Show HN: JournalJerk – In 2017, keep a journal—or else - <AUTHOR> https://www.journaljerk.com <comment><USER2> While there is no way I'd use this service - I value my privacy to an abnormal degree and am not interested in a hard copy of my journal - I'm baffled by the negative feedback so far. This service clearly is not for me. But to say that it is therefore a bad service is logically inexplicable. Do people not have the imagination to conceive of a situation in which (for some) amusing negative rhetoric may have a marketing value? Is it so hard to find something to admire in the audacity of this idea? I have no use for menstrual cups, but I wouldn't scream "But I don't even menstruate!" in a thread started by someone trying to sell them.

</comment><comment><USER3> Hey Colin,

I really like the idea of this! I have a couple questions:

* Do you support any sort of formatting for the contents of the book? e.g. Markdown, LateX, ? Or is it all "subject": $email_title, "text": $email_body?

* Do you have any estimate on how much text fits in a 5x8 book? Does your printing service scale the width of the book based on contents? Aka, if I wrote "walked dog, ate food", every day, would I get a pamphlet? Is there some kind of upper limit?

* Do I have to buy all my cheat days up front? It seems like you could charge "absolutions", maybe even at the end, maybe something like $0.50 for non-prepaid days? It might help people throw good money after bad :)

Thanks for sharing!

</comment><comment><USER4> You don't display any details at all about the final product. Always refer to it as a "beautiful journal" but fail to picture anywhere.

If anyone was even interested in the premise in the end they want the deliverable... So show it.

<comment><AUTHOR> Hi CaveTech,

Great point with a simple answer. I don't have any print samples yet. Turns out the Printing On Demand companies I was working with enjoy taking of several weeks on either side of Christmas. I'm pretty miffed about this myself, frankly.

To further put your mind at ease, I have extensive experience working with printing-on-demand and dropshipping services. I've built out complete pipeline integrations with IngramSpark, Ingram LightningSource, and ZenPrint from scratch. If you keep the journal, you will get your book. Guaranteed.

<comment><USER5> This is a very creative approach for to charge monies first and give discount on application usages..

</comment></comment></comment><comment><USER6> I don't see anything at the site about who is "really" doing this, and am more than a bit concerned someone could spend January collecting $29+ subscriptions from folks with New Years resolutions, and then depend on folks forgetting about it come December. Particularly among those who drop the habit...

<comment><AUTHOR> Hi Ewan,

I definitely understand your concerns. Here's some answers:

I'm doing this. My name is Colin McDonnell, my email is firstname.lastname@example.com. I'm not a scammer.

The service definitely defies some expectations, since its entire goal is to induce a given behavior through (mostly) negative reinforcement. Clearly I (that is, "The Jerk") benefits if people drop the habit. That's part of the incentive. It's why the service is personified as a Jerk...you're not supposed to like him and you certainly don't want him to have your money.

Also remember, there's a positive reinforcement too, in the form of the end- of-year book. And $29 is a GREAT price for a custom hardbound book with shipping. Here's a comparable service that charges $79: [https://www.storyworth.com/holidays](https://www.storyworth.com/holidays). We expect to make the vast majority of profit from the cheat day markup.

</comment></comment><comment><USER7> To piggyback off of the idea to journal in 2017:

I built [http://write.surge.sh](http://write.surge.sh) a few weeks ago and have been using it to keep my own journal and have been successful (unlike the last few times I tried).

It's mainly worked because:

\- it's duration-bound (every journalling session I do is 15 minutes only, you can set a different duration)

\- inactivity within that duration erases your work so I have to keep writing for the whole session.

I was going to post it on Show HN but I'd love people in this thread's feedback on it as well. Source code is also on GitHub: [https://github.com/krrishd/write](https://github.com/krrishd/write)

EDIT: also worth noting based on some criticisms of existing stuff in this thread, everything is locally stored and exportable/importable as JSON, the app is completely client-side.

</comment><comment><USER8> I see this as really good idea for people who are motivated by this kind of accountability. I think the concept of journal and the privacy of such things is kind of leading some commentors astray. I see several use cases that would not be private as such... Or at least would be private but not embarrassing. I love the sense of a finished product at stake, I personally have often been at my most effective creatively in "show must go on" deadline situations. I miiiight become a customer if I can refine my own plan for how I would use it. (eg, I'm considering a poem a day, since that is in my wheelhouse and is broad enough that even 2 words can count.)

Best of luck to you, journal jerk.

</comment><comment><USER9> I love it. So far the negative feedback is privacy but for a project that isn't at a full serious company point yet why is everyone else taking it so serious? Write some funny stuff about the day it doesn't have to be a deep dark secret, if that's what you want do it on your own.

Also I enjoy the idea of mean services for procrastinators like me, if only start farm would yell at me for being late to pay my insurance would stop getting cancelled since I can't pay ahead and their site sucks ass.

</comment><comment><USER10> This seems similar to DayOne. I left day one when they went to their second version where they wanted to keep my journal on their servers. For similar reasons, I won't be signing up for your service. I know your journals are cheaper than self printing (I think you said $29 vs $79) but my privacy and controlling my journal data is easily worth $50 if I wanted a hard copy.

Best of luck going forward!

</comment><comment><USER11> I laughed out loud when I saw this and thought "Genius!" I love the negative reinforcement and I love the cheat day upgrade. Being a huge type snob / nerd / jerk, I, too, would love to at least have some exemplars of the finished product (maybe even a size? perfect bound? saddle stitched?) before plunking down my money. But the psychology is a home run. Kudos.

</comment><comment><USER12> I probably won't use this because a) privacy (not your end, but mine! I use gmail for this sort of thing and they don't need to know my secrets) b) I don't struggle to journal

HOWEVER I really like the idea of the halving fees, and replying by email makes life so easy. Best of luck with it.

</comment><comment><USER13> Great idea, and I like the approach. Something like this can be tricky to pull off.

I did something similar, but as a 30 day meditation challenge: [http://tinyurl.com/gskmt7d](http://tinyurl.com/gskmt7d)

Note: my site isn't operational at the moment.

</comment><comment><USER14> What a great idea. I'd suggest enlarging your appeal though by branding it as a sort of log. People could track projects, write what they've learned about a particular skill etc. rather than focusing on journals only.

</comment><comment><USER15> Can this be automated as a script such that if I forget a day, the computer will automatically write something like "walked the dog, was nice"?

<comment><USER16> With the success of things like recurrent neural networks for text generation, an entirely computer-generated journal would be interesting in itself.

</comment></comment><comment><USER17> Love this idea, just signed up for this, but I'm getting a relay error on sending emails to firstname.lastname@example.com or email@example.com... So effectively I can't write anything

</comment><comment><USER18> "If you actually pay that, I won't hesitate to send you a book of..."

i'm tempted.

<comment><AUTHOR> Try me.

</comment></comment><comment><USER19> Nice work! Fun service, Keep it up!

</comment><comment><USER20> Reminds me of the rich jerk in terms of selling style

</comment><comment><USER21> So you want someone to pay you 27 bucks to take their deepest darkest secretes, all of their lifes troubles, and store them on your servers of unknown levels of security then you want to print that out (automatically revealing it's contents to at least one person printing everything), then finally you want to ship it through an unspecified postal service.

Yea maybe I'm paranoid but I don't think I'd be writing much other then "had coffee" or "walked dog". I'd definetly not say who I'm in love with, what I'm working on, how my social life is going, what experiments I'm working. Sadly that's exactly the kind of contents that you want in a journal.

Edit: My bad, 29 dollars, not 27.

<comment><AUTHOR> Hi gravypod,

Good points all around. I've added an FAQ (journaljerk.com/faq.html) that addresses some of the data security points.

As for the printing and shipping, there's of course nothing we can do about that. I'm printing through IngramSpark, which was a highly automated printing pipeline. It's unlikely someone will pick up your book, especially with malicious intent. As for shipping, I'll likely use UPS or USPS Media Mail, depending on the season and pricing. I'm quite certain they don't read what they ship. But your points are well taken.

Colin

</comment></comment><comment><USER22> The word privacy does not appear anywhere on the site. Nope.

<comment><USER23> Please don't be a jerk on HN, especially when responding to another user's work. Asking a polite question would have more than sufficed.

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

[https://news.ycombinator.com/showhn.html](https://news.ycombinator.com/showhn.html)

<comment><USER22> Apologies, the tone was stronger than intended.

</comment></comment></comment><comment><USER24> Read the first two words of the page.

Thought "fuck you".

Closed the page.

Try and make something actually useful.

