the menus like you
| did.
| wsmhy2011 wrote:
| completely agree
| opportune wrote:
| If you want to do something less buzzwordy with lots of real-
| life applications, look into distributed systems. Try running
| an Apache big data project yourself and write some
| programs/queries for it, try making a change to the project to
| do something cool. My suggestion to check out an Apache big
| data project is just that it gives you a good place to learn,
| not so you can be a "hadoop specialist" or anything like that.
|
| There is way more real world usage of the distributed systems
| concepts and skills you'd learn there (especially in large tech
| companies) than any other flavor of the month. While ML is also
| commonly used in the industry, the signal:noise is really bad,
| because a lot of its uses are superfluous buzzword-driven
| development. However, many many companies rely on distributed
| systems to be able to operate at scale.
| lifewallet_dev wrote:
| Oh, so don't do current buzzwords but past ones like Big Data
| are okay.
|
| And if you wanna learn about distributed systems nothing
| better than Bitcoin or any cryptocurrency based on a P2P
| protocol.
| lcw wrote:
| I agree that they are novel and interesting to learn, but
| practically speaking, the person's point, is they are over
| hyped, and honestly since most use cases popping up aren't
| decentralized or are decentralized, but being regulated by
| a centralized party, like a government, it seems that they
| are the most inefficient way to run a distributed system.
| opportune wrote:
| Big data tools are just one example of distributed systems.
| I suggested looking into them because there are a lot of
| open source ones you can play with, not because I think big
| data isn't a buzzword (though Spark is definitely used a
| lot in industry).
|
| Crypto is of course a distributed system too (at least,
| many are) but in practice it's a bit different than
| anything you'd see in industry because it's trustless.
| rlayton2 wrote:
| Absolutely. I often joke that my work as a data scientist is
| mostly creating bar graphs for people. The actual analysis is
| often reasonably simple, its the aggregating of the data that
| is hard (its messy, its not all in the one spot and there is
| lots of it).
|
| So start with querying your big data to say what the top
| three event types are. Then slowly crank up the analysis
| complexity, but not too much. The data engineering has lots
| of scope for real solid and obvious applications.
| tyre wrote:
| A few reasons for this:
|
| + People care about what other people are talking about. They
| like to fit in, like they're part of the cutting-edge.
|
| + Less experienced people have less...experience with the
| downsides of what they're reading about.
|
| + CS is no longer mostly people who care about computer
| science, in the same way that economics isn't only for people
| who want the understand economics. Tech salaries -- especially
| engineers' -- are super high, like investment bankers. So
| people study the respective fields as a means to an end.
|
| + Twitter is driven by VCs, tech press, and people marketing
| themselves. They're work themselves into circular frenzies all
| the time. Little of it matters. Almost none of them have any
| record of predicting what's next and a long, long record of
| being wrong. This is true of most people! But these are the
| spaces many people look to to see what is "wanted".
|
| You seem to have good instincts. Don't be distracted by peers
| who work at "hot" startups or big named companies. Find
| something you believe should actually exist in the world and
| work on that. It will give you an intrinsic reward that money
| can't buy and status can't fill.
| ravi-delia wrote:
| > CS is no longer mostly people who care about computer
| science, in the same way that economics isn't only for people
| who want the understand economics.
|
| That's the main reason I decided against a CS major even
| though I love the subject. It's just disheartening listening
| to discount business majors butcher even simple technical
| topics. The pure math track actually has more than a few
| people in the same situation, so I wound up meeting some
| enthusiasts anyway.
| cinntaile wrote:
| It's all about incentives.
|
| Joining the hypetrain is a great way to get a bigger budget to
| play with.
|
| AI chatbots are all about saving money and hiding the real
| customer service as much as possible, it's not about creating a
| nice experience.
| lifewallet_dev wrote:
| Sorry but you're wrong, all those buzzwords have their merit
| and there are real impressive and innovative companies or
| projects built on those hypes, not all is "worthless" or a
| "scam". Don't let your ignorance blur your mind, learn about
| them, use them, have your own ideas cause this post sounds like
| you've been reading way too much HN.
| edgyquant wrote:
| The only reason I care to have to AI or blockchain on my resume
| is because both are interesting to work with.
| cuteboy19 wrote:
| A chatbot should be a search engine in disguise, with more
| focus on context. Anything else is a downgrade from a normal
| web interface
| jollybean wrote:
| John Kelly on Charlie Rose, 2016 worth a gander [1]
|
| [1] https://charlierose.com/videos/29530
| captainmuon wrote:
| I think "Watson" was never a thing (a technology or a product).
| Rather it was a marketing term. "Watson" meant any solution or
| research project that was developed by IBM and had remotely to do
| with AI.
|
| A bit like "Active*" or "NET" back in the day for Microsoft.
| Forge36 wrote:
| Capitalize on the "machine learning" hype with a unique name
| sold as a developed product?
| seibelj wrote:
| A friend of mine wanted to show off his Tesla by making it come
| to the front of the restaurant from where he parked it. Like he
| hit a button and it was to drive up. It got stuck somehow and was
| diagonal in the row. He was like "ehh sometimes it doesn't work."
|
| AI in general is very over stated. When it works it's great, when
| it doesn't (which is often) then you lose all trust in it.
| hiptobecubic wrote:
| I think that's the wrong conclusion from this story. The
| conclusion I draw is that some companies (and Tesla in
| particular) don't appreciate the "last mile" when trying to
| apply AI breakthroughs to consumer products.
|
| "The plane lands safely 99% of the time" is an impressive
| demonstration and a completely worthless product, but if that's
| all you have then what can you do other than launch it?
| microtherion wrote:
| That's NOT a product you should be launching with planes and
| cars, considering what would be happening the other 1% of the
| time.
| deltaonefour wrote:
| Except all self driving AI companies have failed to achieve
| reliable AI.
|
| Every single one.
|
| So it says something about AI more than companies.
| sputr wrote:
| >that GPs in particular would be replaced by a lower-cost Watson
| descendant
|
| Everybody is trying to replace GPs (and even specialists) with
| AI.
|
| But I've experienced a massive issue in healthcare that does not
| need an AI, just a good database. I was prescribed intensive
| imunorepresive therapy... and they forgot to put me on
| preventative antibiotics.
|
| If there was a very simple IF on my prescription (if Medrol >
| 16mg && TimeOnMedrol > 3 months { checkIfOnAntibiotics() } ) I
| would not have almost died with a PCP pneumonia.
|
| Engineers always focus on the interesting technical innovation.
| But we have so much low-hanging fruit still to do, that just
| needs to use our existing technical abilities in really, really
| boring ways.
| sedachv wrote:
| > If there was a very simple IF on my prescription
|
| This was supposed to be solved by rule-based/expert systems in
| the 1980s AI bubble.
| rvense wrote:
| The technology they sent on Jeopard answered a question, I think,
| that was looking for the name of a specific king of Egypt with
| "What are trousers?".
|
| Seems pretty obvious that anything that would do that is not
| human-like intelligence, and probably the search results should
| be taken with a handful of salt even if they stuck some
| impressive natural language generation after it.
| [deleted]
| newsbinator wrote:
| I'm okay with this: humans likely make hilariously bad guesses
| about things that are obvious and easily accessible to
| machines, and therefore the reverse is also true.
|
| Guessing "what are trousers" for king of Egypt isn't in itself
| an indicator the whole Watson system is flawed. Although you're
| right: it's an indicator the intelligence is non human-like.
|
| Just like, from Watson's perspective, a human named John making
| hilariously bad guesses related to coin flips isn't in itself
| an indicator that John isn't intelligent either.
|
| Just that there are some categories of knowledge or application
| of that knowledge that some systems are bad at handling.
| akira2501 wrote:
| Humans understand the value of saying "I don't know" then
| their internally measured probability of accuracy is very
| low.
|
| AIs don't seem to have that "gate," and to a human, it does
| make them appear to be very 'foolish' machines.
| oneoff786 wrote:
| AI do have measures of confidence. It's just most use cases
| have them throw out a guess anyway.
| ravi-delia wrote:
| That's really a choice. I mean most machine learning models
| wind up outputting a confidence distribution over possible
| outputs, so it's up to the user to decide how to extract an
| answer from that. They can and do have low confidence when
| they aren't sure.
| rvense wrote:
| > I'm okay with this: humans likely make hilariously bad
| guesses about things that are obvious and easily accessible
| to machines, and therefore the reverse is also true.
|
| Yes, it's almost perfectly dual: the things we do easily,
| without thinking, are hard for machines. Many things that we
| can only do with years of training, machines do effortlessly.
|
| I think technology like Watson has a bright future when
| applied in the right way, but I think it's counter-productive
| to wrap it in anthropomorphic marketing, and especially to
| give it these direct natural language interfaces. Because
| that makes people misunderstand what it is.
| avrionov wrote:
| Many people shame the startups for fake it until you make it, but
| IBM with Watson and Watson Health did exactly that for years and
| 'serious' analysts were predicting how their healthcare AI
| efforts will increase their revenue.
|
| Compare their results with Tesla.
| [deleted]
| tekstar wrote:
| I worked for a large e-commerce company. I wanted to investigate
| putting all our support data into Watson and see what sort of
| recommendations it could provide, maybe a sort of auto-suggestion
| to help our customers. Three really funny points stand out from
| the experience:
|
| 1) To apply for Watson access you needed to show C-level
| approval, so our CEO put his name and phone number on the
| application (trying Watson was somewhat his idea). A few months
| later, an IBM marketing team called HIS CELL and asked for ME.
| Imagine how it felt to have the CEO walk up to me, deadpan hand
| me his personal iphone and say "It's for you."..
|
| 2) They told me they'd help me with the support data idea, and
| every meeting we set up they tried to pitch "what if we put
| Watson on all of your customer's storefronts, we could add a
| 'powered by watson' banner on every page, and you give us a cut
| of GMV?". I pivoted them to our plugin framework and told them to
| build it themselves.
|
| 3) To demo the technology, the first step was to buy a $250k
| server from IBM. To demo it.
|
| Big LOLs all around, never trust big blue.
| PragmaticPulp wrote:
| Everything about this sounds like they hired inexperienced
| sales people and promised them huge payouts if they could close
| certain deals. The kinds of sales people who won't hesitate to
| burn a lot of customer relationships to the ground as long as
| they could close a few big deals for themselves.
| tekstar wrote:
| That's what it felt like, yeah. Also that the tech wasn't
| able to prove itself so they kept it behind a curtain.
|
| Multiple times they'd book a technical meeting to get us on-
| boarded and when I got on the call it was all sales people
| trying.
| Traster wrote:
| >1) To apply for Watson access you needed to show C-level
| approval, so our CEO put his name and phone number on the
| application (trying Watson was somewhat his idea). A few months
| later, an IBM marketing team called HIS CELL and asked for ME.
