When good ideas make bad business - <AUTHOR> https://tjcx.me/posts/i-wasted-40k-on-a-fantastic-startup-idea/ <comment><USER2> 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 "ophthalmologists in small practices (1-10 doctors) in New England who are trying to acquire new patients through social media."

And here's something that's absolutely critical for all engineers trying to build a startup in healthcare to really understand. Healthcare is so alluring because tech people are so idealistic. We think, "Wow, we we can write some code, and then save lives!" And that's sometimes true. But when you are thinking of your customer, revenue model, sales strategy - all that business stuff - the mistake we make is thinking healthcare is different and the same rules don't apply. We think if we can save lives, we can make a business. 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. The psychiatrist's reaction to the sales pitch is the _classic_ thing a doctor will tell when you're not helping their bottom line. As I was reading the post, I could almost predict how she was going to respond.

And if you figure that business stuff out, who knows, you might just build a healthcare business that saves a life or two.

<comment><USER3> 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 remission.

<comment><USER4> This is _precisely_ why we need universal healthcare. The incentive structure of private markets don't properly value human life.

<comment><USER5> "This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life."

Government-run healthcare isn't a panacea that will 'value human life' any more than the insurance companies. You are still a number in a database somewhere.

Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to put any money into R&D.

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).

We need to push the true costs of things to the patient, which will force the price down...not replace the existing inefficient layer of the insurance companies with an even more inefficient layer called the government.

This has worked with many cosmetic surgeries, which used to be very expensive, but aren't covered by insurance.

Insurance should only cover rare surgeries that can't use the free market to reduce the costs.

I can't think of anything that the government runs better than the private sector. Healthcare is no different.

<comment><USER6> Take all my karma...

Implementing something like what you describe, IMHO, would have the greatest positive impact on the health and welfare of Americans, of anything this century.

I have a friend who is very high up in one of the largest health insurance providers in the US, and I have often debated over the years with this person that same point, that the insurance layer is what creates the model for inefficiency, and abuse at the provider level ($5 Tylenol pill, $10 Band-Aid, minor treatments and return visits of dubious value, etc.), and that if we treated medical care as an ordinary consumer good, outside of the extreme emergencies that are bankruptigly expensive, things would be a lot better. The person I know at the insurance company doesn't necessarily disagree either.

<comment><USER7> Take a look at some of the "universal catastrophic coverage" proposals. The ideas is to BOTH socialize and increase market competition for healthcare at the same time. Universal care if you get cancer or for other chronic/terminal conditions. Then have a real market and competition for everything else. Regulate safety but not pricing or delivery. (Many of these plans also call for universal preventative services that drive down costs for the whole system). The Dutch have something closer to this in practice with "universal long-term care insurance" separated from the basic/primary insurance, but I've heard mixed reviews of how this works in practice.

<comment><USER6> It's an interesting concept. The primary concern is that most of the costs for catastrophic medical problems will be incurred due to things like obesity, smoking, heavy drinking, dangerous lifestyles, etc. This creates one of two problems (or both?): either I'm left with the bill for others' bad choices, or individual agency is under state / democratic control (e.g., salty foods banned, dessert banned, drinking banned, etc.).

Neither of those scenarios are ideal.

If the only question was genetic differences, that's a risk I think a lot of people would be willing to take (e.g., that I might be healthy until 100 and then die in your sleep, theretofore paying constantly for others who have had medical problems for 70 years straight). I myself would be willing to take that risk / pay for that style of universal coverage, if not for the aforementioned choice part (smoking, etc.) playing so heavily into the cost, in practice.

<comment><USER8> This is a shockingly uncompassionate perspective - is it satire?

Assuming it's genuine, it's also misguided. Almost no-one wants to be obese, alcoholic, etc - accessible healthcare will reduce the incidence of all of these, which in turn will reduce the externalities associated with them.

You also don't need further state control to discourage smoking, drinking, junk food, etc - taxation is the mechanism used globally to discourage undesirable behaviour.

<comment><USER3> Anarcho-capitalism -- er, "libertarianism" \-- at its finest. It's a deeply nihilistic worldview.

Almost all these things are biologically addictive, and furthermore the companies selling them have long known about their addictive qualities _and then built marketing campaigns to ensure the public was not aware of the risks_.

Taxation is how you recognize the externalities of this behavior while maintaining a free-market system.

<comment><USER6> We've been taxing cigarettes at like 100% or something ridiculous for many years, yet just as many people die from tobacco-related cancers now (if not more) as did when cigarettes were much worse for you (no filters, more chemicals, etc.). Those taxes also did not help to alleviate any of the problems in the medical industry; or if they did, they were obviously offset by something else massive, since cancer healthcare expenditures have risen drastically since their inception.

Also, it's easy to look at something like cigarettes which pretty much everybody would agree are a terrible idea, and say, "fine, tax em", but what about when it's sugar, then butter, then red meat, etc. Let people make their own choices instead, and just don't put the onus on the rest of us to fix the problems of those choices. Banning smoking in public is acceptable because it's no longer a choice that only affects yourself; it affects anyone near you in a really terrible way. But taxing cigarettes (or anything else) is no solution.

</comment></comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER9> 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 from pharmaceuticals that your algo says has high clinical success. Can you "recommend" them? Do they see value. Maybe you have a research tool on your hands.

3\. If you can keep your website alive, focus on SEO and gain traction with more users and play that out. Write blog posts, use affiliate marketing, and grow users. But don't add new features. Just maintain what you have. Try that for a year at least. What did you learn?

I think the toughest thing here is knowing when to stop building the product. That's what stands out to me as your demise.

The doctor was spot on, and those are the kinds of things you want to hear. It just means looks somewhere else. Writing a doc beforehand with potential opportunities is always a good idea, but it's never too late.

Disclaimer: I do product at MEGACORP and love product strategy.

<comment><USER3> 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 ML algorithm and it works transparently with the pharmacy management modules.

Moral of the story: don't get involved with healthcare startups unless you know the structure and economics of the industry. They are very different from consumer / business tech.

<comment><USER10> 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.

<comment><USER3> 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.

<comment><USER10> Sure. Thank you for the explanation!

</comment></comment></comment></comment></comment><comment><USER11> I'm so confused by the tone of this article. Obviously some of the jokes are parodying startup culture and are meant to be funny, however I think the "fantastic idea" stuff is meant seriously?

"So I built something people wanted. Consumers wanted it, doctors wanted it, I wanted it. Where did I go wrong?"

As far as I can tell, nobody wanted it except the author. The one doctor he talked to didn't, and no consumer ever saw it. I feel like the author learned a lesson, but not the full lesson.

Reading this was like watching someone you don't politically agree with doing comedy. You know they're trying to be funny, but you also know they're missing the whole point and aren't self-aware.

<comment><USER12> The funny part is, he might still be wrong about it being worthless. He talked to ten doctors? There are 1M in the US. It's kind of funny to drop all that time and 40k in then give up after ten doctors say no, especially without trying to tweak the product based on feedback.

I, as a consumer, find it worthless and they shouldn't have even started it, but now that you're here, might as well give it a bit more of shot than that. To completely bail on what you have after 10 no's is also the wrong move.

Doesn't seem like he asked the question, "well, what would you pay for?"

<comment><USER13> He should obviously be selling to clinics / hospitals

Plus when did the 'we don't have any budget' excuse stop a SaaS company? That's what you raise VC for - build the product, hand it to the customer for 'free' and charge them what it was really worth based on their usage when you threaten to take it away

<comment><USER14> Or he should try selling it to CVS as a in-the-store tool for OTC products, where his original need came from in the first place.

<comment><USER15> CVS doesn't care if you buy Tylenol or Advil or which one works better, and makes no additional money depending on your choice of product. In fact, the brands pay CVS for the privilege of being featured on an eye-level shelf vs at the bottom.

I think it was a great article. Like it said: To succeed, an offering must create value for all entities involved in the exchange—target customers, the company, and its collaborators. And value is literally measured in dollars, so you're either saving or making money for someone, otherwise it's just a fun project.

<comment><USER14> I would absolutely choose one store over another if they had a proprietary tool to tell me which medicine is scientifically most likely to work for my ailment. I cannot stand the massive wall of choices at pharmacies.

</comment></comment></comment></comment></comment></comment><comment><USER16> I wish he could have invested more in the idea - I think it's an amazing concept but the creator pulled the plug too early. Sales cycles in B2B can take months, and in healthcare they can take years.

Especially the doctor's feedback, she described the possibility of changing her habits slowly as she got used to using the tool.

Unrelated:

"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, like, donating this money if I paid you for this thing, right?"

