9 ms·

My new medical research startup launches today: let me know what you think

94 points by rms 14y ago

ceejayoz 14y ago
As a patient, I'd worry that the "at least two of our expert researchers will validate test results to rule out any errors" would get steered towards the less credentialed folks - the Eagle Scout philosophy major rather than the one or two MDs on the list of staff. I'd have more comments, but the site appears to have gone for now...
- rms 14y ago
  Figures that it would crash. We're working on it. Edit: 38 minutes later, we're up.
- Mycroft65536 14y ago
  The Eagle Scout philosophy majors are doing the photo editing and art design. All of our researchers have a more rigorous background.
  - ceejayoz 14y ago
    That's not borne out by the site. Health Researcher: Justin Alderis is an Eagle Scout who co-chaired the Princeton Philosophical Society for four years while he earned his BS degree from Princeton University, with a focus on the philosophy underlying cognitive science.
icoder 14y ago
Site's down. Perhaps you can put a teaser of what metamed is about in the comments so we have something to read/vote on while you get your site up again.
SCdF 14y ago
While your site is down, let me make one OT comment: I nearly had a heart attack when I saw that the username was 'rms'. Unsurprisingly I suppose, you're not that rms.
- tokenadult 14y ago
  The Hacker News user rms has joked that his username means "Rupert Murdoch sucks," if I remember correctly.
  - rms 14y ago
    It was a joke that outlived its meaning, but still, here we are. :)
    - Macsenour 14y ago
      Ahem, those are also my initials. :)
nostromo 14y ago
From Google Cache (was going to link to it, but the text-only version has a lot of over-laid text and is hard to read): > We work with you and your doctor to figure out how advances in medical science apply to your personal health needs. Our team of researchers will do in-depth, personalized analysis to find new technologies, read scientific journals, talk to experts, and separate real medical breakthroughs from media hype. Whether it’s testing, prevention, treatment, or nutrition, if you have medical questions, we can help inform you about what the options are and what a rushed, ten-minute appointment might have overlooked. Pricing: > $5,000 (Surface); $25,000 (Depth); $250,000 (Comprehensive); $1,000,000 (Original Research)
- samstave 14y ago
  How much original research will my kaiser Insurance cover?
  - Mycroft65536 14y ago
    Most insurance services don't cover our product. Also the pricing structure is wrong, our products packages top out at $50,000.
    - nostromo 14y ago
      Oops, sorry. I got it from Google's cache of your website while it was down: http://webcache.googleusercontent.com/search?q=cache:KFmAkiZVmx8J:www.metamed.com/questions/&hl=en&gl=us&strip=1 http://webcache.googleusercontent.com/search?q=cache:KFmAkiZ...
      - davorak 14y ago
        Did the cache expire or is that a incorrect link.
        ceejayoz 14y ago
        Hit the text-only up the top.
stickbranch 14y ago
I think it'd be nice if your site loaded.
pcrh 14y ago
This is the sort of service that a general practitioner should be providing. The vast majority of patients have routine problems. Though these might be distressing to the individuals, the "standard of care" (assuming correct diagnosis) is established practice, and this service would not affect that. For the few with very rare conditions, or with useless primary care physicians, this service might be useful, however the price is very high for what is essentially a diagnostic/referral service. Nevertheless, I think it could be commercially successful, given the number of people who think they know more about medicine and medical practice than their doctors do.
- apsec112 14y ago
  There are many conditions which are extremely common, but for which more effective treatments don't propagate to patients. About 5% of the US population has clinical depression, for example, and writing gratitude letters has been shown in studies to be quite effective at treating depression (more so than drugs or therapy). Yet, most patients don't know about it.
  - carbocation 14y ago
    > writing gratitude letters has been shown in studies to be quite effective at treating depression (more so than drugs or therapy) I could not find a publication supporting that assertion after a brief pubmed search. Can you provide one?
    - mindcrime 14y ago
      A quick Google search turns this up: http://link.springer.com/article/10.1007%2Fs10902-011-9257-7 http://link.springer.com/article/10.1007%2Fs10902-011-9257-7
      - carbocation 14y ago
        Yes, I did see that, but it doesn't address the important part of the assertion (more so than drugs or therapy) so to be charitable, I assume the OP has a different reference in mind.
ibdthor 14y ago
Not to be that guy, but on the Overview page for Patients & Caregivers, in the picture with the two women, it says "treatment regime" - I believe it should be "treatment regimen".
- abstractbill 14y ago
  Definition #2 of "regime" makes sense to me for this context, though I think regimen is more common in the US (regime is more common in the UK): https://www.google.com/search?q=define%3Aregime https://www.google.com/search?q=define%3Aregime
- michaelhoffman 14y ago
  Merriam-Webster's Medical Dictionary lists "regime" as a synonym for "regimen." Don't be that guy.
tait 14y ago
Congrats on an audacious project! Unfortunately, main site not working for me. So, "at least two of our expert researchers will validate test results to rule out any errors"? What does that mean, exactly? As a board certified pathologist, I have some idea what I mean by validation, but what do you mean? Next, the featured testimonial from "Jerry W." sounds fishy - it may be genuine, but it seems like it was written by marketing, and lacks any detail to provide credibility to skeptical evaluators. Next, when research is published, there is a p value, perhaps 0.04. When you provide your recommendations to patients, I'm sure you are smart enough to hedge appropriately. How do you communicate that? Do you guarantee follow-up if new research modifies the confidence of your previous recommendations? Finally, research evaluating one treatment versus another typically are provided in the context of routine patient care for the average patient. Your clientele here, clearly, are not run of the mill patients. With the proposed fee structure, they are also not likely pursuing routine treatment. This suggests that routinely published research will be less applicable to your customers. This amounts to being a huge selection bias. How do you plan to adjust for this issue? (As a specific example for one class of these problems, for those not familiar with these kinds of issues: the reason we don't perform routine mammograms in women starting at age 20 is not just cost - the prevalence is so low in this age range that the false positive rate is very high. So, patients who obtain a mammogram at age 20 for "screening" are at higher risk of false positives.)
