It does depress me, daily, that I do not have a career in physics or chemistry or biology or medicine where I could work on "big problems." The simple truth is, I'm not smart enough, I don't work hard enough, and I've been napping when opportunity knocked a few times in my life.
That being said, sometimes a man in a saloon has a few drinks and yells at the television, telling the coach of some football team what to do next. Just because he's drunk and in a saloon doesn't mean he's wrong, just boorish.
I lamented the fact that it's easier to upload and simultaneously tweet about a picture from my phone than it is for Scott to lead a normal life. There are lots of reasons why this is so:
1. The barrier for entry (education, &c) is higher in medicine and bioinformatics.
2. There are regulatory obstacles for businesses.
3. The problems are harder to solve than it may seem to the man in the saloon.
4. Some people feel the monetary incentives are to avoid medicine.
p.s. "Hypocrisy" is one of those empty criticisms, like "Unprofessional." If someone says to you, "smoking is bad," it doesn't matter whether he smokes. Maybe, his advice is actually more relevant if he's an older fellow who smoked and now regrets not making a different choice when he was your age.
I have no education, no college etc... and I created software that generates meal plans according to my Crohn's symptoms (made it from my hospital bed at SF General) and now I am off all my meds.
Made an app for a friend that helped her identify that she had a Gluten allergy (later verified by doctor)
And right now I am working on a way to help match patients and doctors based on case histories.
My passion is helping people, so that is what I do. I am not smart, funded etc... I just really really really give a fuck and refuse to quit.
You dont need education, funding or any of those things. You just need drive, passion and google. I cant take these products to market myself and have been turned down by all Incubators, Angels etc... but that does not matter because like i said; I wont quit.
Your problem is not lack of intelligence or funding, your problem is lack of passion. You dont work on these things because you dont give a fuck.
http://hackingcrohns.com - (took down meal plan because I cant afford the machines for the ABM Sim)
http://trackxvsy.com - Site not active but if you want the app email me
http://cvchk.com - going to have this ready for HN Whose hiring (job applipicaion only) but you can see how structured search for a job w/ resume is same as structured search for doc w/ case histroy.
 "Why can't you launch them as some guy? I see people giving diet advice all the time"
I am dealing with medical records not just diet recommendations, I take this very seriously and refuse to take a cavalier attitude toward the health and medical information of other people.
They all just put standard disclaimers at the bottom of the page saying that it isn't medical advice, and that they aren't doctors.
If you have looked into this further and still came to the conclusion that you can't post this stuff, please let me know why.
2) Your successes are commendable, but they do not prove that any John Doe can solve the "Big Problems" your parent spoke of. Historically speaking, at least in physics the "Big Problems" have been solved by extremely smart people. Not just people who refuse to quit.
We may be talking about different "Big Problems" though. I'm thinking of DNA, e=mc^2, the cure for cancer, etc. I don't want to be rude, but I don't think the "Big Problems" of our day will be solved by apps.
The Diet Crisis, Diabetes (which he mentioned directly) etc... are not Physics problems.
Not to be rude but your type of thinking is where part of the problem lies. A mother that wants her child to be healthy or a person that has diabetes does not give a damn about the God Particle or any other big physics issue. The statement that started this whole thread was directly related to diabetes, so with all due respect I believe that my "Apps and software" are a lot more applicable here than Physics research. If we were speaking about energy then you may have a point but we aren't.
BTW: w/ Hacking Crohn's a user can upload their 23 and Me data and generate a meal plan that helps them combat any genetic predispositions they may have to one or more illnesses (not cancer yet but give me time, i'll get there).
 I see your point, but i think that you assume all "big problems" will be solved with a pill or a shot and i disagree. I think that we need a fundamentally different approach to solve some of these issues but I do understand and respect your position.
Now, an app might be able to help guide people to avoid or handle diabetes, but that is not "solve".
I'm not blowing off diabetes in the slightest, in fact I am saying it belongs with the other "Big Problems" which is why I discussed physics.
You should also consider making gut bacteria for zonulin production.
1. The time scales are completely different for internet and biotech. A/B testing online can take hours or days while biotech experiments take months to years. In fact, I came up the idea for the startup while I was waiting 4 months for a substrate to be synthesized!
2. The costs are also dramatically different. The limiting reactant isn't people, it's $$$. Biotech is extremely capital intensive. Equipment, reagents and people all require significant amounts of money over a long period of time.
3. Lastly, hard sciences do not have a monopoly on "big problems". Maximizing my impact is a desire I share with many of the HN crowd. For me, the impact I foresee by improving rating systems dwarfs what I thought I could accomplish in bio-nano. Don't get me wrong, this was simply the right decision for me, which is why I dropped out a year ago with zero regrets.
First, many problems there are much harder just to get to the level that one can do any valuable contribution. And approaching them goes well beyond reading tutorial, playing with it, asking some questions on SE, being expert.
In mathematics, or medicine, it's rather years than weeks.
Second, many deep problems are not that easy to commercialize; even if they may, possibly, save many lives in future, they are not an easy base to make profit in, say, next 10 years.
Third, as projects are way to hard to be run by a few enthusiasts + commercialization is not straightforward - everything works in universities, with an inertia typical for huge institutions (and no 2-3 people startups are available). As a secondary effect, it deters creative people to pursue such option.
And fourth, there is money in programming. When you fail a startup you can still get a great job. If you fail your academic career - it may be harder.
And in general - approach "we have no idea if it is going to work, but let's try!".
In medicine, a failure may cost thousands of lives (and in past it did, a lot of times), so time and cost overhead is enormous.
It's easy to focus in on the seemingly least substantive aspects of the work a company does, such as reducing the idea of google into a company trying to pimp out your attention by way of ads. However, even while that's true it's not the whole story. Take youtube for example, as a part of google. It is also quite easy to trivialize of course, but it is rapidly becoming a nexus of communication. It's increasingly becoming the way that artists share their music, for example. And it's also becoming a host to things like first hand journalistic reporting, educational videos, and many forms of entertainment. How much have people's lives been enriched by the music, art, comedy, and scientific knowledge they've experienced through youtube?
And even if you restrict the subject to merely google search, how much have people's lives been changed by that as well? How many times has a google search helped someone struggling with a disease learn something or gain access to resources which helped them understand their treatment options or find a better doctor or care facility? How many times has a casual google search resulted in someone learning something important that they didn't know before? That sort of thing can affect someone's entire worldview, it can impact the entirety of the rest of their life.
There are things that bother me about the way google, apple, and facebook do business, but I don't think there's anything especially ignoble about their work in general. Much of what they do is to facilitate communication between people. Sometimes the result of communication is banality (e.g. "Check out this bowl of cheerios I made for breakfast, pls RT.") and sometimes it's farce (e.g. Jerry Springer), but sometimes it is the very essence of our civilization in the form of art, science, humor, personal growth, etc.
Edit: Also, I don't disagree with your sentiment in general, but I think it's a bit too harsh to paint companies that are having a significant effect on our world as trivial. And I think there are better and more positive ways to motivate people than the standard "you're wasting your life!" diatribe.
2. There are regulatory obstacles for businesses.
Moreover, it is just more stressful to deal with a regulatory climate where any error is assumed to have happened because you were an evil corner-cutting capitalist who didn't allocate enough for safety. This kind of Monday morning quarterbacking is unfortunately usually done by people who've never shipped a drug or device in their lives, like most politicians, journalists, or federal regulators. Twitter, unlike Genzyme, is not fined millions of dollars by the FDA when its site is down.
Finally, you have to guess what the law is. There is so much "discretion" [3,4] afforded to regulatory agencies that the threat of fines and seizures over bizarre interpretations of the law by a Carmen Ortiz-style ambitious regulator is never far from your mind. Example :
[Newsweek:] What exactly would constitute a “medical
claim?” Would pointing people to medical research papers
[FDA]: It depends. There are rules as to how one can do
that … Those rules are actually worked out pretty well,
and they just would need to make sure they’re staying
within the rules.
[Newsweek:] Are those rules on the Web?
[FDA]: I don’t know where the policy is. I would have to
get it for you. It’s an agencywide policy. I would have to
find it for you. And it won’t be that easy for people to
The agency has urged hospitals to allow vendors to guide
them on security of sophisticated devices. But the vendors
sometimes tell hospitals that they cannot update FDA-
approved systems, leaving those systems open to potential
attacks. In fact, the agency encourages such updates.
“A lot of people are very confused about FDA’s position on
this,” said John Murray Jr., a software compliance expert
at the agency.
In United States v. Park, the Supreme Court held that a
responsible corporate official can be convicted of a
misdemeanor based on his or her position of responsibility
and authority to prevent and correct violations of the
Food Drug and Cosmetic Act (FDCA). Thus, evidence that an
individual participated in the alleged violations or even
had knowledge of them is not necessary.
For just a taste of how all this plays out, look at the FDA's ongoing attempt to regulate mobile health apps. Who knows what the rules will be, what they will cost, or what the fines are? Look at the FDA's attempt to deny people access to their genome without a prescription. Look at the fact that they issued a record 10000+ 483s in 2011, which threaten a business with civil or criminal penalties. Look at the fact that they used these 483s to shut down Teva and Sandoz and Hospira and Bedford at the same time, causing a massive shortage of injectables which they blamed on industry profit seeking and used to gain yet more regulation, more power, more budget.
Look, finally, how they claim in an official court filing against family farms producing raw milk that you have "No Generalized Right to Bodily and Physical Health" , where they approvingly cite the case of Cowan vs. US, where a terminal cancer patient was denied access to experimental medication, denied the right to opt-out of the FDA:
There is No Generalized Right to Bodily and Physical
Plaintiffs’ assertion of a “fundamental right to their own
bodily and physical health, which includes what foods they
do and do not choose to consume for themselves and their
families” is similarly unavailing because plaintiffs do
not have a fundamental right to obtain any food they wish.