| Imagine how it felt to have the CEO walk up to me, deadpan hand
| me his personal iphone and say "It's for you."..
|
| This sounds like the biggest power move you could ever pull.
| lifewallet_dev wrote:
| Wow, I can't believe how accurate this story is, same thing
| happened to me I think summer 2016 but I thought it was because
| our execs were idiots not that IBM would treat every company
| like that... CTO calling me to his office to talk to IBM on
| their personal phone, he was the only one who wanted Watson
| (this was a healthcare company, I was VP of Eng). And yes, they
| were obsessed with putting their logo everywhere, and as soon
| as we heard it was so expensive, we had to tell our CTO to
| chill, we stopped, cause you know you can hire at least 2 devs
| for that money.
| mrtksn wrote:
| The company I worked for used some Oracle tech and I was trying
| to get some high level information about a product but their
| website kept requesting my e-mail just to show me some
| documentation.
|
| Once I provided them with my e-mail, I started receiving "You
| must take us to your leader" messages in a tone as if I was
| their employee and they were commanding me to take them to my
| CEO. I can't imagine myself chasing the CEO in the building
| because some sales people in Oracle told me to do so :)
|
| To be fair, after being in meetings with theirs sales
| engineers(who wore the best shirts I've ever seen) a few times
| I grew to respect their stubbornness and the way they
| structured their corporate machine. It's a valuable lesson to
| have an exposure to corporate dealings I believe, before that I
| used to do freelance stuff and had no idea how a simple webpage
| can cost millions and why a large corporation won't buy that
| easily from a small company with similar or better product at
| the fraction of the cost.
| sjg007 wrote:
| What are these shirts? I must know!
| mrtksn wrote:
| I don't know but my manager was a non-technical guy with
| passion for fashion and even his shirts weren't as nice!
| digisign wrote:
| Unfortunately, still don't know what you're talking
| about. Probably because I don't have expertise in the
| area. Am imaging some kind of white-collar business shirt
| that's... platinum plated? If the design is not
| extravagant, how would anyone know?
| sgt101 wrote:
| These are the best ones I've ever worn :
| https://turnbullandasser.co.uk/products/white-west-
| indian-se...
| Daneel_ wrote:
| For the price you'd want them to be.
| akudha wrote:
| 640$, lol
|
| My entire wardrobe costs less than that, and no, I am not
| lying.
|
| It must be nice to have enough money to spend on such
| luxury. Is it really _that much_ better than a $10
| t-shirt?
| mrtksn wrote:
| Nothing exotic but extremely good quality and attention
| to details that you can recognise from distance. No
| button looks off the shelf, no detail is cheap out. The
| cut matches the body perfectly and elegantly and the
| designer and manufacturer definitely went the extra mile
| even if it wasn't the easiest or cheapest thing to do.
| Maybe cutting in straight lines would be the easiest way
| to do it but if the design requires a slight curve, they
| wouldn't shy away from it. The more you look at it the
| more details you notice that someone must have agonised
| over it even if it wouldn't make any functional
| difference. Just because it's not visible all the time,
| doesn't mean that can't have a nice design, for example
| inside the collar has also a seperate design.
|
| I think @sgt101 is onto something.
| blastonico wrote:
| > You must take us to your leader.
|
| LOL, it sounds like General Zod in Superman II (1981). You
| should have asked if they want you to kneel before them as
| well.
| mrtksn wrote:
| It was both funny and scary as if I was reached by
| demanding aliens who were watching me :)
|
| I didn't know what to do, so I simply start marking it as
| spam and moved on. I guess they had a sales pitch based on
| the stuff I looked at.
| aenis wrote:
| Funny, similar thing happened to me.
|
| IBM along a few other behemots pitched for a serious project
| at a company I worked for as enterprise arch. All companies
| brought their top salespeople, and all tried nasty things,
| but IBM was _by far_ the worst. Their top guy started their
| pitch by saying he chatted with our CEO over the christmas
| holidays. He mentioned - and I am not making this up - that
| he should be talking to people higher in the org. (The most
| junior person in the room was me, the rest were board-2
| /-3s). It soon emerged their thing could not work, and I
| killed it in the first round of pitching. What followed was
| my bosses' boss, the CIO of a very large company, called me
| and gave me an earfull since he himself has to explain to CEO
| why we had the audacity to not choose IBM.
|
| I'd not touch anything IBM ever. Bunch of assholes.
| sgt101 wrote:
| Yup - I had the same "your guy is a problem, he's anti-
| innovation." The brilliant thing was that they rang the CEO
| of the business unit who was at that time +4 on me and had
| never met me. He was flummoxed and invited me for lunch to
| find out how I'd made such a big impression! Did me loads
| of good!
| elygre wrote:
| It sure sounds like IBM were bad. But it sounds like your
| company was even worse, the way your bosses' boss behaved.
| jdkee wrote:
| "Nobody ever got fired for buying IBM" was the common
| phrase at our company in the 1990s. At the time, that was
| certainly true. Which lead to adoption of truly awful tech,
| token-ring over type-1 cable, versus ethernet over twisted
| pair.
| wildzzz wrote:
| It's because they want to talk to the most power in the
| decision but with the least information as to how the
| problem could be solved without the help of
| Oracle/IBM/whoever.
| ethbr0 wrote:
| This, 100%. Think about it another way: IBM et al. sales
| only _lose_ by talking to lower-title folks.
|
| Best case, they lose control of the narrative as it's
| reported up internally, and someone higher up still has
| to approve it.
|
| Worst case, some engineer who actually knows their shit
| very quickly outlines why this can never work for the
| given problem.
|
| Once you're into the VP level, there's (usually) less
| technical knowledge, because folks at that level have
| full days crammed with higher-level decisions. So it's
| more plausible for sales to pitch {insert whatever
| buzzwordy, batshit crazy idea} and have it fly.
| pettycashstash2 wrote:
| I was involved in a small project, and we were running low
| on the money runway for next phase. The IBM sales guy
| literally barged into a FORTUNE 50 CIOs office, without an
| appointment, asking for budget to be approved for the next
| phase. project continued, but I never saw the sales guy
| again. The team had a good chuckle and I never understood
| what the guy was thinking he would achieve with this
| tactic.
| afandian wrote:
| Stories like this about IBM were handed down to me by my
| father. They've been doing this a long time!
| raverbashing wrote:
| A little psychological manipulation and marketing gimmicks
| (including overdressed people and marketing directed to CXOs)
| goes a long way.
| prepend wrote:
| My first Oracle experience was similar. Back in the 90s, I
| was tasked with replacing our old mssql6.5 generic custom
| built rack log server with something stronger as the product
| was successful and we had money.
|
| Oracle put me in touch with their eval solutions people who
| took all my info on number of users, transactions, size, etc
| and came back with an estimate of a $2M Sun+Oracle box. I
| told them that the current solution ran on like $10k of
| licenses and hardware and they revised the spec down to
| $250k.
|
| They were totally clueless but projected absolute competence.
| pettycashstash2 wrote:
| It used to be you can't get fired for hiring big blue. In the
| end it was always a lot of sales /pre sales folks, and a lot of
| substandard subcontractors milking the golden cow. I don't miss
| managing their implementations/deliveries at all.
| lvl100 wrote:
| This reminded me of my experience with them a few years back
| with MQTT. They were pushing their Bluemix/cloud hard and I
| just wanted to test it out. Never again.
| stathibus wrote:
| IBM is famous for charging people for the privilege of talking
| to them, even if you're trying to sell them something.
|
| This strategy makes sense if you consider that even in it's
| heyday Watson was 95% data science consulting firm and 5%
| actual valuable technology.
|
| I really think Watson is one of the biggest tech marketing
| bamboozles of the 21st century. Through Jeopardy they really
| had a segment of the business world and the general public
| convinced that they had cracked AI, but behind the scenes it
| was all one-off custom solutions under one trademark.
| dpflan wrote:
| Deep Blue preceded this. They had specialty equipment for
| crunching chess moves. Really excellent hype machine.
|
| I liked the documentary about it:
| https://m.imdb.com/title/tt0379296/
| indigodaddy wrote:
| Was Deep Blue/Watson basically the starting point of AI/ML,
| or had that already been happening earlier or concurrently?
| umanwizard wrote:
| Deep Blue and Watson aren't the same thing. Deep Blue was
| a chess computer from the 90s -- and it was not the first
| chess computer, so regardless of whether you consider
| computer chess to be part of AI, the answer is no.
| Kye wrote:
| It's a shame we never got a cross of Deep Blue and Battle
| Chess. Make those chess masters fight for their lives.
| Guest42 wrote:
| To me it seemed like those products were the start of the
| hype train, however, I believe the algos trace their
| roots to the 1960s although someone with more knowledge
| or time to research can refine this comment.
| cuteboy19 wrote:
| Deep Blue isn't ML at all, it's just a purpose built
| system for solving chess. It doesn't learn anything as
| such and just a fancy brute forcing machine that
| (smartly) goes through all possible chess moves and
| selects the best possible tree of outcomes. The work on
| actual ML happened independently of this.
| alar44 wrote:
| I don't see the problem here, that was literally the point.
| To build a chess computer.
| civilized wrote:
| That was the last time IBM was cool.
|
| That and it was cool when Watson won at Jeopardy.
| qaq wrote:
| Kindah like Palantir
| jelling wrote:
| Ehh...I get why tech people are suspect of Palantir but
| they're just disrupting other government contractors.
|
| And from my limited experience working with the government,
| they absolutely need / want / rely on having companies hold
| their hand as they insist on doing things the hard, slow,
| and very custom way.
| tsss wrote:
| It doesn't take much to disrupt a fax machine.
| edgyquant wrote:
| Doesn't this apply to most startups though? The core
| technical problems aren't "hard" it's that the industry
| involve can't adapt due to inertia of entrenched
| companies.
| humaniania wrote:
| Because of Thiel's lack of ethics and his support for the
| political far right?
| legerdemain wrote:
| Disrupting? Their stock price has dropped by two thirds
| from its peak. They're probably looking to find a buyer
| at this point, such as IBM itself, while the leadership
| uses them as a stock-printing machine to enrich
| themselves.
| Traster wrote:
| To be honest, my experience of private enterprise is that
| they insist on doing things hard, slow and very custom.
| Almost every problem that exists is distinct enough that
| you can argue it doesn't fit the existing COTS software.
| It's sometimes necesary to build something yourself, but
| no where near as often as it is done.
| [deleted]
| dr_dshiv wrote:
| Can you expand?
| fourthark wrote:
| It's promoted as a complete system, but you end up paying
| them to build out the system to do whatever you wanted to
| do.
| marsRoverDev wrote:
| Yeah, that is patently untrue.
