The physician venture capitalist archetype - Saumitra Thakur (MedMountain Ventures)

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Thanks for joining me today, Sumitra. Really

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excited to have you here. Yo, Rashad. It is good

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to see you. I'm glad to be here. Let's start

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our journey back in 2005. Talk to me about your

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high school days and how you decided to pursue

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neuroscience. 2005? I was 15. I only did nerd

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extracurriculars and incredibly bad JV tennis.

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I think I lost every single game that I ever

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played in three years. Incredibly bad tennis,

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with an incredibly patient coach, speech and

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debate, science research, mock trial, and Science

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Olympiad were my really big extracurriculars,

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speech and debate really being my passion. I

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equivocated a lot on what I wanted my major to

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be when I went to college. I actually originally

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declared classics. And I was very keen to be

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a classics major. The small liberal arts school

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where I went to made a bet that no one who wanted

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to be pre -med would also want to be classics.

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So all the classics language classes conflicted

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with science labs. So I could never actually

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be a classics major. So neuroscience was very

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much a philosophical thing. I always found the

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fact that We're conscious and it feels like something

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to be alive to be the most strange and mysterious

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like thing in the universe and it made me really

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curious about neuroscience as a field because

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it felt like the most important kind of question

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to ask and neuroscience is such a interdisciplinary

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science, it's like very much in applied science.

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And I love the fact that I got to dabble in the

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concepts I was learning in chemistry and physics

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and simple biology and computer science and math,

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all of those in psychology and cognitive psychology

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in particular, like it was a field that had so

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many different kinds of lenses from different

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fields. So for all those reasons, when I did

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go to college, I found all of that very appealing.

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There's a general theory in investing that the

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people who succeed as founders kind of fit this

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persona where they had atypical hobbies in high

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school and in undergrad possibly. Do you find

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that rings through when you diligence founders

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and tell our audience how you spend your days

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now? Do you go deep into their careers and into

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their history and hobbies when they were children

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as well? You know, it's a good question. I'll

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start by where I spend my time. I work part -time

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as a physician, as an internal medicine hospitalist

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at a historic hospital in San Francisco in the

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community, treating a mostly poor local population

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that I'm very, very fond of. I run my VC fund

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full -time at Mountain Ventures, pre -seed seed.

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Uh with brandon another physician we helped build

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the fund several years ago Uh, and that was a

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whole story and we may get into later Uh, and

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in my spare time, uh between my two jobs, uh,

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my wife and I have recently become obsessed with

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surfing Which is our my new version of tennis

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something that I love doing and i'm just absolutely

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terrible at the you know There's I differ from

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a lot of investors. A lot of investors are very

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dogmatic about types and vibes. I'm very much

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a, you know, see people for all their complexity.

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There's many different ways of being right. It

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really matters. You know, is your strategy coherent?

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Is it coherent with my goals? I'm also a really

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big believer that we've had a generation of gut

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check intuitions that are sometimes right. Often

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wrong and there's a lot of money left on the

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table when you over index on those kinds of you

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know gut checks and vibes So for me the psychological

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profile of founder a typical hobby thing If it's

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true, I would find it, you know interesting and

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speaking to a certain pattern of facts But if

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it's wrong, I wouldn't see it as you know, a

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bad thing by any means one of my some of my best

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founders came from resource poor very strict,

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uh, childhoods overseas, where if they had any

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atypical hobbies, they would have been met with

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a slap on the face, not with, you know, praise

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and validation. And they're incredibly, you know,

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serious, competent, well adjusted, you know,

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living life of mind founders now, but they didn't

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have that particular story. And that makes sense.

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Given their background, it wouldn't be what I

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would expect for them. So I see it as my general,

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my short answer is, I don't think of it in that

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way. But my larger answer is the way I like to,

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I always like to see people not as just themselves,

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but like a whole pattern. And I like to keep

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an open mind about all the different ways and

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shapes and sizes those patterns could be that

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could be coherent. Mindful it may not be the

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kind that fits the sort of patterns that I had

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when I grew up. We'll go back to your undergrad

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days soon. There's a lot of talk in the big VC

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firms that AI will replace a lot of jobs, but

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it's never their job it will replace. It will

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replace all the other jobs of mine. Do you agree

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with that statement? And then I'll kind of going

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back to your work as a hospitalist as well. Do

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you think AI will replace a hospitalist or a

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VC's job first? Great questions In both, you

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know, there's a commonality with both in both

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you have someone who exercises judgment and sits

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with liability and There's institutional value

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if nothing else in having an individual who sits

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with liability as opposed to having You know

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kind of like, you know faceless liability. There's

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something about you know, the buck stops with

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someone someone is on the hook and they respond.

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They're on the hook for it. And because of that,

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the system kind of pays them mostly for that.

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I see a lot of clerical things that I do in the

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hospital as an internal medicine hospitalist

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really is like the system being like, we need

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someone to do this. Who sits with liability?

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Who oversees it? Because they make even better

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judgments than if that person were out of the

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loop. For structural reasons, I think that there's

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value in having some number of people. I see

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it less as the zero, like the one job going to

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zero is. always very hard. It becomes like one

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of those asymptotes where it just exponentially

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takes off. I see it as more like you may have

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100, but maybe you could get by with 80, maybe

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you could get by with 60, maybe you could get

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back with 40. Could you make that one person

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far more efficient? Instead of zero radiologists,

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if you have one radiologist doing the work of

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1 .4 radiologists, that's still a radical subversion

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of the status quo. And that one is much more

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achievable. I could see it that way. On the hospital

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side, there are parts of my job that with really

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good automation, I could greatly scale away.

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The most time consuming part of my job is the

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sitting at the bedside, holding hands and crying

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part of my job. The meeting people on the worst

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day of their lives, being there, navigating people,

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complex situations, being like, you know, this

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old person with dementia lives alone. They have

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a daughter who they abandoned when they were

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two. They have a landlord who like kind of shows

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up and helps them out. The landlord and the daughter

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disagree. Who do I make the surrogate decision

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maker? Like, you know, who do I turn to to represent

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the interests of this person? It's like stuff

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like that takes up most. I think also I work

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in a really socially complex population. So this

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may not be like a representative answer of what

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doctors do. This mainland is strange to many

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people listening. Like, what does this do doing?

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Like, what? But anyways, it's like, these are

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like the arts of my job. And those are harder

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things to automate. You could have an advanced

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AI solution. Do it. Even a perfect solution would

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probably just not land as credible in the same

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way. So on the hospital side, maybe one hospitalist

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can do the work of 1 .4 hospitalists in the future.

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Would it go to zero? I don't think so. There's

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a certain kind of top -year license craft intuition

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thing that you do. On the VC side, it's interesting.

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You sent me this message about quantitative trading

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a few days ago. And I've been thinking a lot

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about that. I think it depends on What is the

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kind of transaction you do? How much ambiguity

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are you assuming? How liquid is the market? What

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are the stakes of being wrong? If I were a high

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frequency trader, it would be much easier to

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replace me with a machine. And it's sort of a

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silly thing to say because high frequency traders

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are machines. Like they're essentially people

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who program machines like humans can't do that

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kind of asset trading anymore. But it's essentially

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extremely low transaction cost, super high information

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transactions, where if you're wrong in a microsecond,

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you liquidate your entire holdings. VC transactions

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are like super high ambiguity. They often involve

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doing things that are unprecedented and never

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seen before. So if you template match off what

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existed before, you may get mismatches, and it's

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extremely illiquid. So it's harder to do. In

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terms of not going from one to zero, but one

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person doing the work of 1 .5, the amount of

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time I've spent doing admin, overhead, clerical,

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et cetera, is exponentially lower today than

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it was a year ago, because we built a whole bunch

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of internal AI -based workflows. Sorry, Rashad.

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You asked for tight answers, and here I am giving

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long essays. Please forgive me. Let's stick with

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this. Something I've been thinking about is what

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patterns can I recognize with founders? And I've

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been debating with putting and maybe putting

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founders through is not the right terminology

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because I would be asking them and they can say

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no. Psychological tests and some validated some

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not like Myers -Briggs and Enneagrams and other

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forms of psychological testing and seeing if

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I can find patterns on what archetype makes the

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best founder. Now, I know this goes against vibe

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investing or, you know, I like this founder,

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they can sell. I don't know why they can sell.

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I don't know why I like them. They're just a

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charming person. Do you think there is an avenue

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and are you doing this trying to break down what

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founder charm means? and really trying to analyze

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that and trying to figure out quantitative patterns

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that then you can use to say, all the founders

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who apply to my fund do this test and then you

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have a filter before you speak to the founder.

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In terms of psychometrics, one of the things

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I really appreciate about neuroscience and also

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all the psychology classes I took was doing a

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really deep dive on the academic rigor, the face,

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and other kinds of validity for different kinds

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of psychometric tests. I would argue that most

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of our psychometric tests, the very best psychometric

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tests we have, Are not great. There's no universal

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test. They tend to be very culturally specific

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They tend to be like they tend not to generalize

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well over time The rigor of evidence behind them

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tends to be poor a lot of them come from a particularly

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bad era of like psychology research That was

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kind of bogus and bunk. So I see them as very

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flawed tools It's okay to use flawed tools. We

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do this in science all the time where we're like,

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you know, our measure is flawed. We know how

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it's flawed. So we can still use it in an effective

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way. If it's a final thought or a final part

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of a conversation, I would warn against that

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kind of workflow. I think that you would leave

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a lot of money on the table, filter out a lot

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of people. If it's like the start of a conversation

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and it surfaces things, I think in that way would

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be useful. And I'll toss out something strange

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and this is going to sound very flippant, but

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I really love tarot. I have this little tarot.

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app on my you know like tarot cards those like

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you know like i really enjoyed it my wife and

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i were bored sometime in the pandemics we like

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you know got really into this deep dive of tarot

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and tarot i like because you know objectively

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and i say this in candor this may offend people

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although i doubt the people who listen to your

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podcast You know, Tarot is bogus, but it's sort

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of fun because you flip something and you're

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like, you know, this is death upside down and

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it corresponds to this very kind of like vague

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and strange thing. But then I'm like, you know,

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I never really thought about vague and strange

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things that applies to like this decision, but

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it's just like a radically different point of

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view and a very strange one for me to revisit

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this thing that I'm thinking through. And sometimes,

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you know, just randomly flipping Tarot and taking

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a really weird point of view and being like,

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oh, Like I didn't think of this decision with

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these considerations, but just getting out of

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my head and getting into a radically different

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framework, you know, it surface stuff. I see

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that as an example of it's okay to use flawed

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tools. If you see the flaws and you use it as

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starting a conversation, like, you know, MBTI

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is great. If you get like an ENTJ or something

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and you're like, you know, this person, perhaps

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they're gruff, perhaps they're confident. Maybe

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they're overconfident. I'm curious to see, you

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know, what do they think about this? What do

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I learn about? I do some amount of, you know,

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psychological pinging when I diligence, but for

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me it's much more like how do you and I disagree?

00:13:47.019 --> 00:13:49.600
How do you and I have conflict? If I have a point

00:13:49.600 --> 00:13:51.740
of view and you have a point of view, you know,

00:13:51.879 --> 00:13:55.090
do I have influence with you? Are you like, when

00:13:55.090 --> 00:13:57.549
you have a thought process, how do you communicate?

00:13:58.350 --> 00:14:01.389
How are you in conflict? How are you with pushback?

00:14:01.730 --> 00:14:03.789
How do you treat people on your team? What are

00:14:03.789 --> 00:14:06.049
your internal dynamics? Those are some of the

00:14:06.049 --> 00:14:08.429
psychological factors that I probe. But I see

00:14:08.429 --> 00:14:10.990
it as very much there's no necessarily best pattern.

00:14:11.490 --> 00:14:13.669
Really, it's like, is your pattern effective

00:14:13.669 --> 00:14:16.070
for the sort of larger strategy that you're taking?

00:14:18.269 --> 00:14:21.389
Neuroscience, I think, is a very academic field.

00:14:21.809 --> 00:14:25.129
And you can break down our brain. And I think

00:14:25.129 --> 00:14:27.769
the science in this has changed recently in different

00:14:27.769 --> 00:14:30.970
pathways and cortical tracks. And this is what

00:14:30.970 --> 00:14:32.710
this does. This part of the brain is responsible

00:14:32.710 --> 00:14:36.850
for this. Political science, I would say, is

00:14:36.850 --> 00:14:41.250
on the opposite spectrum, where it's more about

00:14:41.250 --> 00:14:43.789
people and how you interact with people. How

00:14:43.789 --> 00:14:48.730
can you grow movement? I'm sure that the science

00:14:48.730 --> 00:14:51.389
part of political science is challenged at times.

