WEBVTT 00:00:02.129 --> 00:00:05.389 Thanks so much for joining me today, Tanasi. 00:00:05.730 --> 00:00:09.150 Pleasure to be here. If you could give an introduction 00:00:09.150 --> 00:00:13.070 as to what you do today and how did you get here? 00:00:14.029 --> 00:00:20.309 Yeah, so I spend about 40 % of my time looking 00:00:20.309 --> 00:00:24.449 at investments with Halo Health and Genesis Ventures 00:00:24.449 --> 00:00:27.429 as a venture partner for Genesis Ventures, looking 00:00:27.429 --> 00:00:31.339 at all of their health tech portfolio. and Halo 00:00:31.339 --> 00:00:35.619 Health, I'm the chair of the board. Just as background, 00:00:35.840 --> 00:00:38.679 Genesis Ventures is a generalist fund out of 00:00:38.679 --> 00:00:41.320 Greece, investing globally in Greek founders 00:00:41.320 --> 00:00:43.380 mostly, or at least companies willing to have 00:00:43.380 --> 00:00:48.159 a presence in Greece. Recently listed by Sifted 00:00:48.159 --> 00:00:52.539 as a top five most active investors in Europe. 00:00:53.960 --> 00:00:57.619 And Halo Health is Canada's physician angel group. 00:00:57.899 --> 00:01:01.579 and we have about 400 members who are actively 00:01:01.579 --> 00:01:06.319 investing and we've invested in close to 50 companies 00:01:06.319 --> 00:01:10.719 so far with five exits. What are some similarities 00:01:10.719 --> 00:01:14.099 and differences you see in the European or the 00:01:14.099 --> 00:01:16.719 Greek way of investing in startups versus the 00:01:16.719 --> 00:01:21.140 Canadian way? The Canadian ecosystem is much 00:01:21.140 --> 00:01:23.319 more mature compared to the Greek ecosystem. 00:01:23.659 --> 00:01:27.180 About 10 years ago there was We're barely starting 00:01:27.180 --> 00:01:30.640 to see an ecosystem with the first fund being 00:01:30.640 --> 00:01:33.159 created at the time that the first private fund, 00:01:33.180 --> 00:01:36.700 there was maybe one public fund that was created 00:01:36.700 --> 00:01:39.620 in 2011, whereas venture capital has been in 00:01:39.620 --> 00:01:45.239 Canada for decades. So being less mature means 00:01:45.239 --> 00:01:49.620 smaller check sizes, smaller risk appetite, smaller 00:01:49.620 --> 00:01:53.379 exits, everything's just smaller, but growing 00:01:53.379 --> 00:01:59.359 fairly quickly. Fairly. We hit an upswing in 00:01:59.359 --> 00:02:03.459 2021 and then like a lot of things in venture, 00:02:04.060 --> 00:02:07.400 it's stalled a little bit since then. Was the 00:02:07.400 --> 00:02:10.400 plan to always transition to venture from being 00:02:10.400 --> 00:02:13.139 a physician? And if not, like, was there a moment 00:02:13.139 --> 00:02:16.520 or what made you realize that, you know, maybe 00:02:16.520 --> 00:02:18.780 I want to branch out and I want to branch out 00:02:18.780 --> 00:02:21.400 into investing in startups, not something else? 00:02:21.689 --> 00:02:24.669 So I still maintain a small clinical practice 00:02:24.669 --> 00:02:30.590 and it was not the plan. No. I practiced more 00:02:30.590 --> 00:02:35.909 than full -time for 11, 12 years. At the tail 00:02:35.909 --> 00:02:38.389 end of that, I started working for a startup 00:02:38.389 --> 00:02:43.069 called Dialogue, which ended up IPO -ing in 2001. 00:02:43.150 --> 00:02:48.069 So I joined in early 2018. They went in their 00:02:48.069 --> 00:02:51.259 seed stage and then the IPO three years later 00:02:51.259 --> 00:02:54.919 and the big health tech boom. So there I got 00:02:54.919 --> 00:02:57.840 to see a different way of doing things, much 00:02:57.840 --> 00:03:01.960 more agile, much more innovative, different attitudes. 00:03:02.539 --> 00:03:05.699 And that's how I got introduced to the world 00:03:05.699 --> 00:03:08.539 of startups. So investing was something that 00:03:08.539 --> 00:03:13.699 I was doing by myself in the public markets before 00:03:13.699 --> 00:03:18.340 that. But startups was through working at Dialogue. 00:03:19.079 --> 00:03:23.560 And as of 2020, I started looking into angel 00:03:23.560 --> 00:03:27.580 investing. I got to really educate myself through 00:03:27.580 --> 00:03:30.080 Halo Health. And then I started writing checks 00:03:30.080 --> 00:03:37.020 as of 2021. Talk to me a bit more about the mindset 00:03:37.020 --> 00:03:40.580 as a physician and as an investor in startups. 00:03:41.060 --> 00:03:43.400 From my experience, med school teaches you to 00:03:43.400 --> 00:03:49.110 be the anti entrepreneur, the anti VC. to minimize 00:03:49.110 --> 00:03:54.669 risk at all costs. And even the way we think, 00:03:55.530 --> 00:03:58.729 when a patient comes in, my thought process in 00:03:58.729 --> 00:04:01.770 urgent care and a walk -in is always, is this 00:04:01.770 --> 00:04:04.550 going to harm this patient? Is this going to 00:04:04.550 --> 00:04:06.949 lead to a loss of life or limb in the next 24 00:04:06.949 --> 00:04:09.949 hours? And then that timeline expands. Is this 00:04:09.949 --> 00:04:12.169 something here that's going to cause morbidity 00:04:12.169 --> 00:04:14.469 over the next six months? And then is this cancer? 00:04:14.810 --> 00:04:18.930 So it's a very I don't want to use the word pessimist, 00:04:18.970 --> 00:04:22.990 but it's a very risk mitigation approach to work 00:04:22.990 --> 00:04:26.550 and to practice. Whereas venture is often about, 00:04:26.730 --> 00:04:29.470 what is the upside here? How big can this be? 00:04:30.050 --> 00:04:33.569 And we understand risks are inherent in venture 00:04:33.569 --> 00:04:36.069 and we accept them. Whereas medicine, the type 00:04:36.069 --> 00:04:37.949 of thinking is very different. So talk to me 00:04:37.949 --> 00:04:41.750 about, how did you find, maybe through your work 00:04:41.750 --> 00:04:44.009 in dialogue and then Halo Health and Genesis. 00:04:44.490 --> 00:04:47.610 Like, what are your thoughts on the shift in 00:04:47.610 --> 00:04:52.449 mindset between the two practices you do? I think 00:04:52.449 --> 00:04:58.670 the closest parallel would be it's as if you're 00:04:58.670 --> 00:05:02.250 dealing with very undifferentiated patients all 00:05:02.250 --> 00:05:06.009 the time. So a startup, when you see a pitch 00:05:06.009 --> 00:05:09.430 deck, you're not sure what the outcome is going 00:05:09.430 --> 00:05:13.069 to be. There are plenty of risks and you just 00:05:13.069 --> 00:05:17.779 have to price in and then minimize as many of 00:05:17.779 --> 00:05:20.139 the risk as possible. The team, the market, the 00:05:20.139 --> 00:05:24.180 product, the technical due diligence, how well 00:05:24.180 --> 00:05:26.959 the team members know each other, not if they're 00:05:26.959 --> 00:05:35.899 just qualified to be in that market. And you 00:05:35.899 --> 00:05:41.019 just, you have to look for asymmetric bet. So 00:05:41.019 --> 00:05:44.240 we're going to write a check for this much, but 00:05:44.430 --> 00:05:49.170 if this goes well, how big could this be? Whereas 00:05:49.170 --> 00:05:51.709 in medicine, you're still mitigating risks, if 00:05:51.709 --> 00:05:57.389 we're talking about undifferentiated situations 00:05:57.389 --> 00:06:00.649 and not routine cases that you would see in a 00:06:00.649 --> 00:06:07.069 walk -in clinic or in any kind of settings. But 00:06:07.069 --> 00:06:10.310 in medicine, there's no upside. You're just... 00:06:10.060 --> 00:06:12.959 capping your downside. And then that's a completely 00:06:12.959 --> 00:06:15.699 different way of doing things. You do not get 00:06:15.699 --> 00:06:18.779 rewarded for taking risks. You get slapped on 00:06:18.779 --> 00:06:22.959 the wrist for taking risks. In venture, if you 00:06:22.959 --> 00:06:28.439 mitigate risks well enough, you can get rewarded 00:06:28.439 --> 00:06:32.680 quite a bit. And it's also a numbers game. So 00:06:32.680 --> 00:06:37.600 you do your 10 investments, six go to zero, not 00:06:37.600 --> 00:06:40.470 a problem. you get your one or two, they give 00:06:40.470 --> 00:06:45.689 you a hundred X, you're in the top 25%. In medicine, 00:06:46.110 --> 00:06:51.670 six of your diagnoses are not right. You're looking 00:06:51.670 --> 00:06:55.310 at some complications. Well, that's a difference. 