<comment><USER11> really? you took the time to write that as feedback for this project, and couldn't think of something more constructive to say. How about "I was put off by the negative tone. I see what you were going for there, but it came across as too strong for me."</comment></comment>


Git Flow vs. Continuous Delivery - <AUTHOR> https://perlgeek.de/blog-en/automating-deployments/2016-030-git-flow-vs-continuous-delivery.html <comment><USER2> As far as I know, Git Flow does not make any assumptions or recommendations about testing. This is why this article seemed like it is arguing against a straw man.

For example:

> And then, git flow recommends that for going to production, you build > packages from the master branch, and release them. The problem is that by > building a new package or binary from the master branch, you invalidate all > the testing you did in the develop branch.

It's not a problem unless you forgot to run your full test suite on the new master branch before building the release artifact, which I think is best- practice and not limited to any development methodology.</comment>


Haunted by hackers: A suburban family's digital ghost story - <AUTHOR> http://fusion.net/story/212802/haunted-by-hackers-a-suburban-familys-digital-ghost-story/ <comment><USER2> "Kivimaki admitted that, yes, he'd trolled Blair in IRC rooms, and had harassed him offline on occasion—in particular, he'd "shut down his Comcast a few times," and had gotten the Straters' phone service cut off. He also said that he'd copied and pasted the passwords to Amy's social media and email accounts to an IRC channel, but denied he'd been the one to deface the accounts. And he denied, more broadly, that he'd been the sole force behind their harassment campaign."

Yes, he may not have done those other things, but he clearly is responsible. He gave out the passwords intentionally so other people could do the work for him.

This highlights the problem with having little to no punishment for these sorts of crimes: the criminals don't learn why what they did was wrong and continue to do it.

$4000 is nothing if it means I can end all of this nonsense. If it were me, I would have no problem flying to Finland and making sure this guy doesn't ever do anything to me again. They went through the proper channels and the law won't do anything about it.</comment>


Show HN: Soapbox – Embed your message in any page with this URL shortener - <AUTHOR> http://soapbox.alexsci.com/

<comment><USER2> Similar to Snip.ly</comment>


It Costs $30 to Make a DIY EpiPen - <AUTHOR> https://www.technologyreview.com/s/602422/it-costs-30-to-make-a-diy-epipen-and-heres-the-proof <comment><USER3> Medicine is probably the second best place after military where we can observe how greed and corruption are literally killing people.

I'm living in Russia and recently have been involved in medical devices market here. The local market for cardiology stents (little springs they insert non- surgically into your heart to remove artery clogging and prevent heart attack or stroke) has been long occupied by the three US companies. The Russian company I invested in, made their own stent design and launched a production factory in Western Siberia. Our prices are three to four times lower that prices for the same class of stents from the US competitors and the quality is the same or higher. We fought out 15% or the market for the last two years.

I have to say, that almost 99% of all stents in Russia are installed at the cost of the state medical insurance - every person in Russia is covered by this insurance, and that insurance is just sponsored by the state or local budget. The budget allocated to this kind of medical support is fixed, so if the yearly budget is 100M rubles (our local currency) and cost of a manipulation and a stent is 100K rubles then you can install stents in 1000 patients in one year. If the price goes down four-fold, then it will be 4000 patients. And this stent manipulation is a life saver in true sense of this word. So, basically with our stents we can save four times more people's lives, which on a scale of Russia would be tens of thousands of people.

Here enters the greed and corruption. One of the US companies approached one of the most powerful Russian oligarchs with good ties in the government. He lobbied a government decree stating that this US company will be single supplier for cardiology stents starting Jan, 2017. So, all hospitals and clinics are obliged to buy stents only from them, at the price they set. Tens of thousands of Russian people will die each year because of the greed and corruption - and we can't do much about it.

<comment><USER4> Greed in the medical industry doesn't "kill people." There is a difference between not saving someone's life and taking it. That moral distinction undergirds our whole economy.

Corruption is bad, no doubt. But the double standard applied to medical companies makes no sense. If _not saving lives_ is the same as _taking ones_ , then many of the things developed by Silicon Valley are morally abhorrent. How many lives could be saved if the billions of dollars flowing into Facebook, Twitter, Tindr, YouTube, Netflix, etc. were used to buy or develop medicine? I could save the life of a kid in Africa suffering from malaria, but instead I chose to purchase a new Apple Watch. If people actually applied your moral principle in a non-hypocritical way, we'd have almost nothing to talk about on HN.

<comment><USER5> There's a difference between not saving someone's life and bribing an official to stop someone else from saving lives. This is no different than if I got a law passed saying that nobody was allowed to sell or give food to you. When you starve to death, would you say you weren't killed?

<comment><USER4> I agree with you about the specific example. But this thread is about the EpiPen, where no officials were bribed and where there was an FDA-approved alternative on the market until it was voluntarily withdrawn. The outrage is over Mylan taking advantage of transient market conditions to jack up the price on their product.

<comment><USER5> The overall thread was about the EpiPen, but you replied to a comment describing a pretty clear-cut case where bribery was getting people killed, and you wrote a completely general comment saying that greed in this industry wasn't killing people.

If you only meant that to apply to the EpiPen, and not to Russians being killed by their own government because of corruption related to cardiac stents, you chose a really weird way to go about it.

<comment><USER4> The comment I replied to led with a general point about greed in the medical industry getting people killed, and was in a thread about EpiPen. If it wasn't meant to be a comment on the medical industry generally, not just a specific case in Russia, that's pretty weird.

<comment><USER5> Except that "greed in the industry is killing people" is true even if it's rare. "Greed in the medical industry doesn't 'kill people.'" is false if there's just one instance to the contrary. So trying to reverse my argument, while witty, doesn't really work.

</comment></comment></comment></comment></comment></comment></comment><comment><USER6> The Hackers groups are doing what they can to expose Mylan's (EpiPen makers) Greed which is laudable. What is really needed is also an explainer on why a bit of govt. leverage (socialism if you will) is good in Medicine Pricing as well.

Mylan is a really great user of buying legislation. They leveraged their 90% market ownership of the epinephrine auto-injector market such that

[1] It lobbied hard to ensure that all parents of school going kids (or tax payers) paid for EpiPens by making it into a bill that politicians could easily justify.

Once the bill passed and schools all over the country purchased these by the boatloads, then they just kept raising the price over and over and milking the profits.

When it got too much and they could not ignore the patient backlash they have turned again to purchasing legislation..

[2] Now they want to make it so that the patients do not see the copays - instead every one suffers by paying more for health insurance.

[1] [https://www.opensecrets.org/lobby/billsum.php?id=hr2094-113](https://www.opensecrets.org/lobby/billsum.php?id=hr2094-113)

[2] [http://www.nytimes.com/2016/09/16/business/epipen-maker- myla...](http://www.nytimes.com/2016/09/16/business/epipen-maker-mylan- preventative-drug-campaign.html)

With scumbags like these, is it any wonder that the USA has the most expensive healthcare system in the world?

<comment><USER7> Can this be a side effect of the "free healthcare" goal that the state is trying to achieve?

When people don't have to pay for something straight from their pocket, they're not feeling the ripoff so strongly, so they don't revolt.

That's why I personally think that the systems where people vote with their wallets are much more efficient.

<comment><USER8> And yet in countries with universal health care, the cost of health care in real total terms is much lower: [https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita)

Monopolies can dictate terms, which is why monopolistic companies are regulated. But if that monopoly is the state, then it actually works in the citizens favour if the monopoly presses down costs.

<comment><USER9> So the question that comes up with this, if there is no free market like the US medical system, would it kill the incentive for biomedical startups and pharmaceutical research in general (which is largely based on the US now).

<comment><USER10> Is the R&D largely based in the US?

Also, it's important to distinguish between true R&D aimed at developing actual cures and iterative R&D aimed at developing medicine that will get you hooked on long-term courses that maximise profits.

<comment><USER8> And R&D aimed at developing replacements for perfectly-fine drugs that are soon to go out of patent, or R&D that is put on a back burner until some other drug is about to go out of patent etc.

</comment></comment></comment></comment></comment></comment><comment><USER11> Probably too late to really contribute, but either way -

I feel like health is a degenerate case of free markets. In any free market, the price is set by the consumers assessing their utility for the goods or services purchased. In cases of pencils, productivity software, energy, raw materials, etc, consumers compare the methods of resolving the need, or at baseline the cost of not addressing the need.

In healthcare, there are lots of situations where the cost is X dollars vs literal death. Of course, death is not an acceptable alternative, so an acceptable X ends up being very, very high for the treatment. Most people would pay their life savings to treat themselves of any life-threatoning ailment.

I honestly believe that free markets setting prices is good for most industries, but I cannot see it working in situations where the benefit categorically supercedes any amount of money.

It seems like we need to either rethink IP law surrounding healthcare, or have a monopsony (single payer or something else) setting prices.

This is a hard thing for me to resolve, as somebody who normally likes a libertarian approach.

