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I wasted $40k on a fantastic startup idea

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Re: I wasted $40k on a fantastic startup idea

#321

Post by overscore »

conductr wrote: post #252
marcinzm wrote: post #198

Earlier quoted context omitted.

I mean, there's a reason pharmaceutical companies in the US spend $20 billion a year marketing to physicians and it's not because it doesn't work. Doctors in the end are human and as capable of being influenced and biased and taking shortcuts as any other person. That doesn't mean they're evil, just human.

A big chunk of that $20B is on high cost ads to the general public, which doesn’t occur in many other parts of the world. It’s a backwards system when a patient is told to ask their doctor for a prescription to a medication by the company that manufactures said medication.

Yes, one of the few culture shocks when I lived in America was pharmaceutical advertising to the public. Another was constant political advertising on TV.

Re: I wasted $40k on a fantastic startup idea

#322

Post by anjc »

eightysixfour wrote: post #30

I remember reading this the last time and it was posted and I still think the core failure is that the author didn't actually recognize the issue he was solving. He thought the problem was choosing the most effective medicine when the real problem was decision fatigue looking at endless shelves of things that all seem to do the same thing. Those two problems sort of look the same, but the latter cannot be resolved by…

>The tool should have been designed (IMO) as a consumer tool, either a kiosk at CVS/Walgreens/pharmacies to assist with OTC med selection or possibly as a website with ads/referrals. I would absolutely choose a pharmacy over another as a result of them having something to help through that process, especially when I have a headache.

You're making a similar mistake to OP. You're considering the end user, the pharmacy, but are now ignoring manufacturers, suppliers and wholesalers. Why would a major supplier provide their goods to a pharmacy who ranks them last in their kiosks? Why wouldn't they give preferential pricing to pharmacists that give better rankings?

Perhaps large chain pharmacists have buying power here, but they don't need help attracting customers. Perhaps small pharmacists could benefit from this system to attract customers, but if the system ranks Pfizer products last they wont be in business for long.

Point is, perhaps you want it, and perhaps you think pharmacists should want it for you, but the entire supply chain does not want it.

Re: I wasted $40k on a fantastic startup idea

#323

Post by ineiti »

sxg wrote: post #159
intricatedetail wrote: post #144

Earlier quoted context omitted.

Some doctors use expert systems. They select symptoms and computer spits out possible list of treatments and then doctor picks one. If it doesn't work asks to come back and tries the next one. It's kind of like a human in today's self driving cars. Especially when it comes to mental health and anti-depressants. Essentially tests on production.

This isn't even close to how doctors prescribe medications. You don't prescribe meds without having a working diagnosis. Once you have that, you use the knowledge gained in med school and residency to pick the first line drug. If there are contraindications due to comorbidities (which there often are), you have to figure out what other meds you can use. You can consult online resources (e.g. UpToDate) to look up seco…

You might be right for single-casual illnesses like a broken leg, CoVid-19, Tuberculosis, and others. But it's a whole other thing when it comes to more complex illnesses.

Having been for 18 months through different types of psychiatrists and clinics, I came out quite surprised in how "trial and error" this whole system is.

I'm writing this from Switzerland, where we have an (arguably) high quality health care system. But the amount of "OK, that didn't work, lets try this other drug". Or, now, 18 months later, "Oh well, we did the list once through. But who tells me that the MD prescribing the first drug did a correct analysis? Lets start the list from top again." Or, for a friend of mine, his girlfriend found a working cure like that: "Oh, this brochure describes your symptoms so clearly, and it's completely different from what you've been treated for these last 20 years. Let's try it!"

Spoiler alert for my case with the list: the top of the list was not better the second time around.

If you think this is cynical, well, I would like at least _one_ of these drugs to work. If you think the MDs are all useless: well, at some times I was glad they were there.

So, well, I think having a little less than random system might be helping. Let the MDs watch if it makes sense, enter the correct diagnosis, and catch the stupid errors data entry people can make. But i'd give it a try...

Re: I wasted $40k on a fantastic startup idea

#324

Post by overscore »

sxg wrote: post #159
intricatedetail wrote: post #144

Earlier quoted context omitted.