This line kills me and it's exactly why I hate the healthcare industry. She clearly understands that the software could improve patient outcomes, but describes it as a _donation_ and still wouldn't change how she writes prescriptions (out of laziness, I guess?)

<comment><USER17> Sounds like there's an opportunity to have insurance companies pay for the product. This would directly align incentives and lead to overall cheaper care for the patients.

<comment><USER18> I had the same thought. The meta-customers here are the insurance companies. If you can prove that the tool improves the performance of doctors so that they get sued less when they use it then the insurance company will give discounts for doctors on their insurance for using it. Presto! We just created a market for doctors to pay for the service.

</comment></comment></comment><comment><USER19> 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?

Unfortunately a lot of stuff requires medical doctors that have experience. I just went through a severe health emergency, where I was taking one antibiotic and needed to be changed to another. I needed blood tests and constant supervision for the doctor to make this decision.

Psychiatry, which is what I guess the author targeted, is likely even less reliable. My friend is a pharmacist and was on anti-anxiety medication for a year, but decided to try another one, because of the effects on her were affecting her and now she's doing much better. This requires working with a psychiatrist for a year.

I think there's value in surfacing all this information but to expect people to rush into paying for it is naive. It's a nice-to-have-tool that might be useful like a Google-type research tool but nothing someone would want to pay $5/month for since the actual benefit over a psychiatrist just going off experience is completely unknown. There no inherent home run here.

<comment><USER20> >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?

</comment></comment><comment><USER21> Congratulations on learning the hardest lesson, your next startup is now a lot more likely to succeed, so get to work!

A _lot_ of comments criticizing what the author already knows, that the business plan was incomplete. I had the urge to do the same, but read to the very end and realized TJC clearly learned the most important lesson, and it's one I've learned myself, so I have no room to be critical.

BTW, I burned a lot more than $40k and 9 months in my own story, so maybe it helps to hear that other people have made the same mistake and gotten too convinced their idea is valuable without checking carefully enough -- without quite knowing how to check carefully. I know what it feels like to know that I'm doing the right thing, and then find out that it's not good enough.

Fun read, and an important lesson that many very bright people will still learn the hard way, even after reading a story like this. Thank you for sharing.

<comment><USER22> What was your story?

</comment></comment><comment><USER23> Realistically, while I feel that the author is on the right track with this data driven approach to evidence based medicine, the fact remains that the advantages/disadvantages between drugs within the same class of medicine tend to be negligible compared to drug costs. There are then other specific concerns that must be considered eg pregnancy/breastfeeding, liver failure, kidney failure and often what ends up is that one defaults to a standard drug per drug class with alternatives in specific circumstances.

The real benefit IMO would be marketing this to countries with a top down healthcare purchasing system (eg the UK) or as a tool to drug companies/researchers looking to make their own meta analyses (eg abstrackr). It might also be better instead to diversify into correlating symptom clusters with diseases because then the utility to the end user is bigger.

<comment><USER24> I had the same thought:

Sell this product to insurance companies so they can recommend cheaper/safer drugs to their customers, or show the more expensive one and if it truly had better outcomes. Everyone benefits from that.

That said, the medical establishment is a tough tough domain to move.

<comment><USER25> Insurance companies already have teams of doctors and pharmacists analyzing studies to ensure they are pursuing the most effective and cost effective healthcare. They're called Pharmacy and Therapeutics (P&T) Committeea.

</comment></comment></comment><comment><USER26> The author says that they fired the contractors and closed the site. I can never relate to this. You built something that is at least somewhat useful to at least some people. Why not just keep it online forever? It can't cost more than $5/mo to host this, I have a server where I host around ten of my projects for less than $20/mo.

Why do people shut things down instead of just leaving them there, unmaintained? Even that is better than just taking it offline.

<comment><USER27> Well in the case of this particular product that offers medical advice, the info may become outdated fairly quickly. I suspect there is some amount of liability associated with offering potentially out of date medical advice that isn't worth the tiny revenue stream.

<comment><USER28> It's just a programatic meta analysis. And no one's get sued for having an out of date meta analysis.

<comment><USER29> It's America - people get sued for far, far less.

<comment><USER28> Anyone could theoretically get sued for anything. But the chance of getting sued for providing an out of date meta-analysis is indistinguishable from the background chance of getting sued for getting out of bed in the morning. (assuming you're not doing something stupid)

</comment></comment></comment></comment></comment><comment><USER30> I have a family member who worked somewhere that provided tools to medical practitioners to help them determine how a patient would respond to a drug based on their genetics. They also had a hard time selling directly to clinicians, because as the author notes, they do not particularly care about patient outcomes in the abstract sense, because much like the programmer bravado, doctors have a similar one: most of the other doctors are worse than me, they need the tools but I don't because I have a more nuanced view, I know what works for my patients better than any statistical study could tell me, etc.

The only way to make money is to get insurers to require these things, or to sell to some big hospital network administrator who you can focus your sales efforts on. I don't think the product here was mature enough to sign a multimillion dollar contract with a hospital network, and maybe not for insurers either.

</comment><comment><USER31> > Make something people want. It's Y-Combinator's motto and a maxim of > aspiring internet entrepreneurs. The idea is that if you build something > truly awesome, you'll figure out a way to make some money off of it.

Nice narrative style and congratulations on achieving your (first?) failure without too much trauma.

It's possible you invested your own money prematurely, possibly without talking to enough people about the opportunity. Your metric for how much people want something is usually directly tied to revenue, or if you are using engagement as your metric, you should have figured out some way to make money off of it before you invested in development. I suggest that other engineering-minded founders think of sales like writing "hello world" \-- for example, if you're doing a physical consumer product, you can start by shipping pet rocks on day one.

More than just identifying a product people want, you also want to find a network effect or viral marketing approach so you can grow with a sustainable advantage.

</comment><comment><USER32> I think the original poster made the same mistake I did, and took the wrong lesson from the situation.

The startup idea sounds great and I would enthusiastically start working on it right now as a cofounder.

The problem was spending money before having a sense of how to get more.

That's all.

If the startup could have been run entirely without paying contractors or incurring other serious expenses, the poster could have run it for longer, and iterated on models longer, until the product/market fit got dialed in.

There just wasn't enough runway, enough iteration.

</comment><comment><USER33> The most disappointing thing in this story is that glaciermd.com doesn't even resolve anymore.

He started a business in 2017, and closed the doors in 2018. What?

Recently, I was contacted by a person who told me he saw one of my videos on YouTube about Ycombinator (it had 50 views!!!), he had to meet me in person. We met a couple days later. He was a very smart guy with an impressive resume.

He quit his job in equipment manufacturing to pursue entrepreneurship. He was a former USC student, so naturally he traveled back to California, rented a small room where him and his business partner churned on their idea. It was a sort of classified for colleges.

Not a terrible idea in anyway. He knew the college life so he must have known things I didn't. I told him he should have tested his idea before quitting his job and moving into a whole other country where he had only been a student. He showed me the website, and it was obviously made by someone who was learning React. There is no need to go fancy when you are still testing your ideas. But there was a problem.

They were paying thousands of dollars a month to keep this barely functional app running.

This is something I see a lot of young people entering web development are doing. They get beefed-up cloud services that eat up a good chunk of their money. Most people think this is the regular cost of being online. It's not! A year later, the domain name doesn't resolve either.

In the story, OP alludes living with his parents. I imagine to save money. But then there is $40k. I hope that it wasn't mostly on the AWS cost. But he gathered valuable data that did cost money.

Don't shut down the website. Keep it running and make the data available in read only mode and add a donation button (alternative to ads). It should cost $5 a month to host on linode or digitalocean. Don't let the money you spent go down the drain.

</comment><comment><USER34> 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?

</comment><comment><USER35> Oof. The site was practically named after WebMD, and the founder didn't do any market research on that competitor to gauge how viable the business was before quitting their job? This person probably should have known that their main competitor made $0.50/user before they quit their job. Also:

>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.

This person uses the "X% of Americans" line, so they live in the United States, right? The one in North America that views healthcare as a business to wring money out of? They definitely should have done more market research if they could type that with a straight face.

But hey, hindsight is 2020 and they only spent $40k on some very valuable firsthand experience. Sounds like a win if they're planning to run businesses in the future, but for ideas without a clear path to making enough money to sustain themselves, try to use other peoples' money next time :)

<comment><USER36> That line stood out to me also. Anyone who feels that the primary goal of healthcare in the US is to improve health outcomes is incredibly naive about how this industry (which is over 20% of the us economy) works. There is only one group in the entire industry which has an incentive to keep people healthy (insurance) and that is the most hated of the bunch!

<comment><USER37> 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.