<comment><USER12> The choice in a free market is not between one specific product and non- consumption, it is between that product and all alternatives (including non- consumption). If the choice was always between one specific product and non- consumption, bottled water would be very expensive (since water is second only to oxygen in necessity for survival). If there are no good alternatives, we should first ask why that is, before confiscating property or rights from that supplier or provider. I would contend that the healthcare industry has been poorly (over-) regulated, and that government interventions have limited supply of critical goods and services, thus increasing prices and decreasing quality.

<comment><USER13> Consumer choice is, indeed, the underpinning of the free market.

What is preventing other companies to come to market with cheaper versions of the EpiPen? Why are there no cheaper alternatives?

<comment><USER12> I believe there are three alternatives: Epipen, Adrenaclick, and Twinject. The FDA does not allow pharmacists to substitute one for the other at the pharmacy, and many (doctors and patients) opt for the best-known brand.

<comment><USER13> A-ha! This is new information to me. Why are EpiPen substitutes not allowed? Are the products that different?

<comment><USER14> > Why are EpiPen substitutes not allowed?

My understanding is if the prescription says "EpiPen" (or any non-generic drug brand name) the pharmacist must provide an EpiPen (or the brand-name drug). If the prescription says "epinephrine auto injector" or "EpiPen or generic," then the substitution is allowed.

> Are the products that different?

IIRC, they all the current alternatives deliver the same medicine, but they use different injector mechanisms to do so. I think the last alternative withdrew from the US market for some reason, because their mechanism wasn't as reliable with dosing.

IIRC, EpiPen's mechanism is apparently off-patent, so a true generic could enter the market if approved.

</comment></comment></comment></comment></comment></comment><comment><USER7> The title could be rephrased as "Cheap guys risk the lives of thousands of people by promising savings of a few bucks".

The problem is not with the "greedy corporations", but with the poorly dedigned legislation regarding intellectual property rights.

The state created the protectionist environment in which companies can become bullies and be sure that they won't be exposed to any economic competition.

Of course, the complete lack of IP laws would deter companies from investing in research, but the same effect have too strong IP laws. Why would a company risk their money and do research once they found a cash cow which can be milked for a long time, having the state guarantee it?

<comment><USER15> this comment seems wholly unwarranted

how do you think this effort puts thousands of people at risk?

if you download the instruction packet(o) it comes with a Links.txt file that has a link to an instructions video.. which at the time of writing this comment can be found at: [https://www.youtube.com/watch?v=ldFFJRdhVs8](https://www.youtube.com/watch?v=ldFFJRdhVs8) ; i suggest you watch it

all of the components are 'off the shelf' and the drugs are prescription

from this(i) ~random site epinephrine costs 74.95$ for 30mL, the instructions call for .3mL, that is 100 uses from this 75$ vial, or 75 cents of epineprhine per epipencil

when i read the article i thought this was a great effort that could save the lives of anyone who was unable to bare the new price of the epipen, but now i am wondering what from the epipen warrants the price tag? can a loved one even sue epipen if it malfunctions and kills the intended user?

(o) [https://fourthievesvinegar.org/download/#epipencil](https://fourthievesvinegar.org/download/#epipencil)

(i) [http://www.buyemp.com/product/epinephrine- vial](http://www.buyemp.com/product/epinephrine-vial)

<comment><USER16> > how do you think this effort puts thousands of people at risk?

IANAMD, but I suppose air bubbles in the injector could cause problems (?)

<comment><USER17> As far as I understand: a regular bubble of air, while undesirable, won't kill you. That's part of what the lungs are for, and in fact it happens in hospitals all the time.

A very large bubble can kill you, but you need to put some serious effort [1].

[1] [http://www.straightdope.com/columns/read/2866/can-air- inject...](http://www.straightdope.com/columns/read/2866/can-air-injected- into-the-bloodstream-really-kill-you)

</comment></comment></comment></comment><comment><USER18> TIL that an "autoject" is an inexpensive self-injection tool commonly used by diabetics[1] that can be carried safely and used easily. It can be loaded with Insulin, or with any drug whatever. The OP article describes using it to inject epinephrine, stating that

> A 1mL vial of epinephrine costs about $2.50... Doses range from 0.01mL for > babies, to 0.1mL for children, to 0.3mL for adults.

In other words, if your doctor will give you a prescription for the drug itself, you could assemble three epipen equivalents for less than $100.

[1] [https://smile.amazon.com/AJ-1311-Autoject-Injection- Removabl...](https://smile.amazon.com/AJ-1311-Autoject-Injection- Removable/dp/B002M3TBUS/)

<comment><USER19> The trick being that you need a larger needle to inject the epinephrine and they discuss how you can combine two syringes to get the larger needle.

</comment></comment><comment><USER20> (preparing for an onslaught of down votes, but here we go.)

It's awesome to see a 'hacker' building a $30 EpiPen. But looking only at the materials cost for a medical device ignores the millions (sometimes billions?) of dollars spent on R&D, IP licensing, and (perhaps most significantly) regulatory compliance.

The pricing system for devices and drugs is definitely screwed up in the US, but Mylan's 36% gross margin on the devices doesn't seem criminal.

Perhaps they're padding their cost numbers. And perhaps there are IP shenanigans at play that I'm not aware of. But one needs a thorough understanding of the _total_ costs to invent, develop, achieve regulatory clearance for, and market a medical device in order to assess the morality of the pricing.

<comment><USER21> > R&D, IP licensing, and (perhaps most significantly) regulatory compliance

I'm going to call the R&D costs a wash because that cost should also be factored into the price of the diabetic injector that forms the basis of the $30 homebrew design.

From your list, that leaves IP licensing and regulatory compliance which are both imposed by the state.

I believe we would still see plenty of (and actually probably more) innovation with a much more relaxed IP policy that favored small, incremental improvements and the diversity of product variations that competition would bring. In short, copyright terms should be 5-10 years max and should only be granted in cases where there's proof of significant research. Simply, if the ability to monopolize your 'idea' for the better part of a decade doesn't incentivize you sufficiently--it's likewise not worth depriving the public over it.

With regards to regulatory compliance, I believe we're seeing a case of the perfect becoming the enemy of the good. Imagine if the state extended the good-Samaritan policy to all medical providers--legally protecting anyone who exercises good-faith and due-diligence towards improving the health of their fellow man. Also, replace the old-west era FDA with information-age search engines, customer reviews and a plethora of private Consumer Reports -type organizations. In this scenario, there are several auto-injectors available on the market ranging from a $30 model which has failure rate of 50% to a $600 model that's been tested out the wazoo and only fails 1% of the time. Even under this very pessimistic scenario (50% seems pretty conservative to me), many lives are saved because there's a long tail of people who can't afford the $600 model but more than half of them end up surviving an episode of anaphylaxis because they can access the low and mid -range models.

<comment><USER20> I agree with everything above (except the R&D costs thing). The only issue is that Mylan is operating in the current regulatory environment, not the one you described. So at least part of the outrage about the cost should be directed at the regulatory framework we're working in, as well as the distribution channels and methods.

I think this is what Mylan's CEO was attempting to convey on Bloomberg, although with questionable success.

</comment></comment></comment><comment><USER22> This doesn't feel like the right platform for DIY. When someone needs an EpiPen, it's because they might be dying. Presumably, a large and well- capitalized organization will have tested their device extensively and can offer better guarantees about it actually working (I should stress _presumably_ ). There are a lot of ways in which the hacker mindset can be beneficial to society, but this particular application feels like an ethical gray area.

<comment><USER23> The headline says "to expose corporate greed"

The premise is that $57 was the old price. and they bumped it up to $318.

And a DIY group can pull it off for $30, without economy of scale.

From wikipedia "In 2007 when Mylan acquired the rights to market the product, annual sales of all epinephrine autoinjectors were about $200M and EpiPen had around 90% of the market; in 2015 the market size was around $1.5B and Mylan still had about 90% of the market"... $1.5B annually... So if FDA testing costs them $10,000,000 anually, thats still less than 1% of their revenue.

That means that with economy of scale, and dispersing the cost of testing over several million sales, they could easily produce a product for $30. But they don't because they dont really care about saving lives, they care about getting paid. They would prefer people die than them make less money.

Completely not about "hey do it this cheap easier way" but "heres the rock solid proof that a $300 (even $60) EpiPen is stupid"

<comment><USER24> While I agree $300 is a ripoff and takes advantage of how medicine works in the US (i.e. the cost for most users is opaque b/c insurance pays) I can also see that $30 is not likely a viable price --just like I can put a sandwich together for $3 doesn't mean I can run a profitable sandwich shop selling sandwiches at $3.

As a consumer I could see this for $75 - $100 retail (and some discount to institutional buyers) but $30 is probably not viable and of course $300 is ridiculous.