In addition, courts have consistently refused to
extrapolate a generalized right to “bodily and physical
health” from the Supreme Court’s narrow substantive due
process precedents regarding abortion, intimate relations,
and the refusal of lifesaving medical treatment.
See Glucksberg, 521 U.S. at 721 (warning that the fact
“[t]hat many of the rights and liberties protected by the
Due Process Clause sound in personal autonomy does not
warrant the sweeping conclusion that any and all
important, intimate, and personal decisions are so
protected”); see also Cowan v. United States, 5 F. Supp.
2d 1235, 1242 (N.D. Okla. 1998) (rejecting a claim that
the plaintiff had the fundamental “right to take whatever
treatment he wishes due to his terminal condition
regardless of whether the FDA approves the treatment”).
The only solution here is for hackers to carve out a jurisdiction in which the FDA has no say, where patients are free to be early adopters and startups are free to push the technological envelope. Patients in this zone will need to be mature and understand that these are version 1.0s, and may not help or even actually harm them. But every drug or device or surgery needs someone to be first, and a few brave risk takers could both benefit their own health and push humanity forward. After all, we have thousands of people dying for futile risks in various foreign wars.
So, the limiting reagent is not money, or expertise, or motivation, or smarts. raganwald, you and most of HN are plenty smart enough. It's about the freedom for companies to innovate, for patients to take risks. We need a jurisdiction (a seastead? Singapore? Estonia?) that enables us to push the technological frontier. Everything else will fall into place once we can't be punished for innovating.
3 months of doing it my way and I never knew life could be this good, so while I agree that the regulatory climate makes this difficult; I dont care. I will never take such a risky attitude toward others and risk their health or wellbeing because I do not have this right but I also will not use this as an excuse to do nothing when I know I can help.
Of course, that's out of the realm of most start-ups, unless you are starting from a research facility where someone might already know the ropes. That said, my employer (which was once a tiny start-up that grew from a research lab) has directly worked with the FDA to define the regulations around our particular domain.
Have looked into this kind of thing myself before and am interested in how you went about your project and if there's a community around that kind of thing.
My Way = Macrobiotics, Stress Control, Acupuncture etc...
Yes, there are many communities; I mostly used trial and error but the difference is how I measured what worked. I kept a food diary that allowed me use actual nutrient stats etc... to find patterns in my trigger foods.
- a website that republishes FDA information in a far easier to grok manner (assuming they are as impenetrable as most government websites I've had the misfortune to require using)
- a choose-your-own-adventure formatted application made in Twine that would allow you to explicitly follow the known rules
- an application that alerts drug/device developers of guidance updates
Option 1: reduce costs of complying with FDA.
Option 2: reduce the power of FDA.
So then there is Option 2: reduce FDA power. I've come to believe that the second strategy is much more effective in the long run. So what does that entail?
1) Regulator review sites. Something that might be
surprisingly effective would be a site that named and
shamed individual regulators, kind of like TheFunded.com
for regulators. With some good SEO this might be the single
most effective thing one can do. It would be incredibly
popular and could branch out into SEC, EPA, and other
2) Regulatory review sites. Relatedly, with all other
domains (movies, music, books, etc.) there is a thriving
system of competitive, third party reviews and star
ratings. Yelp, Amazon, Metacritic, Rotten Tomatoes, even
Google PageRank are all review methodologies that are
intentionally robust to the decisions of a single
regulator. Figure out how to get 2000 cardiologists
worldwide to do public internet reviews of heart
drug/devices rather than a hand-picked FDA panel of 15, and
you can show under very conservative assumptions that the
resulting rank-ordering of products will be far more
3) Filing in other countries first. For example, within medical device companies, it's well known now that you get your CE Mark in Europe first[1,2,3], and then think about the US. You can get some revenue and the CE Mark process is far more consistent than the US.
4) Otherwise enhancing regulatory competition. Imagine if Harvard, the Mayo Clinic, and Cedars-Sinai could suddenly clear drugs and devices like the FDA. The FDA already contracts with scientists from there to run their expert panels, as they don't have the expertise in house. The CE Mark strategy above is this in embryo, but it's only two jurisdictions (EU and US). I'm not sure how you'd pull this off, but the basic idea is to use other "name brands" in medicine to help set up regulatory competition.
5) Software-based regulatory arbitrage. With modern information technology, it may be possible to locate software-based components of a device/drug overseas in fast market access countries like Singapore, Hong Kong, or Israel.
6) Medical tourism and/or medical cruise ships. Figuring out ways to do internet marketing of offshore medical tourism to Americans, with transparent prices and treatments proven in other countries (even if not FDA approved) will be a big deal over the next 10-20 years as the US medical system enters crisis from all the aging seniors. All you need is a relatively small but high profile group of people voting with their dollars to seek treatment or move operations overseas to start provoking real change. Nothing within the system will do that now.
These are the sorts of ideas, many informational, that I think will have a much bigger impact than methods to streamline compliance.
none of those entities have sovereign immunity!
For example, it might be feasible to get Cedars-Sinai to partner with (say) Singapore's HSA and do some kind of fast track approval process intended to compete with FDA's slow approval. Here Singapore's name brand would be enough for the Asian market while Cedars' brand would establish to American medical tourists that the product/device/service had been vetted.
We need more funding for medical research. PhDs should not be low-paid labor. Too many smart people drop out of research careers due to the low salaries. We should be paying medical researchers similar incomes to engineers at Silicon Valley tech firms.
California taxes are funding one of the biggest research efforts into stem cells. So the big tech firms are contributing to the effort through their taxes.
1) Regarding diabetes and the FDA:
I don't think removing the FDA is going to find a cure for
Early in 1921, Banting took his idea to Professor John
Macleod at the University of Toronto, who was a leading
figure in the study of diabetes in Canada. Macleod didn't
think much of Banting's theories. Despite this, Banting
managed to convince him that his idea was worth trying.
In January 1922 in Toronto, Canada, a 14-year-old boy,
Leonard Thompson, was chosen as the first person with
diabetes to receive insulin. The test was a success.
Leonard, who before the insulin shots was near death,
rapidly regained his strength and appetite. The team now
expanded their testing to other volunteer diabetics, who
reacted just as positively as Leonard to the insulin
The news of the successful treatment of diabetes with
insulin rapidly spread outside of Toronto, and in 1923 the
Nobel Committee decided to award Banting and Macleod the
Nobel Prize in Physiology or Medicine.
2) Regarding type I vs. type II errors:
We need the FDA to regulate drugs and medical devices.
There's too much potential for quackery.
The extreme skepticism of my colleagues led me to believe
that I might never be funded to perform the crucial trial
of antibiotics... I realized then that the medical
understanding of ulcer disease was akin to a religion. No
amount of logical reasoning could budge what people knew in
their hearts to be true. Ulcers were caused by stress, bad
diet, smoking, alcohol and susceptible genes. A bacterial
cause was preposterous.
We should be paying medical researchers similar incomes to
engineers at Silicon Valley tech firms.
4) Concerning stem cells:
California taxes are funding one of the biggest research
efforts into stem cells.
Last September, Nature predicted a stem cell showdown in
Texas, between the FDA and a company providing unproven
stem cell treatments, and that seems to be happening. In a
severe “warning letter” posted on the agency’s website this
week (but dated September 24, 2012), the FDA told
Sugarland, Texas-based Celltex Therapeutics Corporation
that its stem cell products fall under FDA regulation and
need to be approved before use in patients.
The letter is a challenge to new regulations that the Texas
Medical Board put in place in April, which had made FDA
approval an option, not a requirement. Those regulations
state that doctors injecting stem cells into patients need
FDA approval or the approval of a local institutional
review board (IRB). The warning letter makes clear that the
FDA expects its approval to be mandatory—effectively
replacing the “or” with an “and”.
In recent court filings, the Food and Drug Administration
has asserted that stem cells—you know, the ones our bodies
produce naturally—are in fact drugs and subject to its
regulatory oversight. So does that make me a controlled
substance? The bizarre controversy revolves around the
FDA's attempt to regulate the Centeno-Schultz Clinic in
Colorado that performs a nonsurgical stem-cell therapy
We need the FDA
Why is it in Roche's interest to lobby for a stronger FDA? Because FDA alumni are hired by large manufacturers to lobby the FDA and increase barriers to entry for startups. When you get into the details of how regulations are actually enforced, it is all about relationships/politics/press coverage and has very little to do with technical merit.
I could go on in this vein...among other things, you might be interested in the fraction of pre-1938 drugs and pre-1976 devices that are routinely prescribed from an ostensible age of quackery.
However, the fundamental idea is not really to convince people who want the FDA that it should continue to exist, but to get a critical mass of people who don't want the FDA to create a place where it does not have power. Then you and those who agree with you can reside in the US, where the FDA has sole authority. And we can opt-out of the FDA, as both patients and entrepreneurs.
This is going to require thinking outside the confines of the United States and US politics, but the payoff will be nothing short of a revolution in the pace of biomedical innovation.
I for one am happy that the FDA inspects my food and medicine and holds them to a standard of safety. On the other hand they do make some medical devices and advances overly expensive to make and create a barrier to entry into the market.
I worked with a programmer who had designed a watch that had an array of sensors in it with a wireless device to relay the info to your computer automatically. It would have been great for marathoners or people with heart conditions. He wouldn't even start the process of getting it approved, because he was too intimidated by the FDA. That doesn't necessarily mean he was right, but the chilling effect is clear.