- apsec112 14y ago
  Hello. I work for MetaMed, and knew Jerry (not his real name) from long before he became a client - I assure you that that page was in no way written or edited by us. We generally do not include specifics (like real names, medical histories, and so on) to protect patient privacy, which we take extremely seriously.
  - tait 14y ago
    Great, and thanks for the info. I see how that issue - name/history/etc. - would make it hard to provide credible success stories. Site still not working for me, so this may be there: Perhaps, someday, maybe include a patient story or two with medical history but no name? (With appropriate HIPAA waivers...) Even better, it would be WAAY awesome if you posted, whenever possible, the results of your research on your site for review by anybody. It may not be in your current business model, but the "giving back" angle might be the edge that pushes you into popularity.
carbocation 14y ago
Whenever we run a test in medicine, we ask, "How would the result affect management?" If the result, one way or another, would not change management, the test is not worth running. The site is down so I have to go from the headline, but I'd ask the same question: how would this service affect clinical management? Can you offer an example?
- Udo 14y ago
  > Whenever we run a test in medicine, we ask, "How would the result affect management?" Yet, a lot of unnecessary tests are run daily at every hospital I've seen. But what's worse is that often times doctors are reluctant to find out more about a patient's illness simply because they believe "it wouldn't affect treatment and it's not worth it anyway". It doesn't take a scientist to figure out why this approach can be disastrous. At the same time, high-paying private patients are often considered to be worth finding out the specifics. The whole system of clinical knowledge and action is broken from this point on. Doctors often do not keep current with advances in medical research, and I encountered a few who are actively opposed to it, asserting that medicine should not go any further than it does today because it's considered "unnatural". Medicine is in danger of becoming scientifically bankrupt. This startup, while I think it's a great concept, is a symptom of this disease. Practitioners, even in the odd case they're interested in advanced knowledge that is not being passed down from whoever the resident rockstar surgeon is, generally do not have proper access to current knowledge and statistics. It seems to me this system, where a life is more often than not considered ephemeral and expendable (except if you're a small child or a pregnant woman), this system is broken and cannot in its current form provide the services we will need as our civilization advances. As it is, this system plays into the hands of religion and pseudo science (a trend which doctors are generally comfortable with), and it is one of the dehumanizing factors that make our hospitals places of desperation instead of regeneration.
  - apsec112 14y ago
    Hello. I agree with your criticisms of the medical system, and MetaMed was started specifically to help fix these problems - to bring science back into medicine. It's impossible for any one person to keep current with all research, so we provide a service where a team of scientists can keep up on the latest research for individual physicians and patients. We're all about giving access to statistics and scientific knowledge - it's what we do.
MartinCron 14y ago
Interesting idea, but I'm wondering about the iterative nature of some diagnosis and treatment. I'm specifically thinking about how my wife went through lots of trial and error with eliminating particular things from her diet to get a handle on what was making her feel so terrible. The way I'm reading the site, it feels more like a one-shot "we'll run a bunch of tests and give you a single comprehensive analysis" which seems like a good idea in theory, but scares me in practice.
- apsec112 14y ago
  With every research report, we include a summary of what we can do further research on if something changes, we get new information, or the budget is expanded. You're right that we don't make this very prominent on the site, though - thanks for the feedback.
bthomas 14y ago
Interesting idea, but site is not really usable on mobile...
- jimrandomh 14y ago
  The menus at the top use mouse-hover which doesn't make sense on phones, but the links at the bottom go to the same set of pages as the menus.
  - bthomas 14y ago
    Tanks for responding. If curious, the hovers on the who we are page also caused me problems, and assets took a while to load.
orangethirty 14y ago
For reference, make sure your site can handle real traffic before posting it to HN. Not doing so will hurt your brand and reduce chances of getting some good initial traction. More so with such type of service. My initial perception is that I cannot trust a business with my health when they can't even properly setup a website.
Sharma 14y ago
Idea is great. But I feel pricing model needs a revisit. For patients with some serious ailments this is all fine but what about less serious issues like..a person with allergies, thyroid, migraine etc. These are kinds of things which bother people but still not enough to spend 5000 for analysis. Probably a profile based pricing is a good idea? Just a thought.
- ceejayoz 14y ago
  A person with allergies, migraines, etc. is almost certainly better served by going to their general practitioner for a $20 copay.
  - Sharma 14y ago
    Well I am not saying no options available. This service says they use research, data analysis etc. I am sure 20 copay will not get you that. So my point was to pay more that 20 but less than given minimum 5000.
    - ceejayoz 14y ago
      An allergist is likely to have plenty of access to research, data analysis, etc. about their specialty, and cost significantly less than $5,000. $5,000 would buy me consultations with 250 allergists, who'd likely be basing their conclusions on the same sort of research available to the health researchers at MetaMed, as well as it being their actual medical specialty.
- Mycroft65536 14y ago
  The price is based on the amount of work that goes into each report. While people might like to get detailed information about their allergies, and would like to pay $200 for it, we can't review medical records and the literature for that little. Researcher time costs more than that.
lifeisstillgood 14y ago
