36 ms·

How the medical supply industry blocks device startups from selling to hospitals

356 points by lgv 14y ago

jrockway 14y ago
contact with our health care system the fifth leading cause of death in this country Whoa. Can anyone give this in-passing snippet some context?
- lgv 14y ago
  From wikipedia: http://en.wikipedia.org/wiki/Nosocomial_infection http://en.wikipedia.org/wiki/Nosocomial_infection "In the United States, the Centers for Disease Control and Prevention estimate that roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year"
- kyro 14y ago
  Yeah, hospital-acquired infections are huge. In fact, they're a huge reason why we have so many aggressively resistant strains of organisms.
  - excuse-me 14y ago
    More the other way around. Widespread over-the-counter antibiotics, over prescription and agricultural use are the reason there are so many resistant organisms. Healthy people with the organisms going into hospitals full of sick people is the reason they get there. Poor hospital cleaning, high occupancy rates and especially people using keyboards is the reason they are huge.
    - kijin 14y ago
      > people using keyboards Never thought about that before, though I do know that keyboards are filthy. Is there any evidence that the rate of infection increased since medical professionals began to use keyboards for data entry? But I guess that kind of data would be buried under a lot of other factors that emerged over the last 2-3 decades. Also, how would you go about fixing that? Tablets might be easier to clean, but you're still touching a surface. Speech recognition would be cool, but then you're spraying microscopic drops of saliva all over the place. Is paper just as unsanitary, or does the fact that fewer people share the same sheet of paper somehow mitigate the risk?
      - excuse-me 14y ago
        100 years ago patients died because of doctor's neck ties. He would lean over one patient with the tie dragging on their wound, then go to the next patient transferring the infection Of course we are far too advanced to do anything so stupid today. Now we examine a patient, go to the computer at the nurses station and type up the results, then the nurse comes along and rubs their hand over the keyboard and mouse, then you go the next patient .... You can get washable waterproof medical keyboards but they are expensive, and get broken and replaced with whatever IT have on the shelf. Funnily enough I have never seen a waterproof mouse.
      - DanBC 14y ago
        Some keyboards have silver in the keys. Some keyboards have a squishy membrane cover which can be sprayed and scrubbed. But, really, people need to wash their hands (soap and hot water) before they touch a patient.
        excuse-me 14y ago
        The problem is the number of patients and the amount of data that has to be entered into different systems means you would spend 90% of your time washing your hands or taking gloves on and off. Imagine programming where everytime your hand went between the keyboard and mouse you had to go and wash your hands! The problem is that adding more computers is always a 'good thing' - how can more info about a patient be bad?
        kijin 14y ago
        Hand sanitizer? It takes all of 2 seconds to squeeze it onto your hands, and you can apply it on your way to the next patient.
- excuse-me 14y ago
  It depends on quite what you consider a cause of death. Medical errors officialy account for between 100,000 and 200,00 deaths per year, and between 20-35% of people who die in hospital are discovered at autopsy to have been misdiagnosed. BUT consider you are treating an 80year old man for pneumonia and when he dies the autopsy discovers he had undiagnosed prostate cancer - is that 'really' a medical error death? Then there are around 100,000 deaths due to hospital infections. 30,000 of them from MRSA alone = twice the number of people who die of AIDS. The rates in nursing homes and other 'medical' facilities are probably much higher but aren't as well monitored or reported.
- nradov 14y ago
  The Institute of Medicine report "To Err is Human: Building A Safer Health System" states: "At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented". Some improvements have been made since then but it's still a huge problem. http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-S...
bsenftner 14y ago
I experienced this somewhat when consulting for a medical device startup. They'd developed a modular system supporting Laparoscopic procedures, reducing hands during surgery, which equated to significant safety increases as well as cost reductions. However, their big issue continues to be navigating the procurement process at hospitals, which is akin to requiring a full time lobbyist per hospital for the duration of that hospital's adoption of their system: 2-3 years, after getting them to actually try the system, which often requires 18 months of demos, trials, and negotiations. Our technologies we, geeks, develop are going to have a very hard time revolutionizing the medical industry. The big players have closed the door behind them in a major way.
- deleted 14y ago
  [deleted]
- johngalt 14y ago
  You're selling to the wrong party. Don't sell it to the hospitals, sell it to the insurance companies. Hospitals will be thinking 1. "will insurance claims be rejected for non-standard treatment?" 2. "If something goes wrong with my malpractice insurance cover it?" Even if everything goes correctly, and procedures are better/faster/cheaper the insurance companies will just lower the amount they pay. The hospital doesn't have a lot to gain here. Conversely if an insurance company hears about a new better/faster/cheaper treatment suddenly that's they only thing they will pay for and the company selling that treament makes a mint, with hospitals knocking down their door.
  - rsheridan6 14y ago
    I'm not so sure about the insurance companies. I am a pharmacist and I see insurance companies insist on paying for expensive things and declining to pay for cheap things all the time. For example, they won't pay for cheap Relion brand syringes, but they will pay for BD syringes (BD is the bad guy in the linked article), which cost much more. I'm not sure about the reasoning behind this, but I'll bet it's sordid and corrupt.
excuse-me 14y ago
Almost exactly the same with military equipment. Design a product that saves the lives of front line troops, demo it to the troops and they love it. Then try and sell it to the government and you are told that you have to form a consortium with an established supplier - Boeing/Lockheed-Martin/General Dynamics in the US, Thales/BAe/EADS in europe. Now imagine the sort of deal you are offered as a startup negotiating with a trillion $$ global defense company with a stranglehold on the market!
- gscott 14y ago
  And if you try to export it the Government can block the sale of any military use equipment. I know a person who developed an external coating for submarines but the US Military didn't want to use it, so he found a (friendly) country that did but was denied the license to sell it.
  - excuse-me 14y ago
    But not if you simply manufacture it abroad. We found a nice friendly country in the middle east who were more interested in their troops have good equipment than keeping lobbyists in business. They took the idea, made it for us and buy them from us. (don't worry - it was the one full of beard wearing, no-pork eating, religious fundamentalists that like us)
jmvoodoo 14y ago
Someone needs to bring BYOD to the medical industry ;)
- excuse-me 14y ago
  The simple solution is to make all the drugs that a hospital uses illegal. Then overnight pure capitalism would create an efficient market to import and distribute them. When it's cheaper to buy heroin on the street than an aspirin in a hospital you know that the market is screwed up somewhere
angersock 14y ago
Interesting bit from the end of the article: "This isn’t just bad news for Shaw. Because his company is in the red, he has been unable to pull together the financing he needs to expand his factory in Little Elm. So he has partnered with Chinese companies, which put up money to build assembly lines in China in return for permission to produce his syringes for the Chinese market. When his patents do run out, the Chinese manufacturers will be the ones poised to bring his technology to the world market, meaning all the jobs and economic benefits that could have gone to the local residents will instead go to the people of Gansu Province. " Goddamnit.
- mclin 14y ago