There is plenty of basic biomedical research left to be done on animals, and this is far less regulated. In the U.S., rats and mice are effectively exempt from animal welfare laws. NIH imposes some fairly regulations for funding recipients (i.e., universities), but in my experience, it's not very difficult to get a project with legitimate scientific value approved. If you can cure diabetes, it's not unreasonable to ask you to prove it in an animal model first.
My understanding is that approved treatments in humans often lag 10 years or so behind what's known to work in animal models, but until we can cure most major illnesses in rats and mice, we can't blame the slow progress in treatments on the difficulty of translating therapies from the lab to the clinic.
approved treatments in humans often lag 10 years or so
behind what's known to work in animal models
Early in 1921, Banting took his idea to Professor John
Macleod at the University of Toronto, who was a leading
figure in the study of diabetes in Canada.
Banting and Best began their experiments by removing the
pancreas from a dog. ... By giving the diabetic dog a few
injections a day, Banting and Best could keep it healthy
and free of symptoms.
The team was eager to start testing on humans. But on whom
should they test? Banting and Best began by injecting
themselves with the extract. They felt weak and dizzy, but
they were not harmed.
In January 1922 in Toronto, Canada, a 14-year-old boy,
Leonard Thompson, was chosen as the first person with
diabetes to receive insulin. The test was a success.
Leonard, who before the insulin shots was near death,
rapidly regained his strength and appetite. The team now
expanded their testing to other volunteer diabetics, who
reacted just as positively as Leonard to the insulin
The news of the successful treatment of diabetes with
insulin rapidly spread outside of Toronto, and in 1923 the
Nobel Committee decided to award Banting and Macleod the
Nobel Prize in Physiology or Medicine.
What if we tried that today?
You mean, just rely on the judgment of the experts involved and the verbal consent of the patients?
You mean, just allow the doctors to come up with whatever dose they felt warranted and patients to take whatever dose they feel comfortable with?
You mean, resist having some kind of ostensibly judicious central authority approve all such decisions, and rely on the distributed judgments of all consenting participants involved?
Yes. The typical response is that this is a recipe for anarchy. But history shows that it is a recipe for Nobel Prizes, and it is not like 1920s America was much like Somalia.
Would there be risk? Sure. Some people will not be helped and others might even harmed by new and unproven treatments. That's the price if we're serious about rapid progress, or really any progress. There must always be a first human trial; why not as soon as possible if people really are dying?
Needless to say, this kind of boldness won't fly in the modern US. Outside of the internet, the country has become just too risk averse, too wealthy to pay the price of progress. Our task as hackers then is to create at least one spot on this earth where patients can take whatever treatments they want, where entrepreneurs/technologists can invent whatever drugs/devices they want, and where no regulator has the power to intercede between these two consenting parties. And where we can go from idea to human trials as fast as the patient pleases.
"Thalidomide was developed in 1954 by the CIBA pharmaceutical company, marketed under at least 37 names worldwide. It was prescribed as a sedative, tranquilizer, and antiemetic for morning sickness. Thalidomide, launched by Grünenthal on 1 October 1957"
So, slightly more than two years, but it points to the problem: the judgment of the experts may be awfully wrong.
Also: it is true that the Western World is more and more risk averse, but we are more permissive in allowing trials on patients who would die soon, anyway. I doubt it would be two years from idea to Nobel prize, but http://en.wikipedia.org/wiki/FDA_Fast_Track_Development_Prog... states a goal of 60 days for review, and states that that goal generally is reached.
1) First, FDA fast-tracks many bad things. Hundreds of millions of people were irradiated by scanners that FDA waved on through because a fellow .gov agency (TSA) sponsored them. So: even the risk-averse can't trust a single centralized regulator to be "risk-averse" rather than "pro-government". We need multiple regulators (see my posts elsewhere in the thread), where you can use things approved by the slower/expensive/safest one while I can use items approved by the faster/cheaper/riskier ones.
Dr. Holdren passed the letter on to the Food and Drug
Administration for review. But, in the FDA's response, the
agency gave the issues little more than a data-driven brush
off. They cite five studies in response to the professors'
request for independent verification of the safety of these
X-rays; however, three are more than a decade old, and none
of them deal specifically with the low-energy X-rays the
professors are concerned about. The letter also doesn't
mention the FDA's own classification of X-rays as
carcinogens in 2005.
By law, FDA must respond to your 510(k) within 90 days, and
typically they do. The thing you have to understand is that
FDA measures 90 days about the same way the NFL measures
the 60 minutes in a football game. It's not unusual for the
clock to spend more time stopped than running.
Thalidomide in particular is to the FDA what 9/11 is to the TSA, it's the justification for everything they do. If you get into the history books you'll see that Frances Kelsey never actually suspected teratogenic effects; she suspected neurological issues. Moreover, thalidomide was actually a very efficacious drug for morning sickness, it was just unsafe. Yet the 1962 revision to the FD&C act added efficacy testing on top of safety testing.
That's weird. The thing is, toxicological/safety testing, even aggressive safety testing is "only" in the tens of millions, not billions. It's efficacy testing (and then comparative effectiveness) that really piles on the dollars. If the lesson of thalidomide was that we should do aggressive safety testing, then no one got the message, because Kefauver & Harris' 1962 amendments to FD&C meant we ended up spending several hundred billion dollars on efficacy instead.
Perhaps then the lesson from thalidomide might be that pregnant mothers should be much more risk-averse in what drugs they take. It's not really a lesson that says "we need to delay all drugs more", because due to pharmacogenomics some side effects are only going to be apparent when you introduce them into humans on a large scale anyway.
Moreover, risk can't be eliminated, and different people will have different risk profiles. What if a 70 year old man with terminal cancer wants to take an experimental, non-FDA approved drug? Do you sue like the FDA did in Cowan vs. US to prevent him from doing so?
For that matter, what if a 25 year old pregnant woman wants to take a new drug? Do we prevent her from doing so? Maybe we should, but we currently don't stop pregnant women from drinking alcohol or smoking cigarettes.
One has to think very carefully about whether every tragedy means one must ban or mandate something with a federal law.
But it's definitely the most expensive and difficult to test component of FDA regulation. It's also awkwardly theoretical do to the sterility and white coatedness of the testing procedures (you and I both have something to say against RCTs). But at the same time, a market inundated with false claims to efficacy would be terrible. The current mobile health market is a fair comparison---many of them are efficacious, all of them would love to claim it, but nobody knows which ones.
And we kind of know what a safe-but-not-necessarily-effective market for drugs will look like: the supplement industry. Supplements are cheap, they vary in effectiveness on a per person basis, and they have undoubtedly produced some really great things (creatine, omega 3). Take a look at this awesome graphic:
The thing is, with centralized regulation for efficacy two things happen. First, many of the bubbles on that graph never appear in the first place. Second, because they never appear, they never accumulate enough evidence/market size to rise up the list. We are choking the channel if centralized regulators require our minimum viable products to be not just safe, but highly efficacious.
The best way to see this is that centralized regulation kills iteration. Talk to anyone in the drug space: they'd love to be able to change their dosing methodology (altering dosage amount, frequency, formulation) or otherwise take advantage of serendipitous post-market findings. Viagra, famously, was initially intended to medicate blood pressure.
But right now they can't even change the labels on their drugs without the FDA's approval, which is why the average layman gets a folded-up chemistry textbook rather than a user-friendly instruction manual, let alone a website which totes up other people's experiences with the drug. To get a sense of how much that could contribute to the patient user experience, see Help Remedies, which can get away with better UI/UX because they're dealing in generics.
Anyway, on net, I think something like a pharmacogenomic erowid.org [4,5] is the best way to establish efficacy. That would be distributed and the data would be public and constantly updated, with sample sizes far in excess of the current FDA process. Patients would get accounts and link their genomic information with the site after buying any new drug, and input their own survey data in order to see other people's (aggregated, anonymized) experiences. This would mean that you can launch safe drugs of unproven efficacy, and then collect efficacy data at a far larger scale than we do today. But this kind of innovation will only be possible in a jurisdiction outside the FDA's thumb.
I don't argue that the FDA is an efficient structure for doing efficacy testing, I just think punting the value discovery/marketing process to vague distributed processes isn't a good answer.
I think the supplement market is a great example as well. Many low value treatments saturate the market and the responsibility for making decisions is democratized and difficult. Canonical sources of efficacy information might not be needed as barriers to entry, but reputation, trust, and canonization are valuable heuristics in decision making processes and this leads to power.
If Google doesn't link you, you die.
Well, we'd get new treatments a decade faster, but a lot of these treatments would not work and/or would kill people. But, as I said above, I don't think this would dramatically increase the speed of innovation, except for diseases where we don't have effective animal models. It's faster to run experiments on animals than people. For these diseases, removing regulations let people try treatments that worked on animals in humans faster. But the problem is really that there are many diseases we can't treat effectively in any organism, and letting people try any treatment they want in humans isn't going to fix this.
I think you are vastly overestimating what society has to gain by deregulating medicine. You'll get a one-time gain of 10 years of progress at the cost of an unknown number of lives.
It's faster to run experiments on animals than people.
I think you are vastly overestimating what society has to
gain by deregulating medicine. You'll get a one-time gain
of 10 years of progress at the cost of an unknown number of
In scenario I, we do it status quo and safe, with no deaths. Very generously, let us grant that a cure appears in 10 years. This is generous because a regulated market may never iterate upon the cure if it is radical/different (e.g. Barry Marshall and H. pylori).