<comment><USER38> 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 insurance company, it's perversely in their best interests to increase the cost of medical care as much as possible. Medical care is not like cat bonds that might wipe out your risk pool, so it's just a cashflow game.

That's not to say there isn't any downward pressure. On a day to day basis, individual claimants eat more into that margin than was budgeted, so a company might have to raise rates higher than their competitors (essentially they have some pressure to deny claims), but there is very little systematic pressure to reduce overall costs. Also, marketing budget does not count towards profit, which is why insurance companies are in this rat race of brand advertising to steal customers from each other. With auto insurance, for example, upwards of 40% of your premium is just going out the door as ad spend.

Anyway, I would assign a lot of blame in this perverse incentive scheme to poor regulations.

<comment><USER37> 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.

</comment></comment></comment></comment></comment><comment><USER39> > "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, > like, donating this money if I paid you for this thing, right?"

I've never seen such a concise indictment of the American healthcare model.

<comment><USER40> If this thing works as a better search engine for medicine, then I'd want my doctor using it. Could this person have trialled it in a healthcare system with a public-option?

Convince the government your product is a benefit to their doctors and by extension their citizens, and a good government should pay you for it after a proper trial.

Instead he walked into a situation where the incentives are utterly fucked by an atomised, privatised, and consumer-oriented healthcare system.

</comment></comment><comment><USER41> While not a unicorn, this could potentially succeed as an indie-hacker sized project. One potential business strategy could be a high-level information hub - a weekly blog + podcast for example. Each week look at a different drug or illness, look at all the relevant papers, do a short statistical analysis, and summarize. Then get some patreons, run ads, maybe sponsorships for particular drugs, etc. I think there's a lot of math geeks out there that would find this useful/interesting enough to follow on a regular basis, even if just to see what's going on in the healthcare space.

<comment><USER42> Another idea that could make this a viable business: while in general consumers won't pay for this sort of thing, there are certain problems that the medical establishment just does a horrible job treating, where I think people would gladly pay up. Migraines, for example.

I personally suffer from some sort of headache disorder (symptoms are a mix between migraines and cluster headaches, I've had different diagnoses). I went to a neurologist every 3 months for 2 years, at $200 per 30 minute visit, and usually less than 10 of those minutes were spent with the doctor. Every time he made some seat of the pants guess as to what to do next (adjust the dosage I was receiving, or change medications). In the end, I never found anything better than taking a bunch of ibuprofen at the first sign of a headache, and that was something I figured out on my own.

I wouldn't pay a dime to see a comparison of generic and name brand NyQuil, but if a trustworthy source offered me a personalized report on what medications I should be looking at based on my headache symptoms, and had studies to back it up, I'd gladly pay $100+.

</comment></comment><comment><USER43> This is one of the best startup post-mortems I've read on HN. Clear and engaging writing which also provided key insights into the mind of the entrepreneur during his journey. It's sad that it didn't work out but I think it can help teach valuable lessons to anyone reading it.

</comment><comment><USER44> It's a shame this project was shuttered as what screenshots are posted look amazing.

Better data aggregation is desperately needed in medicine and sadly I think the creator has walked face first into the horror of cost merely to access clinical trials. Plus, the cost of paying contractors to extract the actually useful information from those trials.

These are key reasons why Open Science and Open Data are so critical, to produce tools like this one. Sadly I don't think there is a "Startup" level of money available for it even so.

<comment><USER45> He might not have succeeded in getting rich, but he can still turn this into an incredibly effective $40k donation to public health research.

I'm sure there is a researcher out there who can find hosting for this service, and maybe continue to keep it up to date with new trials.

</comment></comment><comment><USER46> It is easy to be an armchair expert, but I saw that this is not a viable idea: almost nobody would pay for it, for 99% of the cases patients and doctors already know the medication that is good enough and good for them (ibuprofen for me, acetaminophen for my friend because Ibuprofen upsets her stomach etc). And remaining 1% will most likely require serious medical attention, not just rando site. Let alone the fact that this is borderline dispensing medical advice which is a highly regulated activity!

One way to look for a similar business is examine.com (disclosure: I do not use them but read their write ups and articles about them on indie hackers- like sites and podcasts). It is a site that gives information about supplements. The supplement landscape is much more wide than that of painkillers, they are hard to compare, and supplements are usually chosen by consumers themselves, and supplement information is unlikely to be treated as a medical advice.

<comment><USER47> Theoretically I could see this being used as a marketing gimmick for the PCP office (we collect a profile of medications best for you based on a statistical evaluation of results from peer reviewed studies!), and that could help docs make the case that patients should see this clinic vs another one nearby. But anyone who has tried to use healthcare in America knows this isn't really one of the limiting considerations in how you choose a doctor or practice.

</comment></comment><comment><USER48> You should market this to insurance companies, not individual doctors.

At their scale, they can use the data to drive their costs down, and can build a business case for paying you something.

<comment><USER49> Insurance companies have very little/not at all influence over prescribing patterns of physicians. If you could tie this improved outcomes, then there is a business model here.

<comment><USER50> >Insurance companies have very little/not at all influence over prescribing patterns of physicians.

Walk into any physician office and ask them how many faxes they get everyday from pharmacists requests the Dr. change their prescription. Then ask the pharmacists what triggers them faxing requests to the Dr.'s requesting change in therapies...hint: insurance companies dictate to the pharmacists their recommendations for Docs.

Edit: I should have noted the "tips". When a pharmacist faxes a Doc a recommendation the pharmacy gets a "tip" and if the Doc actually makes the change, then the pharmacy gets a 2nd "tip." In my experience the Doctors have no idea pharmacists are paid by insurance for recommendations and changes.

</comment></comment></comment><comment><USER51> 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.

</comment><comment><USER52> Hi Tom, thanks for sharing this. I work for a company in the evidence based medicine space that would have become your competitor had you continued to pursue this idea. Send me a line (email in profile), it would be interesting to get introduced.

<comment><USER53> Hey is there a way for patients/caregivers to get involved? I'm particularly interested in finding ways to collect data on trials that are in progress but haven't published results yet. Secondarily trying to build an evidence-based approaches to selecting low-risk adjuvant therapies that hasn't been directly proven in clinical trials.

<comment><USER52> I don't entirely follow your question, but please feel free to send me an email if you want to catch up on this.

</comment></comment></comment><comment><USER54> 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, > like, donating this money if I paid you for this thing, right?"

So, what's the obvious next step ? Prescribing things that won't work so patients keep coming back but not badenough that they flee to another practice ?

<comment><USER55> 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.

<comment> mark-r "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.

</comment></comment></comment><comment><USER56> Guess it's time to rebrand this as a fintech startup that informs investors about high-risk pharma stocks.

<comment><USER53> Yes! Andrew Lo has a great talk on a related subject - [https://www.youtube.com/watch?v=AzELyaVf0v8](https://www.youtube.com/watch?v=AzELyaVf0v8)

</comment></comment><comment><USER50> Its kind of sad picturing the customer with a headache needing a app to tell him what medicine to buy at CVS...while there is a pharmacist right there.

I do like the quip at the end about lacing up all birds and jumping on the bird scooter. This makes me think how badly I need allbirds to join the sharing economy...how great would it be to have allbirds scattered all around your city sidewalks so you have a paid on demand when you need them without having the overhead of actually owning them. Its not sexy and doesn't scale well, ticking all the VC boxes.

<comment><USER57> > while there is a pharmacist right there

who has a very clear understanding of the margin of the various products in the shelf. Maybe competent but certainly not unbiased.

<comment><USER50> Maybe in a small independent pharmacy you have this issue, but biggest pharmacies in the World (CVS, Walgreens, Walmart) the pharmacists will not know the margins of over the counter drugs and have nothing to do with purchasing them.

>Maybe competent but certainly not unbiased.

I suppose they have a bias in the form of legal liability and professional licensure which guide their recommendations. That is, they can be sued for negligence, malpractice and otherwise potentially lose their license to practice. Tech startups are notorious for placing profits before users, and lack accountability in the same way as licensed professionals. In a worst case scenario they fold up shop and move to the next industry to "disrupt".

</comment></comment></comment><comment><USER58> > Make something people want. It's Y-Combinator's motto and a maxim of > aspiring internet entrepreneurs.

I think it's fine motto for startups that are going to be fueled with angel money.

For bootstrapped startups I think it should be: "Make something people want (to pay for!)."

</comment><comment><USER59> The reason that you don't get a result for "best painkiller" when you google best painkiller is that there's no such thing.

Why are you in pain? have you had a lot to drink recently? What kind of painkillers do you usually respond to? Why not simply combine them? Are you going to keep track of all of these predicates for each query?

