Entrepreneurship as the Renaissance

To be an entrepreneur right now is the most powerful thing that you can do. It is our version of the Renaissance. So people that are creating companies now, especially if they create them correctly, have the ability to do two things:

#1 is massively impact the world in really important ways.

#2 is capture exceptional amounts of wealth.

https://www.youtube.com/watch?v=6H37iyvEZJ8 (15:35)


We stumbled into this business model accidentally. In my family, my dad, who passed away, had diabetes for 30 years. Of my 17 aunts and uncles, 11 of them had diabetes. The first thing I really did once I left Facebook was I helped co-found this company called Glooko, which is a diabetes company.

We started very accidentally, with, “Let’s just get all of the data off the glucometer.” Our suspicion was that if we could aggregate enough data, we’d be able to forensically attack this disease by giving interventional tools, by giving forecasting, by giving predictability, to a disease that was otherwise left untreated. People would check themselves every day, maybe, but the docs and endocrinologists would see these people once every six months.

What we found was, over time, that business model made sense. What we were doing was taking a very low cost sensor, putting it on an individual, capturing some very critical data around a specific disease state, sending it into the cloud, aggregating it across populations, and then acting.

When we first went to market, direct to consumer, it was a total failure. We had an Amazon store, we were trying to single-source these little Bluetooth modules, we tried to sell it, nobody would buy it.

We finally stumbled into a payer who said, that’s worth $10 [per member per month] to us. And all of a sudden, the light bulb goes off, and we’re like, “Oh my god, that’s $120/year.” We were trying to sell this little module for a few bucks.

The real business is in building these cloud-based solutions for provider and payer systems and what we really need to do is build very non-invasive, low cost sensors that can capture the data. So that’s what we did.

In asthma COPD, we did the same thing in diabetes, and we’re in the midst of doing the same thing now in chronic heart failures. Same business model.

In order of success I would say diabetes has done unbelievably well for us, asthma COPD is moving in the right direction, and CHF is a little early.

Let’s put $50–$100 million to work, roughly in that general idea, and see what happens around chronic diseases. Then we went to the other end of the spectrum.

Let’s take a bunch of really binary, low-probability bets on things that could be important. One of them was precision medicine, and one of them was a new kind of athletic sensor.

That’s how we started, that’s how it played out. What we’re finding is that the sensor business model seems to be the one for us, where we feel most comfortable in. We’re willing to take lots of capital risk. We’re building good relationships amongst payers and providers who now trust us, that when we come to them with a specific disease state we know what we’re talking about.

https://www.youtube.com/watch?v=8wswvcdpVu8 (3:30)

Define the Critical Metric

You have to be able to define the critical metric that defines the core product value of the business.

Revenue is a lagging indicator that reflects the magnitude of the product-market fit.

In our case, in our precision medicine company, this company called Syapse, we literally talk about lives saved. The reason is because we have this massive longitudinal trial at Intermountain. We found that if you used our platform at the point of care around cancer genomics, you had 75% of all patients at Intermountain — this is one of the best hospitals in the world — getting the wrong drug or dosage. You had a 10%-15% absolute right-off-the-bat reduction of cost. If you were a metastatic stage three cancer patient, you lived twice as long.

The minute I saw that, I said, “Great. That’s our metric from now on.”

Every board meeting starts with how many lives saved. That’s it. Fuck the revenue, that happens as a byproduct.

https://www.youtube.com/watch?v=8wswvcdpVu8 (6:40)

Slow Success

The fail fast approach works for consumer internet businesses, but I don’t think it works for anything that really matters.

https://www.youtube.com/watch?v=PMotykw0SIk (18:00)

Liquidity and Team Turnover

Bringing liquidity into companies sooner will actually allow companies to bake longer and more patiently. So part of what this vehicle is, is about bringing liquidity sooner in a company’s lifecycle.

If we can take this company, use it to acquire something else, and that CEO is now able to compensate their employees — as counterintuitive as it sounds, I suspect that they are less likely to leave. Now you can have employees stay at a business for seven, eight, nine, ten years, which used to be the historical norm. And now it’s not.

If liquidity was a more traditional, predictable, thing, many people would actually say, “You know what? I like these people here. I like the mission of the company. I want to continue to help advance their goals. And now that you’ve solved my compensation problem, I’m willing to commit.”