| dr_dshiv wrote:
| Right, AI is just custom software, with people in the
| back to deal with edge cases?
| Daneel_ wrote:
| It's IF statements all the way down, baby.
| goatherders wrote:
| IBM, Oracle, Panatir....in a lot of cases these are pro
| services companies that custom build whatever is needed.
| LOTS of money in enterprise application development.
| NicoJuicy wrote:
| Oracle is a expensive and "popular" database, IBM does
| many things ( eg. Quantum computers, ... )
|
| Palantir is a consultancy body shop with a dashboard
| product and a probably good pipeline for merging data. (
| Reference - https://news.ycombinator.com/item?id=11646587
| )
|
| Pure consultancy is rated much lower ( eg. Thoughtworks
| if you want a reference)
| ethbr0 wrote:
| Consultancy + adaptable software is a decent business
| model. Unfortunately "adaptable software" for {insert
| industry} is a _really_ hard target to architect right.
|
| Especially when the majority of your tech headcount bills
| by the hour and gets paid to tell the customer "Yes."
| pmorici wrote:
| They are just a contracting company making money off
| billing the government hourly for their employees time.
| It's a horrible business.
| civilized wrote:
| Sounds like an awesome business if you're getting the
| money.
| NicoJuicy wrote:
| Many people think palantir cracked AI.
|
| While they are just using tensorflow and other things
| like anyone else.
|
| Additionally, large tech can't apply for defense
| contracts because of internal ethical concerns of
| employees. So the naritive remains.
| chelical wrote:
| Who thinks that? I've never heard this. People thought
| Watson was a lot more capable than it actually was just
| because of the Jeopardy PR stunt. People outside tech
| were buzzing about IBM and Watson. In my experience,
| people outside tech barely know Palantir exists.
| NicoJuicy wrote:
| A lot of retailers buying their stocks and blindly
| following people like Cathy Woods and random YouTubers.
|
| Not me, but i see some guys trying to spread that
| naritive.
| teawrecks wrote:
| To be fair, paying them for the privilege to sell them
| something makes more sense than the inverse.
| WrtCdEvrydy wrote:
| > an IBM marketing team called HIS CELL and asked for ME.
|
| What the fuck is this? A name/email for your company when
| trying something out is so that you can keep track of any
| support requests we need, not for you to sell shit to me.
| throwaheyy wrote:
| Yeah, the whole culture there (and other places like Oracle)
| is all about implanting mindshare at the decision-maker level
| and driving unilateral adoption from the top down. Pursuing
| such an approach is highly revealing because if the
| technology _actually worked_ , that approach would not be
| necessary.
|
| Once they're "in" at the decision-maker level, they can
| continue to milk the organisation with long-duration support
| and consulting contracts, feeding parasitically and gradually
| becoming more and more entangled.
|
| One spectacular example, 7M budget but in actuality, 1.2B
| down the drain and nothing to show for it
| https://blog.beyondsoftware.com/the-queensland-health-
| payrol...
| spikej wrote:
| Add this one to the list:
| https://en.wikipedia.org/wiki/Phoenix_pay_system
| pram wrote:
| Oh yeah I worked on a similar project at Oracle. The sales
| people basically sold the state on a 'stack' with a bunch
| of random horseshit that was magically supposed to work
| together and then dumped it on engineering. I mean that in
| a totally serious way, sales seemingly just grabbed a bunch
| of names of Oracle software and mashed it together. It
| literally never worked at any point.
|
| Then Oracle sued THEM about it, lmao.
|
| https://en.wikipedia.org/wiki/Cover_Oregon
| fphhotchips wrote:
| > Pursuing such an approach is highly revealing because if
| the technology actually worked, that approach would not be
| necessary.
|
| This is, sadly, untrue. Enterprise reps do this because on
| the whole, it doesn't matter if you have the best
| technology - if the other guy is successful at the CxO
| level, the customer will go their way.
| throwaheyy wrote:
| Correct - not saying that the best technology assures
| success, but that without working tech, marketing to the
| CxO level is the sole viable option.
| rubyfan wrote:
| In my experience this seems to be a theme with very senior
| executives - they are very often interested in snake oil and
| can't seem to discern snake oil from real medicine.
| daniel-thompson wrote:
| This is kind of funny to see after reading the Tech Review's
| piece on Watson Health from 4 years ago (https://www.technologyre
| view.com/2017/06/27/4462/a-reality-c...). They were wrong on the
| outcome but right on the diagnosis - that the marketing got way
| ahead of the engineering.
| throwawayay02 wrote:
| To the surprise of no one who ever paid attention.
| sys_64738 wrote:
| It might be successful if not lumbered with a dinosaur such as
| the IBM tag around its neck. Nobody I know looks to IBM for
| anything nowadays.
| umangkeshri wrote:
| back in 2016 I joined my first company as Fresher and was excited
| to work in the use case of Ml and was given my first project for
| making chat bots using IBM Watson Conversation :P I think that is
| the worst project i have done in my life till now.
| saxonww wrote:
| I really expected that we'd see a change in my lifetime, that GPs
| in particular would be replaced by a lower-cost Watson
| descendant, with there being some other role for patient
| interaction, wet work, and data entry (perhaps just nurses).
|
| My mom worked for a GP for about 20 years, and it seemed to me
| that most of what made that guy a doctor was bedside manner +
| being able to remember a lot of things. But GPs often make
| astounding amounts of money while leaning heavily on their staff
| to actually handle patients and keep the business running. I
| thought it could help drugs get a little cheaper too, because
| there wouldn't be any point in the pharma companies sending out
| salespeople to do lunch seminars to convince the GPs to prescribe
| this or that drug (this still happens).
|
| Maybe this will still happen, but it doesn't seem imminent
| anymore.
| diognesofsinope wrote:
| American Medical Association (and other medical/pharma/health
| workers associations) > IBM
| jakey_bakey wrote:
| The hard part is knowing what things you need to remember
| wiz21c wrote:
| > bedside manner + being able to remember a lot of things
|
| My impression is that accompanying a patient is super
| important, it helps to understand illness, to have a plan in
| case of more complex treatments, etc.
|
| Then my doctor has the ability to know me and gauge my health.
| She's also very good at probabilities and detecting when
| something really goes wrong.
|
| I'm sure that being able to do that require a lot more than
| numbers.
|
| (I'm studying data sciences, I trust them, but my guts tell me
| that diagnosis is in a whole different ballpark)
| telxosser wrote:
| What data is being collected on you? Once a year blood test
| if that even?
|
| I actually suspect it would be trivial to beat my doctor
| after 5 years of higher frequency full blood panel data
| collection.
|
| 10 full blood panel samples a year, have 20 million people do
| that for a data set we can do classification on. I think my
| doctor is kind of out of business then.
|
| Will never happen in my life though with health insurance and
| health bureaucracy.
| [deleted]
| zo1 wrote:
| It won't happen primarily due to government regulation.
| Medical information has "dangerous, don't touch this"
| written all over it, and everyone is scared to try.
| nradov wrote:
| Beat your doctor on what? You can already get 10 full blood
| panel tests per year if you want. You can just pay for it
| and don't need insurance. But what will you do with the
| data? For most people the results won't tell you anything
| useful.
|
| https://www.ondemand.labcorp.com/lab-tests/comprehensive-
| hea...
| chromatin wrote:
| It also helps to have a relationship with a patient (or
| person).
|
| There are some people who will never, ever complain about
| anything. When they complain of severe abdominal pain, for
| example, you pull out all the stops immediately to figure out
| what's wrong, because it's probably really bad.
|
| On the other hand, there are hypochondriacs and people will
| low pain tolerance. While they can certainly also become
| seriously ill -- and one must never forget this -- the tempo
| and pace of workup and order of intervention is markedly
| different, absent other information that shifts the pretest
| probabilities.
| Aeolun wrote:
| > On the other hand, there are hypochondriacs
|
| That's me. I really, really appreciate a GP that both
| understands that I'm not doing it on purpose, and can
| reassure me that nothing is wrong, or figure out that we
| actually do need more testing this time.
|
| Unfortunately it's been years since I had one like that :/
| KerrAvon wrote:
| Sometimes a relationship is bad. If you think someone's a
| hypochondriac, but in fact they're unusually sensitive,
| you'll dismiss a lot of what they say and that can be quite
| damaging over time. (Especially if they're female
| https://www.health.harvard.edu/blog/women-and-pain-
| dispariti...).
|
| I wouldn't eliminate GPs from the process, but many people
| actually would like to hear what the robots have to say
| about their medical conditions. Having second opinions of
| this sort available might lead to better patient outcomes.
| Spooky23 wrote:
| Lol. Maybe people who don't have any medical problems.
|
| There isn't enough humanity in healthcare to begin with.
| Replacement of doctors with AI sounds pretty horrific.
| General practice isn't where healthcare costs are going
| bonkers, and it seems weird to want to cost-cut something
| that actually kind of works in favor of bullshit.
|
| Know what would be a great use of AI? Something real like
| analyzing all of the telemetry in EMRs to provide better
| guidance to doctors to proactively guide people. Some
| CVSHealth chatbot telling me whatever is a waste of time.
| Elof wrote:
| I think the person was suggesting using the results of
| the AI to inform the doctors, not replacing them. Which
| is something I would like as well
| nradov wrote:
| Automated diagnosis applications have existed for
| decades. They have proven useful in limited circumstances
| for certain specialties and rare conditions but for
| routine medical care they're more hassle than they're
| worth.
| nradov wrote:
| There is no evidence that diagnostic robots would
| actually produce better outcomes. The hypochondriacs are
| already able to Google their symptoms and make themselves
| sick with anxiety.
| derefr wrote:
| "Super important" -- more like "super nice-to-have."
| Hospitals don't have any single person on staff who stays
| attached to particular in-patients. Who knows you? Your
| chart.
|
| Yes, of course, hospital care would be _better_ in many ways
| if we did have somebody who statefully understood particular
| patients' needs.
|
| But what I'm saying is, the GPs in hospitals could be
| replaced with stateless diagnostic AI without making hospital
| care any _worse_ than it is now. And hospital care is a large
| part of the medical system, so only replacing diagnostics
| there (while leaving primary-care GPs alone) would still be a
| major optimization, freeing many doctors to provide better
| care, go into specialties, etc.
| nradov wrote:
| That's simply false. You obviously have no idea how
| hospital care is actually delivered. To start with, every
| admitted patient has an assigned attending physician who is
| responsible for coordinating the care team. Some things can
| be documented in the patient chart but there are always
| gaps. Clinical decision support systems for partially
| automating diagnosis could potentially be helpful in some
| limited circumstances but the ones built so far mostly
| don't work very well.
| robbiep wrote:
| I'll second how misguided that view of hospital care is.