Some doctors use expert systems. They select symptoms and computer spits out possible list of treatments and then doctor picks one. If it doesn't work asks to come back and tries the next one. It's kind of like a human in today's self driving cars. Especially when it comes to mental health and anti-depressants. Essentially tests on production.

This isn't even close to how doctors prescribe medications. You don't prescribe meds without having a working diagnosis. Once you have that, you use the knowledge gained in med school and residency to pick the first line drug. If there are contraindications due to comorbidities (which there often are), you have to figure out what other meds you can use. You can consult online resources (e.g. UpToDate) to look up seco…

The closest thing to an expert system I've seen is clinical practice guidelines, which sometimes includes decision trees of indications/contraindications for administering certain medications for common and time-sensitive medical events, like cardiac arrest or exacerbation of breathing difficulty with COPD.

Re: I wasted $40k on a fantastic startup idea

#325

Post by dustinmoris »

>I had literally nothing to say to that. It had been a bit of a working assumption of mine over the past few weeks that if you could improve the health of the patients then, you know, the doctors or the hospitals or whatever would pay for that. There was this giant thing called healthcare right, and its main purpose is improving health—trillions of dollars are spent trying to do this. So if I built a thing that improves health someone should pay me, right?

I think the author makes the wrong assumption that his product does improve health and that the current practices of GPs or other health professionals don't (as much as they could). He misses the most important thing of any professional and successful health care worker: experience.

If a doctor has a high success rate with drug A on their patients then even if some website tells them that drug B _could_ be slightly better why would they try it? There has to be more of an incentive than _just a website saying so_. The doctor has a high success rate with drug A, has seen it working many times and knows everything about side effects or maybe the lack of those. If nobody has complained and it works miracles then it would be foolish for the doctor to start prescribing a new drug simply based on a random website's recommendation. Also doctors do have to stay current and they get medical journals sent home, attend training courses and conferences and learn about new stuff when it's actually relevant and needed.

Re: I wasted $40k on a fantastic startup idea

#327

Post by cycomanic »

brabel wrote: post #276
haser_au wrote: post #240

Earlier quoted context omitted.

This assumes all papers are of equal quality, peer-review and accuracy of results. Which we know they are not. Some studies should have more weight than others. Which has been mentioned in a previous comment; there is no 'right' answer, just a variety of ways to allocate different weights to papers based on various metrics.

You misinterpret the law of large numbers. What the law says is that if you have a large amount of samples, and assuming there's no pervasive bias in the samples, then any large enough sample (and often that's much smaller than you think - the classic example being election voters, with a group of only a few thousand representative voters being enough to predict the outcome of an election over a large country with mi…

But the crucial bit here is the "large" in "large numbers". I expect that even for quite popular drugs the number of studies are maybe in the hundreds, which depending on statistics could well be quite a way from large enough. In particular if a significant fraction are crap studies.

Re: I wasted $40k on a fantastic startup idea

#328

Post by bencollier49 »

alexanderskates wrote: post #140
james1071 wrote: post #129

Earlier quoted context omitted.

It's not hard to get a doctor's attention when he knows you will provide him with golf days and holidays, if he plays his cards right.

At least in the UK, sandwiches are the most that pharma reps can use to bribe doctors with... Which is not to say they aren't effective (you'll get butts in chairs at least, no guarantee they will pay any attention to you though).

Damned bribery and corruption act. I could really do with some free holidays and lavish parties. Now it's all branded mugs and that's your lot. Someone offered us free beer and we had to refuse. Oh, the humanity!

Re: I wasted $40k on a fantastic startup idea

#330

Post by a1o »

coldtea wrote: post #308
sillysaurusx wrote: post #304

Earlier quoted context omitted.

If you study a lot of history, you start to notice that old ideas are bad until they’re suddenly very good. Cannons sucked for a long time, till Napoleon showed they weren’t so bad. I think posting haughty words is a lot easier than trying to make something work.

> If you study a lot of history, you start to notice that old ideas are bad until they’re suddenly very good. Also the opposite: dumb ideas are tried again and again to no avail ever.

Adding as example of dumb ideas, people constantly trying to patent perpetual motion machines.
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