00:06:55.410 --> 00:06:58.629 So it's still making decisions on incomplete 00:06:58.629 --> 00:07:03.170 information. It's still mitigating risk, but 00:07:03.170 --> 00:07:05.750 the overall philosophy is very, very different. 00:07:06.829 --> 00:07:11.370 What advice do you have for non -clinical investors 00:07:11.370 --> 00:07:19.589 who want to invest in healthcare? So, if we're 00:07:19.589 --> 00:07:24.730 talking about digital healthcare or medical device, 00:07:26.509 --> 00:07:30.930 technology is good, and good technology is useful, 00:07:31.769 --> 00:07:35.920 but hospitals, physicians, they don't pay for 00:07:35.920 --> 00:07:38.160 good technology. They pay for a solution to the 00:07:38.160 --> 00:07:41.439 problem. And you need to offer that solution 00:07:41.439 --> 00:07:44.600 and you need to be able to integrate it into 00:07:44.600 --> 00:07:47.379 the daily workflow as seamlessly as possible. 00:07:48.980 --> 00:07:53.180 So unless you're willing to do that integration 00:07:53.180 --> 00:07:56.860 from A to Z and minimize friction as much as 00:07:56.860 --> 00:07:59.579 possible for everyone involved, whether that's 00:07:59.579 --> 00:08:03.490 the... the physician or the clinician who's using 00:08:03.490 --> 00:08:10.290 it, the patient, the administrative staff, your 00:08:10.290 --> 00:08:12.350 good and impressive technology is not going to 00:08:12.350 --> 00:08:16.209 get you anywhere. So this is the important thing 00:08:16.209 --> 00:08:20.430 that I would look at as an investor looking into 00:08:20.430 --> 00:08:26.009 digital health companies. You have two investment 00:08:26.009 --> 00:08:29.740 opportunities. One is an amazing team. But with 00:08:29.740 --> 00:08:32.500 a crappy product, you don't think fits the market. 00:08:32.620 --> 00:08:34.740 You don't think maybe we'll get adoption in healthcare, 00:08:35.240 --> 00:08:40.500 but the team is an amazing team. Team B is not 00:08:40.500 --> 00:08:44.259 such a great team, but their product is something 00:08:44.259 --> 00:08:47.000 that fits your thesis. It's an opportunity you've 00:08:47.000 --> 00:08:49.820 identified and it's a really good product and 00:08:49.820 --> 00:08:54.440 it solves the problem. Who do you pick? Can I 00:08:54.440 --> 00:08:57.120 just ask a qualifying question? What do you mean 00:08:57.120 --> 00:09:05.049 a good team? So a team that understands distribution 00:09:05.049 --> 00:09:08.669 and product iteration, and a team that maybe 00:09:08.669 --> 00:09:10.789 has some experience selling into healthcare, 00:09:11.429 --> 00:09:13.309 and a team that has experience maybe building 00:09:13.309 --> 00:09:16.309 software solutions adjacent to healthcare. All 00:09:16.309 --> 00:09:18.309 right, all right. So I think it's an easy answer 00:09:18.309 --> 00:09:21.289 for me, team, team all the way, team all the 00:09:21.289 --> 00:09:25.250 way. And I've had some recent examples, recent 00:09:25.250 --> 00:09:29.419 examples that remind me of that. So product is 00:09:29.419 --> 00:09:32.059 one thing and then timing and why now entering 00:09:32.059 --> 00:09:37.240 all of that is great. But if the team is not 00:09:37.240 --> 00:09:40.419 agile enough, is not resilient enough, you're 00:09:40.419 --> 00:09:42.500 not gonna get anywhere, even if you have the 00:09:42.500 --> 00:09:45.980 best expert or the best product. How do you test 00:09:45.980 --> 00:09:52.779 for that agility and resilience? It's an art, 00:09:52.899 --> 00:09:59.659 right? There's no silver bullet here. You have 00:09:59.659 --> 00:10:02.259 to, during your interactions, your multiple interactions 00:10:02.259 --> 00:10:03.820 with them, you have to ask them some challenging 00:10:03.820 --> 00:10:05.799 questions. You have to see how they respond. 00:10:05.899 --> 00:10:08.620 You have to ask them questions about their past, 00:10:08.659 --> 00:10:12.980 how they dealt with different challenges, especially 00:10:12.980 --> 00:10:15.259 work -related challenges when it comes to this. 00:10:15.419 --> 00:10:21.279 And then try to get a feel for how, if they're 00:10:21.279 --> 00:10:24.500 more of a missionary or a mercenary type of person 00:10:24.500 --> 00:10:26.779 where they're looking for. missionary being, 00:10:26.779 --> 00:10:28.600 you know, I believe in this company and I will 00:10:28.600 --> 00:10:32.279 do whatever it takes for just to see this materialized 00:10:32.279 --> 00:10:36.519 and to see my product being used by my patients 00:10:36.519 --> 00:10:40.179 or clinicians versus, oh, you know, the metrics 00:10:40.179 --> 00:10:42.419 are good and hopefully we're gonna exit in X 00:10:42.419 --> 00:10:49.220 amount of years for this valuation. So yeah, 00:10:49.299 --> 00:10:52.899 it's a bit of an arts resilience is important. 00:10:54.460 --> 00:11:02.519 having some kind of founder market fit and yeah, 00:11:02.919 --> 00:11:05.519 and high IQ, obviously in high EQ. So the way 00:11:05.519 --> 00:11:07.440 that they answer your questions when they get 00:11:07.440 --> 00:11:12.980 challenged, that's gonna be a big deal. And what 00:11:12.980 --> 00:11:16.500 are some common objective attributes you've seen 00:11:16.500 --> 00:11:19.639 in your successful founders? Are there a certain 00:11:19.639 --> 00:11:22.309 age? Do they come from a certain? area? Have 00:11:22.309 --> 00:11:26.429 they had certain life experiences? Maybe they 00:11:26.429 --> 00:11:28.309 used to play video games. I think that's talked 00:11:28.309 --> 00:11:33.230 about quite a bit in the BC ecosystem. Or they 00:11:33.230 --> 00:11:37.110 maybe failed a grade in school. Are there any 00:11:37.110 --> 00:11:41.470 commonalities you've found? A chip on your shoulder 00:11:41.470 --> 00:11:46.669 does help a little bit. Yeah, I have to say. 00:11:47.669 --> 00:11:50.830 So being smart, having a bit of a chip. I was 00:11:50.830 --> 00:11:53.769 wanting to stand out. I think one of the smartest 00:11:53.769 --> 00:11:59.250 founders that I backed is as a middle child in 00:11:59.250 --> 00:12:02.610 a family of doctors who kind of abandoned the 00:12:02.610 --> 00:12:06.370 pre -med path and then decided to go into banking, 00:12:07.029 --> 00:12:09.309 investment banking, which had to explain to her 00:12:09.309 --> 00:12:11.230 family why it's great. And then once they realized 00:12:11.230 --> 00:12:13.169 that it's great and she has a great salary, she's 00:12:13.169 --> 00:12:18.450 like, oh, well, I want to do a startup. And she's 00:12:18.450 --> 00:12:24.129 just raised an oversubscribed series A. So that 00:12:24.129 --> 00:12:29.389 definitely helps. But I wish it was that easy 00:12:29.389 --> 00:12:33.629 to tell you. Yeah, I think it's something I've 00:12:33.629 --> 00:12:36.629 kind of recognized. I've taken the bet on, you 00:12:36.629 --> 00:12:40.269 know, I have these theses in mind, and I don't 00:12:40.269 --> 00:12:42.429 know if it's something I should continue doing. 