This guy's mistake was not that he mismanaged a company. His mistake was having a shitty idea and being utterly deluded about its value.

</comment><comment><USER60> Forgive me for stating the obvious, but wouldn't talking to doctors with some mockups have prevented most of this?

<comment><USER61> It definitely would have.

</comment></comment><comment><USER62> Perhaps you gave up too soon, your startup journey is shared by most (all?) startups i.e. where they end up finding PMF is often very different from where they started. It's a matter of sticking with it and if it's worth the opp. cost.

Admittedly, this is Survivorship Bias, since the overwhelming majority of startups fail. As PG said: "startups don't fail, founders give up"

<comment><USER63> Sure, but that's not the whole story -- the OP would also need to be okay with changing the idea drastically where and when required. As other people have noted in this thread, not much effort was made when talking to the doctors to find out what problem they _do_ have, and no mention is made of ever even showing this product to consumers.

The fatal flaw here was building a product "in secret" and not launching soon enough.

</comment></comment><comment><USER64> So one thing I will add, you might want to approach the companies that are at the top of the list and offer them the tool as a sale tool.

But overall, the goal of health care as a commercial Endover is to keep you sick (I.e., not healthy, since then you will not spend, and not dead).

So the goal of selling to health care professionals is actually the opposite of your goal of helping patients.

<comment><USER53> I think this is overstated most of the time, otherwise why would we have vaccines?

However, I would be on board with saying that when situations get dire, risk management begins to diverge incentives between patients and providers.

<comment><USER65> Vaccines exist for a tiny fraction of conditions.

And in the market consumers revealed preference is for $1000/yr treatment over $20K vaccine, or equivalent multiples. When a new vaccine is invented, people balk at the price and complain it shouldn't have been created.

Far more investment is in "managing" conditions.

<comment><USER66> I don't buy this line of thinking - the list of curable diseases/conditions is longer than the incurable ones. Selection bias means the incurable ones get more attention (because they have to be managed). The health care industry is (mostly) not a coordinated cartel; it's a bunch of self-interested organizations looking to get a leg-up on the competition.

</comment></comment></comment></comment><comment><USER67> Thank you for your vulnerability and sharing your story with such honesty!

There are easy businesses, and there are hard businesses. Your business fell in the latter category, but your tactics to succeed were based on easier businesses. I still think you could have succeeded if you persisted and weren't so eager to get sales and play startup.

</comment><comment><USER68> I commend your effort. Humanity likely would've progressed more from the application of this data than it would with you working on leveraging autonomous blockchains (not that that's a bad gig either).

I think the general takeaway is:

1\. have an idea 2\. make some mockups with plain HTML/CSS 3\. run it past your target market to see if they'll pay for it 4\. if so, build it

This works even better if your target market is willing to fund the development costs.

I still feel like there's an idea somewhere in here – maybe with medicine, or maybe with supplements, nutrition, etc. You could position yourself as a knowledge base and use the data as a marketing funnel for related products. Examine.com has an interesting business model along these lines. (If I was about to start an anti-anxiety medication, I'd sure as hell pay to know which one worked best.)

</comment><comment><USER69> This is why starting with low or no code is a great idea. He would have saved a lot of money if he went around to potential customers and seen if they would have paid for such a product. Or fake a product with fake data and demo it to see if there's anyone that would pay for the real thing.

</comment><comment><USER70> I think we mistake these ideas as being bad business because of our expectations. Some ideas take longer to produce returns.

I'm currently working on an idea that has no business plan in the near future. It's a cryptocurrency. I hope to make money from in the future by either selling my stash or providing software and services. But in the meantime, I'm running it as a fun/side-project. The project is picking up steam. I've seen interest growing, some coin trading on an exchange.

I don't expect to make money soon. So I do everything myself. I spend little money on the project, 3-5k per year. I enjoy working on it and learning. It helps me learn not only about my project but also about other cryptocurrency. I think that I will make some money, eventually.

</comment><comment><USER71> If you don't know how to monetize, you need investors...duh :) Then you can spend some millions working it out! And if you still cant monetize make sure one of your investors is deeply in the hole on this investment and you control the voting shares and make them buy you out.

</comment><comment><USER72> I can't help but wonder if this would have worked better if the author had:

1) Tried this in a different country. Healthcare in the US is very different from Canada or the EU. Maybe it would fail elsewhere too, but its a completely different marketplace. I have a hard time imagining a Canadian doctor saying "This is better for my patients, sure, but will it help my bottom line?"

2) Worked on a solution that didn't involve so much labour. It was data processing, right? Might be a good fit for ML. (God knows it's being used for everything else.)

That being said, I'm in awe of anyone who goes out on a limb like the author did. He didn't just try an idea, he invested in it. And then he had the courage to tell us about his failure. Bravo!

</comment><comment><USER73> Seems a case of someone not understanding the economics of the vertical they're entering and not wanting to put the effort (ie: time/money) to learn. Doctors generally don't directly make money by having patients get more healthy. Other entities however do. Insurance companies may, self-insured employers definitely do, and hospital chains may (if they're getting bundled payments for procedures). These entities however have very long sale cycles and are old school (ie: won't listen to some 20 year old). Still, there's a whole massive ecosystem of companies in this space so it's far from impossible. Possible to also partner with one of those companies as a sub- vendor.

<comment><USER49> There is a value-based angle here. But as the psychiatrist told him, she doesn't make any more or less by prescribing one drug vs. another. If he was able to link the use of a specific drug to improved outcomes (READ: fewer repeat visits, less time in the hospital), then it could be something that ACTUALLY reduces costs.

</comment></comment><comment><USER74> > On July 2, 2018, GlacierMD powered the world's largest depression meta- > analysis, using data from 846 trials, beating Cipriani's previous record of > 522.

Was this analysis written up somewhere? The author links to Cipriani's study in the Lancet but not to their own.

</comment><comment><USER75> I don't know that I've encountered such a flagrant display of naivete from someone who actually has an education/proficiency in a profession, who is also apparently well-read enough to engage in such a process. It demonstrates a complete lack of respect for other careers that have a tremendous amount of education requirements and proficiencies of their own, not to mention having a basic social awareness of how people behave and respond in the business world and social realm. I get that he was trying to be humorous, but it wasn't informative enough to make me sympathetic to him at all.

</comment><comment><USER76> I would apply for an SBIR and try to get some academic support. Maybe the NIH would be interested. Your algorithm and analysis platform might be the real special sauce here. Maybe even license to a pharma company.

</comment><comment><USER77> My university (University of Hartford, in CT USA) had a required course for all engineering majors: "Engineering Practice". Essentially it was a course on how to take an engineering idea & turn it into a business.

Find a problem, find potential buyers for a solution, figure out what they say they're willing to pay, determine other design constraints, rough design a solution matching the constraints (IE that can be sold for what people will pay), _create a business plan, including estimates of how much funding is needed and a method to get that funding_ , build a prototype, pitch the product to faculty as though they were VCs/banks/other funding sources.

If you're trying to make a _product_ you need to know how it will sell. If you're trying to run a business, you need a business plan! If you can't make money you're better off planning to register as a charity, and your budget will need to take that into account.

This product could maybe have been a good business, if it was aimed at someone willing to pay for the data. Mainly, the insurance companies. They want to make money, so if they could profit by denying coverage of drugs that are less effective they might pay for it.

This could also have been a good charity. Providing helpful information is what educational charities do. Making a nonprofit would save on costs, and might have been enough to make this viable (though certainly not a lucrative money-maker).

</comment><comment><USER45> As you're now 18 months on from July 2018, so have probably moved onto other things...

Please consider approaching some academic institutions, or some medical professional associations to see if they would be interested.

While I doubt any will have any money to pay you, they will almost certainly be able to host this for free, probably indefinitely. You just need to find one interested researcher.

It's hard to tell exactly what it is you made, but informative, interactive, visualisation tools can have really powerful public health effects if marketed well.

</comment><comment><USER78> It's like a brief diploma-less MBA program, like a Montessori MBA.

</comment><comment><USER79> I'm surprised Big Pharma hasn't done something like this for free for doctors. They already spend tons of money marketing to doctors to perscribe their drugs and even club together and spend billions monitoring the perscription data with IQVIA (IMS Health basically). Maybe it's just that I've recently finished reading Bad Pharma by Ben Goldacre, but this sounds like it's right up their street to help manipulate doctor's perscribing.

</comment><comment><USER80> Obviously, the doctor is going to torn to shreds here...but I think this kind of misses something about medicine. You prescribe a drug, you know roughly what it does...but aren't totally sure what is going to happen when the specific patient takes it. SSRIs are a perfect example of this.

