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I am doing this, full-time for almost three years soon. The company is at http://dochuddle.com/ http://dochuddle.com/ So here is the warning: Medical startups

I am doing this, full-time for almost three years soon. The company is at http://dochuddle.com/ http://dochuddle.com/ So here is the warning: Medical startups are hard, really hard. - It is difficult to apply research on 32x32 cat icons on 15megapixel xrays. - It is difficult to get data without year-long contract efforts - It is very difficult/expensive, if not impossible, to use cloud resources due to HIPAA and localization rules so you need to build your own on-premise GPU grids like we did - It is difficult doing most medical things in the USA unless you are on the revenue side (e.g., collections, increasing yield, etc.) -- we got so many raw deal partnership offers in the US that we went overseas to trail our product. The entire medical system in the US is corrupt from the ground up, geared to maximize revenue with minimal lawsuit risk. Patient care rarely enters the conversation internally. I thought financial services was bad (my past career), but at least the metrics were all agreed upon by everyone. In medicine, everyone has an agenda, often diametrically opposed to other parties.

drchiu 10y ago
This is probably one of the most accurate portrayals of medical systems i countries with highly developed and sophisticated legal system. It's sad but one of those things that is only apparent once you're neck deep in it. The people who want to truly help patients are swept aside by those who are in positions to benefit themselves or their friends at the expense of others, including patients. Think administrators, bureaucrats, regulators. When this thread was raised the other day, I jokingly said how machines could never replace doctors. The reason is that you can't sue a machine that makes a mistake. Poor medical outcomes like how random flies get hit by cars on a highway. The powers that be will always insist a doctor be there to sign off. There needs to be a fall guy.
- TuringNYC 10y ago
  @drchiu, it is uncertain how the system will evolve, but one way to solve the fall-guy problem might be to purchase insurance on these systems and have them bonded. It is all new territory, so no one really knows. Self Driving Cars will face the same challenge w/r/t liability insurance when there isn't a driver. It might be a insured & bonded set of algos and systems.
bilbo0s 10y ago
Keep in mind that TuringNYC did not even MENTION the main issue that trips up most startups... ie - they are unfamiliar with how to secure, (and KEEP), FDA approval for their products. It actually comes as a surprise to many of them that they even NEED FDA Approval. Then they are further shocked by how invasive the process is, and how long it can take. And don't even get me started about the look on their faces when they realize that, despite all of that, you're still held CRIMINALLY accountable for any bugs in your software. (Stay away from anything that might injure anyone if you are unsure of the ability of your process to reliably prevent bugs. Things like RTP are no-go areas for all but the most meticulous medical software developers.) Don't get into medical software unless you have an extremely long, and very well funded, runway. This is not an industry where 2 guys in a garage can innovate and side-step the regulations. And whatever you do, stay away from anything that could actually harm the patient if it is wrong.
- mhb 10y ago
  China Creates Special Economic Zone for Medical Tourism: https://news.ycombinator.com/item?id=14022383 https://news.ycombinator.com/item?id=14022383
- TuringNYC 10y ago
  Very good point @bilbo0s and thank you for bringing this up. I didn't mention it as we focused on a non-clinical diagnostic (thus not subject to FDA), decided to entirely avoid the US market (focus on more less risk averse economies open to innovation and aligned via ACO-style systems.) FDA is definitely the biggest hurdle of them all. I'd shudder if we had to deal with that 600 pound gorilla.

drchiu 10y ago

This is probably one of the most accurate portrayals of medical systems i countries with highly developed and sophisticated legal system. It's sad but one of those things that is only apparent once you're neck deep in it. The people who want to truly help patients are swept aside by those who are in positions to benefit themselves or their friends at the expense of others, including patients. Think administrators, bureaucrats, regulators. When this thread was raised the other day, I jokingly said how machines could never replace doctors. The reason is that you can't sue a machine that makes a mistake. Poor medical outcomes like how random flies get hit by cars on a highway. The powers that be will always insist a doctor be there to sign off. There needs to be a fall guy.

TuringNYC 10y ago
@drchiu, it is uncertain how the system will evolve, but one way to solve the fall-guy problem might be to purchase insurance on these systems and have them bonded. It is all new territory, so no one really knows. Self Driving Cars will face the same challenge w/r/t liability insurance when there isn't a driver. It might be a insured & bonded set of algos and systems.

bilbo0s 10y ago

Keep in mind that TuringNYC did not even MENTION the main issue that trips up most startups... ie - they are unfamiliar with how to secure, (and KEEP), FDA approval for their products. It actually comes as a surprise to many of them that they even NEED FDA Approval. Then they are further shocked by how invasive the process is, and how long it can take. And don't even get me started about the look on their faces when they realize that, despite all of that, you're still held CRIMINALLY accountable for any bugs in your software. (Stay away from anything that might injure anyone if you are unsure of the ability of your process to reliably prevent bugs. Things like RTP are no-go areas for all but the most meticulous medical software developers.) Don't get into medical software unless you have an extremely long, and very well funded, runway. This is not an industry where 2 guys in a garage can innovate and side-step the regulations. And whatever you do, stay away from anything that could actually harm the patient if it is wrong.

mhb 10y ago
China Creates Special Economic Zone for Medical Tourism: https://news.ycombinator.com/item?id=14022383 https://news.ycombinator.com/item?id=14022383
TuringNYC 10y ago
Very good point @bilbo0s and thank you for bringing this up. I didn't mention it as we focused on a non-clinical diagnostic (thus not subject to FDA), decided to entirely avoid the US market (focus on more less risk averse economies open to innovation and aligned via ACO-style systems.) FDA is definitely the biggest hurdle of them all. I'd shudder if we had to deal with that 600 pound gorilla.