<comment><USER25> Autoinjectors for other drugs sell at $33 retail: [http://www.buyemp.com/product/meridian-auto- injectors](http://www.buyemp.com/product/meridian-auto-injectors)

They (including epipens) probably cost about $10 to make. That's total cost, from production to delivery to the retail outlet. They would have been handsomely profitable at the old price of $57.

<comment><USER24> Yeah, that seems like a fair take. They'd get away with a little inflation --so $75 - $100 but definitely not $300. That's just opportunistic gouging.

</comment></comment></comment></comment></comment><comment><USER26> So "Four Thieves Vinegar" says their DIY auto-injector works probably almost as well as the EpiPen. Sign me up! </s>

Are we really complaining about an "onerous regulatory process" for a device which untrained laymen need to be able to use in a high stress emergency situation?

I'd like to see Four Thieves Vinegar fund the necessary trials to prove their device is safe, gain FDA approval, bring the device to market, and defend themselves against the inevitable lawsuits, and _then_ tell us how they can sell the device with less than 80% gross margins. The marginal cost of making one more pill or one more device is almost entirely irrelevant, and any article that tries to make a case for a medical product being overpriced based on COGS isn't worth reading IMO.

The price for EpiPens went up because no one else was able to make a competing product that didn't malfunction or deliver the wrong dose of epinephrine.

<comment><USER27> > The price for EpiPens went up because no one else was able to make a > competing product that didn't malfunction or deliver the wrong dose of > epinephrine.

Price hasn't gone up as much in the UK where a state monopoly negotiates.

<comment><USER28> And none of this stuff is being invented in the UK either. US is the king of drug discovery. I'm not saying that I like the current system, because in many ways I don't, but let's not ignore the fact that countries like the UK are not producers.

</comment></comment></comment><comment><USER29> I feel like a lot of the commenters here didn't read the article.

> Four Thieves Vinegar have created and uploaded the plans for the simple > version, called the Epipencil. Also spring loaded, the parts are gathered > over the counter. The epinephrine will still need to be acquired with a > prescription.

This still involves an FDA-approved drug obtained through normal channels; the DIY part is the injector.

Creating DIY medical drugs would certainly be something to be concerned about, but I don't see the problem with DIY medical tools.

<comment><USER30> The problem is that if an auto-injector is truly needed (onset of anaphylaxis), there may not be much time to futz around with it, if it doesn't work properly.

The auto-injector apparatus is not regulated because it is dangerous; it is regulated because a failure to operate would be dangerous. It is regulated for reliability.

The hacker/maker ethos is awesome and drives a lot of innovation in our society, but sometimes there is also a need for careful engineering and rigorous testing.

<comment><USER31> Right, but something 90% effective that you can afford will save a lot more lives than the 100% effective version you can't.

<comment><USER32> Well put.

I've got a heart issue going on and I've had some fascinating results from capturing my heart rate on a consumer grade chest band monitor, then uploading it to influxdb and viewing it with grafana. Total outlay a couple of hundred bucks. Invaluable to me in tracking what's going on with my heart.

Yet that whole stack would never be approved by... Anyone!

<comment><USER33> You should open source it. Would be cool to see how you're doing data vis for this.

</comment></comment></comment></comment></comment><comment><USER34> "Hacking" medicine doesn't really work. See Theranos.

First, epenephrine degrades when exposed to light so your epipencil may be ineffective from the start.

Second, parents when measured took 2.5 minutes to fill a syringe with epinephrine which is not fast enough in an emergency.

The price gouging is terrible. There are cheaper alternatives but Epi-pen has the most well known brand.

People buy Tylenol and Advil not Aspirin and Ibruprofen.

Drs have appealed to ban drug advertising. Medicine should have no place in capitalism.

Source: [http://www.aaaai.org/ask-the-expert/effect-of-light-on- epine...](http://www.aaaai.org/ask-the-expert/effect-of-light-on-epinephrine)

<comment><USER35> > People buy Tylenol and Advil not Aspirin and Ibruprofen.

Aspirin is still a registered trademark of the acetylsalicylic acid in many countries and it's owned by Bayer AG. The generic name of Tylenol is acetaminophen (paracetamol).

<comment><USER36> Aspirin lost its trademark status in the major Allied nations during WW2 when their assets were confiscated.

<comment><USER37> Trademarks were part of the confiscation during WW2, but Aspirin lost its trademark status in US long before that[1].

[1] [https://cyber.harvard.edu/metaschool/fisher/domain/tmcases/b...](https://cyber.harvard.edu/metaschool/fisher/domain/tmcases/bayer.htm)

</comment></comment></comment></comment><comment><USER38> Michael gave a fantastic talk at Hope this year titled "how to torrent a pharmaceutical" where he made Daraprim on stage for only a few cents. Its defingely worth watching: [http://livestream.com/internetsociety3/hopeconf/videos/13073...](http://livestream.com/internetsociety3/hopeconf/videos/130731041)

<comment><USER39> Great talk. Chematica looks really cool, as a way to discover new ways to synthesize chemicals, just by searching a graph of possible reactions in order to reach the target chemical.

</comment></comment><comment><USER40> If you are persistent, you can get CVS to order the "generic" epinephrine injector for $5.

[https://www.facebook.com/barbara.k.hollinger/posts/128523673...](https://www.facebook.com/barbara.k.hollinger/posts/1285236738177708)

</comment><comment><USER41> The hack here is simple: this group did not get FDA approval for their device. Greedy corporations have _repeatedly_ tried to make money by competing with Mylan with cheaper Epipens, but they've been prohibited from doing so by the US government (not so in Europe, where the unfortunate Europeans suffer _eight_ greedy corporations trying to drive prices down).

[http://slatestarcodex.com/2016/08/29/reverse-voxsplaining- dr...](http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs- chairs/)

<comment><USER42> There is Adrenaclick. And 2 generics for it.

(So all you have to do is convince your doctor to write Adrenaclick on your prescription and you can buy the generic for $145 at Walmart)

That price is interesting because it puts some kind of cap on the amount that regulation is leading to the price increase for Epipens. The regulation about substituting Adrenaclick on a prescription for Epipen can be argued, but any doctor that won't write Adrenaclick after a minute of discussion better have a good reason.

</comment></comment><comment><USER43> I just checked and here in China you can buy 10x1mg doses of epinephrine (which is actually adrenalin) over the counter/online for 4元 ($0.6USD) ... [https://world.taobao.com/search/search.htm?sort=price&_ksTS=...](https://world.taobao.com/search/search.htm?sort=price&_ksTS=1474517174609_40&search_type=0&json=on&module=sortList&_input_charset=utf-8&s=0&navigator=all&q=肾上腺素)

That means the epinephrine (adrenalin) itself is essentially free. What do they charge in the US/Europe/Australia?

<comment><USER44> Yes, it's the patented injector with precise and reliable dosing that is the cost. Mis-dosing can kill.

<comment><USER43> I seriously doubt they would be handing out 1mg doses like candy if it was as dangerous as you suggest. China has actually been quite strong with controlling potentially fatal drug distribution in the last 15 years, tightening rules for many substances. The key reason is suicide prevention. Wikipedia says "Although it is commonly believed that administration of adrenaline may cause heart failure by constricting coronary arteries, this is not the case" [https://en.wikipedia.org/wiki/Epinephrine#Adverse_effects](https://en.wikipedia.org/wiki/Epinephrine#Adverse_effects)

(Edit reply to a3n below: My point was that it's not as dangerous as you are making out, not emotional appeals and cultural norms for responsible parenting. Self-administration: good enough for 3 billion+ in China/India/other developing world locations, good enough for me. The whole idea of stabbing yourself with a fat dose of adrenaline is pretty hackish anyway and shows how undeveloped our medical knowledge still is.)

<comment><USER44> If you're injecting with a traditional syringe, you can see how much you're drawing into the syringe, and presumably can create an accurate dose. Assuming you aren't untrained and panicking.

The idea behind the auto injectors is accuracy with relatively little training and skill; a parent can do it while they're watching their kid strangle. That's why you buy an auto injector instead of syringes.

Competing auto injectors have not been as accurate and simple to use, is what I've read.

I would not trust my kid's life to a hacker injector; these are medical devices that are required to go through trials. Even traditional syringes are regulated. Sure, maybe you can decide to use an unregulated injector; I wouldn't, not for my kid.

<comment><USER39> > Competing auto injectors have not been as accurate and simple to use, is > what I've read.

Also legally EpiPen must be fulfilled by a brandname version instead of alternatives, and alternatives are scarce due to the difficulty of passing regulatory approval: [http://slatestarcodex.com/2016/08/29/reverse- voxsplaining-dr...](http://slatestarcodex.com/2016/08/29/reverse-voxsplaining- drugs-vs-chairs/)

</comment></comment></comment></comment></comment><comment><USER45> It may be better than having no epinephrine at hand. But other than that, there are a lot of problems: How sure are you that it will work when you need it? Can you fill the syringe cleanly enough? Will the epinephrine in the syringe degrade, or worse, develop a bacterial growth?