00:12:42.710 --> 00:12:46.250 It's largely to paint a story for my LPs and 00:12:46.250 --> 00:12:50.809 my syndicate investors. I find if I tell them 00:12:50.809 --> 00:12:53.610 I'm just going to invest in the best team, right? 00:12:53.610 --> 00:12:55.690 I'm going to invest in the best founders building 00:12:55.690 --> 00:12:58.110 in health care. That is my whole thesis. That 00:12:58.110 --> 00:13:01.370 doesn't fly well, doesn't resonate. So I have 00:13:01.370 --> 00:13:04.450 to kind of say, OK, I'm looking for inbox management 00:13:04.450 --> 00:13:07.149 and AI diagnostics or, you know, the ambient 00:13:07.149 --> 00:13:09.549 scribe plus, which is what is the additional 00:13:09.549 --> 00:13:13.809 features here or the AI physician or, you know, 00:13:13.950 --> 00:13:17.690 scheduling or whatever it is, RCM. I need these 00:13:17.690 --> 00:13:23.169 theses or the the the the investors who invest 00:13:23.169 --> 00:13:28.490 in us. They don't buy a vision. Do you kind of 00:13:28.490 --> 00:13:30.570 find that being part of Halo Health and talking 00:13:30.570 --> 00:13:35.279 to physicians like Is thesis -driven investment 00:13:35.279 --> 00:13:40.500 the way? What are your thoughts on that? Yeah, 00:13:40.620 --> 00:13:43.080 that's a great question. So there is the prepared 00:13:43.080 --> 00:13:47.019 mind approach where you look into a market and 00:13:47.019 --> 00:13:49.159 you build your own thesis and then you look for 00:13:49.159 --> 00:13:51.899 companies specifically that solve the problems, 00:13:52.379 --> 00:13:57.120 which is great. It has worked for big funds. 00:13:57.279 --> 00:14:01.500 I think Accel was known for that. But at the 00:14:01.500 --> 00:14:04.820 same time, try doing that exercise going back 00:14:04.820 --> 00:14:07.759 in November of 2022 and saying, I'm looking for 00:14:07.759 --> 00:14:10.700 this. And then in January, well, open AI is here, 00:14:11.019 --> 00:14:14.279 right? So you would have to adjust quite a bit. 00:14:15.860 --> 00:14:20.879 So it is a bit of, you know, it is a mix of things, 00:14:21.080 --> 00:14:27.909 but I do like to have a basic a basic idea, a 00:14:27.909 --> 00:14:31.870 basic investment thesis, but then really team 00:14:31.870 --> 00:14:38.769 is the right team in a big -ish market. That's 00:14:38.769 --> 00:14:40.690 the biggest driver as far as I'm concerned. And 00:14:40.690 --> 00:14:44.250 then market is always, it's also hard to pinpoint 00:14:44.250 --> 00:14:48.929 because the market can increase, the right product 00:14:48.929 --> 00:14:52.529 can increase a market just by being so great 00:14:52.529 --> 00:14:56.659 and having more people use it. When we were speaking 00:14:56.659 --> 00:14:58.860 last year, we made a prediction that there will 00:14:58.860 --> 00:15:01.860 be at least one AI scribe unicorn. There's been 00:15:01.860 --> 00:15:06.240 multiple. And I got close into getting into one 00:15:06.240 --> 00:15:08.860 of them, but I didn't have access to capital, 00:15:08.980 --> 00:15:14.179 so I couldn't get in. But that would have been 00:15:14.179 --> 00:15:19.500 a good investment if I did. What are some, so 00:15:19.500 --> 00:15:21.919 to follow on that, what are some predictions 00:15:21.919 --> 00:15:26.059 you are kind of seeing? at this point and I'll 00:15:26.059 --> 00:15:30.779 kind of share mine after. So I think the AI scribe 00:15:30.779 --> 00:15:34.559 plus is here already. So we're going to have 00:15:34.559 --> 00:15:39.000 AI scribes that are just linked with AI agents. 00:15:40.000 --> 00:15:43.480 And basically everything that the physician does 00:15:43.480 --> 00:15:46.159 other than say this is the diagnosis and this 00:15:46.159 --> 00:15:50.460 is the plan is going to be automated. So you 00:15:50.460 --> 00:15:53.779 would see a physician would see a patient go 00:15:53.779 --> 00:15:57.500 through the interview, come up with a diagnosis 00:15:57.500 --> 00:16:00.279 and then plan and just say to the computer or 00:16:00.279 --> 00:16:04.460 to his cell phone, this is the diagnosis, this 00:16:04.460 --> 00:16:07.039 is the plan, organize a consultation with this 00:16:07.039 --> 00:16:09.100 person, organize a consultation with that person 00:16:09.100 --> 00:16:12.259 and I'll see you in three weeks. And then everything 00:16:12.259 --> 00:16:15.519 after that, it's gonna get done. So the appointment 00:16:15.519 --> 00:16:18.639 is gonna get automated, the medication is gonna 00:16:18.639 --> 00:16:22.370 be sent to the patient. going to be direct messages 00:16:22.370 --> 00:16:24.389 back to the physician if there is an adverse 00:16:24.389 --> 00:16:27.690 reaction. There's going to be an AI agent that 00:16:27.690 --> 00:16:29.909 calls you and tells you exactly where you need 00:16:29.909 --> 00:16:31.970 to go, what you need to do in plain language 00:16:31.970 --> 00:16:35.409 that you understand and gets a feel if you're 00:16:35.409 --> 00:16:39.450 anxious or you're not anxious and is able to 00:16:39.450 --> 00:16:43.309 troubleshoot some basic problems and then only 00:16:43.309 --> 00:16:47.309 escalate to the physician if and only the AI 00:16:47.309 --> 00:16:49.570 agent cannot do it. And then AI agents already 00:16:49.570 --> 00:16:52.830 are quite quite good when you talk to them. It 00:16:52.830 --> 00:16:55.929 is, they feel quite natural and then they're 00:16:55.929 --> 00:16:59.490 able to deal with even you asking them relevant 00:16:59.490 --> 00:17:01.809 questions or you interrupting the conversation. 00:17:01.889 --> 00:17:04.450 So I think all of that, all of that is going 00:17:04.450 --> 00:17:07.369 to get automated. So for, I think for the first 00:17:07.369 --> 00:17:10.410 time we're going to have software that makes 00:17:10.410 --> 00:17:12.690 your life easier and doesn't increase the amount 00:17:12.690 --> 00:17:15.069 of things that you need to do. Obviously it's 00:17:15.069 --> 00:17:16.690 not going to happen all at once and it's not 00:17:16.690 --> 00:17:18.029 going to happen. It's not going to be evenly 00:17:18.029 --> 00:17:21.440 distributed, but I think we're move forward there. 00:17:22.880 --> 00:17:25.759 I completely agree. And do you think this will 00:17:25.759 --> 00:17:30.180 be several point solutions like AI for prescription 00:17:30.180 --> 00:17:32.420 generation and anything that happens after that, 00:17:32.420 --> 00:17:35.640 AI for referrals, or do you kind of foresee one 00:17:35.640 --> 00:17:39.500 company taking on everything that happens during 00:17:39.500 --> 00:17:42.299 a physician visit and follow up? And then that 00:17:42.299 --> 00:17:45.799 ties into patient inbound as well and AI agents 00:17:45.799 --> 00:17:57.549 for, because this is a cycle. It's tough to know 00:17:57.549 --> 00:18:02.809 what the market's going to do, but probably two 00:18:02.809 --> 00:18:05.569 or three big players that end up consolidating 00:18:05.569 --> 00:18:08.009 the smaller players. I think that that's how 00:18:08.009 --> 00:18:12.470 I see it. I don't know if the big players are 00:18:12.470 --> 00:18:16.289 going to start off as scribes or agent and move 00:18:16.289 --> 00:18:20.759 into the other direction. Yeah. And does the 00:18:20.759 --> 00:18:23.579 defensibility here lies in the tech or the distribution? 