'“To succeed, an offering must create value for all entities involved in the exchange—target customers, the company, and its collaborators.”' aka product-market fit
As you're now 18 months on from July 2018, so have probably moved onto other things...
Please consider approaching some academic institutions, or some medical professional associations to see if they would be interested.
While I doubt any will have any money to pay you, they will almost certainly be able to host this for free, probably indefinitely. You just need to find one interested researcher.
It's hard to tell exactly what it is you made, but informative, interactive, visualisation tools can have really powerful public health effects if marketed well.
Yep, same here. I've always just used whichever OTC pain killer was most convenient and have never noticed a difference between them. They all seem mildly effective at reducing discomfort. I have taken Ibuprofen for headaches many times and it seems just as helpful as anything else.
Oof. The site was practically named after WebMD, and the founder didn't do any market research on that competitor to gauge how viable the business was before quitting their job? This person probably should have known that their main competitor made $0.50/user before they quit their job. Also:
>It had been a bit of a working assumption of mine over the past few weeks that if you could improve the health of the patients then, you know, the doctors or the hospitals or whatever would pay for that.
This person uses the "X% of Americans" line, so they live in the United States, right? The one in North America that views healthcare as a business to wring money out of? They definitely should have done more market research if they could type that with a straight face.
But hey, hindsight is 2020 and they only spent $40k on some very valuable firsthand experience. Sounds like a win if they're planning to run businesses in the future, but for ideas without a clear path to making enough money to sustain themselves, try to use other peoples' money next time :)
That line stood out to me also. Anyone who feels that the primary goal of healthcare in the US is to improve health outcomes is incredibly naive about how this industry (which is over 20% of the us economy) works. There is only one group in the entire industry which has an incentive to keep people healthy (insurance) and that is the most hated of the bunch!
.. and the doctors he talked to felt they already had the knowledge they needed! If anything, they felt, perhaps, that this devalued their existing knowledge. And they don't make 10% more money for providing 10% better outcomes.
This is probably the root of the problems in US medicine: there is no effective feedback. The ACA (Obamacare) did a little work on this with Medicare payments to hospitals, but that is an exception in the system.
What could we do to make this the basis of the system? Without driving doctors away from patients who have bad prognocices?
Take a look at HMOs, such as Kaiser Permanente. HMOs combine the function of insurers and medical providers in a way that aligns incentives (everyone pays about the same, but healthier people need less care and are thus more profitable customers). There are many problems that come with the HMO model (e.g. the potential for low quality care), but when it works, it directly solves the problem you addressed and exists in the US.
Perverse incentive structures are the fundamental reason US healthcare is so expensive and stupid. It's not "greed" in a simple sense, and it's not "regulation" in a simple sense. It's a system of interacting problems that needs treated in a systemic way.
Blaming the insurance companies strikes me as the political equivalent of yelling at the cashier.
Insurance is one of the oldest industries in the US, which means they have accumulated many (probably well meaning, but ultimately stupid) regulations over the years.
For example, to be taxed as an insurance company (e.g. avoid paying tax on premiums that will partially be paid out in the future), most states assign a maximum profit margin.
That means, in order to make more money as an insurance company, it's perversely in their best interests to increase the cost of medical care as much as possible. Medical care is not like cat bonds that might wipe out your risk pool, so it's just a cashflow game.
That's not to say there isn't any downward pressure. On a day to day basis, individual claimants eat more into that margin than was budgeted, so a company might have to raise rates higher than their competitors (essentially they have some pressure to deny claims), but there is very little systematic pressure to reduce overall costs. Also, marketing budget does not count towards profit, which is why insurance companies are in this rat race of brand advertising to steal customers from each other. With auto insurance, for example, upwards of 40% of your premium is just going out the door as ad spend.
Anyway, I would assign a lot of blame in this perverse incentive scheme to poor regulations.
To put it in software terms, it's not a bug, it's an architecture flaw. The "poor regulations" aren't individual issues, but rather part of the fabric of a framework that causes perverse incentives. Therefore, the simpleminded conservative/rightwing solution to "reduce regulation" doesn't eliminate the perverse incentives - it just changes the flow, the way tossing a rock in a river does.
If I were the one making the decision, I'd change American healthcare with one big thing, modeled on the Japanese system... price controls. Japan's system is more or less like ours, but with one key difference - a government panel sets the prices for all medical goods and services. Providers and insurers have to make their profits within that price structure. This incentivizes both to reduce costs, for the sake of their own profits.
