Cell (5 page)

“I'm not going to take much of your time,” Langley said with a discordant New York accent. “There are only three things I want to convey above and beyond what you have already heard from Mr. Thorn and Dr. Stonebrenner. First off, and most important, the iDoc algorithm was written to be heuristic so that it would improve itself by learning on its own over the course of time. This has already proven to be the case to a marked degree during the beta test. As a backup to iDoc, Amalgamated has employed a large group of internists, surgeons, and other specialists who rotate through a twenty-four-seven state-of-the-art call center. At any given time there are at least fifty of them on hand.

“These doctors assist iDoc's automated decision making as a default mechanism whenever there is the slightest problem. At first, at the outset of the beta test, there were quite a few calls, maybe as often as twenty percent of the episodes. But that changed rapidly, and during the course of the three-month beta-test period, the number of calls coming into the center dropped by eleven percent, meaning the iDoc logarithm is indeed learning.

“The second issue I want to explain is that important subjective issues have been meticulously researched and included in the iDoc algorithm, such as pain and suffering associated with treatment options and possible outcomes, something traditional medicine has always had great difficulty considering. Cost was another issue taken into consideration in the iDoc algorithm. For example, generic drugs are prescribed, provided the efficacy between the generic and the brand-name drug is equal. If the brand-name drug is superior, it is prescribed.

“The third and last issue I want to mention is that it is my firm belief that iDoc will bring about a miraculous democratization of medicine, somewhat akin to what the Gutenberg Bible did for religion. iDoc will free the general public from the clutches of doctors and the medical profession just as the Bible freed the public from the clutches of priests and organized religion. iDoc will be making the paradigm of the practice of medicine personal, meaning that if a drug is prescribed, it will be prescribed because iDoc knows that it will benefit the specific patient rather than knowing it will benefit five percent of patients with the hope that the specific patient will be part of that five percent. Because of this democratization of medicine, I believe the introduction of iDoc will prove to be on par with or more important than other major technological milestones, such as the development of the computer, the Internet, the mobile phone, and DNA sequencing.”

Dr. Clayton Hanson was the final speaker to address the audience. Despite acknowledging to himself that he was acting ridiculous, George flattened himself down in his chair throughout Hanson's brief talk. His remarks, in contrast to those of the other speakers, were pedestrian. He talked briefly about the medical imaging capabilities of iDoc, particularly ultrasound in conjunction with a wireless handheld transducer. He listed as an example the cardiac function tests that could be performed from the privacy of the patient's home. Until now these tests required multiple hospital visits and thousands of dollars. His point was that not only was iDoc a better primary-care physician than a flesh-and-blood individual, it was also going to save society a significant amount of money immediately and over the long haul.

Thorn stepped forward again as soon as Clayton finished and took his seat. “Thank you all for attending. And before I open the floor to questions, I want to remind you that we'll be having a reception and buffet lunch in the restaurant on the first floor of this tower immediately following our presentation, so we all have a chance to speak personally. Okay, who's first?” A number of hands shot up. The excitement in the room was palpable.

CENTURY PLAZA HOTEL

CENTURY CITY, LOS ANGELES, CALIFORNIA

MONDAY, JUNE 30, 2014, 11:00
A.M.

G
eorge took the elevator down to the first floor and walked toward the restaurant's entrance with a number of the other attendees. He was deep in thought, debating what to do next. He knew he should head back to the hospital but couldn't let the opportunity to confront Paula pass, even if he risked being seen by Clayton. He rationalized that he wouldn't be long, and he hadn't received any texts or calls from Claudine Boucher, so things were undoubtedly fine in the MRI unit. George wasn't surprised, since Claudine was one of the more accomplished residents on her last day on an MRI rotation; she knew the ropes in spades.

He walked into the restaurant, which was reserved for Amalgamated, leaned on the bar, and ordered a Diet Coke. Again, the caffeine was a slight risk, considering he had already had coffee, but, hey, he was rolling the dice today. With his drink in hand he moved to a corner of the room, waiting for Paula to appear. He wanted to avoid any conversations with strangers, if possible. The truth was George couldn't shake the feeling of inferiority to these successful market warriors. They were a part of the real world, an arena outside the hospital in which he had limited experience.

He spotted her as she strolled in with the other speakers. There was a smattering of applause. It was apparent that the presentation had elicited a very positive reaction. Luckily for George, Clayton immediately veered off, zeroing in on an attractive female in an expensive business suit. George gathered up his courage and walked over toward Paula. Eyeing the situation, looking for an opportunity to present himself, he saw she looked even better up close and was obviously totally at ease in what was to George an alien environment. He wondered what might have happened between them during their first year of medical school if he hadn't been such an immature ass. Just then she looked up and caught sight of George and smiled broadly. Encouraged by her grin, he headed straight for her.

“George!” Paula exclaimed. “You made it!”

“Hello, Paula.” George put out his hand to shake but she disarmed him by pulling him toward her and kissing him on the cheek. She seemed genuinely happy to see him.