...and that is kind of why you hire a doctor rather than a computer who has looked at some studies...that isn't really what medicine is.

More generally: this just sounded like a terrible business model. Consumers and probably doctors would value the end product but are you going to get back the money spent on contractors manually going through these studies...no. I can see this making sense for a larger company but these kind of projects are terrible for one guy alone, they just tear through cash.

You also don't seem to have asked how doctors/insurance companies actually look at this data either. I am sure I have no idea but the first question should be: is the user looking through these studies manually? Did you survey doctors: how many studies do you look at a week? Do you look at them before prescribing? Etc...and probably do this before you build obv (and try to get money upfront).

</comment><comment><USER81> Step 1: come up with a half baked idea Step 2: quit your job and hire other people Step 3: market research...

Guy did everything wrong and blames his failures on others. Typical.

</comment><comment><USER82> Hey, hey -- what about a grant from WHO, NIH or NHS? What about having a national or world government continuously sponsor this work as a public resource?

<comment><USER83> NIH grants are extremely hard to write and get funded if outside of an educational institution. I have tried both in and out of school; inside it was relatively easy, outside near impossible. YMMV.

</comment></comment><comment><USER84> This is an amazing journey. You got a novel idea. You felt the fire under your belly to bring it to life. You executed that idea and really built the product that people like. So sales and marketing are hard. So what. You have learnt a lot more. The money was not wasted. It's part of a very valuable education and on-hand experience. The lessons learnt will benefit you time and time again.

</comment><comment><USER58> > There was this giant thing called healthcare right, and its main purpose is > improving health—trillions of dollars are spent trying to do this.

There was this giant thing called healthcare, and its main purpose is applying well known treatments to people whose symptoms more or less indicate that treatment might somewhat improve their condition—trillions of dollars are earned trying to do this.

</comment><comment><USER85> For anyone else who, like me, is prone to the excitement of new company ideas and has a tendency to gloss over questions like "is it even possible to monetize this?" I'd recommend reading Disciplined Entrepreneurship. It's not the One True Way but the steps they recommend cover a lot of questions that you should think about during the process.

</comment><comment><USER86> Here's how I see it, and the quote at the end kinda fits into this:

What problem are you trying to solve? Googling "what is the best pain killer" is a very "average user" question. It's also 99% useless.

Pain killer for what? Headache? Muscular pain? Nerve pain? You have a partially severed limb that's bleeding profusely? Oh you mean an OTC pain killer?

Ok do you have stomach problems? Liver problems? Kidney problems? Diabetes? "Oh I don't know" oh well...

"But I'm just trying to get the best drug for your situation" yeah, that doesn't exist. And there are personal preferences (doctor), personal preferences (patient), limitations, marketing pushes, etc.

Finding out drug X is more efficient than drug Y in 5% is just background noise. Hence why the doctor didn't see much value in this.

What would be valuable is finding which drug X to try if drug Y _didn 't work_ or can't be used (though doctors usually have that in their heads).

</comment><comment><USER87> Great writeup. Very honest.

His problem is that this product neither increases the revenue of the practice nor does it reduce(or remove) any existing cost. Without that it's a cost center without clear benefits.

> 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.

No. Or at least you better show clear benefits becuase EVERY medical product makes claims that they improve patient health or patient outcomes.

What he needs to do is figure if there is some costs that are currently incurred by hospitals and practices that could be reduced or removed by using his product. If he can do that, he'll get sales (and in fact, there is a lot of money in 'population health' and related fields). Otherwise, he's got nothing.

</comment><comment><USER88> Hey, I prototyped something similar to this a while back. It used NLP and Elsavier search API to do entity detection and sentiment analysis on drug/effect pairs.

So you would search like "Mirtazapine", and then it would create a word-graph where the drug was in the middle, and it would be connected by things like:

        Mirtazapine --> Reduces --> Anxiety/Depression

        Mirtazapine --> Increases --> Hunger

The words were colored either green/red based on whether it was considered a positive or negative effect, and the size was based on the size of the effect and numbers of mentions.

It was meant to be a tool for clinicians and prescribers to be able to enter a medication and get an easy overview of its effect.

Do you have any interest in pursuing this further?

I know a few investors who I think might still be interested in this.

<comment><USER89> i'm interested in the project you mentioned-- drop me an email adam at springhealth.com if you'd like to chat

</comment></comment><comment><USER90> This would be a useful feature of Google, but it won't be a real company without an innovative business model. 9 months to build a company AND THEN innovate a business model is nowhere near enough time, especially since you probably spent the vast majority of the time on the product. If you had a partner that was equally talented working on the business side since day one you still wouldn't have something in 9 months, but maybe 2 years. And maybe something HUGE. That's the gamble you make going into a startup, and 9 months simply isn't long enough to find that out.

Or maybe you could have been a small acquisition target for Google to incrementally increase their search superiority. I imagine they would be able to monetize eyeballs with searches like these at (very) roughly 100x the rate of WebMD.

</comment><comment><USER91> Thank you for sharing the details of your experience. Healthcare in the US is not a normal market, so normal product- based thinking doesn't work. The end user doesn't pay, so they cannot directly influence the market by choosing products. Your discovery with the doctor who said that improving care doesn't help her, is really insightful. The 80/20 insurance rule fixes insurance profits so they have an incentive to make care as expensive as possible. Despite all this, we all know there is a ton of value in making things better. Your graph of Aleve performing so much better then ibuprofen is really interesting, and seems to capture how other parts of the system could be improved if end users were given the choice. Maybe a trusted review site with data to help patients choose doctors.

</comment><comment><USER92> 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 effective pain killers. What I really want is to fix the root cause and stop having these headaches.

So yea, I can totally see why something like this would fail. If the solution is still qualitatively the same, a small percentage improvement is just micro- optimizations that most doctors and patients won't care much for.

<comment><USER76> What's your blood pressure? I had bad tension headaches from time to time and after starting a bp medicine they've basically disappeared.

<comment><USER92> 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.

<comment><USER76> I was borderline. Higher bp increases your risk of stroke. I figured the headaches were a warning.. I could be wrong about that though.. I take a very low dose ace inhibitor and it works great. Doc said it wasn't a permanent thing necessarily.. I could probably go off of it if I was more consistent with the DASH diet and exercise more and drop 15-20 pounds.

Keto diet supposedly helps drop the bp too but diets are really hard to maintain and stick with.

</comment></comment></comment></comment><comment><USER93> Healthcare startups are a like a 'land war in Asia'... "only a fool would make such a blunder" (via The Princess Bride, perhaps the best film of the 1980's.)

Selling anything to medical practices is remarkably difficult, due to the difficulty of getting a meeting. They may have to lose $250 in billable time to meet with you, and they are bombarded with sales calls from everybody under the sun. Getting adoption is worse, with overworked staff actively hostile to change. I watched a friend sink his heart and cash into a medical research survey system only to find out how impossible of a market it is to break into.

And it is a land war. Selling into large companies is hard fought, but possible. The long tail is practically impenetrable for a software system, not when they could allocate capital to revenue generating marketing, equipment, and staff. I worked at trying to market a low priced medical supply item into a long tail of allied healthcare professionals and found that _there is virtually no network effect_. That is to say, people who share the same medical profession have very little interconnected outside of a very local level, and the work they perform is so physically and mentally draining that they don't really want to spend a lot of time online after hours talking about vendors, or talking with others in their field at all. Durable medical equipment and consumables sales are really driven by incumbent field sales reps more than ecommerce, even still in 2020. Land war.

Look at how difficult a time big tech has had taking on electronic medical records systems. Technology is not the bottleneck.

There are plenty of health tech startups finding traction, and I do believe medical professionals want to continually improve themselves and their practices with whatever tools and information is available to them. The fact is, $40K isn't enough capital to win a land war, no matter how great the solution is (and its looks great). I'm sorry OP had to find that out the hard way.

PS. There is a growing array of health focused startup accelerators that can provide seed money, but more importantly the expertise to navigate the sales and regulatory challenges unique to healthcare.

</comment><comment><USER94> The foremost problem is lack of domain expertise as others have noted. If you lack domain knowledge but love your idea, the best course of action is to keep your day job and gain as much knowledge as you can before quitting.

But another problem is lacking the conviction and traversing the idea maze[0]. Several comments here have provided good paths for possible methods of execution like offering a free API and seeing who is using it.

[0] Summary of Balaji's concept here: [https://cdixon.org/2013/08/04/the-idea- maze](https://cdixon.org/2013/08/04/the-idea-maze)

</comment><comment><USER95> Wow, what a nice and funny story!

Why GlacierMD? You know glaciers tend to melt these days.

