>>What legislation makes you think America is going to be re-industrialized?
>Several actually.
BBB passed. The others died. This Congress passed an historically low number of bills. If reindustrialization of America depends on Congress, we are doomed.
Isn't that part of Paul Graham's startup lore? They were running lisp web servers for their ecommerce store and while a customer was on the phone with an issue, they would patch the server live and ask the customer to reload. Customers would hang up convinced it was their personal glitch.
The tool uses a Forth-like language with immutable data structures and persistent memory snapshots. It also uses Clojure style meta-data and compile-time meta-programming. I have no luck convincing people that a language without curly brackets is useful.
I have found Claude Code is a great help to me. Yes, I can and have tinkered a lot over the decades, but I am perfectly happy letting Claude drive the system administration, and advise on best practices. Certainly for prototype configurations. I can install CC on all VPSes and local machines. NixOS sounds great, but the learning curve is not fun. I installed the CC package from the NixOS unstable channel and I don't have to learn the funky NixOS packaging language. I do have to intervene sometimes as the commands go by, as I know how to drive, so maybe not a solution for true newbies. I can spend a few hours learning how to click around in one of the cloud consoles, or I can let CC install the command line interfaces and do it for me. The $20/mo plan is plenty for system administration and if I pick the haiku model, then CC runs twice as fast on trivial stuff like system administration.
Let's take an example: a managed database, e.g. Postgres or MySQL, vs. a self-hosted one. If you need reasonable uptime, you need at least one read replica. But replication breaks sometimes, or something goes wrong on the master DB, particularly over a period of years.
Are you really going to trust Claude Code to recover in that situation? Do you think it will? I've had DB primaries fail on managed DBs like AWS RDS and Google Cloud SQL, and recovery is generally automatic within minutes. You don't have to lift a finger.
Same goes for something like a managed k8s cluster, like EKS or GKE. There's a big difference between using a fully-managed service and trying to replicate a fully managed system on your own with the help of an LLM.
Of course it does boil down to what you need. But if you need reliability and don't want to have to deal with admin, managed services can make life much simpler. There's a whole class of problems I simply never have to think about.
> The best way I could try to reel him in was to simply suggest that if it were so easy, everyone would be doing it.
Alas, most good entrepreneurial activities violate the efficient market hypothesis. Ditto for many investments. Some people are more alert to opportunities, have better deal flow, etc.
>Because without any form of regulation, the ISP has no requirement to honor that letter?
Is this your personal exerience, or are you making assumptions?
I would love to hear how this process possibly fails to unsubscribe anyone:
1. Go to your state's corporate website and get/buy the name and address of the corporate registered agent for your ISP or whatever. In Texas that costs $1.
2. Write or ask ChatGPT to write a demand letter that they cancel your service as of the date of your letter. If they don't, threaten to sue them in small claims court. In Texas, threaten triple damages under the Deceptive Trade Practices Act. (ChatGPT will help you write demands using the "laundry list" of deceptive acts.)
3. Send letter return receipt requested.
4. A lawyer on their side is now involved. They will neverever show up in any small claims court for this. And if they do, the judge is so on your side for this!
Heck, this works for a bunch of things, once you assert your rights. For example, I made a Coinbase account when they first existed and played with $10 of bitcoin. There it sat for six years or so, and then I tried to log in again. Their identity bullshit was demanding to use a phone number from an older phone and they stonewalled. So I sent a demand letter as above and, surprise!, my account was magically re-enabled for my $3 of bitcoin.
You'd spend far longer in the post office and the courts than you would on the phone.
All the company has to do in that court room is show that you mailed the form to someone whose job has nothing to do with account services, or who doesn't even have access or authorization to access people's private account information, or that they tried and failed to reach you in order to verify your identify since they sure as hell won't cancel the account of someone and shut off their service all because an anonymous letter showed up somewhere nobody was expecting to get it. What a great way to DoS an enemy or competitor if that worked. Just mail off some letters to a few store's webhosts right before Christmas or black friday.
In February I happened to attend a lunch 'n learn presentation at TMCi by a company doing clinical trials based on exactly this venous insufficiency principle. I think I may have been the only one in the audience with gray hair... TMCi is the startup accelerator attached to the Texas Medical Center in Houston.
The startup company is Vivifi Medical[1] and they have clinical trials underway with ten men in a Central American country (El Salvador?). They claim that BPH reverses in a few months after their procedure. Their procedure uses a minimally invasive tool of their own invention to snip the vertical blood vessels that are backflowing from age and gravity, and splice them into some existing horizontal blood vessels. On their board of advisors is Dr. Billy Cohn[2], the wildly innovative heart surgeon who is famous for shopping for his medical device components at Home Depot. Dr. Cohn is on the team building the BiVACOR Total Artificial Heart. Vivifi presented their estimated timeline to FDA approval, with proposed general availability in 2028. My personal BPH will be at the head of the line for this procedure.