00:18:25.559 --> 00:18:29.319 I would have to say distribution. You know, unless 00:18:29.319 --> 00:18:32.160 one product is significantly better than the 00:18:32.160 --> 00:18:34.000 other, but I think distribution is probably going 00:18:34.000 --> 00:18:37.460 to be going to be where it's at. And what are 00:18:37.460 --> 00:18:39.440 some hurdles you're seeing for something like 00:18:39.440 --> 00:18:42.640 this, say like an AI automated AI agent that 00:18:42.640 --> 00:18:45.480 does my referrals and prescriptions for me? Like, 00:18:45.619 --> 00:18:48.400 why doesn't that exist right now? Is it a technical 00:18:48.400 --> 00:18:50.799 problem? Is it a regulatory problem? Because 00:18:50.799 --> 00:18:53.539 I don't need it. I'll happily pay for this. I 00:18:53.539 --> 00:18:55.519 don't need to make money off this, right? Like 00:18:55.519 --> 00:18:58.119 AI scribes, I don't make any money off them. 00:18:59.000 --> 00:19:01.660 And that's, you know, in the past, I would have 00:19:01.660 --> 00:19:04.440 said, if you're not generating revenue for me, 00:19:04.859 --> 00:19:07.220 I'm not, I likely will not use your solution. 00:19:07.380 --> 00:19:10.400 I've changed my mind on that. Because the pain 00:19:10.400 --> 00:19:14.069 point with paperwork and referrals and referral 00:19:14.069 --> 00:19:17.029 rejection and you know I get this because I'm 00:19:17.029 --> 00:19:19.630 still in clinic once a day this referral was 00:19:19.630 --> 00:19:23.069 rejected please send it to someone else and that's 00:19:23.069 --> 00:19:26.450 literally 15 clicks and copy pasting five different 00:19:26.450 --> 00:19:28.690 things and attaching the documents it's like 00:19:28.690 --> 00:19:31.549 10 minutes of my time which should be one click 00:19:31.549 --> 00:19:36.410 um sorry can we go back to the to the question 00:19:36.410 --> 00:19:39.170 so the question is um what's what's the difficulty 00:19:39.829 --> 00:19:43.029 Yeah, is it a technical problem at this point? 00:19:43.269 --> 00:19:46.450 Because before you said that the defensibility 00:19:46.450 --> 00:19:48.730 lies in the distribution, not in the tech. So 00:19:48.730 --> 00:19:51.190 to follow on that, and I agree with that, is 00:19:51.190 --> 00:19:53.730 this a technical problem currently, or is this 00:19:53.730 --> 00:19:56.990 more of a regulatory problem about generating 00:19:56.990 --> 00:20:01.069 prescriptions and the agent needing a license 00:20:01.069 --> 00:20:03.609 maybe to prescribe certain medications? And what's 00:20:03.609 --> 00:20:08.880 the path to that? I don't know if it's a false 00:20:08.880 --> 00:20:13.079 dichotomy. I think it's a little bit of, so technically 00:20:13.079 --> 00:20:17.339 the technology is almost there. So I know a startup 00:20:17.339 --> 00:20:19.400 that does just integrate all of your software 00:20:19.400 --> 00:20:22.180 in one. So you don't have to do 15 clicks, but 00:20:22.180 --> 00:20:24.880 you're not able to talk to it, right? So technically 00:20:24.880 --> 00:20:26.880 the technology is almost there, but there's a 00:20:26.880 --> 00:20:29.599 lot of point solutions. So integrating all of 00:20:29.599 --> 00:20:33.440 that into, you know, customizing that to what 00:20:33.440 --> 00:20:39.190 you need, that's tough. So in terms of regulatory 00:20:39.190 --> 00:20:43.210 hurdles, they're fairly big. And mostly it has 00:20:43.210 --> 00:20:45.650 to do with different geographies and different 00:20:45.650 --> 00:20:54.250 regulatory rules. And then there is how to integrate 00:20:54.250 --> 00:20:58.630 workflow. So there's the clinical, that inertia, 00:20:59.009 --> 00:21:02.849 the status quo that becomes, that's still a problem. 00:21:04.319 --> 00:21:10.420 it's a combination of things, but I think you 00:21:10.420 --> 00:21:14.680 have to, I think if you're able to prove to clinicians 00:21:14.680 --> 00:21:19.180 that you're saving them time, you're providing 00:21:19.180 --> 00:21:22.640 value that's 10x what they're doing right now, 00:21:23.619 --> 00:21:27.880 it's not gonna be, that's gonna help a lot. But 00:21:27.880 --> 00:21:30.880 I think if you have your champion, that's the 00:21:30.880 --> 00:21:34.140 best way to go to market. You have one or two, 00:21:34.170 --> 00:21:37.990 champions per institution, they're going to be 00:21:37.990 --> 00:21:43.230 able to move things along. When do you think 00:21:43.230 --> 00:21:46.789 we will see the first AI agent getting the license 00:21:46.789 --> 00:21:51.049 to practice something in healthcare, be it counseling, 00:21:51.269 --> 00:21:53.890 be it physical therapy, be it like prescribing 00:21:53.890 --> 00:21:57.309 a medication or birth control? When do you think 00:21:57.309 --> 00:22:00.430 that will happen? And you know, what's the path 00:22:00.430 --> 00:22:03.440 to that? If I'm, if I'm a founder, and I'm like, 00:22:03.440 --> 00:22:07.319 you know, I speak to Chad GPT or Gemini or an 00:22:07.319 --> 00:22:09.980 AI agent. I'm like, this is really helpful. I 00:22:09.980 --> 00:22:12.559 would love for this to be my counselor and be 00:22:12.559 --> 00:22:15.660 reimbursed by insurance. And the barrier being 00:22:15.660 --> 00:22:19.839 that it needs to be a registered healthcare AI 00:22:19.839 --> 00:22:23.599 agent professional. Like, what is the path to 00:22:23.599 --> 00:22:25.240 that? When do we see that? And am I thinking 00:22:25.240 --> 00:22:27.700 of this the right way? Because my thinking is 00:22:27.700 --> 00:22:32.769 you need that license to unlock revenue. I agree, 00:22:32.809 --> 00:22:37.130 I agree. I don't know if it's easy to make that 00:22:37.130 --> 00:22:43.289 prediction because there's the issue of liability 00:22:43.289 --> 00:22:48.069 and a lot of healthcare delivery is personal 00:22:48.069 --> 00:22:52.970 and people like the human touch. So I could see 00:22:52.970 --> 00:22:55.690 it, let's say over the next five years being 00:22:55.690 --> 00:22:59.380 authorized for re -prescriptions. or in a really 00:22:59.380 --> 00:23:03.319 menial task. So I, or, you know, re -prescription 00:23:03.319 --> 00:23:08.500 of an OCP or contraceptive, I could see it, maybe 00:23:08.500 --> 00:23:12.099 treating something really, really simple, like 00:23:12.099 --> 00:23:15.140 a benign, like a recurrent rash, for example, 00:23:16.000 --> 00:23:20.059 like another eczema flare up. But I think for 00:23:20.059 --> 00:23:24.019 the most parts, the lowest hanging fruit is administrative 00:23:24.019 --> 00:23:26.680 tasks and administrative costs that have increased 00:23:26.680 --> 00:23:29.430 quite a bit. in North America, and I'm guessing 00:23:29.430 --> 00:23:33.109 other markets as well. So that one, I think it's 00:23:33.109 --> 00:23:37.309 a safer bet. Now, yeah, getting a full license, 00:23:38.609 --> 00:23:41.329 but that's a harder one. And there was also a 00:23:41.329 --> 00:23:43.250 recent publication, I think in the New England, 00:23:45.130 --> 00:23:52.430 where chatting with the therapist chatbot was 00:23:52.430 --> 00:23:56.539 shown to be non -inferior, I think, too. compared 00:23:56.539 --> 00:23:59.400 to chatting with a therapist. Even with that, 00:23:59.539 --> 00:24:02.019 I don't think that's enough to change the status 00:24:02.019 --> 00:24:04.460 quo in the near future. Like, and by near, I 00:24:04.460 --> 00:24:08.279 mean in the 2020s. Yeah, I mean, I've been talking 00:24:08.279 --> 00:24:11.700 to Gemini quite a bit. It always tells me I'm 00:24:11.700 --> 00:24:16.400 smart and ask very interesting questions. Yeah. 00:24:16.579 --> 00:24:20.660 And so I think that the motivational interviewing 00:24:20.660 --> 00:24:23.700 techniques are built in in these chatbots, which 00:24:23.700 --> 00:24:26.430 is very interesting. Um, and I had a conversation 00:24:26.430 --> 00:24:28.869 with an AI agent, which was a networking thing 00:24:28.869 --> 00:24:33.289 and it was very, it made me feel good. Um, I 00:24:33.289 --> 00:24:35.329 don't know if it's good for me to be validated 00:24:35.329 --> 00:24:39.609 that much, but it made me feel good because you 00:24:39.609 --> 00:24:42.930 know, the constant validation also will reduce 00:24:42.930 --> 00:24:46.650 your, your stress tolerance. Um, or when you 00:24:46.650 --> 00:24:49.829 get a negative feedback, you won't be used to 00:24:49.829 --> 00:24:52.029 it because your counselor or your best friend. 