00:14:52.850 --> 00:14:55.909
How did you go from neuroscience to political

00:14:55.909 --> 00:14:59.190
science? Or is it more streamlined than I'm making

00:14:59.190 --> 00:15:03.710
it out to be? When I was in college, I did a

00:15:03.710 --> 00:15:07.090
lot of student organizing, student union stuff.

00:15:07.129 --> 00:15:09.070
It was also the financial crisis. So a lot of

00:15:09.070 --> 00:15:11.710
stuff was going on. I'd see it less as it was

00:15:11.710 --> 00:15:14.269
something that I did and more just that the world

00:15:14.269 --> 00:15:17.090
happened to us. 2008 happened, budget cutbacks

00:15:17.090 --> 00:15:19.850
happened. I was at a college with a very progressive

00:15:19.850 --> 00:15:21.990
approach to financial aid. And there was this

00:15:21.990 --> 00:15:24.309
tension between faculty who said, don't, you

00:15:24.309 --> 00:15:26.509
know, stop hiring like the best faculty and paying

00:15:26.509 --> 00:15:28.750
them well. You know, maybe consider not being

00:15:28.750 --> 00:15:30.929
so like extremely generous. with your financial

00:15:30.929 --> 00:15:33.169
aid is like another area to cut. So we had a

00:15:33.169 --> 00:15:35.289
lot of moral gazing about, you know, what is

00:15:35.289 --> 00:15:37.429
the mission of this institution? What is important?

00:15:37.649 --> 00:15:39.370
How do we treat like, you know, the vulnerable?

00:15:39.490 --> 00:15:41.350
How do we see these things? It was one of those

00:15:41.350 --> 00:15:44.090
things where, you know, just like. It wasn't

00:15:44.090 --> 00:15:46.509
that I sought it out, but the world happened.

00:15:46.990 --> 00:15:50.370
And I'm very sympathetic to free societies. It

00:15:50.370 --> 00:15:53.690
was like 2011, 2012. Stuff was going on in Russia,

00:15:53.990 --> 00:15:55.629
like young people were going on the streets and

00:15:55.629 --> 00:15:58.549
protesting. Stuff was going on in Myanmar. Arab

00:15:58.549 --> 00:16:01.250
Spring was starting to kindle. There was one

00:16:01.250 --> 00:16:04.169
round of... Iran protests, there's a lot of interesting

00:16:04.169 --> 00:16:07.889
things happening globally. People who look like

00:16:07.889 --> 00:16:11.870
me and you at that time were going and, you know,

00:16:12.029 --> 00:16:14.009
being willing to be gunned down or have acid

00:16:14.009 --> 00:16:15.870
thrown in their face or all kinds of horrible

00:16:15.870 --> 00:16:18.730
stuff. So I got really into I spent this period

00:16:18.730 --> 00:16:21.429
of my life thinking, you know, how do I build

00:16:21.429 --> 00:16:23.970
organizations and influence and kind of find

00:16:23.970 --> 00:16:26.490
like key people and elites and like, you know,

00:16:26.610 --> 00:16:29.679
get them resources and back them? I saw that

00:16:29.679 --> 00:16:31.659
is a lot of stuff that just sort of happened

00:16:31.659 --> 00:16:34.240
and I fell into it. I didn't go towards it. But

00:16:34.240 --> 00:16:36.799
when I was in there, it really introduced me

00:16:36.799 --> 00:16:38.799
to these frameworks of, and I think this is what

00:16:38.799 --> 00:16:40.340
you're talking about when you say political science,

00:16:40.519 --> 00:16:42.960
political risk and political economy. Political

00:16:42.960 --> 00:16:45.480
risk is thinking for any kind of industry, any

00:16:45.480 --> 00:16:48.000
kind of business, any kind of anything. You know,

00:16:48.019 --> 00:16:50.879
how does the political situation matter? And

00:16:50.879 --> 00:16:53.840
political economy is any country or any sector

00:16:53.840 --> 00:16:56.379
where it doesn't matter necessarily, like how

00:16:56.379 --> 00:16:59.399
good markets are, et cetera. It's like the role

00:16:59.399 --> 00:17:01.659
of government is just so incredibly powerful.

00:17:01.860 --> 00:17:03.519
So if you're in like a very corrupt country,

00:17:03.340 --> 00:17:05.099
It's all political economy. It doesn't matter

00:17:05.099 --> 00:17:07.559
how good your idea is. It's like, but how do

00:17:07.559 --> 00:17:10.440
you get it through your local ministry that you

00:17:10.440 --> 00:17:14.960
have to deal with? And how do you navigate that?

00:17:15.160 --> 00:17:19.480
In health care, it's all political economy. All

00:17:19.480 --> 00:17:21.480
costs are driven by political economy. All revenues

00:17:21.480 --> 00:17:23.740
are driven by political economy. And it's very

00:17:23.740 --> 00:17:26.740
much understanding. How do you see the balance

00:17:26.740 --> 00:17:28.660
of power between different stakeholders? How

00:17:28.660 --> 00:17:31.299
does it change over time? How do you see the

00:17:31.299 --> 00:17:33.299
government's point of view on antitrust creating

00:17:33.299 --> 00:17:35.960
windows and weaknesses? A lot of the political

00:17:35.960 --> 00:17:38.819
stuff that I did unintentionally just because

00:17:38.819 --> 00:17:42.279
the world swept me up in it way back when, it

00:17:42.279 --> 00:17:44.859
gave me this sensibility that I found very helpful

00:17:44.859 --> 00:17:49.839
as a health care investor. Early on, and I'm

00:17:49.839 --> 00:17:52.400
not that I'm only I've only been investing for

00:17:52.400 --> 00:17:55.500
almost three years now. When I started, I would

00:17:55.500 --> 00:17:58.819
I would have these future maps in my head. I

00:17:58.819 --> 00:18:00.660
would say this is where the health care world

00:18:00.660 --> 00:18:03.880
is going. And this is what the market needs.

00:18:04.339 --> 00:18:06.640
I'm going to define this product I'm looking

00:18:06.640 --> 00:18:10.119
for in epigenetics as one of them and home care.

00:18:10.339 --> 00:18:12.799
Hospital home care was another one. And then

00:18:12.799 --> 00:18:15.380
I'm going to go out and find the best founders

00:18:15.380 --> 00:18:18.460
working in these specific niches. Currently,

00:18:18.460 --> 00:18:20.160
what I'm looking for is a founder working on

00:18:20.160 --> 00:18:22.420
an end -to -end solution for inbox management.

00:18:23.099 --> 00:18:26.359
And I still find myself pre -defining the market,

00:18:26.880 --> 00:18:29.880
which I'm looking for. There's another train

00:18:29.880 --> 00:18:32.539
of thought, and this is a more popular one. As

00:18:32.539 --> 00:18:34.920
long as the founder is building something in

00:18:34.920 --> 00:18:38.519
health, I will back the best founder I can find.

00:18:39.160 --> 00:18:43.299
I will deviate from my thesis of markets I'm

00:18:43.299 --> 00:18:45.039
looking for, and I would just go for the best

00:18:45.039 --> 00:18:49.700
founders. Do you have these mind maps where you're

00:18:49.700 --> 00:18:52.779
looking for these opportunities, and I just want

00:18:52.779 --> 00:18:54.779
to find the best person who's building in this?

00:18:55.299 --> 00:18:58.599
Or are you just generally, as long as it has

00:18:58.599 --> 00:19:00.900
the word health in it, I just want the best founder

00:19:00.900 --> 00:19:06.279
building in health care as a whole? I think that's

00:19:06.279 --> 00:19:09.519
a very good question. I would say our approach

00:19:09.519 --> 00:19:12.150
is very much the second. Because when we raise

00:19:12.150 --> 00:19:15.109
these funds, we have these predefined investment

00:19:15.109 --> 00:19:17.829
periods. So I have like three years, five years.

00:19:18.170 --> 00:19:20.710
So I have to get most of my first checks out

00:19:20.710 --> 00:19:23.490
during this pre -specified time. So there's this

00:19:23.490 --> 00:19:26.710
thing of what is the best, the most interesting

00:19:26.710 --> 00:19:29.509
that I'm seeing right now. But with that said,

00:19:29.710 --> 00:19:32.130
how we rank what the best health care idea is,

00:19:32.349 --> 00:19:35.519
if we do the second strategy, it really requires

00:19:35.519 --> 00:19:38.339
doing the first strategy. Like if you were to

00:19:38.339 --> 00:19:40.619
go out and say, who has the most credible health

00:19:40.619 --> 00:19:43.769
care ideas right now? It's often not like in

00:19:43.769 --> 00:19:45.730
our sector. It's like I think the real winner

00:19:45.730 --> 00:19:47.029
I've been thinking a lot about this like the

00:19:47.029 --> 00:19:50.309
real winners in our sector long term They don't

00:19:50.309 --> 00:19:52.329
win just based on like, you know, I'm making

00:19:52.329 --> 00:19:54.690
money or like money is going up month over month

00:19:54.690 --> 00:19:57.609
They're doing something like weird and strategic

00:19:57.609 --> 00:20:00.490
and like subversive in a very like long -term

00:20:00.490 --> 00:20:02.710
visionary way So if you were to go out and be

00:20:02.710 --> 00:20:04.509
like, what is the best health care company being

00:20:04.509 --> 00:20:07.190
built right now? Doing the second approach you'd

00:20:07.190 --> 00:20:09.150
still probably be executing the first approach

00:20:09.150 --> 00:20:11.049
where you're like hospital at home is where the

00:20:11.049 --> 00:20:13.619
puck is going I have conviction on that, like

00:20:13.619 --> 00:20:15.960
enabling technologies today, like those will

00:20:15.960 --> 00:20:17.920
be the best value companies today, they're going

00:20:17.920 --> 00:20:20.920
to be worth a ton of money in the imminent future.

00:20:21.099 --> 00:20:22.920
Like that's like the best most rational place

00:20:22.920 --> 00:20:25.559
for me to invest. How does that land on you,

00:20:25.660 --> 00:20:32.240
Rashad? Yeah, I think I have under index for

00:20:32.240 --> 00:20:34.299
how much the founder matters. And this may sound

00:20:34.299 --> 00:20:36.720
funny because you hear all the time, the founder

00:20:36.720 --> 00:20:41.369
is the most important thing. But given my somewhat

00:20:41.369 --> 00:20:44.349
rebellious thought nature, I inherently want

00:20:44.349 --> 00:20:46.470
to think against what everyone else is saying.

