[HN Gopher] When good ideas make bad business
___________________________________________________________________
When good ideas make bad business
Author : tomjcleveland
Score : 543 points
Date : 2020-01-03 16:44 UTC (6 hours ago)
(HTM) web link (tjcx.me)
(TXT) w3m dump (tjcx.me)
| royroyroys wrote:
| I'm surprised Big Pharma hasn't done something like this for free
| for doctors. They already spend tons of money marketing to
| doctors to perscribe their drugs and even club together and spend
| billions monitoring the perscription data with IQVIA (IMS Health
| basically). Maybe it's just that I've recently finished reading
| Bad Pharma by Ben Goldacre, but this sounds like it's right up
| their street to help manipulate doctor's perscribing.
| syntex wrote:
| It seems like you stopped far too early pursuing your idea.
| rmah wrote:
| This is one of the best startup post-mortems I've read on HN.
| Clear and engaging writing which also provided key insights into
| the mind of the entrepreneur during his journey. It's sad that it
| didn't work out but I think it can help teach valuable lessons to
| anyone reading it.
| dahart wrote:
| Congratulations on learning the hardest lesson, your next startup
| is now a lot more likely to succeed, so get to work!
|
| A _lot_ of comments criticizing what the author already knows,
| that the business plan was incomplete. I had the urge to do the
| same, but read to the very end and realized TJC clearly learned
| the most important lesson, and it 's one I've learned myself, so
| I have no room to be critical.
|
| BTW, I burned a lot more than $40k and 9 months in my own story,
| so maybe it helps to hear that other people have made the same
| mistake and gotten too convinced their idea is valuable without
| checking carefully enough -- without quite knowing how to check
| carefully. I know what it feels like to know that I'm doing the
| right thing, and then find out that it's not good enough.
|
| Fun read, and an important lesson that many very bright people
| will still learn the hard way, even after reading a story like
| this. Thank you for sharing.
| ouid wrote:
| The reason that you don't get a result for "best painkiller" when
| you google best painkiller is that there's no such thing.
|
| Why are you in pain? have you had a lot to drink recently? What
| kind of painkillers do you usually respond to? Why not simply
| combine them? Are you going to keep track of all of these
| predicates for each query?
|
| This guy's mistake was not that he mismanaged a company. His
| mistake was having a shitty idea and being utterly deluded about
| its value.
| bkraz wrote:
| Thank you for sharing the details of your experience. Healthcare
| in the US is not a normal market, so normal product- based
| thinking doesn't work. The end user doesn't pay, so they cannot
| directly influence the market by choosing products. Your
| discovery with the doctor who said that improving care doesn't
| help her, is really insightful. The 80/20 insurance rule fixes
| insurance profits so they have an incentive to make care as
| expensive as possible. Despite all this, we all know there is a
| ton of value in making things better. Your graph of Aleve
| performing so much better then ibuprofen is really interesting,
| and seems to capture how other parts of the system could be
| improved if end users were given the choice. Maybe a trusted
| review site with data to help patients choose doctors.
| 12xo wrote:
| 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?
| amitmathew wrote:
| I think people are being a little too hard on the author.
| Startups in healthcare are _hard_. Been there, done that, have
| the t-shirt (literally, that 's all that left). I even made the
| same fatal mistake - not identifying who the buyer really is. And
| when I say identifying the buyer, I don't mean it in that hand-
| wavey, vague way like "doctors" or "insurance companies". The
| starting point has to be something like "ophthalmologists in
| small practices (1-10 doctors) in New England who are trying to
| acquire new patients through social media."
|
| And here's something that's absolutely critical for all engineers
| trying to build a startup in healthcare to really understand.
| Healthcare is so alluring because tech people are so idealistic.
| We think, "Wow, we we can write some code, and then save lives!"
| And that's sometimes true. But when you are thinking of your
| customer, revenue model, sales strategy - all that business stuff
| - the mistake we make is thinking healthcare is different and the
| same rules don't apply. We think if we can save lives, we can
| make a business. But the key insight is that you have to take a
| step back and just treat healthcare like any other for-profit
| business. Doctors and hospitals care about what generates
| revenue. Insurance companies want to save money. Pharma companies
| are looking to advertise to new customers. It's no different than
| other industries. The psychiatrist's reaction to the sales pitch
| is the _classic_ thing a doctor will tell when you 're not
| helping their bottom line. As I was reading the post, I could
| almost predict how she was going to respond.
|
| And if you figure that business stuff out, who knows, you might
| just build a healthcare business that saves a life or two.
| macspoofing wrote:
| >I think people are being a little too hard on the author.
| Startups in healthcare are hard.
|
| They are hard, but this case isn't really healthcare-related.
| He tried pitching his product to practices without showing how
| it could increase their revenue, or decrease their costs.
| Without that, his product is just another cost-center with some
| marginal (and ambiguous) healthcare benefits.
| Toenex wrote:
| This. Been through two medical device companies that pivoted
| from clinical trials to product and the major hardships came
| from not fully understanding the money trail. In the UK the
| 'Cathedral' of the NHS means that the benefits may not be felt
| by the your customer.
| jimbokun wrote:
| > But the key insight is that you have to take a step back and
| just treat healthcare like any other for-profit business.
| Doctors and hospitals care about what generates revenue.
| Insurance companies want to save money. Pharma companies are
| looking to advertise to new customers. It's no different than
| other industries.
|
| This is one of the most concise and effective arguments I have
| read for Medicare-For-All, Single Payer, etc.
| amitmathew wrote:
| I'm all for removing the broken system we have today, but a
| single payer system doesn't remove the challenge that the
| entrepreneur faces - it just changes it. Under single payer,
| you are now trying to sell to a large government
| organization, with all the pain and red tape that comes with
| that.
| relaxing wrote:
| Thanks for refocusing the conversation back on the people
| that _really_ matter.
| TheOtherHobbes wrote:
| Not necessarily. Doctors can still have individual
| discretion over their choice of IT service provision (etc)
| under single payer.
|
| The only thing single payer does is eliminate insurance
| company opportunism. It doesn't suddenly convert the entire
| healthcare system into a dystopian concrete monolith.
|
| Although if it did it would make OP's job far easier,
| because if you could prove there were cost and health
| outcome benefits on a national scale you would be able to
| convert the idea into a viable business with a single
| corporate sales pitch, instead of trying to sell to every
| doctor individually.
|
| In fact the real resistance would come from pharma. Single
| payer or not, evidence-based prescribing of empirically
| proven best-in-class drugs would undermine pharma's entire
| business model.
| cal5k wrote:
| > because if you could prove there were cost and health
| outcome benefits on a national scale you would be able to
| convert the idea into a viable business with a single
| corporate sales pitch, instead of trying to sell to every
| doctor individually.
|
| As someone who ran a healthcare business in Canada, I can
| tell you that this is absolutely not the case. Single
| payers are outrageously conservative buyers... sure, you
| may convince them in 5-10 years, but no startup can spend
| 5-10 years burning cash without making revenue.
| Particularly since, unlike with drug discovery, there's
| no guarantee that you'll be the only one selling this if
| the single payer eventually approves it.
|
| What _actually_ happens is that the single payer orients
| itself to big, slow companies that more closely resemble
| it, thus devastating small businesses and rewarding
| large, established players. It is damn near _impossible_
| to create a startup that sells to a single payer
| healthcare system.
| mbesto wrote:
| > As someone who ran a healthcare business in Canada, I
| can tell you that this is absolutely not the case.
|
| Correct me if I'm wrong, but doesn't Canada have publicly
| funded providers? I'm all for single payer, but with a
| completely privatized provider network. Make the free
| market compete for the government's dollars. Technology
| should theoretically reduce costs because it more
| automation generally means higher profits.
|
| provider != payer
| wayoutthere wrote:
| From a business standpoint, saving lives can actually be
| expensive. The longer someone lives, the more healthcare they
| consume.
|
| Health insurance companies are very aware of this, which is why
| they so frequently deny coverage for various life-saving cancer
| treatments. If you die while waiting for treatment, not only do
| they save the cost of the treatment, but also the entire cost
| of ongoing screening / care during remission.
| victor106 wrote:
| The longer you live the more monthly premiums you pay, so
| ideally they do want you to live, but they don't want you to
| use any healthcare services (or use less services) while you
| live.
| harikb wrote:
| No, the moment you are diagnosed with a chronic or life
| threatening disease, your premiums no longer cover the
| medical cost. Otherwise what is the point of insurance.
| Moreover, many regulations prevent them from raising future
| premiums. So kicking you off the insurance plan or letting
| you die is indeed their primary concern
| lotsofpulp wrote:
| This is incorrect. How can they kick you off the
| insurance plan? Also, the ACA has provisions to prevent
| one insurer from having to shoulder the costliest
| patients via some form of cost sharing with all the
| others.
|
| https://www.cms.gov/CCIIO/Programs-and-
| Initiatives/Premium-S...
| jonny_eh wrote:
| A better way to put it is that health insurers don't want
| you to get "sick". So anything to prevent that is usually
| money well spent. That's why vaccines are so easy to get.
| omegaworks wrote:
| This is _precisely_ why we need universal healthcare. The
| incentive structure of private markets don 't properly value
| human life.
| 0xdeadbeefbabe wrote:
| > because tech people are so idealistic
|
| Unless idealism is the strategy to combat idealism?
| planetzero wrote:
| "This is precisely why we need universal healthcare. The
| incentive structure of private markets don't properly value
| human life."
|
| Government-run healthcare isn't a panacea that will 'value
| human life' any more than the insurance companies. You are
| still a number in a database somewhere.
|
| Most new drugs come out of the US and socialized
| governments create generics at a fraction of the cost,
| because they don't have to put any money into R&D.