00:24:52.359 --> 00:24:55.420 or this is something we're seeing, your partner 00:24:55.420 --> 00:24:59.220 who is an AI agent, in some cases, is not providing 00:24:59.220 --> 00:25:04.059 any constructive feedback. Is that something 00:25:04.059 --> 00:25:08.660 you think about? And with the rise of AI agents, 00:25:08.740 --> 00:25:14.539 how do you see the future of mental health? So 00:25:14.539 --> 00:25:16.539 that's an interesting question, because we had 00:25:16.539 --> 00:25:19.519 that discussion with the portfolio company at 00:25:19.519 --> 00:25:25.160 Genesis. My honest opinion is that I don't see 00:25:25.160 --> 00:25:30.740 them replacing a human therapist completely over, 00:25:30.740 --> 00:25:34.559 at least over the next five years. I'm willing 00:25:34.559 --> 00:25:37.680 to bet some money on that, let's say. But it 00:25:37.680 --> 00:25:41.940 is - Why not? You still need that resistance. 00:25:42.599 --> 00:25:45.740 You still need someone to go against, to push 00:25:45.740 --> 00:25:49.900 against your assumptions, your schemas. your 00:25:49.900 --> 00:25:52.819 defense, your ego defense mechanisms, you still 00:25:52.819 --> 00:25:56.720 need that. And do you foresee like payers saying 00:25:56.720 --> 00:26:00.039 you need that to get better? Like, do you foresee 00:26:00.039 --> 00:26:02.900 like data coming out that patients love it? And 00:26:02.900 --> 00:26:05.900 like, I love talking to Gemini, but it's not 00:26:05.900 --> 00:26:08.279 helping my mental health, even though I love 00:26:08.279 --> 00:26:10.500 it. Like, is that kind of you see that data coming 00:26:10.500 --> 00:26:13.660 out at some point? You would need a study that 00:26:13.660 --> 00:26:16.960 shows that outcomes over a long period of time 00:26:16.960 --> 00:26:23.859 are comparable or better. And maybe AI is going 00:26:23.859 --> 00:26:26.240 to go quickly, but there's a lot of nonverbal 00:26:26.240 --> 00:26:29.019 communication that you cannot input into JAD 00:26:29.019 --> 00:26:32.839 GPT, the latest version, or DeepSeq, or Perplexity, 00:26:32.980 --> 00:26:36.880 or whatever you're using. So I don't see it over 00:26:36.880 --> 00:26:40.500 the next five years. I do see a lot of some follow 00:26:40.500 --> 00:26:42.720 -up communication that you may want to have with 00:26:42.720 --> 00:26:45.400 your psychologist. That could be automated if 00:26:45.400 --> 00:26:51.559 you have your CBT, a lot of your journaling could 00:26:51.559 --> 00:26:55.960 be, you can get nudges to do your journaling 00:26:55.960 --> 00:26:58.420 or do the exercises that you agreed upon during 00:26:58.420 --> 00:27:01.140 your CBT session. I could see that being very 00:27:01.140 --> 00:27:11.319 helpful, but not completely. I cannot see a full 00:27:11.319 --> 00:27:15.140 AI agent doing psychotherapy. With that being 00:27:15.140 --> 00:27:19.779 said, at least in developed countries. But then 00:27:19.779 --> 00:27:21.119 if you're talking about the developing world, 00:27:21.220 --> 00:27:24.859 I'm not sure how open the developing world would 00:27:24.859 --> 00:27:29.940 be to having an AI agent as their psychotherapist. 00:27:31.720 --> 00:27:33.960 Talk me through your diligence process. What 00:27:33.960 --> 00:27:36.859 do you look for in startups that kind of come 00:27:36.859 --> 00:27:41.779 in your inbox or are introduced to you? Nothing 00:27:41.779 --> 00:27:48.829 new here. team for sure. Are they complementary? 00:27:49.289 --> 00:27:54.569 Do they have enough experience or enough experience 00:27:54.569 --> 00:27:57.690 in the specific market or in another market, 00:27:58.029 --> 00:28:00.470 but they bring relevant skills to this market? 00:28:01.430 --> 00:28:03.210 Have they known each other for a while? Have 00:28:03.210 --> 00:28:06.930 they worked together because partner, founder 00:28:06.930 --> 00:28:10.450 breakups are a very common cause of failure. 00:28:12.710 --> 00:28:17.480 Then the market needs to be big enough, the timing, 00:28:17.740 --> 00:28:24.319 there needs to be a good answer to why now. And 00:28:24.319 --> 00:28:26.539 some traction or some kind of validation. If 00:28:26.539 --> 00:28:27.759 we're talking about healthcare, there needs to 00:28:27.759 --> 00:28:31.720 be some kind of validation, whether that's some 00:28:31.720 --> 00:28:37.119 IP for a medical device or some beta testing 00:28:37.119 --> 00:28:42.779 or some... at a minimum interviews with the stakeholders 00:28:42.779 --> 00:28:45.279 where they got consistent feedback and now they're 00:28:45.279 --> 00:28:54.700 ready to build. That's about it. I think that's 00:28:54.700 --> 00:28:57.460 the initial screening. And then you have to go 00:28:57.460 --> 00:29:01.640 into due diligence and really look at, are these, 00:29:01.759 --> 00:29:04.299 is this team supporting their claims? What does 00:29:04.299 --> 00:29:06.740 the competition look like? How are they differentiated 00:29:06.740 --> 00:29:13.529 from the competition? and go from there. What 00:29:13.529 --> 00:29:16.730 are you excited about in longevity medicine? 00:29:17.509 --> 00:29:20.869 From what I see, there's this inherent belief 00:29:20.869 --> 00:29:23.690 that we all have, including myself, that more 00:29:23.690 --> 00:29:30.950 data is better, which goes against Western medicine 00:29:30.950 --> 00:29:33.490 in a lot of ways, because we really focus on 00:29:33.490 --> 00:29:37.450 pretest probability. Is this data useful? or 00:29:37.450 --> 00:29:39.150 will it create more uncertainty? And you can 00:29:39.150 --> 00:29:40.970 kind of see this in startups. There's a point 00:29:40.970 --> 00:29:43.009 where you're doing diligence. You don't need 00:29:43.009 --> 00:29:45.829 more data. You will not get more certainty because 00:29:45.829 --> 00:29:48.069 the asset class is uncertain. It's a high -risk 00:29:48.069 --> 00:29:51.029 asset class. Unfortunately, medicine is uncertain. 00:29:51.670 --> 00:29:53.450 Healthcare is uncertain. And I don't think this 00:29:53.450 --> 00:29:56.789 is something patients know or realize that we 00:29:56.789 --> 00:30:00.009 can collect as much data as we want. Prognosis 00:30:00.009 --> 00:30:03.569 and outcome prediction is inherently uncertain. 00:30:03.869 --> 00:30:06.529 That's a probability. It's not deterministic. 00:30:07.220 --> 00:30:11.539 We can never predict your future risk of something 00:30:11.539 --> 00:30:16.779 as 100 % or 0%. And at some point, and I think 00:30:16.779 --> 00:30:19.000 from a business perspective, it's great because 00:30:19.000 --> 00:30:21.900 it creates a data flywheel. You order a test, 00:30:22.180 --> 00:30:24.519 creates uncertainty. You need more testing, more 00:30:24.519 --> 00:30:27.019 uncertainty, more testing. And this is this loop 00:30:27.019 --> 00:30:29.359 where it just keeps going. And so it makes sense. 00:30:29.539 --> 00:30:31.319 And I think it's a massive market opportunity. 