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When good ideas make bad business

• Donald 7y ago
  Guess it's time to rebrand this as a fintech startup that informs investors about high-risk pharma stocks.
  • jcims 7y ago
    Yes! Andrew Lo has a great talk on a related subject - https://www.youtube.com/watch?v=AzELyaVf0v8 https://www.youtube.com/watch?v=AzELyaVf0v8
• gazelle21 7y ago
  The ending was fantastic
• thomasjudge 7y ago
  '“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
• deleted 7y ago
  [deleted]
• Dayshine 7y ago
  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.
• DJBunnies 7y ago
  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 7y ago
    Yes. I didn't know that until right this second.
    • DJBunnies 7y ago
      Wild.
    • rurp 7y ago
      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 7y ago
    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 7y ago
  [deleted]
• leggomylibro 7y ago
  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 :)
  • ghostbrainalpha 7y ago
    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.
    • professionalguy 7y ago
      that's exactly what I was thinking - plus what startup story is complete without some VC intervention?
    • ghostbrainalpha 7y ago
      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.
  • rjkennedy98 7y ago
    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!
• tyingq 7y ago
  Somewhat surprised a search engine wouldn't want it for the perceived value of improved "snippets". Or some company like WebMD.
• bobosha 7y ago
  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 7y ago
    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 7y ago
  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 7y ago
    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.
• earlINmeyerkeg 7y ago
  Can you call it a good idea in hindsight if you acknowledged it was a waste?
• tehansen 7y ago
  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 7y ago
    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 7y ago
      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 7y ago
    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...
• ageyfman 7y ago
  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.
  • SpicyLemonZest 7y ago
    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.
    • tyri_kai_psomi 7y ago
      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 7y ago
        Anyone has a link to the above video?
        • vijucat 7y ago
          I think it's this one: https://www.youtube.com/watch?v=rWRbTnE1PEM https://www.youtube.com/watch?v=rWRbTnE1PEM
        • deleted 7y ago
          [deleted]
• marcinzm 7y ago
  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 7y ago
    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.
• iabacu 7y ago
  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.
  • ageyfman 7y ago
    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 7y ago
      So the insurance companies fund it as a donation to physicians.
    • lonelappde 7y ago
      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 7y ago
      >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.
  • professionalguy 7y ago
    Or R1 research universities
• cowbird 7y ago
  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 7y ago
  It's like a brief diploma-less MBA program, like a Montessori MBA.
• sheeshkebab 7y ago
  Build it and they will come they said, follow your dreams they said... yeah, right.
• codingdave 7y ago
  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.
• streetcat1 7y ago
  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 7y ago
    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.
    • lonelappde 7y ago
      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 7y ago
        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.
    • qroshan 7y ago
      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
• elliotpage 7y ago
  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 7y ago
    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 7y ago
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• 12xo 7y ago
  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?
• johnchristopher 7y ago
  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 7y ago
    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 7y ago
      "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 7y ago
    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.
• uj8efdkjfdshf 7y ago
  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 7y ago
    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 7y ago
      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 7y ago
    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.
• sparkywolf 7y ago
  Hacker News hug of death... Anyone have a mirror or text?
• gkoberger 7y ago
  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.
  • mritchie712 7y ago
    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?"
    • mwilcox 7y ago
      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
      • agentultra 7y ago
        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.
• amirhirsch 7y ago
  > 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.
• symlinkk 7y ago
  I don't see how ads weren't enough to keep this afloat.
• fyp 7y ago
  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.
  • sjg007 7y ago
    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 7y ago
      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 7y ago
        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.
  • lopmotr 7y ago
    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.
• CPLX 7y ago
  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.
• tylerrobinson 7y ago
  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 7y ago
    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 7y ago
      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 7y ago
  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.
• cjdupreez 7y ago
  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 7y ago
    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 7y ago
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• simo7 7y ago
  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.
• throwaway_tech 7y ago
  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 7y ago
    > 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 7y ago
      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".
• sealthedeal 7y ago
  http://theleanstartup.com/ http://theleanstartup.com/
• theklub 7y ago
  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)
• georgewsinger 7y ago
  lol @ giving up after 2 weeks.