| There is ALWAYS a treating team, always an admitting
| consultant/attending
| HaZeust wrote:
| Knowing the ontology of your patients and their risk is also
| a tenet of a doctor's job, but we can do it with AI too.
| Hell, ontological engineering had a revamp specifically so
| that we could have a standardized model to describe any and
| all "parts" of a "whole" in a way that machines could
| understand.
| nradov wrote:
| No we really can't do that with AI yet. Current AI
| technology is nowhere near that level.
| kilburn wrote:
| What many people don't realize is that medicine as a whole is
| already some sort of expert system (i.e.: a flavor of AI).
|
| There are researchers that conduct experiments to produce
| meaningful data and extract conclusions from that data. Then
| there are expert panels that produce guidelines from the
| results of that research. Most diagnostics and treatments are
| prescribed following decision diagrams that doctors
| themselves call... algorithms!
|
| There are several limitations that prevent us from applying
| other AI techniques to the problem. Off the top of my head:
|
| - We do not have the technology for machines to capture the
| contextual and communication nuances that doctors pick up on.
| There can be a world of difference between the exact same
| statement given by two different patients or even the same
| patient in two different situations. Likewise, the effect of
| a doctors' statement can be quite literally the opposite
| depending on who the patient is and their state of mind. One
| of the most important aspects of the GP's job is to handle
| these differences to achieve the best possible outcomes for
| their patients.
|
| - Society at large is not ready to trust machines to make
| such intimately relevant decisions. It is not uncommon for
| patients to hide relevant information from their doctors, and
| to blatantly ignore the recommendations from them. This would
| be many times worse if the doctor part wasn't human.
|
| - We cannot apply modern inference techniques (e.g.: deep
| learning) to the global problem because we have strict rules
| that prevent medical data collection and analysis without a
| clear purpose. Furthermore, these techniques tend to produce
| unexplainable results -which is unacceptable in this field-.
| As a result, there's not enough political capital to relax
| those rules.
| sjg007 wrote:
| > We cannot apply modern inference techniques (e.g.: deep
| learning) to the global problem because we have strict
| rules that prevent medical data collection and analysis
| without a clear purpose.
|
| I mean, China will likely do it, as long as they can
| capture high quality data, so there's that.
| shadowofneptune wrote:
| The attending physician in a modern hospital system is
| primarily a manager. Their main concern is treatment of the
| patient's medical issue, but their role isn't limited to
| that. This patient is refusing care but also refuses to
| leave, what do we do? How should we schedule care around a
| patient who requires the entire floor to assist in daily
| activities of living? They may not get the last word on
| matters outside of their responsibilities, but being the
| physician their words carry weight. This role has remained
| pretty much constant through the modern medical system,
| even as medicines change and nurses and technicians gain
| more responsibilities.
|
| A computer cannot perform that role with the current
| paradigm of AI, even the worst and most arrogant doctor is
| more qualified leader than any computer.
| [deleted]
| oblio wrote:
| I assume that you're from the US?
|
| Those are both people problems. Tech can't solve many people
| problems, especially something as entrenched as healthcare.
| Isn't it huge, something like 10% of the US economy?
| tomrod wrote:
| Yes, due to massively inflated prices.
| cycomanic wrote:
| It's funny how on these forums people who actually do
| something good and useful like GPs are considered
| overpriced, but at the same time many here work for FANGs
| or other webad businesses often making more than GPs. I
| know that if it comes to decide between the health industry
| and Facebook, Google, Apple or MS I sure know which I'd
| rather keep.
| kortilla wrote:
| FAANG doesn't cost 15% of the GDP though. Not sure why
| you're comparing those.
| JshWright wrote:
| Interestingly, I assumed they were outside the US. Primary
| care docs (especially independent primary care docs) are one
| of the lowest paid medical doctors. Most specialists make
| significantly more money (and have a significantly better
| workload/schedule).
| FredPret wrote:
| I thought to myself: no way can this be true. The US
| generates $21tr a year[1]. How can medical be $2.1tr a year?
|
| ...turns out, it's $2.7tr!!! [2]
|
| [1]www.tradingeconomics.com
| [2]https://www.statista.com/study/15826/health-care-and-
| social-...
| vasco wrote:
| 20% https://www.cms.gov/Research-Statistics-Data-and-
| Systems/Sta....
| FredPret wrote:
| Absolutely bonkers. One of every five dollars goes to
| healthcare.
|
| To put this further into perspective: the US military
| budget is immense, as we know... and it clocks in at 3.7%
| of GDP [1]
|
| [1] https://www.statista.com/statistics/266892/military-
| expendit...
| philjohn wrote:
| To put it even further into perspective, that's 2x as
| much as comparable western nations with single-payer, who
| have similar or better outcomes in most cases.
| oblio wrote:
| Why do you think nobody important (politicians, primarily)
| is really trying to solve those major healthcare problems?
|
| If politicians are willing to pork and barrel over a random
| soy farm employing 2000 people, for sure they're not going
| to throw away, say, 5% of the US GDP and possibly 5% of all
| employment in the US.
|
| I don't know how you're going to get out of it...
|
| [1] "There were 22 million workers in the health care
| industry, one of the largest and fastest-growing sectors in
| the United States that accounts for 14% of all U.S.
| workers, according to the Census Bureau's 2019 American
| Community Survey (ACS)."
|
| https://www.census.gov/library/stories/2021/04/who-are-
| our-h...
| Spooky23 wrote:
| We have this health system to avoid taxes, but this crazy
| US system probably costs 97-98% of Americans pay more for
| health stuff than all of their actual taxes combined.
| lotsofpulp wrote:
| >that GPs in particular would be replaced by a lower-cost
| Watson descendant
|
| It is happening. They are called physician assistants and nurse
| practitioners, "supervised" by a doctor. I assume going
| forward, they will take more and more of the usual pink eye/ear
| infection/flu and other common work that does not require 6 to
| 8 years of post bachelor education.
| tryptophan wrote:
| It's happening because hospital corporations love them.
|
| Corps can pay less, and since they have a tenth of the
| education, they order tons of profitable tests, consults, and
| scans because they don't know otherwise.
| colinmhayes wrote:
| This is why insurances are moving toward capitated plans.
| Instead of paying for services provided health care
| providers get paid per patient they care for. That way the
| perverse incentive created by asymmetric information is
| removed.
| lotsofpulp wrote:
| I thought it was the opposite, that everything is moving
| towards value based payment, or at least it seems to be
| for government funded healthcare:
|
| https://www.chcs.org/its-not-just-risk-why-the-shift-to-
| valu...
| colinmhayes wrote:
| Well implemented capitated plans are value based. Value
| based just means there are incentives for better than
| expected health outcomes and disincentives for bad
| outcomes. If you have a non-value based capitated plan
| health care providers would reduce the quality of care,
| so value based strategies were implemented to ensure
| patients receive good care even though providing it costs
| money.
| lotsofpulp wrote:
| Oh, thanks for the clarification. I thought they were not
| compatible.
| plucas wrote:
| This is a mischaracterization of P.A.s (well, not the
| being-paid-less bit). Do you know any personally?
| jac241 wrote:
| It's a mischaracterization for PAs because doctors only
| have ~7.5x minimum more clinical training and not 10x,
| 15000 clinical hours (for med school + family medicine,
| the shortest residency program) vs 2000hrs. Ask any
| radiologist you know what they think about the imaging
| orders from NPs and PAs and that will give you your
| answer.
| SkyPuncher wrote:
| He's exaggerating significantly, but the core point is
| true. pAs and NPs will be the future of hospital care.
| RHSeeger wrote:
| It's worth noting that the higher tiers of nurses have at
| least a masters degree, and like more time working than a
| doctor spends in residency. They are highly trained/skilled
| professionals.
| jac241 wrote:
| I would guess that most people entering NP programs at
| this point have less than 3 years of work experience as a
| nurse, a job where you are not diagnosing, coming up with
| treatment plans, performing procedures or doing any other
| physician tasks.
|
| I don't know if 500hrs of shadowing after a 2yr part-time
| online only program that you don't need any nursing
| degree or experience to enter would count as highly
| trained or skilled. Here's a list of direct entry nursing
| masters programs - https://nursinglicensemap.com/nursing-
| degrees/masters-in-nur...
|
| Here's Johns Hopkins doctor of nursing practice program's
| curriculum -
| https://nursing.jhu.edu/academics/programs/doctoral/msn-
| dnp/... - where more than half of your classes are not
| medicine related and which requires an astounding 1000
| clinical hours and less than 10 credits a semester before
| you can call yourself "doctor". Most medical students
| will have 1000hrs after 3 months in 3rd year, where they
| will be expected to diagnose and come up with treatment
| plans vs just shadowing, and they still have 9 more
| months of 3rd year, 4th year, and a minimum of 3 more
| years in residency. Doctors will likely end up with a
| minimum of 15000 hours of training. The difference really
| is that large, and I feel bad for the patients and for
| the NPs who have no idea how deficient their education
| is. PAs have 2000hrs of clinical experience. Here's a
| chart - https://i.imgur.com/Cj5z4f8.jpg
| RHSeeger wrote:
| I didn't say that nurses have the same medical training
| as a doctor of medicine; just that they are highly
| trained professionals with a fair amount of experience.
| If you match the 3 years of residency with 3 years of
| working as a nurse (they're clearly not the same thing,
| but both are "experience" for the purposes of this
| discussion), a starting medical doctor has 2.5-3 more
| years of training/school/experience than a nurse
| practitioner. That's a lot; but it doesn't reduce the
| fact that the NP has a lot of training. The post I was
| replying too sounded like it was dismissing the amount of
| training/experience being a NP takes, and it bothered me.
| morpheuskafka wrote:
| Why are all the universities on board for this? All these
| midlevel degrees are devaluing their own medical schools.
| nradov wrote:
| Is there any evidence that patients of NPs actually have
| worse outcomes? Given the current physician shortage
| would it be better to wait to see one, or get an
| appointment with a NP right away?
| jac241 wrote:
| Many studies comparing NP and physician outcomes will
| have the NPs under supervision by physicians, which is
| ideally how they would be used, but in practice the true
| supervision level varies widely. I wouldn't see an NP for
| my care personally, and I doubt there are many physicians
| who would. The wait time to see primary care physicians
| is typically less than a week in most places and would be
| worth it. If you're experiencing something you feel is
| too serious to wait a week I would visit the ER (and make
| sure to ask to be seen by the physician also). It's your
| health. Personally I would only trust mine to the people
| who are the experts in their subjects, and not those who
| have less training and can switch between specialties
| without any additional training.
|
| I don't have anything against NPs when the supervision is
| close, but more and more doctors are put into positions
| where they are acting as liability sponges for de-facto
| independent NPs/PAs.