00:30:31.420 --> 00:30:36.829 But we'd love to get your thoughts. Yeah, longevity 00:30:36.829 --> 00:30:39.029 is very trendy these days and longevity means 00:30:39.029 --> 00:30:42.329 different things to different people. So anything 00:30:42.329 --> 00:30:45.650 from I'm just getting blood tests or extra tests 00:30:45.650 --> 00:30:50.269 more often to, well, here's why I'm using metformin 00:30:50.269 --> 00:30:55.269 and rapamycin and then this new, I don't know, 00:30:55.390 --> 00:30:59.910 NAD injection and stem cell injection. So it 00:30:59.910 --> 00:31:01.769 means different things to different people at 00:31:01.769 --> 00:31:05.940 this point. I'm very happy there's interest in 00:31:05.940 --> 00:31:11.000 this segment. To answer your question, yes, so 00:31:11.000 --> 00:31:13.319 traditional Western medicine and evidence -based 00:31:13.319 --> 00:31:15.859 medicine stresses the fact that there is uncertainty 00:31:15.859 --> 00:31:20.779 and that's great, but a couple of things here. 00:31:20.799 --> 00:31:26.019 So if you have better data, then you can change 00:31:26.019 --> 00:31:28.359 your pre -test and post -test probability. What 00:31:28.359 --> 00:31:31.779 do I mean by better data? So full body MRIs may 00:31:31.779 --> 00:31:36.329 give you some false positives, but they will 00:31:36.329 --> 00:31:39.569 cover some edge cases. So they will cover the 00:31:39.569 --> 00:31:42.609 pancreatic cancer. They will cover the glioblastoma 00:31:42.609 --> 00:31:47.549 multiforme, like a rare brain tumor. And if you 00:31:47.549 --> 00:31:53.410 have, you know, a full body MRI at age 50 and 00:31:53.410 --> 00:31:56.569 it's completely clean, you have an idea that 00:31:56.569 --> 00:31:59.910 your presence probability of having, if you go 00:31:59.910 --> 00:32:03.109 do another test, another, let's say, abdominal 00:32:03.109 --> 00:32:07.559 ultrasound in two years, the chances of having 00:32:07.559 --> 00:32:09.819 pancreatic cancer have gone down quite a bit, 00:32:10.299 --> 00:32:13.279 just based on the full body MRI. So I think with 00:32:13.279 --> 00:32:16.380 technology advancing and technology becoming 00:32:16.380 --> 00:32:22.140 more affordable, a lot of preventable deaths 00:32:22.140 --> 00:32:26.019 will go down. And evidence -based medicine so 00:32:26.019 --> 00:32:29.599 far has been very useful because we went from... 00:32:29.640 --> 00:32:34.019 this is just what my opinion is, or this is what 00:32:34.019 --> 00:32:36.259 this KOL does, or this is how we've always done 00:32:36.259 --> 00:32:38.859 it, to okay, this is what the research shows, 00:32:38.880 --> 00:32:44.740 and this is how we use best practices and the 00:32:44.740 --> 00:32:49.059 best research to harmonize treatment and diagnosis, 00:32:49.319 --> 00:32:52.059 which was absolutely necessary in the 90s and 00:32:52.059 --> 00:32:56.069 up to now. But now with technology going... evolving 00:32:56.069 --> 00:32:59.450 really fast and hopefully costs coming down, 00:33:00.049 --> 00:33:05.109 we can have more useful data and cover edge cases 00:33:05.109 --> 00:33:09.109 more easily. So the rare cancers, but also in 00:33:09.109 --> 00:33:12.329 terms of prevention, we can catch cardiovascular 00:33:12.329 --> 00:33:16.349 disease a little bit early or we can catch cancer. 00:33:17.069 --> 00:33:21.609 We can catch hopefully some autoimmune, we can 00:33:21.609 --> 00:33:24.650 prevent some autoimmune diseases from developing. 00:33:26.399 --> 00:33:31.440 So I think that just having cheaper access to 00:33:31.440 --> 00:33:34.359 diagnostics and wider access to diagnostics is 00:33:34.359 --> 00:33:41.740 gonna help just avoid preventable deaths. Now, 00:33:41.740 --> 00:33:43.920 is that gonna happen right away? No, is that 00:33:43.920 --> 00:33:46.980 gonna be evenly distributed right away? No, but 00:33:46.980 --> 00:33:49.599 that's where I think we are going because just 00:33:49.599 --> 00:33:52.420 looking at the latest meta -analysis and just 00:33:52.420 --> 00:33:56.680 trying to... base our clinical guidelines on 00:33:56.680 --> 00:34:00.720 that, already you've lost, there's a lag, okay? 00:34:01.960 --> 00:34:03.880 And your statistics are what they are, that they're 00:34:03.880 --> 00:34:05.519 gonna cover most patients, but they're still 00:34:05.519 --> 00:34:07.420 gonna be edge cases. So we're gonna have fewer 00:34:07.420 --> 00:34:14.099 edge cases just by having more useful data. And 00:34:14.099 --> 00:34:16.739 there are some examples already of a technology 00:34:16.739 --> 00:34:21.219 really changing. the way diseases at least are 00:34:21.219 --> 00:34:23.360 managed and hopefully in the future are prevented. 00:34:23.579 --> 00:34:26.539 So CGM is already helping with a lot with diabetes 00:34:26.539 --> 00:34:29.920 and you have a lot more data, but it's useful 00:34:29.920 --> 00:34:32.320 data and people are able to titrate their medications 00:34:32.320 --> 00:34:35.219 better and then to have more useful discussions 00:34:35.219 --> 00:34:39.099 with their endocrinologist. So wearables are 00:34:39.099 --> 00:34:42.280 going to give us increasingly more useful information. 00:34:42.820 --> 00:34:46.219 So the Apple watch was just approved for diagnosed 00:34:46.219 --> 00:34:49.750 sleep apnea. it's already been approved to diagnose 00:34:49.750 --> 00:34:53.030 atrial fibrillation. And I've had two of my patients 00:34:53.030 --> 00:34:56.889 get diagnosed themselves with their Apple watch. 00:34:57.650 --> 00:35:02.630 And now I'm excited because sleep apnea affects 00:35:02.630 --> 00:35:05.010 about 10 % of the population. And you go through 00:35:05.010 --> 00:35:12.219 this usual questionnaire that's not very helpful 00:35:12.219 --> 00:35:15.719 to try to figure out whether they have sleep 00:35:15.719 --> 00:35:17.880 apnea or not. And the current standard of care 00:35:17.880 --> 00:35:19.480 is that they just have to go to clinic, pick 00:35:19.480 --> 00:35:22.460 up a machine, take their home, and then send 00:35:22.460 --> 00:35:25.619 the machine back, then see a specialist and then 00:35:25.619 --> 00:35:29.119 have treatment delivered to, or have access to 00:35:29.119 --> 00:35:32.599 treatment. Now they can come directly to me and 00:35:32.599 --> 00:35:35.780 then I can send to see the specialist. If they 00:35:35.780 --> 00:35:38.599 wanna do some more testing, fine, but at least 00:35:38.599 --> 00:35:44.119 it's picked up on time. If you had infinite funding 00:35:44.119 --> 00:35:47.119 to build a startup in this space, how would you 00:35:47.119 --> 00:35:54.019 begin? In the preventative medicine space, you 00:35:54.019 --> 00:35:56.019 know, you could have molecular solutions where, 00:35:56.079 --> 00:35:58.639 you know, just go directly at the mitochondrion 00:35:58.639 --> 00:36:02.360 and then, you know, just reverse aging or stop 00:36:02.360 --> 00:36:05.880 disease at the cellular level. I don't have any 00:36:05.880 --> 00:36:08.019 insight. I don't have a lot of insight into that. 00:36:08.039 --> 00:36:10.619 And I'm glad that people are looking into that. 00:36:11.000 --> 00:36:12.900 But if we're talking about, you know, with what 00:36:12.900 --> 00:36:19.380 we have now, it would be... Would you do like 00:36:19.380 --> 00:36:22.320 a NECO style from Sweden, like which is like 00:36:22.320 --> 00:36:24.559 a clinic or would you do like a function health 00:36:24.559 --> 00:36:28.960 or something that's more, you know, telehealth? 00:36:30.000 --> 00:36:32.000 They're converging. The two are converging because 00:36:32.000 --> 00:36:33.619 function health, I think, just bought a full 00:36:33.619 --> 00:36:38.349 body MRI a startup. So I think we are going in 00:36:38.349 --> 00:36:43.329 that direction. And NECO health is using a lot 00:36:43.329 --> 00:36:47.329 of money. So I think that's where we're going. 