  I'm surprised these companies didn't give up and start selling in other countries, like Canada or the UK, to begin with.
ChuckMcM 14y ago
When I think of the federal government 'fixing' health care, this is the sort of thing I think they can fix. Not single payer, not mandatory coverage, just good enforcement of anti-competitive practices, ways to enable innovation with patient consent Etc.
- tyree732 14y ago
  Are you so sure about that? excuse-me's comment, right above yours in my view, talks about how the government has anti-competitive arrangements with big military contractors. How would the situation be different with healthcare?
  - ChuckMcM 14y ago
    Yes. I am sure that Congress could propose laws that prevented anti-competitive market practices with regard to health-care and that this would mitigate some of the problems we currently have with the health care system. I claim that doing so is a more effective way, or at least more efficient in terms of relative improvement, of improving health care. This claim is of course made relative to the existing efforts in the US of trying to regulate the insurance industry around health care.
  - Symmetry 14y ago
    I think the fix in this case would be removing the laws that encourage anti-competitive arrangements.
    - tyree732 14y ago
      How is the government incentivized in any way to do that? Politicians in the US receive substantial campaign contributions from established military suppliers who would stand to lose a lot from said laws. I don't see any rallying cries from the public about the competitiveness of supply arrangements government entities currently have.
      - Symmetry 14y ago
rscale 14y ago
This caught my eye: Kaiser spokesman Jim Anderson argues that if Shaw’s products didn’t make their way to hospitals it was because of “significant supply issues” on Retractable’s end. He also says they were prone to malfunction and that, in several cases, needles detached and were left “stuck in the arms of patients.” I'm doubtful that a Kaiser spokesman would fabricate these problems, which leads me to believe that perhaps this reporting isn't as balanced as it could be. Maybe these needles are great, but perhaps there are two problems here, one being a competitor with a lot of control over the customers, and a second being problems with supply chain and quality control.
- tomp 14y ago
  > I'm doubtful that a Kaiser spokesman would fabricate these problems, Why?
  - debacle 14y ago
    Because that's defamation.
    - jeremyarussell 14y ago
      Only if they can prove the Kaiser spokesperson was lying.
    - oconnore 14y ago
      Do you have any evidence to support them being especially ethical, or is this just a gut reaction? The facts are that we don't have enough facts, we have an unsubstantiated accusation that should be treated as such.
      - debacle 14y ago
        Countering an unsubstantiated accusation with another unsubstantiated accusation isn't going to get us anywhere. It's not about being ethical. It's about exposing yourself to liability.
dr_ 14y ago
"Or he sold his wares to systems so small and poor that they weren’t on the GPOs’ radar—prisons, nursing homes, Indian reservations, and the like." So to minimize my risk of line contamination, I'd be better off getting my medical care in a prison. (Assuming this guys product really does work). What will change this is how hospitals etc. are reimbursed - the trend is that reimbursements will be based on outcomes, especially with changes introduced by the ACA that go into effect in 10/2012. http://www.healthcare.gov/law/timeline/full.html http://www.healthcare.gov/law/timeline/full.html So what matters then, are actual outcomes. If in fact there is an increase in infections from line contamination, or poor surgical outcomes (from a towel being left behind or what have you) - this will be measured and monitored, and believe me hospitals will address them, especially the for-profits, which seem to be surging again. There was a interesting company out of Blueprint Health that addressed hospital procurement, allowing price comparisons. I don't have the details on how the GPO's are dealt with though. http://www.procuredhealth.com/ http://www.procuredhealth.com/
- kposehn 14y ago
  Yeah, the reimbursements look like a good measure. We're a fan of some of the outcome criteria, especially the opportunities we've found to streamline things. dr_, are you in the health tech field?
  - dr_ 14y ago
    yup.
kposehn 14y ago
I'm glad that our startup isn't dealing with medical devices, only with software. Still, I've been working with some medical device makers and it is a wild and crazy world they work in. The whole GPO system is clearly broken, but I've met some people - at device makers no less - that are passionate about ending it. We're doing our part to help that along.
- seehafer 14y ago
  Can you be more specific about what you're doing? I'm in medical device and I would love to see software startups help untangle the mess that is healthcare reimbursement and purchasing.
  - kposehn 14y ago
    Email me - keith [aaaat] appzorz [dooot] com I can't really be super specific yet publicly, but we may be able to talk further.
DanBC 14y ago
The movie EDIT "puncture" (thanks diek!) is a reasonably entertaining account off the retractable needle. US healthcare (and thus, US patients) may miss out on improved syringes, but I hope they're able to sell many of these to the developing world where needle re-use is a serious problem. Re-using needles when 10% of the population has HIV/AIDS is awful. Not just because you risk transmitting HIV to other people, but because people with HIV are not able to resist any infection you pass onto them. I'm surprised that the practices are legal - I'd have thought that the US would have had good law to ensure free and fair competition.
- diek 14y ago
  I thought it was "Puncture", starring Chris Evans.
- gcb 14y ago
  Name one regulated market in the us that have fair competition. Btw. It's not only in the us. Regulation today is the most secure form of monopoly
  - Aloisius 14y ago
    Uh, regulation often prevents monopolies. See: anti-trust regulation.
    - jlawer 14y ago
      Doesn't anti-trust regulation stop people ABUSING monopolies rather then forming them? Most of the teeth I've seen in the anti-trust regulation is the ability to break up companies after they have monopolized.
Estragon 14y ago
There's a movie based on this guy's struggle, but it's pretty terrible.
tylee78 14y ago
reminds me of the 400 dollars the hospital charged me the other day for part of a splint (the wrapping cloth) which was probably manufactured in China for $.50
byandyphillips 14y ago
Wow, I love reading a book on the web. Either cut your copy down by 1/2 (no one is going to read the whole thing) or place a disclaimer at the top on the average it will take to read the whole article.
- jeremyarussell 14y ago
  Or ya know, as an beings who can keep track of things like how fast we read, you could simply scroll through the article like i did, go, okay that's about ten minutes. Then decide if you want to keep going. Saying no one would read the whole thing is a bit much to, considering I read every word, and I'm sure others did to.
- zevyoura 14y ago
  The indicator you're looking for is the size of the scroll bar. Not perfect, but I think it's pretty silly to ask authors of long articles to write a disclaimer about the article's length when it's right in front of you. Also, this is not exceptionally long for an article, I think the lack of pagination contributes to your perception.
lisper 14y ago
I can tell you from firsthand experience (as an investor) that the gist of this article is 100% correct: there are significant barriers to bringing a new medical device to market that have nothing to do with the merits of the product or the supply chain, but are quite simply pure protectionism for the established players. If anyone wants details, contact me privately.
- seehafer 14y ago
  As a product guy who works in medical device startups, I can reinforce this statement. Even if you find a way to exit the supply game by developing something that doctors have some choice over because they believe it has an impact on patient safety/outcomes, you still run into many of the issues detailed in the article. Here's just one: if you develop something that is truly revolutionary, you'll play hell trying to get paid for it, because the payers (private insurance and Medicare for the most part) only pay out for certain codes. It takes years to get a new code.
