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When good ideas make bad business

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Re: When good ideas make bad business

#191

Post by beat »

legitster wrote: post #186
beat wrote: post #179

Earlier quoted context omitted.

I'd like to imagine "laziness" isn't the reason doctors write the prescriptions they do.

"Laziness" is probably unfair - but there is a lot of evidence that everyone, doctors not included, will get stuck in their ways unless forced out of them.

There's much to be said for sticking with things we know work, rather than experimenting with new things that might work better. If a doctor has an effective treatment for a common condition among their patients, what is the cost of trying something new? Do you try it with all patients, or just one?

But "laziness" is something of a trigger word for me in health care discussions, just like "greed" is. It's so easy to attribute what we see as suboptimal outcomes to malice on the part of the person acting - even passive malice like laziness.

Re: When good ideas make bad business

#192

Post by mark-r »

arrosenberg wrote: post #46
johnchristopher wrote: post #33

That was really great writing, though :-). But this part: > “And that isn’t worth something? Prescribing better treatments?” > “Hmmmm,” she said, picking at her fingernails. “Not directly. Of course I always have the best interests of my patients in mind, but, you know, it’s not like they’ll pay more if I prescribe Lexapro instead of Zoloft. They won’t come back more often or refer more friends. So I’d sorta just be,…

The obvious next step (if there is one) is to get the insurance companies to pay for it, since they are the ones who would theoretically reap the benefits.

"Theoretically" is the problem here. Insurance companies won't spend a penny they don't have to, so you need to prove you'll save them more than they pay you starting from day one. That's a tall order.

Re: When good ideas make bad business

#193

Post by kirillzubovsky »

Congratulations on a valuable experience. You have learned a ton and summarized it wisely. This is all worth a lot more than 40k!

Although the typical SF startup drum is about changing the world, it takes a lot more than just a good product to do it, as you've found out, and especially in healthcare, where the barrier to entry is extremely high.

Also, your doctors forgot to mention that Pharma companies actually pay them (indirectly) for prescribing a certain drug. Your software was not just not useful to them, it was actually telling many a story they did not want to hear. Sure, Tylenol might actually be #3 of the list, but their sales rep is a real friendly one, and next time they go out for dinner, it would be a shame to have prescribed something else...

Anyway, now you know. Isn't that an amazing feeling that you've learned so much that others would never dare, and it had only cost you $40k? Keep going, good lessons are worth it!

p.s. Just because your original iteration of the product was not needed by doctor and not valuable enough to be paid by the consumer, it doesn't make it useless.

Perhaps if you made it the #1 on Google, consumers would notice, and use it, then you could use it as a lead-gen for other products, and sell that space/time/data.. whatever.

The funny thing about startup ideas, your first iteration is probably almost always wrong.

Re: When good ideas make bad business

#194

Post by jimbokun »

amitmathew wrote: post #166

I think people are being a little too hard on the author. Startups in healthcare are hard . Been there, done that, have the t-shirt (literally, that's all that left). I even made the same fatal mistake - not identifying who the buyer really is. And when I say identifying the buyer, I don't mean it in that hand-wavey, vague way like "doctors" or "insurance companies". The starting point has to be something like "ophth…

> But the key insight is that you have to take a step back and just treat healthcare like any other for-profit business. Doctors and hospitals care about what generates revenue. Insurance companies want to save money. Pharma companies are looking to advertise to new customers. It's no different than other industries.

This is one of the most concise and effective arguments I have read for Medicare-For-All, Single Payer, etc.

Re: When good ideas make bad business

#195

Post by folli »

omegaworks wrote: post #187
wayoutthere wrote: post #178

Earlier quoted context omitted.

From a business standpoint, saving lives can actually be expensive. The longer someone lives, the more healthcare they consume. Health insurance companies are very aware of this, which is why they so frequently deny coverage for various life-saving cancer treatments. If you die while waiting for treatment, not only do they save the cost of the treatment, but also the entire cost of ongoing screening / care during rem…

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

Universal healthcare won't help you there, since it also requires a stringent cost-benefit-calculation, e.g. the British system is very (in)famous for this.

Re: When good ideas make bad business

#196

Post by fyp »

sjg007 wrote: post #67
fyp wrote: post #45

I have had life long headaches that I have given up on fixing. Occasionally when I switch to a new doctor I will mention it just to see if they have anything new to say. They usually just put me on a concoction of various pain killers (e.g., migraine specific stuff like sumatriptan). These prescriptions actually work great. But so did OTC aleve/advil/tylenol too. The problem was that I didn't really care for more eff…

What’s your blood pressure? I had bad tension headaches from time to time and after starting a bp medicine they’ve basically disappeared.

Pretty spot-on guess! I do have relatively high blood pressure, typically in the 130-150 range.

Doctors have suggested it before but since I am borderline I don't really need to be on meds yet. I think it sounds worse than needing to take pain killers occasionally.

Re: When good ideas make bad business

#198

Post by beat »

chris_va wrote: post #185
beat wrote: post #86

Earlier quoted context omitted.

Perverse incentive structures are the fundamental reason US healthcare is so expensive and stupid. It's not "greed" in a simple sense, and it's not "regulation" in a simple sense. It's a system of interacting problems that needs treated in a systemic way. Blaming the insurance companies strikes me as the political equivalent of yelling at the cashier.

I mostly agree, but... Insurance is one of the oldest industries in the US, which means they have accumulated many (probably well meaning, but ultimately stupid) regulations over the years. For example, to be taxed as an insurance company (e.g. avoid paying tax on premiums that will partially be paid out in the future), most states assign a maximum profit margin. That means, in order to make more money as an insuranc…

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

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

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

Re: When good ideas make bad business

#199

Post by zndr »

omegaworks wrote: post #187
wayoutthere wrote: post #178

Earlier quoted context omitted.

From a business standpoint, saving lives can actually be expensive. The longer someone lives, the more healthcare they consume. Health insurance companies are very aware of this, which is why they so frequently deny coverage for various life-saving cancer treatments. If you die while waiting for treatment, not only do they save the cost of the treatment, but also the entire cost of ongoing screening / care during rem…

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

So, this is why, at least in the US, EU and a few other countries, we have orphan drug policies.

If you don't know orphan drugs are drugs that could be a life saving medical necessity for rare diseases that do not have a large enough base of users to make the drugs affordable. I'm not talking about Shkreli "affordable", but it's literally not feasible to spin up manufacturing, or final trials, or educational materials for doctors affordable. So governments offer massive subsidies or cost investments for some of these drugs that often only help TENS of people, not hundreds, or thousands or millions.

What's missing is a similar policy for funding otherwise for-profit efforts like the authors.Educational tools and products are often seen as less valuable but I believe they could be immensely helpful.

Now as to the authors original flaws? Well, his product has a clear sell-through referral potential, but it's not really functional to do so with prescription drugs. That being said, selling this product to a CVS or a webmd as a feature could be really good, or major hospital networks, or heck even pharma companies. But all of that is often year+ sales cycles, you can't just luck into that.

Re: When good ideas make bad business

#200

Post by orhmeh09 »

folli wrote: post #195
omegaworks wrote: post #187

Earlier quoted context omitted.

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

Universal healthcare won't help you there, since it also requires a stringent cost-benefit-calculation, e.g. the British system is very (in)famous for this.

Ah, but then you have all these with the ever-increasing demand for profit and the issues caused by that incentive on top of it all. Is that an improvement?
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