In scenario II, we accelerate the cure in a deregulated market. The R&D phase takes 1 year and costs us 100 deaths from test pilots / early adopters; the scaling phase takes 2 years and costs us another 900 deaths from volunteers. These numbers are vastly in excess of any reasonable safety testing paradigm in a deregulated space (no one died in Banting & Best's experiments) and I cite them as extremely conservative upper bounds.
Ok. Then in scenario I, the status quo, you had
- 0 die from testing
- cure appears at end of 10 years
- 10 million people die over those 10 years
- 10 million deaths
- 1000 die from testing over 3 years
- 3 million die from disease over those yeers
- cure appears in year 3
- no further deaths
- 3 million + 1000 total deaths
How is medical research founding supported? In order of prominence: Tax money from NIH. State granted and enforced monopoly in the form of patents. State granted extended monopoly (after the patent is expired) which is granted by the FDA, including exclusivity to the data from testing. There is also affects from insurance and the health care system, but that one is much more complex to evaluate in this context.
A completely unregulated industry could had produced faster results, but in that case its business model should not be in an depended relationship with the government. It should not get the majority of its founding from tax money. It should not depend on state granted monopolies.
As it is now, FDA is the regulation that enforces the public right to get what it payed for. Its their money after all. If one would like that to change, one should start by removing tax money and government monopolies to be the sole critical part of medical research.
Regarding patents, they are a form of artificial scarcity on the sales end. Regulation is a form of artificial scarcity on the R&D end. That's why regulatory affairs and IP are the two most important departments in any pharma company.
It's useful to think about what the pharma industry would look like with no FDA and no IP protection. It'd look a lot like food, energy drinks, or supplement manufacturers, making commodity products with marketing as the primary source of margin. Generic drug manufacturers are a good first step towards this; we'll see more of this in the near future with the pharma cliff and end of many major drug patents.
Incidentally, the intersection between regulation and IP produces some extremely bizarre behavior:
This guidance is intended to provide industry with
information on how the Food and Drug Administration (FDA)
is applying the 180-day generic drug exclusivity provisions
of the Federal Food, Drug, and Cosmetic Act (the Act) in
light of recent court decisions. The guidance
addresses the issue of the elimination of the "successful
defense" requirement, which required an abbreviated new
application (ANDA) applicant to be sued for patent
infringement and to prevail in the litigation to receive
the 180-day period of marketing exclusivity.
I can get into the duct-tape upon duct-tape that led to this bizarre state of affairs, but think about how perverse it is that the FDA was telling companies to break patent law (or at least risk a civil lawsuit) as a matter of policy. That's the kind of thing you uncover when you actually look at how regulations are implemented.
Finally, regarding funding, yes, NIH spends about $31B per year, which is a lot. However, drug companies spend $4B per drug approved, which is an incredible amount of money when multiplied across all drugs. I'm not sure exactly how one could stop drug companies from profiting from public domain research as you propose. Are you saying that NIH should get into the business of drug development and/or not allow its funded academics to publish papers or start drug companies?
If you are saying the former, I actually happen to agree that NIH would be reasonably good at drug development, as Francis Collins has proposed, because as a fellow .gov it would be able to play hardball with the FDA in a way that no normal company could. Among other things, it wouldn't fear going out of business, and would be able to appeal to the HHS secretary if FDA retaliated against it. On the other hand, this new NIH-to-FDA pipeline would lose a lot of checks and balances; it'd sort of be like HHS as the large drug co with NIH as the scientists and FDA as the regulatory affairs, without any real check by the market other than the nationalized drug companies of other countries.
Think about how the FDA fast tracked  things like TSA body scanners and you'll get a sense for what its actual commitment to safety is when it's a fellow .gov that is sponsoring a drug/device.
As a final point, if you meant instead that NIH should be abolished and academics should stop publishing papers, I think we will actually see the implosion of the US higher ed research establishment over the next 5-10 years due to MOOCs and budget cuts, so that may come to pass as well.
I think this $4B number is the Research & Development line off a financial report. I am not an accountant but I believe this number can include tons of things that people don't normally think of as R&D but just regular cost of doing business, and what we do think of as research is often a very small percent of it. Perhaps tax laws incentivize companies to put as many expenses in this category (of like 3 categories) as possible.
On a related point, people used to quote a number like it cost $500 million to bring a new drug to market, often as a justification for patents. I remember reading an academic article that showed how the real cost was almost always 1/20 of that, but drug companies were including the construction of optional new plants that were used for existing drugs too, 20 year leases on specialty tree farms and other supplies, and huge "present value" calculations that would take $2 million spent by a university 20 years ago, use the companies cost of capital (maybe 14%), and even though the company only paid $500k for the rights a few years ago they would calcuate some number in the tens or hundreds of millions that was never paid by anyone.
I remember reading an academic article that showed how the
real cost was almost always 1/20 of that
The best response to Light and Warburton is that if it really took only $43 million to ship a drug, then they should raise the capital and start a drug company. It would be by far the most capital-efficient and successful drug company of the last 50 years. If they have really figured out how to cut all the fat, they would be hailed throughout the industry.
But I hope to persuade you that when someone outside the industry is off by two orders of magnitude ($43M vs. $4B), it is likely that they are the ones who have missed something important. I encourage you to read Derek Lowe's more detailed critique here:
The $31B is considered to be 1/3 of all funding for all medical research (including humans and pets/animals). In the area of core research, including those illnesses that are life threatening, then NiH stands for around 95% of the funding.
Having the government do the research, including the testing, and then let generics do the production of the devices/drugs (under somewhat high taxes) could be one way to do it. It would likely be considerable cheaper than the current system, as it would have a hard time doing worse than the current system. The ("we are not worse than the other guy") slogan might not the best, but it would be a start to get somewhere better than now.
Or, they could do the opposite, pulling out from funding medical research. The government do not fund the research for most things. Maybe those 31B$ could be better spent elsewhere and thus force pharma to be self-dependent.
In regard to academics... If Academia fund some research, then same rule again apply. Follow the money. Is it tax money, private researchers money, or institution money that funded the research. If its tax money, then the research belongs in public domain. If its the researchers private money, then its the researchers that decide of the research. If its the institution and the research is funded by private inventors, then its the institutions decision. I might not like it when research is not published to the public domain (will considered it a bit immoral), but primarily one should honor the investor with the result of the funding. If that investor is the public, it should be illegal to prevent the public access to to the result. That include universities that is state funded.
P.S. I am not a lawyer and probably completely wrong.
> It does depress me, daily, that I do not have a career in
> physics or chemistry or biology or medicine where I could
> work on "big problems."
Maybe not, but you can work at one: https://jobs.counsyl.com
I work at counsyl and we're hiring generalist programmers, devops, etc.
How am I changing the world? A) By educating a future generation (my own children) in the ways of the world, by supporting their dreams and showing them how the world must function so they can realize their dreams; and B) by working for a company that provides services to its customers to use to make their employees more productive to grease the wheels of innovation and creativity so their own lives are enriched and their own dreams (and their children's dreams) can be realized.
I met some Counsyl devs at PyCon last year, they were wonderful. We talked about meaningful work.
There are so many companies and nonprofits trying to change the world. They need help with software. A partial list:
Broad Institute: http://www.broadinstitute.org (disclaimer, I work there)
Whatever anyone thinks of the periodic surfacing of the feeling that Raganwald was expressing, the fact that it does come up with a degree of regularity indicates there's an unfulfilled need here.
What can be done to help people fill it?
It seems one thing that factors in is that people feel helpless to get started on the path to working on "big problems". What can be done to make it not feel so overwhelming? What can help us all find our way to approaching these questions and actively searching for solutions?
The folks working on TCP/IP back in the 80s could have shared your worries but now it's the backbone for a technology making all forms of business and science more efficient.
Even if you're working on, say, a dating or pornography site, it's hard to work out what value is or isn't being provided somewhere down the line in the calculus that is human achievement. Even a comment you make here on HN could be the inspiration that leads something into a path to greater things.
It's not an empty criticism. It speaks to your credibility. You are admonishing Google and Facebook for working on "stupid" ideas, when you yourself are working on a presumably stupid idea, since you're not saving anyone's life but instead working on a way so that you can make money. How credible can your rant be if you aren't following your own advice?
I would rather hear the same rant from someone in the field who is frustrated because they are "fighting the good fight", not from someone who is engaging in the exact same "stupid" behavior that they are ranting about.
Crying "hypocrisy" is just the "cry wolf" fallacy.
I doubt there is a high likelihood of a meaningful conversation from someone who is screaming "Why doesn't Google stop working on stupid problems and fix this, while I continue working on my own stupid problems".
Total nonsense. So a drunk who's destroyed their own life telling some teenagers about the dangers of alcohol greatly reduces the likelihood of his argument being valid since he still drinks? Ridiculous. Crying "hypocrit" is just ad hominem. Nothing more noble than that.
Nothing of the sort. He's expressing an opinion about things that nobody disputes. Calling him a hypocrite means you don't like his opinion and think that calling him names is a good way to weaken his argument. Of course it's meaningless and defending such silliness on the grounds that this is all about the credibility of an information source is beyond silly.
1) "Physics is like sex: sure, it may give some practical results, but that's not why we do it." - Feynman
Most smart scientists and engineers I know (not just web programmers) work on their problems due to some combination of: they enjoy the problem, they're scratching their own itch, they get prestige from doing the problem, and they make good money doing it. Even the ones that are working on "important" problems.
2) Sometimes it's hard to see the downstream effects of what we do. By improving ad targeting, maybe Google has enough cash to reinvest in something like self-driving cars, which ends up saving untold numbers of real lives in the future.
By spending time on planetary motion (seems pretty useless) in addition to alchemy (eternal youth and unbounded riches? clear winner), Newton has helped solve more "important problems" than anyone could dream to.