robomartin 14y ago
As an entrepreneur I have dedicated most of the last 25 years to doing hardware (read: manufacturing) ventures. Manufacturing in the US is hard, if not impossible, save cases where the ecosystem or nature of the market can support it. Problems one could face include: ip (patents) mine field, government regulations, liability issues, lack of localized supply chains, high labor costs, high insurance costs, high taxes and more. Then, to boot, if you are lucky enough to have to deal with the government or in an industry where government has decided they know better, well, this can be described with two words: Pain and Frustration. The mechanisms described in the article kept me from even considering making an effort to do some good in the medical field. It's just too painful. Finally, about two years ago, I had enough and decided to be done with making stuff and pivot into software-only products. This was not a huge pivot in that most of the products we manufactured during the last 20 years had significant software elements (embedded, FPGA and related workstation applications). The transition just meant making a very conscious effort to not go after hardware ideas. This was hard in that I personally like making physical products. But, no more. My point in relating this personal story is that I have the scars to understand what this little syringe company must have been through. The article in question highlights something that we should all understand very well at this point: Government rule-making is, more often than not, fraught with unintended consequences that, ultimately, end-up costing us in terms of money, freedom and choice. And, when it comes to the medical field, might even result in people dying. Part of the problem is that we continue to give the keys to the shop to bureaucrats who have zero real-world, business or employed-by-a-non-government-business experience. You really can't expect much from anyone who has lived their entire life within the confines of an ecosystem where personal decisions carry almost no risk. That is vastly different from the real world, where, if you are a bad programmer or lousy barista you get fired and, no, you don't get to enjoy 80% of your salary for the rest of your life. Programmers, for example, know and live this issue of making the wrong decision. In the course of solving a problem we choose an approach and go with it. Sometimes it works and often-times there are unintended consequences that need attention. Other times the approach is entirely wrong and has to be scrapped in favor of a different idea. The solution is evolved rapidly until the right approach surfaces. This ultimately leads to better solutions, particularly if peer reviewed. The trouble with government decision making is that you have the equivalent of managers who don't know how to code --at all-- telling you what algorithm and database to use to solve a problem. Furthermore, it is equivalent to these non-technical managers making their decision the law for the company. And, yes, regardless of what the overwhelming reality of the matter might indicate, changing their laws is either impossible or you need 2/3 of said morons (non-technical managers) to agree to the change. In other words, you should expect the beatings to continue until the morale improves. Of course, reality in the technology world is closer to the idea that those who actually understand the subject should make the decisions. Wouldn't it be cool if every single politician had to have a real job 3/4 of the year? Work three months for government and then go back to the private sector. Now that could be interesting.
digitalengineer 14y ago
Reminds me of something: "Hacking Human Waste" http://news.ycombinator.com/item?id=3456484 http://news.ycombinator.com/item?id=3456484 Two guys found (and patented) a way to get rid of very expensive human (hospital) waste. Working product in a few hospitals and everything, but they're looking for a way to scale up (they are great hackers but suck at finding an investor). Any tips?
saturdaysaint 14y ago
God I hate the healthcare industry. This was on my mind this morning because my girlfriend isn't rich and relies on Lunesta to sleep (I'll leave the fact that her doctor is advising her to take this indefinitely for another day). It's extortionately priced - something like $6 a pill - enough to gouge insurance companies thoroughly and enough to wreck havoc on the finances of someone that's not rich and lacks insurance. It turns out, this is actually the most profitable drug in the world. Yet they can't even sell it in the EU because it's a modest derivative of a (generic) drug that's been around since 1989. It's disturbing that this is where the patent game ends - with power-brokering and lawyering determining who gets the wealth and power.
- jrockway 14y ago
  Why can't she take the generic drug? Also, $180/month is not really what people mean by "high healthcare costs". They mean something like a $50,000/day hospital stay. $180 is a lot if you don't have a lot of money, but it's hardly backbreaking.
  - rsheridan6 14y ago
    The generic drug he's talking about was never approved in the US. It's not available here. You can get it in other countries.
    - saturdaysaint 14y ago
      Indeed, and there's been much discussion that the chemistry that makes Lunesta patentable is trivial, basically a patent for its own sake. "a single isomer drug rarely offers a therapeutic advantage over the mixture of isomers from which it is derived. However, the single isomer is patentable distinct from its multiple-isomer origin. Thus, the drug company can get a monopoly." http://insomnia-relief.com/information/?p=49 http://insomnia-relief.com/information/?p=49
paul 14y ago
When people complain about entrepreneurs building social networks instead of curing cancer, they need to understand that this is a big part of the reason. The internet attracts so much innovation in large part because it's very open to innovation. In more regulated/corrupt (the two are closely related) fields, such as health care, there are many barriers to competition that kill innovative new companies. Mobile was actually very similar to this in the pre-iPhone era (because you needed to make deals with carriers). This in turn leads to less investment, since it's kind of dumb to invest in a doomed company. We're at a point in history where most of our problems are social/political. Our technology is good enough to make the world into a nice place for everyone, but we don't do it because our social "software" is broken. It's easy to make fun of Facebook or Reddit as being all about sharing cat picture, but the reality is that they also are changing the flow of information and influence to be much more peer-to-peer instead of top down (e.g. three television networks). Many will disagree, but I believe that in the long term society will evolve to match this more egalitarian structure. The most effective way to cure cancer may be to first cure the social disfunctions that lead to the types of situations described in this article.
- robomartin 14y ago
  Yes!
- Retric 14y ago
  Building App's is ridiculously simpler than solving major problems like cancer. Consider the smartest person you ever met could spends their entire life working on a cancer cure with everything they had and chances are they would have saved more lives by donating 10% of their salary to a vaccination program.
  - paul 14y ago
    Yeah, cancer definitely isn't the "low hanging fruit". Hospital errors and infections would be much easier to address, though as this article shows, even that is nearly impossible.
    - 14y ago
tdpeterson 14y ago
"In the case of the towel bid, hospital administrators were shown a PowerPoint presentation (a copy of which she gave to me) indicating that going with the Medline and Medical Action bids would save them between 6 and 29 percent. But this was relative to the same companies’ bids the previous year, not the bids offered by other vendors." I'm interested in seeing these slides and sent a request to the article's author. Were the decision makers present aware there were other vendors? If so, how was this data not called into question? It would be interesting to see if the data was presented in a completely misleading way or if there was some level of laziness and complacency on the decision-makers' part as well. Regardless, misleading presentations are always interesting to examine, such as Tufte's assessment of the presentation given to NASA officials before the Columbia disaster (http://www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0001yB&topic_id=1 http://www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0...). Edit: Just received a reply from the author that she's unable to share the presentation as the person that originally shared it has been "subject to legal harassment." Lame!
