[HN Gopher] I wasted $40k on a fantastic startup idea
___________________________________________________________________
I wasted $40k on a fantastic startup idea
Author : swyx
Score : 197 points
Date : 2021-01-18 20:01 UTC (2 hours ago)
(HTM) web link (tjcx.me)
(TXT) w3m dump (tjcx.me)
| eightysixfour wrote:
| I remember reading this the last time and it was posted and I
| still think the core failure is that the author didn't actually
| recognize the issue he was solving. He thought the problem was
| choosing the most effective medicine when the real problem was
| decision fatigue looking at endless shelves of things that all
| seem to do the same thing. Those two problems sort of look the
| same, but the latter cannot be resolved by selling the tool to
| doctors in their offices.
|
| The tool should have been designed (IMO) as a consumer tool,
| either a kiosk at CVS/Walgreens/pharmacies to assist with OTC med
| selection or possibly as a website with ads/referrals. I would
| absolutely choose a pharmacy over another as a result of them
| having something to help through that process, especially when I
| have a headache.
| ihumanable wrote:
| I'm grateful for this comment because it put into words the
| thing I couldn't.
|
| I'm reading the epiphany part of this post, to quote:
|
| You have a mind-shattering headache. You're standing in the
| aisle of your local CVS, massaging your temples while scanning
| the shelves for something--anything--to make make the pain
| stop.
|
| What do you reach for? Tylenol? Advil? Aleve?
|
| Most people, I imagine, grab whatever's cheapest, or closest,
| or whatever they always use. But if you're scrupulous enough to
| ask Google for the best painkiller, here's how your friendly
| neighborhood tech behemoth would answer:
|
| [Screenshot of Google Search Results]
|
| Oh thanks Google that's just all of them.
|
| ---end quote---
|
| The author immediately identifies that this isn't a real
| problem, by their own admissions that "Most people, I imagine,
| grab whatever's cheapest, or closest, or whatever they always
| use." Yea, most people when they have a headache and know that
| most painkillers on the market will result in about the same
| degree of relief, don't bother to cross reference a medical
| meta-analysis, because they have a headache and if the $0.01
| worth of aspirin doesn't make it feel better they will just
| take a second pill and eat the penny.
|
| I like the author's conclusion about how to quickly validate
| business ideas, but even in the title the author still holds
| firm to the belief that this was a "fantastic startup idea"
| even though reality seems to think otherwise. Was this such a
| great idea, do most consumers actually want to review a meta-
| analysis when picking their OTC medicine, or do most people
| just try a few things, get influenced by advertising, and
| purchase the most reasonably priced medicine they think will
| help. I am just a single data point, but I don't normally feel
| naked and unscrupulous when I just read the symptoms that a
| medicine treats and pick one, and that strategy generally works
| just fine.
|
| Solution in search of a problem and also in search of humans
| that act in this weird atypical fashion.
| PeterisP wrote:
| Waiit - "You have a mind-shattering headache. [..] What do
| you reach for? " - isn't this where you're supposed or even
| required to ask the pharmacist? You know, the person who has
| the years-long training to know drug effects, limitations and
| interactions with other drugs?
| hartator wrote:
| > So in July 2018, nine months and $40K after starting GlacierMD,
| I shut it down. [...] The idea is that if you build something
| truly awesome [...] Where did I go wrong?
|
| $40k and 9 months is not that much. Either you gave up just
| before you figure out how to make the business work or maybe
| GlacierMD wasn't that revolutionary.
|
| Why not open sourcing and publishing all that work? You can still
| recoup some money via ad money even if it's not the millions you
| were expecting and at least you have something to show off.
| jwogrady wrote:
| The author brilliantly makes the case against single payer
| healthcare. Bravo. Job well done, sir.
| nickjj wrote:
| That was a fun read. I wish the author mentioned how much he was
| trying to sell the service for. It could have been $59 a month or
| $599 a month and with doctors you could potentially expect the
| same answer.
|
| I'm not a psychologist but some of the author's quoted text came
| off extremely demeaning in written form. If the author happens to
| read this, did you really say those things directly to them?
|
| For example, Susan (psychologist) was quoted as saying:
|
| > _" Oh sure! I mean, I think in many cases I'll just prescribe
| what I normally do, since I'm comfortable with it. But you know
| it's possible that sometimes I'll prescribe something different,
| based on your metastudies."_
|
| To which you replied:
|
| > _" And that isn't worth something? Prescribing better
| treatments?"_
|
| Imagine walking into the office of someone who spent the last ~10
| years at school and then potentially 20 years practicing their
| craft as a successful psychologist and then you waltz in and tell
| them what they prescribe is wrong and your automated treatment
| plan is better.
| worldsayshi wrote:
| If you are to proud to visit stackoverflow or Google to search
| for best practices you're not a very good developer. Sounds
| like the same rule should apply to a doctor or psychiatrist.
|
| Do they have such fragile egos that they can't have someone
| showing them the "new Google for doctors" without feeling
| offended?
|
| (Sorry if that came out a bit edgy. But this hole story irks
| me. It's frustrating when value can't be delivered because of
| cash flow issues.)
| Closi wrote:
| Doctors do have curated platforms where they can lookup
| information, and also have diagnosis tools / checklists in
| them.
| dikaio wrote:
| Agree
| ddorian43 wrote:
| > Do they have such fragile egos that they can't have someone
| showing them the "new Google for doctors" without feeling
| offended?
|
| It's very hard to understand their thinking without being
| yourself a patient or doctor.
