Tuesday, March 20, 2007

Clinical innovations - Ed Roberts, MD, The Doctor Who Gave Bill Gates III His Start

It was the Altair 8800, on the January 1975 cover of Popular Electronics, that really set off the (personal computer) boom. A company called MITS, in Albuquerque, sold the Altair for $395 as a kit and $495 assembled. Within three months 4,000 people had ordered it.

Landmarks in Digital Computing: A Smithsonian Pictorial History, 2007

I see by the March 8, 2007 Forbes Magazine that Bill Gates III, 52, founder of Microsoft, is the world’s man for the seventh year in a row with a net worth of $56 billion.

Contrast this with the economic lot of Ed Roberts, MD, a 65 year old solo internist in Cochran, Georgia, who is struggling to keep his practice going because of low Medicare and Medicaid reimbursements.

Cochran is a rural community with a population of 4,455 – 55% white and 42% black-- with a high rate of Medicare and Medicaid patients and a below average annual income of $24,000. Cochran is 120 miles southwest of Atlanta and 37 miles from Macon.

Robert’s financial situation is ironic because he's the person who gave Bill Gates his start in 1975. Roberts, then an electrical engineer, developed one of the first personal computers, the Altair 8800, which was the prototype that Bill Gates and his fellow Harvard drop-out, Paul Allen, 54, now #19 on the list of the world’s top billionaires with a net worth of $18 billion, adopted to start the Microsoft empire.

The economic contrast between these two billionaires and Dr. Roberts reminds me of a personal experience. Several years back, I was invited to give a talk in Seattle. I was told by a struggling Seattle primary care physician that Microsoft employees were driving German and Japanese luxary cars, while the doctors were driving American economy cars.

You’d think Roberts' medical office would be filled with computers, the latest medical software, digital assistants and other hightech gadgets. After all, 32 years ago, Roberts helped develop one of the world's first personal computers, the Alstair 8800. Roberts turned medical doctor in 1986, the year he graduated from Mercer University Medical School in 1986. He did his internal medicine residency there. He ended up in Cochran, where, he observes, "I wanted to make a difference."

The truth is Roberts now spends very little time working with computers. That's because time is precious for this doctor who says he's too busy to devote much time to computers. He records patient records on a computer, but beyond that doesn’t fuss much with computers and doesn’t have any fancy electronic health record system.

And he says he's not convinced that existing software with its awkward, often irrelevant, features will make his practice operate more efficiently.

"One of the mistakes being made right now is that software is being written with the idea that everything has to be on the computer." Roberts says. "You don't work that way, you are not taught to think that way, and it is a cumbersome way to go."

Such comments may be common for physicians reluctant to dive into the digital age. But for a man whose expertise spans the sciences of both electronics and medicine, it comes as a surprise.

The Road Roberts Traveled

Today, Roberts, 65, is an internist serving Cochrane, Georgia., a small rural town. That's a long way from where he was in the late 1960s and early 1970s working as an electrical engineer in Albuquerque, New Mexixo.

Assigned to a weapons lab with the U.S. Air Force after he graduated college at Oklahoma State University, Roberts was in Albuquerque when he formed his first company, Micro Instrumentation Telementry Systems (MITS).

"We built telemetry equipment for rockets. That was in 1968 and 1969. We didn't do too well because there was not much demand for our product, but we learned a lot about setting up a company and marketing," Roberts recalls.

"By that time, the large scale and medium scale integrated circuits were becoming available. And I became intrigued about building a calculator. But my partners said there was no market for home calculators, so we parted company and I bought them out. Before I got into the calculator business, large-scale integrated circuits became available. And I built the first large-scale calculator for the market."

Known as the MH 16 Calculator, it wasn't anything like the slim, pocket-sized calculators available today. It was about as big as a sheet of paper and sold as a kit for about $170.

From the calculator, sprang for the idea of creating a home computer. So Roberts and his company developed the Altair 8800, a breadbox-sized contraption that also sold in a kit and was one of the first computers designed for personal use.

An article on the Altair 8800 appeared in Popular Electronics magazine in January 1975.

"Project Breakthrough!" read the magazine cover's bold red headline. "World's First Minicomputer Kit to Rival Commercial Models ... 'Altair 8800"'

Overwhelming Response

The response was overwhelming. Computer buffs began calling MITS to find out more about the computer and how it worked. One call came from two Harvard undergraduates who saw the article and got excited: Bill Gates and Paul Allen.

"We were getting ten calls a day from other software people, as well. It became difficult to distinguish. who was real and who wasn't," Roberts recalls. At the time, the company was searching for programs and software to run on the Altair 8800.
"I made the decision that the software had to be in BASIC programming language. And the first person to show up in Albuquerque with a workable BASIC program would have the contract," Roberts says. "There were probably thirty or forty people who were candidates. Paul Allen called and said he had a system he wanted to demo. That was the spring of 1975."

Allen quickly arrived in New Mexico, ready to show off his BASIC software to Roberts and the MITS staff.

"I picked him up at the airport. He was maybe 21. I took him to the hotel in Albuquerque, and he said he didn't have any money to pay the hotel bill so I gave him my credit card so he could stay in the hotel that night," Roberts says.
"The next day, we loaded up his software, but then it crashed. Paul knew what the problem was, so he called Bill (Gates) and they cut a new tape. They sent it out airfreight, and we loaded it and it played. It had a lot of bugs in it, but for a brand new piece of software that had been developed without ever seeing the Altair, it worked, and I was impressed.

"What those guys had done, instead of the usual approach, which was brute force design of software, they had taken the time to design an emulator.

...They had the power to simulate the Altair system. That's the standard way things are done now, but it was unprecedented then, and that was the genius of what they did."

Roberts liked what he saw with Allen and Gates, so they set up shop at MITS and wrote the BASIC programming for the Altair.

What's Roberts' view of Gates, the multi-billionaire who heads Microsoft today?

"Bill is an extremely bright guy, but as far as his technical ability, he isn't unique and that's not why he is where he is," Roberts says. "He has enormous business skills. He has a genius for business, and he would not like to admit this, but luck was a big part of his great success.

To his credit, Roberts displays no resentment or jealousy of Gates’ and Allen’s financial success. “I still touch base with them from time to time,” he says. Roberts is philosophical. He muses, “They saw what they had to do, and they did it.” Which sounds a bit like the Chinese proverb, “To know and not to do is not to know.” Or it smakes of that quote from Napolean Hill in his 1937 motivational classic, Think and Grow Rich! “What the mind can conceive and believe in, the mind can achieve.”

Two Morals Followed by Two Questions

This tale has two morals:

1) Fortunes go to those who sell the world, not to those who concieve the first idea or who develop the first product. The reality is that it takes business smarts and a management team to market an innovative concept to a wider world.

2) Life isn’t necessarily fair for primary care physicians who work in the clinical trenches in rural regions seeing 30 or more Medicare and Medicaid or uninsured patients each day in low income populations.

A 2006 Merritt Hawkins and Associates survey of 285 medical graduating medical residents indicated none (0%) would choose to practice in a community of 10,000 or less.

The two questions are:

Who will replace the Dr. Ed Roberts of rural America?

Who will care for the rural sick?

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