I wasted $40k on a fantastic startup idea (2020)

As a fellow start up founder, I see most of my job being just buying time for the business. Buying time to make, to talk, and to think.

It wasn't like the tool had no value to Susan, maybe with a booth at her go-to annual expo, mentioning a few past lawsuits the tool could avoid, and an affinity partnership with her industry association, the tool would have become a fact of life for her.

It's a lot of work, I'm not denying that. Yet, this is the sort of thing YC's idealized startup stories often fail to say. If "instant Product Market Fit" is so good, then how come practically every new high flying SV startup is using loads of VC money to "bend the market to the product"?

Exciting Startups have to venture far, it's not about "we let you buy your potatoes online" anymore. Chances are you won't get deals by talking to people once. I wouldn't say that means your idea is bad.

> Here I was, living the Silicon Valley dream: making the world a better place through technology.

I don’t know how this has become a thing people believe, however widely it might be believed. But if it’s representative of SV or tech innovation at all, it’s either wildly distorted through a wealthy person’s pet futurism project—or held in the imagination of someone aspiring to that stature. SV is about making money, that’s it, that’s the whole story.

The totally overlapping error here was assuming those things—making the world better, and making money—aren’t inherently in conflict. And overlapping that: assuming that a profit driven health care system has altruistic goals as such, rather than in concert with its profit-driving priorities.

This project could have been successful (and could still do if the author or anyone else wants to pursue it). And it could have been a valuable contribution to society.

The author would probably have realized this error if he’d considered entering a global market where health care has different economic incentives. Programs like this which help people are funded by government contracts and grants, not by payment from arbitrary people acting on their arbitrary interests.

Not everything is a startup. This is a research project - and should be approached that way. There should be donors, a foundation, free access to all participants, reputation-building by writing (& publishing in reputable journals / conferences) studies about its efficacy, a board of doctors actually reviewing & cross-checking recommendations, a doctor-to-doctor helpline, etc.

As the author found out - it's not something people want to buy, but the public. So I think if you approach it from that direction - it might just work.

A lot of startups fail because they never identify a customer. Or even a problem. This one failed because before writing a line of code the founder did not take the next step and ensure that the prospective customer was willing to spend money on a solution.

This is why so many failing startups try to pivot to two-sided business models like advertising. That's one of the hardest businesses there is to start. And it's what the founder did here, too.

It sounds obvious stated as follows, but every startup failure I've read or heard about fails to get these ducks in a row:

- problem to be solved

- customer who has the problem

- customer willing to spend money to solve the problem

- enough customers willing to spend money on solving the problem to fuel a startup

Oddly enough, many of the startup success stories gloss over these fundamental components. The net result is that there's way too much emphasis on the idea and not nearly enough on the customer.

> But then I look at WebMD’s 10-Qs and start to spiral. Turns out the world’s biggest health website makes about $0.50/year per user. That is…not enough money to bootstrap GlacierMD. I’m pouring money into my rent, into my Egyptian contractors, into AWS—I need some cash soon.

The take away here should have been not to pivot entirely, but raise money. You are in Silicon Valley! This is literally why this entire ecosystem exists. Sometimes bootstrapping can be beneficial, but when you have spent $40K of your money, have a good enough prototype with a clear story, and are going up against giant established competitors, forget customers for a while and sell to VCs instead.

If you are really sure that the service adds value for doctors, give it to them for free for a year and prove it. Open up your service for users without worrying about AWS bills or ad revenue. A boatload of money in the bank makes all of this trivial.

https://news.ycombinator.com/item?id=25825917 https://news.ycombinator.com/item?id=21947551

The work flow currently is Drug A comes to market with expense X, it is competing with older Drug B with expense Y. There are no head to head trials, but an expert (usually a pharmacist) can reach solid benefit/harm conclusions. That pharmacist writes up a nice summary with a recommendation and present to a committee made up of other experts (usually doctors w/ academic background). They discuss and come to a formulary decision for the whole hospital.

In insurance companies, some background financial shady stuff can take place (kickback schemes) that influence this process, but some form of honest data analysis takes place anyway.

I used to do this for a while, it can work. Just have to convince the right people that your software would be better than the pharmacist. The market incentives doesn't really encourage that kind of automation/savings, so it will be an uphill battle that need experienced sales folks and good VC money.

I realize I'm a total armchair advisor here and what the hell do I know. But reading how this person approached potential customers I kept thinking "oh man I wonder what will happen when he talks to the insurance companies, why would they not be interested?"

Can you apply that to all kinds of medication, is this is a lot of more work or can you plug it in or let a student do the data entry?

