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Why the Fuck? (raganwald.posterous.com)
911 points by mehulkar 1786 days ago | hide | past | web | favorite | 499 comments



My fellow HNers:

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'm not smart enough" - this is not an excuse.

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.

[edit]

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.


Note: legally I cant "launch" these because I am just some guy but if you would like to see full working versions or my entire portfolio please email me. email is on profile.

[edit] "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.


Why can't you launch them as some guy? I see people giving diet advice all the time, and making money off selling things to go along with it.

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.


Show me where to get doctor case history and I can do the matching website for you => http://maxdemarzi.com/2012/10/18/matches-are-the-new-hotness...


1) "Smart" and "educated" are not the same.

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.


When I mean big I am referring to problems that will help lots of people when solved. Things of a much more practical nature than Physics.

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).

[edit] 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.


"Solving" diabetes implies acting on the biological root of the problem. This makes it a biology/chemistry problem, which is certainly not physics, but also not really the sort of thing apps are good at solving.

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.


> I created software that generates meal plans according to my Crohn's symptoms

You should also consider making gut bacteria for zonulin production.


I was considering trying to make custom pro-biotics but the cost are extreme, with that said; this is still an area I am very interested in. I have reason to believe that probiotics custom tailored to the patient could be an order of magnitude more effective.


OT but no email in your profile, please contact me.


Sorry about that; a@hackingla.com and I sent you email :-)


As someone who switched from a nanoengineering phd focused on medical diagnostics and blood analysis (including some diabetes work) to an internet rating startup, I have some opinions on this matter.

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.


As someone who has always viewed web technology as trivial/frivolous when compared to something as noble as biotech, I for one, out of genuine curiosity and with a goal of possibly updating my beliefs, would be interested to hear about what kind of impact the improvement of a rating system would have.


A short question: have you ever worked in research? Or know well anyone working in academia?

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.


Very good points. I work as a bioinformatics scientist at Novo Nordisk, and we take our jobs very seriously in trying to find medicine for diabetes and other autoimmune diseases - and we feel lucky to have this possibility of success. It is very difficult because of many reasons, especially because each iteration (drug) takes years and costs millions of dollars to try out and hundreds of patients to volunteer to inject it into their body.


And one more point (also: the rationale for regulations in medicine) - in programming you are allowed to risk a lot more. Create a social network and the it fails? No problem! Running out of money so you need to shout down you server? OK!

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.


I think you're being a bit unfair to google, apple, and even, as much as I don't want to say it, ugh, facebook. And I think this comes from trivializing communication.

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.
As someone in the biotech space, this is by far the biggest factor. When you are dealing with humans, crashes and bugs mean deaths. Deaths mean increased regulation, often under the mistaken assumption that more rules would prevent engineers from making bugs. Modern testing and build systems might, but regulators aren't keen to change their testing systems, many of which were encoded by legislation decades ago. For example, adaptive clinical trials have been known to be theoretically superior to the Phase I/II/III design for 15 years, yet are still in limbo[1] at the FDA; their proponents are still banned from trying them out. Facebook does not need a Federal Software Assocation to sign off on its new unit testing framework.

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[2], 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 [5]:

  [Newsweek:] What exactly would constitute a “medical   
  claim?” Would pointing people to medical research papers 
  [qualify]?

  [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 
  follow it…
Another example [6]:

  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.
And one more [7]:

  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.  
Think about that: criminal penalties for violations of laws that "won't be that easy for people to follow", where knowledge or participation in the alleged violations is not necessary. And the law is not static. The FDA also can and does write "guidances" outside of the legislative process which will make your business model illegal overnight or vastly more expensive due to unanticipated regulatory costs. Google does not need to guess what the DNS protocol is or will be in 2013.

For just a taste of how all this plays out, look at the FDA's ongoing attempt to regulate[8] 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[5] people access to their genome without a prescription. Look at the fact that they issued a record 10000+ 483s in 2011[9], 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[10], causing a massive shortage of injectables which they blamed on industry profit seeking and used to gain[11] 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" [12], 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   
  Health.

  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”).
I know it sounds surreal, but they are arguing here that you only control your own body with respect to abortion, intimate relations, and euthanasia. Everything else is controlled by the FDA, yea even unto your death from cancer.

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.

[1] http://jnci.oxfordjournals.org/content/104/18/1347.extract#

[2] http://www.fiercepharma.com/story/genzyme-submits-175m-fine-...

[3] http://www.ivdtechnology.com/article/letters-labcorp-show-fd...

[4] http://www.fdalawblog.net/fda_law_blog_hyman_phelps/2011/03/...

[5] http://www.thedailybeast.com/newsweek/blogs/the-human-condit...

[6] http://articles.washingtonpost.com/2012-12-25/news/36015727_...

[7] http://www.gatewayfda.com/fda-regulations/under-park-doctrin...

[8] http://m.spectrum.ieee.org/biomedical/devices/the-fda-takes-...

[9] http://blog.fdazilla.com/2011/11/fda-issues-483-every-50-min...

[10] http://www.forbes.com/sites/aroy/2012/06/15/how-margaret-ham...

[11] http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm050796....

[12] http://www.organicpastures.com/pdfs/FDA%20dismissal%20docume...


This is why I think that this revolution will be led by hacker/patients and not business men / politicians. I am not trying to be dramatic but I will literally die for this cause because I spent my entire life sick, in bed, shitting blood and trying what everyone else wanted me to.

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.


From experience, a business can make a difference in how the FDA polices a segment of the industry. You need scientists, who really know the domain (and, perhaps, have some contacts at the FDA), who can try to set the bar with FDA.

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.


what does "doing it my way" in this context mean? What did you try and how did you research it?

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.


Their way == Prednazone, Asacol / 6MP

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.


I'm very glad this worked for you. I don't have Crohn's, but I also have an auto immune disease called Ankylosing Spondylitis. For many immune conditions there seems to be an environmental trigger, or something that makes it worse. There is quite abit of research that many of our conditions are caused by interactions with the bacteria in our gut and our immune response to certain food. I saw your other posts about working on tools to help people track these things, I commend you. There is a large body of people who could potentially benefit from this work. Not just people with Crohn's, but many autoimmune conditions. Keep on trucking and I wish you luck.


To the best of your knowledge, would it be illegal (notwithstanding any copyright claims) to produce an interface that would make FDA compliance easier?