A rushed ten minute consult annoys us all, but How often is my medical condition going to be something that say paying the doctor to take 45 mins would not uncover. Most of us have diseases that are horses not zebra - and you have a strong financial incentive to encourage hypochondriacs to keep hearing zebra. If my condition has Gregory House stumped, sure ill pay you but otherwise that lump on your skin is a cyst not a tumour and that shortness of breath is lack of fitness not a heart failure.
- apsec112 14y ago
  According to our research, more than 3% of the American population reports their health to be "good" or "excellent", and spends more than $40,000 annually on medical care. Our service won't be useful for every sniffle (unless you're Bill Gates), but there's a huge amount of opportunity for products in the medical field.
- cowkingdeluxe 14y ago
  There are a good deal of misdiagnoses that cause more months of suffering, especially with diseases like Crohn's disease. Maybe a service like this could prevent that with the help of a more accurate up front diagnosis. Diseases aren't as rare as people tend to think (~1.5 million with a digestive disease in the U.S. alone). That said, here are a couple things which make me skeptical about this: 1) They make claims involving rounded numbers without sources, such as "50% of second opinions contradict the original diagnosis." That's a red flag for me. Would be nice for me to see some sources for claims like that on a site wishing to sell medical research services. 2) Several of the medical researchers do not have a background in anything medical. In fact, one of the senior health researchers' area of expertise includes herbal medicine and Naturopathy (which is a bit anti-vaccination: http://en.wikipedia.org/wiki/Naturopathy http://en.wikipedia.org/wiki/Naturopathy). I would not be happy If I got suggested any alternative medicine remedies for my disease at the cost of $5,000.
  - Mycroft65536 14y ago
    Some things that are labeled "alternative medicine" have actual studies, with decent sample sizes and good methodologies, showing that they work. These things are worth paying attention to. The rest don't meet our standards and get ignored.
guylhem 14y ago
Excellent idea, great concept!!! It's not everyday medicine where you work on simple problems following a statistical approach - an appendicitis is more likely than a Meckel diverticulum, and a simple overeating is even more likely than both. But there are complicated cases - not very often, but that's the one I like, and that most of the passionated doctors do too. Hell - I love such cases. A quick story - I once had the chance to make a one-in-a-million diagnosis while working in the ER of a small hospital, around 2004. A patient presented with a psychiatric history and a psychiatric diagnosis, but somehow it didn't feel right. I had this odd feeling when talking to the patient - no psychiatric symptoms of no kind. It seemed wrong. I ordered basic blood tests (checking for hyponatremia, etc), X-rays - all normal. It was a bit late so I asked for the patient to be served a lunch before being discharged, deeply unsatisfied. Around 10 minutes later, the patient had a new episode - but this time it was in an hospital and I did not have to rely on eyewitnesses - it looked a lot like neurological problem, not a psychiatric problem. After another round of blood tests (I don't like it when I don't know what's happening), brain scan, etc. everything was normal. I noticed the glucose was normal - it should not be, since the patient had had an hospital lunch (in my hospital it included marmelade, and all kind of sweet things!) So I ordered a test to check for insulinoma (I'm weird, I know - its incidence is like one-in-a-million) because it made sense - and the test was negative. At this time, I was just a medical resident - the seniors were a bit mad at me for having spent so much time (and costly diagnostic procedures) on what was proven wrong, and what should be wrong in the first place - because it is so unfrequent. And that's not what one is expected to do in the ER (fortunately, it was late at night) Yet I wasn't satisfied, so I asked the patient to be transferred in the university hospital neurological department for further tests. Something was happening, we didn't know what, someone had labelled the patient "crazy" (not politically correct, but truth is psychiatric patient issues are usually less investigated) but there was something. Guess what- weeks later I got a letter, they found it was a rare variant of insulinoma that our basic test did not detect. That's one of my best moment in life !! That day I made a difference - I removed a wrongful psychiatric diagnosis and gave the proper diagnosis. Patients with insulinoma should not get institutionalized in a psychiatric hospital. That's the medicine I love. Fixing basic problems is the job a mechanic. The kind of medicine I love is unfortunately not possible with the current healthcare setup - and even with usual patients, because most people don't care. They want a quick fix. This startup idea is just great, to take care of people who want the real deal. I wish you luck!! I'm sure you will find great clinicians who will take going as deep as the rabbit hole goes to give excellent care.
naive 14y ago
The website (now loading) lists many health researchers on your team, but it doesn't say say much about their credentials and/or experience in biology/medicine. Can you give us some more details?
- biotech_anon 14y ago
  It also looks like many are associated with the "Singularity Institute." My exposure to that group left me feeling like it was some sort of cult of charlatans and wide-eyed dreamers. The presentations I've seen from them featured graphs without units and a lot of hand waving without hard data or independent validation. Almost like a sort of Scientology for Silicon Valley.
  - sytelus 14y ago
    Whenever the term "meta" is involved with anything, please do expect hand waving ;).
lupatus 14y ago
Kevin, It seems that the Singularity Institute also reads James Altucher: http://www.jamesaltucher.com/what-is-the-quickest-way-to-make-a-million/ http://www.jamesaltucher.com/what-is-the-quickest-way-to-mak.... My guess is that your "productize step" is to also use your researchers to train a specialized medical search engine you'll keep on the back-end (sort of a Mahalo+Watson). If that isn't what you're doing, let me know. Maybe I can help get you there.
- rms 14y ago
  Yup, there are all sorts of interesting problems in solving the back end problems of organizing our research.
ThomPete 14y ago
Great project and may I say great design. Looks very very solid IMHO. Good luck. As someone with a 1000 moles who have been diagnosed with melanoma (luckily early stage and now removed) would this service be of any good for me?
- Mycroft65536 14y ago
  If you're uncertain of the diagnosis or are worried about it coming out of remission, then we will be able to help. How long ago did you have it?