Summary: The incentives of people that work in science and engineering are generally far from altruistic. We don't really know enough about the impact of the stuff we do to be able to say what's important.
But you could certainly find a way to help people indirectly. Some of the same talent that targets people for ads is not necessarily all that different from using psychological principles to help them be healthier, for example.
And there's always the path of partnering with someone who does have the required education. Combine that with your own self-directed education in bioinformatics or similar fields and you could definitely make a real difference.
It's riskier, but it also has the potential for a bigger payoff.
The path is there, there is a way.
I'm not sure how to read this as anything but a passive-aggressive complaint that _other_ people aren't doing more about these problems. You try to disqualify yourself from the responsibilities you imply for others, but the fact is we can all be more diligent, if we like, and we can all do work to improve the lives of others.
Guess what? If you _seriously_ try to help other people, as opposed to just posing so, it is really, really hard. There are many excellent reasons for this. Chiefly, people are actually very good problem solvers, and are particularly interested in their own problems. So any one who has a _real_ problem, has a problem that is pretty hard, or they would have already solved it themselves.
For another you have to fight your way through hordes of posers, who want credit for helping but discover that folks have solved all the easy problems on their own. They don't want to do _real_ work, they want to look good, so they chiefly get in the way and muddy the water. And then you discover that "helping people" has become such a poser cottage industry that simply _meaning_ to help counts, and that saying anything remotely unpleasant is cause for ostracism. 'Cause all these folks have to congratulate one another, and tell one another what a difference they're making, which is all kind of difficult if someone is saying "but does this actually work?"
For example, if I explain that it's simpler to tweet a picture than cure diabetes, because tweeting a picture isn't technically that fucking hard but diabetes is a really complicated problem, I'd pop your bubble of woe at how screwed up the world is. The world isn't actually that screwed, and to the extent it is, it has been getting better pretty much daily since 1945. Barring some corners where some major league posers got in charge. If you look at treatment options and outcomes for diabetics I feel pretty sure you'd see a pretty strong and clear progressive improvement. But if the world is getting better then how can you Make A Difference? So what you want to do is complain, and so not having much to complain about is a problem.
If you want a real complaint, go out and try to actually help some people. I guarantee you will very quickly acquire some very real complaints. And that voicing them will get you ostracised by the posers.
So really, the best thing is to shut up and get to work. Failing that, just shutting up is, under these conditions, not a bad second best at all.
No. You can say that all you want, and I defy you. You're welcome to suggest that there is some better use of my time, but there is nothing more chilling to freedom of thought and expression than someone saying "That thought is too rude, too lame, to annoying, cuts too close," or whatever else and therefore cannot be uttered.
It's like "Let he is without sin cast the first stone." That's a passive-aggressive way of trying to cut criticism out of society.
The multiple people telling you to shut up isn't because they are trying to squelch discussion on the topic. They are telling you to shut up because you, specifically, bring negative value to the discussion and you are responsible for decreasing the signal to noise ratio.
In your example about the dumb, drunken football fan yelling at the TV, the people in the bar are now starting to tell him to STFU because they want to watch the game and not have to listen to the useless, drunken ranting of someone with zero credibility.
But this is a kind of club where I didn't post those writings. And when I have discussed them, I've been civil as is our rule here.
We have two ways of saying "This is noise, not signal." One is to downvote. The other, flagging, is reserved for special cases."Shut up!" is not one of those ways. And if you count, my words here on HN have over 100 votes.
If you don't like what I have to say, argue with it and/or vote on it. That's what we do here. This isn't Reddit.
When you sell books on how CoffeeScript is great and then rant that people aren't solving difficult medical device issues, I wish that there was a version of Hacker News that did not include your comments. Maybe someone will make that.
Rude? Maybe. Unfair? Hardly. The OP completely mischaracterizes what the best groups in our industry do, then laments that people aren't helping his friend, and this lamentation is the extent of his contribution to his friend's plight.
Ad hominem means that I disagree with him because of his person, which is not true. I disagree with him because of specific hypocrisy and finger pointing. I am further disappointed that this story is so popular on Hacker News, because I read Hacker News for insightful posts, and this is just demagoguery - popular because it's what people want to hear. That doesn't make him more wrong, but it does make me more likely to say something about it.
pg is good about handling people with kid gloves. He addresses the OPs points in a rational way that is insightful and without reproach. But I don't think that pg speaks to the problem, which is that a popular, long time contributor to the community is apparently upset that people work to make money and that some things are difficult for non-technical reasons. Bad apples ruin a community, and if the community isn't tended to it devolves into blithering noise.
I also did not comment on his original post, but on a comment thread that began with:
And any drunkard yelling at a television is wrong. His non-participation means that he doesn't actually understand the problem, and without that he cannot be anything other than wrong.
Neither of those are ways to disagree with someone's words. That's the Ad Hominem fallacy. What you may mean is that you dislike the fact that I'm saying them, or the way that I'm saying them, or the color of my tie, or something along those lines. Which is a perfectly valid feeling to have, but it isn't disagreement and Hacker News has specific guidelines discouraging incivility as well as a long-standing antipathy to Ad Hominem abuse.
This kind of response further devolves the discussion. I said nothing so flippant, and suggesting so is disrespectful to me.
Neither of those are ways to disagree with someone's words.
Hypocrisy shows that someone either doesn't understand a problem, or that they are not honest in arguing against it. Finger pointing shows that they want someone else to solve this problem for them, which suggests that they feel superior to the issue.
Hacker News has specific guidelines discouraging incivility as well as a long-standing antipathy to Ad Hominem abuse.
To paraphrase your original article, Why the fuck do people on Hacker News always cry "ad hominem" and point to the guidelines so much? Ad hominem attacks are far more common in real life, when people actually know each other. I am only aware of you insomuch as I have read "your words", so why are you so quick to assume that I disagree with you personally?
Your original post is either naive, flippant, or blinded by emotion. It isn't constructive, it denigrates the work of others, and childishly demands that the world be a better place.
Don't lean on ad hominem, that only serves to mask that there are far bigger problems on the table.
You're complaining about social priorities that have arrived at tweetable pictures before diabetes management -- while noting you haven't the diligence to apply yourself to the problem. Well gee whiz I am just not sure I see the point of that particular statement. Except to put everyone on notice of your noble intentions.
And as I noted, at length, it's my experience that this sort of thing does more to hinder the people who are quietly getting on with exactly what you'd like to see done.
So please get busy. If you cannot manage that, get out of the way.
If every person complaining the world should be better would take the time to visit with a mentally handicapped person, or wipe the drool off an Alzheimer patient's chin, or have coffee with the lonely dude in the corner -- the world _would_ be an enormously better place. Better than they dream.
This is obvious. Also, that these things aren't sexy. Which leads to implications for people's motivations.
One reason Jesus commanded that his followers not let their right hand know the charities the left was up to, was that the pursuit of opinion spoils those charities.
This is an old and important problem. I am not sure that some occasional rudeness to the vainly well-meaning isn't part of the solution.
Let's grant that this may be the case in general regardless of whether it influences me personally. It's important to consider the net benefit or loss to a social environment. It could be that incivility does discourage some people from posting things you think are unhelpful or noisy.
On the other hand, such incivility also signals to other people that incivility is acceptable. You may have the judgment to make such a thing "occasional," but can you be sure everyone else will share your restraint?
I think that the HN style as espoused by Paul and as specifically mentioned in the guidelines is to err on the side of civility here on HN, and the evidence so far seems to suggest that civility does work.
Look at this thread. There is some rudeness, but there're lots of perfectly cogent and civil arguments explaining that my rant was flawed.
Which do you think contributes more to HN? Which do you think is most likely to influence me personally in the future?
Because many people, who say they mean well and actually believe they do, have unconsciously shaped the problems to arrive at those solutions most convenient to themselves. I have done this myself. This sort of self-deception accounts for a large proportion of trouble in the world.
Now if we grant that such people exist, then it won't be a surprise that it is mighty goddam hard to talk them out of anything. Because we can all rationalize all sorts of contradictory input, and what we can't, we can conveniently ignore. Again, I speak from personal experience of my own thinking.
So perhaps you might see why whacking someone with something along the lines of "That's ridiculous, snap out of it" might actually sometimes be more effective than sweet reason.
How well this applies to _you_ is beyond my ken. Seriously. Maybe I have it all wrong.
You find my remarks annoying. Ok, but I have your attention -- and it isn't as if there isn't any thought to what I wrote. It's something more than well-done name-calling. And perhaps you'll agree that there are some people, perhaps not yourself, who might not notice a more polite approach. Again, I haven't anything but a guess about _you_. I'm responding to a _post_.
I hope I strive to be civil. If civility actually interferes with communication, is it actually a good thing in those moments?
I hear the same message either way, but one of those also sends a signal--for better or for worse--to everyone else on HN.
As I joked on my twitter feed, I can hardly write a post titled "Why the fuck?" and get upset if people are profane in response. I tend to think of HN as a special case.
Please don't mistake me, I think civility is really important. I'm just saying it isn't always the right rule. And I hope that, when I break it, I break not from anger or pique, but for effect.
But when we comment on the post, we ought to follow our guidelines. As you did, you were able to criticize the post without being rude, mean, or nasty.
Look: if you really want to get into these fields, it's really not that fucking hard. The people working in science are usually not stupid, and there are some geniuses, but they are mostly not ridiculously smart. They're pretty dedicated to their research, but no more than any programmer who enjoys their work enough to stay late on a regular basis. They put in a lot of time and work, but having done both, working in any startup is probably just as much work.