|
| TLDR: You need to spend 1K hours as a doctor, or shadowing,
| or something similar.
|
| When you are responsible for people with psychosis your
| perspective changes. Can't play nosql games with people's
| lives.
| Falling3 wrote:
| > you waltz in and tell them what they prescribe is wrong and
| your automated treatment plan is better.
|
| That doesn't really capture the conversation though. Susan
| specifically said (as you quoted) that it was possible she
| would use the recommendations of the app. If she took a
| recommendation that means she agreed it was a better treatment.
| His question was not whether his algorithm was better than her
| default prescriptions - because they both agreed that was the
| case at least some of the time - it was whether it was better
| enough to be financially worthwhile.
| yunohn wrote:
| You'd be surprised how many doctors neglect the state of the
| art in medicine... That's also why second opinions are a thing.
| Medicine is a science and hence, an ever changing field.
| chefandy wrote:
| I probably would be surprised if that's true considering that
| in most states in the US, doctors are required to complete
| between 20 and 50 hours of structured CME (continued medical
| education) annually as a prerequisite to relicensure, and
| every one I've spoken to took it pretty seriously.
| stevewodil wrote:
| It's actually a very good sales question, I don't find it
| demeaning at all.
|
| If you're on a sales call selling a product that increases user
| retention and someone says "no we don't need that", you would
| often reply with "So you have perfect user retention then?" to
| probe them and re-open the conversation.
|
| It could come off as standoffish but when used correctly it's
| very effective because it gets the person on the other end to
| open up more and you try to get to the bottom of their
| objections.
| na85 wrote:
| >If you're on a sales call selling a product that increases
| user retention and someone says "no we don't need that", you
| would often reply with "So you have perfect user retention
| then?" to probe them and re-open the conversation.
|
| Assuming that I didn't initiate the call, if I tell some
| sales punk that I don't need their product and they come back
| at me with "So you have perfect user retention then?" my
| answer is going to be "fuck you" followed by ending the call.
|
| Arrogance might work in used car sales but it's not a panacea
| for closing the deal.
| stevewodil wrote:
| I'm sure that happens occasionally as well.
|
| I get it, sales people can be annoying but it really only
| hurts your business (in this hypothetical case) if you have
| a user retention problems and are actively fighting against
| people trying to help you solve that problem with a
| mutually beneficial business agreement.
|
| They will call the next person on their list, I'm sure it
| won't matter much.
| matkoniecz wrote:
| Incoming spam is unwelcome in general, and I would not
| assume that this people are trying to help me.
| na85 wrote:
| >I get it, sales people can be annoying but it really
| only hurts your business (in this hypothetical case) if
| you have a user retention problems and are actively
| fighting against people trying to help you solve that
| problem with a mutually beneficial business agreement.
|
| Oh please. Not every product that's applicable to a given
| business would necessarily be beneficial to that
| business.
|
| I get it, sales people have to drink the kool aid, but
| some humility is needed. Your product isn't right for
| everyone, and the sooner you understand that the sooner
| you can improve the quality of your lead generation.
| robocat wrote:
| HN guidelines: "Please respond to the strongest plausible
| interpretation of what someone says, not a weaker one
| that's easier to criticize. Assume good faith.".
|
| I would presume that sentence is a quickly typed
| paraphrase. If you presume they are a competent
| salesperson, you can also presume that they say it less
| antagonistically in real life. Edit: Or perhaps they have
| found that antagonism is the most profitable solution for
| the business to turn around a "no" answer.
| na85 wrote:
| >HN guidelines
|
| The comment to which I'm responding explicitly argues
| that the phrase, verbatim, is a good sales tactic.
| jrochkind1 wrote:
| I was ready to agree with you because question in the OP
| wasn't so bad, but "So you have perfect user retention then?"
| -- seriously? Yeah, that's being demeaning. Maybe being
| demeaning is a good sales technique, I dunno, but that's
| definitely being a jerk.
|
| But "Are you sure increasing your user retention isn't worth
| something to you?" or something like that maybe.
| stevewodil wrote:
| It really depends on your tonality when you say it. In
| either case, saying "Are you sure increasing your user
| retention isn't worth something to you?" is just going to
| be met with another "No, we don't need it" from the other
| end.
|
| "So you have perfect user retention then?" is a better
| question because you know for a fact that they can't have
| 100% user retention and they know that as well so it forces
| further dialogue.
| dan-robertson wrote:
| The conversations are surely paraphrased and exaggerated--just
| look at the style of the rest of the article.
|
| The position that doctors should be trying new things to
| improve their care sounds good but in practice most doctors are
| strongly biased towards the status quo and usually inaction is
| preferred to a slightly unknown action, even if that action has
| better expectancy.
| ketzo wrote:
| I dunno. I think tech people have a tendency to assume they
| know for certain that they have a better solution, and their
| words/tone can reflect that in a way that can come off as
| very insulting to people who have been working in the space
| for literal decades.
|
| Not everyone, and not all the time. But many people, and
| often enough that it's a stereotype. So I think it's worth
| considering, particularly when you're looking at a customer
| base who (by and large) _really_ aren 't used to being
| condescended to.
|
| Even if you and I personally aren't offended in the slightest
| by what OP said on sales calls, it's possible a psychologist
| in the fourth decade of her career might take "Are you sure
| that's right?" differently than we would.
| xivzgrev wrote:
| I don't think that was the point. The point was better
| healthcare doesn't necessarily translate to more revenue.
| Healthcare is weird like that - you get paid a flat fee for
| visits. There might be an argument to be made that better
| prescriptions = happier patients = more retention, but it's a
| stretch. If your practice is already booked full what's the
| point?