  - ThomPete 14y ago
    Last year, just after I moved to the US in May. Been quite interesting (and scary) to go through the US healthcare system coming from Denmark.
sytelus 14y ago
So how these really work? Do you have experts in every sub-field of medicine lined up to analyse each case? Looking at your team, everyone seems to have title "Health Researcher" but most of them have no real degree in medicine or have any real experience with specific illness. Many seem to have experience and education that is not even remotely close to "health researcher" title let alone be legally licensed to prescribe anything to anyone medicine related in US. So how these people are supposed to read complex test reports, connect subtle dots and give me advice that is better than sub-sub-specialty practicing MD who sees 100s of patients day in day out? Website is full of PR quotes without any details of how it would stand up to claims it has been making.
- apsec112 14y ago
  It would be totally impractical to have full time people studying every sub-sub-sub-specialty: if we saw a person with rare disease X once a year, what would the specialist in X do the rest of the time? That's why we have a large network of outside experts we can consult when very domain-specific knowledge is needed. Also, as someone who spends a lot of time working with doctors, the current medical system does not train people to look at things in detail and connect subtle dots - it trains people to run around doing everything as quickly as they possibly can. (Ask anyone who's in residency if you don't believe me.) A significant part of our advantage is that we can spend much more time on a single patient than a standard ten-minute consultation.
  - sytelus 14y ago
    Well, standard consultation does not cost $5000. If I have $5000 to spend, why should I use this website as opposed to directly finding another expert (with real MD degree and hand-on experience) and get their second opinion? I'm not sure of equivalent hourly rate of doctors but even at $500 per hour, I should be able to get a real specialist to study my reports in-depth and take their couple of hours of consulting time for a fraction of the cost. Again website needs to make explicit how much it would cost, who would do the work and what are their credentials. Lot of statistics such as 50% of second opinions contradicts looks very bogus. Is it from a reliable source?
orangethirty 14y ago
You definitely need a better landing page. Plus your pricing page needs work. Since this is not a cheap service, I would test a version that did not post prices but encouraged inquiries.
- rms 14y ago
  It's probably worth testing, but as hackers and web users we all can't stand websites that don't list prices.
  - orangethirty 14y ago
    I'm a marketing consultant/software engineer. Have plenty of data that points to not listing prices over $1500. Not in your industry, of course. But I have data from different markets.
logjam 14y ago
MD here. The headline on your webpage: "For serious medical conditions, you need direct access to the world’s best researchers." [my emphasis added] Pardon my skepticism, but that sentence and the rest of your not-functioning-very-well website smell of nothing more than an attempt to ripoff very vulnerable people, and other marketing bullshit. But do please prove me wrong - kindly link to the world-class research your docs and researchers have done thus far.
- apsec112 14y ago
  Our consultant network includes Nobel laureates, heads of biology departments, famous professors, and as top-rate people as one can find. They aren't on the first version of the site because a) they're not full-time employees - being very busy, they usually only have a few hours a week - and b), before you ask someone to be on a website, you first have to show them the site, and the site's only been up for about twelve hours because it's launch day. We're currently compiling our business, scientific and medical advisory boards, and will have them up over the next few weeks. Also, why the rudeness? In terms of the disagreement hierarchy (http://www.paulgraham.com/disagree.html http://www.paulgraham.com/disagree.html), you're using DH1 through DH3 - attacking credentials and tone rather than facts.
  - carbocation 14y ago
    > Also, why the rudeness? In terms of the disagreement hierarchy (http://www.paulgraham.com/disagree.html http://www.paulgraham.com/disagree.html), you're using DH1 through DH3 - attacking credentials and tone rather than facts. I think you've got things turned around a bit here. He's not using claims of authority to spuriously attack an argument that you're making. You are the one asserting authority, and he's asking for proof. Since you are basing some of your credibility on authority, it seems like a reasonable request.
  - michaelhoffman 14y ago
    It's very hard to discuss the facts when you withhold them. I would like to know who these Nobel laureates are. If they have examined your service but do not have enough confidence in it to be associated with it publicly that is interesting information.
mijail 14y ago
Can customers receive a print copy or is it only in PDF?
ceejayoz 14y ago
Googling for "Hank Gardstein MD" finds only a Henry (for which Hank is a nickname) Gardstein (http://www.healthgrades.com/physician/dr-henry-gardstein-xcsg4 http://www.healthgrades.com/physician/dr-henry-gardstein-xcs...) with the same school of medicine, medical specialty, and rough date of beginning of practice as that of the profile on MetaMed. That doctor was disbarred (http://w3.health.state.ny.us/opmc/factions.nsf/cd901a6816701d94852568c0004e3fb7/3e643e0499ca9b7a8525747b0058f221/$FILE/lc108744.pdf http://w3.health.state.ny.us/opmc/factions.nsf/cd901a6816701...) for writing online pharmacy prescriptions. Same guy?
- abraininavat 14y ago
  Guy's gotta eat!
raddoc 14y ago
I like the idea in concept but have a couple critiques. 1) Pricing- even the most basic package is ridiculous. For $5000 I would not only fly to your city to spend as much time with you in a face-to-face meeting discussing your medical problems, but I would give you my personal cell phone number for any questions or concerns at a later date. 2) Chart reviews- I don't know the credentials of the people doing the reviews, but I am highly suspect of anyone other than a board certified physician in a given specialty providing medical advise or in any way guiding diagnostic decisions. Having said that, I think there is real opportunity here. I wish you the best of luck.
norabean 14y ago
I did a write-up for MetaMed for my site: http://bit.ly/YZb3G8/ http://bit.ly/YZb3G8/ Please share it if you can. If you know any journalists/bloggers that wish to interview MetaMed founding team, please let me or the person who posted this know.

