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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

#401

Post by GordonS »

DanBC wrote: post #388
mattowen_uk wrote: post #345

Earlier quoted context omitted.

There is also the 'NHS approved medication' list that they can only prescribe from, which restricts whats available to you, and it takes years for something newish to make it onto that list (for reasons...) If you want better options, the only choice in the UK is private healthcare. But yeah, I do still agree with you - GPs don't seem to even be up-to speed on the latest info with regard to a patients condition - sur…

None of this is true.

It's not technically true, but there is a lot of truth in it.

There are lists of recommended treatments, and there are many restrictions on prescription of medications, expensive ones in particular.

At a national level, NICE[0] (or SMC[1] in Scotland) decide what medicines the NHS will pay for, and for what conditions. They determine what medications are licensed for different treatments. They also set guidance on what treatments should be used for different conditions, what the 1st line, 2nd line, 3rd line treatments should be, and what treatments they think should not be used.

At a regional level, there are "formulary" groups, which take the national guidance, and make some tweaks - for example, for monetary reasons, they often increase the restrictions on expensive medications, making them harder to obtain. An example of those restrictions might be that the patient has to have been suffering for longer, the impact of the condition has to be more severe, or the patient must have tried several other (cheaper) medications first.

For expensive medications, it's often not as simple as a consultant saying "I want my patient to have this" - at a regional or hospital level, there are quotas/limits on how many patients per year will be treated with sich expensive medications, and there are comittees that meet regularly to decide who is worthy.

Now, if we put aside those expensive medications for moment: yes, technically consultants are free to use their experience, knowledge and judgement, and prescribe what they see fit (even unlicensed drugs) - but in reality, within the NHS it is uncommon to prescribe outwith the regional formulary guidance, or/and outwith licensed medication uses. There are a number of reasons for this:

1. Consultants take on individual liability when they prescribe unlicensed medicines, and individual hospitals fear legal risk too

2. Consultants will have their balls broken by their department head when they prescribe expensive medications - dept heads have budget responsibility, and in turn they will have their balls broken by the board

3. Consultants regularly meet with others from their department to discuss difficult/unusual cases, and have to justify their decisions to the panel

4. Perhaps it's the workload, but (IME) NHS consultants often have outdated knowledge. I swear some have never so much as read a journal article since they left medical school 30 years previous :( Again IME, private consultants seem to be much more confident to think out of the box with treatments; perhaps it's the commercial competition?

[0] https://www.nice.org.uk [1] https://www.scottishmedicines.org.uk

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

#402

Post by [deleted] »

nickjj wrote: post #352
johnisgood wrote: post #210

Earlier quoted context omitted.

Note: psychologists cannot prescribe anything here (Eastern Europe), psychiatrists can. I do not see any issues telling doctors that they are prescribing the wrong medication because you may know it better than them. I personally learnt a lot about pharmacology due to my illness, and I know what kind of medications are should not be supposed to be prescribed which the doctor working at the ER at that moment may not.…

> I do not see any issues telling doctors that they are prescribing the wrong medication because you may know it better than them. If you're not comfortable with a medication's potential side effects I do think it's worth bringing it up (I'm not a doctor, just an occasional patient) but it really comes down to how it's phrased. There's a very big difference between: "Actually propranolol won't work for me because aft…

[deleted]

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

#403

Post by ecmascript »

hathawsh wrote: post #66
jokethrowaway wrote: post #43

This was a great read! Doctors definitely don't need your product, as they pointed out. But consumers do! I think you should have sold to consumers. Having three doctors in my close family, I often found that whatever the tired doctor at the hospital is recommending is in contrast with what a doctor who care about my health (and is willing to look on their proprietary platforms) is recommending. That's why you ask di…

That was my reaction too. It seems like GlacierMD might have been successful if it had focused on SEO. Whenever someone types "what is the best headache medicine", GlacierMD should have been at the top of the results. The landing page would show the results of the studies for free, but would also let the user sign up so they can enter allergy and preference info and customize the results to them. Nearby doctors would…

Yeah I agree with your comment. Also, he could host it somewhere cheaper after launch and just keep the site up. Getting high up in the SEO isn't really built over the course of one day.