|
| This biz was clearly made for consumers but yea ads are tough
| - need a lot of eyeballs.
| dan-robertson wrote:
| Yeah I agree that's the point of the article. I think what
| I wrote would still be a reason even if it is rationalised
| differently.
|
| The argument that "patients won't know the difference so I
| can just do whatever" must break down at some point
| (hopefully before malpractice) but I think an argument of
| "I'll just keep doing what I did before, it's worked fine
| so far" doesn't encourage worsening treatment or paying for
| more experimentation.
| loceng wrote:
| Psychiatrists are simply experimenting on each person they
| prescribe medications to. The status quo is indoctrination,
| and in this case, the psychiatrist wasn't even willing to use
| actual research based data to improve the treatment of their
| patients - even referencing that they won't make anymore
| money because the patient won't come back more often or refer
| more patients because of it. This is abhorrent unprofessional
| behaviour - but it's likely the attitude of 90%+ of the
| field.
| renewiltord wrote:
| Based on the response he got, it was the right question,
| actually. People aren't Internet-style insecure in real-life,
| especially those who have high social cred (like doctors). Even
| accounting for the humorous exaggeration, the kind of question
| asked from a professional doctor is less likely to cause them
| to be offended and more likely for them to just tell you why
| not. They're not going to be "How dare you question my decades
| of experience?!". They'll answer like they did in the OP.
|
| In _The Mom Test_ , he suggests getting right to the core of a
| customer's pain points. This is just corollary to that.
| arghwhat wrote:
| Although do note that doctors are just humans, with all the
| same flaws. There's just a bias in the kinds of humans that
| tend obtain the title.
| brd wrote:
| Amusingly enough, I've got a document that's essentially a list
| of ideas where the business model is spurious at best and on that
| list is a solution almost identical to what was built here.
|
| I appreciate that someone took the dive and then shared the
| process, pain and failure of seeing it through to its conclusion.
| The only thing missing is the attempt to raise VC money to scale
| it to some sort of expert system you can sell to enterprise
| customers.
| worldsayshi wrote:
| Turning the product described in the article into an enterprise
| product sounds like nonsense to me. The product should arrive
| to the user that benefits the most. Isn't that people in
| general?
| dkarl wrote:
| I'm kind of concerned that people read this as satire but miss
| the most important part, namely the absence of concern about the
| safety and validity of the results. You know, the part where he
| stuck some statistical software in front of a database populated
| by a "motley crew" of contractors and wanted doctors to use it as
| a shortcut for making patient care decisions. The part where he
| implicitly compares the HTML spit out by his system to peer-
| reviewed work by professional researchers. The part where he is
| proud of "beating" a "record" for least discriminating meta-
| analysis.
|
| Reading this story and talking about his marketing and product
| development process feels like watching Lovecraft Country and
| then then only talking about the time travel physics of it.
| There's something real and awful here, hopefully presented in a
| fictionalized or highly exaggerated form. The people in my social
| circles who mistrust tech and despise startup culture -- this is
| exactly how they see us.
| [deleted]
| [deleted]
| analyte123 wrote:
| It sounds like GlacierMD not only presented results from meta-
| analyses, they made a platform to make them easier to do and _did
| their own_ but didn 't publish them. If you built a platform to
| make doing meta-analysis easier, you could collaborate with
| medical researchers and institutions who are publishing meta-
| analyses. Maybe give it to them for free at first, maybe get an
| author credit, some PR, and more sales leads. Researchers can
| probably use grant money to buy access to your platform and still
| save money on paying analysts to do things manually.
| aetherspawn wrote:
| Perhaps this would have been a great business model to start
| astroturfing big pharma by focusing on SEO, allowing users to
| upvote meds that worked well for them and letting big pharma pay
| to bump theirs to the top or highlight it or something like that.
| Or for a given class of med, charge big pharma or individual
| chemists a certain amount for referral back links.
|
| As a consumer your flow is probably naturally: what type? which
| brand? where is cheapest in my area?
|
| There are plenty of energy comparison companies making money that
| way. They have a lot less tangible data.
|
| I'll be honest - the tech is so cool you nearly made me want to
| reach out and buy where you got upto.
| ircoder wrote:
| Oh man! I'm laughing and crying at the same time. I had a very
| similar experience in my first "startup". It hurt me so bad, both
| financially and emotionally, that I could do another "startup"
| for 7 years.
|
| Luckily, the next time I came across Steve Blank and YC Startup
| School materials and instead of burning all my cash over a two
| years I managed to FAIL my next three startups withing few weeks
| with a negligible cost.
|
| Those books and articles saves your life and money!
|
| This is yet another cautionary tale for founders.
| einpoklum wrote:
| A few points come to mind:
|
| 1. Good thing he wasted $40k that he actually had rather than
| $400k he might have borrowed. Of course you could argue that "no
| risk no reward", but still.
|
| 2. The idea itself seems to stem from a weird US-consumer-centric
| bubble. More specifically * "Pain killers"? Those
| medications have different active ingredients with different
| effects, only part of which is some kind of pain (and not a
| single kind). Some are anti-inflammatory, some are analegsic etc.
| Those are really different things. * Different
| people have different reactions to medication, even within the
| same group of active ingredients. One is better served by
| choosing medication based on past experience is similar
| situations. * If it's not clear what you should be
| taking, you probably want to have a doctor examine the entirety
| of your symptoms and make recommendations. * If some
| kind of medication is consistently superior to another for almost
| all people and scenarios, the superior one will likely drown out
| the inferior one in terms of availability and public awareness.