Of course, this would be called radical socialism or some such stupid in America, and Democrats aren't even talking about it (Republicans have no ideas at all on health care). But it's politically a much lower threshold than single-payer (throwing out the whole framework and starting over, basically). And it demonstrably works - Japan's system costs less than half what ours does per capita, with better outcomes.
> There is only one group in the entire industry which has an incentive to keep people healthy (insurance)
The motivation of insurance is to keep the cost of treatment less than the income from premiums -- it doesn't have anything to do with how healthy people are.
Yep - the motivation of health insurance is to keep people out of hospitals and away from healthcare professionals as much as possible.
Sometimes that aligns with keeping people healthy, but other times that aligns with women not getting routine prenatal screening and thus increasing the infant mortality rate.
This is changing. Medicare, medicaid and to an extent tricare are switching away from pay for service models, so there is a financial incentive for providers to improve health outcomes.
OK, so build a site that takes a bunch of patient info (demographic, genetic) and generate 1000s of custom meta-surveys that estimate the most effective medication for that specific patient by weighting the data in various ways. Return only the one that suggests the highest-priced medication. Eventually, move to a bidding system where pharma companies can sponsor the custom reports that recommend their products. Give 5% of the profit to developing world vaccination projects and it'll save lots of lives overall.
Imagine you have a chronic condition, and every month your insurance writes a substantial check for your care. A new treatment comes along that might fix your condition permanently. Surely they'll leap to pay for it?
Unfortunately, they probably won't want to. People frequently change insurance, so the most likely outcome is they'll have to pay for an expensive treatment, but never see the savings.
This is currently playing out for some new expensive new gene therapies.
Sure, but the decisions get made at the scale of a single company, not the industry as a whole.
For the mentioned new gene therapy treatments, people have been asking congress to come up with a new model for how to pay for treatment. Here's a recent opinion piece by a Louisiana Senator where he lists off the proposals he's heard: https://www.statnews.com/2019/06/12/paying-for-coming-genera...
> There is only one group in the entire industry which has an incentive to keep people healthy (insurance) and that is the most hated of the bunch!
A testament that the demand for healthcare services is not only about health results. Albeit there are grave challenges about the way Kaiser or HMO's have supposedly better health results.
At Healthify we’ve built a business by aligning positive health care outcomes with the incentives of people paying for healthcare. I think it’s incorrect to say that American healthcare isn’t interested in positive outcomes, it’s just that the systems in place have made it difficult to track and understand those outcomes in the first place.
We just raised a series B and are hiring engineers (very remote friendly)!
IMHO the point of the article is its title - and certainly, furthermore, the point made at the end:
“To succeed, an offering must create value for all entities involved in the exchange—target customers, the company, and its collaborators.”
I believe the point of this comment is 'do market research before quitting your job'. The author could have learned their presented points while operating this as a side project concurrent to their existing job.
> they only spent $40k on some very valuable firsthand experience.
This. It is very hard to get real world experience. $40k is cheap compared to a bootcamp that won't teach him even 1/10th of this life experience.
Btw, actual figure is not $40k, but one should consider it close to $100k+ if you factor in that he used up his "make my parents support shelter, food, living expenses, car". Depending on the cultural background, they wont be doing this many more times. If you consider how much he lost on the (bay area) salary he otherwise would have earned, add another $100k
Yup. Depending on how attractive OP is to high-salary big tech employers, the opportunity cost alone of not getting paid for most of a year could easily be several hundred thousand dollars.
You spend the whole comment putting down the author for making mistakes and then try to make it look like you're retracting this by putting a positive spin on it towards the end. Not because you especially care, but because you don't want people to downvote you to shit for this obvious trash talking.
"try to use other peoples' money next time (smiley face)" A++++ douchery. Nicely done.
In the story she describes the project as "fun" before he asks what she'd pay. At that point he probably should have picked up that she was being kind and was not in fact seeing a product she was interested in buying.
He probably could have figured that out by asking doctors before he built the thing.
I think he should target not WebMD audience, WebMD doesn't provide searchable and visualizable database of trials and outcomes, but more professional crowd: research institutions and universities, government, pharma corps, pharmacists, hospitals, and charge some subscription fee (e.g. $200/m), and it would be totally different story.