00:20:47.430 --> 00:20:49.849
And sometimes I think what everyone else is saying

00:20:49.849 --> 00:20:54.670
is right. Being consensus correct is easy to

00:20:54.670 --> 00:20:57.710
do. Going against the consensus of being correct

00:20:57.710 --> 00:21:01.970
is very difficult and usually you're wrong. So

00:21:01.970 --> 00:21:04.130
I'm changing my mind there and this is kind of

00:21:04.130 --> 00:21:07.269
just born out of experience. I've invested in

00:21:07.289 --> 00:21:09.490
in startups, and I'm not going to name names

00:21:09.490 --> 00:21:12.089
with amazing products, you know, this product

00:21:12.089 --> 00:21:15.849
is at that point, at least, I would say, five

00:21:15.849 --> 00:21:18.769
times better than anything else out there. But

00:21:18.769 --> 00:21:21.769
the founder conviction and specifically founder

00:21:21.769 --> 00:21:24.049
charm and this this I don't like that this is

00:21:24.049 --> 00:21:27.950
the truth that founder charm matters so much

00:21:27.950 --> 00:21:31.730
because I like to think substance and the product

00:21:31.730 --> 00:21:35.700
should matter more than salesmanship. But I'm

00:21:35.700 --> 00:21:38.259
starting to realize and I have realized salesmanship

00:21:38.259 --> 00:21:42.720
matters a lot more. So, you know, I've changed

00:21:42.720 --> 00:21:48.680
my thinking on this and I am more indexing for

00:21:48.680 --> 00:21:52.720
the ability to sell and just finding the best

00:21:52.720 --> 00:21:55.640
founder, right? If I have these predefined market

00:21:55.640 --> 00:21:58.680
maps and I can't find the best founder or no

00:21:58.680 --> 00:22:01.400
amazing founders building in them, then that's

00:22:01.400 --> 00:22:03.940
okay. I will just go for the best founder. And

00:22:03.940 --> 00:22:05.940
they will teach me about the market and where

00:22:05.940 --> 00:22:09.099
the world is going. And that's a little bit of

00:22:09.099 --> 00:22:11.740
ego because I like to believe because I'm a physician,

00:22:11.819 --> 00:22:14.059
because I'm thinking about this a lot, I can

00:22:14.059 --> 00:22:16.819
see where the world is going. But I think being

00:22:16.819 --> 00:22:20.180
a people picker and not a market picker is probably

00:22:20.180 --> 00:22:23.400
the better way to do this. You know, it's a good

00:22:23.400 --> 00:22:28.500
question. I was at dinner with a couple of the

00:22:28.500 --> 00:22:32.240
physician VCs in San Francisco and one of them

00:22:32.240 --> 00:22:35.960
who I believe is a mutual friend. We were just

00:22:35.960 --> 00:22:38.039
talking about what we do. And I said, we tend

00:22:38.039 --> 00:22:40.920
to be super hands -on. We love finding founders

00:22:40.920 --> 00:22:43.059
where we're like, this founder can grow to be

00:22:43.059 --> 00:22:45.299
a world -class executive. We can help get them

00:22:45.299 --> 00:22:47.640
there. And because we helped build them, we invested

00:22:47.640 --> 00:22:50.619
a great valuation now. We're specialists is what

00:22:50.619 --> 00:22:52.640
we do. We pick up the phone, we help, we coach,

00:22:52.779 --> 00:22:54.859
we mentor. It's what gives me joy. And I will

00:22:54.859 --> 00:22:57.000
make this person a total baller. It's going to

00:22:57.000 --> 00:22:59.259
be great. Like that's a good formula. And this

00:22:59.259 --> 00:23:01.759
person is like, I only choose founders who I

00:23:01.759 --> 00:23:04.059
never have to help again. I am a zero value add

00:23:04.059 --> 00:23:06.799
investor by design. Our founders have to be so

00:23:06.799 --> 00:23:09.779
good. They never need help for anything. And

00:23:09.779 --> 00:23:14.220
it was just such a fun and bombastic and wild

00:23:14.220 --> 00:23:18.809
point of view that It was it definitely had an

00:23:18.809 --> 00:23:22.569
impact on me for what it's worth I See it is,

00:23:22.569 --> 00:23:26.210
you know our sector It's not enough just to build

00:23:26.210 --> 00:23:28.589
the best product in our sector Our sector is

00:23:28.589 --> 00:23:33.349
so busted and super corrupt and crazy that you

00:23:33.349 --> 00:23:37.819
have to be it really helps to have good If deeply

00:23:37.819 --> 00:23:40.440
favors insiders, it helps to have some kind of

00:23:40.440 --> 00:23:43.799
insider ability to navigate. Or at least if you're

00:23:43.799 --> 00:23:46.259
a total outsider, have a certain kind of super

00:23:46.259 --> 00:23:48.480
sophistication to be able to navigate and execute

00:23:48.480 --> 00:23:51.039
in our field. Like too many super smart people,

00:23:51.440 --> 00:23:53.579
totally outsiders, actually build the thing that's

00:23:53.579 --> 00:23:56.039
very important. But it's not in dialogue with

00:23:56.039 --> 00:23:57.940
the health care system as it is. And it can't

00:23:57.940 --> 00:24:00.740
be influential if it's not. So I see a lot of

00:24:00.740 --> 00:24:06.579
value in Like when I look for a really good founder,

00:24:06.779 --> 00:24:08.960
I want to make sure that they can be effective

00:24:08.960 --> 00:24:12.660
in the world as it is. I see it as if they have

00:24:12.660 --> 00:24:15.559
deficiencies, I think of it as are these things

00:24:15.559 --> 00:24:17.539
that I can help with? Can I round it out with

00:24:17.539 --> 00:24:19.740
a key hire? Can I round it out with mentorship?

00:24:20.440 --> 00:24:21.920
Is it the kind of thing where I have influence,

00:24:21.960 --> 00:24:24.130
I don't have influence? But that's also part

00:24:24.130 --> 00:24:25.809
of an investment strategy where I actually like

00:24:25.809 --> 00:24:27.650
to be really hands on. I like to be like, you

00:24:27.650 --> 00:24:29.950
know, super domainy. Like, you know, it's part

00:24:29.950 --> 00:24:31.849
of how I source. It's part of how I get into

00:24:31.849 --> 00:24:33.750
the best deals of the deals that I get into.

00:24:33.890 --> 00:24:36.349
It's part of how I build my relationship and

00:24:36.349 --> 00:24:38.509
my brand. It's part of the promise I make LPs.

00:24:38.690 --> 00:24:41.450
So I would say it's a very reasonable strategy.

00:24:41.609 --> 00:24:44.170
It's coherent for me and our colleague, the one

00:24:44.170 --> 00:24:46.509
who's like, I never help people, you know, like

00:24:46.509 --> 00:24:48.250
they can get bent after I give them a check,

00:24:48.289 --> 00:24:51.069
just go make money. You know, his strategy works

00:24:51.069 --> 00:24:52.650
for him because that's like totally the way.

00:24:52.680 --> 00:24:55.700
does he's like only moonshots it's either you

00:24:55.700 --> 00:24:59.539
know 100x or 0x he doesn't want 5x like you know

00:24:59.539 --> 00:25:01.960
and he just wants to like you know spray and

00:25:01.960 --> 00:25:04.480
pray and that's also a totally valid coherent

00:25:04.480 --> 00:25:07.240
strategy i think where it goes wrong is if you

00:25:07.240 --> 00:25:10.710
mix and match like if you You know, spray and

00:25:10.710 --> 00:25:13.509
pray, but then you spend too much time trying

00:25:13.509 --> 00:25:15.710
to be value -add with a financial strategy that

00:25:15.710 --> 00:25:17.529
doesn't support you in being value -add. You

00:25:17.529 --> 00:25:20.069
know, it doesn't work. Or in turn, if I do a

00:25:20.069 --> 00:25:21.970
lot of, like, prospective bets where, like, this

00:25:21.970 --> 00:25:24.670
person could pop and I have a lot of concentrated

00:25:24.670 --> 00:25:26.670
risk that they can pop and then I do nothing

00:25:26.670 --> 00:25:29.170
to help them pop, it's like a bad execution of

00:25:29.170 --> 00:25:32.069
my strategy. So I'd say the behavior could be

00:25:32.069 --> 00:25:33.829
a good behavior or bad behavior. It really depends

00:25:33.829 --> 00:25:35.789
on how does it fit into, like, you know, a whole

00:25:35.789 --> 00:25:40.680
scheme. If a company like OpenEvidence came to

00:25:40.680 --> 00:25:43.500
you and offered you something in their next round,

00:25:44.299 --> 00:25:46.299
would you invest in them? So a company that's

00:25:46.299 --> 00:25:48.039
growing, that has the potential to grow quite

00:25:48.039 --> 00:25:51.579
a bit more. But in the general thesis of things,

00:25:52.140 --> 00:25:55.259
it's a little bit too big. They're already valued

00:25:55.259 --> 00:25:58.470
over a billion. Would you invest in them? You

00:25:58.470 --> 00:26:01.849
know, if it was a company with excellent fundamentals,

00:26:01.950 --> 00:26:04.289
evaluation that I could believe, and it was,

00:26:04.289 --> 00:26:07.470
you know, a deal that I would love, and it was

00:26:07.470 --> 00:26:09.430
totally out of scope for the fund, what I would

00:26:09.430 --> 00:26:11.849
do is not invest out of the fund, but I'd go

00:26:11.849 --> 00:26:15.069
to my LPs and say, listen, it's out of scope

00:26:15.069 --> 00:26:18.289
of the fund. I'm not doing you dirty by not investing

00:26:18.289 --> 00:26:21.420
your fund money in this. because I made a promise

00:26:21.420 --> 00:26:23.259
for how I would spend that. This is out of scope.

00:26:23.720 --> 00:26:26.400
But this deal is on the table. I'll go to Insiders

00:26:26.400 --> 00:26:30.160
first. If you're interested, we can get you access.

00:26:30.220 --> 00:26:32.400
We can create the vehicle to do it. I would first

00:26:32.400 --> 00:26:34.980
make sure it's out of scope. If it's totally

00:26:34.980 --> 00:26:36.960
out of scope, I'd go to my current fund LPs.

00:26:37.259 --> 00:26:39.740
Then I go to all my firm LPs. And then I would

00:26:39.740 --> 00:26:42.500
go to just friends and others in the ecosystem

00:26:42.500 --> 00:26:45.819
in that order. I feel like that's the honest,

00:26:45.839 --> 00:26:48.319
fiduciary thing to do if a really good deal comes

00:26:48.319 --> 00:26:50.880
by. How do you think about it? What is your take?

00:26:53.160 --> 00:26:55.079
Yeah, to be frank with you, I've been struggling

00:26:55.079 --> 00:26:57.640
with this question because I'm sort of dealing

00:26:57.640 --> 00:27:00.880
with it right now. And I like your answer because

00:27:00.880 --> 00:27:07.240
I don't think it's fair to my investors to not

00:27:07.240 --> 00:27:09.819
present that opportunity and not invest in it

00:27:09.819 --> 00:27:14.019
myself, given that I believe that there is room

00:27:14.019 --> 00:27:16.789
for a considerable more growth. And it's a great

00:27:16.789 --> 00:27:19.269
company to invest in a great mission to back.

00:27:20.890 --> 00:27:24.109
Yeah, so I'm kind of on board here where I think

00:27:24.109 --> 00:27:27.089
it's fair. Now, given the question then becomes

00:27:27.089 --> 00:27:29.369
with your investors come back to you said, you

00:27:29.369 --> 00:27:32.470
know, I already invested in the fund. Can you

00:27:32.470 --> 00:27:36.569
invest in this company out of the fund? Because

00:27:36.569 --> 00:27:39.269
my fiduciary duty is to the investors. That's

00:27:39.269 --> 00:27:42.730
something I think I would be open to. How would

00:27:42.730 --> 00:27:46.440
you deal with that request from your LPs? I you

00:27:46.440 --> 00:27:48.460
know, we're going through fun creation right

00:27:48.460 --> 00:27:51.380
now. So we spent a lot of time doing some philosophical

00:27:51.380 --> 00:27:56.240
reflection I would see it this way our I would

00:27:56.240 --> 00:28:00.440
see it is is it Discretionary, is there a wiggle

00:28:00.440 --> 00:28:03.359
room or not? If there's wiggle room based on

00:28:03.359 --> 00:28:07.180
the fund mandate what we promised etc If there's

00:28:07.180 --> 00:28:09.140
wiggle room, then I would consider taking it

00:28:09.140 --> 00:28:12.240
to an LPAC like an LP advisory committee And

00:28:12.240 --> 00:28:15.980
I would say this deal, it's sort of bending our

00:28:15.980 --> 00:28:19.480
scope, but it's not crazy out of scope. What

00:28:19.480 --> 00:28:20.740
do you think? What do you think? It's a good

00:28:20.740 --> 00:28:23.059
opportunity. The LPs want it. What do you think?

00:28:23.440 --> 00:28:25.440
And I would use the LPAC as a way for LPs to

00:28:25.440 --> 00:28:27.720
have influence to make the decision. If it's

00:28:27.720 --> 00:28:30.259
widely out of scope, It sounds tough, but I would

00:28:30.259 --> 00:28:32.900
tell them, you know, people made a bet on us

00:28:32.900 --> 00:28:35.140
and they expect their money. I think of it as

00:28:35.140 --> 00:28:37.079
Gaussians, like a portfolio is really a bunch

00:28:37.079 --> 00:28:39.500
of Gaussians that behave in different ways and

00:28:39.500 --> 00:28:42.059
correlate to different things. And what we did

00:28:42.059 --> 00:28:44.660
is we promised to be one certain kind of Gaussian

00:28:44.660 --> 00:28:48.210
for people's portfolios. And we owe it to them

00:28:48.210 --> 00:28:50.650
to behave as we promise them. That's what gives

00:28:50.650 --> 00:28:52.750
them predictability. That's what gives them success.

00:28:53.250 --> 00:28:55.950
I could easily get into trading corn futures.