|
| The US is the back-bone of the medical system for the rest
| of the world and also has the best medical schools and best
| quality hospitals (the majority of people with money come
| to the US for life-saving surgeries..this has to tell you
| something).
|
| We need to push the true costs of things to the patient,
| which will force the price down...not replace the existing
| inefficient layer of the insurance companies with an even
| more inefficient layer called the government.
|
| This has worked with many cosmetic surgeries, which used to
| be very expensive, but aren't covered by insurance.
|
| Insurance should only cover rare surgeries that can't use
| the free market to reduce the costs.
|
| I can't think of anything that the government runs better
| than the private sector. Healthcare is no different.
| gonational wrote:
| Take all my karma...
|
| Implementing something like what you describe, IMHO,
| would have the greatest positive impact on the health and
| welfare of Americans, of anything this century.
|
| I have a friend who is very high up in one of the largest
| health insurance providers in the US, and I have often
| debated over the years with this person that same point,
| that the insurance layer is what creates the model for
| inefficiency, and abuse at the provider level ($5 Tylenol
| pill, $10 Band-Aid, minor treatments and return visits of
| dubious value, etc.), and that if we treated medical care
| as an ordinary consumer good, outside of the extreme
| emergencies that are bankruptigly expensive, things would
| be a lot better. The person I know at the insurance
| company doesn't necessarily disagree either.
| achillesheels wrote:
| "Consumer driven healthcare" as the academic researchers
| call it. It is bewildering why we don't have diagnostic
| labs doing email marketing campaigns, for instance. This
| is driven, I think, by an outmoded concept of the
| security of doctor's knowledge. Now, doctors are so
| behind the ball and play defensive to protect themselves
| from malpractice. The idea that an individual cannot make
| educated decisions which are market driven (ie price
| driven) for most mild conditions is incomprehensible.
| [deleted]
| codegeek wrote:
| I am on the fence between Single Payer and your proposed
| solution of "push the cost to patient to force the price
| down". I do think the same but the appeal of universal
| healthcare is similar to the appeal of things like fire
| department. We don't really always need it but when we
| do, we don't want to worry about it.
|
| Honestly, as long we get rid of the mafia middleman a.k.a
| insurance company except for real catastrophic
| situations, I do agree that costs will plummet. Price
| transparency is another key aspect.
| qaq wrote:
| The drug things is partially BS. The top 10 big Pharma
| (in random order)
|
| GlaxoSmithKline British
|
| Eli Lilly US
|
| Sanofi French
|
| AbbVie US
|
| Roche Swiss
|
| Pfizer US
|
| Novartis Swiss
|
| Merck & Co US
|
| AstraZeneca British/Swedish
|
| Johnson & Johnson US
|
| (edit spacing)
| pgsbathhouse wrote:
| >Most new drugs come out of the US and socialized
| governments create generics at a fraction of the cost,
| because they don't have to put any money into R&D.
|
| This is a completely false right-wing talking point. It
| takes 10 minutes to uncover how just totally bullshit
| this is.
|
| Don't ever repeat again or anything remotely like it (aka
| the rest of your post).
|
| https://www.ncbi.nlm.nih.gov/books/NBK50972/
|
| https://other98.com/taxpayers-fund-pharma-research-
| developme...
|
| The government never sees a return in any form on the
| money taxpayers put forth. But private companies do. Just
| waiting like vultures to snag whatever makes it through
| the proof of concept phase and claim credit.
|
| >I can't think of anything that the government runs
| better than the private sector.
|
| ISP's? Roads? Social services? Schools? Emergency
| Services?
| sweeneyrod wrote:
| Your second link has a pie chart that claims that pharma
| companies spend around 200x as much on advertising as
| clinical trials. Do you believe that is true?
| wayoutthere wrote:
| This has been known for a very long time in pharma
| circles. Marketing budgets are several orders of
| magnitude higher than R&D budgets. An extra dollar spent
| on marketing has much higher returns than an extra dollar
| spent on R&D. Most of the real "hard science" R&D is paid
| for with NIH grants.
| sweeneyrod wrote:
| > Marketing budgets are several orders of magnitude
| higher than R&D budgets.
|
| This is a lie. Marketing budgets are approximately equal
| to R&D (https://www.bbc.co.uk/news/business-28212223) so
| you're off by several orders of magnitude.
|
| > Most of the real "hard science" R&D is paid for with
| NIH grants.
|
| Also not true. NIH grants are ~$40 billion/year whereas
| industry R&D are around $80 billion
| (https://www.statista.com/statistics/265085/research-and-
| deve...).
|
| There are definitely lots of problems with the
| pharmaceutical industry, several of which are mentioned
| in that BBC article. But making hyperbolic claims that
| they essentially don't do any R&D isn't helpful.
| pgsbathhouse wrote:
| >This is a lie. Marketing budgets are approximately equal
| to R&D
|
| Your own source doesn't even say that. In the exact BBC
| article you linked:
|
| >But as the table below shows, drug companies spend far
| more on marketing drugs - in some cases twice as much -
| than on developing them
|
| Here's some very very basic reading on the subject that
| you can find in 10 seconds of googling:
| https://en.wikipedia.org/wiki/Pharmaceutical_marketing
|
| In the literally first sentence on this topic:
|
| >pharmaceutical company spending on marketing far exceeds
| that of its research budget
|
| Imagine living in a society where supposedly rational,
| intelligent people hold opinions that don't withstand the
| test of a few keystrokes; opinions that quite literally
| aid in the needless death and suffering of others while
| also just generally being a complete waste of time.
| wayoutthere wrote:
| > The US is the back-bone of the medical system for the
| rest of the world and also has the best medical schools
| and best quality hospitals (the majority of people with
| money come to the US for life-saving surgeries..this has
| to tell you something).
|
| This just means American consumers end up subsidizing
| health care R&D costs for the rest of the globe -- purely
| because our government prevents us from collectively
| bargaining the way pretty much every other country does.
|
| The people coming to the US for the "best quality" are
| generally going to doctors / surgeons in private
| practice, most of whom do not take insurance and can see
| you immediately. There is an almost entirely separate
| (and much higher quality) medical system available to
| those who can afford it. The system the rest of us belong
| to ranks right behind Morocco and Costa Rica in terms of
| outcomes (not joking -- this is according to the WHO). We
| come in dead last among "first world" countries.
| Buge wrote:
| If American consumers stop subsidizing health care R&D
| costs, what will happen to the R&D? Will it decrease?
| Will health care costs in other countries increase as
| they start to bear some of it?
| omegaworks wrote:
| >Government-run healthcare isn't a panacea
|
| I didn't claim it was. Only that our present standards
| incentivize fee-for-service and not outcomes-driven, as
| exemplified by the author's inability to sell his outcome
| optimizing software. ACA tried to remedy that with
| preventative care standards, but the current
| administration is actively dismantling it.
|
| Your model works for cosmetic surgeries because they are
| cosmetic - optional and not life threatening.
|
| When calculating price, the cost to produce a drug is the
| last thing on pharmaceutical companies' minds. The
| question they ask is how much are you willing to pay for
| something that allows you to continue living. It would
| ideally fall just a hair under the patient's perceived
| cost-benefit of continued suffering, the
| credit/insurance-worthiness of the treatment cohort, and
| whether the company faces competitive pressures from
| others selling the drug on the market.
|
| Nothing better depicts the situation than what goes on
| when pharmaceutical companies merge or acquire the rights
| to rarely used drugs[1].
|
| The only way to structurally combat this is with the
| monopsony power of a single payer system.
|
| >I can't think of anything that the government runs
| better than the private sector. Healthcare is no
| different.
|
| Medicare has the highest satisfaction rate of any
| healthcare coverage[2].
|
| 1. https://www.nytimes.com/2015/09/21/business/a-huge-
| overnight...
|
| 2. https://news.gallup.com/poll/186527/americans-
| government-hea...
| NeedMoreTea wrote:
| _Don 't have to put money into R&D._
|
| Between the MRC and NIHR, the UK's NHS puts at least a
| couple of billions (Sterling) into clinical research each
| year, making them the largest clinical research funder in
| Europe. They're not researching generics. Oh and they
| were one of the original funders of PubMed.
|
| I can think of lots of things the government does better
| than the private sector, although admittedly outside the
| US.
| folli wrote:
| Universal healthcare won't help you there, since it also
| requires a stringent cost-benefit-calculation, e.g. the
| British system is very (in)famous for this.
| orhmeh09 wrote:
| Ah, but then you have all these with the ever-increasing
| demand for profit and the issues caused by that incentive
| on top of it all. Is that an improvement?
| ericmcer wrote:
| At least in the above scenario the hospital has a financial
| incentive to treat you (part of why we perform loads of
| unnecessary surgeries in this country).
|
| I'm for a public system I just think it is very difficult
| to do correctly, and if we go into it with idealism instead
| of extreme pessimism we will fail to secure it against
| those who prey on exploiting public money.
| TheOtherHobbes wrote:
| Private healthcare already preys on exploiting the money
| of the public.
|
| I'm not convinced the distinction between "public money"
| and "the money of the public" is particularly clear in
| these situations.
|
| And of course you don't need a hypothetical "correct"
| solution - just one that's clearly less exploitative of
| consumers.
| avip wrote:
| You will be facing same financial dilemmas with public
| healthcare. But it may be more transparent.
| zndr wrote:
| So, this is why, at least in the US, EU and a few other
| countries, we have orphan drug policies.
|
| If you don't know orphan drugs are drugs that could be a
| life saving medical necessity for rare diseases that do not
| have a large enough base of users to make the drugs
| affordable. I'm not talking about Shkreli "affordable", but
| it's literally not feasible to spin up manufacturing, or
| final trials, or educational materials for doctors
| affordable. So governments offer massive subsidies or cost
| investments for some of these drugs that often only help
| TENS of people, not hundreds, or thousands or millions.