Perhaps you gave up too soon, your startup journey is shared by most (all?) startups i.e. where they end up finding PMF is often very different from where they started. It's a matter of sticking with it and if it's worth the opp. cost.
Admittedly, this is Survivorship Bias, since the overwhelming majority of startups fail. As PG said: "startups don't fail, founders give up"
Sure, but that's not the whole story -- the OP would also need to be okay with changing the idea drastically where and when required. As other people have noted in this thread, not much effort was made when talking to the doctors to find out what problem they do have, and no mention is made of ever even showing this product to consumers.
The fatal flaw here was building a product "in secret" and not launching soon enough.
Very nice write up! I can easily see my own biases leading me down some of the paths you mention, so thanks for sharing. A more optimistic way to look at this situation is that you spent $40k to get to the front page of hacker news!
Agreed, this was delightful to read! I really appreciated how the author was open about naivety and blind spots. It made the contrast more apparent when they learned things. I'd love to read more by this person.
Could you try to sell it to insurance companies? They might find value in providing it for free to clinicians because they might save money with better outcomes / preventing follow up visits.
Insurance companies don't care about outcomes - most are structured in a cost plus model where they make the "plus" - so if anything, something that costs more is better for them.
this is quickly changing. For insurers that offer Medicare Advantage plans, they get paid on a per-member per-month model, so outcomes are very germane to their profit margin.
Insurance companies could also use the data to argue with healthcare providers about what the best cost vs value is on a course of treatment, but they probably already have data scientists doing this kind of work for them. Insurance adjusters and all that...
At first I thought this was satire. Here's this guy, who uses a pretty straightforward analysis without any prior healthcare domain experience, thinks he's found the holy grail after a few weeks of work, and then spends all of his money (without first talking to actual domain experts) before he gives up, because Healthcare.
This is why I get so grumpy about startup narratives. If you ask successful unicorns how they got started, they'll usually explain that's exactly what they did. Garrett Camp was just trying to hire a private driver, and realized it was too hard, there's no reason it should be so hard. Jack Dorsey saw a guy who didn't accept credit cards and realized it would be great if he could accept credit cards.
If you don't realize what's going on, that companies pick their founding myth based on which story sells the best rather than which story occurred on the earliest calendar date, it's very easy to get a false picture of how good startup ideas originate.
This. Say what you will about Bezos, but he seems to be the most impressive tech founder out of any of FANG and any of the large unicorns founded after Facebook.
Such an impressive list of deft moves that he made (in a range of different areas) one after another between '94 and 2000 to set Amazon on a path to meteoric growth.
Part of being a successful founder is spinning a yarn for your startup though. It's not improbable that the majority of successful founders are also just good at telling the story about it while glossing over the boring hard parts.
Couldn't the founder story still be true, but simply incomplete? E.g. Jack Dorsey may have been frustrated that a company didn't accept credit cards, but also, he was already a successful entrepreneur and may have spent months or years researching the problem before starting Square?
A lot of these founder stories boil down to coming up with a good idea and then building it. You hear more about the stories where that worked out and less about the stories where it didn't. Plus the ideas and execution quality all vary, along with market timing.
It's hard to say what exactly can be learned from such stories.
There's a lot of survivorship bias there. Case and point: the author did have this specific problem, and surely this problem is common.
Uber 'bought' their market - it might not even be viable when they run out of dumping money and have to raise prices.
I think there might be some opportunity in this guys startup with some pivoting.
Also I think there was some funniness on the feedback: Doctor used 'cost' as an excuse, but it may have simply been that the product was not hugely valuable.
Maybe for common drugs it won't help, but there are a zillion drugs out there, maybe doctors want a good reference.
The revenue model he didn't articulate comes from the drug companies. If Doctors used his tool, drug companies might pay for it in some way.
Finally, I have to say 200K lines of code sounds like a lot ...
I think the _"thinking he's found the holy grail"_ and _"eating Domino's at his parents basement"_ were added more for flavor than anything.
He had an idea, that seemed good, and invested $40k that apparently he could afford to loose. He made some mistakes that could be avoided in hindsight (like everyone trying something new).
The dreams of being billionaire and stuff is just to make the reading fun (it did for me).
"Please don't post shallow dismissals, especially of other people's work. A good critical comment teaches us something."