00:28:56.089 --> 00:28:57.990
And honestly, depending on what's going on with

00:28:57.990 --> 00:28:59.490
tariffs and stuff, corn futures are probably

00:28:59.490 --> 00:29:01.470
a really good idea right now. I could totally

00:29:01.470 --> 00:29:03.670
get into trading corn futures, and I could totally

00:29:03.670 --> 00:29:08.490
make some good money. I saw this crypto bankruptcy.

00:29:09.079 --> 00:29:11.579
Debt transaction come across my desk that was

00:29:11.579 --> 00:29:13.839
extremely attractive and had absolutely zero

00:29:13.839 --> 00:29:16.700
relevance and people made some kind of crazy

00:29:16.700 --> 00:29:19.980
5x 6x return very quickly doing this bankruptcy

00:29:19.980 --> 00:29:23.319
transaction on this Notable recent crypto company

00:29:23.319 --> 00:29:25.619
that went down and it was a really cool deal

00:29:25.619 --> 00:29:27.359
and it was just so widely out of scope It would

00:29:27.359 --> 00:29:29.660
be like wrong for me and the Gaussian behavior.

00:29:29.660 --> 00:29:32.720
I promised my LPs if I did make money, but I

00:29:32.720 --> 00:29:34.990
did it in a way that was like, you know a risk

00:29:34.990 --> 00:29:37.329
profile and a bet that's like way wild from what

00:29:37.329 --> 00:29:39.589
I promised. So that's how I'd see it. If it was

00:29:39.589 --> 00:29:41.910
plausible to get to LPAC, if it's not plausible,

00:29:42.349 --> 00:29:46.029
it sounds tough to say, but I'd say, you know,

00:29:46.049 --> 00:29:47.950
it's not right. It's not right. We're not being

00:29:47.950 --> 00:29:50.109
a good fiduciary to all of our LPs. If we do

00:29:50.109 --> 00:29:52.789
this, even if some LPs want, what I would tell

00:29:52.789 --> 00:29:55.210
them is, you know, how can we make this right?

00:29:55.250 --> 00:29:58.210
If you want SPV allocation and if it's an all

00:29:58.210 --> 00:30:00.369
insider SPV, like we'll do it without fees or

00:30:00.369 --> 00:30:02.549
whatever, like we're here for you. I can't do

00:30:02.549 --> 00:30:05.480
it out of the fund. It's not right. But I can

00:30:05.480 --> 00:30:08.880
like, you know help you otherwise Going back

00:30:08.880 --> 00:30:11.279
to your undergrad days was miss school always

00:30:11.279 --> 00:30:14.319
on the card. I Did my best to get out of it and

00:30:14.319 --> 00:30:16.559
I had a lot of South Asian pressure to go into

00:30:16.559 --> 00:30:21.059
it I would describe it as schizophrenic I fell

00:30:21.059 --> 00:30:23.440
in love with medicine, but I was pretty far on

00:30:23.440 --> 00:30:27.119
my journey before I did I Think that I went into

00:30:27.119 --> 00:30:30.279
it Definitely with the wrong motives and definitely

00:30:30.279 --> 00:30:33.230
with bad decision -making Whenever I give advice

00:30:33.230 --> 00:30:35.670
to people, I'm always like, you know, I'll tell

00:30:35.670 --> 00:30:37.150
you what I did. And I'm like, don't do what I

00:30:37.150 --> 00:30:38.789
did. Like I'll give you frameworks and I'll tell

00:30:38.789 --> 00:30:41.329
you the frameworks I wish I used. But, you know,

00:30:41.410 --> 00:30:44.170
I made it work and it is so dumb lucky that I

00:30:44.170 --> 00:30:47.910
did. I kind of love medicine. And in hindsight,

00:30:47.950 --> 00:30:51.890
you know, I'm glad I did what I did, but by all

00:30:51.890 --> 00:30:54.529
means, you know, it's kind of dumb luck that

00:30:54.529 --> 00:30:58.230
I fell in love with it. And how did you decide

00:30:58.230 --> 00:31:01.819
to do an MBA while in med school? I had this

00:31:01.819 --> 00:31:03.940
startup. The political stuff that was going on

00:31:03.940 --> 00:31:06.180
in the world just really swept me up into it.

00:31:06.180 --> 00:31:09.359
And I was doing a bunch of stuff with this colleague

00:31:09.359 --> 00:31:12.240
of mine. He was all in. A lot of stuff was coming

00:31:12.240 --> 00:31:17.160
to a head. And we just needed some time to see

00:31:17.160 --> 00:31:19.579
if we could make it work and where we could take

00:31:19.579 --> 00:31:24.099
it. And there was no way to get time off other

00:31:24.099 --> 00:31:27.619
than doing it via degree. So I shot my shot and

00:31:27.619 --> 00:31:31.880
I got really lucky. And my very weird application,

00:31:32.200 --> 00:31:35.400
which was largely panned by very normal people

00:31:35.400 --> 00:31:37.380
was very well received by Stanford for which

00:31:37.380 --> 00:31:39.859
I'm very grateful. So then I went and I did my

00:31:39.859 --> 00:31:43.740
MBA at Stanford. And I spent my first year basically

00:31:43.740 --> 00:31:46.460
treating it as a face -saving excuse so I could

00:31:46.460 --> 00:31:49.319
work all my spare time on this other thing that

00:31:49.319 --> 00:31:53.460
I had going on. Tell me a bit more about the

00:31:53.460 --> 00:31:58.450
other thing you had going on. got really good

00:31:58.450 --> 00:32:01.549
at building political movements, both around

00:32:01.549 --> 00:32:04.269
famous people and organizing large amounts of

00:32:04.269 --> 00:32:06.410
young people in the US and around the world,

00:32:06.809 --> 00:32:09.890
and very, very good at trafficking in elites,

00:32:10.289 --> 00:32:12.769
trafficking in for young people, student body

00:32:12.769 --> 00:32:15.710
presidents of top universities, Rhodes Scholars,

00:32:15.990 --> 00:32:20.230
Olympians. kids of billionaires, like, you know,

00:32:20.289 --> 00:32:22.009
the kids in Nobel laureates. On the flip side,

00:32:22.049 --> 00:32:23.930
it would be like the Nobel laureates, a whole

00:32:23.930 --> 00:32:27.170
bunch of US ambassadors, a bunch of foreign intelligence

00:32:27.170 --> 00:32:30.410
heads, a couple of heads of state. We got like

00:32:30.410 --> 00:32:33.369
really into if anyone was doing something around

00:32:33.369 --> 00:32:35.490
any of the causes we cared about. We cared a

00:32:35.490 --> 00:32:38.130
lot about countering violent extremism. We cared

00:32:38.130 --> 00:32:40.329
a lot about free society movements overseas,

00:32:40.890 --> 00:32:44.869
getting people access to Elite resources doing

00:32:44.869 --> 00:32:46.509
things like, you know taking someone who's like

00:32:46.509 --> 00:32:48.950
an intelligence chief from like, you know, one

00:32:48.950 --> 00:32:53.589
of the allied, you know, uh european powers who's

00:32:53.589 --> 00:32:55.589
now focusing on countering violent extremism

00:32:55.589 --> 00:32:57.869
this one, you know isis was recruiting on facebook

00:32:57.869 --> 00:33:00.450
that era taking them around silicon valley taking

00:33:00.450 --> 00:33:02.630
them to all the tech companies and Like, you

00:33:02.630 --> 00:33:04.430
know sitting them down and doing these like high

00:33:04.430 --> 00:33:07.509
-level conversations around Uh, you know, how

00:33:07.509 --> 00:33:10.069
do we do this track two diplomacy was also really

00:33:10.069 --> 00:33:12.150
interesting at this time. There was a lot of

00:33:12.150 --> 00:33:15.220
middle eastern tension, especially around Iran.

00:33:15.579 --> 00:33:17.319
It'd be kind of cool that we could do stuff like

00:33:17.319 --> 00:33:20.059
get a former head of Mossad and a former chief

00:33:20.059 --> 00:33:23.200
nuclear negotiator of Iran who, depending on

00:33:23.200 --> 00:33:25.579
how a presidential election goes, is either extremely

00:33:25.579 --> 00:33:28.539
influential or hiding out in Princeton and getting

00:33:28.539 --> 00:33:31.200
them, you know, talking and arguing on the side

00:33:31.200 --> 00:33:33.420
and getting like a smulk, stuff like that. We

00:33:33.420 --> 00:33:37.380
were just really good at doing that kind of stuff.

00:33:38.180 --> 00:33:41.220
It had And every now and then we'd be really

00:33:41.220 --> 00:33:44.059
good at monetizing it, but we kept finding cool

00:33:44.059 --> 00:33:45.960
opportunities to have impact that never really

00:33:45.960 --> 00:33:48.079
led to monetization. We built a lot of network

00:33:48.079 --> 00:33:50.400
power and we never really found a way to make

00:33:50.400 --> 00:33:55.079
a lot of cash. It was work that we were really

00:33:55.079 --> 00:33:57.960
good at doing and it was work that I enjoyed

00:33:57.960 --> 00:34:02.500
until I didn't. It was very much white knuckle

00:34:02.500 --> 00:34:07.059
politics and you had to have a very high tolerance

00:34:07.059 --> 00:34:10.219
for constant conflict. There's a lot of take

00:34:10.219 --> 00:34:13.539
a favor, call a favor, burn people. Like, you

00:34:13.539 --> 00:34:16.679
know, there'd be so many people mad at you. Some

00:34:16.679 --> 00:34:20.320
of them would be kind of scary people overseas

00:34:20.320 --> 00:34:23.260
who were, you know, quasi mobsters. You'd just

00:34:23.260 --> 00:34:25.909
sort of, you know, you'd end up in a lot of situations

00:34:25.909 --> 00:34:28.010
where you're like, you know, this is, this is

00:34:28.010 --> 00:34:31.070
a lot. The person I did it with was both extremely

00:34:31.070 --> 00:34:33.750
talented at it and had a supernatural patience

00:34:33.750 --> 00:34:36.329
for conflict. But at some point I was just like

00:34:36.329 --> 00:34:39.590
so spiritually crushed and unhappy. I didn't

00:34:39.590 --> 00:34:41.230
like the way that I was treating people and it

00:34:41.230 --> 00:34:43.429
just wasn't work that I wanted to do. So that

00:34:43.429 --> 00:34:45.489
was my sort of like full arc of that journey,

00:34:45.610 --> 00:34:48.329
which played out during my one and a half years

00:34:48.329 --> 00:34:53.280
of my two years of my MBA. What are some tactics

00:34:53.280 --> 00:34:56.079
you use to get these people in the same room

00:34:56.079 --> 00:34:58.639
together? Because I'm assuming a lot of people

00:34:58.639 --> 00:35:02.699
would love to, there's kind of the common saying,

00:35:03.000 --> 00:35:07.659
your network is your net worth. How were you

00:35:07.659 --> 00:35:10.960
able to get all these very influential people

00:35:10.960 --> 00:35:15.880
who run big structures and countries in the world?