Research can be ridiculous amounts of fun, and it can be extremely satisfying. The progress is a lot slower, more incremental, and less visible than releasing a webapp, but if you're working on something you think is important, it still feels great. But the pay isn't great, the work isn't easy, you need to spend a lot of time in school, and academic politics is a pain. And you have to be ok with the fact that your personal impact will probably be small. (The last is the part that puts a lot of people off.)
If you don't want to do research directly, there are plenty of places to go where you can help indirectly. I work for a company that builds HPC hardware, and some of our customers are labs big and small. There are lots of companies that write research software, or you can contribute to the many open source projects that support scientists. (Witness the huge scientific Python community.)
You did not make bad life choices just because you aren't contributing to "big problems". The world is bigger than science and research, and that's ok. Working on social webapps, because they are more fun and pay more, is ok. But if you're not working on these things, and you're working in startups and tech, it's because you probably don't want to.
Aside: I would love to see someone study the differences between in-person and online arguments.
Politicians tend to say "Here's this bad thing. Those people over there, that do this bad thing? They're destroying our society. They're bad and they should feel bad, and anyone who supports them is bad and should feel bad."
You can see how someone saying the latter, while doing the bad thing, isn't just a hypocrite, but is an annoying judgemental hypocrite. We're just holding them to their own standards.
Some people say that's the problem - don't have any standards any no-one will call you a hypocrite. I'd disagree. Have standards, just don't be a judgemental idiot about them.
Mohammad was trained as a physician, but has had a long-standing interest in software (and has even some experience coding, though we don't let him touch it nowadays).
The very fact that you can think in all three domains make you potentially a thousand times more privileged than most great designers and devs from a start-up point of view.
OTOH, just because you don't have a career in a basic science doesn't mean you can't change the world. IMO, the biggest challenges facing us are in the field of computer science and computer/electrical engineering.
We need to make computers more efficient and we need to find a way to power the future expansion of data centers around the globe. Less than half of the world's population is taking part in the information economy, and already our data centers are using about 2% of the electrical supply. And all we are doing with those is Siri, Maps, and facebook.
If we want our cloud computing resources to do the heavy lifting in the future, we are going to need massive amounts of computing power and a way to supply electricity to that.
I'm not sure these really apply to Bioinformatics. Particularly if you're looking at the research market, you don't need FDA approval to write research tools. And a lot of the current problems are not really research problems but "how to I make these tools easy for non-computer people to use". If you look at things like Galaxy and Pipeline pilot, you may get some idea of what I mean.
So is building twitter, making an iPhone app or anything else. They all may look easier than they might be. But honestly I'd say building and scaling twitter is no easier than building a usable tool for launching Bioinformatics applications (for example).
Anyway, if you're actually interested in any of this stuff with respect to Bioinformatics, ping me (new at sgenomics dot org).
Doesn't mean he's right, either. Just means he's an asshole in a saloon who never wanted to do something, but out of his resentment of all those who've made more money than him, he tries to assert some flimsy moral superiority over them because they made money, instead of doing that stuff he somehow always found excuses for not doing.
Of course, there are lots of edtech startups that have meager ambitions and meager products too, but many are aspiring to be a part of shifting education.
Here's why I suggest something in education.
I'm not smart enough to be a medical doctor or theoretical physicist either, but I have the drive to make the world a better place for my children. And if I can't cure cancer myself, if I can improve the education system, maybe I can pave the way for someone else to cure cancer. Maybe I can do that in a scalable way and pave the way for all kinds of brilliant minds.
This system has its share of barriers too, of course. A lot of edtech startups are smartly starting with a small, doable solution. But many that I know have the ambition and drive to do much more.
There are LOTS of problems in the education system that need solving. If you want a list, email me and I can send you lots. If you go buy an educator a coffee, s/he can give you a laundry list too.
The field of education desperately needs people who have the drive and desire to make a change. Change education, and it will have a cascading effect into other fields too.
For all of the people in this thread or reading this thread who wish more people would address "big problems"-- I totally agree. So get in there! The problems of biology are indeed fantastically hard to solve, but that's part of what makes them worthwhile. And don't worry-- the natural world is so vast and ill-understood that biologists are very patient as long as you are trying to learn; the good ones recognize that there may be an infinity of things you don't understand, but the things they don't understand sum to infinity minus one, so we're all in the same boat.
Cheers, and hope this discussion encourages a few people to pursue the biggest problems they can!
Secondly, as always, follow the money. If you want better medical research, the contact your representatives. There's really no other way - there are plenty of scientists, but to do the research, they need to feed, clothe, and house themselves. This means either doing profitable research (like the iphone) or grabbing grant money (which is where your representative comes in).
Unless there's a profound shift in grassroots approval of grants for medical research, there's not going to be any real change in how things are done. Until there's more grants for the research in the name of the public good, you'll see the lopsided profit-driven research, simply because it pays its own way.
Nothing more annoying than a good person who wants to claim how bad they have it.
Just out of curiosity, can you identify the actual point in time when you came to believe that self-awareness of bad behavior makes that bad behavior acceptable?
I invite you to criticize my words. If your intent is to criticize my speaking my words, I defy you.
To be honest, even your last line doesn't impress me much. I've been told smoking is bad and I never smoked. I've also been told to go to university and work in a stable job. Not all advice from older people is applicable to everyone. I will not regret not being a doctor (or whatever you are advising) because I am happy and the world needs more happy people :)
It is a ,myth that only Science people get the opportunity to solve big science problems.
It just seems intuitive that there is a strong correlation between academic acclaim and occupational success in the sciences, and being classically and comprehensively educated in the sciences.
And the hypocrisy cry is just an ad hominem fallacy.
If I am sitting down for a nice steak dinner with someone and they start telling me that I shouldn't eat meat because of cruelty in modern cattle farming, I'm not going to accuse them of being wrong... but I am going to tell them to shut the hell up. Nobody likes hypocritical whining.
There's a bit of subjectivity to this. Generally when someone makes an argument and the response is merely "you're a hypocrite", the inference is that person #2 believes that person #1 is wrong and that's the best counter they've got. I understand there's some inference on my part, but that's how I usually see it.
Someone does not have to literally say "You are wrong because you're a hypocrite" in order for the fallacy to apply.
Maybe I'm giving people here too much credit.
So maybe I should think about what people are saying even if it doesn't mean that what I am saying is wrong.
1., google did produce google search. i don't think there is a more important product in the last 20 years when it comes to the knowledge of the world.
2., apple's iphone is being used as a platform for health services (to stay in your health example). there are health startups targeting iOS, big pharma as well - patient adherence programs, even diabetes hardware, just look:
3., facebook, twitter facilitate human interaction. see the arab spring, it was not facebook specifically, but the network effect within it helped the people in egypt, etc. to post, share, discuss.
4., even small examples count, just look at BingoCardCreator with it's HN fame. it targets teachers, do you need something more nobler, grandiose than that?
This is some quite "grass is greener" thinking. The world needs all kinds.
If you care about any of these issues, go work on it. Being whiny and taking a better-than-thou man-child is lame.
Personally, there's stuff I care about I don't cry about it in public.
if it depresses you 'daily', then go learn the computer science and make the algorithms you want to see.
otherwise, live your life and enjoy it. and please just shut the fuck up about how hard you've got it.
Which woman would speak up about diversity in conferences if the response was "Shut the fuck up and organize a conference."--Oh, wait...
There are several answers to that.
1. The most obvious is that people need to make a living. People can and do work at some discount in order to work on things they think are important, but it rarely stretches as much as 10x. I expect most workers either don't care or can't afford to.
2. A lot of people do work for nonprofits (the biggest of which is the government), but the number of such jobs is constrained by the amount of money nonprofits can raise.
3. The number of people employed on frivolous things seems larger than it is, because e.g. things designed for entertainment are by their nature more visible than infrastructure. So it is dangerous to draw conclusions based on anecdotal evidence.
Someone is following their own advice:
So regarding hypocrisy, while it's true in certain contexts and under certain conditions, calling out hypocrisy, could constitute a logical fallacy, simply stating that possibility, says very little about how to value it.
Is hypocrisy good or bad? Perhaps the question is ill-framed. Avoiding hypocrisy, can create a powerful resonance between the speaker's aligned actions and words. It may be worth nothing this not a moral value judgement, but speaks to leadership. People on average, appear more willing to follow those with strong and bold congruency, and yet abandon them, when that illusion shatters (aka Lance Armstrong).
That said, my own view is that hypocrisy is generally inefficient, as it appears to increase the noise in the system.* As the proverb goes "talk is cheap" and hence it costs little to put an opinion out there, which is not bad in and of itself, merely that it requires little effort.
Thus with a sea of opinions floating out there, and limited time to process (if your cognition doesn't naturally operate in a frequentist manner), who can you trust?
There does not appear to be a definitive set of answers, however the heuristic of matching words to actions, while not perfect, combined with a test for integrity, has personally proven useful over the years.
*cf bounded rationality, opportunity cost, SnR etc.
In general if one has a slightly more divergent worldview than that of the company in which he/she finds themselves, it's historically been useful (albeit frustrating at times), to be more considered and precise.
Between my best friend, a fellow coder/entrepreneur of ten years, (who has a very different personality), we can communicate in shorthand as he understands what I mean, irrespective of the natural imprecision, that creeps in by wanting to be "good enough" to get the message across. Although the early days of our friendship was somewhat.. challenging.
Some of the usernames on HN that I've noticed that have insightful content, do not appear to reward sloppy rhetoric, and even, I suspect, use it as a filtering signal.
Hence, it would seem rational to at least demonstrate one is willing to embrace the norms of that group, but more importantly to avoid genuine misunderstanding, which has plagued me since childhood.