Thoughtful critique is good, but this post breaks the guidelines and falls outside the kind of thing we're going for here. I know it's the internet default generally, but please be more thoughtful when posting comments to HN, especially about other people's work.
Seems a case of someone not understanding the economics of the vertical they're entering and not wanting to put the effort (ie: time/money) to learn. Doctors generally don't directly make money by having patients get more healthy. Other entities however do. Insurance companies may, self-insured employers definitely do, and hospital chains may (if they're getting bundled payments for procedures). These entities however have very long sale cycles and are old school (ie: won't listen to some 20 year old). Still, there's a whole massive ecosystem of companies in this space so it's far from impossible. Possible to also partner with one of those companies as a sub-vendor.
There is a value-based angle here. But as the psychiatrist told him, she doesn't make any more or less by prescribing one drug vs. another. If he was able to link the use of a specific drug to improved outcomes (READ: fewer repeat visits, less time in the hospital), then it could be something that ACTUALLY reduces costs.
Insurance companies have very little/not at all influence over prescribing patterns of physicians. If you could tie this improved outcomes, then there is a business model here.
Insurance companies dictate what treatments they will cover for which conditions.
However, insurance companies are perversely cost conscious, because they are paid as a percentage of medical costs, not as surplus between premiums and costs.
>Insurance companies have very little/not at all influence over prescribing patterns of physicians.
Walk into any physician office and ask them how many faxes they get everyday from pharmacists requests the Dr. change their prescription. Then ask the pharmacists what triggers them faxing requests to the Dr.'s requesting change in therapies...hint: insurance companies dictate to the pharmacists their recommendations for Docs.
Edit: I should have noted the "tips". When a pharmacist faxes a Doc a recommendation the pharmacy gets a "tip" and if the Doc actually makes the change, then the pharmacy gets a 2nd "tip." In my experience the Doctors have no idea pharmacists are paid by insurance for recommendations and changes.
I was given some advice long ago that I stick to, and which avoids situations like this entirely -- if a startup cannot point to a repeatable transaction where they get revenue in exchange for something... then it not a business, it is a side project.
Admittedly, side projects can grow into something over time, as you evolve the idea. But there is zero reason to quit your job for such ideas.
And in the market consumers revealed preference is for $1000/yr treatment over $20K vaccine, or equivalent multiples. When a new vaccine is invented, people balk at the price and complain it shouldn't have been created.
I don't buy this line of thinking - the list of curable diseases/conditions is longer than the incurable ones. Selection bias means the incurable ones get more attention (because they have to be managed). The health care industry is (mostly) not a coordinated cartel; it's a bunch of self-interested organizations looking to get a leg-up on the competition.
Yeah it's dumb.
A Cure will instantly make any product 10000x more valuable because it can be sold across the globe while care is very much limited to local hospitals.
Even the incentive system doesn't add up.
It's as dumb as claiming that the cure for baldness is not invented because of the hat / wig / hair-transplant cartel that want's to keep you bald
It's a shame this project was shuttered as what screenshots are posted look amazing.
Better data aggregation is desperately needed in medicine and sadly I think the creator has walked face first into the horror of cost merely to access clinical trials. Plus, the cost of paying contractors to extract the actually useful information from those trials.
These are key reasons why Open Science and Open Data are so critical, to produce tools like this one. Sadly I don't think there is a "Startup" level of money available for it even so.
It was really good to read some self reflection and analysis on why you failed. Most people ignore the actual reasons their ideas/businesses fail and instead blame it on someone, or something... Most of the time, its the fact that there was no real market for their product!
Silicon Valley doesnt necessarily suffer from a lack of engineering talent as so much a lack of marketing talent. Far too many ideas go to market without any understanding of the actual market. But hey, people get to say they were a CEO for a few months and that sounds great on their Tinder, I mean LinkedIn profile. Right?
> “And that isn’t worth something? Prescribing better treatments?”
> “Hmmmm,” she said, picking at her fingernails. “Not directly. Of course I always have the best interests of my patients in mind, but, you know, it’s not like they’ll pay more if I prescribe Lexapro instead of Zoloft. They won’t come back more often or refer more friends. So I’d sorta just be, like, donating this money if I paid you for this thing, right?”
So, what's the obvious next step ? Prescribing things that won't work so patients keep coming back but not badenough that they flee to another practice ?