00:35:18.349 --> 00:35:22.949
come in the same room together as determined

00:35:22.949 --> 00:35:27.719
by a couple MBA 20 -somethings at Stanford. You

00:35:27.719 --> 00:35:29.820
know good question a lot of it was what I would

00:35:29.820 --> 00:35:33.019
call silo arbitrage inside a silo There's a very

00:35:33.019 --> 00:35:35.500
clear ladder for influence across silos It's

00:35:35.500 --> 00:35:38.800
very unclear and if you take two very different

00:35:38.800 --> 00:35:42.659
silos and you cross pollinate them It's very

00:35:42.659 --> 00:35:45.360
hard for it's like usually the connections don't

00:35:45.360 --> 00:35:47.880
exist People are usually very flattered to be

00:35:47.880 --> 00:35:50.260
asked and it's very hard for them to size up

00:35:50.260 --> 00:35:53.159
You know, like is this like someone at my ladder

00:35:53.159 --> 00:35:56.329
level above me below me? and essentially what

00:35:56.329 --> 00:35:58.730
we did is we just sort of like you know parlayed

00:35:58.730 --> 00:36:00.989
we'd be like you know we have access here's like

00:36:00.989 --> 00:36:04.730
someone who uh we had a my colleague had a mentor

00:36:04.730 --> 00:36:08.800
who was a very important civil rights era leader

00:36:08.800 --> 00:36:10.760
at the State Department and a very prominent

00:36:10.760 --> 00:36:13.159
ambassador to some very key countries. But these

00:36:13.159 --> 00:36:14.980
are not like the first 25 countries that you

00:36:14.980 --> 00:36:16.719
would name, but they were very important in the

00:36:16.719 --> 00:36:19.199
year 1980. And for people in the State Department,

00:36:19.340 --> 00:36:21.900
this guy was a legend. And it's like, you know,

00:36:22.019 --> 00:36:24.739
his mentorship and sponsorship built us a lot

00:36:24.739 --> 00:36:27.099
of goodwill with a lot of recent ambassadors

00:36:27.099 --> 00:36:29.460
to a lot of countries. And when you have those

00:36:29.460 --> 00:36:31.760
people who are like, you know, the presidential

00:36:31.760 --> 00:36:33.599
election change, you know, like with the change

00:36:33.599 --> 00:36:36.480
of like already in the like presidency, a lot

00:36:36.480 --> 00:36:38.199
of political appointees are out. They're now

00:36:38.199 --> 00:36:41.139
back just like in the wild. They tend to be very

00:36:41.139 --> 00:36:43.380
powerful and influential people. So you go to

00:36:43.380 --> 00:36:44.980
them, they're flattered to be asked because you

00:36:44.980 --> 00:36:47.440
have the other guy. They have incredible cache

00:36:47.440 --> 00:36:49.460
with like the elites in the countries where they

00:36:49.460 --> 00:36:51.679
used to be the US ambassador to, and you get

00:36:51.679 --> 00:36:54.159
to know them. And then like you take those elites

00:36:54.159 --> 00:36:55.599
and then you're like, you know, in turn, you

00:36:55.599 --> 00:36:57.320
sort of like do a parlay where you're like, this

00:36:57.320 --> 00:37:00.159
is really siloed, this is really siloed, that's

00:37:00.159 --> 00:37:03.170
really siloed. I have connections here and it's

00:37:03.170 --> 00:37:05.010
kind of intriguing in their swagger. And how

00:37:05.010 --> 00:37:07.989
do I do something that's like very valuable and

00:37:07.989 --> 00:37:11.429
useful and use this to meet people in that silo?

00:37:11.489 --> 00:37:13.690
And in turn, when I meet people in that silo,

00:37:13.889 --> 00:37:15.929
like, you know, what can I do that's very valuable?

00:37:16.230 --> 00:37:19.889
I think a lot of it is knowing what is valuable

00:37:19.889 --> 00:37:22.489
to people. Who do people not know? And a lot

00:37:22.489 --> 00:37:24.269
of it is like, what is the kind of information

00:37:24.269 --> 00:37:29.699
that's like intriguing and valuable? Like, It's

00:37:29.699 --> 00:37:33.280
much better now, but at that time, the Bay Area

00:37:33.280 --> 00:37:36.059
was relatively disconnected from DC politics

00:37:36.059 --> 00:37:38.480
and the foreign affairs apparatus. You could

00:37:38.480 --> 00:37:41.360
get a lot of interesting conversations and bring

00:37:41.360 --> 00:37:44.980
some really visionary people to the table by

00:37:44.980 --> 00:37:48.500
bringing interesting foreign affairs types, policy

00:37:48.500 --> 00:37:51.159
types out this way. It was just like a pathway

00:37:51.159 --> 00:37:53.820
that was not very well -worn. So by doing that,

00:37:53.820 --> 00:37:55.940
we would just get interesting people at the table,

00:37:55.940 --> 00:38:00.130
and then we'd get to know them. network asset

00:38:00.130 --> 00:38:02.030
that we had was also super useful. There was

00:38:02.030 --> 00:38:04.130
like a whole bunch of people who were like, listen,

00:38:04.250 --> 00:38:06.449
I'm launching a book and I'd love to get like

00:38:06.449 --> 00:38:09.190
500 people to turn out for this event. And we

00:38:09.190 --> 00:38:11.590
could, you know, swap favors with various people

00:38:11.590 --> 00:38:13.309
and like, you don't get those kinds of crowds.

00:38:14.150 --> 00:38:17.690
So things like that, you know, a lot of it was,

00:38:17.690 --> 00:38:20.389
you know, parlaying, like doing something and

00:38:20.389 --> 00:38:21.909
thinking like three steps ahead and being like,

00:38:22.030 --> 00:38:24.840
how do we parlay this into this into that? And

00:38:24.840 --> 00:38:27.059
what's valuable for everyone? How do we solve

00:38:27.059 --> 00:38:30.719
their problems in a way that furthers our work?

00:38:32.059 --> 00:38:37.420
I believe that cultural heterogeneity is the

00:38:37.420 --> 00:38:42.039
path to, quote unquote, world peace. I think

00:38:42.039 --> 00:38:48.019
intermingling cultures, races, and following

00:38:48.019 --> 00:38:51.059
the Singapore experiment where we're dividing

00:38:51.059 --> 00:38:54.659
residential areas to ensure that the amount of

00:38:54.659 --> 00:38:57.820
diversity is stable across the residential areas.

00:38:57.860 --> 00:38:59.599
You don't get a little Portugal and a little

00:38:59.599 --> 00:39:03.739
Italy. It's all intermixed. I think that is the

00:39:03.739 --> 00:39:08.039
only path, I believe, for us to live peacefully

00:39:08.039 --> 00:39:12.579
in this world. Given what you know about politics

00:39:12.579 --> 00:39:16.599
and people, if you could snap your fingers and

00:39:16.599 --> 00:39:20.219
get rid of the concept of nations and have the

00:39:20.219 --> 00:39:23.920
world be one country, Would you do it and if

00:39:23.920 --> 00:39:26.900
you would why and if not, why not? You know,

00:39:26.900 --> 00:39:29.199
it's a good question. I think your point is a

00:39:29.199 --> 00:39:34.539
good one that people mixing People mixing is

00:39:34.539 --> 00:39:37.760
a good thing If I could get rid of countries

00:39:37.760 --> 00:39:41.199
today, I would not if I could make movement between

00:39:41.199 --> 00:39:44.519
countries much easier I would I think that the

00:39:44.519 --> 00:39:47.019
world I would make two observations. The first

00:39:47.019 --> 00:39:51.300
is that The world has many different countries,

00:39:51.639 --> 00:39:54.219
all of which have different configurations of

00:39:54.219 --> 00:39:57.480
social networks, freedoms, rights, obligations,

00:39:57.860 --> 00:40:01.440
etc. And if people could freely move... and find

00:40:01.440 --> 00:40:04.119
the place where they agree philosophically with

00:40:04.119 --> 00:40:06.539
where they are, that kind of flow of people I

00:40:06.539 --> 00:40:08.980
think is a directionally good thing. Like it's

00:40:08.980 --> 00:40:10.739
a secular trend, that kind of movement is good.

00:40:10.960 --> 00:40:13.199
There's a lot of ambiguity about what the right

00:40:13.199 --> 00:40:16.099
way is to dial a lot of these levers. You could

00:40:16.099 --> 00:40:18.760
say that the US has a very coherent bet around

00:40:18.760 --> 00:40:22.260
innovation versus a relatively brittle safety

00:40:22.260 --> 00:40:25.059
net. Canada is on that spectrum, but it's a little

00:40:25.059 --> 00:40:27.360
bit closer to like a slightly more robust safety

00:40:27.360 --> 00:40:30.300
net, but not more so. Sweden is on that spectrum,

00:40:30.500 --> 00:40:34.800
but it's more so on the safety net side. But

00:40:34.800 --> 00:40:38.099
innovative enough, certainly not innovative.

00:40:38.559 --> 00:40:40.719
And all of those are reasonable bets. A very

00:40:40.719 --> 00:40:42.880
reasonable person a priori would be very happy

00:40:42.880 --> 00:40:45.320
for doing the whole veil of ignorance thing.

00:40:45.400 --> 00:40:47.159
Someone could be very happy through the veil,

00:40:47.320 --> 00:40:49.159
choosing to be in any one of those societies

00:40:49.159 --> 00:40:52.639
based on totally normal preferences. Fully respect

00:40:52.639 --> 00:40:58.349
that. Totally respect that. There was this really

00:40:58.349 --> 00:41:00.469
good book. I never actually learned how to say

00:41:00.469 --> 00:41:02.230
his last name I'm gonna put it in chat in case

00:41:02.230 --> 00:41:04.130
you know how to say it. Have you ever heard of

00:41:04.130 --> 00:41:10.349
this guy? He's a MIT economic historian Turkish

00:41:10.349 --> 00:41:14.409
I Have his book, but I haven't read it. His book

00:41:14.409 --> 00:41:18.789
is awesome. His book is awesome Darren I can

00:41:18.789 --> 00:41:21.230
mogul his books are you know, he wrote a really

00:41:21.230 --> 00:41:25.110
good book on technology power and social transformation

00:41:25.420 --> 00:41:27.820
all of these things that were great technologies

00:41:27.820 --> 00:41:30.760
on a secular trend, like a super long 50, 100

00:41:30.760 --> 00:41:35.280
year trend, such as automation in the textile

00:41:35.280 --> 00:41:38.340
industry in the United Kingdom or England way

00:41:38.340 --> 00:41:41.699
back when. All of those were good trends that

00:41:41.699 --> 00:41:44.659
lurched society forward, and they were just like

00:41:44.659 --> 00:41:46.739
super catastrophic, wrecked a bunch of lives,

00:41:47.019 --> 00:41:49.019
people went hungry, people died, like it was

00:41:49.019 --> 00:41:51.639
super frictional when it actually went down.

00:41:52.039 --> 00:41:54.280
Really good secular trends tend to be very frictional,

00:41:54.420 --> 00:41:58.130
and it's useful to buy very I feel like the past

00:41:58.130 --> 00:42:00.550
15 years has been like a very humbling demonstration

00:42:00.550 --> 00:42:02.550
of, you know, just what those are. I feel like

00:42:02.550 --> 00:42:05.250
if nation borders disappeared today, you'd have

00:42:05.250 --> 00:42:08.289
7 billion people with wildly different configurations

00:42:08.289 --> 00:42:10.750
of how they want to live, what obligations they

00:42:10.750 --> 00:42:14.010
feel towards each other, et cetera. Over a thousand

00:42:14.010 --> 00:42:16.710
years, it may be a very stable equilibrium that

00:42:16.710 --> 00:42:18.630
emerges, but the chaos of that would be quite

00:42:18.630 --> 00:42:21.289
high. But if we kept borders today and we had

00:42:21.289 --> 00:42:23.489
better and freer movement of people and goods

00:42:23.489 --> 00:42:27.940
across borders, that would be still pretty revolutionary,

00:42:28.360 --> 00:42:33.940
but I think a much more gentle change. For those

00:42:33.940 --> 00:42:36.139
listening, his book, and I have read a third

00:42:36.139 --> 00:42:38.800
of it, Power and Progress, Our Thousand Year

00:42:38.800 --> 00:42:41.500
Struggle Over Technology and Prosperity, and

00:42:41.500 --> 00:42:45.139
it's Darren and Simon Johnson. And I think it

00:42:45.139 --> 00:42:49.559
picks on this notion that, and this is again,

00:42:49.599 --> 00:42:52.519
a common notion among the investing world that,

00:42:52.519 --> 00:42:57.469
you know, all technologies improve humanity and

00:42:57.469 --> 00:43:00.869
are net positive. And from what I remember, Darren

00:43:00.869 --> 00:43:04.929
argues that that's not necessarily true. When

00:43:04.929 --> 00:43:08.650
do you think we will cross the barrier of too

00:43:08.650 --> 00:43:12.929
much technology, too much efficiency, and we

00:43:12.929 --> 00:43:15.349
will actually suffer? Maybe we will live 200

00:43:15.349 --> 00:43:19.230
years, but it will be 200 years filled with depression

00:43:19.230 --> 00:43:22.829
and sadness and misery as opposed to living a

00:43:22.829 --> 00:43:27.579
happy 70 years. You know, I'm a big fan of growth.

00:43:27.659 --> 00:43:29.880
I'm a big fan of growth, and I'm a big fan of

00:43:29.880 --> 00:43:33.860
the potential for a great future. Human norms

00:43:33.860 --> 00:43:38.159
have to change around the state of technology.