|
| What's missing is a similar policy for funding otherwise
| for-profit efforts like the authors.Educational tools and
| products are often seen as less valuable but I believe they
| could be immensely helpful.
|
| Now as to the authors original flaws? Well, his product has
| a clear sell-through referral potential, but it's not
| really functional to do so with prescription drugs. That
| being said, selling this product to a CVS or a webmd as a
| feature could be really good, or major hospital networks,
| or heck even pharma companies. But all of that is often
| year+ sales cycles, you can't just luck into that.
| angrais wrote:
| Surely you can't leave us hanging?
|
| What's the t-shirt look like? :)
| ljm wrote:
| At risk of identifying myself, I work in this industry (or
| should I say, I work in the medical field) and yes... it's
| insane. And of course, you get that privileged peak behind the
| veil, you get to see how the sausage is made as it were.
|
| It is truly humbling because there is no easy solution, there
| are no unified APIs; you couldn't use them even if there were,
| because your medical records are highly sensitive. So forget
| about poking around production to solve a bug, you've got to do
| it through observability.
|
| You can't move fast and break things because your downtime will
| get the regulators involved, because peoples livelihoods are at
| stake. You will get official complaints through various
| official bodies who can and will sanction the business.
|
| In short, it's not a fucking joke and it takes a lot more time
| and a lot more money to do something serious here, and for good
| reason.
|
| Note that I'm not talking about low-key wearables like Fitbits
| that monitor your pulse, I'm talking about doctors, triage,
| etc.
| Donald wrote:
| Guess it's time to rebrand this as a fintech startup that informs
| investors about high-risk pharma stocks.
| jcims wrote:
| Yes! Andrew Lo has a great talk on a related subject -
| https://www.youtube.com/watch?v=AzELyaVf0v8
| johnchristopher wrote:
| That was really great writing, though :-).
|
| 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 ?
| arrosenberg wrote:
| 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.
| mark-r wrote:
| "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.
| cardine wrote:
| 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.
| opportune wrote:
| I have a family member who worked somewhere that provided tools
| to medical practitioners to help them determine how a patient
| would respond to a drug based on their genetics. They also had a
| hard time selling directly to clinicians, because as the author
| notes, they do not particularly care about patient outcomes in
| the abstract sense, because much like the programmer bravado,
| doctors have a similar one: most of the other doctors are worse
| than me, they need the tools but I don't because I have a more
| nuanced view, I know what works for my patients better than any
| statistical study could tell me, etc.
|
| The only way to make money is to get insurers to require these
| things, or to sell to some big hospital network administrator who
| you can focus your sales efforts on. I don't think the product
| here was mature enough to sign a multimillion dollar contract
| with a hospital network, and maybe not for insurers either.
| gazelle21 wrote:
| The ending was fantastic
| uj8efdkjfdshf wrote:
| 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.
| allcentury wrote:
| I had the same thought:
|
| 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.
| lotsofpulp wrote:
| 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.
| wayoutthere wrote:
| 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.
| stevewilhelm wrote:
| TLDR: OP learned the hard way that a good idea was a feature, not
| a viable business.
| RocketSyntax wrote:
| did you try selling to pharmaceutical companies what about
| healthcare provider networks what about EMR companies? they would
| probably compare you to open source tech R packages, but it's
| worth a shot.
|
| you could make a "reference database" out of it and charge for
| access to the latest version
| hangonhn wrote:
| Failed entrepreneur, perhaps, but one hell of an entertaining
| writer and storyteller while throwing in bits of wisdoms. I also
| came away with one insight at the end. I'm going to sign up for
| the news letter.
| dumbfounder wrote:
| This would be a useful feature of Google, but it won't be a real
| company without an innovative business model. 9 months to build a
| company AND THEN innovate a business model is nowhere near enough
| time, especially since you probably spent the vast majority of
| the time on the product. If you had a partner that was equally
| talented working on the business side since day one you still
| wouldn't have something in 9 months, but maybe 2 years. And maybe
| something HUGE. That's the gamble you make going into a startup,
| and 9 months simply isn't long enough to find that out.
|
| Or maybe you could have been a small acquisition target for
| Google to incrementally increase their search superiority. I
| imagine they would be able to monetize eyeballs with searches
| like these at (very) roughly 100x the rate of WebMD.
| rwmj wrote:
| Others have said this, but $40K is a bargain to get this
| experience. If you include the opportunity cost, my own 4 year
| start up failure cost me way more than this (even if you don't
| include lost opportunities it was probably about this sum of
| money). You still have the database/website that you can continue
| to run in your spare time and you never know it might even make
| you a return in future.
| jdennaho wrote:
| You could have made value for the customer too, you needed cash
| to keep the operations going. Doctors will pay for this if it
| lets them get a leg up on other doctors that's how you need to
| sell it. "Doctor X prescribes what he always prescribes, I make
| decision based on cutting edge studies." If they got arbitrage
| because of that and could steal patients, especially doctors with
| a new practice then you have a sale my friend. You gave up too
| easy.
| sparkywolf wrote:
| Hacker News hug of death... Anyone have a mirror or text?
| [deleted]
| acvny wrote:
| Wow, what a nice and funny story!
|
| Why GlacierMD? You know glaciers tend to melt these days.
|
| You'd be surprised that the dumb and not so noble idea of your
| buddy with Doppelganger could gain much more traction and make
| much much more money than your idealistic thing... this is
| usually the thing.
|
| People are attracted more to fun than to pragmatic usefulness.
|
| You feel almost like a martyr who wanted to save the world, but
| nobody understood you. I am very sorry and I see great value in
| your idea, but looks like people don't want to consume that.
|
| Indeed, why would a medical practice want to completely cure the
| patient and never see them again?
|
| Really fun read and with lots of useful references.
| dnprock wrote:
| I think we mistake these ideas as being bad business because of
| our expectations. Some ideas take longer to produce returns.
|
| I'm currently working on an idea that has no business plan in the
| near future. It's a cryptocurrency. I hope to make money from in
| the future by either selling my stash or providing software and
| services. But in the meantime, I'm running it as a fun/side-
| project. The project is picking up steam. I've seen interest
| growing, some coin trading on an exchange.
|
| I don't expect to make money soon. So I do everything myself. I
| spend little money on the project, 3-5k per year. I enjoy working
| on it and learning. It helps me learn not only about my project
| but also about other cryptocurrency. I think that I will make
| some money, eventually.
| gkoberger wrote:
| I'm so confused by the tone of this article. Obviously some of
| the jokes are parodying startup culture and are meant to be
| funny, however I think the "fantastic idea" stuff is meant
| seriously?
|
| "So I built something people wanted. Consumers wanted it, doctors
| wanted it, I wanted it. Where did I go wrong?"
|
| As far as I can tell, nobody wanted it except the author. The one
| doctor he talked to didn't, and no consumer ever saw it. I feel
| like the author learned a lesson, but not the full lesson.
|
| Reading this was like watching someone you don't politically
| agree with doing comedy. You know they're trying to be funny, but
| you also know they're missing the whole point and aren't self-
| aware.
| utopian3 wrote:
| Ya, I'm surprised it's not just a static landing page for
| consumers with ads. At .50 cents per user, that's only 80k
| users required to break even (ignoring the time variable there)
| MFLoon wrote:
| I'm no adtech expert, but I'm pretty sure he would not be
| getting .50 cents per user per year - that's what WebMD, one
| of the top 1000 most trafficked web sites in the world makes,
| so I assume it can sell it's ad space at a much higher price
| than a greenfield site with no traffic would.
| utopian3 wrote:
| Fair point. I just searched for a bit, but can't seem to
| find a good "average revenue per user" for ad-based SaaS
| products. Anyone know?
| mritchie712 wrote:
| The funny part is, he might still be wrong about it being
| worthless. He talked to ten doctors? There are 1M in the US.
| It's kind of funny to drop all that time and 40k in then give
| up after ten doctors say no, especially without trying to tweak
| the product based on feedback.
|
| I, as a consumer, find it worthless and they shouldn't have
| even started it, but now that you're here, might as well give
| it a bit more of shot than that. To completely bail on what you
| have after 10 no's is also the wrong move.
|
| Doesn't seem like he asked the question, "well, what would you
| pay for?"
| the-pigeon wrote:
| Yeah. For investing so much time and money it seems like he
| gave up after a couple of bad meetings.
|
| It takes years to figure out how to properly sell your
| product. He didn't find out that his product wouldn't work in
| the marketplace he just found out he didn't know how to sell
| it.
| mwilcox wrote:
| He should obviously be selling to clinics / hospitals
|
| Plus when did the 'we don't have any budget' excuse stop a
| SaaS company? That's what you raise VC for - build the
| product, hand it to the customer for 'free' and charge them
| what it was really worth based on their usage when you
| threaten to take it away
| eightysixfour wrote:
| Or he should try selling it to CVS as a in-the-store tool
| for OTC products, where his original need came from in the
| first place.
| jimbokun wrote:
| Interesting, could be a differentiator from other
| pharmacies.
| Androider wrote:
| CVS doesn't care if you buy Tylenol or Advil or which one
| works better, and makes no additional money depending on
| your choice of product. In fact, the brands pay CVS for
| the privilege of being featured on an eye-level shelf vs
| at the bottom.
|
| I think it was a great article. Like it said: To succeed,
| an offering must create value for all entities involved
| in the exchange--target customers, the company, and its
| collaborators. And value is literally measured in
| dollars, so you're either saving or making money for
| someone, otherwise it's just a fun project.
| eightysixfour wrote:
| I would absolutely choose one store over another if they
| had a proprietary tool to tell me which medicine is
| scientifically most likely to work for my ailment. I
| cannot stand the massive wall of choices at pharmacies.