• sjg007 7y ago
  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.
• 2pointsomone 7y ago
  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 7y ago
  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 7y ago
    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+.
• pascalxus 7y ago
  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 7y ago
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• sethammons 7y ago
  he "worked at a startup that leveraged autonomous blockchains to transfer money from naïve investors to slightly less naïve twenty-somethings. There are worse gigs." This sounds like a scam or fraud.
• jupp0r 7y ago
  Forgive me for stating the obvious, but wouldn't talking to doctors with some mockups have prevented most of this?
  • omarchowdhury 7y ago
    It definitely would have.
• choeger 7y ago
  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 7y ago
  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.
• syntex 7y ago
  It seems like you stopped far too early pursuing your idea.
• rmah 7y ago
  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 7y ago
  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.
  • moneywoes 7y ago
    What was your story?
• ouid 7y ago
  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.
• RocketSyntax 7y ago
  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
• deleted 7y ago
  [deleted]
• ggggtez 7y ago
  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.
• scotty79 7y ago
  > 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.
• legitster 7y ago
  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?)
  • gringoDan 7y ago
    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 7y ago
      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.
    • AlexCoventry 7y ago
      Actuaries employed by insurance companies are probably already better at this kind of analysis than he is, though.
  • gbasin 7y ago
    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
  • 7y ago
• mynegation 7y ago
  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 7y ago
    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.
• whiddershins 7y ago
  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.
• wyldfire 7y ago
  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 7y ago
    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.
• scotty79 7y ago
  > 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 7y ago
  Just FYI: "Doppelganger" exists in Russia and makes tons of money from government contracts.
  • perpetualpatzer 7y ago
    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.
• billconan 7y ago
  I can't understand the last part of the article "Doppelganger has created value for the customer but not for the company." Isn't the value for the company created through the value for the customers? I.E. you take a percentage of the value for the customers as the value for the company. What would be an example of creating value for the company?
• ww520 7y ago
  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.
• Edmond 7y ago
  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 7y ago
  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.)
• tombert 7y ago
  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?
• bkraz 7y ago
  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.
• opportune 7y ago
  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.
• stevespang 7y ago
  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 7y ago
  > 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.
• StavrosK 7y ago
  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 7y ago
    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.
    • StavrosK 7y ago
      Perhaps... Would a disclaimer help there?
    • JamesBarney 7y ago
      It's just a programatic meta analysis. And no one's get sued for having an out of date meta analysis.
      • celestialcheese 7y ago
        It's America - people get sued for far, far less.
        • JamesBarney 7y ago
          Anyone could theoretically get sued for anything. But the chance of getting sued for providing an out of date meta-analysis is indistinguishable from the background chance of getting sued for getting out of bed in the morning. (assuming you're not doing something stupid)
  • 7y ago
• nautilus12 7y ago
  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?
• dougb5 7y ago
  > 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 7y ago
  Great article!
• catchmeifyoucan 7y ago
  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 7y ago
    > I do product at MEGACORP and love product strategy. Where should one go/read/listen/watch to learn more about product strategy?
    • catchmeifyoucan 7y ago
      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.
  • bduerst 7y ago
    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.
• nickelcitymario 7y ago
  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!
• ping_pong 7y ago
  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.
  • astura 7y ago
    >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? Am I wrong or isn't solving these issues basically the service UpToDate offers?
• royroyroys 7y ago
  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.
• godelzilla 7y ago
  The point of healthcare under capitalism is to profit from sick people, not to heal them.
• reggieband 7y ago
  > 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 7y ago
    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 7y ago
      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.
• desireco42 7y ago
  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.
• deleted 7y ago
  [deleted]
• nwsm 7y ago
  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.
• amitmathew 7y ago
  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.
  • wayoutthere 7y ago
    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.
    • omegaworks 7y ago
      This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life.
• jdennaho 7y ago
  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.
• SAI_Peregrinus 7y ago
  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).