| The popularity of multiple kinds of medication usually (?)
| indicates they are preferable in different scenarios.
|
| 3. When I first saw what the novelty was supposed to be, I was
| unimpressed. I mean, ok, it's not trivial to do statistical
| analysis in R - but it seems like anyone with some R and
| statistics experience can do it. It doesn't seem like there's a
| lot of secret sauce. There might still be commercial viability
| here, but it's at best risky.
|
| 4. What was the initial business plan? Revenue model? Who was
| supposed to pay for what? Specifically, suppose one person paid
| for a recommendation for pain medication. Ok, so they got it -
| but it's not going to be a secret. It's now public.
| xmly wrote:
| So long...
| llaolleh wrote:
| I love the author's writing style. I found it kind of funny. But
| there's a lot he could've done better.
|
| My top recommendation would've been to find someone in medicine
| as a co-founder. This could've helped him find flaws in the
| economic model faster. I still think his project has amazing
| potential, except that it's going to have to go through a couple
| of iterations. For example - what if he somehow integrated this
| information to make it so that it's easier to connect customers
| to future doctors and take a affiliate fee?
|
| Also imagine if we had a better medical search engine. There's so
| much information in medicine that is still blocked off to
| consumers. The author mentions that consumers do not want to go
| through the details - maybe we can make something that can dumb
| it down for people and put a directory of doctors who can help
| explain further?
| capiki wrote:
| The author has a great sense of humor. This was really fun to
| read:)
| offtop5 wrote:
| I loved reading this, but it doesn't seem like he thought this
| through all the way. For one you'd want to figure out how you
| plan to monetize anything you expect an roi on before you start
| spending all of your money. Two giving out medical advice feels
| like a giant cluster of potential headaches, and liability. A
| doctor who trust your website and then maybe one of her patients
| has a bad reaction, may have grounds to sue you particularly if
| you charge a fee to use the product.
| madamelic wrote:
| The current ideology of needing to go big fast kills a lot of
| decent ideas.
|
| Everyone thinks there are two modes for a service: dead or worth
| $1B+.
|
| Not to like bash you while you are down but you may have been
| able to do this while working and not spending $40k on
| contractors.
|
| Not everyone needs to raise $10M, get a flashy office, employ 200
| people and have all of the trappings of a "successful" startup
| founder; if anything, that's antithetical to what you should be
| doing.
|
| No MVP, no testing their model, just straight to "Next Best
| Thing". It definitely hurts, I've been there too for my first
| "next big thing" and I doubt you'll be the last to get burnt by
| the image VC firms sell.
| chadash wrote:
| $40K is not much to put into a business. You'd likely be
| putting down more than that just to open a convenience store.
|
| Sure you need to spend a lot of money to grow a $1B+ business,
| but the same is true for a $100M business or a $10M business
| and even most $1M businesses.
| madamelic wrote:
| $40k is a lot to put in a business you have no idea if it can
| make money or whether it is needed.
|
| It's a definite that people have to eat. I would assume most
| failures in restaurants and convenience stores are
| operations, not a critically flawed business model.
|
| ---
|
| But yes, I guess $40k is less than $2M, but it also takes
| $40k away from another venture and possibly having to go back
| to a day job to take another run at something.
|
| All because you didn't validate the problem before cutting
| off your income source.
| heavenlyblue wrote:
| You would not need to put up a lot of money if you just came
| to a market to sell some vegetables. For less central areas
| you could potentially sell stuff for free. Convenience store
| is a bad example as these are heavily standardised by now: we
| all expect a high diversity of products and thus the
| equipment needed to store it
| boffinism wrote:
| For an article written in October of last year it sure is funny
| that there's an HN discussion about it from last January...
|
| https://news.ycombinator.com/item?id=21947551
| eecks wrote:
| Well written - that was an entertaining read.
| amadeuspagel wrote:
| Why not try to fund it by selling pharmacies, or with some kind
| of affiliate program?
| sneak wrote:
| I think that people are probably misleading themselves if they
| say they want it, but aren't willing to pay for it.
|
| People fork over money for IAPs by the millions per minute,
| because they want the results.
|
| I think if it were truly that desirable, people would have been
| happy to pay for it. I just don't think it provided that much
| value to the customer.
| notahacker wrote:
| Mostly they're being polite (and showing they understand
| perfectly well how they _could_ use it, so no need to explain
| its purpose any further thanks). They 're not really misleading
| _themselves_...
|
| Ultimately the author's problem is that he was showing Susan a
| clever project that looked much more attractive than notes
| she'd usually consult rather than asking her how many times a
| year she wasn't sure what to prescribe and how difficult it
| actually was for her to get a sound recommendation from a
| source she trusted.
|
| Even if he was trying to demo a finished product rather than
| figuring out if it should exist, asking those questions would
| still have been more likely to put her in the frame of mind
| where she asks about or spots the _really difficult to
| ascertain info that has professional liability repercussions_
| rather than just liking the UI and being impressed that this
| programmer is citing the Hamilton Rating Scale for depression)
| jokethrowaway wrote:
| This was a great read!
|
| Doctors definitely don't need your product, as they pointed out.
|
| But consumers do!
|
| I think you should have sold to consumers.
|
| Having three doctors in my close family, I often found that
| whatever the tired doctor at the hospital is recommending is in
| contrast with what a doctor who care about my health (and is
| willing to look on their proprietary platforms) is recommending.
| That's why you ask different private doctors' opinions when
| things matter.