It will take a while to gain traction, but if you go to conferences, add more kinds of medications, establish a brand and gain reputation, this could be very successful. The contribution to modern medicine is invaluable.

How many big kinds of medications are there? For the Top20 most common cancers, IBS, Neuropathy, acne, MS, heart disease, hypertension, arthritis and you've got most of the big ones covered. You can also add beauty treatments such as hair loss, skin rejuvenation and you are already in the beauty sector with much lower barriers to entry.

Might be a couple of months of data entry but then you would have this invaluable neural net no?

I wouldn't work on this full-time, but sending out emails here and there, developing it further here and there could be quite fruitful with a very good time spent/impact ratio.

Like honestly, this product could still reach that type of success. No idea if this guy still has the code base around, or is chilling in thread, but hit me up if so lol, I'll happily buy it off you. Or at least point you towards how to make this make money

The examples I see in the article (picking the 'best' pain medication or antidepressant) aren't all that interesting to me. Like, of course naproxen wins, it has the longest half life of all of the listed medications...and the comparison of SSRI are well known at this point. I find it hard to believe that a board certified psychiatrist (Susan) wouldn't know which medication has better efficacy in which scenarios.

Perhaps this is meant for providers that don't understand the pharmacology and evidence behind the drugs they're prescribing. If that's the case, maybe we should be asking ourselves if we should be the ones prescribing that medication or if a specialist should.

And maybe it can elucidate useful findings quicker than academia, but I doubt by much. And funnily enough, there are already tools that exist to make meta-analyses and systematic reviews a lot quicker than they used to be.

People talk about bad startups that do happen, but not nearly enough about good ones that don’t. We should be at least as outraged at the systems that quietly steal what could have been.

I remember thinking about how sad it is that companies could succeed, or fail, off the basis of good, or bad, marketing.

There's a weird effect where data-driven decision making becomes essentially unstoppable given a big enough sized company, and it essentially condemns companies small enough when they believe that their decision making and technical prowess alone can earn them respectful competition against the "big boys."

And then they find out everything is corrupt, everything is about money, they don't have nearly enough money for the real players to even stop laughing at them for a moment, and they quit and cut their losses.

Sometimes it is simple - make a piece of software so valuable, businesses or consumer are willing to pay money for it. Sometimes you have to be more creative. For example, Brex makes software for managing business credit cards. It's handy, but I'm not sure I would pay for it. But the Brex model takes a cut of credit card processing fees, so they can give their product away for free.

In this case you could target consumers and give it away for free, then when someone wants a prescription for a medicine they found on your site, you can "recommend" local doctors. Doctors will pay a lot for the patient leads.

Also other factors apply, because a "headache" is really a rather complicated phenomenon...

Once money was desperately needed...the response was to cold call small doctors offices? That, clearly, shows the deep lack of understanding of the market for this type of product.

I wanted to riff of a couple of points:

'“Yeah okay that’s great but nobody cares about this math crap. You need doctors.” Goddamnit he was right. If nobody could be bothered with the math, then I was no better than Gwyneth Paltrow hawking vagina eggs. To build trust I needed to get endorsements from trustworthy people.'

This slightly miscommunicates how it works; it's even more annoying. True you need the people usually first. But one day it will come down to math/science. And if you don't have that right the same people will roll their eyes at that too even if they can't spell math.

And "Occasionally I like to disconnect from the IV drip of internet pseudoknowledge and learn stuff from books. I know, it’s weird—maybe even a bit hipster. But recently I read Wharton’s introductory marketing textbook, Strategic Marketing Management."

I'm sending this in from the engineering cheerleading club: Never apologize or down play reading (a book) or writing. It's good! The other side doesn't get it? That's why you need a pulse so not to care about such things.

In the alternative? Get a 12-pack and re-watch the 'Breakfast Club' with the other side. In the end we all play more than one roles and we all could use help on the way.

I don't even think "have a business plan" is the takeaway, because no plan survives first contact with the market. All business plans are built on the assumption that people want what you're currently building.

To me, the takeaway is you need a good 2-3 year runway for startups today. Maybe it only took a year to find PMF a decade ago, but it's much harder now. "The digital X" isn't enough. "X for mobile" isn't enough. "Uber for X" isn't enough. I think this is why web3 is partly as big as it is. It's very easy to say "X on blockchain" and get money for it.

You need to have a strong idea of the community you're serving, and those communities are becoming more and more nuanced. Once you find it, it'll take you a fair amount of time to win it over.