TwoBit 14y ago
While the main point about the medical supply monopoly seems solid, I'm suspicious about this Shaw guy, his character, and his product. I'd like to see an objective counter-point.
guard-of-terra 14y ago
But why doesn't they try to sell to other hospitals? In Europe, e.g., Switz hospitals are very well known for their quality. They might be interested.
mahkra 14y ago
This sounds like what the movie puncture was about. It doesn't end well. Still worth seeing. http://www.imdb.com/title/tt1582248/ http://www.imdb.com/title/tt1582248/
scotty79 14y ago
"Then, in 1986 Congress passed a bill exempting GPOs from the anti-kickback provisions embedded in Medicare law. This meant that instead of collecting membership dues, GPOs could collect “fees”—in other industries they might be called kickbacks or bribes—from suppliers in the form of a share of sales revenue." No one in their right mind could imagine that anyone could be genuinely stupid enough to think that allowing organisation that was supposed to work for buyers, take money from sellers is a good idea. That law was 100% surely bought. You don't need any other proof that USA has best Congress money can buy.
robomartin 14y ago
After spending way too much time on this thread here's my parting thought: Some choose to believe that corporate greed is the cause of issues such as that highlighted by this article. Others believe that the political and legal system in place has flaws that create the conditions necessary for such things to happen. And some are in between these two schools of though. Here's the kicker: While we live within and with our reality other parts of the world are watching. And in some parts (China?) they are surely having thoughts akin to "these people are too stupid to get out of their own way". And so, we'll keep arguing and "enjoying" the ineptitude, complexities and realities of our reality while others will watch, learn, study and take measures to ensure that they don't fall into the same traps. Yes, there will probably be better syringes in China than in the US. And, with time, that will be true about a lot more things and a number of other countries. Enjoy.
- mudil 14y ago
  Thanks, robomartin, for your thoughtful commentary. You are right 100%, through and through. Unfortunately, as I learned long time ago, it seems to me that much of the people on HN believe that gov't is never at fault. That regulation, taxation, and other forms of gov't oppression are good things. Ever. Especially, when reassured by a politician. Today's progressives are just sheeple. They will believe blindly any politician that says "for the children's future" or "for teachers and fire fighters," so let's raise taxes or strangle pharmaceutical companies. A "progressive" used to mean "believe in individual" or "believe in freedom." Today it means "believe in gov't" or "believe in regulation" or "believe in politically correct speech", etc etc (the list is long). Progressives, in other words, are just statists.
  - robomartin 14y ago
    Thanks for the feedback. People create a view of the world based on where they came from, what they have experienced, what they've been taught and many other factors (for example, religious indoctrination). This is a fact. Regrettably the governing class in a country like the US knows this very well and has learned how to pander and manipulate the masses in their favor. This is also a fact. Then you have the media. Most people will subscribe to one ideology and set forth to consume media that aligns with this ideology as closely as possible. This is comfortable and easy to chew on. No gag reflex involved. This is another fact. The media know this, and feed that need. They report with overblown outrage about mostly unimportant stories. They go on and on all day long beating the same dumb story to death until they can't flatten it any more. They cater to the audience that, due to ideology, will stay with them. It's SEO, TV style. This is also a fact. All of this leads to great levels of polarization. How else would you have huge chunks of the population self-identify with one party or another? They buy into a "tribe" and stick with it, no matter what. Tribal behavior is a most fundamental human trait. This, also, is fact. Those in the middle of all of this, a group of which I consider myself a member, are willing to stop and think for a moment and not rattle off what others are saying without some thought and consideration. This is hard. This requires work. This requires rejecting years of unintentional indoctrination and trying to see the world for what it is. This is about the Allegory of the Cave in more ways than one (http://en.wikipedia.org/wiki/Allegory_of_the_Cave http://en.wikipedia.org/wiki/Allegory_of_the_Cave). It requires consciously refraining from the most fundamental human impulse to be tribal and believe what has been pounded into your brain. This is hard (I repeat) and this is why most people don't do it. At home we make it a point to learn about multiple points of view. We watch CNN and FOX. We also watch Al Jazeera and LinkTV. We are also fortunate enough to speak more than a couple of languages, so we consume international news from more than one perspective as well. It's amazing what you can learn this way. I don't know where I am going with this except to say that there are a lot of voting groups that, just like Plato's cave, have been living and looking at the shadows in their own caves. And virtually nothing more than that. Government workers, Politicians and Unionized workers (to be brutal in my generalization) are examples of such groups. Individually none of them are bad people. As a voting and acting block they can be absolute morons, but only because all they've been willing to consider are the shadows. I don't know how to fix it. I don't know if it's even possible.
ricardonunez 14y ago
I'm wondering if the best option for them isn't to create a partnership with a existing manufactures. It will be easier for them to get in the market.
rdl 14y ago
I hope Amazon casts its all-powerful crappy-legacy-vendor-destroying eye upon the medical supply market soon. All the value-add GPOs offer (other than pricing) is stuff Amazon could easily do for free -- inventory tracking, etc. It's all IT, and basically zero marginal cost. As long as existing GPOs can't legally prevent a hospital from also using the Amazon GPO, I don't see how anyone could stand against Amazon. Amazon would have zero incentive to lock new device vendors out of the market. Sure, purchases from the Amazon GPO wouldn't contribute to meeting your legacy GPO quotas and rebates, but Amazon has access to capital at levels which will let them destroy regional competition if required -- they could price match any subsidized prices.
- creamyhorror 14y ago
  "casts its all-powerful crappy-legacy-vendor-destroying eye" The most memorable phrase I've heard all week.
hypervisor 14y ago
He needs to sell his product in a different country. If the system is broken here, he should go elsewhere and see if he can make a change.
anxiousape 14y ago
So he's a great innovator. So stop complaining and sell it outside of USA.
Duff 14y ago
Is there anything significant, important market out there that is not a cesspool of corruption?
tripzilch 14y ago
This article definitely took its sweet time to get to the point. Sure it's interesting, but the first thing I want to know is, "what did they do this time?", so I can decide whether maybe I already know about it or not. Certainly the story about developing new products for a failing healthcare industry is interesting, and I would love to have read about it, if I hadn't been skimming through "yeah yeah yeah and how did they prevent him from bringing it to market? skip skip skip, aha."--IMO, it's just wasting my time, though I would have gladly read the stories about the entrepeneurs if only they'd have gotten to the point first. Even though I thankfully don't have anything to do with the US healthcare system, I'd love to pass this story on to some of my friends that unfortunately do. Except I don't want to waste their time either. And that really is a missed opportunity to bring to light something rotten in the system, because of a badly written article.