The obvious next step (if there is one) is to get the insurance companies to pay for it, since they are the ones who would theoretically reap the benefits.
"Theoretically" is the problem here. Insurance companies won't spend a penny they don't have to, so you need to prove you'll save them more than they pay you starting from day one. That's a tall order.
The solution is to educate the patients so that they demand this sort of data driven analysis from their doctors.
If such a product existed I would use it continually and challenge my doctors when they contradict it. If patients aren't educated and care, health professionals won't care enough to purchase it.
Realistically, while I feel that the author is on the right track with this data driven approach to evidence based medicine, the fact remains that the advantages/disadvantages between drugs within the same class of medicine tend to be negligible compared to drug costs. There are then other specific concerns that must be considered eg pregnancy/breastfeeding, liver failure, kidney failure and often what ends up is that one defaults to a standard drug per drug class with alternatives in specific circumstances.
The real benefit IMO would be marketing this to countries with a top down healthcare purchasing system (eg the UK) or as a tool to drug companies/researchers looking to make their own meta analyses (eg abstrackr). It might also be better instead to diversify into correlating symptom clusters with diseases because then the utility to the end user is bigger.
Sell this product to insurance companies so they can recommend cheaper/safer drugs to their customers, or show the more expensive one and if it truly had better outcomes. Everyone benefits from that.
That said, the medical establishment is a tough tough domain to move.
Insurance companies already have teams of doctors and pharmacists analyzing studies to ensure they are pursuing the most effective and cost effective healthcare. They’re called Pharmacy and Therapeutics (P&T) Committeea.
I worked at a company in the early 00s that did exactly this -- natural language processing of medical records for meta analysis. Even when it worked, we couldn't sell it for much. The budget of each study was too low to really build a business around, and the low number of potential buyers didn't help things.
Eventually we pivoted the tech to a B2B SaaS play because it was too hard to sell.
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[ 5.9 ms ] story [ 298 ms ] threadPlease consider approaching some academic institutions, or some medical professional associations to see if they would be interested.
While I doubt any will have any money to pay you, they will almost certainly be able to host this for free, probably indefinitely. You just need to find one interested researcher.
It's hard to tell exactly what it is you made, but informative, interactive, visualisation tools can have really powerful public health effects if marketed well.
Are there people that don't know acetaminophen is for headaches and ibprofin is for muscle aches?
Actually taking both together is more effective. Take one tablet of ibuprofen and one of acetaminophen.
>It had been a bit of a working assumption of mine over the past few weeks that if you could improve the health of the patients then, you know, the doctors or the hospitals or whatever would pay for that.
This person uses the "X% of Americans" line, so they live in the United States, right? The one in North America that views healthcare as a business to wring money out of? They definitely should have done more market research if they could type that with a straight face.
But hey, hindsight is 2020 and they only spent $40k on some very valuable firsthand experience. Sounds like a win if they're planning to run businesses in the future, but for ideas without a clear path to making enough money to sustain themselves, try to use other peoples' money next time :)
If WebMD owned 20% of his product, for say $300k in Seed Money, he could have used that Runway to build something really cool.
And WebMD would have an incentive to promote his site and help bring free users.
I'm going to try and get this in front of them using my contacts, but it is a long shot.
What could we do to make this the basis of the system? Without driving doctors away from patients who have bad prognocices?
Blaming the insurance companies strikes me as the political equivalent of yelling at the cashier.
Insurance is one of the oldest industries in the US, which means they have accumulated many (probably well meaning, but ultimately stupid) regulations over the years.
For example, to be taxed as an insurance company (e.g. avoid paying tax on premiums that will partially be paid out in the future), most states assign a maximum profit margin.
That means, in order to make more money as an insurance company, it's perversely in their best interests to increase the cost of medical care as much as possible. Medical care is not like cat bonds that might wipe out your risk pool, so it's just a cashflow game.
That's not to say there isn't any downward pressure. On a day to day basis, individual claimants eat more into that margin than was budgeted, so a company might have to raise rates higher than their competitors (essentially they have some pressure to deny claims), but there is very little systematic pressure to reduce overall costs. Also, marketing budget does not count towards profit, which is why insurance companies are in this rat race of brand advertising to steal customers from each other. With auto insurance, for example, upwards of 40% of your premium is just going out the door as ad spend.
Anyway, I would assign a lot of blame in this perverse incentive scheme to poor regulations.