|
| I found myself googling studies on what's the better treatment
| for $x and I would pay for better-than-a-doctor-advice backed by
| actual studies.
|
| I think the problem, in your situation, is the scale of the
| operation.
|
| If you want to do B2C, you often need investments and you can
| expect to become profitable in a few years.
|
| Either find some funding or fix your cashflow.
| hathawsh wrote:
| That was my reaction too. It seems like GlacierMD might have
| been successful if it had focused on SEO. Whenever someone
| types "what is the best headache medicine", GlacierMD should
| have been at the top of the results. The landing page would
| show the results of the studies for free, but would also let
| the user sign up so they can enter allergy and preference info
| and customize the results to them. Nearby doctors would
| advertise on the site.
|
| So, in essence, before spending any money, I would go out and
| interview doctors to see if they're willing to pay for a
| channel of new customers. I would also try to gauge how many
| customers would be willing to sign up and enter their info so
| local doctors could advertise to them. And, of course, I would
| check with a lawyer to ensure I'm not bumping into HIPAA.
| diebeforei485 wrote:
| Before spending all that cash or even incorporating, he should
| have pitched his idea to VC in the health space.
| fourseventy wrote:
| This is the classic case of building a product that you hope will
| solve a problem instead of finding a problem first then building
| a product to solve it. The correct approach would have been to
| have those conversations with doctors before spending $40k to
| build the product.
|
| I've made this very mistake myself but I was lucky enough to have
| enough runway to start over and talk to customers first then
| pivot the product to something that they actually need.
|
| I call this the "I have an idea for a startup!" issue. You hear
| it all the time from family/friends. Where they tell you this
| great idea for a product they had. This is the wrong approach.
| What you want to say is something like "There is this really
| interesting problem that everyone in ecommerce is facing right
| now"
| ummonk wrote:
| Uh no. He had a problem - how to choose a medicine - and built
| a product to solve that problem. The issue was that solving the
| problem isn't something people wish to pay for, not that the
| problem doesn't exist.
| ignoramous wrote:
| In other words, _" solve a frequent, burning problem"_.
|
| Tom Blomfield worte about how during YC S11 they had trouble
| growing at all. He chanced upon a customer who fit their
| product's user persona to a tee but at the end of a 20m
| conversation Tom realised the it wasn't really a _burning
| problem_ for them at all.
|
| And so they pivoted...to GoCardless.
|
| https://archive.is/8IDcl
| takinola wrote:
| To be more accurate, you want to find a problem that people
| will pay (money, time, etc) for. He never tried to test that
| until it was too late. To be fair, this is a very, very
| common failure mode and I can imagine most people reading
| this story can identify with it.
| dvt wrote:
| > Uh no. He had a problem - how to choose a medicine...
|
| Did he though? He even mentions that customers generally pick
| _whatever_ (because they don 't really care what's the
| perfectly optimized headache pill they should take) and
| doctors thought it was neat, but no one really wanted to pay
| for it. Their solution (e.g. prescribing what they would
| typically prescribe) was good enough.
|
| It doesn't really sound like there's a problem there.
| dewey wrote:
| Solving your own problem and then saying "Oh I found someone
| interested in my solution" isn't really what they mean by
| finding customers though.
| woeirua wrote:
| I don't think most doctors or customers would even consider
| this to be a real problem. For some specific, rare conditions
| sure. But for Tylenol? Come on. No one is going to pay for
| that.
| skybrian wrote:
| To be fair, when he started he didn't know he wanted to talk to
| doctors. That was after a pivot.
|
| Also, $40k is downright cheap compared to most failed projects
| to improve medicine. If it were someone else's money, that is.
| [deleted]
| mbay wrote:
| should have made it enterprise software for HMOs - they profit
| when their population has better outcomes. Or sell it Epic or
| something and they'd package it into their systems.
| jonathan-adly wrote:
| He needed a co-founder who has experience in health care. As a
| Clinical Pharmacist and a developer - this idea would automate
| part of my clinical pharmacist job and is viable. He needed to
| sell to hospitals and PBMs as a tool to automate formulary
| management.
|
| Selling to those entities are really *really* difficult and there
| is no good distribution channel, but doable with an experienced
| person who sold them stuff before.
| gault8121 wrote:
| This article's thesis seems to be that medical professionals are
| not incentized to provide the best interventions, and as a
| result, wouldn't pay for this service. However, what the author
| fails to mention is the competitors in this space that are
| successful, such as Up To Date, which provides really high-
| quality research trial data: https://www.uptodate.com/home
|
| Rather than building a product that informs medical professionals
| about effective interventions, I wonder if the creator would have
| had more success if he deeply explored what sources of
| information these medical professionals pay for now - do they pay
| for anything at all, such as UpToDate, and don't want to pay this
| because it's an additional expense? If the creator found which
| sources people are using, the creator could sell this database as
| a feature for these partners and widely disseminate this data
| through partner channels rather than creating a competing source
| of information. It seems to be a case of this being a good
| instance of a B2B2C model, where selling this service to other
| businesses that sell directly to medical professionals could be
| more viable than trying to sell directly to them.
|
| Alternatively, if the creator wanted to sell to patients, rather
| than medical professionals, the blueprint here is all of the
| consumer reports companies, such as Wirecutter, which is one of
| the New York Times's most popular services. Here, again, a
| "Wirecutter for medical interventions" could be quite successful,
| and you could sell this service to media companies that provide
| consumer reports as a service that would bolster these companies.
|
| It's bad the creator wasn't able to find traction, as getting
| more medical data into the hands of consumers could have a huge
| postive impact over time.