00:36:47.630 --> 00:36:52.630 So which means regular blood tests and full body 00:36:52.630 --> 00:36:54.929 scans. I don't know if I would do them every 00:36:54.929 --> 00:36:57.510 year, but you could do maybe full body scans 00:36:57.510 --> 00:36:59.869 every few years and then in between some liquid 00:36:59.869 --> 00:37:02.670 biopsies that work better than what we have right 00:37:02.670 --> 00:37:06.079 now because nothing works really well. from the 00:37:06.079 --> 00:37:09.500 blood test that existed in the market. So I think 00:37:09.500 --> 00:37:12.480 that's, yeah, that's very feasible in the next 00:37:12.480 --> 00:37:14.699 few years until you have the next revolution 00:37:14.699 --> 00:37:21.420 at the molecular level. Let's say I'm a physician, 00:37:21.679 --> 00:37:24.599 you know, I graduated from high school, went 00:37:24.599 --> 00:37:26.980 to undergrad for pre -med, did med school, did 00:37:26.980 --> 00:37:28.960 residency, did fellowship, and I'm attending. 00:37:29.579 --> 00:37:32.139 The only thing I know is medicine. I know nothing 00:37:32.139 --> 00:37:37.110 else. And I have a problem in my workspace and 00:37:37.110 --> 00:37:39.570 I'm thinking, you know, this is a solution that 00:37:39.570 --> 00:37:43.710 could work. And then I come across A16Z and Sequoia 00:37:43.710 --> 00:37:45.869 and I'm excited and I'm like, OK, this looks 00:37:45.869 --> 00:37:49.590 promising. I want to build a startup. How should 00:37:49.590 --> 00:37:53.230 I go about what are some mistakes I'm going to 00:37:53.230 --> 00:37:56.969 make that I can avoid? And what are some mistakes 00:37:56.969 --> 00:37:59.570 I'm just going to make anyways that are unavoidable? 00:38:00.090 --> 00:38:04.269 What advice do you have for this physician? So 00:38:04.269 --> 00:38:08.949 a lot of the physicians that I see are exactly 00:38:08.949 --> 00:38:10.889 that and they tend to be academic physicians 00:38:10.889 --> 00:38:14.710 and they want to build something based on their 00:38:14.710 --> 00:38:18.550 research. And the most common mistake is just 00:38:18.550 --> 00:38:20.690 trying to do everything themselves and trying 00:38:20.690 --> 00:38:25.070 to recruit among either their students or some 00:38:25.070 --> 00:38:28.510 undergrad or someone who doesn't have enough 00:38:28.510 --> 00:38:31.780 expertise. there's a lot of not knowing what 00:38:31.780 --> 00:38:36.179 you do not know. This is the most common problem 00:38:36.179 --> 00:38:38.559 that I see and trying to keep all of the equity 00:38:38.559 --> 00:38:42.539 to yourself and not understanding that this is 00:38:42.539 --> 00:38:46.159 a completely different game. And your skills 00:38:46.159 --> 00:38:50.039 have made you an expert in what you do, but building 00:38:50.039 --> 00:38:53.219 a company going from, so I have good technology 00:38:53.219 --> 00:38:56.500 or good research or maybe even good IP, going 00:38:56.500 --> 00:39:00.550 from that to I have a successful company that 00:39:00.550 --> 00:39:04.670 is a completely different game. And there's ego 00:39:04.670 --> 00:39:08.829 that gets involved here, or there's just ignorance 00:39:08.829 --> 00:39:11.630 of what we don't know, which is normal. We all 00:39:11.630 --> 00:39:14.969 have blind spots. But the number one thing would 00:39:14.969 --> 00:39:17.829 be to build a team around you, understand that 00:39:17.829 --> 00:39:19.809 you don't have commercialization experience. 00:39:20.449 --> 00:39:22.789 You will need someone to take care of technology, 00:39:22.949 --> 00:39:26.489 even if you are the chief scientific officer. 00:39:27.849 --> 00:39:30.849 You need people to build a commercially minded 00:39:30.849 --> 00:39:37.170 team around you. So let's say that you get over 00:39:37.170 --> 00:39:39.389 that. The other thing to understand is that someone 00:39:39.389 --> 00:39:42.809 who worked at a big pharma company and has 20 00:39:42.809 --> 00:39:45.070 years of experience is not necessarily the best 00:39:45.070 --> 00:39:47.409 co -founder for you. You need someone who has 00:39:47.409 --> 00:39:49.449 some technical skills or some commercialization 00:39:49.449 --> 00:39:52.849 experience, but you need someone who understands 00:39:52.849 --> 00:39:55.269 startups and the uncertainty of startups and 00:39:55.269 --> 00:39:58.420 the resilience that's required. and to be able 00:39:58.420 --> 00:40:03.539 to tolerate rejection, whether that's from investors 00:40:03.539 --> 00:40:06.440 or from the initial customers where you're going 00:40:06.440 --> 00:40:13.239 to have setbacks and you're starting on a new 00:40:13.239 --> 00:40:17.519 adventure essentially and then you need the best 00:40:17.519 --> 00:40:20.960 team and you need to realize that your previous 00:40:20.960 --> 00:40:29.190 career has not prepared you for this. If your 00:40:29.190 --> 00:40:33.949 kids came to you and said, dad, I want to be 00:40:33.949 --> 00:40:36.969 an emergent medicine doctor, what would you tell 00:40:36.969 --> 00:40:45.250 them? My kids too. So that would be in 16 years. 00:40:50.530 --> 00:40:55.070 I would say just get a good idea of what it is. 00:40:55.869 --> 00:41:01.110 just go shadow a few emergency physicians and 00:41:01.110 --> 00:41:04.030 then, you know, talk to people who are early 00:41:04.030 --> 00:41:06.110 in their career, talk to people who are late 00:41:06.110 --> 00:41:11.170 in their career, get a feel for, you know, the 00:41:11.170 --> 00:41:18.289 profession and then get a feel for, you know, 00:41:18.829 --> 00:41:24.309 and see if you like it. But I would start the 00:41:24.309 --> 00:41:27.860 real Question here is, is why? Okay. And I'm 00:41:27.860 --> 00:41:29.760 trying to really get to the, what do you like 00:41:29.760 --> 00:41:33.460 about it? What is it that drives you to do this? 00:41:33.760 --> 00:41:36.460 What are your strengths? What are your weaknesses? 00:41:37.019 --> 00:41:40.239 And then is this the only thing that will make 00:41:40.239 --> 00:41:44.739 you happy? I think starting with knowing yourself 00:41:44.739 --> 00:41:54.670 and strengths, weaknesses, ambitions. Interest, 00:41:55.329 --> 00:41:58.170 once you get to know that, I think then you can 00:41:58.170 --> 00:42:01.510 see that there's a lot of ways to be happy or 00:42:01.510 --> 00:42:04.750 to have a successful career or whatever your 00:42:04.750 --> 00:42:07.730 ambition is to make a lot of money or have a 00:42:07.730 --> 00:42:13.389 big impact in society. And once you know yourself, 00:42:14.130 --> 00:42:16.369 you have to identify at least a few solutions. 