|
| Here are a few studies - (CRNA) We found an increased
| risk of adverse disposition in cases where the anesthesia
| provider was a nonanesthesiology professional.
| https://www.ncbi.nlm.nih.gov/pubmed/22305625
|
| Comparing urgent care visits between MD/DOs and
| Midlevels. Doctors saw more complicated patients,
| addressed more complaints and deprescribed more. https://
| link.springer.com/article/10.1007/s11606-021-06669-w
|
| NPs/PAs practicing in states with independent
| prescription authority were > 20 times more likely to
| overprescribe opioids than NPs/PAs in prescription-
| restricted states.
| https://pubmed.ncbi.nlm.nih.gov/32333312/
|
| Both 30-day mortality rate and mortality rate after
| complications (failure-to-rescue) were lower when
| anesthesiologists directed anesthesia care.
| https://pubmed.ncbi.nlm.nih.gov/10861159/
|
| Compared with dermatologists, PAs performed more skin
| biopsies per case of skin cancer diagnosed and diagnosed
| fewer melanomas in situ, suggesting that the diagnostic
| accuracy of PAs may be lower than that of dermatologists.
| https://www.ncbi.nlm.nih.gov/pubmed/29710082
|
| Advanced practice clinicians are associated with more
| imaging services than PCPs for similar patients during
| E&M office visits. https://jamanetwork.com/journals/jamai
| nternalmedicine/fullar...
|
| Nonphysician clinicians were more likely to prescribe
| antibiotics than practicing physicians in outpatient
| settings, and resident physicians were less likely to
| prescribe antibiotics.
| https://www.ncbi.nlm.nih.gov/pubmed/15922696
|
| The quality of referrals to an academic medical center
| was higher for physicians than for NPs and PAs regarding
| the clarity of the referral question, understanding of
| pathophysiology, and adequate prereferral evaluation and
| documentation. https://www.mayoclinicproceedings.org/arti
| cle/S0025-6196(13)...
|
| Resident teams are economically more efficient than MLP
| teams and have higher patient satisfaction.
| https://www.ncbi.nlm.nih.gov/m/pubmed/26217425/
| RHSeeger wrote:
| My expectation is that the outcomes would be similar for
| the common issues, and would start to deviate as you got
| into more uncommon problems. A doctor will have a lot
| more "background knowledge" to be able to consider things
| that are outside the every day. At least in my mind, it's
| not unlike someone in software development with a degree
| in it vs not. For most things, the person without a
| degree will do a fine job; but for some things, they
| won't be able to consider many of the possible
| options/tools, because they just haven't been exposed to
| them.
| lotsofpulp wrote:
| >Corps can pay less, and since they have a tenth of the
| education, they order tons of profitable tests, consults,
| and scans because they don't know otherwise.
|
| Hence the purpose of managed care organizations (MCOs,
| health insurance companies) employing people to approve and
| deny (or design systems that approve or deny) payment for
| unnecessary tests, consults, and scans. And in a taxpayer
| funded system, the government employs people to performs
| the same roles.
| goodells wrote:
| Yep. The midlevels are supported by automatic protocols in
| Epic (e.g. sepsis, DKA -> put these dozens of orders in with
| 5 clicks) that physicians decide on and approve. They also
| rely more heavily on imaging instead of a physical exam and
| history. When unsure, they can consult a physician, even a
| specialist.
|
| It's a very polarizing topic in medicine that patients
| generally aren't privy to. Especially for resident physicians
| who often make half as much as these midlevels yet have more
| education, there's a lot of bitterness. The federal
| government is ultimately to blame... having a fixed number of
| residency spots to artificially limit the supply of new
| physicians is terrible, and this is the predictable result.
|
| I think hospitals support inefficient midlevels because they
| can bill patients for the increased resource usage, but it's
| not good for the system overall when unnecessary scans and
| consults are done, and more complex patients don't get
| comprehensive care. Many foresee a two-tiered system
| developing, where the rich see physicians, and the poor see
| midlevels.
| nradov wrote:
| A two tiered system might actually be better for improving
| access to affordable health. Mid-level providers seem to
| achieve equivalent outcomes for routine cases at lower
| cost.
|
| I agree that Congress should increase funding for residency
| programs.
|
| https://www.ama-assn.org/education/gme-funding/ama-seeks-
| mor...
| goodells wrote:
| I generally dismiss these "equivalent outcome" studies.
| Any midlevel will (and should) bounce the more
| complicated cases to their supervising physicians.
| Outcomes at that point are meaningless.
|
| There's definitely a trade off between resources devoted
| to education vs. acceptable risks from failed procedures,
| missed/delayed diagnoses, and increased utilization of
| imaging and referrals (and the physician radiologists and
| others who participate in that - it goes full circle).
| Physicians now are probably on one extreme end of that,
| and midlevels on the other.
|
| On the topic of servicing rural areas... the problem is
| that nobody with better options (which includes
| midlevels) wants to live in these places. These educated,
| high-earning people want to live in urban areas, and they
| can. CMS has tried to incentivize this with billing by
| offering higher reimbursement rates to rural places that
| have a midlevel on staff. That's about it, though.
| mlyle wrote:
| > I generally dismiss these "equivalent outcome" studies.
| Any midlevel will (and should) bounce the more
| complicated cases to their supervising physicians.
| Outcomes at that point are meaningless.
|
| If midlevels can successfully detect complicated cases to
| a supervising physician, and handle a whole lot of other
| care independently... and the net result is equivalent
| outcomes... this isn't a massive win? You've conserved
| the really expensive and contended resource for where
| it's needed and not made anything worse...
| goodells wrote:
| It's not so clear cut for a few reasons.
|
| #1 - Funky/misleading statistics - Generally they claim
| that these NPs with uncomplicated patients do as well as
| physicians with complicated patients. It's not claiming
| that of any randomly selected patient, regardless of who
| they see, the outcome is the same. Therefore, if
| uncomplicated patients saw physicians, outcomes for the
| physicians could improve. In primary care managing
| hypertension or diabetes, this isn't as pertinent. For
| something like anesthesiology, it's more so counting how
| many times shit hits the fan, and brain cells die when
| the anesthesiologist takes time to be summoned.
|
| #2 - They're not conserving expensive resources. Imagine
| a patient comes in with a lump on their hand. An NP might
| see a weird lump, order an MRI which gets read by a
| radiologist, refer to an orthopedic surgeon who
| specializes in the hand, who removes tissue to send to a
| pathologist, who determines it's a common benign tumor of
| the fascia. That's three physicians who spent much more
| time here! The patient no longer has use of their
| interphalangeal joints. The physician would probably try
| to shine a light through it, note the patient's
| Scandinavian ancestry and family history of plantar
| fasciitis, and tell them to live with it and come back if
| it changes.
|
| No resources were saved here, but the patient's DASH
| score (disability of the arm, shoulder, and hand) is
| still 0 so the outcomes are the same.
|
| This happens all the time.
|
| #3 - Bad incentives - Medicaid would not in a million
| years cover this, but the game of medical pinball where
| patients bounce around through in-network referrals can
| funnel those with decent insurance into procedures.
| Especially when most people have poor health literacy. A
| hospital executive probably just splooged in his pants
| seeing how much money their loss-leader of primary care
| is driving to radiology and the surgical specialties
| where they actually make money.
|
| #4 - It's insincere. All of this can be viewed as
| possibly successful when the midlevels are part of the
| healthcare _team_ and know their limitations. But the NP
| groups are increasingly pushing for independent practice
| and prescribing rights in state legislatures across the
| country. CRNAs require a physician supervisor... in many
| places, that doesn't necessarily need to be an
| anesthesiologist, and the surgeon performing the
| procedure can suffice. The AANA recently changed its name
| to the "American Association of Nurse Anesthesiology"...
| It used to be "Anesthetists". The CEO and president (two
| different people) of the American Nurses Association both
| refer to themselves as "Doctor" in a healthcare setting
| even though one holds a DNP and the other a PhD. It's
| pervasive.
| lotsofpulp wrote:
| > the problem is that nobody with better options (which
| includes midlevels) wants to live in these places.
|
| Or the problem is that people are not offered enough
| money to make the sacrifices they would make by living in
| rural places.
| itg wrote:
| I'm having a hard time understanding why they would be
| bitter. Residency is temporary and a part of the training
| process. Once completed, doctors will make 2x-3x+ compared
| to midlevels for the rest of their careers.
| goodells wrote:
| Residency has a lot of problems. The match is stressful
| enough. Medical school graduates carry a huge amount of
| debt, but must complete residency before earning enough
| to meaningfully pay it off. Residencies pay 40-85k and
| most resident physicians are expected to work 80+ hours
| per week. 80 is the theoretical maximum, but that doesn't
| count time arranging work, studying, taking board exams,
| etc.
|
| All this, and if you don't complete your residency, you
| have no prosperous future as a doctor. You might re-match
| to another residency if you're very lucky. The hospitals
| know this and act accordingly. Residents and even medical
| students paying tuition (!) were assigned to treat COVID
| patients and couldn't really decline without risking the
| future they're heavily invested in.
|
| Keep in mind, the federal government pays ~150k per year
| to the hospital for having the resident. Yet the
| residents are often more indentured workhorses than
| trainees. It's not uncommon for entire departments to run
| overnight with only residents, but no attending
| physicians.
|
| Now imagine being in this situation, and not being
| allowed into the "providers lounge" because you're a
| resident. Or using a broad-spectrum antibiotic instead of
| something more specific and being scolded for poor
| antibiotic stewardship, while the NP who has "completed
| their training" can't even properly decide antibiotics
| are indicated some of the time. And if that NP were ever
| treated the way a resident is, they could go get a job at
| the hospital on the other side of town and start in a
| week.
| rcpt wrote:
| You can read r/noctor if you want examples
| lotsofpulp wrote:
| Because the future is for doctors to not make 3x compared
| to them. The mid levels are being used to increase supply
| of healthcare, using the doctor's license for liability,
| in order to reduce the price doctors collect (per unit of
| time and effort).
|
| Basically, they are watching their expected wealth /
| purchasing power be reduced.
| jac241 wrote:
| If someone was making more than twice as much as you,
| working half as many hours as you, seeing half as many
| patients as you, and were less qualified for their
| similar role, you would be upset too.
| lotsofpulp wrote:
| >Many foresee a two-tiered system developing, where the
| rich see physicians, and the poor see midlevels.
|
| There already was a tiered system, with rich people being
| able to buy concierge medicine and getting preferred
| treatment based on who knows who on the hospital's board or
| if their name is on a wing of the hospital.
|
| The change now is a more visible and more granular price
| segmentation.
| jac241 wrote:
| There's no price segmentation. You pay the same for a
| visit with a PA or NP as for one with a physician, so why
| see someone with less than a tenth the experience who may
| have gone to an online only school with 100% acceptance
| rate and shadowed for 500hrs of "clinical experience"
| right out of nursing school?