| tomtheelder wrote:
| Is it possible to sell to single payer health providers in
| other countries? Something like this could have massive
| implications for, say, the UK's NHS.
| agentultra wrote:
| Or try insurance actuaries. If _better outcomes_ is the
| goal then doctors will want to keep their premiums low by
| prescribing the optimal drug. If the actuaries are able to
| see what the doctors are prescribing and what is the better
| fit they might be able to increase premiums for doctors
| that take more risks prescribing off of the meta-analysis.
| jonny_eh wrote:
| Exactly! Find the people that benefit from healthier
| patients, that'd be insurers or HMOs like Kaiser
| Permanente.
|
| Edit: Or even Medicaire?
| tootie wrote:
| I don't think it's parody at all. I think he's laughing in
| retrospect at his true emotions as a naive developer who had
| read too much HN.
| jariel wrote:
| It's not a parody of anything, it's just his story, similar to
| most startups.
| gkoberger wrote:
| By parody, I don't mean the entire thing. I mean lines like
| this:
|
| "Call me when you have a business plan," I said, lacing up my
| Allbirds before and riding my Lime scooter into the sunset.
| nwsm wrote:
| Yes that is obviously a joke. He is poking fun at himself
| for feeling like a business genius after reading one
| chapter of a Wharton textbook.
| jstrong wrote:
| > Reading this was like watching someone you don't politically
| agree with doing comedy. You know they're trying to be funny,
| but you also know they're missing the whole point and aren't
| self-aware.
|
| are you not supposed to laugh at the jokes of someone you
| disagree with politically? is it possible someone could be
| "self-aware" and still disagree with you?
| justingreet wrote:
| I take the article to be written in the mindset he had at the
| time. When he made that quote you mentioned, he thought as he
| was heads-down building the product that it would be useful to
| those people.
|
| He then goes on to describe the evidence specifically why
| doctor's DIDN'T want it. All the author was trying to do with
| that quote was explain what he was thinking at the time.
| stevespang wrote:
| Anyone who feels that the primary goal of healthcare in the US is
| to improve health outcomes is incredibly naive about how this
| industry works . . .
|
| So true, the health industry doesn't give a s___t whether you
| live or die - - they only want their money.
|
| My advice ? Get into vitamins and supplements, it's all a pack of
| lies and deceptions just like big health, it's all based on
| supposedly respectable, bogus "sources" of information which you
| make "believeable", most of the cusomers are women over 40
| looking in the mirror at their beauty wasting away . . .
|
| There is HUGE money in vitamins and suuplements and they have a
| monsterous lobby to fend off the AMA and the doctors so they can
| keep selling their snake oil . . .
|
| Oh, and as far as painkillers go . .
|
| Multiple research shows that Naproxen sodium has the least
| detrimental effect on the heart - - as all NSAID's do.
|
| Acetaminophen or Tylenol is an serious destroyer of glutathione,
| one of the largest natural antioxidants in the human body, mostly
| in the liver.
| scotty79 wrote:
| > There was this giant thing called healthcare right, and its
| main purpose is improving health--trillions of dollars are spent
| trying to do this.
|
| There was this giant thing called healthcare, and its main
| purpose is applying well known treatments to people whose
| symptoms more or less indicate that treatment might somewhat
| improve their condition--trillions of dollars are earned trying
| to do this.
| godelzilla wrote:
| The point of healthcare under capitalism is to profit from sick
| people, not to heal them.
| macspoofing wrote:
| Great writeup. Very honest.
|
| His problem is that this product neither increases the revenue of
| the practice nor does it reduce(or remove) any existing cost.
| Without that it's a cost center without clear benefits.
|
| > 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.
|
| No. Or at least you better show clear benefits becuase EVERY
| medical product makes claims that they improve patient health or
| patient outcomes.
|
| What he needs to do is figure if there is some costs that are
| currently incurred by hospitals and practices that could be
| reduced or removed by using his product. If he can do that, he'll
| get sales (and in fact, there is a lot of money in 'population
| health' and related fields). Otherwise, he's got nothing.
| amirhirsch wrote:
| > Make something people want. It's Y-Combinator's motto and a
| maxim of aspiring internet entrepreneurs. The idea is that if you
| build something truly awesome, you'll figure out a way to make
| some money off of it.
|
| Nice narrative style and congratulations on achieving your
| (first?) failure without too much trauma.
|
| It's possible you invested your own money prematurely, possibly
| without talking to enough people about the opportunity. Your
| metric for how much people want something is usually directly
| tied to revenue, or if you are using engagement as your metric,
| you should have figured out some way to make money off of it
| before you invested in development. I suggest that other
| engineering-minded founders think of sales like writing "hello
| world" -- for example, if you're doing a physical consumer
| product, you can start by shipping pet rocks on day one.
|
| More than just identifying a product people want, you also want
| to find a network effect or viral marketing approach so you can
| grow with a sustainable advantage.
| StavrosK wrote:
| The author says that they fired the contractors and closed the
| site. I can never relate to this. You built something that is at
| least somewhat useful to at least some people. Why not just keep
| it online forever? It can't cost more than $5/mo to host this, I
| have a server where I host around ten of my projects for less
| than $20/mo.
|
| Why do people shut things down instead of just leaving them
| there, unmaintained? Even that is better than just taking it
| offline.
| cosmic_shame wrote:
| Well in the case of this particular product that offers medical
| advice, the info may become outdated fairly quickly. I suspect
| there is some amount of liability associated with offering
| potentially out of date medical advice that isn't worth the
| tiny revenue stream.
| JamesBarney wrote:
| It's just a programatic meta analysis. And no one's get sued
| for having an out of date meta analysis.
| celestialcheese wrote:
| It's America - people get sued for far, far less.
| StavrosK wrote:
| Perhaps... Would a disclaimer help there?
| WC3w6pXxgGd wrote:
| Hosting a database with this data would cost thousands of
| dollars a month. I know from experience.
| stickfigure wrote:
| I was tempted to post this same question. I suspect the answer
| is that the OP just doesn't know how to scale it down; it was
| built by contractors and he/she might not even have the keys to
| the boxes, let alone know how to keep them running.
|
| It is unfortunate. Even if the data goes stale and the product
| is no longer fit for purpose, it shows well and would make a
| great demonstration for his/her future endeavors. And you never
| know who might stumble across it in the future and want to
| revive the technology.
|
| I've had fairly sophisticated sites running on Google App
| Engine for years after the company was "shut down". One ended
| up being instrumental as a demo when meeting a later cofounder.
| symlinkk wrote:
| I don't see how ads weren't enough to keep this afloat.
| kevan wrote:
| For anyone else who, like me, is prone to the excitement of new
| company ideas and has a tendency to gloss over questions like "is
| it even possible to monetize this?" I'd recommend reading
| Disciplined Entrepreneurship. It's not the One True Way but the
| steps they recommend cover a lot of questions that you should
| think about during the process.
| thomasjudge wrote:
| '"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
| taurath wrote:
| So, given the author quit his money making startup to make a
| business that would be helpful for humanity, I assume that all of
| his data and IP is now in a .zip file up for auction and not
| actually disseminated to people who could use it right? It tells
| you that what people say is their motivations, especially when it
| comes to startups are often not at all the case.
| ggggtez wrote:
| Step 1: come up with a half baked idea Step 2: quit your job and
| hire other people Step 3: market research...
|
| Guy did everything wrong and blames his failures on others.
| Typical.
| SAI_Peregrinus wrote:
| My university (University of Hartford, in CT USA) had a required
| course for all engineering majors: "Engineering Practice".
| Essentially it was a course on how to take an engineering idea &
| turn it into a business.
|
| Find a problem, find potential buyers for a solution, figure out
| what they say they're willing to pay, determine other design
| constraints, rough design a solution matching the constraints (IE
| that can be sold for what people will pay), _create a business
| plan, including estimates of how much funding is needed and a
| method to get that funding_ , build a prototype, pitch the
| product to faculty as though they were VCs/banks/other funding
| sources.
|
| If you're trying to make a _product_ you need to know how it will
| sell. If you 're trying to run a business, you need a business
| plan! If you can't make money you're better off planning to
| register as a charity, and your budget will need to take that
| into account.
|
| This product could maybe have been a good business, if it was
| aimed at someone willing to pay for the data. Mainly, the
| insurance companies. They want to make money, so if they could
| profit by denying coverage of drugs that are less effective they
| might pay for it.
|
| This could also have been a good charity. Providing helpful
| information is what educational charities do. Making a nonprofit
| would save on costs, and might have been enough to make this
| viable (though certainly not a lucrative money-maker).
| hogFeast wrote:
| Obviously, the doctor is going to torn to shreds here...but I
| think this kind of misses something about medicine. You prescribe
| a drug, you know roughly what it does...but aren't totally sure
| what is going to happen when the specific patient takes it. SSRIs
| are a perfect example of this.
|
| ...and that is kind of why you hire a doctor rather than a
| computer who has looked at some studies...that isn't really what
| medicine is.
|
| More generally: this just sounded like a terrible business model.
| Consumers and probably doctors would value the end product but
| are you going to get back the money spent on contractors manually
| going through these studies...no. I can see this making sense for
| a larger company but these kind of projects are terrible for one
| guy alone, they just tear through cash.
|
| You also don't seem to have asked how doctors/insurance companies
| actually look at this data either. I am sure I have no idea but
| the first question should be: is the user looking through these
| studies manually? Did you survey doctors: how many studies do you
| look at a week? Do you look at them before prescribing? Etc...and
| probably do this before you build obv (and try to get money
| upfront).
| pilingual wrote:
| The foremost problem is lack of domain expertise as others have
| noted. If you lack domain knowledge but love your idea, the best
| course of action is to keep your day job and gain as much
| knowledge as you can before quitting.