Examples: - 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


Good question. Broadly speaking, the whole regulatory space (not just FDA, but all other agencies) is indeed a massive business opportunity. There are basically two ways to operate here:

  Option 1: reduce costs of complying with FDA. 
  Option 2: reduce the power of FDA.
Option 1 means automation of form submissions, NLP/data mining on past enforcement actions, search engines for FDA.gov like FDAZilla, reproducible research templates for regulatory filings, that kind of thing. That helps, but only up to a point, as the FDA themselves is not very tech savvy and will look askance at any attempt to significantly streamline the process. From their perspective: streamlining means regulators will do more work in a shorter amount of time for no increase in pay, which they don't want to do, and which may well be perceived by them as aggressive behavior on your part (moving too fast). They think in terms of years to clearance, not days or weeks.

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 agencies.

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 accurate.

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[4] 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.

[1] http://thehill.com/blogs/healthwatch/medical-devices-and-pre...

[2] http://www.nytimes.com/2011/02/10/business/10device.html?pag...

[3] http://www.medicaldevices.org/system/files/FDA%20impact%20US...

[4] www.emergogroup.com/files/fast-access-markets-slides.pdf


> 4) Imagine if Harvard, the Mayo Clinic, and Cedars-Sinai could suddenly clear drugs and devices like the FDA.

none of those entities have sovereign immunity!


Right, but if there were a private system similar to the one in which Underwriters Laboratories operates, that'd be preferable. I'm not sure how to get there from here, which is why I said "I'm not sure how you'd pull this off".

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.


Something like this already exists, albeit in an early stage: http://www.legitscript.com/products/IBUPROFEN (see the product search input on the left-hand side)


We need the FDA to regulate drugs and medical devices. There's too much potential for quackery. I don't think removing the FDA is going to find a cure for diabetes. It's a fundamental research problem at this stage. Stem cells are showing some potential as a future cure. See the article below.

http://www.medicalnewstoday.com/articles/252759.php

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.

http://www.cirm.ca.gov/


Let's go point by point.

1) Regarding diabetes and the FDA:

  I don't think removing the FDA is going to find a cure for 
  diabetes.
Well, before the FDA as such even existed, Banting and Best came up with the idea for insulin supplementation in 1921. A patient was treated by 1922. They won the Nobel Prize by 1923. Today's FDA would have made their methods completely impossible and they would have been criminally prosecuted.

http://www.nobelprize.org/educational/medicine/insulin/disco...

  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 
  extract.

  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.
  
Point: the FDA need not exist to make progress against diabetes. That is, federal regulation is not a necessary condition.

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. 
So that is the key question: is the goal to allow rapid technological progress or is the goal to prevent quackery? You can of course eliminate all quackery by rejecting all new devices (high false negative rate), and many major innovations sound like quackery at the beginning. Here's another Nobel Laureate, Barry Marshall.

http://www.nobelprize.org/nobel_prizes/medicine/laureates/20...

  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.
3) Regarding researcher income:

  We should be paying medical researchers similar incomes to 
  engineers at Silicon Valley tech firms.
The thing is that the entire higher education establishment is about to crash hard with the student loan bubble. I think an alternative paradigm is to reduce the equipment costs associated with starting a bio lab, via diybio.org, biocurious.org, openpcr.org, and the like. This goes in hand with broadly reducing capital costs (regulatory + equipment). In so doing it will become easier to do biotech startups with a Valley culture, and the salaries will follow.

4) Concerning stem cells:

  California taxes are funding one of the biggest research 
  efforts into stem cells.
Nothing against CIRM, they're fantastic. But the FDA is forcing the resulting stem cell startups overseas.

http://blogs.nature.com/news/2012/10/texas-stem-cell-provide...

  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”.
http://gizmodo.com/5881492/according-to-the-fda-your-stem-ce...

  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 
  called Regenexx-C.

5) At the end of the day

  We need the FDA
You might want to look at the FDA Alumni Association (http://fdaaa.org) or the membership list of the Alliance for a Stronger FDA (http://strengthenfda.org/members/).

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.


No one was arguing that point. The FDA does good things. The FDA does bad things. The question is whether the FDA is more helpful than harmful.

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.


Sure, I am also happy that there is some regulatory body at all, but without consistent testing criteria and regulatory standards, it simply cannot be as effective.

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.


I think you would be rather surprised what those standard really are. Far lower than you would expect.


I am aware of those standards. I'm also aware of how much worse it was before we had them.


Exactly, the solution is to fix those standards, not remove them. That's why I tend to not take Libertarian "certification bodies for safety, not 'regulation'" ideas seriously.


> > 2. There are regulatory obstacles for businesses. > As someone in the biotech space, this is by far the biggest factor. When you are dealing with humans, crashes and bugs mean deaths. Deaths mean increased regulation, often under the mistaken assumption that more rules would prevent engineers from making bugs. Modern testing and build systems might, but regulators aren't keen to change their testing systems, many of which were encoded by legislation decades ago. For example, adaptive clinical trials have been known to be theoretically superior to the Phase I/II/III design for 15 years, yet are still in limbo[1] at the FDA; their proponents are still banned from trying them out. Facebook does not need a Federal Software Assocation to sign off on its new unit testing framework.

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
The reason for this is regulation and IRB. I direct you to Banting and Best (which I also linked below):

http://www.nobelprize.org/educational/medicine/insulin/disco...

  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 
  extract.

  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.
Two years from idea to animal trials to safety trials (self-experimentation) to human trials to Nobel Prize. That was when pharma moved at the speed of software; that is what a landscape free for innovation can produce.

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.


http://en.wikipedia.org/wiki/Thalidomide#Development:

"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.[9] 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.


So, a few points (I didn't downvote you).

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.

http://arstechnica.com/science/2010/11/fda-sidesteps-safety-...

  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.
2) Second, the formal IND fast-track program you mention is very political to get into (on the device side there's something similar called Pathway to Innovation). Moreover, FDA doesn't count days like you and I count days. It's like an NFL game which is 60 minutes but actually takes three hours; every time they email you back, it stops their clock. And they can email you back to ask for data that takes months to gather. This is from a device consultant but the principle is the same for drugs:

http://www.myraqa.com/blog/how_long_is_90_days

  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.
3) Third, regarding thalidomide, as you probably know there were three major catastrophes that increased FDA power (1906 publication of the Jungle which birthed proto-FDA, 1938 elixir of sulfalinamide, and 1962 thalidomide) and another major catastrophe in the early 90s that reduced FDA power (FDA delays on AZT and slowdown of AIDS drugs).