| lotsofpulp wrote:
| It will happen via in network and out of network
| agreements.
|
| Healthcare providers with greater proportion of NP/PA
| will be selling for cheaper, so MCO will sell access to
| only them in their lower price plans, and healthcare
| providers where you get to see doctors will be in higher
| price plans.
|
| This already happens, especially with many healthcare
| providers not accepting lower reimbursed Medicaid
| patients.
| cube00 wrote:
| _> But GPs often make astounding amounts of money while leaning
| heavily on their staff to actually handle patients and keep the
| business running._
|
| The private ones might the ones in the public system at least
| in my country need to see a patient every 10 minutes to keep
| their heads above water.
| james-redwood wrote:
| This is more or less the case in many European countries.
| Less so here in the UK, but approaching there rather quickly
| due to astoundingly poor management by various successive
| governments. It's tough back in South Africa as well, and
| they pay their doctors extraordinarily well.
| nradclif wrote:
| What country are you from, if you don't mind me asking?
| InvertedRhodium wrote:
| I'm in New Zealand and it's not too far from what was
| described.
| kilburn wrote:
| I'm from Spain and my wife is a family doctor. It really is
| like that here too.
| flipchart wrote:
| I've heard Canada is like that. I've had similar experience
| in South Africa, even in private health care, but I
| definitely had the impression that my doctor somewhat cared
| about me, especially after going to them for a few years
| herval wrote:
| > what made that guy a doctor was bedside manner + being able
| to remember a lot of things
|
| That sounds like a lot of professions, engineering management
| included :-)
| dukeofdoom wrote:
| Bribing politicians is far more profitable. Never thought my
| own prime minster would become a pfizer sales rep...but here we
| are.
| Brybry wrote:
| The American medical system is truly bizarre.
|
| I've been to private practices where every day at lunch or near
| end of day there would be some drug rep with food for all the
| staff.
|
| And a psychiatrist that had stacks of free samples of drugs.
|
| Even contact lenses are marketed with free samples.
| Scoundreller wrote:
| > Even contact lenses are marketed with free samples.
|
| I mean, yeah? If a shoe company required you to buy a shoe
| before trying it on without free returns, the shoe may as
| well not exist.
| listenallyall wrote:
| Everyone talks about the relationship between drug reps and
| doctors like it's the most incestuous, evil, corrupt thing.
| How else are doctors, especially those who are 10, 20 years
| removed from their residency, supposed to learn about new
| treatments and medicines? Alexa, what is best current
| treatment for a duodenal ulcer? You think a doctor is going
| to spend his limited downtime perusing the PDR (which no
| longer exists, and was always heavily influenced by the drug
| manufacturers anyway)?
|
| Sure, there may be some excesses (although the truly major
| perks like entire vacations dressed up as a "conference" no
| longer exist), but I would _much_ rather have doctors be
| aware of new drugs and yes, subject to marketing pitches,
| than have these drugs languish (eventually leading to drugs
| not being created) because nobody knows about them.
| afandian wrote:
| Is there no continuing training throughout the career of a
| doctor? And if not, how are they qualified to evaluate the
| claims of a sales rep?
| Jabbles wrote:
| Scrubs covers this:
| https://www.youtube.com/watch?v=JVTWoPeMWSQ
| rafale wrote:
| It's their responsibility to stay up-to-date. If a dev can
| keep up with front end tech stacks, doctors, who are much
| more elite in their education, should keep track of latest
| treatment breakthroughs in their domain of expertise.
| divbzero wrote:
| Continuing medical education not only a responsibility
| but also a requirement to maintain a medical license in
| many states ( _e.g._ California [1]).
|
| [1]: https://www.mbc.ca.gov/Licensing/Physicians-and-
| Surgeons/Ren...
| listenallyall wrote:
| Take a look at what that actually entails. Inexpensive
| online courses with guaranteed passing exams, many of
| which have zero to do with actually treating sick people
| -- Secondhand Smoke. Medical Ethics. Herbal Medicine
| Review.
|
| Even if a practitioner took it seriously and wanted to
| get a real education about actual medical issues, they
| aren't going to find coverage of brand new drugs in an
| educational setting unless it was arranged by the drug
| companies themselves.
|
| https://www.netce.com/specials.php?productid=MD22X,MDSUB
| listenallyall wrote:
| First of all, the vast majority of devs do NOT stay "up
| to date." Most know one language or even just one
| platform... i.e. "WordPress developer" or "Oracle admin".
| Secondly, how do you think YOU hear about new
| technologies... usually due to marketing. Did React just
| come out of nowhere? No, Facebook marketed it
| relentlessly. Did people discover Kotlin on their own?
| No, JetBrains and Google hit people over the head with
| it. Etc, etc
| nextaccountic wrote:
| > How else are doctors, especially those who are 10, 20
| years removed from their residency, supposed to learn about
| new treatments and medicines?
|
| With some other mechanism that doesn't have major conflicts
| of interest? Like, I don't know, attending to actual
| courses, like any other profession that requires continuing
| training.
| colinmhayes wrote:
| In Illinois Doctors have to go to a one week conference
| every year that is supposed to talk about this stuff. They
| also have to take board exams every few years that make
| sure they're staying caught up on new advances.
| listenallyall wrote:
| It's 60 hours every 3 years, of which webinars are
| acceptable, and no records need to be submitted with the
| renewal application. There are no tests or exams. The
| "new advances" they must keep up on include Sexual
| Harassment Prevention and Implicit Bias.
|
| https://www.isms.org/CME/Medical-License/License-
| Requirement...
| [deleted]
| austinjp wrote:
| Part of the job, as stipulated by medical regulators around
| the world, is keeping up-to-date with evidence. This can be
| achieved by reading journals and attending conferences, in
| theory.
|
| But.... journal publishers exploit their monopolies, and
| conferences are funded by corporate sponsors. So perhaps
| they're not so different.
| listenallyall wrote:
| Medical conferences basically would not exist if it
| wasn't for suppliers and drug companies paying for
| sponsorships, trade show booths, opportunities to speak,
| etc. Not really any different than any industry's trade
| conferences.
| throwawayboise wrote:
| Sounds just like every technology conference I've ever
| been to. A bunch of software and hardware vendor booths,
| and most of the speakers being authors hawking their
| latest books.
| cosmodisk wrote:
| I used to see this in our country, where 10 people are
| queueing outside doc's office ( this is public health system)
| when some well dressed man goes straight into the office not
| even bothering to ask if there's anyone in there and fast
| forward a few min and the doctor is 'on break', whilst
| drinking coffee with the sales rep, while all those people
| sit and wait. Eventually it got outlawed.
| PragmaticPulp wrote:
| > My mom worked for a GP for about 20 years, and it seemed to
| me that most of what made that guy a doctor was bedside manner
| + being able to remember a lot of things.
|
| That's exactly right, but there's nothing wrong with that.
|
| A good doctor's memory of patients spanning decades of a career
| and all of the various treatments that they did or did not
| respond to is very valuable. It's a good thing that they
| offload as much as possible to other people so they can focus
| on doing what they do best.
| geofft wrote:
| I think the comment above, most charitably read, is that a
| lot more people would have access to high-quality healthcare
| if you could put this work on robots instead of people,
| because computers excel at storing data and looking it up
| accurately and following predetermined rules. There would be
| fewer cases of people going to their doctor and being told
| "oh, it's nothing" when it actually is a specific, rare, and
| urgent problem. And then they would end up going to a human
| specialist to figure out how to fix that problem.
| kijin wrote:
| > _there wouldn 't be any point in the pharma companies sending
| out salespeople to do lunch seminars to convince the GPs to
| prescribe this or that drug_
|
| Right, but there would be a lot of point in making deals with
| whoever builds Watson-like devices, to turn them ever-so-
| slightly more likely to prescribe one drug over another or make
| one diagnosis over another. It might even be cheaper than
| hiring and sending out a bunch of salespeople.
| Aeolun wrote:
| > GPs often make astounding amounts of money while leaning
| heavily on their staff to actually handle patients and keep the
| business running
|
| I've seen this in Japan (ish), but in the Netherlands it's
| definitely the GP's doing most of the job. The assistant just
| does bookings and waves me in when it's my turn.
| 0xbadcafebee wrote:
| Medicine is a business. Its incentive is profit, not patient
| outcome. Everybody knows the problems with medicine and the
| solutions are straightforward. But they don't result in more
| profits, only better patient outcomes. So you only get advances
| when it increases profit.
|
| Come up with a way for better patient outcomes to result in
| higher profits and you'll see advances in patient care real
| damn fast.
| jac241 wrote:
| Please list some of the solutions, because from where I am
| (actually in a hospital) all I see are people who care about
| patient outcomes.
| 0xbadcafebee wrote:
| 1. Stop charging so much. People aren't seeking treatment
| because they're afraid of the bills.
|
| I have other solutions, but there's no point in listing
| them because nobody will implement them (for the same
| reason that one won't be: profits over patients)
| snarf21 wrote:
| There is no need to market to Doctors now when they market
| directly to consumers who go demand they get the new medicine.
|
| If we want to reduce costs, we need to move to lower level
| providers like a LPN or CRNP. Most people coming into a GP have
| the flu or an ear infection or .... and that can be handled by
| them. There will be one MD and to handle complicated cases and
| to supervise. We've already switched so that intake is done by
| CNA making $15/hour. In the US at least working at FAANG pays
| far more than being a GP.
| chromatin wrote:
| _> In the US at least working at FAANG pays far more than
| being a GP._
|
| Not just FAANG, either.
|
| The assertion by grandparent poster that GPs are
| "astoundingly" well paid is bonkers.
| jbullock35 wrote:
| "Astoundingly" is vague.
|
| According to the Bureau of Labor Statistics, the mean
| salary of "family and general practitioners" in May 2020
| was $214,370 [1]. This figure includes salaries from GPs
| throughout the country (i.e., not just in the Bay Area).
|
| You can also look at median salaries. According to the BLS,
| all ten of the occupations with the highest median incomes
| in the U.S. are medical occupations [2]. "Family medicine
| physicians" are 10th on this list.
|
| [1] https://www.bls.gov/ooh/healthcare/physicians-and-
| surgeons.h...
|
| [2] https://www.bls.gov/ooh/highest-paying.htm
| snarf21 wrote:
| Additionally, a GP has med school plus residency. A
| Stanford CS grad will start higher than most GPs with only
| a bachelors degree.
| erosenbe0 wrote:
| Mediocre GP makes 200k cash in Omaha or any average city
| and has choice among many employers and systems. Stanford
| CS represents top talent and moreover does not make 200k
| cash in Omaha, and can only make the big bucks at a fixed
| number of entities in fixed locations with fixed
| hierarchies and systems.