00:43:39.260 --> 00:43:41.519
And human norms are very slow to change. You

00:43:41.519 --> 00:43:43.880
see this with birth rates, where a lot of countries,

00:43:44.320 --> 00:43:46.739
when child mortality drops, birth rates continue

00:43:46.739 --> 00:43:49.480
to be very high, and you see a lot of frictions

00:43:49.480 --> 00:43:52.099
in population. You'd see that as an example of

00:43:52.099 --> 00:43:55.329
how human norms are slow. You see teachers talk

00:43:55.329 --> 00:43:58.210
about gen alpha and how spooked they are about

00:43:58.210 --> 00:44:00.010
the weird behaviors. I don't know how old your

00:44:00.010 --> 00:44:02.090
kids are shot if they're gen alpha or gen z,

00:44:02.429 --> 00:44:04.670
but you see teachers, you know, I'm sure you

00:44:04.670 --> 00:44:06.929
had a lot of philosophical conversations with

00:44:06.929 --> 00:44:09.670
your wife about screen time. It's a good example

00:44:09.670 --> 00:44:13.590
of how it takes a hot minute. for people to norm

00:44:13.590 --> 00:44:16.570
around technology. I think technology is great

00:44:16.570 --> 00:44:19.670
in the long term, and I see it not as we should

00:44:19.670 --> 00:44:22.449
see technology as good or see technology as bad,

00:44:22.789 --> 00:44:24.730
but we should see it as where there's friction,

00:44:25.250 --> 00:44:28.070
there's light, and where there's friction, there's

00:44:28.070 --> 00:44:31.420
just so much heat. And the heat to reality, the

00:44:31.420 --> 00:44:33.360
heat can be really destabilizing. I think a lot

00:44:33.360 --> 00:44:35.239
of the political trends we've seen in the past

00:44:35.239 --> 00:44:38.059
five, six years in Europe are an example of very

00:44:38.059 --> 00:44:44.610
well -intended visionary policies around... You

00:44:44.610 --> 00:44:47.690
know things like refugees an issue very like

00:44:47.690 --> 00:44:49.909
close to me and important to me and then like

00:44:49.909 --> 00:44:52.809
a wild societal backlash You know against too

00:44:52.809 --> 00:44:56.190
many refugees too quickly Leading to like, you

00:44:56.190 --> 00:44:59.469
know wild swings in politics and a lot of destabilization

00:44:59.469 --> 00:45:03.349
in global politics and you see that and you're

00:45:03.349 --> 00:45:08.559
like, you know sometimes it's worth kind of slow

00:45:08.559 --> 00:45:10.599
walking and being a little bit more cautious.

00:45:11.000 --> 00:45:12.820
If we're really thinking about what stage is

00:45:12.820 --> 00:45:14.940
this best on the order of like 200 years and

00:45:14.940 --> 00:45:17.519
500 years, sometimes going slower, but I would

00:45:17.519 --> 00:45:19.860
say it's definitely not worth stopping. It's

00:45:19.860 --> 00:45:21.619
more, we should see it as trade -offs, we should

00:45:21.619 --> 00:45:26.260
see it as complex. The startup founding team

00:45:26.260 --> 00:45:33.010
A has an amazing AI engineer. But a mediocre

00:45:33.010 --> 00:45:35.429
domain expert and for building in health care

00:45:35.429 --> 00:45:39.010
a mediocre physician or a clinician So our funding

00:45:39.010 --> 00:45:43.090
team be as a mediocre engineer, but an amazing

00:45:43.090 --> 00:45:46.150
physician or clinician on the team. Which team

00:45:46.150 --> 00:45:51.530
do you pick? Totally depends All my answers every

00:45:51.530 --> 00:45:53.329
time we do this for shot. I always give my it

00:45:53.329 --> 00:45:56.579
totally depends and my it's not categorical,

00:45:56.920 --> 00:45:59.300
it's all hyper contextual, so I must be your

00:45:59.300 --> 00:46:03.519
most tedious guest. I would argue this. At every

00:46:03.519 --> 00:46:06.840
company, at every phase, there is an axis of

00:46:06.840 --> 00:46:09.900
complexity. There's like a single thing that

00:46:09.900 --> 00:46:12.559
just stands above as the hardest possible thing

00:46:12.559 --> 00:46:16.809
that they do. For example, sometimes it is technology,

00:46:17.010 --> 00:46:19.030
like the really hard thing about this company

00:46:19.030 --> 00:46:22.090
is this very, very hard tech problem. Sometimes,

00:46:22.329 --> 00:46:23.769
especially in our sector, because our sector

00:46:23.769 --> 00:46:26.289
is so busted, corrupt, and inefficient, it's

00:46:26.289 --> 00:46:28.650
entirely strategic. The technology exists off

00:46:28.650 --> 00:46:30.989
the shelf. The exact configuration of how you

00:46:30.989 --> 00:46:34.730
use it, how you dial it in, requires an exceptional

00:46:34.730 --> 00:46:37.710
strategic savvy well beyond what a common person

00:46:37.710 --> 00:46:41.010
off the street can do. Like that itself is distinguishing

00:46:41.010 --> 00:46:43.949
enough to be the thing that's basis of the company.

00:46:44.309 --> 00:46:46.989
Some companies are like hardcore deep tech companies,

00:46:47.050 --> 00:46:48.510
you got to have the smartest people in the world

00:46:48.510 --> 00:46:51.210
doing it and it totally pays. And in that case,

00:46:51.210 --> 00:46:53.530
it's like do the engineer team and either I play

00:46:53.530 --> 00:46:55.550
the role of the clinician or we replace the clinician

00:46:55.550 --> 00:46:57.409
or we upskill the clinician, we do whatever.

00:46:57.769 --> 00:46:59.929
But the engineer is like a scarce asset and it

00:46:59.929 --> 00:47:03.150
makes sense. If that like weak physician strong

00:47:03.150 --> 00:47:05.630
engineer is doing something else. So for example,

00:47:05.730 --> 00:47:08.590
one of my very successful companies is doing

00:47:08.590 --> 00:47:13.420
an MSO strategy with pediatric OTs. It's very

00:47:13.420 --> 00:47:15.559
similar to what's been done in mental health

00:47:15.559 --> 00:47:18.559
and it is a technologically straightforward almost

00:47:18.559 --> 00:47:21.159
trivial company Largely doing technologically

00:47:21.159 --> 00:47:24.659
solve problems, but it has an extremely strategic

00:47:24.659 --> 00:47:27.860
very domain specific kind of go -to -market if

00:47:27.860 --> 00:47:30.820
you have the very weak clinician, strong engineer

00:47:30.820 --> 00:47:32.980
doing the latter business, they're totally going

00:47:32.980 --> 00:47:35.579
to flounder because like the really good engineer

00:47:35.579 --> 00:47:37.960
is using like 1 % of their strength. It's like

00:47:37.960 --> 00:47:40.300
if you and I were lifting weights and you could

00:47:40.300 --> 00:47:42.659
lift like, you know, if you bench like, you know,

00:47:42.760 --> 00:47:45.000
350 pounds and I bench, I forget my real bench

00:47:45.000 --> 00:47:46.320
is like, I don't know, like 50, but it's like

00:47:46.320 --> 00:47:48.420
the bar plus a little bit, but you and I are

00:47:48.420 --> 00:47:50.539
benching one pound dumbbells. Like it doesn't

00:47:50.539 --> 00:47:53.380
matter that you can bench like, you know, like,

00:47:53.559 --> 00:47:55.559
you know, like my hand will move like pretty

00:47:55.559 --> 00:47:58.579
fast as well. Like I'm barely using your raw.

00:47:58.480 --> 00:48:01.539
power. So it's like, you know, how much does

00:48:01.539 --> 00:48:03.739
the raw power matter in that case? So I see it

00:48:03.739 --> 00:48:05.420
as that I see it as like, what is the kind of

00:48:05.420 --> 00:48:08.239
problem they're solving? Another company that

00:48:08.239 --> 00:48:11.719
I'm very fond of did AI hearing aids, and they

00:48:11.719 --> 00:48:15.579
solved a bunch of very complex human audiology

00:48:15.579 --> 00:48:19.519
audiogram problems. And it was essentially a

00:48:19.519 --> 00:48:23.500
like math company, like a math physiology company

00:48:23.500 --> 00:48:26.719
for like, you know, six years. And there it paid

00:48:26.719 --> 00:48:30.570
to have the most hardcore domain experts ever.

00:48:30.889 --> 00:48:32.969
And now they're commercializing in hearing aids,

00:48:33.070 --> 00:48:35.050
which is like a super strategic busted space

00:48:35.050 --> 00:48:38.570
and the complexities entirely generic strategy,

00:48:38.670 --> 00:48:41.070
go to market complexity. It's not like, you know,

00:48:41.170 --> 00:48:44.909
best engineer in the world complexity. Do you

00:48:44.909 --> 00:48:48.550
think a good distribution strategy or a good

00:48:48.550 --> 00:48:53.519
network into your customers? Could be where defensibility

00:48:53.519 --> 00:48:55.860
lies oftentimes when I look for defensibility

00:48:55.860 --> 00:48:59.820
as you know, what's IP? But it could it just

00:48:59.820 --> 00:49:02.179
be like I'm an influencer in this space and that's

00:49:02.179 --> 00:49:05.000
my defensibility I would say more than influencer

00:49:05.000 --> 00:49:08.260
if you can get sales and grab land Have you used

00:49:08.260 --> 00:49:10.440
a bridge Rashad like have you used a bridge when

00:49:10.440 --> 00:49:13.559
rounding? I saw the inpatient workflow for my

00:49:13.559 --> 00:49:15.719
hospital and it was garbage. It was like totally

00:49:15.719 --> 00:49:20.849
garbage. It was so bad And for this to be the

00:49:20.849 --> 00:49:24.690
unicorn, incumbent, best company in the field,

00:49:24.769 --> 00:49:29.070
and I'm like, this product is trash. For my use

00:49:29.070 --> 00:49:32.369
case specifically, the amount of redundancy and

00:49:32.369 --> 00:49:34.530
work that it takes, like opening up a portal,

00:49:34.869 --> 00:49:39.829
copying, pasting text, it is so silly and bad

00:49:39.829 --> 00:49:41.610
at what it does, at least for Android and for

00:49:41.610 --> 00:49:43.409
inpatient hospital is drowning. It just sucks.

00:49:43.750 --> 00:49:45.690
It's totally built for a very different use case.

00:49:46.489 --> 00:49:48.949
My employer is very much like, it doesn't matter.

00:49:49.110 --> 00:49:51.670
This is what we're doing. You know, this is what

00:49:51.670 --> 00:49:54.150
Epic likes. This is what like, you know, our

00:49:54.150 --> 00:49:56.909
like hospital system likes. This is what's like,

00:49:57.050 --> 00:49:58.730
it's entirely a distribution thing. The best

00:49:58.730 --> 00:50:00.889
product doesn't win. The meritocracy doesn't

00:50:00.889 --> 00:50:02.989
work in healthcare. It is like way too corrupt,

00:50:03.010 --> 00:50:06.050
you know, access to distribution, strategic,

00:50:06.369 --> 00:50:08.610
you know, strategically navigating tech lockout,

00:50:08.730 --> 00:50:11.210
tech value chain is where a lot of value comes

00:50:11.210 --> 00:50:12.929
up. There's also why whenever you hang out with

00:50:12.929 --> 00:50:14.630
doctors, all we ever do is complain about the

00:50:14.630 --> 00:50:17.710
tools we have. it's like weird things lead to

00:50:17.710 --> 00:50:20.829
the winners. It's not like the best product won

00:50:20.829 --> 00:50:23.010
and next week when a better product comes out,

00:50:23.349 --> 00:50:25.789
we'll immediately grab it. It's entirely who

00:50:25.789 --> 00:50:28.150
grabbed land and had like, you know, these relationships

00:50:28.150 --> 00:50:33.610
to navigate way back when. That being said, how

00:50:33.610 --> 00:50:37.670
much do you index for having an amazing product

00:50:37.670 --> 00:50:39.929
when looking at founders? And, you know, I'll

00:50:39.929 --> 00:50:42.280
kind of... bring this conversation is that I've

00:50:42.280 --> 00:50:45.340
had conversations with founders where I'm looking

00:50:45.340 --> 00:50:47.260
at their product, I'm looking at what they're

00:50:47.260 --> 00:50:49.579
saying, and I'm thinking, you know, there's no

00:50:49.579 --> 00:50:51.760
way this is going to succeed. And then they say,

00:50:51.980 --> 00:50:54.360
we launched six months ago and we're doing 200

00:50:54.360 --> 00:50:58.039
,000 a month in revenue. How do you kind of deal

00:50:58.039 --> 00:51:01.320
with that scenario and what do you do when that

00:51:01.320 --> 00:51:07.030
happens? I love being wrong because There's something