94 points by rms 14y ago

As a patient, I'd worry that the "at least two of our expert researchers will validate test results to rule out any errors" would get steered towards the less credentialed folks - the Eagle Scout philosophy major rather than the one or two MDs on the list of staff. I'd have more comments, but the site appears to have gone for now...

rms 14y ago
Figures that it would crash. We're working on it. Edit: 38 minutes later, we're up.
Mycroft65536 14y ago
The Eagle Scout philosophy majors are doing the photo editing and art design. All of our researchers have a more rigorous background.
- ceejayoz 14y ago
  That's not borne out by the site. Health Researcher: Justin Alderis is an Eagle Scout who co-chaired the Princeton Philosophical Society for four years while he earned his BS degree from Princeton University, with a focus on the philosophy underlying cognitive science.

icoder 14y ago

Site's down. Perhaps you can put a teaser of what metamed is about in the comments so we have something to read/vote on while you get your site up again.

SCdF 14y ago

While your site is down, let me make one OT comment: I nearly had a heart attack when I saw that the username was 'rms'. Unsurprisingly I suppose, you're not that rms.

tokenadult 14y ago
The Hacker News user rms has joked that his username means "Rupert Murdoch sucks," if I remember correctly.
- rms 14y ago
  It was a joke that outlived its meaning, but still, here we are. :)
  - Macsenour 14y ago
    Ahem, those are also my initials. :)

nostromo 14y ago

From Google Cache (was going to link to it, but the text-only version has a lot of over-laid text and is hard to read): > We work with you and your doctor to figure out how advances in medical science apply to your personal health needs. Our team of researchers will do in-depth, personalized analysis to find new technologies, read scientific journals, talk to experts, and separate real medical breakthroughs from media hype. Whether it’s testing, prevention, treatment, or nutrition, if you have medical questions, we can help inform you about what the options are and what a rushed, ten-minute appointment might have overlooked. Pricing: > $5,000 (Surface); $25,000 (Depth); $250,000 (Comprehensive); $1,000,000 (Original Research)

samstave 14y ago
How much original research will my kaiser Insurance cover?
- Mycroft65536 14y ago
  Most insurance services don't cover our product. Also the pricing structure is wrong, our products packages top out at $50,000.
  - nostromo 14y ago
    Oops, sorry. I got it from Google's cache of your website while it was down: http://webcache.googleusercontent.com/search?q=cache:KFmAkiZVmx8J:www.metamed.com/questions/&hl=en&gl=us&strip=1 http://webcache.googleusercontent.com/search?q=cache:KFmAkiZ...
    - davorak 14y ago
      Did the cache expire or is that a incorrect link.
      - ceejayoz 14y ago
        Hit the text-only up the top.

stickbranch 14y ago

I think it'd be nice if your site loaded.

pcrh 14y ago

This is the sort of service that a general practitioner should be providing. The vast majority of patients have routine problems. Though these might be distressing to the individuals, the "standard of care" (assuming correct diagnosis) is established practice, and this service would not affect that. For the few with very rare conditions, or with useless primary care physicians, this service might be useful, however the price is very high for what is essentially a diagnostic/referral service. Nevertheless, I think it could be commercially successful, given the number of people who think they know more about medicine and medical practice than their doctors do.

apsec112 14y ago
There are many conditions which are extremely common, but for which more effective treatments don't propagate to patients. About 5% of the US population has clinical depression, for example, and writing gratitude letters has been shown in studies to be quite effective at treating depression (more so than drugs or therapy). Yet, most patients don't know about it.
- carbocation 14y ago
  > writing gratitude letters has been shown in studies to be quite effective at treating depression (more so than drugs or therapy) I could not find a publication supporting that assertion after a brief pubmed search. Can you provide one?
  - mindcrime 14y ago
    A quick Google search turns this up: http://link.springer.com/article/10.1007%2Fs10902-011-9257-7 http://link.springer.com/article/10.1007%2Fs10902-011-9257-7
    - carbocation 14y ago
      Yes, I did see that, but it doesn't address the important part of the assertion (more so than drugs or therapy) so to be charitable, I assume the OP has a different reference in mind.

ibdthor 14y ago

Not to be that guy, but on the Overview page for Patients & Caregivers, in the picture with the two women, it says "treatment regime" - I believe it should be "treatment regimen".

abstractbill 14y ago
Definition #2 of "regime" makes sense to me for this context, though I think regimen is more common in the US (regime is more common in the UK): https://www.google.com/search?q=define%3Aregime https://www.google.com/search?q=define%3Aregime
michaelhoffman 14y ago
Merriam-Webster's Medical Dictionary lists "regime" as a synonym for "regimen." Don't be that guy.

tait 14y ago

Congrats on an audacious project! Unfortunately, main site not working for me. So, "at least two of our expert researchers will validate test results to rule out any errors"? What does that mean, exactly? As a board certified pathologist, I have some idea what I mean by validation, but what do you mean? Next, the featured testimonial from "Jerry W." sounds fishy - it may be genuine, but it seems like it was written by marketing, and lacks any detail to provide credibility to skeptical evaluators. Next, when research is published, there is a p value, perhaps 0.04. When you provide your recommendations to patients, I'm sure you are smart enough to hedge appropriately. How do you communicate that? Do you guarantee follow-up if new research modifies the confidence of your previous recommendations? Finally, research evaluating one treatment versus another typically are provided in the context of routine patient care for the average patient. Your clientele here, clearly, are not run of the mill patients. With the proposed fee structure, they are also not likely pursuing routine treatment. This suggests that routinely published research will be less applicable to your customers. This amounts to being a huge selection bias. How do you plan to adjust for this issue? (As a specific example for one class of these problems, for those not familiar with these kinds of issues: the reason we don't perform routine mammograms in women starting at age 20 is not just cost - the prevalence is so low in this age range that the false positive rate is very high. So, patients who obtain a mammogram at age 20 for "screening" are at higher risk of false positives.)