You'd be surprised that the dumb and not so noble idea of your buddy with Doppelganger could gain much more traction and make much much more money than your idealistic thing... this is usually the thing.

People are attracted more to fun than to pragmatic usefulness.

You feel almost like a martyr who wanted to save the world, but nobody understood you. I am very sorry and I see great value in your idea, but looks like people don't want to consume that.

Indeed, why would a medical practice want to completely cure the patient and never see them again?

Really fun read and with lots of useful references.

</comment><comment><USER96> Oh man this is depressing. I have a few ideas that I'd like to get funded and make a business out of, but I have no idea how useful they would be to the average consumer and how I would go about raising funds (doesn't help that my current job has a pretty strict NDA which pretty much covers all software).

At least you gave it a go; even if it didn't work out, you don't have to wonder "what if?" for your entire life, and I think it's pretty cool that you built something you were passionate about; at the very least, stuff like this is pretty good resume fuel, right?

</comment><comment><USER97> HN with the editorial decisions on the title again. What's with this?? Seems good enough to go with the author's actual intended title for a few hours on the HN front page, and now it's changed?

</comment><comment><USER58> > 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.

Wow. That's not how any of (especially 'for profit') healthcare works.

I think it's a good heuristic that you definitely shouldn't build a product if you rely on getting money from 'some profession or some institutions or whatever'. This indicates that much more research into your future customers and motivations is needed before you attempt to create business.

</comment><comment><USER98> I love the idea, but I'm sad that the author focused on doctors, and not ordinary people that he mentioned at the very beginning. This could be a great application used by everyone, including Google, to provide better search results, at the same time providing more and more traffic. Mentioned ad revenue could also work, but not only this.

If the author reads this, do not be like Google, don't give up, just pivot. Yes, I think it's Brilliant Startup Idea that could be back in a few months better than last time. :)

</comment><comment><USER99> Falling in love with an idea plus ignoring reality is the surest road to hubris and failure. Be religious about results, customer value, profitability and employee welfare, not ideas. Ideas are a dime a dozen; executing and pivoting into what works too often is stymied by ego and thousands of other self-destructive tendencies that increase the likelihood failure in millions of ways. There are very few ways to succeed, with a little help from happy accidents and flexible resilience under pressure.

</comment><comment><USER100> Honestly, it sounds more useful than [https://www.ibm.com/watson- health](https://www.ibm.com/watson-health)

Pretty similar to [https://www.ibm.com/blogs/watson-health/hospital- pharmacists...](https://www.ibm.com/blogs/watson-health/hospital-pharmacists- tap-ai-to-improve-drug-information-searches/) even.

Product sounds fine, but not selling them 1 by 1 to doctors.

</comment><comment><USER101> You could have made value for the customer too, you needed cash to keep the operations going. Doctors will pay for this if it lets them get a leg up on other doctors that's how you need to sell it. "Doctor X prescribes what he always prescribes, I make decision based on cutting edge studies." If they got arbitrage because of that and could steal patients, especially doctors with a new practice then you have a sale my friend. You gave up too easy.

</comment><comment><USER102> '"To succeed, an offering must create value for all entities involved in the exchange—target customers, the company, and its collaborators."' aka product- market fit

</comment><comment><USER103> > I had literally nothing to say to that.

I think this is literally why salesmen exist.

One of my good friends is a real estate agent and he is helping me find a house. My job is to complain about every place we see. Every single time he finds a way to spin my complaint into a positive or something constructive. Roof leaky? You can get it fixed for $X dollars and we can work that into an agreement.

For a great salesman there is no objection that cannot be overcome.

<comment><USER104> A lack of money from the customer can't be overcome. In your case if you can't afford any of the houses there is nothing the great salesman can do. Of course a great salesman qualifies their prospects before attempting to sell.

<comment><USER103> In the specific case of the article, the developer was reacting to the doctor saying: "So I'd sorta just be, like, donating this money if I paid you for this thing, right?" This was not a price objection type statement.

Also, selling houses to people who did not have enough money for a house was the basis of an entire financial crisis. It looks like creative salesmen found a way around that.

You can argue some extremes if you want but exceptional salesmen are expected to sell ice to eskimos and sand to arabs. And I would expect them to handle the pretty simple objections raised in this article, especially those around price concerns.

</comment></comment></comment><comment><USER105> Others have said this, but $40K is a bargain to get this experience. If you include the opportunity cost, my own 4 year start up failure cost me way more than this (even if you don't include lost opportunities it was probably about this sum of money). You still have the database/website that you can continue to run in your spare time and you never know it might even make you a return in future.

</comment><comment><USER106> I feel like one can just review the symptom relief for each product.

Are there people that don't know acetaminophen is for headaches and ibprofin is for muscle aches?

<comment><USER107> Yes. I didn't know that until right this second.

<comment><USER108> Yep, same here. I've always just used whichever OTC pain killer was most convenient and have never noticed a difference between them. They all seem mildly effective at reducing discomfort. I have taken Ibuprofen for headaches many times and it seems just as helpful as anything else.

</comment></comment></comment><comment><USER109> I was given some advice long ago that I stick to, and which avoids situations like this entirely -- if a startup cannot point to a repeatable transaction where they get revenue in exchange for something... then it not a business, it is a side project.

Admittedly, side projects can grow into something over time, as you evolve the idea. But there is zero reason to quit your job for such ideas.

</comment><comment><USER110> So, given the author quit his money making startup to make a business that would be helpful for humanity, I assume that all of his data and IP is now in a .zip file up for auction and not actually disseminated to people who could use it right? It tells you that what people say is their motivations, especially when it comes to startups are often not at all the case.

</comment><comment><USER111> I'd go further and say, if this could provably generate ad based revenue from a non-trivial number of users, Google would build the same thing and include it in the basic search result shown in the article (with adwords suggestions) for effectively zero cost to Google.

So, even if it were financially successful, it wouldn't likely survive the competition.

</comment><comment><USER112> I can't understand the last part of the article

"Doppelganger has created value for the customer but not for the company."

Isn't the value for the company created through the value for the customers? I.E. you take a percentage of the value for the customers as the value for the company.

What would be an example of creating value for the company?

</comment><comment><USER113> Company that made Doppelganger-like product is flourishing. They are selling it`s product to governments and other companies for ton of money. [https://en.wikipedia.org/wiki/FindFace](https://en.wikipedia.org/wiki/FindFace)

</comment><comment><USER114> I'm not convinced the idea could never possibly turn into a successful business.

Maybe he just tried to sell to the wrong people, maybe pharmaceutical companies could have been interested, maybe re-packaging the product differently...who knows...

The fact that it could provide real value for many people already sets it apart from most ideas.

</comment><comment><USER115> [http://theleanstartup.com/](http://theleanstartup.com/)

</comment><comment><USER5> If you are interested in creating a startup, you should first find something that can actually make money and then work on creating a great product around it.

Too many people come up with a great idea and then hope for the best when it comes to market fit and actually getting customers and achieving profitability.

</comment><comment><USER116> So many mistakes here in both concept and execution. That conversation with the Psychiatrist is bizarre, and must have been embellished for a good story. I think what 'Susan' is actually trying to say is that the incremental benefit of using this 'auto meta-analysed' data over the actual studies is very small. The author tries to cast this as 'Doctors not wanting to improve healthcare', which is just a rationalisation for the product which is not useful. Case in point, the spreadsheet cited at the start of the article largely links to a systematic review that is already published, ie the author is copying data someone else has already aggregated and then re-analysing it in basically the same way with a few more studies. And then trying to charge people to access it. This seems manifestly inferior to the existing system if you ask me. Cochrane would be turning in his grave.

There just isn't a product you can sell here.

</comment><comment><USER117> This could have worked. It would have been possible to sell an integration with a major health insurance company or provider network (or a few) as a tool available to their members.

Like as a United Healthcare sponsored portal that helps you pick OTC drugs, or similar. Those guys love stuff like this. And I've actually worked in this space so I'm not just making things up.

With that said, the way to do that would be to make it a destination with a growing userbase and then approach them for partnership. Which would have cost money and taken a while to ramp up, so you'd need some runway. Also it's not a strategy to actually get rich, that wouldn't lead to tens of millions in revenue or valuation probably.

But it was in fact a good idea and there were some paths forward you could have taken. Had you done so there's an excellent chance you would have discovered some interesting and perhaps lucrative product extensions along the way.

</comment><comment><USER118> If the technique is solid, they should sell to big insurance companies. That are the actors that are interested in paying for the most efficient treatments. At least when it comes to choosing between short and efficient or long lasting.