• gavinray 7y ago
  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 7y ago
    i'm interested in the project you mentioned-- drop me an email adam at springhealth.com if you'd like to chat
• raverbashing 7y ago
  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).
• dnprock 7y ago
  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.
• kevan 7y ago
  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.
• kirillzubovsky 7y ago
  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.
• indigodaddy 7y ago
  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?
• dumbfounder 7y ago
  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.
• stevewilhelm 7y ago
  TLDR: OP learned the hard way that a good idea was a feature, not a viable business.
• hangonhn 7y ago
  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.
• rwmj 7y ago
  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.
• macspoofing 7y ago
  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.
• hogFeast 7y ago
  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).
• kkotak 7y ago
  I think writing is your true calling OP,
• bcrosby95 7y ago
  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.
• pilingual 7y ago
  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 https://cdixon.org/2013/08/04/the-idea-maze
• acvny 7y ago
  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.
• _bxg1 7y ago
  > “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.
  • thundergolfer 7y ago
    If this thing works as a better search engine for medicine, then I'd want my doctor using it. Could this person have trialled it in a healthcare system with a public-option? Convince the government your product is a benefit to their doctors and by extension their citizens, and a good government should pay you for it after a proper trial. Instead he walked into a situation where the incentives are utterly fucked by an atomised, privatised, and consumer-oriented healthcare system.
• AndrewKemendo 7y ago
  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.
• rdiddly 7y ago
  I liked this "my startup failed" story more than many, not least because of all the gratuitous wry allusions to SV culture.
• WC3w6pXxgGd 7y ago
  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?
• taurath 7y ago
  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.
• wiggler00m 7y ago
  "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.
• acvny 7y ago
  And by the way, your mistake was that you forgot 3 very important letters - MVP.
• ibudiallo 7y ago
  The most disappointing thing in this story is that glaciermd.com doesn't even resolve anymore. He started a business in 2017, and closed the doors in 2018. What? Recently, I was contacted by a person who told me he saw one of my videos on YouTube about Ycombinator (it had 50 views!!!), he had to meet me in person. We met a couple days later. He was a very smart guy with an impressive resume. He quit his job in equipment manufacturing to pursue entrepreneurship. He was a former USC student, so naturally he traveled back to California, rented a small room where him and his business partner churned on their idea. It was a sort of classified for colleges. Not a terrible idea in anyway. He knew the college life so he must have known things I didn't. I told him he should have tested his idea before quitting his job and moving into a whole other country where he had only been a student. He showed me the website, and it was obviously made by someone who was learning React. There is no need to go fancy when you are still testing your ideas. But there was a problem. They were paying thousands of dollars a month to keep this barely functional app running. This is something I see a lot of young people entering web development are doing. They get beefed-up cloud services that eat up a good chunk of their money. Most people think this is the regular cost of being online. It's not! A year later, the domain name doesn't resolve either. In the story, OP alludes living with his parents. I imagine to save money. But then there is $40k. I hope that it wasn't mostly on the AWS cost. But he gathered valuable data that did cost money. 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.
• monkin 7y ago
  I love the idea, but I'm sad that the author focused on doctors, and not ordinary people that he mentioned at the very beginning. This could be a great application used by everyone, including Google, to provide better search results, at the same time providing more and more traffic. Mentioned ad revenue could also work, but not only this. If the author reads this, do not be like Google, don't give up, just pivot. Yes, I think it's Brilliant Startup Idea that could be back in a few months better than last time. :)
• around_here 7y ago
  OP needs to look outside of the US where this kind of data will be used for the benefit of patients, and primary healthcare isn’t run like a business.
• mehrdadn 7y ago
  I'm so confused. Not like I'm a doctor, but doesn't the foundational assumption seem fatally flawed? How can you reduce drug efficacy to a single number? It's one thing to compare brands of the same drug, but why in the world are aspirin and acetaminophen (or whatever) just viewed like interchangeable substitutes here? I know I certainly don't reach for the strongest painkiller—but rather the weakest one that might do the job. And I know my doctors certainly never viewed these painkillers as interchangeable. Don't the natures of the effects and side effects actually matter to people?
