
When good ideas make bad business - tomjcleveland
https://tjcx.me/posts/i-wasted-40k-on-a-fantastic-startup-idea/
======
amitmathew
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
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
This is _precisely_ why we need universal healthcare. The incentive structure
of private markets don't properly value human life.

~~~
planetzero
"This is precisely why we need universal healthcare. The incentive structure
of private markets don't properly value human life."

Government-run healthcare isn't a panacea that will 'value human life' any
more than the insurance companies. You are still a number in a database
somewhere.

Most new drugs come out of the US and socialized governments create generics
at a fraction of the cost, because they don't have to put any money into R&D.

The US is the back-bone of the medical system for the rest of the world and
also has the best medical schools and best quality hospitals (the majority of
people with money come to the US for life-saving surgeries..this has to tell
you something).

We need to push the true costs of things to the patient, which will force the
price down...not replace the existing inefficient layer of the insurance
companies with an even more inefficient layer called the government.

This has worked with many cosmetic surgeries, which used to be very expensive,
but aren't covered by insurance.

Insurance should only cover rare surgeries that can't use the free market to
reduce the costs.

I can't think of anything that the government runs better than the private
sector. Healthcare is no different.

~~~
gonational
Take all my karma...

Implementing something like what you describe, IMHO, would have the greatest
positive impact on the health and welfare of Americans, of anything this
century.

I have a friend who is very high up in one of the largest health insurance
providers in the US, and I have often debated over the years with this person
that same point, that the insurance layer is what creates the model for
inefficiency, and abuse at the provider level ($5 Tylenol pill, $10 Band-Aid,
minor treatments and return visits of dubious value, etc.), and that if we
treated medical care as an ordinary consumer good, outside of the extreme
emergencies that are bankruptigly expensive, things would be a lot better. The
person I know at the insurance company doesn’t necessarily disagree either.

~~~
jacobr1
Take a look at some of the "universal catastrophic coverage" proposals. The
ideas is to BOTH socialize and increase market competition for healthcare at
the same time. Universal care if you get cancer or for other chronic/terminal
conditions. Then have a real market and competition for everything else.
Regulate safety but not pricing or delivery. (Many of these plans also call
for universal preventative services that drive down costs for the whole
system). The Dutch have something closer to this in practice with "universal
long-term care insurance" separated from the basic/primary insurance, but I've
heard mixed reviews of how this works in practice.

~~~
gonational
It’s an interesting concept. The primary concern is that most of the costs for
catastrophic medical problems will be incurred due to things like obesity,
smoking, heavy drinking, dangerous lifestyles, etc. This creates one of two
problems (or both?): either I’m left with the bill for others’ bad choices, or
individual agency is under state / democratic control (e.g., salty foods
banned, dessert banned, drinking banned, etc.).

Neither of those scenarios are ideal.

If the only question was genetic differences, that’s a risk I think a lot of
people would be willing to take (e.g., that I might be healthy until 100 and
then die in your sleep, theretofore paying constantly for others who have had
medical problems for 70 years straight). I myself would be willing to take
that risk / pay for that style of universal coverage, if not for the
aforementioned choice part (smoking, etc.) playing so heavily into the cost,
in practice.

~~~
donaltroddyn
This is a shockingly uncompassionate perspective - is it satire?

Assuming it's genuine, it's also misguided. Almost no-one wants to be obese,
alcoholic, etc - accessible healthcare will reduce the incidence of all of
these, which in turn will reduce the externalities associated with them.

You also don't need further state control to discourage smoking, drinking,
junk food, etc - taxation is the mechanism used globally to discourage
undesirable behaviour.

~~~
wayoutthere
Anarcho-capitalism -- er, "libertarianism" \-- at its finest. It's a deeply
nihilistic worldview.

Almost all these things are biologically addictive, and furthermore the
companies selling them have long known about their addictive qualities _and
then built marketing campaigns to ensure the public was not aware of the
risks_.

Taxation is how you recognize the externalities of this behavior while
maintaining a free-market system.

~~~
gonational
We’ve been taxing cigarettes at like 100% or something ridiculous for many
years, yet just as many people die from tobacco-related cancers now (if not
more) as did when cigarettes were much worse for you (no filters, more
chemicals, etc.). Those taxes also did not help to alleviate any of the
problems in the medical industry; or if they did, they were obviously offset
by something else massive, since cancer healthcare expenditures have risen
drastically since their inception.

Also, it’s easy to look at something like cigarettes which pretty much
everybody would agree are a terrible idea, and say, “fine, tax em”, but what
about when it’s sugar, then butter, then red meat, etc. Let people make their
own choices instead, and just don’t put the onus on the rest of us to fix the
problems of those choices. Banning smoking in public is acceptable because
it’s no longer a choice that only affects yourself; it affects anyone near you
in a really terrible way. But taxing cigarettes (or anything else) is no
solution.

------
catchmeifyoucan
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.

~~~
wayoutthere
This is a classic case of "it's not a product, it's a feature". This is true
of almost everything in healthcare that's software-related: it's only useful
if it's integrated with the EMR. This is why you never see software startups
in healthcare.