| dr_ wrote:
| A hospital system is incentivized in some ways to get people
| discharged as soon as possible and ideally with a good outcome.
| A service like UpToDate is one of the tools that may facilitate
| that by providing valuable clinical pearls to facilitate
| decision making. So it's not surprising that UpToDate is
| largely paid for by large institutions and academic medical
| centers, and not as much by individual medical providers.
| gzer0 wrote:
| https://opensourcemed.com
|
| It's a crudely built version of UpToDate from 2018 as it was on
| April 2018. Useful for 98% of the population still.
|
| Edit: definitely works better on mobile, and the search needs
| to be fixed.. this isn't my website but a resource that I've
| been passed down/told about by medical students.
| repeek wrote:
| I don't think he had the correct buyer either. While medical
| professionals may be the user, for this type of service you
| need to be selling into hospitals or health systems. They have
| the incentive for their providers, collectively, to improve the
| quality of care.
|
| I doubt UpToDate makes their bones off individual
| subscriptions. The real money to keep a company afloat is from
| b2b enterprise contracts.
| Closi wrote:
| I thought exactly the same when they were talking about
| trying to convince doctors to buy it - surely they don't
| misunderstand their market that much though?
| viraptor wrote:
| There are also services in non-us countries like "How to treat"
| https://www.ausdoc.com.au/howtotreat Which are relatively
| popular and used by doctors. Although it's already edited
| rather than raw data.
| jarym wrote:
| Maybe its just me but I would have approached drug companies to
| partner with their marketing teams. THAT would have been
| something worth paying for TO THEM.
| yaboy wrote:
| Never approach marketing teams unless you're Theranos sized
| courting Walgreens.
|
| Corporate marketers hate risk. It's a great way to lose your
| cushy job. What I have seen happen is that they embrace
| innovation, parade you around their offices and never close on
| a deal.
|
| I saw this happen. The founder of BuyYourFriendADrink was the
| doyenne of Diageo's hallways but after burning six months of
| runway no revenue producing contract was inked. Some corporate
| politicians simply exist to take meetings.
| _0o6v wrote:
| > Make something people want
|
| That's a charity.
|
| > Make something people want __and will pay you for__
|
| That's a business.
|
| You learnt the hard way.
| drran wrote:
| > Make something people want __and stuff it with ads__
|
| That's a business.
| PeterisP wrote:
| IMHO "Make something people want" implies that people will want
| to pay you for it[1]. If people want it, they'll come asking
| you to take their money - if their response is "meh, I'd try it
| for free" then I'd argue it's misleading to tell that they want
| it, the most you could say is that they are interested.
|
| [1] the other limitation is whether they can afford to pay you
| despite wanting it; there are products/markets where the target
| audience is eager to pay but their collective budget is too
| small for the scale you need.
| ohazi wrote:
| > There was this giant thing called _healthcare_ right, and its
| main purpose is _improving health_
|
| My reaction to this was:
|
| _laughing_ : Oh, how adorably naive.
|
| followed shortly by:
|
| _crying_ : Ugh, we're so fucked.
| pramsey wrote:
| It felt like there was a missing chapter!
|
| Consumers don't see the value at all.
|
| Doctors see the value, but won't pay for it, because it doesn't
| change their bottom line.
|
| Whose bottom line _does_ this change then?
|
| HMOs, insurance companies, organizations that want to improve the
| health of a population in aggregate. They'd pay money to have
| healthier people (on average) to provide the service to their
| docs (who see the value) to use for free.
|
| Well, maybe; but I was hoping to see that theory validated in the
| last turn of the wheel.
| adamlangsner wrote:
| He quotes Strategic Marketing Management, which is a great book
| if a bit academic. Another great quote I always remember from
| that book:
|
| "Marketing is not about selling a product, but about figuring out
| what product to sell"
| computerlab wrote:
| If you want to see an index of meta studies, you can check out
| the Cochrane Collaboration: https://www.cochranelibrary.com/
|
| It's mentioned in the book Bad Pharma which has a pretty good
| breakdown of how drug marketing to consumers and medical
| professionals distorts decision making.
| loceng wrote:
| '"Oh, uh--hmmmm," she said. "I don't know if we can spare the
| budget here, to be honest. It's very fun...but I'm not sure if
| our practice can justify this cost."' - Susan (psychiatrist)
|
| It just goes to show you how haphazard and lacking of scientific
| method the psychiatrist field is.
|
| '"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?"' - Susan again
|
| This is an absolutely disgusting response to me. They don't care
| because the costs of shitty treatment - medications that fuck a
| person up - are externalized, the practitioner/psychiatrist
| doesn't have to deal with whatever severe "side" effects the
| medications they'll experiment on a person with.
| thebradbain wrote:
| I would have absolutely used this -- as a consumer tool. I
| _would_ even pay a (small) subscription for the service, as I'm
| an avid user of WebMD who is more often than not overwhelmed by
| potential treatments for any given symptom, but I admit that most
| likely would not scale.
|
| I do, however, think it makes much more sense as a consumer tool
| rather than a doctor tool: if I've already gone through the
| trouble of making an appointment at a doctor, who I trust, I've
| either given up on trying to resolve the issue myself and will
| trust their prescription, or I have no idea how to approach the
| issue or symptoms I'm feeling as communicated by WebMD. Your
| value proposition is saving the consumer time and effort of
| booking an appointment to find out how to best fix a minor-
| medical issue they (or, say, their child) may have. Is that a
| sustainable proposition? I don't know, but it makes much more
| sense to me than as a tool to tell doctors how to do their job
| "better".