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.


While I don't disagree with most of your points here, I want to know more about your opinions on efficacy testing. It is definitely a strange corner of the FDA mandate and seems most justified by their marketing restriction power---the principle that marketing medical claims should be done from a position of earned, valid authority.

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.


So, regarding efficacy testing, I think the costs/benefits have to be assessed in full context. If you go back to the time before the FDA, it was a time of incredible wonder drugs and useless patent medicines. Kind of like the Internet: the price of being able to put up a domain name in 10 minutes with no centralized check for accuracy means information proliferates and the web/market/search sorts it out.

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:

http://www.informationisbeautiful.net/play/snake-oil-supplem...

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[1].

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[2] 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[3], 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.

[1] http://www.mc.vanderbilt.edu/lens/article/?id=116

[2] http://dailymed.nlm.nih.gov/

[3] http://www.helpineedhelp.com

[4] http://www.pharmgkb.org/

[5] http://www.erowid.org/


To take the internet domain registration metaphor further, it also requires a centralized value authority (google) in order to be navigable. In some sense, Google's primary task is spam filtering---analogous to efficacy guarantees---which enable efficient information gathering.

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.


> Two years from idea to animal trials to safety trials (self-experimentation) to human trials to Nobel Prize. That was when pharma moved at the speed of software; that is what a landscape free for innovation can produce.

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.


First off, I am happy that we both seem to agree on a qualitative fact: there is indeed a tradeoff between what statisticians call type I and type II errors. At one extreme, you can let everything through, advance technology rapidly, and suffer some side effects (type I bias). Or you can block everything, stop technology, and suffer no side effects (type II bias). If we agree on this qualitative point, the key is whether we are currently at a Pareto optimum. Is our current system optimizing the type I vs. type II tradeoff? I have a numerical scenario below which you can critique, but first to your points.

  It's faster to run experiments on animals than people. 
I'm not gainsaying the utility of animal models. I just think the goal needs to be to get to humans as soon as the safety data is in, because people are dying.

  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.
Well, the reason sulfalinamide/thalidomide were heavily covered in 1938/1962 respectively was that those were relatively rare events. So I would somewhat disagree that the number of lives would be unknown. But, ok, let's take as a given that some would die. On the other side of the ledger, we both agree that tens of millions of people each year are dying from cancer and heart disease. So let's consider two scenarios for a cure for condition X, which kills 1 million people per year.

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
In scenario II, you had

  - 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
So scenario II saves ~7 million lives. Feel free to play with the numbers, but that's the kind of calculus I think we need to engage in, one that explicitly reckons with the cost of delay. In reality, the number of deaths attributable to R&D won't be close to 1000, though it won't be zero. But there is no reasonable scenario in which R&D actually consumes anything close to as many lives as the disease itself.


My engineering services business does regulatory affairs and compliance engineering work for medical device manufacturers, in addition to embedded SW. IEC 62304 and IEC 60601-1 3rd edition, etc. I can say that the parent comment is spot on. Great summary, IMO.


There is a other point of view, if one looks at who is paying the cost of the medical research: The public.

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.


Lot of important points to engage there, and generally agree with the spirit of the comments. I think many biotech startups would instantly take a deal that gave them and their patients the ability to opt-out of FDA, in exchange for some demonstration that they aren't using public funds (e.g. committing to not use some fraction of the research literature, ineligibility for all govt grants, etc.).

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:

http://www.fda.gov/downloads/Drugs/.../Guidances/ucm079342.p...

  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.
How crazy is that? For many years official FDA policy was that a generic maker had to actually be sued for patent infringement - and win in the lawsuit - as the condition for receiving a 180-day monopoly!

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[1], 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 [2] 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.

[1] http://www.forbes.com/sites/matthewherper/2012/02/10/the-tru...

[2] http://arstechnica.com/science/2010/11/fda-sidesteps-safety-...


> Finally, regarding funding, yes, NIH spends about $31B per year, which is a lot. However, drug companies spend $4B per drug approved[1], which is an incredible amount of money when multiplied across all drugs.

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
This is the Light and Warburton study. The short answer is that it's kind of like a freshman saying "I could build Facebook overnight" by wgetting Facebook's CSS/JS. But for anyone in engineering who knows what FB's backend infrastructure is like, they know it would be nontrivial to clone FB.

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:

http://pipeline.corante.com/archives/2011/03/07/the_costs_of...

http://pipeline.corante.com/archives/2011/03/08/that_43_mill...


I prefer a more clean structure in which one pick one scheme and go with it. If tax money is supposed to be the major way to fund medical research, then the goal (effective treatement) and the cost (tax dollars) should be combined to get the most treatments for least amount of dollars. The current system is not cost effective, and no attempt at even trying to bring it into some form of cost effective control has even been made. Current system is to first pump tax dollar at research, then throw state monopolies and exclusive right to medical companies so they will take the tax produced research and produce products, which in effect means that the products with the most earning under least effort gets made. Treatment effectiveness just happens to get lost in the transition, and get traded for profit vs production costs. That can not be the best use of tax money, or the power of granting state monopolies.

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.


The other solution is for the U.S. to reign in all the statutory laws that have dropped the requirement of mens rea. Originally to be criminally guilty you had to have intent and action. Over the last few decades we have been progressing or law system to exclude intent making it possible to be found criminally guilty of crimes you had no intent on breaking. Including a strong default of mends rea in all laws that do not otherwise mention it would allow defendants to use the laws convoluted nature as a valid defense.

P.S. I am not a lawyer and probably completely wrong.


Thank you for this post. It should be a Wikipedia page about regulation.


  > 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."
Seconded, though I could never find the words to express this before. How the fuck is anything that I'm doing right now helping to make the world a better place? How could I even begin to make a difference with my life? Making software is the only thing that I'm marginally proficient at--I'll never start a company that sends a man to Mars or discovers the cure to a horrifying disease. Is making the next $BIG_SOCIAL_NETWORK the best that I have to aspire to?


> I'll never start a company that sends a man to Mars or discovers the cure to a horrifying disease.

Maybe not, but you can work at one: https://jobs.counsyl.com

I work at counsyl and we're hiring generalist programmers, devops, etc.


But we all can't work there. Not only are there not enough jobs at That One Company That's Changing The World, someone needs to provide the tools and services the business is built on; all the ancillary things that allow Us to make progress (computers, operating systems ... vehicles and their fuel ... food for the humans ... waste receptacles and their sanitation ... 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.