apsec112 14y ago
Hello. I work for MetaMed, and knew Jerry (not his real name) from long before he became a client - I assure you that that page was in no way written or edited by us. We generally do not include specifics (like real names, medical histories, and so on) to protect patient privacy, which we take extremely seriously.
- tait 14y ago
  Great, and thanks for the info. I see how that issue - name/history/etc. - would make it hard to provide credible success stories. Site still not working for me, so this may be there: Perhaps, someday, maybe include a patient story or two with medical history but no name? (With appropriate HIPAA waivers...) Even better, it would be WAAY awesome if you posted, whenever possible, the results of your research on your site for review by anybody. It may not be in your current business model, but the "giving back" angle might be the edge that pushes you into popularity.

carbocation 14y ago

Whenever we run a test in medicine, we ask, "How would the result affect management?" If the result, one way or another, would not change management, the test is not worth running. The site is down so I have to go from the headline, but I'd ask the same question: how would this service affect clinical management? Can you offer an example?

Udo 14y ago
> Whenever we run a test in medicine, we ask, "How would the result affect management?" Yet, a lot of unnecessary tests are run daily at every hospital I've seen. But what's worse is that often times doctors are reluctant to find out more about a patient's illness simply because they believe "it wouldn't affect treatment and it's not worth it anyway". It doesn't take a scientist to figure out why this approach can be disastrous. At the same time, high-paying private patients are often considered to be worth finding out the specifics. The whole system of clinical knowledge and action is broken from this point on. Doctors often do not keep current with advances in medical research, and I encountered a few who are actively opposed to it, asserting that medicine should not go any further than it does today because it's considered "unnatural". Medicine is in danger of becoming scientifically bankrupt. This startup, while I think it's a great concept, is a symptom of this disease. Practitioners, even in the odd case they're interested in advanced knowledge that is not being passed down from whoever the resident rockstar surgeon is, generally do not have proper access to current knowledge and statistics. It seems to me this system, where a life is more often than not considered ephemeral and expendable (except if you're a small child or a pregnant woman), this system is broken and cannot in its current form provide the services we will need as our civilization advances. As it is, this system plays into the hands of religion and pseudo science (a trend which doctors are generally comfortable with), and it is one of the dehumanizing factors that make our hospitals places of desperation instead of regeneration.
- apsec112 14y ago
  Hello. I agree with your criticisms of the medical system, and MetaMed was started specifically to help fix these problems - to bring science back into medicine. It's impossible for any one person to keep current with all research, so we provide a service where a team of scientists can keep up on the latest research for individual physicians and patients. We're all about giving access to statistics and scientific knowledge - it's what we do.

MartinCron 14y ago

Interesting idea, but I'm wondering about the iterative nature of some diagnosis and treatment. I'm specifically thinking about how my wife went through lots of trial and error with eliminating particular things from her diet to get a handle on what was making her feel so terrible. The way I'm reading the site, it feels more like a one-shot "we'll run a bunch of tests and give you a single comprehensive analysis" which seems like a good idea in theory, but scares me in practice.

apsec112 14y ago
With every research report, we include a summary of what we can do further research on if something changes, we get new information, or the budget is expanded. You're right that we don't make this very prominent on the site, though - thanks for the feedback.

bthomas 14y ago

Interesting idea, but site is not really usable on mobile...

jimrandomh 14y ago
The menus at the top use mouse-hover which doesn't make sense on phones, but the links at the bottom go to the same set of pages as the menus.
- bthomas 14y ago
  Tanks for responding. If curious, the hovers on the who we are page also caused me problems, and assets took a while to load.

orangethirty 14y ago

For reference, make sure your site can handle real traffic before posting it to HN. Not doing so will hurt your brand and reduce chances of getting some good initial traction. More so with such type of service. My initial perception is that I cannot trust a business with my health when they can't even properly setup a website.

Sharma 14y ago

Idea is great. But I feel pricing model needs a revisit. For patients with some serious ailments this is all fine but what about less serious issues like..a person with allergies, thyroid, migraine etc. These are kinds of things which bother people but still not enough to spend 5000 for analysis. Probably a profile based pricing is a good idea? Just a thought.

ceejayoz 14y ago
A person with allergies, migraines, etc. is almost certainly better served by going to their general practitioner for a $20 copay.
- Sharma 14y ago
  Well I am not saying no options available. This service says they use research, data analysis etc. I am sure 20 copay will not get you that. So my point was to pay more that 20 but less than given minimum 5000.
  - ceejayoz 14y ago
    An allergist is likely to have plenty of access to research, data analysis, etc. about their specialty, and cost significantly less than $5,000. $5,000 would buy me consultations with 250 allergists, who'd likely be basing their conclusions on the same sort of research available to the health researchers at MetaMed, as well as it being their actual medical specialty.
Mycroft65536 14y ago
The price is based on the amount of work that goes into each report. While people might like to get detailed information about their allergies, and would like to pay $200 for it, we can't review medical records and the literature for that little. Researcher time costs more than that.

lifeisstillgood 14y ago

A rushed ten minute consult annoys us all, but How often is my medical condition going to be something that say paying the doctor to take 45 mins would not uncover. Most of us have diseases that are horses not zebra - and you have a strong financial incentive to encourage hypochondriacs to keep hearing zebra. If my condition has Gregory House stumped, sure ill pay you but otherwise that lump on your skin is a cyst not a tumour and that shortness of breath is lack of fitness not a heart failure.