00:42:16.530 --> 00:42:18.630 It cannot just be, I will be an emergency physician 00:42:18.630 --> 00:42:24.480 or die. identify a few solutions, go try them 00:42:24.480 --> 00:42:27.280 out. If you think emergency medicine is for you, 00:42:27.539 --> 00:42:31.079 go for it. And just because you did it for 10 00:42:31.079 --> 00:42:32.840 years or 12 years doesn't mean that you're married 00:42:32.840 --> 00:42:37.920 to it for life. So that's how I would address 00:42:37.920 --> 00:42:48.539 that. I would say no. That's been my answer for 00:42:48.539 --> 00:42:51.199 a few. for a few years, but my wife tells me, 00:42:51.440 --> 00:42:53.920 no, no, no, she has to walk me back from that. 00:42:54.400 --> 00:42:59.460 So. Yeah, I think my 12 year old, she has an 00:42:59.460 --> 00:43:02.739 interest in science and I can see, and even the 00:43:02.739 --> 00:43:05.320 five year old that they're starting to kind of 00:43:05.320 --> 00:43:09.440 pick on things and starting to go the medical 00:43:09.440 --> 00:43:11.659 route. And I'm trying to kind of sway them away, 00:43:11.900 --> 00:43:16.579 but we'll see if I win that battle. What brings 00:43:16.579 --> 00:43:22.230 you more satisfaction? and joy investing in a 00:43:22.230 --> 00:43:25.409 team that needs coaching or investing in a founding 00:43:25.409 --> 00:43:28.809 team that you just your hands off? Do you think 00:43:28.809 --> 00:43:34.190 the job is to help founders specifically coaching 00:43:34.190 --> 00:43:36.690 with, you know, scaling and team building and 00:43:36.690 --> 00:43:40.150 management of that sort, or is the job to just 00:43:40.150 --> 00:43:41.989 pick the best founders and get out of the way 00:43:41.989 --> 00:43:43.489 and maybe help them a little bit here and there, 00:43:43.489 --> 00:43:51.539 but you're not involved that deeply? No, picking 00:43:51.539 --> 00:43:53.639 the best founders and getting out of their way. 00:43:54.019 --> 00:43:57.440 Like there's not, I don't care to maximize my 00:43:57.440 --> 00:44:00.500 impact on within that team, picking the best 00:44:00.500 --> 00:44:05.139 founders. It's a difficult decision anyway, just 00:44:05.139 --> 00:44:07.920 sometimes just even finding the right team is 00:44:07.920 --> 00:44:10.820 hard. And then let alone doing due diligence 00:44:10.820 --> 00:44:15.719 and then negotiating and everything else that 00:44:15.719 --> 00:44:18.280 goes with the deal. So no, picking the right 00:44:18.280 --> 00:44:21.719 team. getting out of their way, that's absolutely 00:44:21.719 --> 00:44:24.980 fine. Now, if I can help in any way, that's fine, 00:44:24.980 --> 00:44:28.039 but I do not want to be involved in the day -to 00:44:28.039 --> 00:44:30.920 -day. And it doesn't, you know, if you have a 00:44:30.920 --> 00:44:33.579 lot of big portfolio, it's not really realistic 00:44:33.579 --> 00:44:35.340 to say, oh, well, I'm going to help you with 00:44:35.340 --> 00:44:39.059 this and that, or I'm going to be doing part 00:44:39.059 --> 00:44:41.320 of the work. Mind you, over the last six months, 00:44:41.320 --> 00:44:44.760 I have been helping a company, but, so maybe 00:44:44.760 --> 00:44:50.389 that's colored by that, but. No, just it's so 00:44:50.389 --> 00:44:53.269 delightful just getting those updates and things 00:44:53.269 --> 00:44:55.869 are going up into the rights and then, you know, 00:44:55.929 --> 00:45:00.530 this new opportunity that gets unlocked or there's 00:45:00.530 --> 00:45:05.489 interest by this acquirer. That's venture is 00:45:05.489 --> 00:45:10.429 hard enough as it is. So I prefer to have picked 00:45:10.429 --> 00:45:16.429 a good team. If you had to pick out of investing 00:45:16.429 --> 00:45:19.309 in medical device, versus digital health, what 00:45:19.309 --> 00:45:24.469 would you pick? Oh, medical device is hard. So 00:45:24.469 --> 00:45:28.650 definitely digital health. Medical device, you 00:45:28.650 --> 00:45:33.730 have all the technical risk of building something, 00:45:34.030 --> 00:45:35.989 going to regulatory, and then you have to build 00:45:35.989 --> 00:45:39.489 distribution, which is very hard. Which do you 00:45:39.489 --> 00:45:42.210 think is harder, FDA approval or distribution 00:45:42.210 --> 00:45:45.949 and market adoption? I think distribution is 00:45:45.949 --> 00:45:48.960 harder. I think distribution is harder. Interesting, 00:45:49.380 --> 00:45:53.099 because we celebrate FDA approval so much, you 00:45:53.099 --> 00:45:56.519 know, from it almost feels like the startup has 00:45:56.519 --> 00:45:59.920 succeeded post -approval. They haven't, but I 00:45:59.920 --> 00:46:02.119 think that that's what the, and maybe it's because 00:46:02.119 --> 00:46:04.260 both things are so hard, we need to celebrate 00:46:04.260 --> 00:46:07.239 our successes. The only thing that I'm going 00:46:07.239 --> 00:46:12.219 to say here is, oh, you could just get acquired 00:46:12.219 --> 00:46:16.769 as soon as you get your FDA approval, and That's, 00:46:16.789 --> 00:46:21.170 I think that's a great path to exit. There are 00:46:21.170 --> 00:46:23.369 not a lot of players that will acquire you. Okay, 00:46:23.510 --> 00:46:26.349 that's been consolidated to four or five players 00:46:26.349 --> 00:46:30.710 that do acquire a medical device. So you need 00:46:30.710 --> 00:46:32.829 to probably have built some relationship with 00:46:32.829 --> 00:46:35.449 one of them or a few of them from before you 00:46:35.449 --> 00:46:40.110 get your FDA approval. But, you know, selling 00:46:40.110 --> 00:46:43.690 after that, It's hard. Building your Salesforce, 00:46:43.829 --> 00:46:47.869 going after KOLs, that takes a lot of capital, 00:46:48.110 --> 00:46:52.150 a lot of energy, and there's a lot of challenges 00:46:52.150 --> 00:46:55.650 there. And it takes a bit of different skillset 00:46:55.650 --> 00:46:58.409 from the team, because your CTO is not as active, 00:46:58.630 --> 00:47:01.769 the technical team is maybe improving the device 00:47:01.769 --> 00:47:05.849 a little bit, but you need to hire a second team. 00:47:06.710 --> 00:47:11.250 Whereas digital health, faster go -to -markets, 00:47:11.989 --> 00:47:17.210 no defensibility, yes. You may or may not be 00:47:17.210 --> 00:47:22.210 able to be as sticky as a medical device. But 00:47:22.210 --> 00:47:29.150 generally, with AI, with a lot of the inefficiencies 00:47:29.150 --> 00:47:32.849 in healthcare, I find it's a better investment. 00:47:34.030 --> 00:47:36.510 And it definitely fits my background better. 00:47:38.510 --> 00:47:42.550 Is it easier to teach entrepreneurship and business 00:47:42.550 --> 00:47:46.150 to a healthcare expert or physician or to teach 00:47:46.150 --> 00:47:50.570 healthcare to a business or entrepreneurship 00:47:50.570 --> 00:47:55.789 expert? I think it's easier to have help on board, 00:47:56.909 --> 00:48:00.889 to have healthcare expert or healthcare expertise 00:48:00.889 --> 00:48:03.429 to have access to that when you're an entrepreneur. 00:48:04.610 --> 00:48:06.989 Becoming an entrepreneur, there's a lot of... 00:48:06.920 --> 00:48:11.119 personality traits that go with it that you medicine, 00:48:11.380 --> 00:48:15.000 clinical medicine selects out for it and that 00:48:15.000 --> 00:48:18.340 are actively discouraged. So I would prefer an 00:48:18.340 --> 00:48:23.159 entrepreneur who has a great advisor and then 00:48:23.159 --> 00:48:26.139 a few clinicians on his team, leading a team 00:48:26.139 --> 00:48:29.860 as opposed to a physician by himself or I don't 00:48:29.860 --> 00:48:33.739 know, maybe a physician who's well surrounded 00:48:33.739 --> 00:48:36.300 could do it, but generally I would I would invest 00:48:36.300 --> 00:48:40.679 more in an entrepreneur. OK. Last question, Tennessee. 00:48:41.119 --> 00:48:43.820 If you could go back in time and talk to your 00:48:43.820 --> 00:48:46.519 20 -year -old self, what would you tell him? 00:48:49.199 --> 00:48:51.300 One thing is certain things are going to change 00:48:51.300 --> 00:48:53.599 a lot. And you're not going to be able to predict 00:48:53.599 --> 00:49:00.059 how they're going to change. So just stay flexible. 00:49:00.340 --> 00:49:05.019 Just stay flexible. And success is just, you 00:49:05.019 --> 00:49:08.860 know, or happiness going from failure to failure 00:49:08.860 --> 00:49:11.400 without a loss of morale. Just stay flexible, 00:49:11.599 --> 00:49:16.659 stay resilient, and you're gonna end up ahead 00:49:16.659 --> 00:49:19.179 in the end. Thank you.