|
| But another problem is lacking the conviction and traversing the
| idea maze[0]. Several comments here have provided good paths for
| possible methods of execution like offering a free API and seeing
| who is using it.
|
| [0] Summary of Balaji's concept here:
| https://cdixon.org/2013/08/04/the-idea-maze
| fyp wrote:
| I have had life long headaches that I have given up on fixing.
| Occasionally when I switch to a new doctor I will mention it just
| to see if they have anything new to say.
|
| They usually just put me on a concoction of various pain killers
| (e.g., migraine specific stuff like sumatriptan). These
| prescriptions actually work great. But so did OTC
| aleve/advil/tylenol too.
|
| The problem was that I didn't really care for more effective pain
| killers. What I really want is to fix the root cause and stop
| having these headaches.
|
| So yea, I can totally see why something like this would fail. If
| the solution is still qualitatively the same, a small percentage
| improvement is just micro-optimizations that most doctors and
| patients won't care much for.
| lopmotr wrote:
| It seems like a flaw in the system though because those micro-
| optimizations are what usually drives the free market and
| accumulate to become huge. If all buying decisions were just
| made on the same coarse decision making then the useful
| competition-by-endless-small-improvements would be replaced
| with competition-by-insidious-marketing, which I guess is the
| state that pain medicine is in.
| sjg007 wrote:
| What's your blood pressure? I had bad tension headaches from
| time to time and after starting a bp medicine they've basically
| disappeared.
| fyp wrote:
| Pretty spot-on guess! I do have relatively high blood
| pressure, typically in the 130-150 range.
|
| Doctors have suggested it before but since I am borderline I
| don't really need to be on meds yet. I think it sounds worse
| than needing to take pain killers occasionally.
| sjg007 wrote:
| I was borderline. Higher bp increases your risk of stroke.
| I figured the headaches were a warning.. I could be wrong
| about that though.. I take a very low dose ace inhibitor
| and it works great. Doc said it wasn't a permanent thing
| necessarily.. I could probably go off of it if I was more
| consistent with the DASH diet and exercise more and drop
| 15-20 pounds.
|
| Keto diet supposedly helps drop the bp too but diets are
| really hard to maintain and stick with.
| kirillzubovsky wrote:
| Congratulations on a valuable experience. You have learned a ton
| and summarized it wisely. This is all worth a lot more than 40k!
|
| Although the typical SF startup drum is about changing the world,
| it takes a lot more than just a good product to do it, as you've
| found out, and especially in healthcare, where the barrier to
| entry is extremely high.
|
| Also, your doctors forgot to mention that Pharma companies
| actually pay them (indirectly) for prescribing a certain drug.
| Your software was not just not useful to them, it was actually
| telling many a story they did not want to hear. Sure, Tylenol
| might actually be #3 of the list, but their sales rep is a real
| friendly one, and next time they go out for dinner, it would be a
| shame to have prescribed something else...
|
| Anyway, now you know. Isn't that an amazing feeling that you've
| learned so much that others would never dare, and it had only
| cost you $40k? Keep going, good lessons are worth it!
|
| p.s. Just because your original iteration of the product was not
| needed by doctor and not valuable enough to be paid by the
| consumer, it doesn't make it useless.
|
| Perhaps if you made it the #1 on Google, consumers would notice,
| and use it, then you could use it as a lead-gen for other
| products, and sell that space/time/data.. whatever.
|
| The funny thing about startup ideas, your first iteration is
| probably almost always wrong.
| brundolf wrote:
| > "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?"
|
| I've never seen such a concise indictment of the American
| healthcare model.
| [deleted]
| nautilus12 wrote:
| Why not go after the most obvious buyer for this in
| pharmeceutical companies? Is it because the conflict of interest
| would undermine the whole idea?
| reggieband wrote:
| > I had literally nothing to say to that.
|
| I think this is literally why salesmen exist.
|
| One of my good friends is a real estate agent and he is helping
| me find a house. My job is to complain about every place we see.
| Every single time he finds a way to spin my complaint into a
| positive or something constructive. Roof leaky? You can get it
| fixed for $X dollars and we can work that into an agreement.
|
| For a great salesman there is no objection that cannot be
| overcome.
| danieltillett wrote:
| A lack of money from the customer can't be overcome. In your
| case if you can't afford any of the houses there is nothing the
| great salesman can do. Of course a great salesman qualifies
| their prospects before attempting to sell.
| reggieband wrote:
| In the specific case of the article, the developer was
| reacting to the doctor saying: "So I'd sorta just be, like,
| donating this money if I paid you for this thing, right?"
| This was not a price objection type statement.
|
| Also, selling houses to people who did not have enough money
| for a house was the basis of an entire financial crisis. It
| looks like creative salesmen found a way around that.
|
| You can argue some extremes if you want but exceptional
| salesmen are expected to sell ice to eskimos and sand to
| arabs. And I would expect them to handle the pretty simple
| objections raised in this article, especially those around
| price concerns.
| Dayshine wrote:
| 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.
| CPLX wrote:
| This could have worked. It would have been possible to sell an
| integration with a major health insurance company or provider
| network (or a few) as a tool available to their members.
|
| Like as a United Healthcare sponsored portal that helps you pick
| OTC drugs, or similar. Those guys love stuff like this. And I've
| actually worked in this space so I'm not just making things up.
|
| With that said, the way to do that would be to make it a
| destination with a growing userbase and then approach them for
| partnership. Which would have cost money and taken a while to
| ramp up, so you'd need some runway. Also it's not a strategy to
| actually get rich, that wouldn't lead to tens of millions in
| revenue or valuation probably.
|
| But it was in fact a good idea and there were some paths forward
| you could have taken. Had you done so there's an excellent chance
| you would have discovered some interesting and perhaps lucrative
| product extensions along the way.
| scotty79 wrote:
| > 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.
|
| Wow. That's not how any of (especially 'for profit') healthcare
| works.
|
| I think it's a good heuristic that you definitely shouldn't build
| a product if you rely on getting money from 'some profession or
| some institutions or whatever'. This indicates that much more
| research into your future customers and motivations is needed
| before you attempt to create business.
| tylerrobinson wrote:
| Hi Tom, thanks for sharing this. I work for a company in the
| evidence based medicine space that would have become your
| competitor had you continued to pursue this idea. Send me a line
| (email in profile), it would be interesting to get introduced.
| jcims wrote:
| Hey is there a way for patients/caregivers to get involved? I'm
| particularly interested in finding ways to collect data on
| trials that are in progress but haven't published results yet.
| Secondarily trying to build an evidence-based approaches to
| selecting low-risk adjuvant therapies that hasn't been directly
| proven in clinical trials.
| tylerrobinson wrote:
| I don't entirely follow your question, but please feel free
| to send me an email if you want to catch up on this.
| codewithcheese wrote:
| If you don't know how to monetize, you need investors...duh :)
| Then you can spend some millions working it out! And if you still
| cant monetize make sure one of your investors is deeply in the
| hole on this investment and you control the voting shares and
| make them buy you out.
| desireco42 wrote:
| I would say, sorry for your loss.
|
| This story is fantastic, honest and educational. Clearly the
| author is smart, yet this doesn't prevent him from making some
| stupid mistakes. I know it is obvious, but this story is very
| educational.
|
| Thank you for writing this.
| DJBunnies wrote:
| I feel like one can just review the symptom relief for each
| product.
|
| Are there people that don't know acetaminophen is for headaches
| and ibprofin is for muscle aches?
| SpicyLemonZest wrote:
| Yes. I didn't know that until right this second.
| DJBunnies wrote:
| Wild.
| rurp wrote:
| 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.
| danieltillett wrote:
| Yes those of us that know ibuprofen is better for headache than
| acetaminophen.
|
| Actually taking both together is more effective. Take one
| tablet of ibuprofen and one of acetaminophen.
| [deleted]
| cjdupreez wrote:
| Unfortunately, I feel like this is a lesson that's best learned
| the hard way. Everyone can tell you from the get-go to "have a
| business plan" before committing financially and professionally
| to a self-concocted venture. It's not until you run through it
| and witness the brutality of failure first-hand that you realize
| the importance of doing your homework first and having a plan.
| cortesoft wrote:
| I don't know, I have never witnessed the brutality of this
| failure first hand and I understand the importance of doing my
| homework and having a plan.
| [deleted]
| legitster wrote:
| I wish he could have invested more in the idea - I think it's an
| amazing concept but the creator pulled the plug too early. Sales
| cycles in B2B can take months, and in healthcare they can take
| years.
|
| Especially the doctor's feedback, she described the possibility
| of changing her habits slowly as she got used to using the tool.
|
| Unrelated:
|
| "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?"
|
| This line kills me and it's exactly why I hate the healthcare
| industry. She clearly understands that the software could improve
| patient outcomes, but describes it as a _donation_ and still
| wouldn 't change how she writes prescriptions (out of laziness, I
| guess?)
| logfromblammo wrote:
| That anecdotal interaction is extremely damning for the entire
| US healthcare system. Physician admits she prioritizes practice
| revenues over patient outcomes. Other physicians express
| similar preference. Inventor of useful tool tosses it into the
| mothballs.
|
| That tool isn't just a physician aid. If that's what doctors
| are really doing, it's more like a physician replacement. If
| they won't do evidence-based medicine, and prefer to be legal
| drug dealers, for profitability reasons, we should _all_ be
| contributing to the creation of the auto-doc, instead of trying
| to help them.
|
| That $40k would have been better spent lobbying to remove the
| guild protections from the practice of medicine.