> there not enough jobs at That One Company That's Changing The World

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)

JCVI: http://www.jcvi.org

Sanger: http://www.sanger.ac.uk

23andme: https://www.23andme.com


Thank you for this list! It'd be great if there was a resource somewhere that aggregated these companies so hackers could reference it as they look to switch jobs.


That's an interesting idea.

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?


It's called "mid-life", and it ultimately doesn't care what you're actually doing. If you're just making money, you feel bad that you aren't helping people, or that you aren't accomplishing enough. If you're helping people, you feel just as bad about how you don't seem to be helping people, or about all the ways you could imagine doing more.



Many of the JCVI programmers groan and complain that they can't turn that organization around. I am not convinced additional programmers will fix JCVI.


Big problems are solved in small steps and your software could make those steps significantly more efficient.

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.


Since you're struggling to find words, you might find the concept of 'alienation' helpful: http://en.wikipedia.org/wiki/Social_alienation


Just to remember Bill Gates only made software and he is doing pretty well at the moment trying to make the world a better place and cure horrifying disease.


> "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.

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.


No, he's 100% right. This irrelevant "hypocrisy" charge scares people into pointing things out that should be pointed out. So what if someone admonishes Google/Facebook for working on "stupid" ideas while working on an even stupider one? Wouldn't that put said person in a better position to know about working on stupid ideas?

Crying "hypocrisy" is just the "cry wolf" fallacy.


There is a perception difference, for sure, but an argument's validity is not reduced by the person saying it. Granted, here it's much more opinion than fact, so...


No, but the likelihood of the argument having any value is greatly reduced if the person themself doesn't believe in it enough to actually follow the argument.

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".


>No, but the likelihood of the argument having any value is greatly reduced if the person themself doesn't believe in it enough to actually follow the argument.

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.


It isn't the argument's validity, but the source's trustworthiness. These are related but not the same; the source's trustworthiness is a contributing factor to whether or not I want to spend (waste?) the time verifying the validity.


Oh, nonsense. It's entirely about the argument's validity, and this bit about the source's trustworthiness is a red herring. Is this "source" claiming to reveal secret information about Google's being a big ad business we can't verify for ourselves and that would change our minds if we decide that he can be trusted?

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.


Two points:

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.


Directly pursuing medical advances without the required stamp of education might be difficult because of the obstacles society puts up for that path (perhaps rightly so). You could certainly educate yourself in the field, but you'd likely have a tough time winning acceptance for your advances.

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.


Well then shut up and go do something better.

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.


> shut up

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.


Please don't try to twist your dumb rant into some sort of free speech issue.

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.


What? I don't agree at all. I wrote something in my personal blog on the Internet. That's the bar. If you want to tweet, or write something in on your blog, that's also the bar.

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.


The core problem is that 100 more people on Hacker News think that your top comment is valuable, and further that you take this as justification that your viewpoint is supported by the community. As there is no way for folks to only participate in the HN that disagrees with your rants, folks are being negative. That's the only tool they have.

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.


You're being incredibly rude and unfair. The guy wrote a blog post on his personal blog. It gets posted to HN and gets massive criticism. And now you're complaining that he posted a response to that in the comments? If you don't like the voting behavior, add something valuable to the discussion rather than slinging empty complaints and repeating ad hominems. e.g. http://news.ycombinator.com/item?id=5090255 and http://news.ycombinator.com/item?id=5089296


You're being incredibly rude and unfair.

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.

http://news.ycombinator.com/item?id=5089296

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:

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.

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.


"disagree with him because of hypocrisy and finger-pointing"

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.


or the color of my tie

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.


Would you prefer "stop posing"?

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.


No I would not prefer "stop posing." And all I see from your words is a deep commitment to being abrasive. If this is the way you wish to comport yourself here, I suggest you direct your words to others who will be more receptive to the style in which you choose to express yourself.

Plonk.


In most endeavors you can divide people into roughly two camps – those who talk shit and those who bring the shit. You happen to be talking shit, in a domain that you (presumably) have no experience in. Add to that the angry, hyperbolic tone of the post, and the fact that you offer no suggestions whatsoever as to the marshaling of Internet tech resources towards something as unrelated to the skills of most Google employees as Diabetes research, and it's not hard to see why people would be dismissive.


You can make this point perfectly well without being so nasty.


Maybe. I've been 25 years experimenting with it.

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.


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?


Neither of us know much of one another beyond what we've read here. I can tell you I've gone through a master class in earnest and civil argumentation, and discovered that it is not universally successful.

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 don't find your words annoying. But consider the difference between sending me an email that says, "Reg, that was a lame post," and saying the same thing on HN.

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.


But there are also those who read the post and think ooh, me too.

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.


Baffling that you mention the guidelines when your blog psot (although not submitted by you) had a tremendously link-baity title and had little of interest to say.


The "not submitted by me" is the key point. I submit my own posts when I think they're of interest to HN. I have zero problem with people downvoting or even flagging a post that doesn't belong here.

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.


I don't know if you are more closely acquainted with the OP than I but I wouldn't assume that he isn't actually doing anything good in the world. If nothing else he's trying to encourage others to do something good and from the looks of things, you're right, he has gotten a complaint. I really hope he doesn't use it as an excuse to give up and never accomplish anything like the complainer seems to have.


> 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.

(warning: rant)

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.


Your point about hypocrisy is something I have thought myself- Being a hypocrite doesn't make your argument wrong by default, and it's strange that we instantly act like it does. There must be some reason we act this way, does anyone have a good explanation?


It's because we treat arguments like battles, looking for that one opening to strike no matter how desperate it may be. It's why you see a lot of people quote a single sentence out of a three paragraph post and reply to that, ignoring the rest of it.

Aside: I would love to see someone study the differences between in-person and online arguments.


Politicians don't tend to say "Here's this bad thing; we all do it; let's see what we can do to lower the incidence of this bad thing."

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.


If someone claims that "you should always do X" and then proceeds to do Y, isn't the fact that they did Y evidence that "always do X" isn't a good rule?


No. It suggests it's easier to give advice than to follow it.


Only if "because I do it" is their one and only argument for "always do X". Which it rarely, if ever, is.


If it's of any consolation, it depresses me daily that I have a future career in medicine but don't have a strong skill set (be it programming, statistics, biomedical engineering) to work on any meaningful problems. There's really not a day that goes by where I don't regret not majoring in one of those areas, or being more interested in them at a younger age. I'm just a guy who can design an okay-looking site. I'll be good at only applying solutions that others, like you, can develop.


