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When good ideas make bad business

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Re: When good ideas make bad business

#311

Post by rsp1984 »

wayoutthere wrote: post #228
catchmeifyoucan wrote: post #136

I still think this idea is powerful. Not because I believe it transforms healthcare, but because it informs consumers a bit more. That’s what seemed to get you excited in the first place. There are a few paths I see still: a. Assuming you own a database, expose your dataset as an API. Consider possible consumers. Open source it, and monitor the usage. Who’s using that data. b. Cold message a few folks on Linkedin fro…

This is a classic case of "it's not a product, it's a feature". This is true of almost everything in healthcare that's software-related: it's only useful if it's integrated with the EMR. This is why you never see software startups in healthcare. In this case, similar functionality (drug recommendations) exist within EMR systems. Except the recommendations are issued by other doctors and medical researchers, not some…

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

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

Re: When good ideas make bad business

#312

Post by qaq »

jacobr1 wrote: post #309
qaq wrote: post #276

Earlier quoted context omitted.

The drug things is partially BS. The top 10 big Pharma (in random order) GlaxoSmithKline British Eli Lilly US Sanofi French AbbVie US Roche Swiss Pfizer US Novartis Swiss Merck & Co US AstraZeneca British/Swedish Johnson & Johnson US (edit spacing)

Hard to say. These are all internationalized firms with a variety of global operations centers. I know GSK does a lot of their research in North Carolina. But that is beside the key argument, which is that the US pays more (in aggregated cost and volume) to these firms, such that the total revenue for a product line during the patent lifetime justifies the cost to both bring the drug to market and pay for a variety o…

Is it more than aggregate of all other markets?

Re: When good ideas make bad business

#313

Post by gen220 »

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.

Just my opinion, but I don't think "private markets" are incompatible with a proper valuation of human life?

It's a bit macabre, but, to me, "dead people don't pay taxes / generate GDP" seems pretty interchangeable with "dead people don't pay insurance premiums / contribute to a risk pool".

To me, the problem is that billed medical costs (what the hospital charges you) have come unhinged from realized medical costs (what the hospital spends on helping you, including salaries, supplies, etc).

If that world is alien-sounding, it's similar to how the billed education costs at universities have come unhinged from realized education costs. In both of those environments, the ballooning costs seem to be propped up by well-intentioned but fundamentally "unnatural" source of funds, in the form of government subsidies.

These have been exploited by profiteering and accounting optimizations, over the course of literal decades. If your surgery costs 2k to perform, the hospital will happily charge you 20k, collect 3k in insurance, and write off the remaining 17k as un-recovered medical expense, for which the government will reimburse some portion.

The more obvious solution to me, would be to take a hard look at how these subsidies are actually used (/gamed), and steadily reduce/focus them over time, so that hospitals don't have an incentive to inflate costs. The source of the problem isn't anything fundamental about "the private market", it's rather about the current set of public incentives that have distorted the private market into it's current form.

Re: When good ideas make bad business

#314

Post by CompleteWalker »

rsp1984 wrote: post #311
wayoutthere wrote: post #228

Earlier quoted context omitted.

This is a classic case of "it's not a product, it's a feature". This is true of almost everything in healthcare that's software-related: it's only useful if it's integrated with the EMR. This is why you never see software startups in healthcare. In this case, similar functionality (drug recommendations) exist within EMR systems. Except the recommendations are issued by other doctors and medical researchers, not some…

There's barely anything more frustrating than a fascinating discussion on HN and then folks start kicking around lingo and acronyms that you can't even Google because they could mean a million things. So please, have mercy and cure my ignorance and explain what EMR means.

Best guess is Electronic Medical Record... I had to google it.

https://healthit.ahrq.gov/key-topics/electronic-medical-reco...

Re: When good ideas make bad business

#315

Post by dr_zoidberg »

victor106 wrote: post #84
tyri_kai_psomi wrote: post #71

Earlier quoted context omitted.