356 points by lgv 14y ago

contact with our health care system the fifth leading cause of death in this country Whoa. Can anyone give this in-passing snippet some context?

lgv 14y ago
From wikipedia: http://en.wikipedia.org/wiki/Nosocomial_infection http://en.wikipedia.org/wiki/Nosocomial_infection "In the United States, the Centers for Disease Control and Prevention estimate that roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year"
kyro 14y ago
Yeah, hospital-acquired infections are huge. In fact, they're a huge reason why we have so many aggressively resistant strains of organisms.
- excuse-me 14y ago
  More the other way around. Widespread over-the-counter antibiotics, over prescription and agricultural use are the reason there are so many resistant organisms. Healthy people with the organisms going into hospitals full of sick people is the reason they get there. Poor hospital cleaning, high occupancy rates and especially people using keyboards is the reason they are huge.
  - kijin 14y ago
    > people using keyboards Never thought about that before, though I do know that keyboards are filthy. Is there any evidence that the rate of infection increased since medical professionals began to use keyboards for data entry? But I guess that kind of data would be buried under a lot of other factors that emerged over the last 2-3 decades. Also, how would you go about fixing that? Tablets might be easier to clean, but you're still touching a surface. Speech recognition would be cool, but then you're spraying microscopic drops of saliva all over the place. Is paper just as unsanitary, or does the fact that fewer people share the same sheet of paper somehow mitigate the risk?
    - excuse-me 14y ago
      100 years ago patients died because of doctor's neck ties. He would lean over one patient with the tie dragging on their wound, then go to the next patient transferring the infection Of course we are far too advanced to do anything so stupid today. Now we examine a patient, go to the computer at the nurses station and type up the results, then the nurse comes along and rubs their hand over the keyboard and mouse, then you go the next patient .... You can get washable waterproof medical keyboards but they are expensive, and get broken and replaced with whatever IT have on the shelf. Funnily enough I have never seen a waterproof mouse.
    - DanBC 14y ago
      Some keyboards have silver in the keys. Some keyboards have a squishy membrane cover which can be sprayed and scrubbed. But, really, people need to wash their hands (soap and hot water) before they touch a patient.
      - excuse-me 14y ago
        The problem is the number of patients and the amount of data that has to be entered into different systems means you would spend 90% of your time washing your hands or taking gloves on and off. Imagine programming where everytime your hand went between the keyboard and mouse you had to go and wash your hands! The problem is that adding more computers is always a 'good thing' - how can more info about a patient be bad?
        kijin 14y ago
        Hand sanitizer? It takes all of 2 seconds to squeeze it onto your hands, and you can apply it on your way to the next patient.
excuse-me 14y ago
It depends on quite what you consider a cause of death. Medical errors officialy account for between 100,000 and 200,00 deaths per year, and between 20-35% of people who die in hospital are discovered at autopsy to have been misdiagnosed. BUT consider you are treating an 80year old man for pneumonia and when he dies the autopsy discovers he had undiagnosed prostate cancer - is that 'really' a medical error death? Then there are around 100,000 deaths due to hospital infections. 30,000 of them from MRSA alone = twice the number of people who die of AIDS. The rates in nursing homes and other 'medical' facilities are probably much higher but aren't as well monitored or reported.
nradov 14y ago
The Institute of Medicine report "To Err is Human: Building A Safer Health System" states: "At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented". Some improvements have been made since then but it's still a huge problem. http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-S...

bsenftner 14y ago

I experienced this somewhat when consulting for a medical device startup. They'd developed a modular system supporting Laparoscopic procedures, reducing hands during surgery, which equated to significant safety increases as well as cost reductions. However, their big issue continues to be navigating the procurement process at hospitals, which is akin to requiring a full time lobbyist per hospital for the duration of that hospital's adoption of their system: 2-3 years, after getting them to actually try the system, which often requires 18 months of demos, trials, and negotiations. Our technologies we, geeks, develop are going to have a very hard time revolutionizing the medical industry. The big players have closed the door behind them in a major way.

deleted 14y ago
[deleted]
johngalt 14y ago
You're selling to the wrong party. Don't sell it to the hospitals, sell it to the insurance companies. Hospitals will be thinking 1. "will insurance claims be rejected for non-standard treatment?" 2. "If something goes wrong with my malpractice insurance cover it?" Even if everything goes correctly, and procedures are better/faster/cheaper the insurance companies will just lower the amount they pay. The hospital doesn't have a lot to gain here. Conversely if an insurance company hears about a new better/faster/cheaper treatment suddenly that's they only thing they will pay for and the company selling that treament makes a mint, with hospitals knocking down their door.
- rsheridan6 14y ago
  I'm not so sure about the insurance companies. I am a pharmacist and I see insurance companies insist on paying for expensive things and declining to pay for cheap things all the time. For example, they won't pay for cheap Relion brand syringes, but they will pay for BD syringes (BD is the bad guy in the linked article), which cost much more. I'm not sure about the reasoning behind this, but I'll bet it's sordid and corrupt.

excuse-me 14y ago

Almost exactly the same with military equipment. Design a product that saves the lives of front line troops, demo it to the troops and they love it. Then try and sell it to the government and you are told that you have to form a consortium with an established supplier - Boeing/Lockheed-Martin/General Dynamics in the US, Thales/BAe/EADS in europe. Now imagine the sort of deal you are offered as a startup negotiating with a trillion $$ global defense company with a stranglehold on the market!

gscott 14y ago
And if you try to export it the Government can block the sale of any military use equipment. I know a person who developed an external coating for submarines but the US Military didn't want to use it, so he found a (friendly) country that did but was denied the license to sell it.
- excuse-me 14y ago
  But not if you simply manufacture it abroad. We found a nice friendly country in the middle east who were more interested in their troops have good equipment than keeping lobbyists in business. They took the idea, made it for us and buy them from us. (don't worry - it was the one full of beard wearing, no-pork eating, religious fundamentalists that like us)

jmvoodoo 14y ago

Someone needs to bring BYOD to the medical industry ;)

excuse-me 14y ago
The simple solution is to make all the drugs that a hospital uses illegal. Then overnight pure capitalism would create an efficient market to import and distribute them. When it's cheaper to buy heroin on the street than an aspirin in a hospital you know that the market is screwed up somewhere

angersock 14y ago

Interesting bit from the end of the article: "This isn’t just bad news for Shaw. Because his company is in the red, he has been unable to pull together the financing he needs to expand his factory in Little Elm. So he has partnered with Chinese companies, which put up money to build assembly lines in China in return for permission to produce his syringes for the Chinese market. When his patents do run out, the Chinese manufacturers will be the ones poised to bring his technology to the world market, meaning all the jobs and economic benefits that could have gone to the local residents will instead go to the people of Gansu Province. " Goddamnit.

mclin 14y ago
I'm surprised these companies didn't give up and start selling in other countries, like Canada or the UK, to begin with.