(I know what a cliche, what a special snowflake etc etc ;) Yes I dislike how it sounds too.
Lastly my own values dictate a personal preference for dialectic over sophistication. But perhaps that's a debate for another time.
Just trying to help a bit :)
It took me a minute to figure out why you were talking about hypocrisy.
Usually it takes a few iterations of a post, to improve the quality or tone, even though from my perspective, the core spirit of message remains unchanged between drafts.
The trick in communication is to be understood on multiple levels, not to simply output claims, irrespective of how accurate they are. Took me two decades to realize that, and still trying to improve. :)
Hence, the feedback is appreciated.
First, you're comma-splicing some of your sentences, making it harder to read what you're saying. Commas have rhymes and reasons to them; and, it is good to know when to use them and where. It also seems like you are too quick to begin a new paragraph. Concepts that connect to one another should be put into the same paragraph so a person knows where one idea (or sub-idea) ends and another begins.
And second, you're choosing to use words that are larger that, while possibly being more precise, actually make you more difficult to understand in a normal conversation. For example, "I find articulating the conceptual stream to be a challenge." "The conceptual stream" is hard to follow. What conceptual stream? Do you mean you're having trouble articulating what you want to say? Then why not say that? "Conceptual stream" is not something usually said in conversational English and means that people will need to parse everything you said, rather than read it. It's almost like obfuscating code, or at least code-golfing. For the right audience it's great; but in other audiences, or in production code, it's just difficult, and un-necessarily so. Remember that in most instances, people online that you're speaking with are conversing at about the same level as a group of chums in a circle, at a pub.
What you say may very well be important; but, remember that being heard is equally important, and speaking in language too high to be followed in a conversation is too high to be heard, especially since so much is already lost from speaker to listener.
I've read some of your other comments in other posts, and I have noticed that you can and do speak in a more conversational tone, albeit fleetingly so, and often by mistake (if you consider it a mistake. It seems more like passion for a topic seeping through); so, I know you still can.
Long story short, know your audience.
A fair point. While some statements could be a somewhat unfamiliar/unusual, it only take a little more effort to process, if one just thinks about it.
eg "conceptual stream"
Take the concept of a stream (aka a social network news feed, or a data stream).
Take the concept of a concept. Then merge the two. Hence you should have an image of a stream of concepts, interconnected via a graph.
Another way to look at it could be to picture a sports commentator. We see him speedily narrating the action as he watches the game. Event's are often linked: "He hit the ball", "Now he's going for 3rd base", "Oh and it's a homerun", "the crowd is ecstatic"
Now what if we replaced the real word events, with concepts?
Sometimes events are completely unconnected too, concepts work in a similar way (at least for me).
Now in my head the nodes on the graph connect, although this may be non-obvious. Nodes could correlate with concepts and edges roughly with causality. How accurate that graph (map) to reality is, would always open to honest debate (if the goal is towards improving accuracy versus trying to score points).
It's difficult perhaps, because in some ways probably different to how you usually operate. There is also the very real possibility, that many simply find metacognition, largely uninteresting (which is fine too).
Continuing this theme, there are some are highly visual thinkers (such as Temple Grandin ), while for myself, for the most part am most comfortably naturally operating abstractly, conceptually, strategically and focusing on outcomes. In theory I tend towards impartiality, but in practice I'm biased towards a utilitarian framework.
Many highly intelligent people here operate highly tuned abstract pattern matching. I simply don't work like that, and yet I can appreciate its general effectiveness. I do feel genuinely happy, if on occasion, the courtesy is reciprocated. Ideally this would be irrespective of whether at that point in time, there happened to be agreement or not.
"Stream of Consciousness, focusing on the concepts that arise"
I know it's already been said, and English is obviously not your first language, but you should try to tone down the verbiage a bit:
", while for myself, for the most part am most comfortably naturally operating abstractly, conceptually, strategically and focusing on outcomes"
No need to repeat "most"
"most comfortably" is redundant with "naturally"
If you are focusing on concepts you can't be focusing on outcomes
It's just that I would have thought that a problem that so many people had (again, such as obesity, diabetes, etc.) and that led to such horrible quality of life would cause there to be tons of money ready to pounce on a solution (and would have cited the depressing amount of resources thrown at things like diet pills, as well as the number of Google ads people have placed on the keywords "diabetes cure", as evidence).
Let me put it this way. How many people do you know that have made it big selling out to a MegaCorp? Not many, I'm sure, but now how many people do you know that have cured diabetes?
Even though making it big in the startup world is not a sure thing, curing diabetes is even less of a sure thing.
The minimum viable cure for diabetes still has to be a cute for diabetes. This is unarguably a harder problem to solve than "apply a filter to a photo and put in on the web."
An unhealthy diet plays a large role in obesity and diabetes (the other one being a sedentary lifestyle). Research has unsurprisingly shown that if people know how to create food from scratch and care about a healthy diet, their risk to become obese reduces significantly.
My startup appetico tries to create cooking apps that are as engaging as Instagram, Pinterest, Angry Birds etc. because otherwise kids most likely won't start cooking for themselves.
That is a really tough story to sell to investors in itself. People won't go back 20, 30 years later and pay us because they realize that they are not obese because we got them into healthy cooking. It's easier (but still hard...) to sell that cookbook publishing is a $1bn industry that is still growing despite falling sales for books overall.
Shameless plug: We're looking for seed investors and basically everyone else who would like to tackle this problem with us. Shoot me a mail at whateverhuis at gmail dot com!
Trends and bubbles seem to be exaggerated by the fact that in our globalized world the media reporting tends to synchronize over large parts of the globe when it comes to those trends (e.g. Facebook being hyped almost universally prior to its IPO).
I think this is why YC and other incubators exist today to help developers financially so that they can work on Real World Problems rather than coming up with another photo sharing apps?
I also wonder why YC did not encourage devs who want to work in such domains. Aza Raskin's Massive Health is the one which comes in my mind that is doing something for humanity.
Why the fuck are the greatest minds of our generation toiling away on a book publishing platform? Oh, right, because you think it's important. Guess what- we all have different opinions. Is book publishing more important than dating? Before you laugh, think about it- finding someone to share your life with is very important to a lot of people. A lot more than will ever publish a book.
It's pretty depressing to see this upvoted as far as it has been on HN. What is it actually saying? It's like one of those stupid motivational posters (only negative)- all emotion-tugging, no depth.
Why are you making a book publishing platform and not following your own advice?
I think that publishing platforms are important. Connecting people to knowledge (slow content) is probably more important than finding the optimal feed format for consuming the daily news and gossip (fast content).
Screw up at Facebook, you get yelled at on Twitter and your share price dips for a few days. Screw up a medical device, you get sued out of existence.
This probably doesn't explain the whole thing, but it is certainly related.
Or, you know, people die.
Of course this is nothing new (Economic version: "That Which is Seen, and That Which is Not Seen"). Just another cognitive bias.
There is some more-or-less optimal middle ground between too little and too much regulation, but I don't think we're on it now. In fact, maybe it would be worthwhile to have a two-tier system, one for ordinary medical devices, another for experimental "this will probably kill you but perhaps you have nothing to lose" situations.
Also it did help that the users grew confident in it over time. It was not like these overnight success stories (not even success story) which you hear all over the news :)
All we need is just one state with medical contractual freedom.
Spin the FDA off as a non government agency, with no force of law behind it, let it create a voluntary approval process (something akin to the UL process for approving home electrical devices, for example) and let it be.
In ayurveda, there are 3 types of medicines, food, herbs and poisons. The current allopathic system is purely the last type. It is heavily regulated because it is big money. There is not big money in the first two. (You may think there is money in food, but not fresh food which you actually have to prepare and eat within an hour, not prepare and let sit and pump full of preservatives).
I know someone, kind of financially successful, who swears by everything that his team developed a cure for AIDS, but they found out after years of politics that they will never get approval from legal entities to release.
There are a lot of people that proclaim that have cure for AIDS/cancer/whatever, and many of them blame the establishment for blocking it. The same history appears with perpetual movement machines. Without more proof, probably it just another too optimistic investigator, a scammer or a crackpot.
Can you put me in contact with them?
I have met tons of engineers who work on interesting problems like building models of query patterns to detect spiking queries (Google Trends and Google Hot Trends, all publicly accessible: http://www.google.com/trends/), Gmail, Maps/Directions/Traffic, improving (machine) efficiency of Google Search, and tons of systems problems/architectures like MapReduce, Dremel, etc. And people I haven't met are working on everything from Flu Trends to Driverless Cars.
This oft-repeated claim that Google is squandering a bunch of engineer talent building things that don't improve humanity reflects a distorted view of what Google engineers do, one that is easily refuted even by the publicly-accessible information about Google's engineering accomplishments.
I'm glad that Google is working on things like automated cars from the same revenue that they get from something as simple as online advertisements.
No doubt. When I was diagnosed as a diabetic a few months ago, one of the first things my doctor told me was "get online and research diabetes". Now, he knows I'm the type that would do that anyway, and that I try to be a very active participant in my own health-care decisions, but still... rather than trying to recite a laundry list of data and dump it into my brain, he's basically tell me "go use Google".
Heck, as far as that goes, my doctor routinely Googles things himself, while we're talking. Just a couple of days ago, we were talking about some test I might need, and he's going to Google and looking up stuff while we're talking.
So yeah, Google are helping people in any number of areas, albeit indirectly.
Sure people can get taxis but there's much more of a logistical impediment. You have to call a cab (which will arrive in an unpredictable amount of time, especially on busy nights when you want it most). And you have to leave your car at the party and find some way back to it the next day. If your own car could drive you home it's an absolute no-brainer.