| ako wrote:
| A freelance GP (waarnemend huisarts) in the Netherlands
| makes on average 65 euros per hour... It pays better to
| be a freelance software engineer. Less education
| required, less responsibilities, impact of mistakes is
| also usually less.
| erosenbe0 wrote:
| USA has an extremely inefficient system of training for
| doctors which wastes literally years of human potential.
| First you go to university from 18-22 but not even 2/3rds
| of the year. The rest of the year is some level of waste
| for most students. You often purposefully dumb down and
| study less rigorous subjects than an engineer because you
| need all top grades to be get into medical school and
| can't risk it. Then medical school is an excessively long
| four years which has further periods of time waste and a
| lack of integral training until late in the process. Then
| there is a highly unfocused three year residency with
| what are widely understood as illegal discriminatory
| labor requirements holding on to their anachronistic 1910
| white-male origins by a proverbial thread. So at age 29
| you can finally be a GP after many unnecessary years of
| wasteful, repetitive, unfocused study, vacations and
| debt. This exclusivity and opportunity hoarding results
| in a reasonably high skill at a very very unnecessary
| level of cost and personnel shortages.
| ako wrote:
| Dutch system is quite similar: 3 years bachelor, 3 years
| masters, including 18 months coschappen (residency), and
| then 3 years of specialization to GP (other
| specializations take longer).
| (https://universitaire.bachelors.nl/faq/ik-wil-dokter-
| worden/)
|
| Many specializations come with very low job
| opportunities, being a GP is very stressfull: low paid
| assembly line type of work, a GP is expected to see 6
| patient per hour, do home visits, follow up with patients
| and hospitals, and run a practice, manage employees,
| follow lots of trainings, etc. Having your own practice
| as a GP is not very popular any more, a lot of GP just
| want to freelance part time, not having the additional
| stress of running a practice.
| erosenbe0 wrote:
| Reimbursement for GP services in the USA runs
| $150-$300/hour depending on whether you are seeing
| elderly patients or people on employment plans, and a
| doctor will see about half that, plus or minus depending
| on the setup. Hence $200k per year if a doctor sees about
| 6 or 7 hours of patients plus a few hours of paperwork,
| calls, and emails 5 days a week.
| vasili111 wrote:
| AI cannot replace doctors. It can help doctors a lot but not
| replace.
| colinmhayes wrote:
| Of course AI could replace doctors. Some people will always
| prefer the bedside manner a person provides, but many others
| won't care, and AI will eventually do a good job at imitating
| a good doctor's bedside manner.
| Firmwarrior wrote:
| The only way AI is going to replace doctors is if medical
| technology advances to the point where you can repair a
| human as well as you can repair a machine (or someone
| invents AGI, I guess)
|
| There are just too many unknowns and fiddly things going on
| with human bodies
|
| edit: Haha, I guess Tex's sibling comment makes a good
| point though..
| telxosser wrote:
| Machine learning could beat my doctor right now. "Using
| Random Forest Algorithm for Breast Cancer Diagnosis"
| https://ieeexplore.ieee.org/document/8644835
|
| Most of what the doctor is doing is a type of modern
| shamanism though. Person doesn't feel good, so the doctor
| orders a useless test, test comes back negative so the
| person feels better. Then we complain health care cost too
| much.
|
| 10 full blood panel samples a year with other bio-metric
| data and a data set of 20 million people to do
| classification on would crush the doctor over time.
|
| This bullshit health system though makes it impossible to
| have any real innovation at a mass scale. We will never
| have personal higher frequency medical data in my lifetime
| that would actually hugely improve the system and cut most
| of the cost out.
| jac241 wrote:
| The hard part in medicine isn't diagnosis and it's not
| performing the surgeries, it's disease prevention, it's
| working with patients to find treatment plans they can
| tolerate, and it's coordinating all of the moving parts
| (skilled nursing facilities, pharmacies, inpatient rehab
| facilities, outpatient rehab facilities, durable medical
| equipment, home health care, insurance companies) to
| deliver care that results in a good outcome. Where
| hospital care falls apart is when labs/tests don't get
| performed in a timely manner and when
| protocols/standardized treatments aren't followed. You
| don't need AI to make that work, you need wider adoption
| of checklists with workflows that are efficient enough to
| continue to deliver care to the same amount of people
| while they're being implemented so that hospitals are
| willing to adopt them. The diseases that can be
| effectively caught with screening tests - colon cancer,
| cervical cancer, breast cancer, lung cancer in high risk
| patients, abdominal aortic aneurysms, hyperlipidemia,
| hypertension, depression, etc. - already have screening
| programs in place.
|
| Every dollar spent coming up with the next automated
| imaging diagnosis model would be better spent on a model
| that encourages people to get up and exercise 5x/week,
| quit smoking (or never start), and get their colonoscopy.
| Once the patient is presenting to the doctor with heart
| failure, coronary artery disease, carotid stenosis, COPD,
| colon cancer, etc. the battle is already lost.
|
| Complain all you want about the healthcare system holding
| data back. You don't need the healthcare system to make
| the biggest impact on people's health.
|
| --- I'll add that your shamanism comment sounds like the
| typical bs that the 20-something software engineer, who
| thinks they know everything because they make more than
| 100k a year and have never had to go to a doctor for
| anything other than strep throat or generalized anxiety
| disorder let alone spent anytime in a hospital other than
| to visit family members, that are everywhere on this site
| loves to say about physicians or other healthcare workers
| to shit on them.
| Aeolun wrote:
| That just means we need a general artificial intelligence to
| do it. We don't have those now, but I wouldn't say never.
| throwthere wrote:
| Yeah like most businesses the owner his staff to help out. I'm
| curious what you think GPs actually make, because in the US
| it's not astronomical. Watson went after the wrong problem--
| doctors don't comprise huge amounts of healthcare spending.
| It's a recurring issue, tech thinks they have a solution and in
| reality the devs don't have a good grasp on the actual
| landscape they're playing in.
| ricardobayes wrote:
| I thought the same, but as I grow older, I believe people would
| reject this. Even a subpar human GP would be much more accepted
| than a computer. That's not necessarily true in some societies
| though, e.g. Japan probably would accept it. That said, I would
| probably focus on fixing the system first in a way that a
| significant percent of population doesn't need to order fish
| medicine off amazon to get treatment.
| Bombthecat wrote:
| I'm not so sure, sure the first generation might throw a
| tantrum, but the next generation will a accept it... Much
| like cars or trains..
| Scoundreller wrote:
| > I thought the same, but as I grow older, I believe people
| would reject this.
|
| At some point, the (possibly subpar) GP will be a costlier
| decision (whether in dollars/time/frustration).
|
| Just like grocery stores having 10 self-checkouts and 1
| cashier.
| CodeGlitch wrote:
| I wouldn't mind seeing a computer first before a GP. A lot of
| the time a GP will say something like "here try these tablets
| and come back in a week". The true worth of a GP is the
| follow-up appointments and understanding conditions over
| time.
| throwawayboise wrote:
| I mean, I won't even use the self-service kiosk at McDonald's.
| I sure as hell am not going to interact with a computer for my
| medical care.
| chromatin wrote:
| _> I really expected that we 'd see a change in my lifetime,
| that GPs in particular would be replaced by a lower-cost Watson
| descendant, with there being some other role for patient
| interaction, wet work, and data entry (perhaps just nurses)._
|
| Perhaps this indicates a major gap in your visibility into and
| understanding of modern medical practice?
|
| _> My mom worked for a GP for about 20 years, and it seemed to
| me that most of what made that guy a doctor was bedside manner
| + being able to remember a lot of things._
|
| "being able to remember a lot of things" -- Yes, absolutely.
| This is an area where AI-assisted decision support (like
| Watson) could be, and I hope will be, extremely valuable.
|
| OTOH, you also rightly recognize bedside manner -- as anyone
| who has been a patient or a patient's family caregiver will
| attest, this is an essential component of core, and I think
| likely also the healing process. We won't get this from a
| machine until there is a true general purpose AI, at which
| point I expect an AI singularity anyway.
|
| But consider that there are other factors of the practice of
| general medicine that you haven't even touched upon. For
| example, liability: In the office you envision, where Watson/AI
| makes medical decisions and these are executed by other roles
| like nursing, where does ultimate responsibility (and legal
| liability) lie? Remember that Watson outputs probabilities --
| suppose the following:
|
| Chance of disease X: 89% Chance of disease Y: 10% Chance of
| disease Z: 1%
|
| If disease X, intervention A has an 80% probability of success.
| However, if disease Y, intervention A has an 80% probability of
| harm.
|
| (before you object that this is contrived, this represents a
| realistic situation I encountered recently, where intervention
| A is high dose steroids)
|
| Now, will we put the onus on the patient to select an
| intervention? I don't think that would be very popular. While I
| certainly do not advocate paternalism, when faced with
| difficult decisions quite many people openly defer to their
| physician.
|
| _> But GPs often make astounding amounts of money_
|
| I suppose this could be true for some definitions of
| "astounding," but it's generally accepted that GP/"primary care
| physician" pay is essentially the lowest of all specialties ,
| which is a major contributor to lack of access to primary care
| in industrialized countries (while you'll not have a hard time
| finding a private pay dermatologist, for instance)
|
| ANd on top of this, we are posting on HN where a mid level
| software engineer total comp can EASILY outpace the average US
| primary care physician salary.
|
| _> while leaning heavily on their staff to actually handle
| patients and keep the business running._
|
| Do not all professionals and business executives rely on highly
| trained staff as force multipliers? This is a fundamental
| principle of the advancement of human economies. It is grossly
| inefficient to operate with individuals as "jack of all trades"
| when they can instead each become specialized to support a
| bigger or broader goal.
|
| By "leaning heavily on their staff to actually handle patients
| and keep the business running" are you suggesting that the
| primary care physician should be performing check-in, insurance
| verification, rooming, vitals measurement, blood draw,
| medication administration etc? That is a certain recipe for
| massively decreased throughput and shortages/decreased access
| to primary care.
|
| _> I thought it could help drugs get a little cheaper too,
| because there wouldn 't be any point in the pharma companies
| sending out salespeople to do lunch seminars to convince the
| GPs to prescribe this or that drug (this still happens)._
|
| This has been massively curtailed for 20+ years, at least in
| the US. I am not sure about other countries. But overall I
| think this is a seriously minor portion of the (exorbitant)
| price of medications in industrialized countries.