It would be nice if there were some kind of universal project "retirement home" where these sorts of things could go to pasture, caretakers could prod at the idea and pull it apart, find the intrinsic value if any, and integrate the guts of it into some broader universal API. Such a platform of trinkets that solve tiny everyday problems that individually have little value might actually be useful in any sort of recommendation engine. API calls could be metered so the original creators of each piece get some kind of return however small.

Give me 40k and some failed IPs to play with and I'll deliver a prototype in a few months...

How could we change medicine so that such tools could be adopted? Patients probably won't individually notice any difference, and they don't control what they pay. Insurance companies might be motivated to provide something like this to doctors under the theory that better results are probably cheaper in the long term. A single payer system might perhaps provide certain solutions to doctors and hospitals in various manners, but adopting novel stuff like this from small shops might become effectively impossible. What models would allow for an inventor inventing something like this?

I find the distribution->product->tech pipeline a more constructive way to think about building a business than "product-market fit", or "starting from a pain point". And it's a lot more productive than the reverse tech->product->distribution pipeline.

Either way, I think for all the shortcomings and faults the VC and accelerator world has, this is a good example of a mistake that's much more easily avoided when following a proper development plan for your startup.

What if your model has small errors? What if the data is wrong? What if the data is good but people you've payed cheaply to enter it in the database did some small mistakes? It's not like we are dealing with consumer goods, where small mistakes might not be so important. We are dealing with people lives and health, where any kind of mistake should not be tolerated.

It also doesn’t scale well as more papers come out they need more consultants to populate the database with it. So one option for OP was to sell to google but I dont think it scales well enough for them to buy either.

But let's stay on track: The thing with painkillers is that they are not really predictable (so I don't wonder that he failed). Even if a study suggests that a certain kind of medicine might help better, this doesn't mean anything. It especially does not mean, that the painkiller will help me.

I've tried a lot of them, based on recommendations from the doctor, from the internet, from the pharmacist. In the end I found one agent that really helps me and I sticked with that.

And I guess the doctors had no reason to use a service made by a guy without expertise, the data coming from some outsourced workers without any third party validation (no putting the face of few doctors isn't a validation).

My favorite line from the post

You're unfortunately dealing with an unfree market, which is why the psychiatrist tended to her nails instead of shitting her pants when you revealed tech that could potentially make her obsolete.

It could potentially provide tremendous value for someone else solving for an overlapping problem - and strengthen the recognition of the author. There are no requirements to give a single second of your time to it after that. Just dump it on some free place online. No need to provide contact details, if you prefer not to. Maybe someone will eventually rummage through the dump, find it and appreciate it, maybe not. Maybe someone will figure out a way to use parts or insights from it into a crowdsourced public good which does not rely on VCs, ads, or paying customers.

There are countless valuable learnings that are lost when founders abandon their projects and just wipe their efforts from the earth.

Imagine how much further and faster we could progress as a species if there was a culture to release your abandoned projects like that.

I think you need something with a very concise value prop I'm working on that for my next thing right now. Something simple.

FYI don't use AWS for these sorts of projects use something cheaper.

Is there any chance of the remaining data and possibly code being released/sold?

He was onto something with the doctor thing.

1) Things that help people make money are 100x more valuable, i.e. something that helps the Docs generate more revenue.

2) This was insulting: "So I’d sorta just be, like, donating this money if I paid you for this thing, right"

Seriously a professional talking about a 'donation' if it didn't actually increase her revenue? What a jerk. "I care about my patients but in the end I just give them Zoloft!" I mean that might say a lot about that line of work.

That said, I think they might actually use it, if it's institutionalized - i.e. they use it Med School, doctors everywhere use it, two doctors 'unsure' about something both check it etc. it becomes 'something needed' at the office and everyone is expected to have it.

I suspect there's opportunity there, it's just take some time and structuring.

I have no idea what kind of marketing he did and for exactly how long, but it feels like there's a lot of people, organizations, and companies that could have been interested here beyond a few doctors in SF. Like, not to put too fine a point on it, but how many disabled people did he talk to? How many industry groups (American Lung Association, etc.)?

Another option is to augment the product to allow consumers to track their existing medications. Using their demographic data + current prescriptions, you could then used their self reported drug efficacy to recommend possible alternatives.

You wanted to sell to practitioners directly. Your market is suppliers. They are in the position to sell it to doctors by the thousands for next to nothing.

Go make some phone calls.

When talking to doctors, he's not selling his idea or service - he has to first sell his own credibility, and then the credibility of his service. He is claiming that the intended/unintended effects of medicines can be coded into a big searchable table, that his "contractors" have done this, and his service is now usable and valuable.