It may be a better Idea to look into a syringe+vial combination on hand, prescribed by a doctor. Less convenient, and you need to learn how to use it (and preferably teach those close to you), but this may be a whole lot safer. The downside of course is the problem of self-administration when in anaphylactic shock.

</comment><comment><USER46> I've had to use an EpiPen twice in my life. Oh my gosh, the terror in your heart when you're self administering it is real. I will never forget the experience for the rest of my life. I don't want to trust some hack with no FDA approval in that moment.

I don't give a damn if the product is $50 or $500. I will buy it, it's saved my life many times. Its not awesome to see a hacker point out while the materials are cheap

<comment><USER47> Imagine the terror if you can't afford one, and you need one. The hack wouldn't be so unwelcome then?

<comment><USER46> If you had an issue where you needed one, nothing would stop you from getting one no matter the cost

<comment><USER48> If it's a case of cutting back on the coffee budget to ensure one always has an epipen handy, of course you're right.

If it's a case of having to choose between paying the paying the electricity bill and buying an epipen, and you have to guess at the probability of you needing an epipen in the next month vs the certainty of the electric company shutting off your power, with the extra fees and penalties that'll cost to turn it back on, "no matter the cost" is no longer the standard to use.

</comment></comment></comment></comment><comment><USER49> Wouldn't it be better to focus on the reasons why there is no viable competition for this company even though the business seems to be extremely profitable?

The article links to another that lists some of the issues: [https://www.statnews.com/2016/09/09/epipen-lack-of- innovatio...](https://www.statnews.com/2016/09/09/epipen-lack-of-innovation/)

This points out (among other things) that the design is patent protected and FDA rules make it difficult to come up with other designs that don't violate the patent. It is also mentioned that the devices need to go through long and expensive regulatory process.

</comment><comment><USER39> Regarding the original price hike which motivated this project, I saw an interesting perspective on the matter: [https://www.youtube.com/watch?v=RoMlxVimwiU](https://www.youtube.com/watch?v=RoMlxVimwiU)

Now granted Shkreli is a controversial figure, but basically drug companies are businesses, and if you sort of detach yourself and look from a business perspective and value-based pricing, Epipen competes with the ER, and $600 is a bargain vs an ER visit.

And of course his ultimate conclusion is that maybe life saving drugs are more like water and power than cell phones and wine? Maybe the government should get involved in making generic drugs available.

<comment><USER50> > if you sort of detach yourself and look from a business perspective and > value-based pricing, Epipen competes with the ER, and $600 is a bargain vs > an ER visit.

This is exploitation of inelastic demand (death is a pretty high priced alternative to $600), and it's pretty clear that's exactly what government regulations and market controls are supposed to protect against.

<comment><USER39> Yes, that is the conclusion that he reached: that the government should just nationalize generics for public benefit. That's sort of the extreme version of mandated pricing.

Someone else in the comment section shared another perspective which reaches the opposite conclusion: that these regulations have created the problems in the first place, and the government should not touch this sector at all: [http://slatestarcodex.com/2016/08/29/reverse-voxsplaining- dr...](http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs- chairs/)

</comment></comment></comment><comment><USER51> Somewhat tangential: I surmise that this title will be subject to editing by HN staff, but I think that "Hacker group creates $30 DIY Epipen to expose corporate greed and save lives" is an exemplary post title for HN and want to see more like it.

<comment><USER51> Sure enough, the title was changed to "It Costs $30 to Make a DIY EpiPen," which strips out several important details: Who did it, why they did it, and what they hope the results will be.

</comment></comment><comment> a-no-n Just saw more Epipen Congressional testimony. The actual unit cost of the Epipen (whether branded or "generic") is around $67 USD. Assuming that this cost were not overly inflated beyond actual overhead and unit costs, in order to be sustainable, a reasonable retail price without distributors would be $134 USD... with distributors $200-238.

That said, the more downward pressure from competitors (commercial or nonprofit projects), the better for customers; especially where a monopoly existed, it's rational to for customers to band together and attack excessive hegemony.

Enteprising folks need to jump on this to sell this as a kit (w/ or w/o the medication).

<comment><USER39> > Enteprising folks need to jump on this to sell this as a kit (w/ or w/o the > medication).

Unfortunately, that's a real great way to get shut down by the FDA. Medical devices are after all subject to regulation. Others have tried making their own epipens too, but they all keep running into the slow approval process and unfavorable laws protecting Epipen: [http://www.washingtonexaminer.com/fda- partly-to-blame-in-epi...](http://www.washingtonexaminer.com/fda-partly-to- blame-in-epipen-price-debacle/article/2600315)

Also as we know from value based pricing, things aren't priced based on unit costs (otherwise all software should be essentially free, and the software industry is the greediest industry on earth), but rather what customers will pay. And when there are no alternatives, you get to set the price.

</comment></comment><comment><USER52> "3.1.24 The health economics model assumes that people who receive adrenaline auto-injectors will be allocated two epinephrine pens (EpiPens) with an average shelf-life of 6 months. Each auto-inject EpiPen costs the NHS £28.77 (British national formulary 60). This equates to £115.08 per person per year."

[https://www.nice.org.uk/guidance/cg116/resources/costing- rep...](https://www.nice.org.uk/guidance/cg116/resources/costing- report-136427293)

From 2011 - but I can't imagine the cost has gone up by that much.

</comment><comment><USER53> $30 is way too much, production cost of EpiPen is probably in single-digit dollars, maybe even less. That's not the point, nobody thinks EpiPen costs $300 to produce.

The system it built in a very specific and deliberate way in the US - <USER2> are patented drugs that are expensive, by design, and the pharma is supposed to finance R&D and FDA testing and so on from that money, instead of financing it through taxation, or venture investing, or other means. Now, one can claim maybe Mylan is abusing the system and the money that were supposed to finance R&D are instead financing lavish salaries or whatever. And one can claim the system should not be built at all like this but should be built other way. Maybe.

But completely ignoring the whole design and saying "ah, we've discovered it costs $30!" is useless. Yes, it actually costs even less to manufacture, way less. It's obvious. The reason why Mylan charges more is not because it costs a lot to manufacture. The reason is because that's how patented drugs market in US works. If one wants to change it, it needs to be understood how it works. It's not corruption, it's the design of the system.

</comment><comment><USER54> There are 3 epipens in this article.

The non-generic at ~$350

The generic at ~$150

And the homemade at ~$30

The homemade is equivalent to the generic and the difference between generic and non-generic is not clearly mentioned so let's talk about the price of the generic epipen.

According to the article there is difficult bureaucracy to navigate and very large liability should an epipen fail. On top of that there's distribution and offices that needs a cut or to be paid for.

Is 5x markup that horrible?

</comment><comment><USER55> Ther's an abysmal difference between hacking something together an manufacturing a reliable product at scale that people can bet their lives on. Everything, from R&D to the cost of lawsuits, FDA trials and regulatory frameworks makes these comparisons dumb and ridiculous.

I've been manufacturing products for thirty years. It's never simple for good products, not even a cup of coffee at Starbucks.

</comment><comment><USER56> I am a hacker at heart, and I believe there are definitely some shady dealings with government and industry lobbyists, however, I like to look at things on both sides, since there is always another side.

Truth is if it was more than one hacker in this collective making the 'Epipencil' they must have designed, procured materials, fabricated and did this all in less than an hour to say $30, and they would have had to do all of that in less than an hour to meet minimum wage requirements.

This does NOT speak to QA/QC, testing, insurance, FDA approval, legal costs or even their hacker lab overhead in equipment and energy to make one, let alone hundreds of thousands of these potentially life-saving products.

My guess is that the $150 per Epipen is close to what you need to fulfill all of the above and then some requirements. Far from the $300 or more in pen price hikes, so it was good they did this as an exercise for putting Mylan and government in the spotlight. Bravo, really!

My belief is that it is not solely big bad corporations, but big bad government AND big bad corporations. Just look at the moral integrity of our two current POTUS candidates.

I am trying to become more financially literate in my old age, and I am trying to teach my children likewise, since financial illiteracy is a deterrent to poor people improving their lives, or hackers making a worthwhile dollar in conjunction with learning and exploration.

I tell my kids to think twice when they reactively say or answer:

"ASAP" \- when is that? Point to a date on the calendar;

"It will take 5 min." \- It never takes just a minute or five;

"It only cost $8 for the materials." \- How much is your time worth? Learning is a benefit that cannot be quantified too easily, but for other matters, you need to value your time.

<comment><USER57> You're getting too tied up into the specifics. I don't think you need to believe that the price of an Epipen should be $30 to see the point about price gouging.