She looked around, still holding on to his hand, and spotted Bradley Thorn shaking hands just behind her. “Bradley, excuse me, this is a dear friend of mine from Columbia Medical School, George Wilson.”

Thorn peered at George over his half glasses. He was holding one of Amalgamated's spreadsheets.

“George, this is Bradley Thorn, my boss. George is a radiology resident over at L.A. University Medical Center. Which makes him one of our new employees!”

“My pleasure,” Thorn replied. “Excuse me.” He turned from George, his sights set on a big-name CNBC host standing nearby.

Paula smiled at George and shrugged. “Sorry. He's in ‘biz' mode.” She aimed another beaming smile at George; she was obviously still on a high after the excitement of the presentation.

“Hey, no problem. I get it.” George didn't want her to feel defensive.

“I really am glad you came,” she said. “Thanks!”

“Me, too. It was lucky that I could get away,” George said, feeling a bit nervous and less confrontational now that he was actually talking with Paula. “It's the last day of this month's rotation, so the resident I'm supervising is entirely comfortable working alone. Tomorrow will be a different story. July first. I'll be shepherding one or more first-year residents. You know what that means.”

She gave him a blank look.

“July first. The first day of residency, nationwide, for freshly minted medical school grads?” He was trying to help her remember all the requirements to becoming a full-fledged specialist.

“Oh, right. Aka, the deadliest month of the year for patients.” She chuckled, although there was truth in the statement. Both knew that hospital deaths spiked in July, when thousands of new residents began attending patients.

“I'll be in the ER next month . . . well, tomorrow, actually,” George said. “Supervising a few first-years there. It's my last year as a resident. Finally I will make some real money.” He had meant to say it in jest, but it didn't come out that way. The look on Paula's face was confirmation.

Paula regarded him for a beat, sensing his nervousness. “Thanks again for coming, George. I really wanted you to be here. So . . . what do you think of iDoc?”

“I think the app is amazing. A real paradigm shifter, just as it's being billed. Wish I had thought of it.” His eyes stayed close on her.

“And, of course, you did. Don't think I've forgotten. It's why I wanted you to be here for our announcement, so you would see it was becoming a reality, not just an idea no one acted upon. It's actually happening!”

George was taken aback. He had not expected such honesty.

“It was a huge amount of work,” she continued. “Tens of thousands of man-hours. Millions upon millions of dollars. But we did it. And it works. It works better than we ever imagined. It's the answer, George. Better care. Lower costs. That's something the ACA will never do on its own.”

George didn't quite know what to say. He had been so sure that he was going to have to argue to get the credit for giving her the idea.

“Do you have any free cash?” Paula inquired.

“Pardon me?” George was thrown by the question.

“Sorry. I didn't mean it like that. What I meant to say was that whatever you have, invest it in Amalgamated stock. It's going to go through the roof. And that's not insider trading advice. Maybe if I had told you yesterday, but not after today's presentation to the investor community at large. I'm leveraged to the hilt with stock options and—”

“I'm a medical resident, Paula,” George replied in an even tone. “I make a bit less than fifty-five thousand dollars a year putting in eighty-hour workweeks and trying to pay down my med school debt while subsidizing my grandmother's assisted-living expenses. Stock options are not an
option
for me. I'm sure they are fine for you with what I'm sure is a significantly higher salary, but not for me.”

Paula took a step back as if he had just thrown a splash of cold water in her face. “Hey, I'm just trying to be a friend, an appreciative one at that. I'm certainly not going to apologize for my compensation package, if that is what you are implying. I work hard for what I earn, and my work is valuable, as time is going to prove. Not just to my employers, but to the general public. Because of that, our company's stock will rise. Considerably.” She paused. “We all make choices in life, George. I'm happy with mine. You should be with yours, too.”

George didn't quite know how to respond. He had been feeling outclassed by Paula's success and then annoyed by her hubris, but her frank response disarmed him.

“Hey! Remember our old argument about how wasteful you thought it was for me to be doing the combined MD-MBA program?” Paula asked. Her tone had changed again. It was now nostalgic and teasing.

“You've won that one, obviously,” George conceded.

She laughed, visibly relaxing as she took him by the arm, leading him to a quiet corner of the room. “Listen, no more of this. We're friends. Why don't you come over to my house for a visit? We can catch up some—in a more personal environment.”

“Well . . . ,” George stammered. She had him off balance again.

“Come on. I bought a house not too long ago and have barely had time to try out the pool.”

“I'm not sure that we should—”

“What? Catch up on old times? Truth is, George, I don't have a lot of friends out here. Colleagues, yeah, I got plenty of those. But I have been working nonstop, twenty-four-seven—we both know what that's all about. I'm realizing I need people I can relax around, where there is no competition to get a particular project done. I don't have too many such friends here.” She laughed again. “Actually, I don't have
any
at the moment. So, what do you say? No pressure.”