This too bold a claim, especially from "some random guy". That's why none of the doctors were interested.

In his blog post, he's assuming his product actually has value, but somehow has opposing stakeholders.

Not saying it wasn't worth it. People should take risks. Just be sure to fully account for them.

Individual doctors are not the customer. When the incentive for the customer doesn't outweigh the investment, that's when you need to scale up the customer.

The customer for this product is a business that deals with tens or hundreds of thousands of patients: health insurance companies, government healthcare purchasing departments (large market outside the USA), the sales department at the drug companies themselves, etc. These companies are all incentivized by getting better treatments for their patients because that either lowers their costs, or sells more of their drugs (when they're the best option).

Imho, the main thing that prevented this product from being useful was the lack of evidence that using it actually improves treatment outcomes compared to what doctors/patients already do. If he could have pointed to studies showing this, the doctors might have reacted differently. Even better, if he could have used his fancy statistics to create personalized recommendations and then demonstrated that they improve outcomes, he might have been on to something. The current tool was optimizing for the average patient, but nowadays we want personalized medicine.

... are there? I mean, I guess you got paid handsomely, but still. Leaving that aside there aren't many tech jobs I would be ashamed of having more than that one.

Anyways, I wouldn't pay for this as I love doing the research myself. Google for the plebs and pubmed and more specialized websites for the patricians is usually good enough.

I would pay for Doppelgänger though. I would pay more than 1 € even! Maybe 4.99! I would even consider 9.99 if the database is huge. The idea of finding my doppelganger sounds amazing.

If you can convince people to buy the higher margin drug? Yeah, there's lots of easy money to be made in that even though customers don't want that.

Google for "best X" and in a ton of markets all you will get is a bunch of skeevy affiliate sites promoting the best deals for them and a good look at who is willing to lay down the most $$$ on adwords.

Even for branded sites with a rep (e.g. like tomshardware) i have my suspicions that they weight their recommendations towards companies that buy advertising on their sites.

My experience in that industry taught me to never go to a hospital, most of the staff don’t care about patient care at all. It’s just another workplace and everyone is worried about keeping their job, internal politics or money. Patients always seemed to come last. So why would they be interested in better outcomes by using a software? They aren’t really incentivized to do better in any way. Aside from gaming government requirements, wrapped around patient care, to get more money, only then do they care about outcome.

Yes I’m jaded, certainly won’t go back.

What I would do if I was you is go back to your first step: your unhappiness with Google's search for medical drugs. Have you talked to GOOG about integrating your data into their search? You might be able to sell a subset of your data and code to them for a small sum, and assist them with the integration of your idea into their universal search.

It seems to me this is a classic case of spending too much on the tool and thinking that users will just somehow come. Too much on the tool; not enough on the marketing. A more streamlined MVP would have sufficed to see if there was a product/market fit and to figure out how to monetize it.

This could be avoided by pretending the solution exists and asking people how they feel about paying for it.

That said this can be a great not for profit idea.

Well the good news is if you ever want to go be an epidemiologist, you've already heard this bit!

To me, "make something people want" is a proxy for "make something people are willing to pay for." To truly want something, you have to be willing to expend resources to obtain it. Anything less than that is people blowing smoke.

1. do marketing: convince patients that GlacierMD is the greatest thing since the discovery of antibiotics and insulin

2. sell it to doctors: Dear Susan, this is the biggest thing to happen in the industry in the last 10 years, you don't want to be left outside, as you can lose lots of patients. Trust me, having an GlacierMD on your front door for just $99 /month is a great deal I am making to you as one of our first customers.

This might be a very useful filter.

As a physician, lol. Lmao

I can see why so many things wrong but I believe the author also noticed these major flaws/mistakes and wrote himself.

And if I called all my tiny projects or websites I built startups, I'd be the startup king of America.

If you want a rent-paying idea, then that looks more like a boring 'me too' idea. Yet another Pingdom clone should do the trick.

Your real profit would have been to follow the Yelp model to charge for placed ads and charge to manage reviews.

Just as Yelp gets a cut of online orders you could have partnered with mail order drug companies for a percentage to order directly.

If you wanted to get into really morally grey area do the doctor shopping too. Who prescribed what.

There are just lots of weird backwards incentives and deeply entrenched institutions that make it simply brutal to try and make changes.

This reads like a parody to me. This whole thing is real, though, right?

Did anyone catch what the name of the drug for depression treatment was?

That stretches credulity. It’s, like, 750 lines of code per day, working every day.

They didn't want it enough. More specifically, the exchange of benefits for the cost was not clear enough