If you really wanted a better estimate of costs, you should look at costs around wages, etc... as you indicate, as well as the cost reduction that comes from improved manufacturing processes.

The central issue though is not about the specific price, it's about looking at the point when profit evolves into price gouging. It's not something that can be quantified precisely, but it's fairly clear that we're far from an 'optimised' price for this product, and we'll probably only get to that price with effective competition.

<comment><USER56> No, I actually agreed with the gist of the article. And I do think the group has brought a greedy company to task.

I was speaking to financial illiteracy, and perhaps I didn't communicate it too well.

I know costing well, and I even had a truly innovative, potential Medicaid device to aid blind people in walking unassisted by canes, or canines way back in 1995.

I am not sure how cheap an Epipen can be made at a sufficient profit for a company to either take it on as their only product, or as a horizontal or vertical market offshoot of their existing business without looking at the numbers. I strongly suspect it is far from $30 if it is to be made and sold at sufficient profit and not charity work, or a device of the Theranos/Elizabeth Holmes kind.

I was pointing at the over-simplified, short title as possibly another misleading example of what things truly cost to make to have a final price at $60 or $150 when there is more involved than cost of materials whether bought in quantity for a prototype or discounted in bulk.

Did any of the lines at the bottom of my post ring with you? I only ask, since I am an experienced senior manager with a very eclectic skill set, and I have heard them from the young to the old and experienced, and I am still amazed when I hear them.

<comment><USER57> Ah, fair enough, my misunderstanding. As for your points about people misunderstanding costs, I've no doubt it happens sometimes.

</comment></comment></comment></comment><comment><USER58> The expected market response should have been a flood of alternatives at 1/100 or even 1/10 the price since the base ingredient costs pennies. But these 'ideal' market scenarios that are in public interest rarely come through.

What we often get instead are completely self serving and crafty efforts in collusion with 'ngos' and lobbyists to leech tax payer subsidies and 'force' it onto institutions via legislation.

This pattern is repeated so often and widely its predictable. Also predictable is framing it as a capitalism vs socialism issue to trigger and distract while the corruption continues unabated.

The problem is healthcare is critical. If your checks and balances and idealised system does not work you risk letting people feed on others desperation and create demons. And these sociopaths then multiply within your society killing it from within. This is the biggest argument for socialized healthcare.

</comment><comment><USER59> > corporate greed

Can we please give blame where it's due? [http://slatestarcodex.com/2016/08/29/reverse-voxsplaining- dr...](http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs- chairs/)

<comment><USER42> Generic Adrenaclick is $145. Maybe some of the rest of the $455 difference can be explained by regulation, but a lot of it comes down to Mylan choosing to price the drug that way.

You can also look at Mylan offering $300 coupons to consumers to get them to utilize their insurance. Maybe they are just incredibly generous, but it's more likely that they are happy to net the $300 from the insurance (in other words, they profit at $300).

<comment><USER59> > a lot of it comes down to Mylan choosing to price the drug that way.

Because the FDA is killing off any competitors. Did you read the link?

<comment><USER42> I mention a competitor in the first sentence of my comment!

Feel free to complain about the substitution rules surrounding Epipen prescriptions, but it's clearly a competitor in the sense you invoke with _killing off any competitors_. It's the same dose of the same drug intended for use in the same situations.

</comment></comment></comment></comment><comment><USER60> The original costs about 33€ in Slovenia [http://www.cbz.si/cbz/bazazdr2.nsf/o/208079B7D727DABEC1257C7...](http://www.cbz.si/cbz/bazazdr2.nsf/o/208079B7D727DABEC1257C780004AFA0?opendocument)

</comment><comment><USER61> This is an interesting approach. I've been wondering about refilling the things -- once the injectors I have expire, I may disassemble one to see if I can work that out.

As long as the needle hasn't been used, and the refill is the same dosage as it came with, I'd expect it to be just as effective as a new injector.

(Disclaimer: I am not a doctor, even if I were you're not paying me, this is not medical advice)

This may be legal to do commercially as well, since you're not manufacturing new devices that could infringe the patent. Sorting out FDA issues would be the only hard part (though likely very hard).

(Disclaimer: Nor am I a lawyer, and you are still not paying me, this is not legal advice)

</comment><comment><USER62> There are so many reasons the EpiPen costs $318, corporate greed being one of them. One of the huge reasons that no one talks about is that most rarely actually sell for $318. It's priced at that, but insurance companies negotiate a lower (unpublished) price in most/all insurance purchases. It's only those with no insurance or who are buying it without insurance that pay the full price.

This is true for nearly all drugs, medical equipment, or medical procedures in the US. This is one of the huge problems with our system. Everyone puts a huge price-tag on their stuff knowing that insurance with negotiate down.

To me, this seems like the biggest problem here.

<comment><USER63> Yes but I spoke to a parent who said that in many cases and situations, they are required to purchase more than what insurance covers.

Nobody cares about what insurance companies pay. Like you said, they have professional negotiators on their side. But cash patients, people without insurance, or people required to buy more than what their insurance covers, do need the help.

<comment><USER64> I recently had a hospital bill where they forgot to bill my insurance. They automatically gave me a 40% discount, before I even asked them. That's not to say that the price doesn't matter, but that no one should actually pay MSRP for medical care regardless of insurance.

</comment></comment></comment><comment><USER65> Is EpiPen that well known among Americans? I (non-American) never heard of it until all the news about it's price in the US.

Does it get prescribed more often in the US than other countries? Why didn't I know about the existence of this thing?

<comment><USER66> Probably because you don't suffer from life threatening allergies.

In EU we have more than a single brand of epinephrine autoinjectors in the wild.

<comment><USER65> Probably. But it still seems like many people discuss it as if it was such a "normal and everyday" thing. There are many kinds of medicine that is taken by ~1% of the population, how could people know about all of them?

Or perhaps it also only got famous in the US due to this price rise.

<comment><USER66> No, they are ubiquitous as the epinephrine autoinjector is a required part of an extended medical aid kit.

<comment><USER65> Okay, and do ordinary people have/see extended medical aid kits? What is that by the way? A first-aid kit? Is it in cars, at home, at workplaces or where?

<comment><USER66> At workplaces sometimes, all doctor offices in schools, most GP offices, all hospitals.

(in EU)

</comment></comment></comment></comment></comment></comment><comment><USER44> Other big grownup companies have tried to make a precise injector, and not done nearly as well as Epipen. It's not just a needle in front of a spring. (I haven't read the article, it won't load atm.)

</comment><comment><USER67> it does cost $30 to make an epipen.

However.

It needs to be proved to work, which is rightly arduous. Unlike in (most)software, you can just fix it later. Defects kill. There needs to be a high bar of evidence to prove that:

A) the drug works

B) It doesn't cause your face to melt off

C) its reliable.

All of this is costly, Now, you have two choices, nationalise your drug R&D and charge a uniform cost spread over all drug classes, or through general taxation. Or Sweep away all your regulations on drug prices and start again. (like why the fuck is medicaid not allowed to collectively bargain on price? that's taxpayer subsidy right there...)

In the UK there is a thing called NICE, which is semi autonomous and run by people who can understand stats (ie not politicians) its job is to evaluate the cost of drugs, and crucially the effectiveness of all drugs prescribed within the NHS.

Is the drug actually effective? (sure 50% more powerful, but it costs 190%, just double up the old one, etc etc)

does it provide value for money?

is it safe?

are all the questions they ask. If a drug fails the tests its either written out of guidelines, or more unusually its banned.

</comment><comment><USER19> Pretty neat. I wondered why you could just use an autoinjector like diabetics use (answer you need a larger diameter needle). Still easily doable and its all off the shelf made by medical device manufacturers and drug makers so not so much "DIY" as "repurposing existing medical gear to be more versatile".

</comment><comment><USER68> How much does it cost to get and maintain FDA approval for marketing the EpiPen? What are the financial costs of the legal risks you are taking by selling it to patients? In other words, if it's so lucrative, why isn't anyone else doing it?

</comment><comment><USER69> Thats like saying pirated software exposes the greed of software companies. I don't think that anybody believes that EpiPens themselves are very expensive at all - just like software, the cost comes from the cost of development, which in this market consists mostly of regulatory compliance and approval. If it were easy to bring an epinephrin injector to market, Teva would have already done so and Sanofi wouldn't have had to recall theirs. If there were more auto injectors on the market, the prices would go down.

The outrageous price of EpiPens is not a result of corporate greed so much as a failure of the FDA and Congress - but mostly Congress, the FDA is their subordinate. They failed to promogulate rules that maintained a competitive market for epinephrin auto injectors.

<comment><USER29> If the current price of the EpiPen isn't due to corporate greed, then why did the price used to be significantly lower?

