5 ms·

I’m a physician. I really appreciate Tom’s enthusiasm, but I think that enthusiasm led him to overestimate the significance of the problem. Moreover he didn’t r

I’m a physician. I really appreciate Tom’s enthusiasm, but I think that enthusiasm led him to overestimate the significance of the problem. Moreover he didn’t really understand for whom he was building this product. At first he thought it would be a consumer product. But he realized that consumers would not pay/subscribe and later learned that advertising wouldn’t work. Next he thought doctors would pay because “Doctors have money, right?” Again paying for this or any service is an expense. Its value has to justify the expense. We pay hundreds of dollars a year for UpToDate because it’s valuable. Cochrane is the gold standard for meta-analyses and they’re publishing for topics that are of clinical significance. Ultimately I doubt anyone is going to change their practice based on this product because there isn’t a compelling reason to do so. My major observation is that Tom tried to make a healthcare startup with negligible understanding of healthcare: the players, how payments work, how physicians practice, and what patients want/need. By not understanding the environment you’re not going to be able to understand the Problem which means your Solution will probably fail. This is a mistake repeated by most of the engineer founded health startups I’ve read about. Finally for anyone wondering I usually recommend ibuprofen 800mg every 8 hours and Tylenol 1000mg every 8 hours. This isn’t medical advice, just something you may find from a quick search.

scyzoryk_xyz 5y ago
I’ve been a PM in a small healthcare tech company run by engineers over the past few years and this 100%.
peter_retief 5y ago
I am developing a non invasive diagnosis tool that uses infrared absorption, electrical activity and a few other sensors with machine learning. As it stands there are some physicians who think it has potential. I am also using it to identify people which would make it useful in its own right. My question is, do you think a quick diagnosis tool would be helpful and would someone be prepared to pay something for it?
BoiledCabbage 5y ago
I agree. And what Tom didn't realize is that Doctors aren't financially incetivized to give better healthcare. There is no money in it for them. If anything, return visits because of a partial prior resolution make more money. Now clearly I'm not saying that doctors try to give bad diagnoses for profit (because they don't). But beyond a certain minimum bar, and on a purely financial basis, improving diagnostics or prescription accuracy doesn't not make a medical practice more money. And the responses here illustrte that. Now, whether that's the right/wrong incentive strucgture is a whole 'nother discussion. And I personally can't think of something better than what we currently have - but it is a truth of the current system.
- DeathArrow 5y ago
  > But beyond a certain minimum bar, and on a purely financial basis, improving diagnostics or prescription accuracy doesn't not make a medical practice more money. But giving better diagnostics and better prescriptions can result in improved profits if it's marketed in an efficient way. Would you go to a clinic that will give you the best diagnostic and prescription possible or to one where you are unsure about the result? Some mediocre restaurants in tourist areas are doing well because they are vouched for and have TripAdvisor stickers on their front door. What if clinics had GlacierMD stickers on their front door? To sell GlacierMD to doctors you have first to convince the patients that is something great about it.
- jstummbillig 5y ago
  > If anything, return visits because of a partial prior resolution make more money. I don't know what system you are referring to, but in the EU, for common physician services, this is (fortunately) not how it works. Physicians are by and large being paid per case, not per visit. In Germany a case is being defined as the same patient visiting the same physician in the same quarter of the year (https://www.kbv.de/tools/ebm/html/3.1_162396960999493856215104.html https://www.kbv.de/tools/ebm/html/3.1_1623969609994938562151...)
  - gehwartzen 4y ago
    I'm assuming the US as that is the case here. Each visit is billed for individually. By the case is certainly a much better model.