• duelingjello 7y ago
  Falling in love with an idea plus ignoring reality is the surest road to hubris and failure. Be religious about results, customer value, profitability and employee welfare, not ideas. Ideas are a dime a dozen; executing and pivoting into what works too often is stymied by ego and thousands of other self-destructive tendencies that increase the likelihood failure in millions of ways. There are very few ways to succeed, with a little help from happy accidents and flexible resilience under pressure.
• reilly3000 7y ago
  Healthcare startups are a like a 'land war in Asia'... "only a fool would make such a blunder" (via The Princess Bride, perhaps the best film of the 1980's.) Selling anything to medical practices is remarkably difficult, due to the difficulty of getting a meeting. They may have to lose $250 in billable time to meet with you, and they are bombarded with sales calls from everybody under the sun. Getting adoption is worse, with overworked staff actively hostile to change. I watched a friend sink his heart and cash into a medical research survey system only to find out how impossible of a market it is to break into. And it is a land war. Selling into large companies is hard fought, but possible. The long tail is practically impenetrable for a software system, not when they could allocate capital to revenue generating marketing, equipment, and staff. I worked at trying to market a low priced medical supply item into a long tail of allied healthcare professionals and found that there is virtually no network effect. That is to say, people who share the same medical profession have very little interconnected outside of a very local level, and the work they perform is so physically and mentally draining that they don't really want to spend a lot of time online after hours talking about vendors, or talking with others in their field at all. Durable medical equipment and consumables sales are really driven by incumbent field sales reps more than ecommerce, even still in 2020. Land war. Look at how difficult a time big tech has had taking on electronic medical records systems. Technology is not the bottleneck. There are plenty of health tech startups finding traction, and I do believe medical professionals want to continually improve themselves and their practices with whatever tools and information is available to them. The fact is, $40K isn't enough capital to win a land war, no matter how great the solution is (and its looks great). I'm sorry OP had to find that out the hard way. PS. There is a growing array of health focused startup accelerators that can provide seed money, but more importantly the expertise to navigate the sales and regulatory challenges unique to healthcare.
• mkevac 7y ago
  Company that made Doppelganger-like product is flourishing. They are selling it`s product to governments and other companies for ton of money. https://en.wikipedia.org/wiki/FindFace https://en.wikipedia.org/wiki/FindFace
• dutchblacksmith 7y ago
  I bet that within some years, this idea will surface and gain momentum. Keep it as a side project.
• Gatsky 7y ago
  So many mistakes here in both concept and execution. That conversation with the Psychiatrist is bizarre, and must have been embellished for a good story. I think what 'Susan' is actually trying to say is that the incremental benefit of using this 'auto meta-analysed' data over the actual studies is very small. The author tries to cast this as 'Doctors not wanting to improve healthcare', which is just a rationalisation for the product which is not useful. Case in point, the spreadsheet cited at the start of the article largely links to a systematic review that is already published, ie the author is copying data someone else has already aggregated and then re-analysing it in basically the same way with a few more studies. And then trying to charge people to access it. This seems manifestly inferior to the existing system if you ask me. Cochrane would be turning in his grave. There just isn't a product you can sell here.
• Cougher 7y ago
  I don't know that I've encountered such a flagrant display of naivete from someone who actually has an education/proficiency in a profession, who is also apparently well-read enough to engage in such a process. It demonstrates a complete lack of respect for other careers that have a tremendous amount of education requirements and proficiencies of their own, not to mention having a basic social awareness of how people behave and respond in the business world and social realm. I get that he was trying to be humorous, but it wasn't informative enough to make me sympathetic to him at all.
• prithsr 7y ago
  Barring any advice or input on the idea (which I do think is solid), this was a really fun read.
• phonon 7y ago
  Honestly, it sounds more useful than https://www.ibm.com/watson-health https://www.ibm.com/watson-health Pretty similar to https://www.ibm.com/blogs/watson-health/hospital-pharmacists-tap-ai-to-improve-drug-information-searches/ https://www.ibm.com/blogs/watson-health/hospital-pharmacists... even. Product sounds fine, but not selling them 1 by 1 to doctors.