|
| I'd imagine if you went the WebMD consumer route, too, once you
| reach a certain user-size, you'd have no problem partnering with
| pharmacies (or even pharmaceutical companies) to offer coupons
| for some OTC medicines in exchange for a referral fee, as is
| standard in the industry (a. la. GoodRx). Then you're providing
| value to the consumer in the form of recommending useful
| medicines, providing the consumer a way to get that medicine for
| a lower cost, saving them time and money spent at the doctor's
| office, and providing the pharmacy/pharmaceutical company a new
| customer.
| ddevault wrote:
| This is a case-study in how capitalism fails. It is _not_ a
| system that maximizes efficiency. Here we have a product which
| materially improves peoples lives and health, which fails because
| no one is incentivized to pay for it. If we had a nationalized
| system it would be a no-brainer for the government to pick up the
| bill.
|
| Capitalism sucks in general terms, but healthcare and capitalism
| is an awful, evil combination.
| newbie578 wrote:
| Really interesting to read. We can all now be captain Hindsight,
| but no point in stating the obvious, as long as you and others
| reading it have learned from the story.
|
| Although, I have to mention, reading the article and seeing
| mentions of MVP and no testing or concrete business plan, I
| remembered the book "Disciplined Entrepreneurship: 24 Steps to a
| Successful Startup"[1] and I loved how Bill Aulet in the book
| mentioned the MVP model and gave his own thought:
|
| Instead of everyone rushing MVPs, he recommends to people to
| rather chase an MVBI, a minimum viable business idea, since as he
| says, the purpose of a business is to create value and capture
| it, since you are not running a charity.
|
| I must say he convinced me, and changed my line of thinking, it
| does make sense when you think about it, you cannot build the
| product for the sake of the product.
|
| I also like the quote "Real entrepreneurs fall in love not with
| their product, but with their business plan."
|
| [1] - https://www.goodreads.com/book/show/18652777-disciplined-
| ent...
| laser wrote:
| "Doppelganger has created value for the customer but not for the
| company."
|
| Tell that to "Celebs", which's sole app function is the described
| and makes ~$200K MRR.
| twobitshifter wrote:
| That's shocking to me. They have subscriptions? Why is someone
| subscribing to an app like this?
|
| Looked at things on the App Store. It's not clear what a
| subscription gets you but they're charging $4.99 _a week_ for
| the premium features.
| rdiddly wrote:
| Yeah, I was going to chime in and say "I bet Doppelganger would
| make more money than GlacierMD." Cynical content warning:
| Precisely because it's not geared toward helping others, which
| no one gives a shit about, and is all about _your photo of
| yourself_ which everybody obsesses over.
| rossmohax wrote:
| Analysing studies and providing summary on various topics is what
| examine.com does. I am a happy customer, so there is definitely a
| way of monetising meta-analysis.
| dvt wrote:
| > So I built something people wanted. Consumers wanted it,
| doctors wanted it, I wanted it. Where did I go wrong?
|
| A lot of people in this thread are talking about the woes of
| ethical doctoring, the problems of healthcare, and so on. The
| reality here is that _no one wanted it_ -- at least no one that
| he was selling to. I can relate. I 've been there -- building
| something for months and then hearing crickets. The Y Combinator
| motto -- "Make something people want" -- is actually pretty tough
| to get right. In fact, it's the crux of any viable business. The
| reason why 9/10 businesses fail is largely in part due to the
| fact that they _aren 't_ making something people want.
|
| Prospective customer interviews suck (especially for technical
| folks), but they are integral to building a product people want.
| Doing them before an MVP is crucial.
| maxrobot wrote:
| I am sure that by mining data from people's phones he could have
| sold users data to the lowest bidder...
| ummonk wrote:
| This seems like it needs to be a nonprofit database - perhaps
| funded by government grants or industry sponsors - rather than a
| for-profit growth-oriented startup.
| rel2thr wrote:
| I like your idea, but I'm confused why you didn't try the webmd
| competitor route.. 50c/user that webmd makes is pretty good
| really , with good SEO + content marketing you could scale to
| enough users to make things interesting
| sixQuarks wrote:
| Exactly. This was the right path in this case. The value is for
| the consumer, if he could attract just 100K visitors per month,
| that's $500,000/year.
|
| Not only that, he would have a highly targeted group of users
| that he could tailor all kinds of products and services to.
| ivalm wrote:
| You need 1mil visitors for 500k.
| saaaaaam wrote:
| Indeed. Which what 100k per month comes to, give or take :)
| yaboy wrote:
| You're both wrong. 100k visitors per month [?] 100k
| unique users per month. Very different things!
| patel011393 wrote:
| As a researcher interested in improving evidence synthesis, I
| would have loved to use this. Can't this still continue as a
| volunteer service/non-profit/research project? It reminds me of
| Examine (https://examine.com/) with broader application
| potential...
| ibudiallo wrote:
| I thought I read this here before:
| https://news.ycombinator.com/item?id=21947551
|
| I still feel the same about it[1]:
|
| > Don't shut down the website. Keep it running and make the data
| available in read only mode and add a donation button
| (alternative to ads). It should cost $5 a month to host on linode
| or digitalocean. Don't let the money you spent go down the drain.
|
| [1]: https://news.ycombinator.com/item?id=21951604
| extrememacaroni wrote:
| This reminds me of an idea I had days ago of using an AI to tell
| poisonous mushrooms from edible ones apart, from photos.