ChuckMcM 14y ago

When I think of the federal government 'fixing' health care, this is the sort of thing I think they can fix. Not single payer, not mandatory coverage, just good enforcement of anti-competitive practices, ways to enable innovation with patient consent Etc.

tyree732 14y ago
Are you so sure about that? excuse-me's comment, right above yours in my view, talks about how the government has anti-competitive arrangements with big military contractors. How would the situation be different with healthcare?
- ChuckMcM 14y ago
  Yes. I am sure that Congress could propose laws that prevented anti-competitive market practices with regard to health-care and that this would mitigate some of the problems we currently have with the health care system. I claim that doing so is a more effective way, or at least more efficient in terms of relative improvement, of improving health care. This claim is of course made relative to the existing efforts in the US of trying to regulate the insurance industry around health care.
- Symmetry 14y ago
  I think the fix in this case would be removing the laws that encourage anti-competitive arrangements.
  - tyree732 14y ago
    How is the government incentivized in any way to do that? Politicians in the US receive substantial campaign contributions from established military suppliers who would stand to lose a lot from said laws. I don't see any rallying cries from the public about the competitiveness of supply arrangements government entities currently have.
    - Symmetry 14y ago

rscale 14y ago

This caught my eye: Kaiser spokesman Jim Anderson argues that if Shaw’s products didn’t make their way to hospitals it was because of “significant supply issues” on Retractable’s end. He also says they were prone to malfunction and that, in several cases, needles detached and were left “stuck in the arms of patients.” I'm doubtful that a Kaiser spokesman would fabricate these problems, which leads me to believe that perhaps this reporting isn't as balanced as it could be. Maybe these needles are great, but perhaps there are two problems here, one being a competitor with a lot of control over the customers, and a second being problems with supply chain and quality control.

tomp 14y ago
> I'm doubtful that a Kaiser spokesman would fabricate these problems, Why?
- debacle 14y ago
  Because that's defamation.
  - jeremyarussell 14y ago
    Only if they can prove the Kaiser spokesperson was lying.
  - oconnore 14y ago
    Do you have any evidence to support them being especially ethical, or is this just a gut reaction? The facts are that we don't have enough facts, we have an unsubstantiated accusation that should be treated as such.
    - debacle 14y ago
      Countering an unsubstantiated accusation with another unsubstantiated accusation isn't going to get us anywhere. It's not about being ethical. It's about exposing yourself to liability.

dr_ 14y ago

"Or he sold his wares to systems so small and poor that they weren’t on the GPOs’ radar—prisons, nursing homes, Indian reservations, and the like." So to minimize my risk of line contamination, I'd be better off getting my medical care in a prison. (Assuming this guys product really does work). What will change this is how hospitals etc. are reimbursed - the trend is that reimbursements will be based on outcomes, especially with changes introduced by the ACA that go into effect in 10/2012. http://www.healthcare.gov/law/timeline/full.html http://www.healthcare.gov/law/timeline/full.html So what matters then, are actual outcomes. If in fact there is an increase in infections from line contamination, or poor surgical outcomes (from a towel being left behind or what have you) - this will be measured and monitored, and believe me hospitals will address them, especially the for-profits, which seem to be surging again. There was a interesting company out of Blueprint Health that addressed hospital procurement, allowing price comparisons. I don't have the details on how the GPO's are dealt with though. http://www.procuredhealth.com/ http://www.procuredhealth.com/

kposehn 14y ago
Yeah, the reimbursements look like a good measure. We're a fan of some of the outcome criteria, especially the opportunities we've found to streamline things. dr_, are you in the health tech field?
- dr_ 14y ago
  yup.

kposehn 14y ago

I'm glad that our startup isn't dealing with medical devices, only with software. Still, I've been working with some medical device makers and it is a wild and crazy world they work in. The whole GPO system is clearly broken, but I've met some people - at device makers no less - that are passionate about ending it. We're doing our part to help that along.

seehafer 14y ago
Can you be more specific about what you're doing? I'm in medical device and I would love to see software startups help untangle the mess that is healthcare reimbursement and purchasing.
- kposehn 14y ago
  Email me - keith [aaaat] appzorz [dooot] com I can't really be super specific yet publicly, but we may be able to talk further.

DanBC 14y ago

The movie EDIT "puncture" (thanks diek!) is a reasonably entertaining account off the retractable needle. US healthcare (and thus, US patients) may miss out on improved syringes, but I hope they're able to sell many of these to the developing world where needle re-use is a serious problem. Re-using needles when 10% of the population has HIV/AIDS is awful. Not just because you risk transmitting HIV to other people, but because people with HIV are not able to resist any infection you pass onto them. I'm surprised that the practices are legal - I'd have thought that the US would have had good law to ensure free and fair competition.

diek 14y ago
I thought it was "Puncture", starring Chris Evans.
gcb 14y ago
Name one regulated market in the us that have fair competition. Btw. It's not only in the us. Regulation today is the most secure form of monopoly
- Aloisius 14y ago
  Uh, regulation often prevents monopolies. See: anti-trust regulation.
  - jlawer 14y ago
    Doesn't anti-trust regulation stop people ABUSING monopolies rather then forming them? Most of the teeth I've seen in the anti-trust regulation is the ability to break up companies after they have monopolized.

Estragon 14y ago

There's a movie based on this guy's struggle, but it's pretty terrible.

tylee78 14y ago

reminds me of the 400 dollars the hospital charged me the other day for part of a splint (the wrapping cloth) which was probably manufactured in China for $.50

byandyphillips 14y ago

Wow, I love reading a book on the web. Either cut your copy down by 1/2 (no one is going to read the whole thing) or place a disclaimer at the top on the average it will take to read the whole article.

jeremyarussell 14y ago
Or ya know, as an beings who can keep track of things like how fast we read, you could simply scroll through the article like i did, go, okay that's about ten minutes. Then decide if you want to keep going. Saying no one would read the whole thing is a bit much to, considering I read every word, and I'm sure others did to.
zevyoura 14y ago
The indicator you're looking for is the size of the scroll bar. Not perfect, but I think it's pretty silly to ask authors of long articles to write a disclaimer about the article's length when it's right in front of you. Also, this is not exceptionally long for an article, I think the lack of pagination contributes to your perception.

lisper 14y ago

I can tell you from firsthand experience (as an investor) that the gist of this article is 100% correct: there are significant barriers to bringing a new medical device to market that have nothing to do with the merits of the product or the supply chain, but are quite simply pure protectionism for the established players. If anyone wants details, contact me privately.