</comment><comment><USER119> Very nice write up! I can easily see my own biases leading me down some of the paths you mention, so thanks for sharing. A more optimistic way to look at this situation is that you spent $40k to get to the front page of hacker news!

<comment><USER120> Agreed, this was delightful to read! I really appreciated how the author was open about naivety and blind spots. It made the contrast more apparent when they learned things. I'd love to read more by this person.

</comment></comment><comment><USER121> I would say, sorry for your loss.

This story is fantastic, honest and educational. Clearly the author is smart, yet this doesn't prevent him from making some stupid mistakes. I know it is obvious, but this story is very educational.

Thank you for writing this.

</comment><comment><USER122> Failed entrepreneur, perhaps, but one hell of an entertaining writer and storyteller while throwing in bits of wisdoms. I also came away with one insight at the end. I'm going to sign up for the news letter.

</comment><comment><USER123> Could you try to sell it to insurance companies? They might find value in providing it for free to clinicians because they might save money with better outcomes / preventing follow up visits.

<comment><USER124> Insurance companies don't care about outcomes - most are structured in a cost plus model where they make the "plus" \- so if anything, something that costs more is better for them.

<comment><USER49> this is quickly changing. For insurers that offer Medicare Advantage plans, they get paid on a per-member per-month model, so outcomes are very germane to their profit margin.

</comment></comment></comment><comment><USER125> he "worked at a startup that leveraged autonomous blockchains to transfer money from naïve investors to slightly less naïve twenty-somethings. There are worse gigs."

This sounds like a scam or fraud.

</comment><comment><USER126> This sounds like it could be a useful feature of some other healthcare product, ie not a standalone product.

Maybe try selling the tech asset, you might be able to more than recoup your investment :)

</comment><comment><USER127> I don't see how ads weren't enough to keep this afloat.

</comment><comment><USER128> To get in the door with doctors you need to pay them to use your product and then sell the data they generate to other companies. (not HIPPA data, but metrics, etc)

</comment><comment><USER129> It was really good to read some self reflection and analysis on why you failed. Most people ignore the actual reasons their ideas/businesses fail and instead blame it on someone, or something... Most of the time, its the fact that there was no real market for their product!

Silicon Valley doesnt necessarily suffer from a lack of engineering talent as so much a lack of marketing talent. Far too many ideas go to market without any understanding of the actual market. But hey, people get to say they were a CEO for a few months and that sounds great on their Tinder, I mean LinkedIn profile. Right?

</comment><comment><USER130> OP needs to look outside of the US where this kind of data will be used for the benefit of patients, and primary healthcare isn't run like a business.

</comment><comment><USER131> Why not go after the most obvious buyer for this in pharmeceutical companies? Is it because the conflict of interest would undermine the whole idea?

</comment><comment><USER132> Really good writing.

Definitely a questionable move to quit their job for a business with no market research, but I enjoyed the second-hand learning experience.

</comment><comment><USER133> Somewhat surprised a search engine wouldn't want it for the perceived value of improved "snippets". Or some company like WebMD.

</comment><comment><USER134> I liked this "my startup failed" story more than many, not least because of all the gratuitous wry allusions to SV culture.

</comment><comment><USER135> did you try selling to pharmaceutical companies what about healthcare provider networks what about EMR companies? they would probably compare you to open source tech R packages, but it's worth a shot.

you could make a "reference database" out of it and charge for access to the latest version

</comment><comment><USER136> Barring any advice or input on the idea (which I do think is solid), this was a really fun read.

</comment><comment><USER137> I bet that within some years, this idea will surface and gain momentum. Keep it as a side project.

</comment><comment><USER138> Just FYI: "Doppelganger" exists in Russia and makes tons of money from government contracts.

<comment><USER139> This was my reaction ... it's presented in the article as a fun idea without a market, but seems like a plausible play to build a saleable corpus of facial recognition data.

</comment></comment><comment><USER140> It's an excellent write up and there's great lessons in there for all of us. And, it's great that he started talking to actual doctors, if only he had done that first. I know i've made that mistake many times.

As for the medical industry: the idea is to keep people sick as long as possible. You can't make money from people who get better or people who die.

</comment><comment><USER141> TLDR: OP learned the hard way that a good idea was a feature, not a viable business.

</comment><comment><USER95> And by the way, your mistake was that you forgot 3 very important letters - MVP.

</comment><comment><USER142> Can you call it a good idea in hindsight if you acknowledged it was a waste?

</comment><comment><USER143> It seems like you stopped far too early pursuing your idea.

</comment><comment><USER144> Hacker News hug of death... Anyone have a mirror or text?

</comment><comment><USER145> I think writing is your true calling OP,

</comment><comment><USER146> Build it and they will come they said, follow your dreams they said...

yeah, right.

</comment><comment><USER147> The point of healthcare under capitalism is to profit from sick people, not to heal them.

</comment><comment><USER49> At first I thought this was satire. Here's this guy, who uses a pretty straightforward analysis without any prior healthcare domain experience, thinks he's found the holy grail after a few weeks of work, and then spends all of his money (without first talking to actual domain experts) before he gives up, because Healthcare.

<comment><USER107> This is why I get so grumpy about startup narratives. If you ask successful unicorns how they got started, they'll usually explain that's exactly what they did. Garrett Camp was just trying to hire a private driver, and realized it was too hard, there's no reason it should be so hard. Jack Dorsey saw a guy who didn't accept credit cards and realized it would be great if he could accept credit cards.

If you don't realize what's going on, that companies pick their founding myth based on which story sells the best rather than which story occurred on the earliest calendar date, it's very easy to get a false picture of how good startup ideas originate.

<comment><USER148> 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.

<comment><USER149> Anyone has a link to the above video?

<comment><USER150> I think it's this one: [https://www.youtube.com/watch?v=rWRbTnE1PEM](https://www.youtube.com/watch?v=rWRbTnE1PEM)

</comment></comment></comment></comment></comment><comment><USER151> lol @ giving up after 2 weeks.

</comment><comment><USER152> _" I had ten more meetings with doctors all over the Bay Area—surely not all of them were ruthless capitalists like Susan."_

10 meetings is inadequate. You should be willing to do 1000+ meetings if you really want this to fly (or prove it cannot).

You could also explore other business models (ie. rather than charging the practice directly find another way to make money).

Even if it fails, valuable experience, not a waste. Cool idea, and admire your initiative.

</comment><comment><USER153> Unfortunately, I feel like this is a lesson that's best learned the hard way. Everyone can tell you from the get-go to "have a business plan" before committing financially and professionally to a self-concocted venture. It's not until you run through it and witness the brutality of failure first-hand that you realize the importance of doing your homework first and having a plan.

<comment><USER154> I don't know, I have never witnessed the brutality of this failure first hand and I understand the importance of doing my homework and having a plan.</comment></comment>


Geni Clone Growing A Lot Faster Than Geni - <AUTHOR> http://www.techcrunch.com/2007/11/28/geni-clone-growing-faster-than-geni/ <comment><USER2> Maybe startups should take the trouble to offer localized versions within a couple months of launching. The Samwers are taking advantage of the fact that startups are ignoring something that's probably trivially easy.

<comment><USER3> I haven't dealt with it before, but I'm told i18n is a pain -- not close to trivial.

A good system would be automated though -- making adding the Russian language equivalent site at startup.ru scalable in software.

<comment><USER4> Isn't this Unicode support? Something that has been somewhat lacking in Ruby but present in Python.

Technically it shouldn't be a problem, it's just a matter of getting translators :)

<comment><USER5> It's a hassle. Every string displayed in your site (aside from the user created stuff) now becomes a bundle of strings, one for each language. Also, how are you going to organize the different versions of your site? Will you just use the same URL for each page and just have some global user language preference that makes each page render accordingly? Now the smallest change in the text of your site will now require consulting with your translators, which in practice means that you no longer do small changes. You accumulate lots of changes and send them off to your translators in one chunk, then update them when _all_ the translations get back to you. Slowing down the iteration cycle can be fatal to a startup.

To avoid this, you can instead maintain a different site for each language and bring your non-English (well, non-whatever you're comfortable with) sites up to date with the English as you do translations. Now you have forked your code.

Hassle.

<comment><USER4> URLs aren't a big deal. Most people bookmark anyway, they don't type them in. I mean are we going to complain about the character set for domain names next?

I surf sites that are natively in other languages and seeing words in URLs that aren't in English doesn't bother me. It reminds me the world is a big place :)

> Every string displayed in your site (aside from the user created stuff) now > becomes a bundle of strings, one for each language.

That's good practice anyway, from the standpoint of being able to make changes without touching the code.

> Hassle.

 _Web development_ is a hassle in the first place. But being able to handle other languages isn't any more complex than separating presentation from code.