<comment><USER44> It's what the traffic will bear.

The cost is in the patented injector, the drug itself is cheap. Others have tried to market similar injectors, which didn't work as well as the Epipen.

As cost slowly rose, insurance paid for it, and parents didn't notice it as it was hidden in rising insurance premiums. Then deductibles skyrocketed, and suddenly insurance wasn't covering it all; parents had to pay the balance, or all of it.

If you didn't have insurance, you already watched it go up as it happened.

Finally the cost was raised arbitrarily, to cover the company's coming losses as their patent on the delivery system will expire. This, I've read recently, is common: a spike in price before generics take over.

The traffic bears this price, because parents don't want their kids to die from accidental exposure to peanuts and other allergens.

<comment><USER70> I'm missing something - why were the costs rising?

<comment><USER44> Because they could.

</comment></comment></comment></comment></comment><comment><USER71> Ok so Mylan can get them made for $30 and sells them (now) for $150. Is a 5X sale price not acceptable? If not why aren't people going after every single product manufactured and sold?

Don't get me wrong, I'm not defending anyone here; that whole industry needs some fixing. I'm just tossing out the question.

<comment><USER72> They _announced_ a cheaper $300 product for 2 packs. But my understanding is that product is not on the market yet. I also wonder if some conditions are attached to it, as they keep on selling the normal $600 2-pack Epipen.

</comment></comment><comment><USER73> Should be wearing gloves and preserving sterile field for making something injectable.

</comment><comment><USER74> Url changed from [https://www.minds.com/blog/view/625077755582623755](https://www.minds.com/blog/view/625077755582623755), which points to this.

</comment><comment><USER75> It costs $30 to make an EpiPen at home why dont you create a company and sell it for $50 and solve the problem all ya complaining about ?

Mylan deserves our appreciation for inventing EpiPen when none of the other smarty pants who claim to make it in $30 bothered to help the needy.

<comment><USER53> > why dont you create a company and sell it for $50

Patents. FDA.

> Mylan deserves our appreciation for inventing EpiPen

Mylan didn't invent EpiPen. A guy named Sheldon Kaplan[1] working for company named Survival Technology did. He didn't get any special money from it. After a long chain of acquisions the rights to EpiPen ended up in Mylan. They have nothing to do with its invention except that they paid money to buy rights to it.

[1] [https://en.wikipedia.org/wiki/Epinephrine_autoinjector](https://en.wikipedia.org/wiki/Epinephrine_autoinjector)

<comment><USER75> > They have nothing to do with its invention except that they paid money to > buy rights to it.

That is like saying Google had not hand in success of Youtube because it was initially done by someone else. Dont you agree that Mylan deserves a hifi for making it useful and famous ?

<comment><USER53> Nope. They didn't make it useful (they didn't make it anything, they bought it as is) and as for famous, the only thing they made it famous for is as an example of runaway medical costs, which is hardly praise-worthy.

Don't get me wrong, I don't object to the concept of private property, investment and profit. But I also don't feel particularly obligated to be thankful for something Mylan didn't actually do.

</comment></comment></comment></comment><comment><USER76> DON'T POP A NEWSLETTER FORM OVER THE TEXT I AM TRYING TO READ.

I'm sure this is an interesting article but the only way we will stop this practice is if we stop giving user-hostile publications our eyeballs.

</comment><comment><USER77> Watch the video. All described is loading epinephrine into an autoinjector. This is great because it suggests the barrier to competition is relatively low hanging fruit for those already in the drug delivery markets.

Also: screw mylan

</comment><comment><USER78> If the product is so expensive, and someone can make a competing product for less viably I find it hard to believe that it hasn't been done. A more fair comparison would be "medical aid which wasnt subjected to the same regulations and testing is cheaper to make and distribute" aka Corporate greed.

<comment><USER39> Not sure how that's greed as much as a case of too much regulation.

Companies exist to make a profit, why are we getting upset when they do so within the confines of law? Here, the law allows for lobbying and high regulatory burden which creates a monopoly for EpiPen.

I don't expect public shaming to reduce corporations from seeking profit. I do have great hopes for reforming laws to incentivize competition so that the desire for profit benefits us all.

</comment></comment><comment><USER79> If someone knows how to make a product for $30 that the competition charges $300 for, why not go into business and undercut their price by a huge margin? Millions of users' lives would be instantly improved with dramatically cheaper epipens. That will do far more to combat greed than a blog post.

However, I think that if someone were to try this, they'd find there are many more costs involved than the raw ingredients and it might not be quite so simple to massively undercut the competition. But still, they should go for it! Competition is is the best medicine for over priced goods.

<comment><USER53> > why not go into business and undercut their price by a huge margin

Patents. FDA.

<comment><USER66> FDA mostly. There are other, better ways to deliver epinephrine than with a spring loaded syringe, e.g. pneumatic injector.</comment></comment></comment>


0bin: A Client-Side Encrypted Pastebin - <AUTHOR> http://0bin.net/

<comment><USER2> The problem with these is that even if the code is set to be cached forever, there's no easy way for the user to verify that this is the case. How do you defend against an attacker (say, the FBI) taking control of the servers and causing them to serve javascript which sends the messages to themselves unencrypted?

<comment><USER3> At the moment an attacker doesn't even need to take control of the servers since all the code is sent without SSL so a MITM attack would be enough.

Edit: though of course if the javascript is never requested again it limits the window of opportunity to man-in-the-middle.

<comment><USER4> This was on HN previously, but not at this domain, they said the key generation and link formation was performed client-side, at no point does the key get sent to the server.

You send the encrypted message to the server and the javascript serves the url that combines the client side key and the servers uid for the paste.

See: <http://sebsauvage.net/paste/>

<comment><USER5> This should be a top-level comment.

</comment></comment></comment></comment><comment><USER6> "Error Paste could not be saved. Please try again later."

Damn.

<comment><USER7> Just fixed that. First day out, first bug out :-)

</comment></comment><comment><USER8> The short URL feature doesn't work. The short URL created is <http://0bin.net/paste/undefined>

</comment><comment><USER9> Just a note, the 0 (zero) in the page logo/title is (or looks a lot like) the Scandinavian letter Ø, which is in no way related to the number 0.

</comment><comment><USER10> nice idea though.</comment>


Ask HN: Shall I reveal founders cheating behavior to investors? - <AUTHOR> I stayed at an "AI" startup for a few months and figured that the cofounders obtained investments by cheating investors. They took open source code from github repo of latest AI publication and run the code as demo showing to investors. They didn't make any improvements to the code because they are incapable of doing it but they claim that's their work. Ironically, investors believed them and invested millions.<p>I personally know one of the investors. Shall I tell them the truth? <comment><USER2> There are a number of issues.

1\. Don't be too surprised if the investors don't care. Because a) as long as they put a decent play together who cares? and b) what are they going to do? sue them? that will make the investor look bad (they should have done DD) and give them a bad rep (who would ideally want to take investment from an investor who has a track record of suing you).

2\. If the investor has a board position it might be ok. But you're probably under an NDA with the company. Disclosing this to the investor might be violating that NDA and you should consider this.

I would probably mention in casually if you mention it at all. Like, you found it interesting how that play worked out and were a bit surprised that they could get funding using a publicly available demo. Probably I would make it part of a wider discussion or something...

</comment><comment><USER3> Are you prepare to look for a new job? If so, yes.

I would frame it slightly differently. I would set up coffee with the investor you know. Ask them what they thought of the demo. Ask them if the demo was the reason they invested. Ask them how large a role it played in their decision to invest. Ask them if they believe the code in the demo is proprietary or open- source. If the answers are different than the truth, re-do the demo in front of them, including going to Github and cloning the repo.</comment>


Rumor or not?  Apple Planning a $249 to $299 'iPad Mini' This Year - <AUTHOR> http://mashable.com/2012/04/16/apple-ipad-mini-rumor/

<comment><USER2> It would be a horrible move.. their success has been based on the focus on just so few products. I feel this might hurt their trademark.

<comment><AUTHOR> It depends on how innovator they will make it! It could hurt their trademark or it also could boost it at a point that it will be a new major product of Apple!</comment></comment>


Ask HN: Is there any API to UI tool? - <AUTHOR> I mean, hit an API and render the UI, basically dynamically create UI from API. would love that kinda tool for rapid prototyping for my personal project. <comment><USER2> That's basically what the entire web is: a data service that describes the UI to the front end. It wouldn't make sense to create (from scratch) an entirely new protocol/language for an API to create a UI when such a thing already exists.

And if you don't have a description of the UI that comes to the client along with the API payload, then how can the client know how to render it? It's too ambiguous -- data schemas are not deterministic when it comes to UIs. That's why HTML/XML are not sufficient for rendering UIs. You need CSS to tell the browser how it looks and JavaScript to tell the browser how it behaves.