apsec112 14y ago
According to our research, more than 3% of the American population reports their health to be "good" or "excellent", and spends more than $40,000 annually on medical care. Our service won't be useful for every sniffle (unless you're Bill Gates), but there's a huge amount of opportunity for products in the medical field.
cowkingdeluxe 14y ago
There are a good deal of misdiagnoses that cause more months of suffering, especially with diseases like Crohn's disease. Maybe a service like this could prevent that with the help of a more accurate up front diagnosis. Diseases aren't as rare as people tend to think (~1.5 million with a digestive disease in the U.S. alone). That said, here are a couple things which make me skeptical about this: 1) They make claims involving rounded numbers without sources, such as "50% of second opinions contradict the original diagnosis." That's a red flag for me. Would be nice for me to see some sources for claims like that on a site wishing to sell medical research services. 2) Several of the medical researchers do not have a background in anything medical. In fact, one of the senior health researchers' area of expertise includes herbal medicine and Naturopathy (which is a bit anti-vaccination: http://en.wikipedia.org/wiki/Naturopathy http://en.wikipedia.org/wiki/Naturopathy). I would not be happy If I got suggested any alternative medicine remedies for my disease at the cost of $5,000.
- Mycroft65536 14y ago
  Some things that are labeled "alternative medicine" have actual studies, with decent sample sizes and good methodologies, showing that they work. These things are worth paying attention to. The rest don't meet our standards and get ignored.

guylhem 14y ago

Excellent idea, great concept!!! It's not everyday medicine where you work on simple problems following a statistical approach - an appendicitis is more likely than a Meckel diverticulum, and a simple overeating is even more likely than both. But there are complicated cases - not very often, but that's the one I like, and that most of the passionated doctors do too. Hell - I love such cases. A quick story - I once had the chance to make a one-in-a-million diagnosis while working in the ER of a small hospital, around 2004. A patient presented with a psychiatric history and a psychiatric diagnosis, but somehow it didn't feel right. I had this odd feeling when talking to the patient - no psychiatric symptoms of no kind. It seemed wrong. I ordered basic blood tests (checking for hyponatremia, etc), X-rays - all normal. It was a bit late so I asked for the patient to be served a lunch before being discharged, deeply unsatisfied. Around 10 minutes later, the patient had a new episode - but this time it was in an hospital and I did not have to rely on eyewitnesses - it looked a lot like neurological problem, not a psychiatric problem. After another round of blood tests (I don't like it when I don't know what's happening), brain scan, etc. everything was normal. I noticed the glucose was normal - it should not be, since the patient had had an hospital lunch (in my hospital it included marmelade, and all kind of sweet things!) So I ordered a test to check for insulinoma (I'm weird, I know - its incidence is like one-in-a-million) because it made sense - and the test was negative. At this time, I was just a medical resident - the seniors were a bit mad at me for having spent so much time (and costly diagnostic procedures) on what was proven wrong, and what should be wrong in the first place - because it is so unfrequent. And that's not what one is expected to do in the ER (fortunately, it was late at night) Yet I wasn't satisfied, so I asked the patient to be transferred in the university hospital neurological department for further tests. Something was happening, we didn't know what, someone had labelled the patient "crazy" (not politically correct, but truth is psychiatric patient issues are usually less investigated) but there was something. Guess what- weeks later I got a letter, they found it was a rare variant of insulinoma that our basic test did not detect. That's one of my best moment in life !! That day I made a difference - I removed a wrongful psychiatric diagnosis and gave the proper diagnosis. Patients with insulinoma should not get institutionalized in a psychiatric hospital. That's the medicine I love. Fixing basic problems is the job a mechanic. The kind of medicine I love is unfortunately not possible with the current healthcare setup - and even with usual patients, because most people don't care. They want a quick fix. This startup idea is just great, to take care of people who want the real deal. I wish you luck!! I'm sure you will find great clinicians who will take going as deep as the rabbit hole goes to give excellent care.

naive 14y ago

The website (now loading) lists many health researchers on your team, but it doesn't say say much about their credentials and/or experience in biology/medicine. Can you give us some more details?

biotech_anon 14y ago
It also looks like many are associated with the "Singularity Institute." My exposure to that group left me feeling like it was some sort of cult of charlatans and wide-eyed dreamers. The presentations I've seen from them featured graphs without units and a lot of hand waving without hard data or independent validation. Almost like a sort of Scientology for Silicon Valley.
- sytelus 14y ago
  Whenever the term "meta" is involved with anything, please do expect hand waving ;).

lupatus 14y ago

Kevin, It seems that the Singularity Institute also reads James Altucher: http://www.jamesaltucher.com/what-is-the-quickest-way-to-make-a-million/ http://www.jamesaltucher.com/what-is-the-quickest-way-to-mak.... My guess is that your "productize step" is to also use your researchers to train a specialized medical search engine you'll keep on the back-end (sort of a Mahalo+Watson). If that isn't what you're doing, let me know. Maybe I can help get you there.

rms 14y ago
Yup, there are all sorts of interesting problems in solving the back end problems of organizing our research.

ThomPete 14y ago

Great project and may I say great design. Looks very very solid IMHO. Good luck. As someone with a 1000 moles who have been diagnosed with melanoma (luckily early stage and now removed) would this service be of any good for me?