In this case, similar functionality (drug recommendations) exist within EMR
systems. Except the recommendations are issued by other doctors and medical
researchers, not some ML algorithm and it works transparently with the
pharmacy management modules.

Moral of the story: don't get involved with healthcare startups unless you
know the structure and economics of the industry. They are very different from
consumer / business tech.

~~~
rsp1984
There's barely anything more frustrating than a fascinating discussion on HN
and then folks start kicking around lingo and acronyms that you can't even
Google because they could mean a million things.

So please, have mercy and cure my ignorance and explain what EMR means.

~~~
wayoutthere
EMR is basically anything and everything related to the operation of a
doctor's office and/or hospital. Think scheduling, patient records, ordering
lab tests, sending prescriptions to the pharmacy, billing.... all of it. It's
what your doctor is furiously typing data in to during your visit. They also
include a lot of functionality designed to, among other things, make sure your
doctor doesn't write you prescriptions for a drug cocktail that will kill you.

It's spoken about as a monolith because that's how it's sold -- there are
maybe a dozen platforms in wide use (which are then usually customized by a
system integrator for a big hospital). They do have every option you could
possibly think of.

I'm not criticizing you here (you're not trying to do a medical startup), but
anyone who _is_ trying to do a medical startup needs to know a whole lot about
EMR systems -- more specifically how they are bought and sold -- if they want
to make any traction. All medical software flows through the EMR, and they are
closed platforms by design.

~~~
rsp1984
Sure. Thank you for the explanation!

------
gkoberger
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
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
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

~~~
eightysixfour
Or he should try selling it to CVS as a in-the-store tool for OTC products,
where his original need came from in the first place.

~~~
Androider
CVS doesn't care if you buy Tylenol or Advil or which one works better, and
makes no additional money depending on your choice of product. In fact, the
brands pay CVS for the privilege of being featured on an eye-level shelf vs at
the bottom.

I think it was a great article. Like it said: To succeed, an offering must
create value for all entities involved in the exchange—target customers, the
company, and its collaborators. And value is literally measured in dollars, so
you're either saving or making money for someone, otherwise it's just a fun
project.

~~~
eightysixfour
I would absolutely choose one store over another if they had a proprietary
tool to tell me which medicine is scientifically most likely to work for my
ailment. I cannot stand the massive wall of choices at pharmacies.

------
legitster
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
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
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.

------
ping_pong
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
>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?

------
dahart
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
What was your story?

------
uj8efdkjfdshf
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
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
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.

------
StavrosK
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
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.

~~~
JamesBarney
It's just a programatic meta analysis. And no one's get sued for having an out
of date meta analysis.

~~~
celestialcheese
It's America - people get sued for far, far less.

~~~
JamesBarney
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)

------
opportune
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.

------
amirhirsch
> 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.

------
whiddershins
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.

------
ibudiallo
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.

------
mehrdadn
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?

------
leggomylibro
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 :)

~~~
rjkennedy98
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!

~~~
beat
Perverse incentive structures are the fundamental reason US healthcare is so
expensive and stupid. It's not "greed" in a simple sense, and it's not
"regulation" in a simple sense. It's a system of interacting problems that
needs treated in a systemic way.

Blaming the insurance companies strikes me as the political equivalent of
yelling at the cashier.

~~~
chris_va
I mostly agree, but...

Insurance is one of the oldest industries in the US, which means they have
accumulated many (probably well meaning, but ultimately stupid) regulations
over the years.

For example, to be taxed as an insurance company (e.g. avoid paying tax on
premiums that will partially be paid out in the future), most states assign a
maximum profit margin.

That means, in order to make more money as an insurance company, it's
perversely in their best interests to increase the cost of medical care as
much as possible. Medical care is not like cat bonds that might wipe out your
risk pool, so it's just a cashflow game.

That's not to say there isn't any downward pressure. On a day to day basis,
individual claimants eat more into that margin than was budgeted, so a company
might have to raise rates higher than their competitors (essentially they have
some pressure to deny claims), but there is very little systematic pressure to
reduce overall costs. Also, marketing budget does not count towards profit,
which is why insurance companies are in this rat race of brand advertising to
steal customers from each other. With auto insurance, for example, upwards of
40% of your premium is just going out the door as ad spend.

Anyway, I would assign a lot of blame in this perverse incentive scheme to
poor regulations.

~~~
beat
To put it in software terms, it's not a bug, it's an architecture flaw. The
"poor regulations" aren't individual issues, but rather part of the fabric of
a framework that causes perverse incentives. Therefore, the simpleminded
conservative/rightwing solution to "reduce regulation" doesn't eliminate the
perverse incentives - it just changes the flow, the way tossing a rock in a
river does.

If I were the one making the decision, I'd change American healthcare with one
big thing, modeled on the Japanese system... price controls. Japan's system is
more or less like ours, but with one key difference - a government panel sets
the prices for all medical goods and services. Providers and insurers have to
make their profits within that price structure. This incentivizes both to
reduce costs, for the sake of their own profits.

Of course, this would be called radical socialism or some such stupid in
America, and Democrats aren't even talking about it (Republicans have no ideas
at all on health care). But it's politically a much lower threshold than
single-payer (throwing out the whole framework and starting over, basically).
And it demonstrably works - Japan's system costs less than half what ours does
per capita, with better outcomes.

------
_bxg1
> “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
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.

------
scottmsul
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
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+.

------
rmah
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.

------
elliotpage
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
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.

------
mynegation
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
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.

------
iabacu
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
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.