I am sure he could self-host it or rent a cheap server somewhere. AWS is crazy expensive so it seems kind of unnecessary to host it there if you are low on cash. I host a site with 40 TB worth of images and my bill is probably way less than his was.

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

#404

Post by Breza »

dsign wrote: post #311
dkarl wrote: post #109

I'm kind of concerned that people read this as satire but miss the most important part, namely the absence of concern about the safety and validity of the results. You know, the part where he stuck some statistical software in front of a database populated by a "motley crew" of contractors and wanted doctors to use it as a shortcut for making patient care decisions. The part where he implicitly compares the HTML spit…

I'm kind of concerned that our gold standard in medical practice is "this needs to work for everybody". We should really be more intent on doing personalized medicine.

The reason it takes so long to become a physician is because they have to tailor treatments to specific patients. Guidelines are there to help them make decisions.

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

#405

Post by ag_user123 »

wpietri wrote: post #261
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…

I'd be skeptical that would work. A friend did a ton of user testing of improvements to a price-comparison site back when those were the rage. With some frequency the engineers would come up with a way to help people make a better buying decision. E.g., picking a TV is a problem, so they'd make a wizard that would ask you questions and then give you a recommendation. Problem solved, right? Alas, no. Turns out most of…

It's true people don't trust new user guidance things, but if your product is useful you can build trust over time or not?

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

#406

Post by chefandy »

conductr wrote: post #253
chefandy wrote: post #99

Earlier quoted context omitted.

I probably would be surprised if that's true considering that in most states in the US, doctors are required to complete between 20 and 50 hours of structured CME (continued medical education) annually as a prerequisite to relicensure, and every one I've spoken to took it pretty seriously.

They are not unaware of the new stuff. But it doesn’t enter their day to day until it’s reached critical mass or if they’ve identified a couple suitable patients to recommend it to. Eg. Advil’s not working for a patient’s headache so, tell patient to try Tylenol because I learned about it during CMEs. Advil remains default for a long while. In many cases, until this doctors kid replaces him in the practice. Their gen…

Are you a physician, work in medical education, or have some other sort of broader source of information than that of a patient? I've primarily had experience as a patient, but it certainly wasn't what you describe. Obviously anybody limited to a patient's perspective wouldn't have anything more than anecdotal data.

Though back in the day, I did support for a CD-ROM based CME product... It was simple software so most of the people who called were in their 70s and 80s and not very comfortable with technology. They all seemed pretty concerned with learning the new stuff.

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

#407

Post by VEEG889 »

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

#408

Post by conductr »

chefandy wrote: post #406
conductr wrote: post #253

Earlier quoted context omitted.

They are not unaware of the new stuff. But it doesn’t enter their day to day until it’s reached critical mass or if they’ve identified a couple suitable patients to recommend it to. Eg. Advil’s not working for a patient’s headache so, tell patient to try Tylenol because I learned about it during CMEs. Advil remains default for a long while. In many cases, until this doctors kid replaces him in the practice. Their gen…

Are you a physician, work in medical education, or have some other sort of broader source of information than that of a patient? I've primarily had experience as a patient, but it certainly wasn't what you describe. Obviously anybody limited to a patient's perspective wouldn't have anything more than anecdotal data. Though back in the day, I did support for a CD-ROM based CME product... It was simple software so most…

I worked along side physicians for several years. I'm still in healthcare but more corporate. I have interacted with physicians as a clinician, business partner, and patient. They love to learn that's no doubt. But the OP content was about changing their prescription protocols based on some hacked together ML that has no traditional clout. That was never going to fly; not without some [insert specialty] doctor's endorsement or some medical journal nods.

When it comes to the business of healthcare, doctors are generally open to things that will make their jobs easier (they are money motivated creatures too). But, they don't necessarily like learning new things themselves. As a whole, they are rather resistant to change. It took a long time to incorporate any technology bedside (e-charts, etc).

As a patient, I/family has been referred to other doctors specifically because they were younger or knew their education differed in a meaningful way. The old guy knew his ways were outdated and we would benefit from the new ways. So he was aware of the new way, but wasn't practicing it.

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