OJFord 5y ago
Yeah I adopted my confused face from the 'problem' statement/'killer' start-up pitch on. Have a headache and don't know which drug to buy? Come on. You have a headache and you take either acetaminophen or ibuprofen, both of which you already have. You don't buy anything. I'm not a physician, I just take (rarely anything other than max dose) them per the label, which is different to your suggestion (1g/4h, max 4g/day) at least where I am. Ibuprofen if something seems 'inflamationy' or if I have drunk/will drink alcohol (on some sort of naïve hand-wavy basis to lighten the livery load).
smnrchrds 5y ago
If the COVID-19 pandemic has taught me anything about science, it's that if you do a "meta-analysis" without reading each paper carefully and critically, you can end up proving anything regardless of its veracity. You cannot replace domain-expert scientists spending huge amounts of time painstakingly going over every detail of many papers to weed out mistakes and fraud in order to write a meta-analysis, with a computer program. Well, at least not until we figure out AGI. Until then, it would be irresponsible to rely on such a program for any clinical decisions. https://news.ycombinator.com/item?id=29249686 https://news.ycombinator.com/item?id=29249686 https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted https://astralcodexten.substack.com/p/ivermectin-much-more-t... https://ivmmeta.com/ https://ivmmeta.com/ (Note the long list of things in the right sidebar which the "meta-analysis" shows have huge positive effects on COVID treatment)
- beaconstudios 4y ago
  I think the generalised lesson to be learned is that in reducing complexity (and all modelling requires reducing complexity), you get to make decisions about which bits of data are cut out, and this is a decision that can introduce bias. We can't just blindly trust reductions, especially in areas where there are competing interests. This is why transparency is so important! If I can reproduce your methodology, I can critique it for bias.
- Gatsky 5y ago
  Yes, this is a perfect example. ivmmeta is shocking, born of either complete bad faith or madness.
- fsckboy 5y ago
  ok, but... would a meta meta-analysis analysis show that on average, meta analyses do find positive benefits? get back to me.
  - smnrchrds 5y ago
    "TOO META" https://xkcd.com/1447/ https://xkcd.com/1447/
reilly3000 5y ago
I’m not a doctor but I watched a friend’s startup have the exact same experience. My personal experience was an early job selling online advertising to all categories of businesses. I quickly learned that medical offices are absolutely inundated with salespeople like pharma reps, and doctors time is already scant. Naturally they tend to want to see evidence in a way most other SMB decision makers do not. Since at time, bundled payments have gone into effect and consolidation means that the purchasing process is exponentially more complex. Startups: don’t sell to medical offices without deep domain experience, deeper pockets, and rigorous evidence.
thrdbndndn 5y ago
Together? That sounds a lot..
cobertos 5y ago
I think this startup would have more of a chance if it was able to solve the Google/trust problem with medical advice. From my perspective as an ignorant consumer, Googling medical things always leaves me unsatisfied. I get too much mixed advice when I poll multiple websites and my final feeling is that I've learned no new information, there was no clear information winner. Part of that is the SEO spam problem, part of it is not knowing accurate Google words for medical stuff.
jimmont 5y ago
> By not understanding the environment you’re not going to be able to understand the Problem which means your Solution will probably fail. Yes it boils down to politics. Having built a platform for accelerating routine histocompatibility analysis (providing customers a profit from the start) I got to see this firsthand. Risk aversion across the industry, small armies of established technicians working manually, administrators making purchasing decisions with no understanding of the science or impact, the myopic insular bent of academics, the massive gap between healthcare and modern technology. One could pay labs to save time, improve outcomes while reducing risk and they still wouldn't use your product if it doesn't map onto their political priorities.