The best you could do is an API explorer. But maybe React + Relay would get you closer to what you want.

</comment><comment><USER3> You'd have to sketch out and describe some pseudo code for me to better understand what you're wanting but I'll mention that Bootstrap makes it pretty easy to rough out a UI.</comment>


Ask HN: how long should the recruiting process take? - <AUTHOR>

How long do you think the recruiting process should take, from the time you first submit your resume, until the day you are offered the job verbally? <comment><USER2> Weeks. Figure most people's processes break down into 3 phases:

(1) Pre-screening/qualification/bucketing

(2) Phone screens and online interviews

(3) On-site interviews

Each phase takes N days. The hand-off between each pair of phases takes time. Phase (1) has the built-in lag of you sending something and it getting to the top of someone's pile. Phases (2) and (3) involve coordinating schedules with you and with interviewers. Phase (3) involves making sure the whole hiring team is available to interview you. All three phases may involve a group decision-making exercise of some sort.

If you budgeted a week to each of these phases you wouldn't be too far off.

If you need the process to go faster or fit your schedule, ask! It's a sellers market, and an employer that can't show some flex (or at least talk reasonably about their constraints) is sending you a valuable signal.

</comment><comment><USER3> A few days to schedule an interview upon receipt of your resume. Interview within current or following week. Rejection or offer within a few days of interview. Start date within 2 weeks.

Days = business days. Weekends can stretch things out. Ideally at most a month from resume submission to chair-buttocks contact.

</comment><comment><USER4> Yeah I've had weeks be normal. And days too. Sometimes its company procedure, sometimes it's just normal for things in either scenario.

</comment><comment><USER5> Anything from 5 minutes (not to say 0 seconds) to ten years. Of course, if you're in the later situation, don't burn bridges!</comment>


New measure of success for social networks: someone makes a song about you (The Facebook Song) - <AUTHOR> http://mashable.com/2007/05/06/facebook-song/ <comment><USER2> The best is "New Friend Request" by Gym Class Heroes, about MySpace. Probably the only social network song to be released by a major label.

<http://www.youtube.com/watch?v=8FT7S15UgSM>

</comment><comment><USER3> not sure how much this has to do with startups, but if we're going to get on the topic of facebook songs: <http://youtube.com/watch?v=6FahBBnfHAQ></comment>


Voter Registration Fraud - <AUTHOR> https://www.heartsucker.com/blog/voter-registration-fraud <comment><USER2> We were told that this never happens. This is why ID isn't required. Right?</comment>


Apple dropped the ball with their HTML5 demos - <AUTHOR> http://atomicrobotdesign.com/blog/htmlcss/apple-dropped-the-ball-with-their-html5-demos/

<comment><USER2> A slight correction for the article:

They say, "You're not going to win me over if I have to own a Mac or use a nightly build to see something," but if you have a Webkit nightly on Windows you'll still see that same message telling you to use Safari on OS X.

So, basically you'll need a Mac to see any CSS 3D transforms. It's because that portion of Safari relies on the Core graphics framework.

</comment><comment><USER3> I get 113 out of 160 on my Safari browser from html5test.com.</comment>


Windows Tools Aren't Worth Selling. - <AUTHOR> http://etherealmind.com/windows-tools-not-worth-selling/

<comment><USER2> This is interesting that arriving onsite with a Mac may get you on the network quicker. A lot of places I know consider Macs to be a black box, and generally "harder to support."

I personally feel I sort of _graduated_ away from Windows in my career but ultimately if I was stuck with just about anything I feel like I could get some light programming, design, or admin work done, so it is weird to me that these debates go on. It's just a tool, tell me more about what you're doing.</comment>


Supercharging JavaScript Performance with Asm.js - <AUTHOR> http://blogs.windows.com/msedgedev/2015/11/10/supercharging-javascript-performance-with-asm-js/ <comment><USER2> I let the example chess program run 4 times and the each time white (the un- optimized version) won. Granted that is not enough times to prove anything but funny anyway.

<comment><USER3> White has first-mover advantage, maybe your browser does not support asm.js? At least on Firefox blue won, but the page load so slow I don't care to repeat the experiment right now.

<comment><USER2> Your right, my browser does not support asm.js. I was still expecting 50/50 but the white advantage seems to be very overwhelming in practice.</comment></comment></comment>


Fake company gets approval for risky trial - New Scientst - <AUTHOR> http://www.newscientist.com/article/mg20227023.700-fake-company-gets-approval-for-risky-trial.html?DCMP=OTC-rss&nsref=online-news <comment><USER2> 2 out of 3 rejected the trail. Now, all 3 will likely be subject to increased government regulation. If the past serves as any indication, this regulation will be cumbersome, ill-thought out, and expensive.

Now, I'm not saying I am totally opposed to Government oversight, but this just illustrates a larger problem in our system- a few bad apples cause the entire system to fall apart and forces many good companies to jump through hoops and raise the cost burden on consumers.

Now, in this particular case- shouldn't the FDA be overseeing this?

<comment><USER3> The risk/reward equation in health care research is completely out of whack.

Obviously researching drugs, medical devices, etc, can kill people. But my god, the greater benefits we could have if testing a new drug didn't cost BILLIONS.</comment></comment>


Viddy returns $18M of its $30M Series B - <AUTHOR> http://allthingsd.com/20130507/social-startup-viddy-recapitalizes-shuffles-board/

<comment><USER2> When Viddy raised money, it was when folks were jumping on the who will be the "Instagram of video" bandwagon.

Socialcam and Viddy appeared to be the front-runners for that, but then certain things got in the way

\- FB cracked down on both for being aggressive with people's feeds. This killed growth.

\- SocialCam got acquired for $60M by Autodesk which as a comparable transaction wasn't very favorable for Viddy (on a price/user valuation multiple basis since there was little to no revenue)

\- Investors had control of the board and likely decided based on the above and other factors (such as company founders departing) that this was throwing good money after bad and so decided to take their money back

</comment><comment><USER3> Can someone explain to me how this works? I've never heard of a company returning money except in the event of a shutdown.

<comment><USER4> It's usually more likely to happen when you have a board that is firmly controlled by the people who've invested the money in the company, and, when they see a significant change in market conditions (or makeup of the company) - decide that their ROI will be greater if they withdraw some of that investment.

I'd be interested in knowing, though, what the precise financial transaction looks like. Dividend? I would think that they would try and avoid those tax consequences.

<comment><USER5> IANAA, but "return of capital" is non-taxable.

<comment><USER4> Thanks - [http://www.investinganswers.com/financial- dictionary/investi...](http://www.investinganswers.com/financial- dictionary/investing/return-capital-roc-914)

</comment></comment></comment></comment><comment><USER6> VC probably got over 50% votes and forced this on them. Valuation goes back down.

</comment><comment><USER7> It's really hard to say one way or the other what this is. "Recapitalization" is a hilarious euphemism for "gimme back my cash," but considering they're keeping a lot of what's in the bank and still going with their investors, it could also be a very good sign. What reasonable person would want more liability to investors than necessary?

Granted, the ~50% staff reduction probably sets off some alarm bells, but if it really is a matter of improving efficiency, that's actually really good business for a startup.

Unless I'm missing something... this is either news in both directions at once or neither. Now my head hurts.

<comment><USER8> Here's my semi-educated guess on what's going on. I could be off, but I have some sense of app store ebbs and flows by now:

1) Viddy is hurting bad in terms of users -- You'll see that JJ has tens of millions of followers but the interactions and view counts on his videos are very, very low in comparison. It makes sense to give it back because their growth is probably very, very, low. If they are around 40-50th in Photo and Video they are definitely doing less than 10k downloads a day.

2) Viddy actually has quite a good app. They have a pretty solid team, and can ship quite quickly.

3) Apple is promoting the shit out of video applications. Even though no one is really using them* -- things like Vyclone, etc. Either they are hoping for one of these to really take off and cause iPhone sales in the same way Instagram did, or are about to introduce new technology which makes video- capturing much better/easier/etc in the same way that Instagram came at the perfect time for the iPhone 4's camera enhancement.

Since Socialcam's sale, Viddy is definitely in the best position in terms of Instagram-like video apps, so if there are new advancements in the iPhone 5+ that do make video more appealing somehow, they will be the go to app. That being said, video is hard, and no one like to watch shitty videos which is why I'm bearish on video apps in general.

*Vine is up there, but it's still an unproven quantity I would argue. Is it's current success tied to it's insane distribution network? Time will tell.

<comment><USER7> Interesting; thanks for the insight. I still can't claim to really get it, but this definitely sheds at least some light on the subject.

</comment></comment></comment><comment><USER9> Do the investors remain in control of the shares they acquired when they put the money in? If so isn't this like buying shares in a company for free?</comment>