Between this lamentation and Raganwald's lamentation, me thinks two should at least get together to solve diabetes or some other problem where your domain expertise and his software development expertise can be combined. I've seen your design skills and they are solid. I was actually surprised when you said you are headed for a career in medicine. Never would have expected that.


A doctor with an understanding of programming - even if he's not a world-class programmer - is more than a few steps ahead of others. If you get that career in medicine started, you've got tremendous potential in ways other people do not.


How exactly?


Case in point, the founder of the startup I work for.

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).

http://www.patientsknowbest.com/about-us.html


Kyro I have told you many times. You don't need to be killer at design (you are pretty solid) or development when you got domain knowledge like you do.

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.


I think people are reacting negatively to your post because it comes off as a criticism of the people who work on the problems you described. If this was not the intended effect, perhaps you should clarify on your blog post, because most readers are interpreting it that way.


I do think a lot of good minds are being wasted on pretty meaningless endeavors - simply to make investors happy. But that is capitalism in a nutshell. Money talks, everything else walks. Don't get me wrong, I'm not bashing capitalism, everything has it's pros and cons. That said, I personally feel that only certain aspects of medicine are a good investment.

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.


1. The barrier for entry (education, &c) is higher in medicine and bioinformatics.

2. There are regulatory obstacles for businesses.

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.

3. The problems are harder to solve than it may seem to the man in the saloon.

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).


"Just because he's drunk and in a saloon doesn't mean he's wrong"

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.


Yeah, yeah, downvote away. Ultimately, this is the ultimate, overwrought version of those stupid blog posts complaining that nobody codes something that does X, but when it's put to them why they don't make it, they answer, "Eh, it's not billable hours for me. But, hey, someone out there on the internet can do that for me, right?"


I'd like to humbly suggest going into the growing education technology (aka "edtech") field. There are lots of startups here with big ambitions and hiring needs (disclaimer: I'm in an edtech startup).

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.


Don't give up yet! I studied linguistics in undergrad; learned to program in order to build websites; spent several years as a software engineer; and then decided I could only complain for so long that no one had cured type 1 diabetes (which I, like Scott Hanselman, suffer from) before putting my best foot forward. I am now getting my PhD in Bioinformatics, knee-deep in immune cells after not having taken a real bio class since middle school.

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!


That's pointless handwringing. Firstly, people in science aren't smarter than people outside. They just have different motivations and a better grasp of the scientific process.

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.


You're obviously a smart dude.

Nothing more annoying than a good person who wants to claim how bad they have it.


>Just because he's drunk and in a saloon doesn't mean he's wrong, just boorish.

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?


Yelling at a television in a saloon may or may not be acceptable, I suspect it depends on the saloon. Self-awareness has nothing to do with it. Now if you're trying to suggest that it is unacceptable for me to voice opinions on a blog, we need to talk.

I invite you to criticize my words. If your intent is to criticize my speaking my words, I defy you.


One can be rude, and still be correct in their reasoning. I do believe that was the point here. Additionally, one can still engage in bad or unhealthy behavior and still recognize it as wrong.


I don't believe any claim was made about if the behavior was wrong or not. The claim was simply that the drunk might actually have good advice about what the coach should do next, even if he had a poor way of giving it.


Hi taganwald, I'm the one who outright called you a hypocrite. I hope you don't take it personally, that's just what I feel reading this. I'm a programmer because that's what I like doing, not because I think that this is the best way I can contribute to the world.

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 :)


actually non-educated people solve Big Science problems daily...and most enlightened science people welcome the additional solving power.

It is a ,myth that only Science people get the opportunity to solve big science problems.


Any examples?

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.


Very well said.

And the hypocrisy cry is just an ad hominem fallacy.


The hypocrisy cry is only an ad hominen fallacy if we are saying that he is wrong because he is a hypocrite. If the accusation is not part of a presumably logical argument, then the accusation does not constitute a logical 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.


This is an important point that people often misunderstand in internet arguments. Attacking or insulting someone is probably not a good idea in general, but it doesn't constitute an "ad hominem" and doesn't affect the rest of the argument presented unless it's being argued that the other person is wrong because e.g. they smell bad. If it's just mentioned that they smell bad and they're wrong for other reasons, it's not that fallacy.


I do understand that in order for an argument to be fallacious it has to actually be part of an argument.

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.


See, looking over this thread I see lots of "You are wrong, AND you are a hypocrite" but relatively little "You are wrong BECAUSE you are a hypocrite".

Maybe I'm giving people here too much credit.


"Ad Hominem Tu Quoque." But when someone criticizes me, I try to remember that the Ad Hominem Fallacy is any suggestion that someone's words are wrong because they are objectionable. The good side is that I can say my words may still be right. But by the same token, the personal criticism may still be valid even if my words are right.

So maybe I should think about what people are saying even if it doesn't mean that what I am saying is wrong.


Oh of course, the sword cuts both ways. Their criticism of you may be perfectly valid and worth noting. But it's still no refutation of your original claim, which I think is how it's generally presented.


HackingHealth.ca might be of interest to some of you who want to help but not necessarly know where to start and/or find the barrier of entry very abrupt. It's an event very similar to a hackaton where developers, designers and health professionals work together during all the weekend on real practical ideas that will be tested in clinical environment shortly after. Two have happened in Montreal and Toronto and where huge success. The next one is in Vancouver, late February. Lots of other cities are coming in the following months (sf, melbourne, london). Anyhow, feel free to email me (phzbox at gmail) if you're interested in sponsoring or organizing one in your city; I'd be more than happy to help a fellow HNer wanting to hack health.


what is your point? it's your life so if you want to do something different, then go do it.


Regarding smoking, I doubt there's any smoker who doesn't know about all the warnings and possible issues. By the way, some of them smoke for the sheer pleasure of doing it (aroma, gesture etc.), not necessarily because they're addicted.


Hypocrisy is not always an empty criticism, but you have picked an example that is. Someone who smokes saying "smoking is bad for you" is not a serious hypocrisy -- it could actually be informed wisdom, and they are just stating a fact. Someone in a position of power or influence who smokes on a regular basis, yet would form laws or prosecute/punish others for doing so, is a much better example of when hypocrisy is not at all an empty criticism.


But you can collaborate with the domain expert, can't you?


this won't be seen anymore, euro-timezone for the win, but anyway:

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: http://www.bgstar.com/web/ibgstar

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?