seehafer 14y ago
As a product guy who works in medical device startups, I can reinforce this statement. Even if you find a way to exit the supply game by developing something that doctors have some choice over because they believe it has an impact on patient safety/outcomes, you still run into many of the issues detailed in the article. Here's just one: if you develop something that is truly revolutionary, you'll play hell trying to get paid for it, because the payers (private insurance and Medicare for the most part) only pay out for certain codes. It takes years to get a new code.

robomartin 14y ago

As an entrepreneur I have dedicated most of the last 25 years to doing hardware (read: manufacturing) ventures. Manufacturing in the US is hard, if not impossible, save cases where the ecosystem or nature of the market can support it. Problems one could face include: ip (patents) mine field, government regulations, liability issues, lack of localized supply chains, high labor costs, high insurance costs, high taxes and more. Then, to boot, if you are lucky enough to have to deal with the government or in an industry where government has decided they know better, well, this can be described with two words: Pain and Frustration. The mechanisms described in the article kept me from even considering making an effort to do some good in the medical field. It's just too painful. Finally, about two years ago, I had enough and decided to be done with making stuff and pivot into software-only products. This was not a huge pivot in that most of the products we manufactured during the last 20 years had significant software elements (embedded, FPGA and related workstation applications). The transition just meant making a very conscious effort to not go after hardware ideas. This was hard in that I personally like making physical products. But, no more. My point in relating this personal story is that I have the scars to understand what this little syringe company must have been through. The article in question highlights something that we should all understand very well at this point: Government rule-making is, more often than not, fraught with unintended consequences that, ultimately, end-up costing us in terms of money, freedom and choice. And, when it comes to the medical field, might even result in people dying. Part of the problem is that we continue to give the keys to the shop to bureaucrats who have zero real-world, business or employed-by-a-non-government-business experience. You really can't expect much from anyone who has lived their entire life within the confines of an ecosystem where personal decisions carry almost no risk. That is vastly different from the real world, where, if you are a bad programmer or lousy barista you get fired and, no, you don't get to enjoy 80% of your salary for the rest of your life. Programmers, for example, know and live this issue of making the wrong decision. In the course of solving a problem we choose an approach and go with it. Sometimes it works and often-times there are unintended consequences that need attention. Other times the approach is entirely wrong and has to be scrapped in favor of a different idea. The solution is evolved rapidly until the right approach surfaces. This ultimately leads to better solutions, particularly if peer reviewed. The trouble with government decision making is that you have the equivalent of managers who don't know how to code --at all-- telling you what algorithm and database to use to solve a problem. Furthermore, it is equivalent to these non-technical managers making their decision the law for the company. And, yes, regardless of what the overwhelming reality of the matter might indicate, changing their laws is either impossible or you need 2/3 of said morons (non-technical managers) to agree to the change. In other words, you should expect the beatings to continue until the morale improves. Of course, reality in the technology world is closer to the idea that those who actually understand the subject should make the decisions. Wouldn't it be cool if every single politician had to have a real job 3/4 of the year? Work three months for government and then go back to the private sector. Now that could be interesting.

digitalengineer 14y ago

Reminds me of something: "Hacking Human Waste" http://news.ycombinator.com/item?id=3456484 http://news.ycombinator.com/item?id=3456484 Two guys found (and patented) a way to get rid of very expensive human (hospital) waste. Working product in a few hospitals and everything, but they're looking for a way to scale up (they are great hackers but suck at finding an investor). Any tips?

saturdaysaint 14y ago

God I hate the healthcare industry. This was on my mind this morning because my girlfriend isn't rich and relies on Lunesta to sleep (I'll leave the fact that her doctor is advising her to take this indefinitely for another day). It's extortionately priced - something like $6 a pill - enough to gouge insurance companies thoroughly and enough to wreck havoc on the finances of someone that's not rich and lacks insurance. It turns out, this is actually the most profitable drug in the world. Yet they can't even sell it in the EU because it's a modest derivative of a (generic) drug that's been around since 1989. It's disturbing that this is where the patent game ends - with power-brokering and lawyering determining who gets the wealth and power.

jrockway 14y ago
Why can't she take the generic drug? Also, $180/month is not really what people mean by "high healthcare costs". They mean something like a $50,000/day hospital stay. $180 is a lot if you don't have a lot of money, but it's hardly backbreaking.
- rsheridan6 14y ago
  The generic drug he's talking about was never approved in the US. It's not available here. You can get it in other countries.
  - saturdaysaint 14y ago
    Indeed, and there's been much discussion that the chemistry that makes Lunesta patentable is trivial, basically a patent for its own sake. "a single isomer drug rarely offers a therapeutic advantage over the mixture of isomers from which it is derived. However, the single isomer is patentable distinct from its multiple-isomer origin. Thus, the drug company can get a monopoly." http://insomnia-relief.com/information/?p=49 http://insomnia-relief.com/information/?p=49

paul 14y ago

When people complain about entrepreneurs building social networks instead of curing cancer, they need to understand that this is a big part of the reason. The internet attracts so much innovation in large part because it's very open to innovation. In more regulated/corrupt (the two are closely related) fields, such as health care, there are many barriers to competition that kill innovative new companies. Mobile was actually very similar to this in the pre-iPhone era (because you needed to make deals with carriers). This in turn leads to less investment, since it's kind of dumb to invest in a doomed company. We're at a point in history where most of our problems are social/political. Our technology is good enough to make the world into a nice place for everyone, but we don't do it because our social "software" is broken. It's easy to make fun of Facebook or Reddit as being all about sharing cat picture, but the reality is that they also are changing the flow of information and influence to be much more peer-to-peer instead of top down (e.g. three television networks). Many will disagree, but I believe that in the long term society will evolve to match this more egalitarian structure. The most effective way to cure cancer may be to first cure the social disfunctions that lead to the types of situations described in this article.

robomartin 14y ago
Yes!
Retric 14y ago
Building App's is ridiculously simpler than solving major problems like cancer. Consider the smartest person you ever met could spends their entire life working on a cancer cure with everything they had and chances are they would have saved more lives by donating 10% of their salary to a vaccination program.
- paul 14y ago
  Yeah, cancer definitely isn't the "low hanging fruit". Hospital errors and infections would be much easier to address, though as this article shows, even that is nearly impossible.
  - 14y ago

tdpeterson 14y ago

"In the case of the towel bid, hospital administrators were shown a PowerPoint presentation (a copy of which she gave to me) indicating that going with the Medline and Medical Action bids would save them between 6 and 29 percent. But this was relative to the same companies’ bids the previous year, not the bids offered by other vendors." I'm interested in seeing these slides and sent a request to the article's author. Were the decision makers present aware there were other vendors? If so, how was this data not called into question? It would be interesting to see if the data was presented in a completely misleading way or if there was some level of laziness and complacency on the decision-makers' part as well. Regardless, misleading presentations are always interesting to examine, such as Tufte's assessment of the presentation given to NASA officials before the Columbia disaster (http://www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0001yB&topic_id=1 http://www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0...). Edit: Just received a reply from the author that she's unable to share the presentation as the person that originally shared it has been "subject to legal harassment." Lame!

