Eric J. Topol, MD: Hello. I am Eric Topol, editor-in-chief of Medscape. I have a thoroughly delightful chance today to interview Vinod Khosla, who many years ago started Khosla Ventures, one of the most successful venture capital firms in the world.
Vinod, I think you started out in engineering in India at one of the most prestigious institutes of technology, then you went to Carnegie Mellon, and then Stanford. But engineering wasn't where you landed long-term, because at some point you started Sun Microsystems, right?
Vinod Khosla, MS, MBA: Yes. When I started out, there wasn't a thing called computer science. That tells you how old I am.
In those days, you could pursue any new area if you created your own program because there were not a lot of programs. At the Indian Institute of Technology, we started the computer science program, and then I moved to biomedical engineering. I went on to get a master's degree in biomedical engineering at Carnegie Mellon. That was also a tiny program in the basement.
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Dr Topol: When you started Sun Microsystems—and that turned out to be one of the four horsemen of the Internet— did you know where that was headed? That was extraordinary.
Mr Khosla: We were pretty excited about the idea of distributing computing. That was a fundamentally new idea. It is funny in retrospect; the networking piece is the one piece no one wanted, so we kept getting requests to delete it. It's similar to the data piece that no one wants in medicine now.
When you start something, often you know it is a fundamental idea that should be developed, but you do not actually know how it will play out. That's what's interesting about all of these new spaces. You do a lot of discovery. It's like playing video games and discovering new puzzles to solve along the way.
In healthcare, the equivalent would be to say that there is no billing code for this or that. What is fundamentally new that should be valuable?
Dr Topol: You are an avid reader. When we first got together, you had read my book, The Creative Destruction of Medicine. I believe that we realized that a lot of our ideas were in alignment because you were also seeing this big disruption. Since that time, you have been shaking it up and getting behind many new exciting technologies.
But I want to set the record straight, because your ideas about doctors have been misconstrued. They have these quotes [attributed to you]: "Khosla says that 80% of doctors are going to be replaced." You wrote a white paper on that. Let's get that clarified.
Mr Khosla: Fundamentally, doctors spend a lot of time doing things that others can do for them. We have technology similar to a doctor's assistant, which can do many of the things that doctors do today.
My view is that doctors should be involved in the most human elements of care. A very large percentage of what doctors do can be done with technology, which would free the doctor to do other things. No doctor spends enough time with the typical patient. The median patient visit is so short.