|
| If all general-practice docs do is take height, weight, pulse,
| BP, blood oxidation, and run a CBC with lipid panel before
| prescribing your drugs for the year, that doesn't seem like
| something only an MD or NP could do. But by law, if you want
| prescription-only medicines, you have to go to a prescription-
| drug dealer and pay them for the scrip, before going to pay
| someone else, again, for the actual drug.
|
| And if they're not actually doing (what I perceive to be) their
| jobs? If they're just "phoning it in" to collect a paycheck?
| That's one job I'd love to automate out of existence.
| beat wrote:
| I don't know how old you are, but at a certain point, the
| input of a general practice doctor becomes very valuable.
| Remember, the doctor doesn't even do the little tests you
| mentioned, like taking measurements and blood tests - they
| just order them, and nurses or technicians do the work. The
| doctor's job is to _make decisions and give advice_.
|
| About a dozen years ago, my doctor caught my blood pressure
| shooting up in my annual exam and started treating me for
| high blood pressure. High blood pressure is a "silent killer"
| that leads to premature deaths for millions. You don't feel
| sick, while your heart struggles and your brain risks
| explosions. And treating it, once diagnosed, isn't
| straightforward. It took six months of experimenting with
| various medications to find the combination that worked for
| me. That's a doctor's judgment and expertise, not something
| for some technician with a community college associate's
| degree. And this summer, when a critical potassium depletion
| drove me to a scary ER visit, she noted that one of my BP
| meds could affect potassium and adjusted my dosages.
|
| And it's not just an expert-system thing that could be
| replaced by a robot, either. She's not just dealing with my
| measurements - she's dealing with my fears, and helping me
| decide on best approaches. That requires a human touch.
| logfromblammo wrote:
| So your doc abrogated her responsibility to warn you about
| the side-effects of the prescribed drug.
|
| You went to the ER, because you were not aware that cramps,
| constipation, spiking BP, and muscle weakness are symptoms
| of hypokalemia, which could be resolved quickly by
| dissolving KCl from the grocery store in water and drinking
| it.
|
| That's patient education that needs to happen _before_ you
| go to the ER.
|
| Just like with the GlacialMD thing, it's no skin off your
| doc's nose if you have to drop $500-$2000 on an ER copay
| because you had an electrolyte crisis from the medication
| she prescribed, and didn't know ahead of time that could be
| a possibility.
|
| And the rest of you out there, learn to measure your own
| BP. You can't leave it to an annual exam to find out it's
| getting high, and the BP taken in the doc's office may
| include the "white coat effect" (or as I call it, the "what
| will this cost me effect").
| beat wrote:
| I'd like to imagine "laziness" isn't the reason doctors write
| the prescriptions they do.
| legitster wrote:
| "Laziness" is probably unfair - but there is a lot of
| evidence that everyone, doctors not included, will get stuck
| in their ways unless forced out of them.
| beat wrote:
| There's much to be said for sticking with things we know
| work, rather than experimenting with new things that might
| work better. If a doctor has an effective treatment for a
| common condition among their patients, what is the cost of
| trying something new? Do you try it with all patients, or
| just one?
|
| But "laziness" is something of a trigger word for me in
| health care discussions, just like "greed" is. It's so easy
| to attribute what we see as suboptimal outcomes to malice
| on the part of the person acting - even passive malice like
| laziness.
| MadWombat wrote:
| She basically just told him that if she treats her patients
| better they will visit her less. This is not laziness, this
| is malevolence.
| gbasin wrote:
| Indeed. There's also concierge medicine and new models that are
| more concerned with patient outcomes, or at least the
| appearance of caring about them
| gringoDan wrote:
| Sounds like there's an opportunity to have insurance companies
| pay for the product. This would directly align incentives and
| lead to overall cheaper care for the patients.
| lightsighter wrote:
| I had the same thought. The meta-customers here are the
| insurance companies. If you can prove that the tool improves
| the performance of doctors so that they get sued less when
| they use it then the insurance company will give discounts
| for doctors on their insurance for using it. Presto! We just
| created a market for doctors to pay for the service.
| simo7 wrote:
| I'm not convinced the idea could never possibly turn into a
| successful business.
|
| Maybe he just tried to sell to the wrong people, maybe
| pharmaceutical companies could have been interested, maybe re-
| packaging the product differently...who knows...
|
| The fact that it could provide real value for many people already
| sets it apart from most ideas.
| dougb5 wrote:
| > On July 2, 2018, GlacierMD powered the world's largest
| depression meta-analysis, using data from 846 trials, beating
| Cipriani's previous record of 522.
|
| Was this analysis written up somewhere? The author links to
| Cipriani's study in the Lancet but not to their own.
| SeanFerree wrote:
| Great article!
| mynegation wrote:
| It is easy to be an armchair expert, but I saw that this is not a
| viable idea: almost nobody would pay for it, for 99% of the cases
| patients and doctors already know the medication that is good
| enough and good for them (ibuprofen for me, acetaminophen for my
| friend because Ibuprofen upsets her stomach etc). And remaining
| 1% will most likely require serious medical attention, not just
| rando site. Let alone the fact that this is borderline dispensing
| medical advice which is a highly regulated activity!
|
| One way to look for a similar business is examine.com
| (disclosure: I do not use them but read their write ups and
| articles about them on indie hackers-like sites and podcasts). It
| is a site that gives information about supplements. The
| supplement landscape is much more wide than that of painkillers,
| they are hard to compare, and supplements are usually chosen by
| consumers themselves, and supplement information is unlikely to
| be treated as a medical advice.
| anarchodev wrote:
| Theoretically I could see this being used as a marketing
| gimmick for the PCP office (we collect a profile of medications
| best for you based on a statistical evaluation of results from
| peer reviewed studies!), and that could help docs make the case
| that patients should see this clinic vs another one nearby. But
| anyone who has tried to use healthcare in America knows this
| isn't really one of the limiting considerations in how you
| choose a doctor or practice.
| leggomylibro wrote:
| 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 :)
| SquishyPanda23 wrote:
| He also seems to have misread Susan.
|
| 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.
| jimbokun wrote:
| > 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.
| riku_iki wrote:
| > WebMD
|
| 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.
| rjkennedy98 wrote:
| 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!
| gnopgnip wrote:
| 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.
| irq-1 wrote:
| > 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.
| bduerst wrote:
| 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.
| n4r9 wrote:
| My thoughts exactly. In fact I would modify this to:
|
| > the motivation of insurance is to keep the cost of
| treatment _that they cannot avoid liability for_ less than
| the income from premiums
| conanbatt wrote:
| > 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.
| rconti wrote:
| .. 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.
| larkost wrote:
| 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?
| ghayes wrote:
| 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.
| beat wrote:
| 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.
| chris_va wrote:
| I mostly agree, but...
|
| 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.
| beat wrote:
| 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.
| justincredible wrote:
| s/systematic/systemic/
| enjo wrote:
| 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)!
| tlb wrote:
| 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.
| nitwit005 wrote:
| 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.
| war1025 wrote:
| Shouldn't it still work out in the aggregate? Assuming
| people move both in and out of the provider?
| nitwit005 wrote:
| 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...
| Uptrenda wrote:
| 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.
| harikb wrote:
| > 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
| CydeWeys wrote:
| 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.
| ghostbrainalpha wrote:
| I feel like the best play would have been to spend 100% of his
| effort to get WebMD as the first Angel Investor.
|
| 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.
| ghostbrainalpha wrote:
| Does anyone know Bob Brisco the C.E.O. of Web MD?
|
| I'm going to try and get this in front of them using my
| contacts, but it is a long shot.
| professionalguy wrote:
| that's exactly what I was thinking - plus what startup story
| is complete without some VC intervention?
| sicromoft wrote:
| > The founder didn't do any market research ... before quitting
| their job
|
| That was the entire point of the article (written by the
| founder). What was the point of this comment?
| lostgame wrote:
| 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.
| tyingq wrote:
| Somewhat surprised a search engine wouldn't want it for the
| perceived value of improved "snippets". Or some company like
| WebMD.
| kkotak wrote:
| I think writing is your true calling OP,
| bobosha wrote:
| 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"
| sombremesa wrote:
| 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.
| elamje wrote:
| 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!
| jergason wrote:
| 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.
| whiddershins wrote:
| I think the original poster made the same mistake I did, and took
| the wrong lesson from the situation.
|
| The startup idea sounds great and I would enthusiastically start
| working on it right now as a cofounder.
|
| The problem was spending money before having a sense of how to
| get more.
|
| That's all.
|
| If the startup could have been run entirely without paying
| contractors or incurring other serious expenses, the poster could
| have run it for longer, and iterated on models longer, until the
| product/market fit got dialed in.
|
| There just wasn't enough runway, enough iteration.
| indigodaddy wrote:
| HN with the editorial decisions on the title again. What's with
| this?? Seems good enough to go with the author's actual intended
| title for a few hours on the HN front page, and now it's changed?
| earlINmeyerkeg wrote:
| Can you call it a good idea in hindsight if you acknowledged it
| was a waste?
| throwaway_tech wrote:
| Its kind of sad picturing the customer with a headache needing a
| app to tell him what medicine to buy at CVS...while there is a
| pharmacist right there.
|
| I do like the quip at the end about lacing up all birds and
| jumping on the bird scooter. This makes me think how badly I need
| allbirds to join the sharing economy...how great would it be to
| have allbirds scattered all around your city sidewalks so you
| have a paid on demand when you need them without having the
| overhead of actually owning them. Its not sexy and doesn't scale
| well, ticking all the VC boxes.
| heisenbit wrote:
| > while there is a pharmacist right there
|
| who has a very clear understanding of the margin of the various
| products in the shelf. Maybe competent but certainly not
| unbiased.
