Hacker News Reader

Comment by icelancer | Hacker News Reader

>> Without some solution like this, it's hard to imagine any non-essential neural implants really taking off: who would ever buy a neural lace from a startup — or even an established company like Google who might just lose interest — if there was no guarentee of patches and maintenance?

Speaking as someone who lived with chronic, daily, horrific pain for years before a surgery miraculously solved most of my problems - if that surgery had not worked or wasn't available, I would have eventually signed up.

Thousands or more people live with debilitating pain that drives them to suicidal ideation, drug abuse, and worse.

We already live in the future you describe and people turn to far worse things than neural implants to cope.

View on HN

Agreed. I meant 'essential' in a weak sense to include all high stakes medical cases, not just literally life and death.

The key thing is that we won't be able to get much benefit from neural implants as an enhancement technology without solving this problem; there's a ton of potential value which will be left on the table because people are reasonably afraid of these risks.

> I would have eventually signed up.

You could have signed up only if excessive regulatory burden wouldn't have killed or prevented the startup from existing.

I find the whole "medical startups should support their patients post bankruptcy" train of thought very disingenuous: as long as we as a society make no public concerted effort to cure these people and leave them to the mercy of the markets, then surely some relief from their problems, even if temporary, is better than none, especially if it provides valuable experience that other more successful companies can use in the future for many more patients.

In view of these future possible patients, it would be downright imoral to burden such startups, which already take enormous risks, with unreasonable costs such as ensuring their devices function into perpetuity.

Yes, they should be regulated to not make the problem worse after they inevitably fail - primum non nocere. But most of the other ideas proposed in the article have a toxic effect on the business viability of medical startups, possibly preventing them altogether.

Then they should escrow all of their intellectual property and at the very least release it all to public domain the instant they stop supporting the device.

I strongly doubt the issue preventing support for these patients is the intelectual property in general. Source code, I agree, but things like medical patents are irrelevant if you have to replace a battery cell in a custom form factor or chemistry that is no longer manufactured, per the article. The insurers actively fought the patient changing his own battery.

You also diminish the expected value of the startup because the ability to liquidate IP after comercial bankruptcy is a factor reducing risk - investors get at least something back. If you dictate confiscation of that IP, you also reduce the willingness to invest in what already is a very risky proposition. And that's how you get to a 3 trillion ponzi bubble in crypto that solves no problem, while similar investment into medical startups would create thousands of products, treatments and long term wealth.

Sorry, but no amount of downvotes will make me accept a clearly populist and virtue signaling approach that will actively harm patients and discourage investment in medical innovation.

So your solution is to just treat patients like garbage and shrug at them when your startup goes bankrupt? You want to protect overly rich VCs instead of the patients?

Virtue signalling? I call this "not being like dr Mengele"… if you think that's virtue signalling you are just a bad person.

I believe he's clearly indicated that he think this is in the best interests of the patients, not the VCs. Not sure if it's a reading comprehension issue or if you're just trying to score points.

He wants the patients to actually get their devices that make their lives bearable rather than these devices continuing to remain theoretical.

I wouldn't be so sure. I read manholio's posts multiple times and their position it still unclear to me. "Immoral to the investors" but some - I believe feinted - concern for the people.

I am having a hard time treating investments as oxygen masks on airplanes.

> He wants the patients to actually get their devices that make their lives bearable rather than these devices continuing to remain theoretical.

Yes he did say that, but it's a false dilemma fallacy. Startups with insufficient regulation don't get you “devices that would otherwise remained theoretical”, they give you FTX and Theranos.

If you want to build a health start-up but cannot uphold basics ethical principles (like: do not abandon your patients on their own if your business plan failed), you should just seek another market.

> And that's how you get to a 3 trillion ponzi bubble in crypto that solves no problem, while similar investment into medical startups would create thousands of products, treatments and long term wealth.

I'm extremely glad that the types of people involved in crypto are in no way incentivised to do the same thing to the medical industry. Theranos was bad enough.

I'm not sure why you'd ever want to see crypto's web of scams and lies replicated in the medical industry. At least with crypto the harm is mainly limited to finances. When the grifters are peddling drugs and medical devices the consequences are much more dire.

> Sorry, but no amount of downvotes will make me accept a clearly populist and virtue signaling approach that will actively harm patients and discourage investment in medical innovation.

Not allowing bad actors free reign over people's health isn't populist or virtue signalling. The majority of these regulations were written in blood.

Flawless in principle, but harmful slogans in practice because it fails to develop those ideas for the particular situation at hand.

Sure, medical regulation should exist - I specifically mentioned the "primum non nocere" principle as the basis for that protection. Things like access to source code and right to repair, some guarantee the device can be removed and won't become actively harmful etc.

But some of the specific kind of regulation this article argues for are unreasonable to the point of killing the prospect of a cure.

The point of the crypto example is not that regulation is harmful, but that people respond to incentives - exactly the same investors have a choice between some sort of a MMORPG poker that is crypto versus a medical start-up. And guess what, they choose the "investment" where money is moved around and they have the chance to earn something at the loss of others, as opposed to the medical startup that could cure people but is - due to dumb regulations - more likely to lose money in the average/EV case. It's not me who brings the crypto madnesses into the medical field, it's whomever bombastically claims some irrational behavior from investors, while expecting them to foot the bill for medical innovation - that was the premiss of the comment you replied to.

That's because you assume that progress comes from millionaires investing cheap central-bank money into start-ups, which isn't how the world works.

When you count on the collusion of gamblers and oligopolists to take socially positive gambles you're already stuck in a dead end.

You might have missed the part where I write: "as long as we as a society make no public concerted effort to cure these people and leave them to the mercy of the markets...". Everything follows.

Even then, I'd rather let the big corp do their things being while regulated than letting reckless startups harming people in the process of trying to get a nice exit getting acquired by the same big corps. I've yet to see an example where the move fast, break things and kill people line of thinking from the SV produced some net social gains.

I agree. Schematics, documentation, software should be in government escrow, otherwise you're not allowed to patent. Software updates have to be saved here as well.

If the company goes bankrupt all IP will be released to the people. At least then motivated people can learn how to fix things.

Reply on news.ycombinator.com