There is a problem with the way that HN wants article titles - this one is link-baity and has caused some unneeded negative reaction to a reasonable blog post. I have no idea what it could have been changed to when being submitted, or if that new title would have been kept.


Someone could have shown better judgement and not submitted it.


> 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."

This is some quite "grass is greener" thinking. The world needs all kinds.


Attention whoring at its worst.

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.


dude, pick one angle and stick with it.

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.


I don't have diabetes, Scott Hanselman has diabetes. If everyone with "first world problems" followed your advice and shut up, how would we every hear about anything except AIDS, Malaria, or Gun Violence?

Which woman would speak up about diversity in conferences if the response was "Shut the fuck up and organize a conference."--Oh, wait...


“It is not fair to ask of others what you are not willing to do yourself.” -- Eleanor Roosevelt


you're a pretty big crybaby.


Please don't underestimate #2. We in the software field have massive liberty compared to scientists trying to solve problems relating to human life and disease. And indeed, there are plenty of smart people who avoid this realm just because of that, and go into software instead.


Essentially he's asking why person-hours are expended on things that make the most money rather than things that are important, for some definition of important.

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.


Meta: OP is looking past the author's sentiment, generalizations and inaccuracies to respond thoughtfully to the central point of the message.

Someone is following their own advice:

http://www.paulgraham.com/disagree.html

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.


Do you speak like this in real life? I went ahead and read your other comments on other threads and I can't understand what you're writing until I've read the words at least three times.


Interesting that you should pick up on that. It usually depends on the audience.

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.


You use too many ",", and they make your writing hard to understand. Use shorter sentences, and consider replacing "," with a full stop.


It's not about commas, it's about "asides" (I just looked this up in a dictionary, I hope it's a correct term in English) - end it's true that he's using many of them, but I wouldn't necessarily recommend changing this. Rather, I'd think about assigning priorities to those asides and grouping them in relevant chunks, using parentheses, dashes and semicolons beside colons, because - as we all should know (and those who do not have a chance to learn) - this could substantially increase readability of his writing. Long sentences can be a pleasure to read as long as their construction follows some consistent plan.

Just trying to help a bit :)


Since you asked earlier, you probably got downvoted for concatenating a reply to the bottom of your post about a totally different part of the thread with no transition in between.

It took me a minute to figure out why you were talking about hypocrisy.


Thanks. In general I find articulating the conceptual stream to be a challenge, especially since it jumps around disjointedly.

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.


I actually think the parent's confusion is twofold.

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.

:)


>"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

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 [1]), 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.

[1] http://en.wikipedia.org/wiki/Temple_Grandin


I see what you're referring to, basically:

"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


Am I wrong in thinking that, if you actually did solve the kinds of problems mentioned in the article (obesity, diabetes, etc.) that your resulting business would make a lot of money? Is it really "makes more money" that keeps people working on ad-optimization, and not a simpler reason like "that is the kind of mathematical problem with an algorithmic solution that the analytical brain of a programmer can solve"?

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).


Actually solving diabetes would make you a lot of money. This is almost certainly accurate. But-

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.


There's also the MVP factor. It's easy to throw out a half-broken software prototype and then "pivot" until you have something you can sell (whether to users or a bigger company).

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."


The critical distinction here is between how much something would make, and how much it would make per person-hour.


Ah, that perfectly explains it; sorry for failing to notice that variable. :( (I was actually quite prepared to be told "actually, there isn't much money in those things", and had thereby been in the interim researching the market size of things like "weight loss"; I've been quite shocked to find out that, globally, it is only about three times as large as the market for "smartphones".)


That's definitely true. Also, preventing diseases is much harder to monetize than treating them.

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!


4. Our economic system does not allocate resources as efficiently as we as a society would like to. In particular it is susceptible to favoring the short term over the long term, and tends to develop self-reinforcing trends and bubbles.

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).


The most obvious is that people need to make a living

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.


"Reginald Braithwaite is a software developer at Leanpub, where he and his colleagues take the friction out of writing and selling books"

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?


There's an old saying that applies to this: Don't throw with stones when you live in a glasshouse. I can't really give much respect to people that don't follow their own advice and that rant with profanity at people that make a difference in the world to at least 1 billion people (Google and FB combined).


>>I can't really give much respect to people that don't follow their own advice

http://en.wikipedia.org/wiki/Tu_quoque


He said respect, there was no judgement as to correctness or not. I for one also don't respect hypocrites.


Upvoted because it makes for an interesting discussion, which is what HN is for. An upvote doesn't mean agreement, it means (AFAICR) 'worth having on the site'.


I don't think it does make for an interesting discussion, though. It doesn't even try to investigate the reasons why more people work in social tech than in healthcare, for example.


> 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).


Maybe he admits that he isn't a great mind? He might mask this admission by being overtly aggressive and profane, but let's not lose sight of this possibility.


To launch a Facebook clone you sign up for Heroku or AWS, push some Rails code, and start promoting yourself. To launch a medical device you spend years cutting through regulation and red tape, negotiating with and marketing to an industry that is probably threatened by your existence and will do its best to stop you.

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.


> Screw up a medical device, you get sued out of existence.

Or, you know, people die.


People also die because of late or never materialized medical technology. We just prefer that people die from inaction (because is "normal") than from mistakes. This may be psychologically attractive because we avoid SEEING all the blood and dead bodies, but probably not the best way to minimize death and suffering.

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.


The most scary moment - one of the applications we've written was used to take life-saving medications on time. Scary stuff I'm telling you.


Off-topic, but I'm curious how you handled that situation. Personally, a safe-guard I might build in would be to audit our code by an independent third-party. Was this at all feasible in your situation, and/or how did you handle QA?


Well... External QA for app which costs 2.99$ (or less at times)? No. We just tried to make sure it worked properly - some code reviews, several unit tests to cover some nasty edge cases and that's it. I really hope everybody is alive and well. :)

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 :)


When I was a kid, volunteering at a hospital for Community Service, I was assigned a task to transfer pills from bottles to those plastic + foil single serving wrappers using a hot glue machine, and deliver said pills to the wards. I had no training, supervision, or QA/QC in this job.



Because consenting adults aren't allowed to engage in an exchange of medical services without the approval of federal bureaucrats + lurking personal injury lawyers.

All we need is just one state with medical contractual freedom.