~~~
throwaway_tech
>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.

------
kirillzubovsky
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.

------
tylerrobinson
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
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
I don't entirely follow your question, but please feel free to send me an
email if you want to catch up on this.

------
johnchristopher
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
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
"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.

------
Donald
Guess it's time to rebrand this as a fintech startup that informs investors
about high-risk pharma stocks.

~~~
jcims
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)

------
throwaway_tech
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
> 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
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".

------
scotty79
> 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!)."

------
ouid
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.

------
jupp0r
Forgive me for stating the obvious, but wouldn't talking to doctors with some
mockups have prevented most of this?

~~~
omarchowdhury
It definitely would have.

------
bobosha
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
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.

------
streetcat1
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
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
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
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.

------
2pointsomone
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.

------
mtm7
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.)

------
bcrosby95
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.

------
dnprock
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.

------
codewithcheese
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.

------
nickelcitymario
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!

------
marcinzm
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
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.

------
dougb5
> 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.

------
Cougher
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.

------
sjg007
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.

------
SAI_Peregrinus
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).

------
Dayshine
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.

------
lalos
It's like a brief diploma-less MBA program, like a Montessori MBA.

------
royroyroys
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.

------
hogFeast
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).

------
ggggtez
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.

------
wyldfire
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
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.

------
ww520
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.

------
scotty79
> 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.

------
kevan
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.

------
raverbashing
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).

------
macspoofing
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.

------
gavinray
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
i'm interested in the project you mentioned-- drop me an email adam at
springhealth.com if you'd like to chat

------
dumbfounder
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.

------
bkraz
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.

------
fyp
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
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
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
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.

------
reilly3000
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.

------
pilingual
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
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.

------
tombert
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?

------
indigodaddy
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?

------
scotty79
> 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.

------
monkin
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. :)

------
duelingjello
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.

------
phonon
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...](https://www.ibm.com/blogs/watson-health/hospital-pharmacists-
tap-ai-to-improve-drug-information-searches/) even.

Product sounds fine, but not selling them 1 by 1 to doctors.

------
jdennaho
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.

------
thomasjudge
'“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

------
reggieband
> 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
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
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.

------
rwmj
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.

------
DJBunnies
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
Yes. I didn't know that until right this second.

~~~
rurp
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.

------
codingdave
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.

------
taurath
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.

------
AndrewKemendo
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.

------
billconan
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?

------
mkevac
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)

------
simo7
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.

------
sealthedeal
[http://theleanstartup.com/](http://theleanstartup.com/)

------
planetzero
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.

------
Gatsky
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.

------
CPLX
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.

------
choeger
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.

------
elamje
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
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.

------
desireco42
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.

------
hangonhn
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.

------
tehansen
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
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
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.

------
sethammons
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.

------
Edmond
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 :)

------
symlinkk
I don't see how ads weren't enough to keep this afloat.

------
theklub
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)

------
12xo
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?

------
around_here
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.

------
nautilus12
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?

------
nwsm
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.

------
tyingq
Somewhat surprised a search engine wouldn't want it for the perceived value of
improved "snippets". Or some company like WebMD.

------
rdiddly
I liked this "my startup failed" story more than many, not least because of
all the gratuitous wry allusions to SV culture.

------
RocketSyntax
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

------
prithsr
Barring any advice or input on the idea (which I do think is solid), this was
a really fun read.

------
dutchblacksmith
I bet that within some years, this idea will surface and gain momentum. Keep
it as a side project.

------
entropyneur
Just FYI: "Doppelganger" exists in Russia and makes tons of money from
government contracts.

~~~
perpetualpatzer
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.

------
pascalxus
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.

------
stevewilhelm
TLDR: OP learned the hard way that a good idea was a feature, not a viable
business.

------
acvny
And by the way, your mistake was that you forgot 3 very important letters -
MVP.

------
earlINmeyerkeg
Can you call it a good idea in hindsight if you acknowledged it was a waste?

------
syntex
It seems like you stopped far too early pursuing your idea.

------
sparkywolf
Hacker News hug of death... Anyone have a mirror or text?

------
kkotak
I think writing is your true calling OP,

------
sheeshkebab
Build it and they will come they said, follow your dreams they said...

yeah, right.

------
godelzilla
The point of healthcare under capitalism is to profit from sick people, not to
heal them.

------
ageyfman
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
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
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
Anyone has a link to the above video?

~~~
vijucat
I think it's this one:
[https://www.youtube.com/watch?v=rWRbTnE1PEM](https://www.youtube.com/watch?v=rWRbTnE1PEM)

------
georgewsinger
lol @ giving up after 2 weeks.

------
wiggler00m
_" 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.

------
cjdupreez
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
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.