If I were the one making the decision, I'd change American healthcare with one big thing, modeled on the Japanese system... price controls. Japan's system is more or less like ours, but with one key difference - a government panel sets the prices for all medical goods and services. Providers and insurers have to make their profits within that price structure. This incentivizes both to reduce costs, for the sake of their own profits.
Of course, this would be called radical socialism or some such stupid in America, and Democrats aren't even talking about it (Republicans have no ideas at all on health care). But it's politically a much lower threshold than single-payer (throwing out the whole framework and starting over, basically). And it demonstrably works - Japan's system costs less than half what ours does per capita, with better outcomes.
The motivation of insurance is to keep the cost of treatment less than the income from premiums -- it doesn't have anything to do with how healthy people are.
> the motivation of insurance is to keep the cost of treatment that they cannot avoid liability for less than the income from premiums
Sometimes that aligns with keeping people healthy, but other times that aligns with women not getting routine prenatal screening and thus increasing the infant mortality rate.
Unfortunately, they probably won't want to. People frequently change insurance, so the most likely outcome is they'll have to pay for an expensive treatment, but never see the savings.
This is currently playing out for some new expensive new gene therapies.
For the mentioned new gene therapy treatments, people have been asking congress to come up with a new model for how to pay for treatment. Here's a recent opinion piece by a Louisiana Senator where he lists off the proposals he's heard: https://www.statnews.com/2019/06/12/paying-for-coming-genera...
A testament that the demand for healthcare services is not only about health results. Albeit there are grave challenges about the way Kaiser or HMO's have supposedly better health results.
We just raised a series B and are hiring engineers (very remote friendly)!
That was the entire point of the article (written by the founder). What was the point of this comment?
“To succeed, an offering must create value for all entities involved in the exchange—target customers, the company, and its collaborators.”
I believe the point of this comment is 'do market research before quitting your job'. The author could have learned their presented points while operating this as a side project concurrent to their existing job.
This. It is very hard to get real world experience. $40k is cheap compared to a bootcamp that won't teach him even 1/10th of this life experience.
Btw, actual figure is not $40k, but one should consider it close to $100k+ if you factor in that he used up his "make my parents support shelter, food, living expenses, car". Depending on the cultural background, they wont be doing this many more times. If you consider how much he lost on the (bay area) salary he otherwise would have earned, add another $100k
"try to use other peoples' money next time (smiley face)" A++++ douchery. Nicely done.
In the story she describes the project as "fun" before he asks what she'd pay. At that point he probably should have picked up that she was being kind and was not in fact seeing a product she was interested in buying.
He probably could have figured that out by asking doctors before he built the thing.
Which is the entire point of the article, made very explicitly.
I think he should target not WebMD audience, WebMD doesn't provide searchable and visualizable database of trials and outcomes, but more professional crowd: research institutions and universities, government, pharma corps, pharmacists, hospitals, and charge some subscription fee (e.g. $200/m), and it would be totally different story.
Admittedly, this is Survivorship Bias, since the overwhelming majority of startups fail. As PG said: "startups don't fail, founders give up"
The fatal flaw here was building a product "in secret" and not launching soon enough.
If you don't realize what's going on, that companies pick their founding myth based on which story sells the best rather than which story occurred on the earliest calendar date, it's very easy to get a false picture of how good startup ideas originate.
It was always a business-first mindset in an area of high growth.
That one short video filmed in 1997 should be a masterclass by itself.
Such an impressive list of deft moves that he made (in a range of different areas) one after another between '94 and 2000 to set Amazon on a path to meteoric growth.
I'd also add that in his stints at different firms pre-Amazon he was quite clearly an outlier among high-achievers.
For example, a recent Musk biography spent maybe a page on the part where he became successful, and a Jobs one just a paragraph or two.
I'd like to see a compilation of these details.
In a certain harsh sense, if you're gullible enough to believe in those stories you're probably not ready to start your own business.
It's hard to say what exactly can be learned from such stories.
Uber 'bought' their market - it might not even be viable when they run out of dumping money and have to raise prices.
I think there might be some opportunity in this guys startup with some pivoting.
Also I think there was some funniness on the feedback: Doctor used 'cost' as an excuse, but it may have simply been that the product was not hugely valuable.
Maybe for common drugs it won't help, but there are a zillion drugs out there, maybe doctors want a good reference.