The most realistic founding story so far is Bezos explanation for how he founded Amazon. It was always a business-first mindset in an area of high growth. That one short video filmed in 1997 should be a masterclass by itself.

Anyone has a link to the above video?

This'd be one instance of said interview: https://www.youtube.com/watch?v=rWRbTnE1PEM

Re: When good ideas make bad business

#316

Post by wayoutthere »

rsp1984 wrote: post #311
wayoutthere wrote: post #228

Earlier quoted context omitted.

This is a classic case of "it's not a product, it's a feature". This is true of almost everything in healthcare that's software-related: it's only useful if it's integrated with the EMR. This is why you never see software startups in healthcare. In this case, similar functionality (drug recommendations) exist within EMR systems. Except the recommendations are issued by other doctors and medical researchers, not some…

There's barely anything more frustrating than a fascinating discussion on HN and then folks start kicking around lingo and acronyms that you can't even Google because they could mean a million things. So please, have mercy and cure my ignorance and explain what EMR means.

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

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

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

Re: When good ideas make bad business

#317

Post by wayoutthere »

Buge wrote: post #284
wayoutthere wrote: post #215

Earlier quoted context omitted.

> The US is the back-bone of the medical system for the rest of the world and also has the best medical schools and best quality hospitals (the majority of people with money come to the US for life-saving surgeries..this has to tell you something). This just means American consumers end up subsidizing health care R&D costs for the rest of the globe — purely because our government prevents us from collectively bargain…

If American consumers stop subsidizing health care R&D costs, what will happen to the R&D? Will it decrease? Will health care costs in other countries increase as they start to bear some of it?

I assume it will continue because the drug companies need products to sell. It's not like they're just going to close up shop, but it may be the end of windfall profits.

The other problem right now is that it's not profitable to create drugs that actually cure anything. It's far more profitable to research drugs that help control chronic conditions (like diabetes, hypertension or Alzheimers) rather than drugs that can cure a condition outright. This is one part of why nobody researches things like antibiotics anymore.

Re: When good ideas make bad business

#318

Post by astura »

ping_pong wrote: post #139

The first example the author gave with painkillers is inherently bad. Sure, Aleve is the most powerful. But it also has the most side effects, including ulcers if used for too long. There's a lot of nuanced information when it comes to drugs. If you want to go on pain killers like Aleve for long term, you probably need to take acid blockers as well, like Nexium. So where does that fall into the analysis? Unfortunatel…

>Sure, Aleve is the most powerful. But it also has the most side effects, including ulcers if used for too long. There's a lot of nuanced information when it comes to drugs. If you want to go on pain killers like Aleve for long term, you probably need to take acid blockers as well, like Nexium. So where does that fall into the analysis?

Am I wrong or isn't solving these issues basically the service UpToDate offers?

Re: When good ideas make bad business

#319

Post by mehrdadn »

I'm so confused. Not like I'm a doctor, but doesn't the foundational assumption seem fatally flawed? How can you reduce drug efficacy to a single number? It's one thing to compare brands of the same drug, but why in the world are aspirin and acetaminophen (or whatever) just viewed like interchangeable substitutes here? I know I certainly don't reach for the strongest painkiller—but rather the weakest one that might do the job. And I know my doctors certainly never viewed these painkillers as interchangeable. Don't the natures of the effects and side effects actually matter to people?

Re: When good ideas make bad business

#320

Post by trileansoftware »

brianpgordon wrote: post #304
amitmathew wrote: post #203

Earlier quoted context omitted.

I'm all for removing the broken system we have today, but a single payer system doesn't remove the challenge that the entrepreneur faces - it just changes it. Under single payer, you are now trying to sell to a large government organization, with all the pain and red tape that comes with that.

Presumably the government will be incentivized to try to save lives in a way that simply doesn't exist for doctors and insurance companies trying to make a profit.

What happens in reality in systems like that is that doctors are lectured to avoid prescribing expensive exams, things like MRI or PET scans, even sometimes not telling patients they should do them if they could afford to pay them on their own.

And the same goes for drug prescriptions.

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