<comment><USER5> I'm not sure what you're talking about with URLs. I was talking about the implications of implementing this in different ways and saying that there's no easy way.

<comment><USER4> Re: _"Also, how are you going to organize the different versions of your site? Will you just use the same URL for each page"_

<comment><USER5> It's not the unicode. That's easy. It's "how are you going to separate the English, French, Hindi, etc. versions, from each other?" Will you have different URLs or the same URLs with a global preference, or something else?

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER6> Part of it depends on the language and framework that you're using. Not to start a flame war, just pointing out a simple fact: RoR doesn't handled i10n and l8n nearly as well as Python/Django does, for instance. If your language doesn't support Unicode strings well, you're kinda screwed when it comes to setting up your site in Russian.

I agree, though. We in American startups tend to be rather myopic when it comes to different languages and cultures.

</comment><comment><USER7> I always thought Geni's interface kind of sucked. There could be a lot of reasons this one is taking off while Geni is stalled.</comment>


Why Los Angeles Should Have a Startup Fund - <AUTHOR> http://thestartupcafe.com/startup-lottery/ <comment><USER2> Letting politicians decide which startups get funded and which don't seems like an inevitable way to let politics get in the way of merit:

\- Politically-connected startups get funded first

\- Political goals other than merit (diversity, "social justice," etc) are used as criteria

\- Arbitrary political limitations get placed on the company ("you can't do business with anyone who [performs abortion | does business in Libya | employes illegal immigrants | uses e-Verify...]")

\- Startups are steered toward political ends rather than growth ("while you're here, why don't you make a version of your app that teaches kids about [why immigration is good | why immigration is bad | why CO2 is evil | why CO2 is necessary to plant life]")

\- etc.

Beyond even that, it's a really tough gig to identify succesful startups from bad startups. Venture funds do it full time and are right only 1-in-5 times. Imagine your favorite city bureaocrat (who gets paid a city bureaucrat wage) trying to figure out if Spotify will be succesful or not. The best VC teams are not suddently going to work for the city government.

In short, you get what you deserve when you put politicians in charge of doling out money, especially in a context that has so much discretion.

<comment><USER3> They could do a matching fund, or provide tax incentives.

<comment><USER4> Or, they could do something towards _actually_ solving the state budget problems and just fire themselves.

</comment></comment></comment><comment><USER5> Government-run funds are doomed to be crap. I'd much rather have it go towards entrepreneurial education or something. Teach more young people about the idea of starting their own company. They'll do the rest.

</comment><comment><USER6> There is a way to get money from the government funds now for your startup. One of the companies I work with went after grants (and were awarded them) to help develop our technology.

You have to attempt to solve a problem that those offering grants care about, but I think this is an often overlooked opportunity for startups.

I won't be holding my breathe for a fund here in LA.

</comment><comment><USER7> LA has tons of tax breaks for new and small businesses. As a new business or one making less than $100k you pay no city taxes at all.

I have actually been quite surprised by how accommodating such a large city was in facilitating tax breaks towards starting my business there. The city clerks actually called me up and helped me file for deductions after I had completely missed deadlines.

Anyhow the problem with LA as a startup culture has a lot to do with the proximity of Hollywood. People dream big, and have a tendency to ignore the more pragmatic aspects of building a business over the long term. Businesses in LA tend to go big and flame out very quickly. It doesn't help that its relatively common for LA startups to be funded by dumb money from someone who made their bucks as a big dreamer. LA is unique because of its lack of tempered pragmatism, but unfortunately and ironically I feel like for a startup culture, thats its undoing...

</comment><comment><USER8> As someone who lives in LA and is currently bootstrapping a startup, I would love to see more $$ poured in to the LA startup scene.

It seems like LA has largely been ignored by VC and angel investors.

<comment><USER2> LA is no Silicon Valley, but there is more money floating around SoCal than you think.

I assume you've checked in with the Tech Coast Angels (<http://www.techcoastangels.com/>) and some of Frank Peters' contacts?

There's also an event next week for LA startups: [http://community.intellicontact.com/p/fundingpost/newsletter...](http://community.intellicontact.com/p/fundingpost/newsletters/chicagoventureevent/posts/meet- angels-vcs-in-los-angeles-silicon-valley-in-june2)

<comment><USER9> Do you have any experience attending the event that's being held next week? What's the turnout like?

</comment></comment></comment><comment><USER4> Another terrible idea from a state bankrupt from terrible ideas.

</comment><comment><USER10> California can barely keep itself running - the odds of this great idea happening are 0 unfortunately.</comment>


Adding PCIe to Your Raspberry Pi 4, the Easier Way - <AUTHOR> https://hackaday.com/2020/07/01/adding-pcie-to-your-raspberry-pi-4-the-easier-way/ <comment><USER2> PCIe on single board computer (SBC) is a fun thing. Linus Tech Tips once connected a Latte Panda SBC with a RTX Titan GPU and tried it with various games [1]. Terribly slow CPU with blazing fast GPU is a strange combination.

[1] [https://m.youtube.com/watch?v=LMsrVbjOJU8](https://m.youtube.com/watch?v=LMsrVbjOJU8)</comment>


At the World's First Cybathlon, Proud Cyborg Athletes Raced for the Gold - <AUTHOR> http://spectrum.ieee.org/the-human-os/biomedical/bionics/at-the-worlds-first-cyborg-olympics-manmachine-hybrids-raced-for-the-gold <comment><USER2> Video highlights from the event and from the pre-trials: [http://www.cybathlon.ethz.ch/en/for-the-media/video- gallery....](http://www.cybathlon.ethz.ch/en/for-the-media/video-gallery.html)

</comment><comment><USER3> I was there! :) They have many photos on their Facebook pages, go check them out.

</comment><comment><USER4> You can't spell Cybathlon without Cylon!

#SoSpellWeAll</comment>


How to get cheap and targeted paid traffic? - <AUTHOR> http://aymeric.gaurat.net/index.php/2010/how-to-get-cheap-and-targeted-paid-traffic/

<comment><AUTHOR> I'd be interested to hear how you guys kickstart the traffic on a new website. (Let's assume you don't have a huge following on your blog or on Twitter)

<comment><USER2> Before starting development, and especially during development, keep an eye on a very broad set of Google Alerts that blanket your market. Read each alert carefully and identify websites that talk about your market or your competitors.

This will give you a list of places you can start a conversation with. So while you're preparing for launch, keep notes of each candidate website. Notes to keep: name of the author of the article, URL of the article, when it was written, etc.

Now when you can share something, email them saying you read their article about X and thought they might be interested in this new thing you just built. Tell them very briefly (2-3 sentences) what your new thing does/is and how it's different, and give them your contact details (including phone or Skype - some like to chat).

This strategy becomes more important after launch as you don't have to wait before getting in touch. You can email them immediately as they can see your live product.

</comment></comment><comment><USER3> (Disclaimer: I work for Bizo)

Bizo allows you to target on specific business demographics (Company Size, Job Function, etc.), and to do so cheaply (starts at $5/day). One advantage Bizo has over Facebook, StumbleUpon, etc. is that the ads are shown across many websites instead of just one.

Unfortunately, "professional coach" is not one of Bizo's targetable segments, so other offerings may work better for CoachFire. Your other sites, however, may be a better fit:

<http://www.bizo.com/marketer/selfserve>

LinkedIn has a similar offering (<https://www.linkedin.com/directads/>) that allows you to target people in the "Professional Training and Coaching" industry, but, similar to the other sites you mentioned, ads will only be shown to users browsing LinkedIn.

<comment><USER4> I manage the SEM campaigns for Vistage (business coaching) at a digital agency. Looks like Bizo might be a good fit for them. Anyone in particular I should talk with to get some more info?

<comment><USER3> Great, drop a line to email@example.com - he can get you started and answer any questions you have</comment></comment></comment>


Has anyone used paste? What differentiates paste in your opinon?  - <AUTHOR> http://pythonpaste.org/ <comment><USER2> That looks quite cool. It looks like a formalization of WSGI application techniques, rather than anything entirely novel, but it's simplicity is very appealing. The examples are impressively tight...not a lot of extraneous crap required to fire up an application.

</comment><comment><USER3> Paste is a toolkit for building WSGI apps. There's nothing else quite like it. I use it a lot, both by itself and as a part of Pylons.

<comment><USER4> what's WSGI?

<comment><AUTHOR> Check this video from the maker of Pylons to get a good overview of WSGI - <http://video.google.com/videoplay?docid=-872784530622495809>

</comment></comment></comment><comment><USER5> The best thing about paste is that you can also eat it when you've been working on your app for awhile.</comment>