00:51:07.030 --> 00:51:08.909
that I thought was true that's not true. So I'd

00:51:08.909 --> 00:51:11.969
be very intrigued in that situation to be like,

00:51:11.969 --> 00:51:15.269
why was my gut hunch way wrong? I put a lot of

00:51:15.269 --> 00:51:19.630
value in empiric validation. When I think of

00:51:19.630 --> 00:51:23.289
products, I think of them in the context of enterprise

00:51:23.289 --> 00:51:28.070
sales. In health care, no one can say yes, but

00:51:28.070 --> 00:51:30.170
everyone can say no. It's like the worst kind

00:51:30.170 --> 00:51:34.590
of and hardest enterprise sale. And I think of

00:51:34.590 --> 00:51:38.239
it specifically I use a sales qualification system

00:51:38.239 --> 00:51:42.099
called MedPic. I like to go through it letter

00:51:42.099 --> 00:51:44.019
by letter. There's a really good Salesforce article

00:51:44.019 --> 00:51:45.760
that breaks it down and is like, here are all

00:51:45.760 --> 00:51:48.420
the categories. Here's how you kind of qualify

00:51:48.420 --> 00:51:51.099
your pipeline to say this is a good customer,

00:51:51.239 --> 00:51:53.179
this is a bad customer. I go through that framework

00:51:53.179 --> 00:51:55.500
and I try to understand if I was looking at a

00:51:55.500 --> 00:52:00.059
sales pipeline, is this a product that... Could

00:52:00.059 --> 00:52:02.699
get through an enterprise sales process. I would

00:52:02.699 --> 00:52:05.219
think about is this something an economic buyer

00:52:05.219 --> 00:52:08.579
an internal champion and an end user would all

00:52:08.579 --> 00:52:12.760
be thrilled about and I see it as You know, there's

00:52:12.760 --> 00:52:14.639
this joke that I hear from a lot of my friends

00:52:14.639 --> 00:52:16.420
who are in their 30s who were single and dating

00:52:16.420 --> 00:52:19.059
Where you know anything less than a hell? Yeah

00:52:19.059 --> 00:52:21.699
as a hell no where you just have to like, you

00:52:21.699 --> 00:52:23.960
know It's like you're kind of like in your groove

00:52:23.960 --> 00:52:25.460
and you're very settled if you're gonna change

00:52:25.460 --> 00:52:26.880
something You really have to be ripped out of

00:52:26.880 --> 00:52:30.329
your seat. The same is true for enterprise sales,

00:52:30.750 --> 00:52:32.130
you gotta be ripped out of your seat. It's gotta

00:52:32.130 --> 00:52:34.050
be really good. It's gotta be motivating to all

00:52:34.050 --> 00:52:36.809
those key holders. So if they don't have sales,

00:52:37.170 --> 00:52:39.269
I think a lot theoretically about that framework.

00:52:39.309 --> 00:52:42.309
And I think about... How does it, when I picture

00:52:42.309 --> 00:52:44.010
a year from now and they're actually selling,

00:52:44.269 --> 00:52:47.449
where will this product naturally be successful?

00:52:47.550 --> 00:52:49.309
Where will it get stuck? What are the kinds of

00:52:49.309 --> 00:52:51.429
customers? Where in those customers will it get

00:52:51.429 --> 00:52:54.289
stuck? And how do I form an opinion about, can

00:52:54.289 --> 00:52:56.570
any product win in this space and get through?

00:52:57.730 --> 00:53:00.210
What do the founders think? Are they sophisticated

00:53:00.210 --> 00:53:02.570
in sales? Do they have discipline? If I offer

00:53:02.570 --> 00:53:04.909
this framework, how do they engage? If it was

00:53:04.909 --> 00:53:06.670
the example you gave where they're like, yeah,

00:53:06.690 --> 00:53:09.289
you know, like Mic Drop, we're doing 200K in

00:53:09.289 --> 00:53:11.469
sales we just launched. I'd be like, that's pretty

00:53:11.469 --> 00:53:14.050
dope. And I'd be like, what worked? What worked?

00:53:14.230 --> 00:53:17.170
And how do I use my framework of how enterprise

00:53:17.170 --> 00:53:20.449
sales happened to figure out my theory of mind

00:53:20.449 --> 00:53:22.230
for all those stakeholders and different kinds

00:53:22.230 --> 00:53:24.789
of customers? Clearly, these folks discovered

00:53:24.789 --> 00:53:26.610
something interesting. And I'd be like, teach

00:53:26.610 --> 00:53:30.690
me what is the signal here? What is the sort

00:53:30.690 --> 00:53:32.550
of thing I can learn about the world from what

00:53:32.550 --> 00:53:38.050
you guys experienced? Oftentimes, when I look

00:53:38.050 --> 00:53:42.030
at DEX, my mind inherently goes, how does this

00:53:42.030 --> 00:53:44.750
increase revenue for the organization or the

00:53:44.750 --> 00:53:50.130
buyer, as opposed to the other side of the coin

00:53:50.130 --> 00:53:54.869
being, how does it save expenses? And I generally

00:53:54.869 --> 00:53:57.269
think if there is no CPD court, you can bill

00:53:57.269 --> 00:54:00.090
for this and in practice, not just in theory,

00:54:00.409 --> 00:54:02.690
and there is no revenue model for this, it's

00:54:02.690 --> 00:54:04.869
unlikely to succeed. Now, AIS credits have argued

00:54:04.869 --> 00:54:09.269
against this clearly, right? How do you think

00:54:09.269 --> 00:54:13.010
of, when a startup is pitching to you, do they

00:54:13.010 --> 00:54:16.190
need to tell you, this is a CPD code, this is

00:54:16.190 --> 00:54:18.849
how my customer will make money by using my product?

00:54:19.769 --> 00:54:22.769
Or is it more, you know, I'm just gonna grow

00:54:22.769 --> 00:54:25.510
and grow and grow and I will get sticky enough

00:54:25.510 --> 00:54:27.769
that at some point people will pay for my solution

00:54:27.769 --> 00:54:30.530
as it becomes incorporated into their workflow

00:54:30.530 --> 00:54:32.989
and they cannot work without it. And it seems

00:54:32.989 --> 00:54:36.250
like open evidence, Hippocratic AI, AI scribes.

00:54:36.570 --> 00:54:38.789
It seemed like they're all like, we're just going

00:54:38.789 --> 00:54:42.010
to grow. And then people eventually pay for it

00:54:42.010 --> 00:54:44.550
because it's almost like oxygen. Open Evidence

00:54:44.550 --> 00:54:47.110
has something clever going on. They have NPIs.

00:54:47.190 --> 00:54:49.329
They have search queries by what people submit

00:54:49.329 --> 00:54:51.329
and they sell pharma ads. So they've essentially

00:54:51.329 --> 00:54:54.130
stolen Doximity's business model, but made it

00:54:54.130 --> 00:54:56.250
much more valuable. I see Doximity is a bogus

00:54:56.250 --> 00:54:58.289
company that we only use for free facts. It's

00:54:58.289 --> 00:55:00.610
like our dirty secret is doctors. I've never

00:55:00.610 --> 00:55:04.139
met anyone who's ever used Doximity ever. for

00:55:04.139 --> 00:55:06.239
anything and all I do is hang out with Help IT

00:55:06.239 --> 00:55:09.159
people. What else does it do? It has a newsfeed.

00:55:09.260 --> 00:55:12.480
I don't know. That's the amazing thing. I use

00:55:12.480 --> 00:55:14.960
it as a phone, like a phone app and a fax machine.

00:55:15.219 --> 00:55:17.400
And basically they have my NPI and they make

00:55:17.400 --> 00:55:19.380
all their revenue through ads and open evidence

00:55:19.380 --> 00:55:21.500
is done the same. And that is just such a dope

00:55:21.500 --> 00:55:23.960
and good business model. If it remains free forever,

00:55:24.539 --> 00:55:27.289
they're like... pilling, you know, they're milling,

00:55:27.289 --> 00:55:29.610
you know, GLP one adds to me knowing my NPI,

00:55:29.730 --> 00:55:32.710
my geography, etc. That will make them boatloads

00:55:32.710 --> 00:55:34.829
of money forever. If that's all they do, like

00:55:34.829 --> 00:55:37.349
they've already made a ton. So that model I find

00:55:37.349 --> 00:55:40.809
really fascinating. For your question, I use

00:55:40.809 --> 00:55:42.849
the framework I mentioned, the enterprise sale

00:55:42.849 --> 00:55:44.969
framework, I think of for the economic buyer,

00:55:45.730 --> 00:55:47.730
different kinds of economic buyers care about

00:55:47.730 --> 00:55:50.230
different things. If it's a healthcare system,

00:55:50.429 --> 00:55:55.980
they almost always Discount any promise of like

00:55:55.980 --> 00:55:58.699
I reduce costs so you will make money in a statistical

00:55:58.699 --> 00:56:01.380
sense long term Because it's like the wells been

00:56:01.380 --> 00:56:03.199
poisoned so many companies have said that for

00:56:03.199 --> 00:56:05.559
so long and it's never true So it's like they

00:56:05.559 --> 00:56:07.539
would believe that if you've been on market for

00:56:07.539 --> 00:56:10.460
five years and you have Incredible validation

00:56:10.460 --> 00:56:12.639
help economic outcomes like they will buy that

00:56:12.639 --> 00:56:15.619
story Revenue is a much easier story for them

00:56:15.619 --> 00:56:18.539
to tell there are weird niches where people will

00:56:18.539 --> 00:56:22.300
pay for other things like if you're in a cash

00:56:22.300 --> 00:56:24.820
pay competitive specialty doing something that

00:56:24.820 --> 00:56:27.940
really benefits from like white glove concierge

00:56:27.940 --> 00:56:30.219
service there's an intriguing willingness to

00:56:30.219 --> 00:56:32.820
pay where people are like you know if it makes

00:56:32.820 --> 00:56:35.630
people do their knee surgery with me and not

00:56:35.630 --> 00:56:37.449
the person next door, you know, that's interesting.

00:56:37.550 --> 00:56:39.829
Like that is interesting to me. So for folks

00:56:39.829 --> 00:56:41.909
like that, they may pay for different things.

00:56:42.190 --> 00:56:44.570
I use that as my wedge to be like, is this a

00:56:44.570 --> 00:56:50.050
credible story? Can it move customers? What would

00:56:50.050 --> 00:56:53.909
your 20 year old self think of the work you're

00:56:53.909 --> 00:56:55.989
doing right now and where you are right now,

00:56:56.190 --> 00:57:06.539
your career? You know, I think the most intriguing

00:57:06.539 --> 00:57:12.380
thing my 20 -year -old self would clue into is

00:57:12.380 --> 00:57:17.079
the fact that I live my life not totally obsessed

00:57:17.079 --> 00:57:19.699
with status and with hype when I was 20. And

00:57:19.699 --> 00:57:21.139
I think one of the reasons I stuck with this

00:57:21.139 --> 00:57:23.500
politics thing as long as I did is I was so...

00:57:24.789 --> 00:57:28.070
fixated in the rat race and prestige and hype,

00:57:28.309 --> 00:57:31.110
etc. After I had my big burnout and I was like,

00:57:31.170 --> 00:57:32.829
I just want to do stuff that I enjoy with people

00:57:32.829 --> 00:57:35.250
I like, I had the courage to say, you know, I

00:57:35.250 --> 00:57:37.190
don't want to join a fund. I'd rather build a

00:57:37.190 --> 00:57:39.090
fund. I'd rather be like, you know, I'd rather

00:57:39.090 --> 00:57:40.710
like go to a happy hour and everyone be like,

00:57:40.710 --> 00:57:42.389
I don't know this guy, I'm gonna go hit up like,

00:57:42.389 --> 00:57:44.510
you know, this dude from like famous fund instead.

00:57:44.829 --> 00:57:46.829
Like, I'm totally happy being a background character.

00:57:46.829 --> 00:57:49.250
I'm totally happy just being a random like, you

00:57:49.250 --> 00:57:52.780
know, guy doing his thing. I'm not so concerned

00:57:52.780 --> 00:57:56.519
about like, you know, status, hype, rank. I just

00:57:56.519 --> 00:57:58.260
like being good at what I do, doing it with people

00:57:58.260 --> 00:58:00.639
I love, you know, hanging out with folks I really

00:58:00.639 --> 00:58:02.559
care about. I think that would have been the

00:58:02.559 --> 00:58:04.980
thing that really sticks with 20 year old me.