scyzoryk_xyz 5y ago

I’ve been a PM in a small healthcare tech company run by engineers over the past few years and this 100%.

peter_retief 5y ago

I am developing a non invasive diagnosis tool that uses infrared absorption, electrical activity and a few other sensors with machine learning. As it stands there are some physicians who think it has potential. I am also using it to identify people which would make it useful in its own right. My question is, do you think a quick diagnosis tool would be helpful and would someone be prepared to pay something for it?

BoiledCabbage 5y ago

I agree. And what Tom didn't realize is that Doctors aren't financially incetivized to give better healthcare. There is no money in it for them. If anything, return visits because of a partial prior resolution make more money. Now clearly I'm not saying that doctors try to give bad diagnoses for profit (because they don't). But beyond a certain minimum bar, and on a purely financial basis, improving diagnostics or prescription accuracy doesn't not make a medical practice more money. And the responses here illustrte that. Now, whether that's the right/wrong incentive strucgture is a whole 'nother discussion. And I personally can't think of something better than what we currently have - but it is a truth of the current system.

DeathArrow 5y ago
> But beyond a certain minimum bar, and on a purely financial basis, improving diagnostics or prescription accuracy doesn't not make a medical practice more money. But giving better diagnostics and better prescriptions can result in improved profits if it's marketed in an efficient way. Would you go to a clinic that will give you the best diagnostic and prescription possible or to one where you are unsure about the result? Some mediocre restaurants in tourist areas are doing well because they are vouched for and have TripAdvisor stickers on their front door. What if clinics had GlacierMD stickers on their front door? To sell GlacierMD to doctors you have first to convince the patients that is something great about it.
jstummbillig 5y ago
> If anything, return visits because of a partial prior resolution make more money. I don't know what system you are referring to, but in the EU, for common physician services, this is (fortunately) not how it works. Physicians are by and large being paid per case, not per visit. In Germany a case is being defined as the same patient visiting the same physician in the same quarter of the year (https://www.kbv.de/tools/ebm/html/3.1_162396960999493856215104.html https://www.kbv.de/tools/ebm/html/3.1_1623969609994938562151...)
- gehwartzen 4y ago
  I'm assuming the US as that is the case here. Each visit is billed for individually. By the case is certainly a much better model.

OJFord 5y ago

Yeah I adopted my confused face from the 'problem' statement/'killer' start-up pitch on. Have a headache and don't know which drug to buy? Come on. You have a headache and you take either acetaminophen or ibuprofen, both of which you already have. You don't buy anything. I'm not a physician, I just take (rarely anything other than max dose) them per the label, which is different to your suggestion (1g/4h, max 4g/day) at least where I am. Ibuprofen if something seems 'inflamationy' or if I have drunk/will drink alcohol (on some sort of naïve hand-wavy basis to lighten the livery load).

smnrchrds 5y ago

If the COVID-19 pandemic has taught me anything about science, it's that if you do a "meta-analysis" without reading each paper carefully and critically, you can end up proving anything regardless of its veracity. You cannot replace domain-expert scientists spending huge amounts of time painstakingly going over every detail of many papers to weed out mistakes and fraud in order to write a meta-analysis, with a computer program. Well, at least not until we figure out AGI. Until then, it would be irresponsible to rely on such a program for any clinical decisions. https://news.ycombinator.com/item?id=29249686 https://news.ycombinator.com/item?id=29249686 https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted https://astralcodexten.substack.com/p/ivermectin-much-more-t... https://ivmmeta.com/ https://ivmmeta.com/ (Note the long list of things in the right sidebar which the "meta-analysis" shows have huge positive effects on COVID treatment)

beaconstudios 4y ago
I think the generalised lesson to be learned is that in reducing complexity (and all modelling requires reducing complexity), you get to make decisions about which bits of data are cut out, and this is a decision that can introduce bias. We can't just blindly trust reductions, especially in areas where there are competing interests. This is why transparency is so important! If I can reproduce your methodology, I can critique it for bias.
Gatsky 5y ago
Yes, this is a perfect example. ivmmeta is shocking, born of either complete bad faith or madness.
fsckboy 5y ago
ok, but... would a meta meta-analysis analysis show that on average, meta analyses do find positive benefits? get back to me.
- smnrchrds 5y ago
  "TOO META" https://xkcd.com/1447/ https://xkcd.com/1447/

reilly3000 5y ago

I’m not a doctor but I watched a friend’s startup have the exact same experience. My personal experience was an early job selling online advertising to all categories of businesses. I quickly learned that medical offices are absolutely inundated with salespeople like pharma reps, and doctors time is already scant. Naturally they tend to want to see evidence in a way most other SMB decision makers do not. Since at time, bundled payments have gone into effect and consolidation means that the purchasing process is exponentially more complex. Startups: don’t sell to medical offices without deep domain experience, deeper pockets, and rigorous evidence.

thrdbndndn 5y ago

Together? That sounds a lot..

cobertos 5y ago

I think this startup would have more of a chance if it was able to solve the Google/trust problem with medical advice. From my perspective as an ignorant consumer, Googling medical things always leaves me unsatisfied. I get too much mixed advice when I poll multiple websites and my final feeling is that I've learned no new information, there was no clear information winner. Part of that is the SEO spam problem, part of it is not knowing accurate Google words for medical stuff.

jimmont 5y ago

> By not understanding the environment you’re not going to be able to understand the Problem which means your Solution will probably fail. Yes it boils down to politics. Having built a platform for accelerating routine histocompatibility analysis (providing customers a profit from the start) I got to see this firsthand. Risk aversion across the industry, small armies of established technicians working manually, administrators making purchasing decisions with no understanding of the science or impact, the myopic insular bent of academics, the massive gap between healthcare and modern technology. One could pay labs to save time, improve outcomes while reducing risk and they still wouldn't use your product if it doesn't map onto their political priorities.