No thank you, Christian Scientists are "experimental" enough. We don't need the Tim Ferrises of the world selling snake oil to parents (as medicine).


We also don't need the government telling adults what kinds of contractual agreements they can or can't enter into. "Caveat Emptor" and all that. People are, at the end of the day, responsible for the outcome of their own actions. Interestingly enough, this is still true even if we DO have a nanny state and an FDA and all the accompanying B.S.

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.


Yes I agree with this, I think the current system is worse than snake oil because you have government people telling you exactly what is medicine. And they are the FOOD and Drug administration. They are now telling people what they can label on things like blueberry extracts. That should just not be their business, they should just keep dangerous chemicals out of our lives.

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).


Besides, creating Facebook clones is sexier. At this moment, your content is rated lower than @benihana's scathing criticism of @raganwald's outrageous assumption that saving lives is somehow nobler than squeezing out yet another social app-turd.


. To launch a medical device you spend years cutting through regulation and red tape, negotiating with and marketing to an industry that is probably threatened by your existence and will do its best to stop you.

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.


Do they have any available information? Preliminary test? Cured it in vitro, animal models, a few humans? Patents? Any other interesting medical/biological result published?

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.


If true that's so outrageous you can count on me to work really hard for free on their behalf to get the word out.

Can you put me in contact with them?


I am not saying I believe it, but they keep making the claim every time the subject comes up.


In my five years at Google, I am not sure I have met a single engineer who is "trying to figure out how to get Scott Hanselman to click on ads."

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.


Furthermore, many basic services form a backbone of functionality for larger features. Things like voicemail transcription and 311 speech recognition were likely used to develop better recognition models so that deaf people can now have closed captioning for online videos, and will allow us to have natural interfaces with our public infrastructure in the future. Spam and importance filtering in GMail might be used to research and develop distributed machine learning, which can be used for much larger scale problems in other industries.

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.


My first thought when he asked why the great minds at Google are doing nothing for people suffering from diabetes and other ailments: How many people do you think have had their health greatly improved by researching their condition through Google?


How many people do you think have had their health greatly improved by researching their condition through Google?

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.


Just one thing to add: I think that driverless cars could be a huge force for good. At the top of the list IMO is obsoleting DUIs completely.

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.


They could be, but human tendency makes me cautious in my optimism. For example, as cars get more fuel efficient, rather than saving their money, people tend to simply drive further. As cars get safer, people tend to take more risk.

What, I cannot help but wonder, will be the proverbial fly in the ointment when self-driving cars take over the market?


That makes sense. And I am sure engineers working on cool problems at Facebook and other large companies can say the same. But there has to be someone thinking about how to get people to click on ads at these companies, because selling ad clicks is their bread and butter. Right?


Yes I'm sure there must be some mixture of business people, engineers, and UX people who do focus on this. But I've never met any of them, and have never had a conversation with any other engineer that discussed how to get people to click on ads. My point is that it's a small minority of Google's engineering effort that goes towards this.


There are ads and there are ads. Spamming you with Brand awareness billboards so that you buy Frobulous instead Snaztacular (both produced in the same assembly line and recipe) at the grocery store is one thing, helping you find a good deal on a product you are searching for (even if you don't know its name) is another


The former is done by ads. The latter by communities and volunteers.

I'm yet to see an ad that wants me to find a good (for me) deal on a product I want.


Part of the rationalization I have made for creating ads is that proper targeting gives exposure of products that people would actually need/want. When scaled up to millions of people this specialized ad delivery allows for much greater diversity of products and solutions in the marketplace. Ideally this should lead to less of a "winner take all" effect in a group of competitors and would allow for more niche solutions to be catered to and sustained.

Certainly I would never say this goal is comparable to anything in medicine, but the domain does have ambitions beyond simply making money.


The revenue made from advertising funds all of the programs you mention. Surely there's at least a few engineers working on the ad platforms.


It appears that Diabetes research receives over a billion in funding each year just from the NIH [1][2]. As far as I can tell this doesn't include private funding for cures/treatments.

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.

[1] General Disease research numbers http://report.nih.gov/categorical_spending.aspx

[2] Diabetes funding by project http://report.nih.gov/categorical_spending_project_listing.a...


I've had Type 1 diabetes for about 20 years now; it's a little bit of pain in the ass, but I don't get why people bellyache about it so much. Blood sugar meters? Check. Fast-acting insulin? Check. Insulin pumps? Check.

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.


My dad had type 1 diabetes. He had all the problems you mention, and died when I was 11.

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!).


I'm sorry to hear. That he experienced so much pain and suffering, and that you lost him so young, is exactly the reason I can't feel sorry for myself (and no other diabetic should either).

Awesome that his hacker spirit lives on in you...


Unless our hA1cs are under 6, it's more than likely that diabetes will be our ultimate cause of death. Type 1 diabetics almost always die of Type 1 diabetes. I think that's a good reason to bellyache. It's a big deal.


Historically, you're correct that our prognosis is poor. Then again, we cannot compare numbers with the generation before us because they were, more than likely, cruising around with sugars consistently in the 200-400mg/dL range.

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.


True, it can always be worse. Having a 6.3 A1c with MDI and no CGM or pump is very fortunate. Perhaps you've still got working beta cells. Congrats on those results!


Hm. I always assumed my efforts would yield similar results for anyone. Maybe I am luckier than I deserve and should pay closer attention to what other diabetics have to endure.

In the meantime, here's to fighting the good fight.


Diabetes has a variety of causes. Concentrating on just one cause - too much sugar in the diet - how much money is spent by producers of sugar on, for example, advertising each year?

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.


Type II diabetes is almost entirely the result of obesity. Put on 10 pounds and your fasting blood glucose will skyrocket. Sure, there are genetic factors that predispose a person to insulin resistance, but the dominant factor is adipose tissue. Type I (juvenile/auto-immune) is more interesting.

Sugar production in the US is heavily subsidized.


Type II diabetes is almost entirely the result of obesity. Put on 10 pounds and your fasting blood glucose will skyrocket. Sure, there are genetic factors that predispose a person to insulin resistance, but the dominant factor is adipose tissue.

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.


Also, just to be clear... I'm not suggesting that diet soda is exactly good for you. I plan to try and wean myself off of that as well, over time. But the sugar (HFCS really) in plain soda is just horrible, horrible, evil stuff... especially when it's in soda, since sugar that comes into your body in such a ready to digest form seems to hit your bloodstream much faster than, say, a piece of orange, which also has plenty of sugar (fructose) but has to be digested to get to the sugar.