As far as a startup, their TAM is about 500 million men. I had the Urolift procedure for BPH three years ago, and it cost about $15K on the Medicare benefits statement, though Urolift's clips amounted to only a few thousand dollars. Similarly, Vivifi's charges for this procedure are only a few thousand dollars per procedure, but it holds the promise of being a final solution. Currently Urolift is much less disruptive than TURP, which needs a couple of days in the hospital and almost always leads to retrograde ejaculation (into the bladder).
Thanks for the shout out. I am the CEO of Vivifi medical. We are building off the gat and Goren’s work and making it better and more robust. More importantly making it more accessible to patients through urologists.
Our early clinical trial data from Panama is looking highly encouraging and we are working hard to bring this to the market in the fastest manner possible.
Are you planning to publish the longitudinal data, esp. of endpoints 2 and 3 (prostate size, urinary flow). It would greatly add to the public understanding of this procedure. Why didn't you go for PSA? It's easy to obtain altough one probably wouldn't expect significant changes in this short time frame.
Have you found that with your procedure, to quote the blog piece, "new venous bypasses grow to replace the destroyed spermatic veins," as found in Gat and Goren's work in follow ups? Or is the long term data not there yet?
Thank you for taking a risk on this by the way. As someone who has family history it's heartening to know there are people taking this seriously.
We actually bypass the spermatic vessels. There is historical evidence that bypassing the spermatic vessels is a superior way to treat varicoceles.
So our procedure shouldn’t have the recurrence (of varicoceles or bph) concerns. But this needs to be established through long term studies.
Thanks for sharing your story. It’s stories like yours — people with family histories and real-world experiences — that fuel everything we’re doing.
We are currently gathering insights to better understand patient preferences and would greatly appreciate your input. If you are interested in participating in a short survey, please contact us at info@vivifimedical.com.
Thank you for helping us shape the future of patient care.
Would this procedure be advisable on someone currently with varicocele, less than 40 years old, and with family history of prostate cancer (both grandfathers)?
While we think this procedure has the potential to be a prophylactic treatment, there is no evidence to back that up.
There is a recent study, however, published by Cleveland clinic that demonstrated higher prostate cancer recurrence rates in patients with high local testosterone levels (around the prostate) post prostatectomies.
Also this procedure is not currently approved for treatment of prostatic issues. But if varicocele results in testicular pain, it’s often times treated.
Nothing in the parent differs from a product promotion; there are no alternatives, no negatives, no considerations, nothing but praise - even of a member of the board of advisors.
> there are no alternatives, no negatives, no considerations, nothing but praise
His account is over ten years old, and active. Maybe he's just impressed? Why don't you provide alternatives or negatives, if you can? Cynicism for cynicism's sake is pointless.
In case you missed it, there's a comment parallel to yours by the founder of the company. They also provide their email in a child comment to that. Link: https://news.ycombinator.com/item?id=43804502
Not at all. Our device does not go through the penis, doesn’t damage the urethra or resect prostatic tissue. As a result, there is no risk to any sexual or urinary functionalities. There is no post op catheter.
> As a result, there is no risk to any sexual or urinary functionalities.
You can say "based on [X], we believe the risk of [Y] is insignificant." Saying there is "no risk" is far too sweeping a claim given the level of evidence it sounds like you've gathered.
You are correct - we will have to back our claim through clinical evidence.
However, there is no risk to urinary function, because we do not insert anything through the penis. There is no damage to the urethra.
Similarly, sexual dysfunctions happen because of damages to prostatic nerves when folks are poking stuff through the prostate or cutting things out.
Its similar to saying that getting a BPH procedure poses no risk to your eyesight.
My statements are based on the 200+ patients done through bilateral sclerotherapy of varicocele patients, which is an inferior version of our procedure. But I agree with you point - we will prove it out through our own clinical studies.
Not at this time, apologizes. As we move along, we intend on releasing data and images through publications.
However, if you are into reading scientific papers, you can look up microsurgical anastomosis for varicocele treatment by Belgrano and Flati (separate bodies of work). That should give you an idea and good visual picture of the procedure.
Super interesting, thank you for your candid post - keep crushing in life as it sounds like you already are, good person! Hope you are staying healthy.
Back in the day, I was an outside contractor installing a new storage system for the Livermore lab's secure computing facility. (Designing nuclear weapons) I had no security clearance. When I was present there was a rotating blue light, similar to a police car, warning people that an uncleared person was present. When I was in the facility, people would refer to the area being "dirty".
Since Russia is loading planes with bricks of gold to pay for imports and evade banking sanctions, they must think bricks of gold are useful in a dire situation.
BBB passed. The others died. This Congress passed an historically low number of bills. If reindustrialization of America depends on Congress, we are doomed.
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