|
| Then I realized I don't want to be responsible for anyone's
| death.
| syntaxing wrote:
| What if you limited the range from I don't know if it's
| poisonous to X% likely poisonous vs is/is not poisonous?
| eropple wrote:
| People empirically do not understand probability in a useful
| way. Folks will, in aggregate, read that as "X% poisonous",
| not "X% chance to be kill you."
|
| "Oh, that's only 25%, it'll be fiiine."
| byecomputer wrote:
| Even if you can avoid being liable for it, I'd think most
| people wouldn't want someone's death hanging over their head
| for reasons beyond the legal.
| frompdx wrote:
| Definitely a neat idea, but how would this work? Most
| identification starts with a spore print. What if instead of an
| AI to identify mushrooms it was software that used a
| classification system like what is described in "Mushrooms
| Demystified".
|
| Edit: Should clarify most reading I have done on mushroom ID
| involves taking spore prints as an essential step but it's not
| always the rule.
| harry8 wrote:
| Isn't the volume so low on that and the latency requirements so
| undemanding that ML is overkill to get the answer as well as
| the accuracy issues with false positive for "not deadly" being
| somewhat asymmetric?
|
| I still think of ML as having a niche of "mostly right is ok"
| and useful for very, very large volume otherwise one or more
| people does better for less. That may change in time. Self
| driving cars are very close now they say, but i suppose we've
| been hearing that for a few years without getting there.
| nightsd01 wrote:
| Already exists, I heard about it on NPR the other day (perhaps
| the idea got implanted into your subconscious)
| https://mushroomai.ml/#mushroomai
| Const-me wrote:
| I don't believe modern state of AI is good enough for the job.
| At least not yet.
|
| A human expert might look at your photo and instead of saying
| "you may / should not eat that" start asking questions, about
| local ecosystem, climate and weather. Or they might ask you to
| shoot more photos, e.g. bottom of the cap or microscopic photo
| of spores.
|
| I'm not an expert in AI but based on what I know they aren't
| smart enough for that, at least not yet.
| klyrs wrote:
| Yikes! Some species require microscopes to differentiate.
| Thanks for not making that app!
| MichaelRazum wrote:
| I think the idea is good. Something like AI suggested drugs. But
| I guess that is hard to do the right way. On the other hand if I
| really care for the a new drug I take. Just using google scholar
| and quite often you have some summery studies which compare
| different meds.
| raverbashing wrote:
| I think this was posted already (a couple of years? ago)
|
| Anyway, yeah, it wasn't a good value proposition (and is it just
| me or GlacierMD is a bad name for this)?
|
| Because in the end, it doesn't matter much if you don't get "the
| _absolutely best choice_ of drug ". If it solves your problem
| great, if not, doctors can exchange it, but that's when the drug
| or dosage is bad, not "not great".
| jaywalk wrote:
| From Glacier, it's a very short mental route to Titanic. So,
| yeah I'd say naming your product that brings up thoughts of the
| Titanic is not great.
| rusteh1 wrote:
| Iceberg != Glacier. AWS manages to market Glacier without
| people expecting S3 to sink to the bottom of the Atlantic
| jaywalk wrote:
| Good point, but AWS Glacier also has a very clear
| connection to the word since it's a cold storage service.
| stevewodil wrote:
| I would definitely look at antidepressants on GlacierMD,
| because I think I want to take one but the options and side
| effects are all over the place
| yawnxyz wrote:
| yeah if it was something like "we can recommend a cheaper drug"
| then there might be an incentive... but also that's not how
| drugs are even priced. The healthcare world is such a mess.
| Charging doctor's offices for SaaS is very very tricky.
| danhak wrote:
| Healthcare is tough. There are few markets with more inertia and
| misaligned incentives than this.
|
| With respect to pitching the product directly to clinicians, OP
| may have misunderstood his target market or overestimated the
| value proposition.
|
| It seems like a very big request to ask a doctor to deviate from
| a treatment with which they already have a high level of
| experience.
| gjs278 wrote:
| it would probably cost what, $20 a month to keep this on line if
| it has very few users? why not just keep it online and stop
| updating it?
| Brian_K_White wrote:
| Sounds like this might work to offer it to doctors as a white
| label phone app or pwa, that each customer (doctor or group or
| clinic or hospital etc) skins and gives to their own customers or
| sticks on their own website.
|
| It has the recommendation engine and the doctors marketing looks
| and some forms of low-friction way to contact the doctor
| (generate billable service) from email to video chat.
|
| Doctor pays for the startup skinning, any feature changes or
| updates, and a subscription which pays for ongoing development of
| the engine and the datasets, maybe some related hosting.
|
| Doctor maybe gives the app to tge users free, maybe charges if
| they think they can pull it off, and generates sales from the in-
| app "help me" buttons.
|
| Could have a few quasi-generic versions geared to different kinds
| of practises that smaller practices could share.
| joeraut wrote:
| Original post from January 2020:
| https://news.ycombinator.com/item?id=21947551
| baxtr wrote:
| _> But in fact everyone gave me some version of Susan 's answer.
| "We just can't justify the cost," a pediatrician told me. "I'm
| not sure it's in the budget," said a primary care physician.
| "It's awesome," said a hospitalist. "You should try to sell
| this!" Ugh._
|
| In B2B People pay either to reduce costs or drive sales. It's as
| easy as that.
| gnicholas wrote:
| Previously discussed:
| https://news.ycombinator.com/item?id=21947551
|
| Weird that the blog post is dated Oct 2020 but was apparently
| discussed on HN in Jan 2020...
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