| throwaway_tech wrote:
| Maybe in a small independent pharmacy you have this issue,
| but biggest pharmacies in the World (CVS, Walgreens, Walmart)
| the pharmacists will not know the margins of over the counter
| drugs and have nothing to do with purchasing them.
|
| >Maybe competent but certainly not unbiased.
|
| I suppose they have a bias in the form of legal liability and
| professional licensure which guide their recommendations.
| That is, they can be sued for negligence, malpractice and
| otherwise potentially lose their license to practice. Tech
| startups are notorious for placing profits before users, and
| lack accountability in the same way as licensed
| professionals. In a worst case scenario they fold up shop and
| move to the next industry to "disrupt".
| AndrewKemendo wrote:
| I'd go further and say, if this could provably generate ad based
| revenue from a non-trivial number of users, Google would build
| the same thing and include it in the basic search result shown in
| the article (with adwords suggestions) for effectively zero cost
| to Google.
|
| So, even if it were financially successful, it wouldn't likely
| survive the competition.
| tehansen wrote:
| 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.
| outside1234 wrote:
| 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.
| ageyfman wrote:
| 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.
| entropicdrifter wrote:
| 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...
| [deleted]
| sealthedeal wrote:
| http://theleanstartup.com/
| wyldfire wrote:
| Hey, hey -- what about a grant from WHO, NIH or NHS? What about
| having a national or world government continuously sponsor this
| work as a public resource?
| brianobush wrote:
| NIH grants are extremely hard to write and get funded if
| outside of an educational institution. I have tried both in and
| out of school; inside it was relatively easy, outside near
| impossible. YMMV.
| theklub wrote:
| To get in the door with doctors you need to pay them to use your
| product and then sell the data they generate to other companies.
| (not HIPPA data, but metrics, etc)
| ageyfman wrote:
| 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.
| dang wrote:
| " _Don 't be snarky._"
|
| " _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
| rebuilder wrote:
| I still rate the odds of this being satire pretty high. It's
| just too pat. Maybe based on a true story, but I wouldn't bet
| on it.
| SpicyLemonZest wrote:
| 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.
| mLuby wrote:
| Exactly. Founder myths gloss over the starting details
| heavily (perhaps because then they seem merely lucky and
| hardworking).
|
| 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.
| pm90 wrote:
| There is a deep yearning in humans for a good story.
| However, taking these stories at face value is a recipe for
| certain failure.
|
| 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.
| bduerst wrote:
| 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.
| ghayes wrote:
| 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?
| CydeWeys wrote:
| 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.
| jariel wrote:
| 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
| ...
| tyri_kai_psomi wrote:
| The most realistic founding story so far is Bezos explanation
| for how he founded Amazon.
|
| 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.
| victor106 wrote:
| Anyone has a link to the above video?
| __oh_es wrote:
| https://www.youtube.com/watch?v=rWRbTnE1PEM
| [deleted]
| vijucat wrote:
| I think it's this one:
| https://www.youtube.com/watch?v=rWRbTnE1PEM
| [deleted]
| anongraddebt wrote:
| 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.
| mytailorisrich wrote:
| One thing to keep in mind is that he worked for nearly a
| decade in product/business roles before founding Amazon.
| anongraddebt wrote:
| I agree that that explains some of the difference. Not
| sure it means that he isn't the most impressive.
|
| I'd also add that in his stints at different firms pre-
| Amazon he was quite clearly an outlier among high-
| achievers.
| jblz wrote:
| > autonomous blockchains
|
| It just _has_ to be satire, though!
| soneca wrote:
| 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).
| georgewsinger wrote:
| lol @ giving up after 2 weeks.
| marcinzm wrote:
| 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.
| ageyfman wrote:
| 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.
| sjg007 wrote:
| I would apply for an SBIR and try to get some academic support.
| Maybe the NIH would be interested. Your algorithm and analysis
| platform might be the real special sauce here. Maybe even license
| to a pharma company.
| iabacu wrote:
| You should market this to insurance companies, not individual
| doctors.
|
| At their scale, they can use the data to drive their costs down,
| and can build a business case for paying you something.
| professionalguy wrote:
| Or R1 research universities
| ageyfman wrote:
| 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.
| wizzwizz4 wrote:
| So the insurance companies fund it as a donation to
| physicians.
| lonelappde wrote:
| 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.
| throwaway_tech wrote:
| >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.
| catchmeifyoucan wrote:
| I still think this idea is powerful. Not because I believe it
| transforms healthcare, but because it informs consumers a bit
| more. That's what seemed to get you excited in the first place.
|
| There are a few paths I see still:
|
| a. Assuming you own a database, expose your dataset as an API.
| Consider possible consumers. Open source it, and monitor the
| usage. Who's using that data.
|
| b. Cold message a few folks on Linkedin from pharmaceuticals that
| your algo says has high clinical success. Can you "recommend"
| them? Do they see value. Maybe you have a research tool on your
| hands.
|
| 3. If you can keep your website alive, focus on SEO and gain
| traction with more users and play that out. Write blog posts, use
| affiliate marketing, and grow users. But don't add new features.
| Just maintain what you have. Try that for a year at least. What
| did you learn?
|
| I think the toughest thing here is knowing when to stop building
| the product. That's what stands out to me as your demise.
|
| The doctor was spot on, and those are the kinds of things you
| want to hear. It just means looks somewhere else. Writing a doc
| beforehand with potential opportunities is always a good idea,
| but it's never too late.
|
| Disclaimer: I do product at MEGACORP and love product strategy.
| utopian3 wrote:
| > I do product at MEGACORP and love product strategy.
|
| Where should one go/read/listen/watch to learn more about
| product strategy?
| catchmeifyoucan wrote:
| Biggest rec. is to talk to people who have done something
| interesting or catches your eye. I always email people asking
| how they did something - people usually are really friendly
| and willing to share.
|
| Websites like Indiehacker, stratchery are good. Would also
| recommend the innovator's dilemma if you're at a big company.
| There are also a few videos on Youtube by CNBC on products of
| the past - and I've enjoyed those.
| nikita2206 wrote:
| Maybe you could open source it, and with the help of people
| from the community get sort of grant from Google or Amazon or
| say digital ocean so that this could work without you having to
| pay for servers? All the work that contractors were doing,
| people could do that for free. The only thing is I'd license
| this thing so that it can't be used commercially (except for
| research)
| wayoutthere wrote:
| This is a classic case of "it's not a product, it's a feature".
| This is true of almost everything in healthcare that's
| software-related: it's only useful if it's integrated with the
| EMR. This is why you never see software startups in healthcare.
|
| In this case, similar functionality (drug recommendations)
| exist within EMR systems. Except the recommendations are issued
| by other doctors and medical researchers, not some ML algorithm
| and it works transparently with the pharmacy management
| modules.
|
| Moral of the story: don't get involved with healthcare startups
| unless you know the structure and economics of the industry.
| They are very different from consumer / business tech.
| rconti wrote:
| Yeah, I've gotta wonder how much money it can possibly take per
| month to keep running, if you stop paying people to add data to
| it.
| rossdavidh wrote:
| Another possibility: how many people would be willing to donate
| a few bucks a month to support it? Call it the public radio
| model. You won't get rich, but you might pay for upkeep and
| servers.
| achillean wrote:
| Donations are extremely difficult to make work. I tried it
| after getting decent traction in 2009 and didn't receive a
| single donation to cover server expenses. I'm guessing with
| Patreon things have gotten a bit easier but for a business I
| would highly advise against going down the donations route.
| In general, small payments also tend to take up a
| disproportionate amount of your support time compared to
| larger transactions so you have to be prepared to deal w/
| that.
| bduerst wrote:
| I was thinking the same, except OP's product seems more like a
| feature for an EMR platform and less a standalone product.
|
| The only downside is that sharing this information may open up
| the hospital to more liability - i.e. a patient takes an opiate
| instead of an NSAID and then blames the hospital for
| recommending the opiate to them because of how much more
| effective the opiate is at treating pain in clinical trials.
| scotty79 wrote:
| > Make something people want. It's Y-Combinator's motto and a
| maxim of aspiring internet entrepreneurs.
|
| I think it's fine motto for startups that are going to be fueled
| with angel money.
|
| For bootstrapped startups I think it should be: "Make something
| people want (to pay for!)."
| entropyneur wrote:
| Just FYI: "Doppelganger" exists in Russia and makes tons of money
| from government contracts.
| perpetualpatzer wrote:
| This was my reaction ... it's presented in the article as a fun
| idea without a market, but seems like a plausible play to build
| a saleable corpus of facial recognition data.
| nickelcitymario wrote:
| I can't help but wonder if this would have worked better if the
| author had:
|
| 1) Tried this in a different country. Healthcare in the US is
| very different from Canada or the EU. Maybe it would fail
| elsewhere too, but its a completely different marketplace. I have
| a hard time imagining a Canadian doctor saying "This is better
| for my patients, sure, but will it help my bottom line?"
|
| 2) Worked on a solution that didn't involve so much labour. It
| was data processing, right? Might be a good fit for ML. (God
| knows it's being used for everything else.)
|
| That being said, I'm in awe of anyone who goes out on a limb like
| the author did. He didn't just try an idea, he invested in it.
| And then he had the courage to tell us about his failure. Bravo!
| cowbird wrote:
| That was a good reading. Thank you.
|
| Funny affirmation: If nobody could be bothered with the math,
| then I was no better than Gwenyth Paltrow hawking vagina eggs.
| lalos wrote:
| It's like a brief diploma-less MBA program, like a Montessori
| MBA.
| 2pointsomone wrote:
| Thank you for your vulnerability and sharing your story with such
| honesty!
|
| There are easy businesses, and there are hard businesses. Your
| business fell in the latter category, but your tactics to succeed
| were based on easier businesses. I still think you could have
| succeeded if you persisted and weren't so eager to get sales and
| play startup.