What, I cannot help but wonder, will be the proverbial fly in the ointment when self-driving cars take over the market?
I'm yet to see an ad that wants me to find a good (for me) deal on a product I want.
Certainly I would never say this goal is comparable to anything in medicine, but the domain does have ambitions beyond simply making money.
Maybe I'm misinterpreting the data here, but it looks like many people and many millions of dollars are devoted to solving real world problems like the one Scott Hanselman has.
 General Disease research numbers http://report.nih.gov/categorical_spending.aspx
 Diabetes funding by project http://report.nih.gov/categorical_spending_project_listing.a...
Blindness, amputation and kidney failure are no longer guaranteed and I'm grateful as heck for that. For now I'll count my blessings: one of which is the fact that my wife has yet to find me laid out in a diabetic coma -- something that was very, very common less than 50 years ago.
Yes, died essentially because the equipment wasn't as good back then (he was born in the late 1930s, died in the 1980s) as it is now.
He also taught me to program when I was 7 (by pairing together on a ZX Spectrum!).
Awesome that his hacker spirit lives on in you...
I realize that what works for me won't necessarily work for others, but I have a really hard time complaining in light of the fact that I regularly achieve A1Cs of less than 6.3 with nothing more than a glucose meter, syringes and some Humalog. Maybe I'm lucky, but testing sugars 4-8 times a day and injecting before every meal isn't hard work.
Perhaps our demise will be miserable but for now I'm grateful for my current quality of life. It could be so much worse.
In the meantime, here's to fighting the good fight.
How much is paid by those producers of sugar in tax, and how much of that tax is used for research?
I agree with your general point though.
Sugar production in the US is heavily subsidized.
Thankfully, the inverse is largely true as well. Develop diabetes, and if you lose enough weight, you can often avoid the need for meds altogether. I was just diagnosed as a type II diabetic about 3 months ago... they originally had me on injectable insulin and Metformin, but as I've lost weight (17 lbs in ~ 3 months) and switched to a low carb diet, I've been able to stop taking insulin and still see my blood glucose numbers move closer and closer to stabilizing in the normal range.
I'm hoping (and my doctor seems confident) that if I lose more weight and stay active (and eat right) that I'll be able to drop the Metformin eventually.
One thing this experience has taught me though, has been a much greater appreciate for the evils of simple sugars and high glycemic index carbs. I now look at a bottle of (non diet) soda and the idea of drinking that shit just makes me sick.
A 3" orange has about 14 g of sugar.
12 oz (a 355 ml can) of coca cola has 39 g of sugar.
Maybe smart people don't care about money all that much, but they want their lives to not suck, their effort to not feel wasted, their identity not wrapped up in the service of dysfunction and politics. There are not many places where you can better humanity for a living and live the life such a person deserves, and it is not the job of humans to sacrifice themselves for no reward. That's why people who do so, effectively, are so rare.
Here's a guy who left the ivory tower for Google: http://cs.unm.edu/~terran/academic_blog/?p=113
I’m concerned that the US — one of the innovation powerhouses of the world — will hurt its own future considerably if we continue to make educational professions unappealing.
I don't think most of our medical breakthroughs in the last 50 years came from geniuses either. They came from mostly regular people, who put the perspiration in and slaved away trying and failing time and time again to deliver life saving products.
The sad thing is these people aren't praised for their work and these people have a much higher bar to set. These people aren't any more gifted than the guys at Google. They just made the choice to work in Medicine and not Software Engineering. To me post like OP's say "To everyone who has done anything in medicine in the last 100 years, your achievements don't matter because you aren't as famous as Rob Pike."
Why the fuck does this guy think that the engineers at Google would be have half as good as the researchers at Johns Hopkins? What special quality do they have that allows any field they enter to turn to gold? Is it really the case that Google Engineers are super humans or is OP ignoring the hundreds/thousands of researchers who are working towards a cure for diabetes?
Yet I can't think of a single innovation I've seen from them. Good governments, great fashion, cheap furniture, sure. But what is the innovation they speak of?
Fwiw, Iceland was number one last year. Was it for their constitution?
My point is that I don't think you really have to look into history for "when American was dominant in innovation". (And this is coming from a major cynic of current affairs in the US!)
It can be noted that most people studying engineering in Sweden go on to work for companies like ABB, Volvo, Ericsson, Scania etc.
Good question. How I'd answer for the 1940s-60s depends heavily on what you consider the status of research labs that were outside academia, but rather academic in terms of personnel, style, and management: the national labs, the NSA, the Manhattan Project, Bell Labs, etc.
If that's included as honorary academia, I would feel comfortable saying that "academia" (or perhaps "academia-plus") had most of the geniuses of that era.
Why do we write posts complaining about other people not saving the world?
We do things we enjoy, things we're passionate or curious about, things we care about or have no choice but to do them. Glamour is a factor. Money too.
Perhaps if I had diabetes, or someone very close to me was suffering from the disease, then I would spend some time thinking about how to more efficiently manage one's blood sugar levels. Perhaps if I were closer to the realities of obesity, then I Move You (my former startup focused around getting healthy through social pressure) would have worked out differently. I learned that this isn't something I'm passionate about, but I know there are others who are.
I couldn't care less if Facebook didn't exist because humanity focused it's work into solving real problems. But some people just don't care. As long as they are living their good life... who cares about diabetes?
The biggest problem IMHO is our generation's goals. Money, money and more money.
If the world provided better ways for us to help each other instead of distracting us, while they suck work and money out of us, until we die. Imagine how different everything could be...
I will work hard if there is an incentive. I will not work hard because someone is trying to guilt-trip me to.
Our own fear and depravity damn us to these outcomes. :(
Is Empathy possible?
Who are they?
And what is Money that you make such a fuss about?
Why humans should care about others?
If someones not-well being is affecting my well-being then I will care.
If someone is suffering and that is making me feel bad, I will help, because then I will feel good, It have nothing to do with knowing how they feel or wanting to help them.
Realize that you are ultimate cause and driver. You do not have empathy, you have selfish selfish needs to feel good, and you invent all sorts to put yourself in a way of distress, so you could find a way back to nirvana, and then you could throw more trouble in your way.
Distractions, I see no difference between playing video games till you die or discovering cure to aids/cancer and find out the meaning of life. It is just something that helps get rid of boredom.
There is no higher goals, causes. You make up words. And sometimes you will be disappointed when a man next to you do not live by your standards. Then you can engage him in healthy discussion, or war, to come to some sort of conclusion :D
Maybe people aren't solving medical issues because it's not easy. Case in point: a man by the name of Thomas Shaw engineered a syringe that after it's use the tip retracts inside of the syringe to prevent people from jabbing themselves, an obviously genius idea, right? He's worked on the design for over 15 years and has failed to crack into the market, although accomplished many other notable contracts and things other budding start-ups wanting to crack into the medical market could only dream of. Other companies have copied his device, he's had to fight even though his device has been proven to be the best in comparison to others.
The medical industry is not only tightly regulated, it's heavily infiltrated by super lobbyist groups. Doctors taking kickbacks for exclusively using a particular medical supplier or company regardless of safety or price.
Having said that, what makes this guy think people aren't out there solving problems? While diabetes is a serious medical issue, it's manageable. But I would much prefer resources are allocated to illnesses where they're only treatable for so long before you die, like you know cancer and leukaemia. Be grateful you have a condition that if managed properly you can still live a normal life unlike those who are bed ridden and slowly dying from cancer because even though the treatments they have can cure them if caught early they make you extremely sick in the process.
Writing a blog post comprised heavily of expletives that most people immediately reject is not really promoting a discourse.
Want to be a grad student? 80-90% pay cut. (Unless you go to Switzerland and then it's closer to 70%).
Want to be a university research programmer? 70% pay cut.
Removing economic considerations, would I rather be researching auto-immune disease? Sure. But 'doing good' means compromises like buying a house at 45 instead of 35.
No one asks doctors to make these compromises.
Edit: If someone wants to deposit $2m in my bank account I'll quit my job on Tuesday and go to grad school.
Grad school pay for a CS PhD is about $20K-$30K, assuming full funding, not a good assumption.
Run the numbers when you move the wage bar down from the 70-110K down to 20-30K (almost certainly without spouse/family health insurance) for about 4-8 years; then the followon work at a University won't pay well. Think about how many people would leave 30-40K on the table to go work for a university instead of doing ads. While most people aren't aces at finance, they can do the basic math that this calculation involves. :-)
The key problem, of course, is that research structures in the US are not designed to be profit returning; if they were, they'd look different and the really off-the-wall stuff wouldn't be done.
I, of course, am stupid enough to have gone for a MS, and am planning on pursuing a PhD. Hopefully I can get a job afterwards.
In the case you had $2M: Have you consider that reasearch problem are far longer and thus far less exciting than the ones we, programers, are used to solve?
pile of money
But my focusing on the stuff I'm good at hasn't stopped other people from doing (what my doctor friends decribe to me as) extremely interesting research in the health area.
Seriously, great programmers are needed in bioinformatics, engineering and infrastructure. Some already are there, but the field is generally unglamorous and you can get much better pay for a job that doesn't involve your deep knowledge of microcontrollers at all. Bah, even if you're a civil engineer starting with just a basic knowledge of programming, unless you get lucky you'll get incentives to switch into developing knock-off websites way too many times. The chance of return on improving your basic programming skill to average is just higher than on improving your decent material engineering skill to superb.
And what are some of the "pretty good ways to make a good deal more money more predictably" that you're referencing?
so.. you are saying you need to.. be one of the best minds?