George studied her face. As far as he could tell she was sincere, which was sad in one way. It sounded as if she didn't have much of a life. But he was in that same sad boat. “Sure,” he replied. Her vulnerability was not only appealing, it was her saving grace.

“Great! I'll text you my address. It's in Santa Monica. How about Saturday? One o'clock okay?”

“Well . . . I
am
off Saturday,” George conceded.

“Keep it in mind. A
friend
date. We've been down that other road, and it didn't work. And . . . there's one more caveat. You cannot mention Pia Grazdani. I do not want to even hear her name. Deal?” She smiled. A genuine warm smile.

“Deal,” George said. Her warmth was infectious. It made George want to be around her.

“I can even pick you up if you want. The company has, in their infinite wisdom, bequeathed me a brand-sparkling-new Porsche Carrera to show their iDoc gratitude.” She smiled again.

George shuffled his feet and changed the subject. “Is iDoc really that good? I mean, there were some pretty bold statements made in your presentation. Were you exaggerating a bit for the sake of the potential investors?”

“We were not exaggerating in the slightest. iDoc is truly fantastic. Maybe even better than we explained. To be perfectly honest, we actually held back to a degree.”

“In what way?”

“Well, for instance . . . and how is it that you can turn me into a shameless blabbermouth?” She wasn't looking for an answer to her question, and George noticed that she had grasped his arm again. “Our beta-test group is using smartphones just like the one you have in your hand, Mr. Nomophobe.”

“Nomophobe?” George questioned. “What the hell is that?”

“It's the fear of being out of mobile phone contact.”

George did have his phone in his hand. He had the ringer off but wanted to be sure to feel the vibration if Claudine texted him.

“What we could have added to the presentation was a solution that we have come up with during the iDoc beta test. The problem with the smartphone is . . . well, it's not a problem so much as an inconvenience that has the potential to become a problem . . . is the
battery
. iDoc runs constantly with its vast array of wireless sensors. Batteries run down,
fast
. Our beta testers need to recharge all the time. Three times a day plus charging it overnight while asleep. While that isn't a deal breaker, it is an inconvenience.”

“So what's the solution to that?”

“Graphene,” she whispered.

“Graphene?” George replied, matching her hushed tone. “Never heard of it.”

“It's been around since the sixties. It's not like it's a secret, even though I'm trying to keep this between us because we're presenting iDoc to investors as it will run today, not tomorrow. Anyway, it's also not a secret that we've established close relationships with the world's major smartphone manufacturers. We became aware of graphene's potential by accident. UCLA discovered a process to make a nontoxic, highly efficient energy-storage medium out of pure carbon. Graphene. It's a ridiculously simple technology and Amalgamated helped fund their efforts in finding a way to mass-produce it with small embedded electrodes.”

“You lost me.”

“It's a supercapacitor. It charges much more rapidly than a chemical battery. It's high density, in that it can hold a lot of electrons, and we can make it one atom thick. Long story short, the technology will have the capability to charge a smartphone from zero percent to one hundred percent in one second. Flat.”

“Seriously?”

“Absolutely. Smartphone models with graphene-based batteries will begin rolling out this fall.” She looked around; still, no one was within earshot. “Now, that
is
a secret of sorts. As co–patent holders in the technology, we've asked manufacturers to not release any information about it until we go wide with iDoc. We want to overwhelm the public's perception that iDoc is revolutionary. The new battery technology coinciding with iDoc's release will reinforce investors' assessment that a new paradigm has been entered. And it will also help serve to get any non-smartphone users into stores to buy new ones.”

“And if you can't afford a new phone?”

“We'll subsidize it. Or, more accurately, Obamacare will subsidize it. That's another bit of holdback, too.”

“How can—”

“Everyone in the beta test loves iDoc, George. It's better than a real doctor. For all the little things patients want to talk to their doctor about and can't because that doctor is unavailable. The acceptance of iDoc was immediate. It will change medicine. We're talking health care, not sick care, as Bradley alluded to during the presentation. Let me give you a personal example of how this works. Recently I woke up with a sore throat. My first concern was strep, as a friend of mine had been diagnosed with it. I dropped a saliva sample onto the designated location of my phone's touchscreen and asked iDoc for an analysis. Within so many seconds, strep
was
detected in the flora of my mouth. iDoc emailed a script to my local pharmacy and the prescription was waiting for me when I arrived. I was subsequently contacted by iDoc at later intervals, unprompted, asking to monitor my saliva again. Might have forgotten, but iDoc did not.”

“But what about this call center? Isn't that cheating? Because real doctors are the backup?”

“Not at all. iDoc has been learning. Learning
fast
. Just as Lewis Langley reported. iDoc is using the ‘real doctor' backup at a significantly lower rate now than at the beginning of the beta-test period.”

“Where is this call center located?”

“Upstairs on the seventh floor of the neighboring building, which houses Amalgamated's home office. Would you like to see it? I'd be happy to show it to you.” She was enjoying this. Her tendency to show off was taking over.