| scottmsul wrote:
| While not a unicorn, this could potentially succeed as an indie-
| hacker sized project. One potential business strategy could be a
| high-level information hub - a weekly blog + podcast for example.
| Each week look at a different drug or illness, look at all the
| relevant papers, do a short statistical analysis, and summarize.
| Then get some patreons, run ads, maybe sponsorships for
| particular drugs, etc. I think there's a lot of math geeks out
| there that would find this useful/interesting enough to follow on
| a regular basis, even if just to see what's going on in the
| healthcare space.
| mrfredward wrote:
| Another idea that could make this a viable business: while in
| general consumers won't pay for this sort of thing, there are
| certain problems that the medical establishment just does a
| horrible job treating, where I think people would gladly pay
| up. Migraines, for example.
|
| I personally suffer from some sort of headache disorder
| (symptoms are a mix between migraines and cluster headaches,
| I've had different diagnoses). I went to a neurologist every 3
| months for 2 years, at $200 per 30 minute visit, and usually
| less than 10 of those minutes were spent with the doctor. Every
| time he made some seat of the pants guess as to what to do next
| (adjust the dosage I was receiving, or change medications). In
| the end, I never found anything better than taking a bunch of
| ibuprofen at the first sign of a headache, and that was
| something I figured out on my own.
|
| I wouldn't pay a dime to see a comparison of generic and name
| brand NyQuil, but if a trustworthy source offered me a
| personalized report on what medications I should be looking at
| based on my headache symptoms, and had studies to back it up,
| I'd gladly pay $100+.
| sheeshkebab wrote:
| Build it and they will come they said, follow your dreams they
| said...
|
| yeah, right.
| ww520 wrote:
| This is an amazing journey. You got a novel idea. You felt the
| fire under your belly to bring it to life. You executed that idea
| and really built the product that people like. So sales and
| marketing are hard. So what. You have learnt a lot more. The
| money was not wasted. It's part of a very valuable education and
| on-hand experience. The lessons learnt will benefit you time and
| time again.
| codingdave wrote:
| 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.
| ping_pong wrote:
| The first example the author gave with painkillers is inherently
| bad.
|
| Sure, Aleve is the most powerful. But it also has the most side
| effects, including ulcers if used for too long. There's a lot of
| nuanced information when it comes to drugs. If you want to go on
| pain killers like Aleve for long term, you probably need to take
| acid blockers as well, like Nexium. So where does that fall into
| the analysis?
|
| Unfortunately a lot of stuff requires medical doctors that have
| experience. I just went through a severe health emergency, where
| I was taking one antibiotic and needed to be changed to another.
| I needed blood tests and constant supervision for the doctor to
| make this decision.
|
| Psychiatry, which is what I guess the author targeted, is likely
| even less reliable. My friend is a pharmacist and was on anti-
| anxiety medication for a year, but decided to try another one,
| because of the effects on her were affecting her and now she's
| doing much better. This requires working with a psychiatrist for
| a year.
|
| I think there's value in surfacing all this information but to
| expect people to rush into paying for it is naive. It's a nice-
| to-have-tool that might be useful like a Google-type research
| tool but nothing someone would want to pay $5/month for since the
| actual benefit over a psychiatrist just going off experience is
| completely unknown. There no inherent home run here.
| wiggler00m wrote:
| _" I had ten more meetings with doctors all over the Bay Area--
| surely not all of them were ruthless capitalists like Susan."_
|
| 10 meetings is inadequate. You should be willing to do 1000+
| meetings if you really want this to fly (or prove it cannot).
|
| You could also explore other business models (ie. rather than
| charging the practice directly find another way to make money).
|
| Even if it fails, valuable experience, not a waste. Cool idea,
| and admire your initiative.
| pascalxus wrote:
| It's an excellent write up and there's great lessons in there for
| all of us. And, it's great that he started talking to actual
| doctors, if only he had done that first. I know i've made that
| mistake many times.
|
| As for the medical industry: the idea is to keep people sick as
| long as possible. You can't make money from people who get better
| or people who die.
| [deleted]
| gavinray wrote:
| Hey, I prototyped something similar to this a while back. It used
| NLP and Elsavier search API to do entity detection and sentiment
| analysis on drug/effect pairs.
|
| So you would search like "Mirtazapine", and then it would create
| a word-graph where the drug was in the middle, and it would be
| connected by things like: Mirtazapine -->
| Reduces --> Anxiety/Depression Mirtazapine -->
| Increases --> Hunger
|
| The words were colored either green/red based on whether it was
| considered a positive or negative effect, and the size was based
| on the size of the effect and numbers of mentions.
|
| It was meant to be a tool for clinicians and prescribers to be
| able to enter a medication and get an easy overview of its
| effect.
|
| Do you have any interest in pursuing this further?
|
| I know a few investors who I think might still be interested in
| this.
| itschekkers wrote:
| i'm interested in the project you mentioned-- drop me an email
| adam at springhealth.com if you'd like to chat
| rdiddly wrote:
| I liked this "my startup failed" story more than many, not least
| because of all the gratuitous wry allusions to SV culture.
| sethammons wrote:
| he "worked at a startup that leveraged autonomous blockchains to
| transfer money from naive investors to slightly less naive
| twenty-somethings. There are worse gigs."
|
| This sounds like a scam or fraud.
| streetcat1 wrote:
| So one thing I will add, you might want to approach the companies
| that are at the top of the list and offer them the tool as a sale
| tool.
|
| 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.
| jcims wrote:
| I think this is overstated most of the time, otherwise why
| would we have vaccines?
|
| However, I would be on board with saying that when situations
| get dire, risk management begins to diverge incentives between
| patients and providers.
| qroshan wrote:
| 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
| lonelappde wrote:
| Vaccines exist for a tiny fraction of conditions.
|
| 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.
| sangnoir wrote:
| 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.
| WC3w6pXxgGd wrote:
| The author did not do enough market research before creating the
| product; he created something that didn't solve an existing
| demand.
|
| From a doctor: "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 here's an interesting question: how do you align a doctor's
| pay with the outcome of their treatment?
| jupp0r wrote:
| Forgive me for stating the obvious, but wouldn't talking to
| doctors with some mockups have prevented most of this?
| omarchowdhury wrote:
| It definitely would have.
| Edmond wrote:
| This sounds like it could be a useful feature of some other
| healthcare product, ie not a standalone product.
|
| Maybe try selling the tech asset, you might be able to more than
| recoup your investment :)
| mtm7 wrote:
| I commend your effort. Humanity likely would've progressed more
| from the application of this data than it would with you working
| on leveraging autonomous blockchains (not that that's a bad gig
| either).
|
| I think the general takeaway is:
|
| 1. have an idea 2. make some mockups with plain HTML/CSS 3. run
| it past your target market to see if they'll pay for it 4. if so,
| build it
|
| This works even better if your target market is willing to fund
| the development costs.
|
| I still feel like there's an idea somewhere in here - maybe with
| medicine, or maybe with supplements, nutrition, etc. You could
| position yourself as a knowledge base and use the data as a
| marketing funnel for related products. Examine.com has an
| interesting business model along these lines. (If I was about to
| start an anti-anxiety medication, I'd sure as hell pay to know
| which one worked best.)
| nwsm wrote:
| Really good writing.
|
| Definitely a questionable move to quit their job for a business
| with no market research, but I enjoyed the second-hand learning
| experience.
| elliotpage wrote:
| 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.
| Dayshine wrote:
| He might not have succeeded in getting rich, but he can still
| turn this into an incredibly effective $40k donation to public
| health research.
|
| 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.
| [deleted]
| tombert wrote:
| Oh man this is depressing. I have a few ideas that I'd like to
| get funded and make a business out of, but I have no idea how
| useful they would be to the average consumer and how I would go
| about raising funds (doesn't help that my current job has a
| pretty strict NDA which pretty much covers all software).
|
| At least you gave it a go; even if it didn't work out, you don't
| have to wonder "what if?" for your entire life, and I think it's
| pretty cool that you built something you were passionate about;
| at the very least, stuff like this is pretty good resume fuel,
| right?
| bcrosby95 wrote:
| This is why starting with low or no code is a great idea. He
| would have saved a lot of money if he went around to potential
| customers and seen if they would have paid for such a product. Or
| fake a product with fake data and demo it to see if there's
| anyone that would pay for the real thing.
| raverbashing wrote:
| Here's how I see it, and the quote at the end kinda fits into
| this:
|
| What problem are you trying to solve? Googling "what is the best
| pain killer" is a very "average user" question. It's also 99%
| useless.
|
| Pain killer for what? Headache? Muscular pain? Nerve pain? You
| have a partially severed limb that's bleeding profusely? Oh you
| mean an OTC pain killer?
|
| Ok do you have stomach problems? Liver problems? Kidney problems?
| Diabetes? "Oh I don't know" oh well...
|
| "But I'm just trying to get the best drug for your situation"
| yeah, that doesn't exist. And there are personal preferences
| (doctor), personal preferences (patient), limitations, marketing
| pushes, etc.
|
| Finding out drug X is more efficient than drug Y in 5% is just
| background noise. Hence why the doctor didn't see much value in
| this.
|
| What would be valuable is finding which drug X to try if drug Y
| _didn 't work_ or can't be used (though doctors usually have that
| in their heads).
| choeger wrote:
| If the technique is solid, they should sell to big insurance
| companies. That are the actors that are interested in paying for
| the most efficient treatments. At least when it comes to choosing
| between short and efficient or long lasting.
| planetzero wrote:
| If you are interested in creating a startup, you should first
| find something that can actually make money and then work on
| creating a great product around it.
|
| Too many people come up with a great idea and then hope for the
| best when it comes to market fit and actually getting customers
| and achieving profitability.
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