|
| In any case, I doubt it would make much of an impact on
| utilization in most contexts, as insurance/health
| plans/prescription benefits have already implemented fairly
| strict guidelines-based formularies and coverage tiers (again,
| at least in the US -- I can't speak to other industrialized
| countries, although I expect they are similar or even more
| strict)
|
| (edit: another poster points out all the direct to consumder
| drug advertising -- I agree - this probably has a much bigger
| influence in 2022; ad budgets are absolutely insance)
|
| _> Maybe this will still happen, but it doesn 't seem imminent
| anymore._
|
| Here we agree. I am certain we'll see AI-assisted physician
| decision support, but (a) the physician won't go away and (b) I
| think it'll be an unfortunately long ways in the future.
| crispyambulance wrote:
| > most of what made that guy a doctor was bedside manner +
| being able to remember a lot of things.
|
| Sure, that, and recognizing patterns and adjusting medication
| and being able to use good judgement for when to escalate to a
| referral for a specialist. But that's a lot!
|
| I actually go to a teaching hospital for my primary care. It
| means I get seen by residents, and almost always also by very
| experienced teaching doctors. It ends up meaning that I get
| more time and attention by people who are actively learning and
| trying hard to do the right thing. The trade-off is there's no
| long-term trust relationship, but I am OK with that. I've also
| experienced care from elderly family doctors who run a "one-
| man-band" with a nurse and a receptionist, they're nice but I
| think I get better care at a teaching hospital.
| hiptobecubic wrote:
| I thought we'd have banned Dr lobbying by now, even without a
| technological revolution.
| jac241 wrote:
| I thought we'd have banned software engineer lobbying by now,
| look how much harm they're causing -
| https://www.healthline.com/health-news/social-media-use-
| incr...
| bigbillheck wrote:
| We haven't banned other kinds of lobbying, why would doctors
| be different?
| robotresearcher wrote:
| Someone should persuade governments to ban lobbying. But who?
| lumost wrote:
| Anecdotally, the main business value I've seen from ML/AI tech
| has been in cases where
|
| 1. A basic solution shipped and made a ton of money e.g. Ads,
| Search, recommendations etc.
|
| 2. It is financially feasible to have a dedicated team(s) make
| small incremental progress on these solutions. Even very small
| gains are beneficial.
|
| 3. The business perceives a threat if they fall behind in this
| area.
|
| The thing is that the gains on the basic solution (heuristics,
| off the shelf pre-trained CV model, open voice recognition) are
| pretty small, and if the threat of others making progress goes
| away - the inferred value of further investment will probably
| vanish as well.
|
| Other applications which put the AI in the driver's seat
| (sometimes literally) seem far from production - or if they do
| work, then they work reasonably well using an alternate approach
| from what you might expect.
| wslh wrote:
| I am aware that a friend's very small company related to
| NLP/NLU[1] beat IBM in a sale because the algorithms worked
| better than the Watson ones what seems incredible in two things:
| beating them at sales and technologically.
|
| [1] https://natural.do/en/
| boboche wrote:
| IBM is such a shadow of what it used to be. Hopefully newer
| health+genomic+ai startups or initiatives at less dinosauresques
| companies will make the next leap happen in our lifetime.
| shane_b wrote:
| Currently they have one of the only if not the only enterprise
| permissioned blockchain project called fabric and it's open
| source.
|
| I could see them making a comeback with crypto but not the way
| we think about it today. Instead, inter-enterprise operations
| infrastructure.
| lotsofpulp wrote:
| Based on their lack of competitive pay, I assume IBM does or
| will end up competing with TCS, Cognizant, Infosys, etc.
| sadwings wrote:
| > one of the only if not the only enterprise "permissioned"
| blockchain projects
|
| Not quite, check out Corda's R3 project - it's already being
| widely used in enterprise and projects are being built on top
| of it.
| shane_b wrote:
| Good to know, thank you.
| beckingz wrote:
| I attended a talk a few years ago given by one of the
| blockchain VPs at IBM.
|
| It turned out that under the hood they were just using
| conventional distributed database technology. All marketing
| in order to get multiple companies to work together on shared
| systems.
| shane_b wrote:
| I believe it. There's value in shared systems but not
| necessarily a special data store.
| spookthesunset wrote:
| The problem with "blockchain" is it is a textbook example of
| a solution in search of a problem.
| shane_b wrote:
| I agree when thinking about building software in one org
| where there is coordination. When expanding to multi org
| and international, the problems to solve become much
| clearer imo.
| AlexandrB wrote:
| What is the use case for this technology? If it's
| permissioned, it might as well be a normal database with the
| "append-only" setting enabled.
| shane_b wrote:
| HyperLedger Fabric docs have an example of a manufacturer,
| vendor and short term finance provider all on the same
| network with transactions happening instantaneously. Then
| when you look into case studies, Honeywell has an airplane
| parts marketplace that's apparently streamlined their sales
| process. I've seen some Upwork contractors demoing medical
| data platforms. I didn't understand that one as much.
| tomrod wrote:
| Federated, hashed data stores in zero-trust environments is
| one (though this isn't the best or only way to approach it,
| and blockchain is almost always unneeded), where you don't
| want to share the underlying data but want to provide
| enough information to support reporting requirements.
| Public health, taxation, etc. come to mind.
| funstuff007 wrote:
| What happens to all the people they paid up for the hire at the
| slick Astor Place office?
|
| https://www.businessinsider.com/ibm-watson-office-tour-2016-...
| draw_down wrote:
| pb060 wrote:
| Wish they had resumed IBM Chef Watson, it was completely useless
| and the exotic ingredients made the recipes impossible to
| prepare, but for a while it was my favorite procrastination
| activity
| amelius wrote:
| Did they sell their contracts for collecting patient data as
| well?
| transfire wrote:
| The only real business problem is they didn't program Watson to
| do what the Healthcare industry actually wants -- make more
| $$$$$. The last thing they want is a computer that can actually
| diagnose people and provide effective solutions.
| tomrod wrote:
| > The last thing they want is a computer that can actually
| diagnose people and provide effective solutions.
|
| Intimately knowing the non-profit side of the healthcare system
| as well as the construction and operation of data science
| systems, I wholeheartedly disagree with your assertion and your
| conclusion as being a general takeaway.
| stillworks wrote:
| Can you possibly provide some objective comments on why that
| comment may be incorrect ?
| tomrod wrote:
| Here is a submarine Wired article on what Watson promoters
| expected it to do -- which supports what the parent
| commenter thought, the focus being on "bottom-line":
| https://www.wired.com/insights/2015/02/what-can-watson-do-
| fo...
|
| Here is insight into how non-profit and community health
| programs are funded:
| https://www.parklandhospital.com/financial-summary
|
| Here is a section of Healthcare new dedicated to AI/ML
| implementations and other related events:
| https://www.healthcareitnews.com/topics/artificial-
| intellige...
|
| Here is CMS's directive for hospital price transparency:
| https://www.cms.gov/hospital-price-transparency
|
| The parent comment assumed that everything in healthcare is
| profit-motive driven. However, there are large portions of
| the healthcare industry that are non-profit, that are
| transparent in their funding and their costs, and that are
| looking to implement AI to improve healthcare outcomes.
| Parkland Health and Hospital System, Harris Health System,
| University Health System are some that I am more familiar
| with that run with this (PHHS recently achieved HIMMS Level
| 7 certification, for example). These are social safety-net
| hospitals and healthcare systems -- they care for everyone
| regardless of ability to pay. They focus not only on
| emergency and inpatient care, but also ambulatory care,
| primary care, and even fund (at arm's length) community
| (non-profit) medicaid insurers.
|
| On a more subjective side, I've seen a lot of folks out to
| make a buck, but the non-profit healthcare side has been
| much more focused on patient outcomes.
| sklargh wrote:
| Turns out advertising at every tennis major can't make you a
| leader in analytics, ML and basic managed services.
| mnd999 wrote:
| They're good at scoreboards though. Although the Wimbledon one
| did break down during Isner vs Mahut.
| telxosser wrote:
| What data was it using again? The blood panel your doctor
| orders every one to two years?
|
| Medical diagnosis is a trivial problem for machine learning to
| beat humans. Humans are terrible at this.
|
| The problem is there is not even the concept of high frequency
| medical data. Imagine machine learning in quant stock trading
| with samples once a year. Of course it isn't going to work.
|
| The problem is all in the externalities. Doctors don't want AI.
| They can see the automation path and their bank account change
| down the line quite clearly. Not to mention most doctors don't
| know anything about data science so how can you have any faith
| in the algorithm prediction? No one wants to be the test case
| and then get a law suit. "I was just following what the
| computer said was correct". Wrong answer, pay up.
|
| The real irony to me is in a 100 years people look at the
| current medical system as complete quakery. Literally have
| everything right now to build medical super intelligence but
| stuck with the human doctors doing the exact same things from
| 50 years ago.
| rurp wrote:
| I agree with this so strongly. The medical gatekeeping is
| absolutely absurd. I can't remember the last time I learned
| something from a doctor that I hadn't already learned myself
| with a quick online search. For every visit in the past
| decade or longer they either told me what I already knew or
| we were both stumped.
|
| If drives me crazy that I can't make my own decisions about
| my own health, even for trivial cases. I've spent countless
| hours and dollars going to pointless doctor visits just to
| get a routine refill. Literally the conversation at most of
| these visits is as simple as me telling the doc that
| everything is fine with $medA, lets just keep it the same;
| followed by the doctor saying sure and writing me a new
| script. Such a massive inefficient waste of time.
| Spivak wrote:
| Yep. Rank and file MDs don't provide a whole lot of value
| except to people who are totally ignorant of common
| illnesses, health issues, or injuries.
|
| If I had the ability to order my own tests, blood work, and
| adjust the dosages of my meds I could do it a hell of a lot
| better than the doctor I see every 6-12 months. Antibiotics
| are the some of the worst with this. The doc literally
| doesn't even look at me, I just describe my symptoms and
| they go "yep sounds like an infection" -- like Gods
| almighty you could be a web form. And it would would
| actually cost my insurance less which is even more
| infuriating.
|
| Specialists I have found are actually useful and so I can't
| really bring myself to hate that Tier 1 MDs act as a screen
| for people whose time is valuable.
| BlueTemplar wrote:
| I'm not sure that it would be necessarily the doctor that
| would actually gets condemned in this case. Could as well /
| instead be the programmer(s) that made the AI.
|
| But this is why the current crop of AIs (which Watson itself
| might NOT be part of) is problematic : they're too much black
| boxes.
|
| So they directly clash with the laws that assume on one hand
| perfect transparency of the tools used, and on the other
| perfect responsibility of the people using them.
|
| How long before the use itself of a neural network is deemed
| to have been illegal because it broke one of the laws
| mandating the explanation of the algorithm that has been used
| to make a decision to the person that this decision targeted
| ?
|
| Eventually, way down the line, this might involve giving some
| kind of civil status to computer programs so they can
| actually be made responsible.
| 1270018080 wrote:
| You can only market to upper level execs who are out of touch
| with technology for so long before it catches up to you.
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