And there's a lot more sugar in a soda than in a piece of fruit. (although fruit juices have a lot of sugar, which is why people suggest that you drink small amounts or water it down.)

A 3" orange has about 14 g of sugar.

12 oz (a 355 ml can) of coca cola has 39 g of sugar.


Thanks for making the distinction. I've had Type I diabetes for over 20 years and occasionally get the "but you're not fat" comment. EDUCATE :o)


They need to change the stupid name already. Hypoinsulinomia and caloroglucitis, or something.


So totally agree. Especially when I learned of how many young type 1s have eating disorders because they think they must be fat :(


That the general population does not distinguish between Type I and Type II Diabetes it an unfortunate fact of life. But that someone who is diagnosed with Type I Diabetes does not inform himself about it and learn about the difference is simply inexcusable stupidity.


Totally. The fact that Type 1 and Type 2 share a name, and a "type" is insane.


Bad incentives.

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.


Is there any indication that education needs geniuses? Does it substantially improve innovation? When America was world dominant in innovation, were its geniuses in academia, or industry?


I doubt any industry needs geniuses. I don't think the human race needs a super-human .01% individuals to come in and solve all our problems every quarter century. I wouldn't be surprised if 90% of the genetic geniuses Mother Nature gives are struggling in the 3rd world somewhere.

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?


So Sweden is ranked as the "most innovative" country, with the USA coming in seventh. Switzerland and Singapore beat the US also.

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!)


"Yet I can't think of a single innovation I've seen from them."

http://www.thelocal.se/15578/20081110/

http://en.wikipedia.org/wiki/List_of_Swedish_inventions

http://www.du.ac.in/fileadmin/DU/DUCorner/pdf/14812_IR_Examp...

It can be noted that most people studying engineering in Sweden go on to work for companies like ABB, Volvo, Ericsson, Scania etc.


I would consider Iceland innovative, 81% of the country runs on renewable energy, making energy ubiquitous


> When America was world dominant in innovation, were its geniuses in academia, or industry?

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.


Google includes teams that are very similar to Bell, including the surviving employ.


When the US was dominant, was it truly because of the quality of output, or because of an advantage of not being leveled by WWII?


The US was dominant even before WWII


Why do we play videogames? Why do we create art? Why do we eat tasty unhealthy foods? Why do we go on hikes or climb rocks?

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.


But this just states what this generation lacks the most... Empathy.

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...


As someone who left biomedical field and moved into tech, one of the biggest reasons for my move is that I have a distaste towards relying on guilt in order affect things (this probably goes back all the way to my childhood and my parents' use of guilt in order to affect my own decision-making), and that I generally dislike people who rely on it to further their causes.

I will work hard if there is an incentive. I will not work hard because someone is trying to guilt-trip me to.


We could live in a post-scarcity world, but, no, we have to have it all, and exert power over others.

Our own fear and depravity damn us to these outcomes. :(


How do others feel?

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


I hate to sound rude, I mean well. But why the fuck is Raganwald whining about start-ups that aren't solving real problems instead of solving the problems himself? That's what really irks me about today's society. People bitch and whine about things, wanting people to change the world and yet don't do a single things themselves to make it happen. I hate the mentality that it's up to everyone else to solve serious problems when Raganwald is wasting his time whining about people not solving real problems behind his computer screen oblivious to the fact there are people out there trying to make a difference. Curing things doesn't happen over night. After the initial study, it can take upwards of 10 years before a new drug can come to market.

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.


He is just starting conversation it seems. I agree that we should do more about things that matter and in that, most posts to this are right.


I don't think he succeeded in starting any kind of conversation. He just sort of screamed vehemently at the internet, eliciting what appears to be a general backlash from HN.

Writing a blog post comprised heavily of expletives that most people immediately reject is not really promoting a discourse.


Because research pays terribly and not everyone has the luxury of martyrdom.

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.


This is a pretty fair summary. A badly-paid software engineer (BS in CS) makes a little under a PhD in CS at a university. Which is where I'm at right now, literally. :-)

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.


"buying a house at 45 instead of 35" is an economic considerations, no? ;)

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?


    economic considerations
Erm -- look over there.

    pile of money
Yes. I did research as a student and as a research programmer / computational biologist. I was just an author on a paper for work done three years ago. There will probably be another one being written up in a year or two.


[deleted]


I believe you're replying to the wrong comment.


Thanks for the heads up. Too many hours of work and no sleep.


Who says programmers are the greatest minds of our generation?


This is a huge part of it. There's a certain arrogance in this tired, oft-repeated claim. And more subtly, people can be great at different things. Tech stuff has always come quite easily to me. Chemistry, biology, or creating social change? Not so much.

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.


Well, I upvoted you, because yes, but I'll make a refinement to the question: just replace "greatest minds" with "greatest programmers".

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.


Because they make 100k straight out of college.


Clearly I'm working for the wrong employer


It must be a "Valley" thing (and the associated cost of living), because depend on one's location, 100k would be a good figure for a project manager. Someone straight out of school? Not a chance.


And in the "Valley", with rent and (California income) taxes what they are today, 100k isn't as great as you might think.


I think there's a certain degree of arrogance to that claim, but a lot of truth. For the smartest minds of our generation, programming is not that hard to pick up. I've seen (classical) engineers and physics PhDs working in ad tech and social games many times.


Who says web-programmers are programmers?


Mostly everyone.


Everyone of web-programmers?


No, the set of programmers.


Generally their bank accounts.


There are pretty good ways to make a good deal more money more predictably than working at Google or playing the startup lottery...


I wasn't saying that any given programmer was the best mind of their generation - just that many of the best minds of these recent generations have been programmers, or involved in technology development in some manner.

And what are some of the "pretty good ways to make a good deal more money more predictably" that you're referencing?


Uh, finance? Maybe this isn't as obvious to a non-New Yorker, but that seems to me like the easiest way for a smart person to make money.


Except that it isn't at all easy to get into finance, and the profits are not guaranteed in any case, as you seemed to imply.


>it isn't at all easy to get into finance

so.. you are saying you need to.. be one of the best minds?


I was thinking 'finance' too. I'll add 'oil industry' to that list as well.


By your definition, those realtors of 2006-2008 were the greatest minds of that period, so were the financial analysts, and the personal wealth managers who had nothing other than a 1 week seminar to certify them as such.


And Fifty Shades of Gray would be the greatest book of the last year ;-)

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