Mycroft65536 14y ago
If you're uncertain of the diagnosis or are worried about it coming out of remission, then we will be able to help. How long ago did you have it?
- ThomPete 14y ago
  Last year, just after I moved to the US in May. Been quite interesting (and scary) to go through the US healthcare system coming from Denmark.

sytelus 14y ago

So how these really work? Do you have experts in every sub-field of medicine lined up to analyse each case? Looking at your team, everyone seems to have title "Health Researcher" but most of them have no real degree in medicine or have any real experience with specific illness. Many seem to have experience and education that is not even remotely close to "health researcher" title let alone be legally licensed to prescribe anything to anyone medicine related in US. So how these people are supposed to read complex test reports, connect subtle dots and give me advice that is better than sub-sub-specialty practicing MD who sees 100s of patients day in day out? Website is full of PR quotes without any details of how it would stand up to claims it has been making.

apsec112 14y ago
It would be totally impractical to have full time people studying every sub-sub-sub-specialty: if we saw a person with rare disease X once a year, what would the specialist in X do the rest of the time? That's why we have a large network of outside experts we can consult when very domain-specific knowledge is needed. Also, as someone who spends a lot of time working with doctors, the current medical system does not train people to look at things in detail and connect subtle dots - it trains people to run around doing everything as quickly as they possibly can. (Ask anyone who's in residency if you don't believe me.) A significant part of our advantage is that we can spend much more time on a single patient than a standard ten-minute consultation.
- sytelus 14y ago
  Well, standard consultation does not cost $5000. If I have $5000 to spend, why should I use this website as opposed to directly finding another expert (with real MD degree and hand-on experience) and get their second opinion? I'm not sure of equivalent hourly rate of doctors but even at $500 per hour, I should be able to get a real specialist to study my reports in-depth and take their couple of hours of consulting time for a fraction of the cost. Again website needs to make explicit how much it would cost, who would do the work and what are their credentials. Lot of statistics such as 50% of second opinions contradicts looks very bogus. Is it from a reliable source?

orangethirty 14y ago

You definitely need a better landing page. Plus your pricing page needs work. Since this is not a cheap service, I would test a version that did not post prices but encouraged inquiries.

rms 14y ago
It's probably worth testing, but as hackers and web users we all can't stand websites that don't list prices.
- orangethirty 14y ago
  I'm a marketing consultant/software engineer. Have plenty of data that points to not listing prices over $1500. Not in your industry, of course. But I have data from different markets.

logjam 14y ago

MD here. The headline on your webpage: "For serious medical conditions, you need direct access to the world’s best researchers." [my emphasis added] Pardon my skepticism, but that sentence and the rest of your not-functioning-very-well website smell of nothing more than an attempt to ripoff very vulnerable people, and other marketing bullshit. But do please prove me wrong - kindly link to the world-class research your docs and researchers have done thus far.

apsec112 14y ago
Our consultant network includes Nobel laureates, heads of biology departments, famous professors, and as top-rate people as one can find. They aren't on the first version of the site because a) they're not full-time employees - being very busy, they usually only have a few hours a week - and b), before you ask someone to be on a website, you first have to show them the site, and the site's only been up for about twelve hours because it's launch day. We're currently compiling our business, scientific and medical advisory boards, and will have them up over the next few weeks. Also, why the rudeness? In terms of the disagreement hierarchy (http://www.paulgraham.com/disagree.html http://www.paulgraham.com/disagree.html), you're using DH1 through DH3 - attacking credentials and tone rather than facts.
- carbocation 14y ago
  > Also, why the rudeness? In terms of the disagreement hierarchy (http://www.paulgraham.com/disagree.html http://www.paulgraham.com/disagree.html), you're using DH1 through DH3 - attacking credentials and tone rather than facts. I think you've got things turned around a bit here. He's not using claims of authority to spuriously attack an argument that you're making. You are the one asserting authority, and he's asking for proof. Since you are basing some of your credibility on authority, it seems like a reasonable request.
- michaelhoffman 14y ago
  It's very hard to discuss the facts when you withhold them. I would like to know who these Nobel laureates are. If they have examined your service but do not have enough confidence in it to be associated with it publicly that is interesting information.

mijail 14y ago

Can customers receive a print copy or is it only in PDF?

ceejayoz 14y ago

Googling for "Hank Gardstein MD" finds only a Henry (for which Hank is a nickname) Gardstein (http://www.healthgrades.com/physician/dr-henry-gardstein-xcsg4 http://www.healthgrades.com/physician/dr-henry-gardstein-xcs...) with the same school of medicine, medical specialty, and rough date of beginning of practice as that of the profile on MetaMed. That doctor was disbarred (http://w3.health.state.ny.us/opmc/factions.nsf/cd901a6816701d94852568c0004e3fb7/3e643e0499ca9b7a8525747b0058f221/$FILE/lc108744.pdf http://w3.health.state.ny.us/opmc/factions.nsf/cd901a6816701...) for writing online pharmacy prescriptions. Same guy?

abraininavat 14y ago
Guy's gotta eat!

raddoc 14y ago

I like the idea in concept but have a couple critiques. 1) Pricing- even the most basic package is ridiculous. For $5000 I would not only fly to your city to spend as much time with you in a face-to-face meeting discussing your medical problems, but I would give you my personal cell phone number for any questions or concerns at a later date. 2) Chart reviews- I don't know the credentials of the people doing the reviews, but I am highly suspect of anyone other than a board certified physician in a given specialty providing medical advise or in any way guiding diagnostic decisions. Having said that, I think there is real opportunity here. I wish you the best of luck.

norabean 14y ago

I did a write-up for MetaMed for my site: http://bit.ly/YZb3G8/ http://bit.ly/YZb3G8/ Please share it if you can. If you know any journalists/bloggers that wish to interview MetaMed founding team, please let me or the person who posted this know.