00:58:05.199 --> 00:58:07.480
And it would have been very strange and it would

00:58:07.480 --> 00:58:09.539
have been very frustrating because it's one of

00:58:09.539 --> 00:58:11.579
those things that's like insight versus knowledge.

00:58:11.619 --> 00:58:13.820
Like you can give knowledge. You can be like,

00:58:13.880 --> 00:58:16.099
yo, like, let me show you this math proof. And

00:58:16.099 --> 00:58:17.679
it's like, cool, like, cool. Like now I know

00:58:17.679 --> 00:58:19.719
it. Then there's insight, which you just have

00:58:19.719 --> 00:58:22.239
to learn. And I think that I'm kind of stupid.

00:58:22.639 --> 00:58:24.400
I just couldn't understand the stove is hot until

00:58:24.400 --> 00:58:26.320
I kept touching it and burning my hand. And finally

00:58:26.320 --> 00:58:28.320
the inside hit me and I'm like, ah, like, you

00:58:28.320 --> 00:58:30.860
know, this is how it works. So that would be

00:58:30.860 --> 00:58:33.420
the thing that most surprises me. And it probably

00:58:33.420 --> 00:58:35.739
would have like perplexed me and maybe infuriated

00:58:35.739 --> 00:58:37.860
me because I would have been like, cool. But

00:58:37.860 --> 00:58:39.820
like, I don't know how I become that guy, you

00:58:39.820 --> 00:58:41.400
know, because I still kind of really care about

00:58:41.400 --> 00:58:47.400
these things. What are you excited about in healthcare

00:58:47.400 --> 00:58:50.429
in the next five years? And what are you excited

00:58:50.429 --> 00:58:56.050
about with your personal career life? In my,

00:58:56.190 --> 00:59:03.130
you know, so on the VC side. I think that there

00:59:03.130 --> 00:59:08.289
is an unstable we had after like 30 to 40 years

00:59:08.289 --> 00:59:13.010
of extremely stable policy consensus, bipartisan

00:59:13.010 --> 00:59:16.159
on health care. It's become a total knife fight.

00:59:16.480 --> 00:59:18.780
Like the balance of power between payers, big

00:59:18.780 --> 00:59:22.219
providers, small providers, life science, pharma

00:59:22.219 --> 00:59:25.139
is all kinds of messed up. How it maps to left

00:59:25.139 --> 00:59:27.380
and right, how it maps to parties, all messed

00:59:27.380 --> 00:59:30.639
up. Who wins and who loses, totally messed up.

00:59:31.059 --> 00:59:33.659
The Trump administration has basically burnt

00:59:33.659 --> 00:59:35.420
down everything that we understood about, you

00:59:35.420 --> 00:59:38.239
know, balance of power in our sector, you know,

00:59:38.239 --> 00:59:41.099
when they came in. And if you look at their policy

00:59:41.099 --> 00:59:45.840
considerations, it's all over the map. It's terrifying

00:59:45.840 --> 00:59:50.460
as a citizen. But the old system that's kind

00:59:50.460 --> 00:59:52.900
of burning down had a whole bunch of problems

00:59:52.900 --> 00:59:56.079
with it. And I'm very curious about, is there

00:59:56.079 --> 01:00:00.019
a window in all this chaos to back the right

01:00:00.019 --> 01:00:01.360
kinds of companies, the kinds of companies that

01:00:01.360 --> 01:00:03.719
I'd be proud to see exist in the world that can

01:00:03.719 --> 01:00:06.000
build and blossom because a lot of stuff is cracking

01:00:06.000 --> 01:00:08.440
in our healthcare system? Is there something

01:00:08.440 --> 01:00:11.400
that we could do that's interesting and better?

01:00:11.679 --> 01:00:15.880
I find that stuff really intriguing. And we always

01:00:15.880 --> 01:00:18.400
talk about how there's like a new era of AI,

01:00:18.619 --> 01:00:21.340
but this recent era of AI is a whole bunch more

01:00:21.340 --> 01:00:24.260
interesting than CNNs were 10 years ago. So I'm

01:00:24.260 --> 01:00:27.280
also very intrigued by, you know, what are the

01:00:27.280 --> 01:00:29.940
kinds of things like maybe actually, like we're

01:00:29.940 --> 01:00:31.739
actually finally getting serious about stuff

01:00:31.739 --> 01:00:35.570
that can minimize paperwork burden, etc. really

01:00:35.570 --> 01:00:38.070
not by improving the existence of paperwork,

01:00:38.230 --> 01:00:40.250
but really just making paperwork a tedious things

01:00:40.250 --> 01:00:42.769
that computers fight with each other about and

01:00:42.769 --> 01:00:44.929
sort of disintermediate us more and more. These

01:00:44.929 --> 01:00:47.769
are some things I'm excited about in my investing

01:00:47.769 --> 01:00:51.829
hat. In my personal hat... One of the really

01:00:51.829 --> 01:00:54.650
big insights I had as a VCA is that work expands

01:00:54.650 --> 01:00:56.469
to fill the time. You probably feel this. There's

01:00:56.469 --> 01:00:59.210
like an infinite number of happy hours and things

01:00:59.210 --> 01:01:01.610
you can do, et cetera. And sometime in the past

01:01:01.610 --> 01:01:04.050
two years, just running a team of four, I got

01:01:04.050 --> 01:01:06.329
so busy that I had to cut down a lot and I just

01:01:06.329 --> 01:01:08.769
did a lot less. And the amazing thing is I found

01:01:08.769 --> 01:01:11.050
out that I could both do a lot less and still

01:01:11.050 --> 01:01:15.170
be as or more effective and have actually like

01:01:15.170 --> 01:01:18.929
free time to think and do deep work. And the

01:01:18.929 --> 01:01:20.650
thing I'm most excited about my personal life

01:01:20.650 --> 01:01:24.449
is more deep work. In an entire year, me and

01:01:24.449 --> 01:01:27.449
you as VCs, there's one or two documents that

01:01:27.449 --> 01:01:29.690
we signed and wires that we approved that were

01:01:29.690 --> 01:01:31.550
by and far the single most important stuff we

01:01:31.550 --> 01:01:33.730
did that year. And if that was all we did that

01:01:33.730 --> 01:01:35.909
year in the story of our lives, that would probably

01:01:35.909 --> 01:01:39.869
be enough. Everything else washes away. I like

01:01:39.869 --> 01:01:44.110
the idea of more time spinning around in a chair

01:01:44.110 --> 01:01:49.000
or floating around in the ocean. thinking, thinking

01:01:49.000 --> 01:01:52.760
deep instead of just going, you know, five days

01:01:52.760 --> 01:01:55.000
a week, you know, seven to eight hours of 30

01:01:55.000 --> 01:01:58.880
minute coffee chats back to back. There's a lot

01:01:58.880 --> 01:02:02.800
of physicians listening to this podcast and they're

01:02:02.800 --> 01:02:06.039
wanting to break into startup investing, venture

01:02:06.039 --> 01:02:09.579
capital, entrepreneurship. What piece of advice

01:02:09.579 --> 01:02:13.300
do you have for them? I would toss out a few

01:02:13.300 --> 01:02:15.980
things on the entrepreneurship side, I would

01:02:15.980 --> 01:02:19.630
say Don't overthink it. Doctors have always been

01:02:19.630 --> 01:02:23.670
entrepreneurial. Almost everyone who you think

01:02:23.670 --> 01:02:25.769
of when you were a kid and they were doctors

01:02:25.769 --> 01:02:27.909
were doing something like very entrepreneurial.

01:02:28.909 --> 01:02:31.550
And almost certainly because of the nature of

01:02:31.550 --> 01:02:35.500
our work. You have a fixed and totally safe employment

01:02:35.500 --> 01:02:37.420
thing that you can turn to if everything blows

01:02:37.420 --> 01:02:40.219
up So feel that you have swagger random people

01:02:40.219 --> 01:02:42.980
just show up and start doing things people with

01:02:42.980 --> 01:02:45.420
less tools than you This is a great era because

01:02:45.420 --> 01:02:46.860
there's a million things that you don't know

01:02:46.860 --> 01:02:48.619
and there's so many tools that can help you There

01:02:48.619 --> 01:02:50.679
are people they can help you and also a chat

01:02:50.679 --> 01:02:52.480
GPT now. It's like, you know, it's pretty good

01:02:52.940 --> 01:02:55.019
Like, you know, it may not know everything and

01:02:55.019 --> 01:02:56.780
it won't be an expert, but it certainly is a

01:02:56.780 --> 01:02:59.119
few chapters ahead of you in a bunch of, you

01:02:59.119 --> 01:03:01.119
know, entrepreneurship topics you want to learn

01:03:01.119 --> 01:03:03.539
about. It'll point you in the way to, you know,

01:03:03.699 --> 01:03:05.300
read and learn and grow. We've learned harder

01:03:05.300 --> 01:03:07.420
things. I would say on the entrepreneurship side,

01:03:07.460 --> 01:03:10.699
go for it. On the healthcare side, I would say

01:03:10.699 --> 01:03:14.840
the most important thing for investing either

01:03:14.840 --> 01:03:19.000
time or money in a company is no access of complexity

01:03:19.000 --> 01:03:22.619
and know where you're smart. And if the main

01:03:22.619 --> 01:03:25.239
complexity in something is, let's say you're

01:03:25.239 --> 01:03:26.880
a cardiologist, let's say you're an interventional

01:03:26.880 --> 01:03:28.860
cardiologist and you're looking at stents. And

01:03:28.860 --> 01:03:31.599
if the main axis of complexity for that company

01:03:31.599 --> 01:03:36.559
is like a technical innovation in some kind of

01:03:36.559 --> 01:03:39.170
technical. innovation that's legible to you as

01:03:39.170 --> 01:03:40.769
a proceduralist who does it where you're like,

01:03:40.809 --> 01:03:43.250
if we do this, this kind of a big deal, like

01:03:43.250 --> 01:03:45.210
I would pay a lot more money, cool, that is a

01:03:45.210 --> 01:03:47.769
good bet. If the axis of complexity is totally

01:03:47.769 --> 01:03:49.750
illegible to you, if you're an interventional

01:03:49.750 --> 01:03:51.829
cardiologist, and you're looking at an orthopedic

01:03:51.829 --> 01:03:54.809
screw for hand surgery that angles slightly differently

01:03:54.809 --> 01:03:56.909
than the incumbent screw, then it's like, you

01:03:56.909 --> 01:03:59.349
know, have humility and like be like, you know,

01:03:59.389 --> 01:04:03.130
is this like, you know, like, is this really

01:04:03.130 --> 01:04:04.949
like, you know, the right kind of bet? The other

01:04:04.949 --> 01:04:07.289
is that you're too smart to have to know everything

01:04:07.289 --> 01:04:09.469
and be the extra expert. In the same way, we

01:04:09.469 --> 01:04:11.590
don't expect the interventional cardiologist

01:04:11.590 --> 01:04:16.829
also to be an expert in, you know, advanced management

01:04:16.829 --> 01:04:19.329
of renal tubular acidosis or something. It's

01:04:19.329 --> 01:04:21.130
like, use the team, use the team in the same

01:04:21.130 --> 01:04:22.949
way. It's like you're too smart to be like, you

01:04:22.949 --> 01:04:25.289
know, learning everything and being the expert.

01:04:25.710 --> 01:04:27.650
It's like if you see a deal and you love it and

01:04:27.650 --> 01:04:31.550
you're like, I love this med device. I love the

01:04:31.550 --> 01:04:33.829
technology. But the whole cap table thing, some

01:04:33.829 --> 01:04:36.050
of these weird terms that they've given to us,

01:04:36.329 --> 01:04:38.510
that's kind of beyond me. It's cool. You're too

01:04:38.510 --> 01:04:41.010
smart to become an expert in that. Use the team.

01:04:41.130 --> 01:04:43.469
Use the team. Ask friends. Ask your network,

01:04:43.530 --> 01:04:46.090
et cetera. It's how we work in the hospital.

01:04:46.329 --> 01:04:47.969
I think it's also what makes us successful when

01:04:47.969 --> 01:04:50.530
we invest. I think we're much more team player

01:04:50.530 --> 01:04:53.309
oriented. It's the same game. Use the same skills.

01:04:54.889 --> 01:04:57.670
Awesome. Thanks so much, Dmitry. Cool. Appreciate

01:04:57.670 --> 01:04:59.230
you, Rashad. It's always fun to do this.