TwoBit 14y ago

While the main point about the medical supply monopoly seems solid, I'm suspicious about this Shaw guy, his character, and his product. I'd like to see an objective counter-point.

guard-of-terra 14y ago

But why doesn't they try to sell to other hospitals? In Europe, e.g., Switz hospitals are very well known for their quality. They might be interested.

mahkra 14y ago

This sounds like what the movie puncture was about. It doesn't end well. Still worth seeing. http://www.imdb.com/title/tt1582248/ http://www.imdb.com/title/tt1582248/

scotty79 14y ago

"Then, in 1986 Congress passed a bill exempting GPOs from the anti-kickback provisions embedded in Medicare law. This meant that instead of collecting membership dues, GPOs could collect “fees”—in other industries they might be called kickbacks or bribes—from suppliers in the form of a share of sales revenue." No one in their right mind could imagine that anyone could be genuinely stupid enough to think that allowing organisation that was supposed to work for buyers, take money from sellers is a good idea. That law was 100% surely bought. You don't need any other proof that USA has best Congress money can buy.

robomartin 14y ago

After spending way too much time on this thread here's my parting thought: Some choose to believe that corporate greed is the cause of issues such as that highlighted by this article. Others believe that the political and legal system in place has flaws that create the conditions necessary for such things to happen. And some are in between these two schools of though. Here's the kicker: While we live within and with our reality other parts of the world are watching. And in some parts (China?) they are surely having thoughts akin to "these people are too stupid to get out of their own way". And so, we'll keep arguing and "enjoying" the ineptitude, complexities and realities of our reality while others will watch, learn, study and take measures to ensure that they don't fall into the same traps. Yes, there will probably be better syringes in China than in the US. And, with time, that will be true about a lot more things and a number of other countries. Enjoy.

mudil 14y ago
Thanks, robomartin, for your thoughtful commentary. You are right 100%, through and through. Unfortunately, as I learned long time ago, it seems to me that much of the people on HN believe that gov't is never at fault. That regulation, taxation, and other forms of gov't oppression are good things. Ever. Especially, when reassured by a politician. Today's progressives are just sheeple. They will believe blindly any politician that says "for the children's future" or "for teachers and fire fighters," so let's raise taxes or strangle pharmaceutical companies. A "progressive" used to mean "believe in individual" or "believe in freedom." Today it means "believe in gov't" or "believe in regulation" or "believe in politically correct speech", etc etc (the list is long). Progressives, in other words, are just statists.
- robomartin 14y ago
  Thanks for the feedback. People create a view of the world based on where they came from, what they have experienced, what they've been taught and many other factors (for example, religious indoctrination). This is a fact. Regrettably the governing class in a country like the US knows this very well and has learned how to pander and manipulate the masses in their favor. This is also a fact. Then you have the media. Most people will subscribe to one ideology and set forth to consume media that aligns with this ideology as closely as possible. This is comfortable and easy to chew on. No gag reflex involved. This is another fact. The media know this, and feed that need. They report with overblown outrage about mostly unimportant stories. They go on and on all day long beating the same dumb story to death until they can't flatten it any more. They cater to the audience that, due to ideology, will stay with them. It's SEO, TV style. This is also a fact. All of this leads to great levels of polarization. How else would you have huge chunks of the population self-identify with one party or another? They buy into a "tribe" and stick with it, no matter what. Tribal behavior is a most fundamental human trait. This, also, is fact. Those in the middle of all of this, a group of which I consider myself a member, are willing to stop and think for a moment and not rattle off what others are saying without some thought and consideration. This is hard. This requires work. This requires rejecting years of unintentional indoctrination and trying to see the world for what it is. This is about the Allegory of the Cave in more ways than one (http://en.wikipedia.org/wiki/Allegory_of_the_Cave http://en.wikipedia.org/wiki/Allegory_of_the_Cave). It requires consciously refraining from the most fundamental human impulse to be tribal and believe what has been pounded into your brain. This is hard (I repeat) and this is why most people don't do it. At home we make it a point to learn about multiple points of view. We watch CNN and FOX. We also watch Al Jazeera and LinkTV. We are also fortunate enough to speak more than a couple of languages, so we consume international news from more than one perspective as well. It's amazing what you can learn this way. I don't know where I am going with this except to say that there are a lot of voting groups that, just like Plato's cave, have been living and looking at the shadows in their own caves. And virtually nothing more than that. Government workers, Politicians and Unionized workers (to be brutal in my generalization) are examples of such groups. Individually none of them are bad people. As a voting and acting block they can be absolute morons, but only because all they've been willing to consider are the shadows. I don't know how to fix it. I don't know if it's even possible.

ricardonunez 14y ago

I'm wondering if the best option for them isn't to create a partnership with a existing manufactures. It will be easier for them to get in the market.

rdl 14y ago

I hope Amazon casts its all-powerful crappy-legacy-vendor-destroying eye upon the medical supply market soon. All the value-add GPOs offer (other than pricing) is stuff Amazon could easily do for free -- inventory tracking, etc. It's all IT, and basically zero marginal cost. As long as existing GPOs can't legally prevent a hospital from also using the Amazon GPO, I don't see how anyone could stand against Amazon. Amazon would have zero incentive to lock new device vendors out of the market. Sure, purchases from the Amazon GPO wouldn't contribute to meeting your legacy GPO quotas and rebates, but Amazon has access to capital at levels which will let them destroy regional competition if required -- they could price match any subsidized prices.

creamyhorror 14y ago
"casts its all-powerful crappy-legacy-vendor-destroying eye" The most memorable phrase I've heard all week.

hypervisor 14y ago

He needs to sell his product in a different country. If the system is broken here, he should go elsewhere and see if he can make a change.

anxiousape 14y ago

So he's a great innovator. So stop complaining and sell it outside of USA.

Duff 14y ago

Is there anything significant, important market out there that is not a cesspool of corruption?

tripzilch 14y ago

This article definitely took its sweet time to get to the point. Sure it's interesting, but the first thing I want to know is, "what did they do this time?", so I can decide whether maybe I already know about it or not. Certainly the story about developing new products for a failing healthcare industry is interesting, and I would love to have read about it, if I hadn't been skimming through "yeah yeah yeah and how did they prevent him from bringing it to market? skip skip skip, aha."--IMO, it's just wasting my time, though I would have gladly read the stories about the entrepeneurs if only they'd have gotten to the point first. Even though I thankfully don't have anything to do with the US healthcare system, I'd love to pass this story on to some of my friends that unfortunately do. Except I don't want to waste their time either. And that really is a missed opportunity to bring to light something rotten in the system, because of a badly written article.