The revenue model he didn't articulate comes from the drug companies. If Doctors used his tool, drug companies might pay for it in some way.
Finally, I have to say 200K lines of code sounds like a lot ...
It just _has_ to be satire, though!
He had an idea, that seemed good, and invested $40k that apparently he could afford to loose. He made some mistakes that could be avoided in hindsight (like everyone trying something new). The dreams of being billionaire and stuff is just to make the reading fun (it did for me).
"Please don't post shallow dismissals, especially of other people's work. A good critical comment teaches us something."
Thoughtful critique is good, but this post breaks the guidelines and falls outside the kind of thing we're going for here. I know it's the internet default generally, but please be more thoughtful when posting comments to HN, especially about other people's work.
https://news.ycombinator.com/newsguidelines.html
At their scale, they can use the data to drive their costs down, and can build a business case for paying you something.
However, insurance companies are perversely cost conscious, because they are paid as a percentage of medical costs, not as surplus between premiums and costs.
Walk into any physician office and ask them how many faxes they get everyday from pharmacists requests the Dr. change their prescription. Then ask the pharmacists what triggers them faxing requests to the Dr.'s requesting change in therapies...hint: insurance companies dictate to the pharmacists their recommendations for Docs.
Edit: I should have noted the "tips". When a pharmacist faxes a Doc a recommendation the pharmacy gets a "tip" and if the Doc actually makes the change, then the pharmacy gets a 2nd "tip." In my experience the Doctors have no idea pharmacists are paid by insurance for recommendations and changes.
Funny affirmation: If nobody could be bothered with the math, then I was no better than Gwenyth Paltrow hawking vagina eggs.
yeah, right.
Admittedly, side projects can grow into something over time, as you evolve the idea. But there is zero reason to quit your job for such ideas.
But overall, the goal of health care as a commercial Endover is to keep you sick (I.e., not healthy, since then you will not spend, and not dead).
So the goal of selling to health care professionals is actually the opposite of your goal of helping patients.
However, I would be on board with saying that when situations get dire, risk management begins to diverge incentives between patients and providers.
And in the market consumers revealed preference is for $1000/yr treatment over $20K vaccine, or equivalent multiples. When a new vaccine is invented, people balk at the price and complain it shouldn't have been created.
Far more investment is in "managing" conditions.
It's as dumb as claiming that the cure for baldness is not invented because of the hat / wig / hair-transplant cartel that want's to keep you bald
Better data aggregation is desperately needed in medicine and sadly I think the creator has walked face first into the horror of cost merely to access clinical trials. Plus, the cost of paying contractors to extract the actually useful information from those trials.
These are key reasons why Open Science and Open Data are so critical, to produce tools like this one. Sadly I don't think there is a "Startup" level of money available for it even so.
I'm sure there is a researcher out there who can find hosting for this service, and maybe continue to keep it up to date with new trials.
Silicon Valley doesnt necessarily suffer from a lack of engineering talent as so much a lack of marketing talent. Far too many ideas go to market without any understanding of the actual market. But hey, people get to say they were a CEO for a few months and that sounds great on their Tinder, I mean LinkedIn profile. Right?
But this part:
> “And that isn’t worth something? Prescribing better treatments?”
> “Hmmmm,” she said, picking at her fingernails. “Not directly. Of course I always have the best interests of my patients in mind, but, you know, it’s not like they’ll pay more if I prescribe Lexapro instead of Zoloft. They won’t come back more often or refer more friends. So I’d sorta just be, like, donating this money if I paid you for this thing, right?”
So, what's the obvious next step ? Prescribing things that won't work so patients keep coming back but not badenough that they flee to another practice ?
If such a product existed I would use it continually and challenge my doctors when they contradict it. If patients aren't educated and care, health professionals won't care enough to purchase it.
The real benefit IMO would be marketing this to countries with a top down healthcare purchasing system (eg the UK) or as a tool to drug companies/researchers looking to make their own meta analyses (eg abstrackr). It might also be better instead to diversify into correlating symptom clusters with diseases because then the utility to the end user is bigger.
Sell this product to insurance companies so they can recommend cheaper/safer drugs to their customers, or show the more expensive one and if it truly had better outcomes. Everyone benefits from that.
That said, the medical establishment is a tough tough domain to move.
Eventually we pivoted the tech to a B2B SaaS play because it was too hard to sell.