Hacker News Reader

Comment by lultimouomo | Hacker News Reader

It's not clear to me if he invented a new device, or simply built a 2$ home made version of a 6000$ standard bubble-CPAP. In other word, is this a story about ingenuity saving lives, or about regulation and industry profiting on medical devices killing lives?

(Note that I'm not saying that we necessarily have too much regulation or that medical industry profits too much; I'm just saying that in this specific case they would be failing to save people, while overall they could still be optimal)

View on HN

I'd say it's about the value of low-cost alternatives from an industry (medical devices) that very often disregards cost entirely.

I understand the precision and expertise that goes into medical devices, and they've saved millions of lives (mine included) — but in countries where $6,000 means something might as well not exist, they need something in-between precision manufacturing or nothing at all.

I think the real story is that there is clearly a market need for a simpler and cheaper (if less effective) bubble CPAP, which will save many lives in countries that can't afford the $6K version. It wouldn't be used here in the US but it'd do a lot of good in Bangladesh.

I don't think it's a story of over-regulation, as I doubt Bangladesh has regulations in place only allowing the $6K version.

> I don't think it's a story of over-regulation, as I doubt Bangladesh has regulations in place only allowing the $6K version.

Well it still could be. It's not because there's no over regulation there that there's the expertise required to build and market an inexpensive CPAP machine there. As far as we know, as soon as they get the expertise, they could just move to another country and get a better wage in doing so.

I'm a software engineer and it's something that I think about. I'm only making 60k$ in Canada while the US the average is higher and in USD. I'm only 2 hours away in car from the US.

My guess: the hack one is less effective but in that area, a $6000 device might as well not exist, way out of reach for 99% of the people. So, maybe less effective in theory, but in reality it is saving countless lives.

It's true that some money goes to designers, lawyers etc etc but when they see an opening, they do rip people off.

Exactly, something that saves 95% of patients but is 0% affordable is worse than something that saves 50% of patients but is 100% affordable.

Accessibility broadens as waste is eliminated from the system. No other manner increases accessibility. Medical device manufacturers would prefer to make a device with less waste, they'd make more money (see empires built on low price commodities). Regulation unfortunately builds in tremendous waste and reduces accessibility. A waste reduction like this is an incredible achievement.

Medical device manufacturers would prefer to make a device with less waste, they'd make more money (see empires built on low price commodities).

This seems like an oversimplification. The people capturing those gains are very often not the manufacturers. Often it's the retailers, not the manufacturers, who build those empires.

Unless it's different specifically in the medical device industry; if so, do you have examples?

The medical device industry (at least in the US) is very special. It does not have retailers per se, but there are a lot of middlemen who take varying, often enormous cuts. Medical device manufacturers make enormous amounts of money though. I am not sure how much of this is specific to the internal US market vs. carries over to US exports.

For a good treatment of this and many other aspects of US healthcare costs, see An American Sickness by Elisabeth Rosenthal.

But are there examples of medical device manufacturers making a killing by selling low price commodities?

I suspect that the manufacturing costs for many medical devices are quite low, e.g. stints, but this is not public data to my knowledge. But the manufacturers make a killing because they charge a high price.

Of course the medical manufacturers do well, they're granted monopoly power from the government through the regulatory process.

Reply on news.ycombinator.com