Part of this vehicle is trying to turn back the incentive towards people staying at companies longer, which is going to be required if you’re going to try and solve hard problems.

Right now the Silicon Valley attrition rates in most companies is 20%. That means every five years your entire employee base is turned over. How do you do anything valuable if everybody’s new, every five years? It’s probably not possible.

https://www.youtube.com/watch?v=PMotykw0SIk (44:20)


These big problems take an amount of funding and people that is just different from an eight person team trying to build an app on the internet. This is fucking cancer. It’s hard! If you build a big company, you see the investment required to solve really big, meaningful, long-term problems. That can be lost sometimes in Silicon Valley.

It’s become a rallying cry for how to do things. We will get paid a lot, but it will take longer, and we will go through these valleys where it just feels sometimes really lonely. We have to have the courage to keep doubling down, if we believe that it’s right. That goes back to instrumenting and building the company and helping them in a way where we can understand the underlying data so we see these leading indicators that tell [of future success].

https://www.youtube.com/watch?v=Nqy6CcU84Xs (14:30)


It’s a real litmus test of a CEOs ability to tell a narrative that creates an envelope of trust. It’s not dissimilar to how a CEO has to manage his or her employees at a company if you’re going to build a very successful company. You have to tell a story that is both inspirational but practical, and believable. When you can do that to your employees, what happens is you have high levels of retention, high levels of employee satisfaction, morale, and people execute.

That’s not dissimilar to working with Wall Street and telling a narrative that is relatively believable and backing it up with enough data points along the way.

When we talk about what’s happening right now, there’s too many of these private companies or public companies, or small tech companies, that are frankly not very durable. I think we’re just not willing to have the hard conversation about that. There are some good businesses. Are they great businesses? No. Will they ever be great businesses? No. We just need to admit that.

But Google, Tesla, Workday, Amazon, are amazing. Tesla got battered in the press because Elon didn’t hit his 2016 ship goals. Except, he committed to shipping 80,000, and he shipped 72,000 or 73,000 cars. That’s just incredible. In the grand scheme of things, will those 6,000 or 7,000 units really matter? No!

By 2021, the guy’s basically going to drive the energy independence of the United States. He deserves some whitespace to operate. The quarterly perturbations don’t truly matter.

https://www.youtube.com/watch?v=Nqy6CcU84Xs (38:40)

The Business Narrative Barbell

Most people should probably be running quarterly businesses unless they’re not. If they’re not, they need to tell that story and just be open and transparent about it and build the credibility to tell a broad narrative and then back it up with facts. Stay small and really tight, or go really, really, big. It goes back to the reverse-implied odds of raising all this money and creating all these false expectations and turning out to be a middleman business that’s actually going to have compressing margins over time.

There’s a lot of them that are like that. Right now, what’s great about the last few months is that, for the first time in probably 17 years, Silicon Valley is forced to explore and introspect around all this rhetoric, which was just dripping in all of this self-righteousness. For the first time we’re realizing that all of that was a crock of bullshit.

What’s good about that is that we can now become like everybody else. I think what we need to internalize is that we are as much stewards of the status quo as everybody else. That’s a healthy place to be for the long term fluidity of what we’re trying to do.

https://www.youtube.com/watch?v=Nqy6CcU84Xs (40:35)


There should be one culture: Win. We fucking win. When we’re done winning, we win some more. When we do that, we have winning for dessert, and then we go to bed in a blanket of winning. It’s about winning.

Those are artificial tactics: “We only do Series A’s.” No. It’s about winning. Buffett started off owning a bunch of random businesses and then learned about insurance. He learned about a market, and then owned that market, because he wanted to win. And then he bought Burlington Northern Santa Fe, cause he wanted to keep winning. Then he did Heinz. He’s a winner. You want to be around winners.

A company’s job is to win on behalf of their shareholders.

https://www.youtube.com/watch?v=Nqy6CcU84Xs (51:10)

Capital Allocation

Mark is becoming a master capital allocator. What Warren Buffet is is a capital allocator. What Larry is learning to become is a capital allocator. Jeff is actually the best capital allocator of all of them. He takes just enough small bets, makes thousands of bets. The minute that something works, he’s able to put money into it.

He’s the only person to have built two hundred billion dollar companies. AWS and Amazon’s retail business. Nobody else has. Facebook has acquired it, and Larry has acquired it. Jeff built it.

AWS is a tax on the internet. The minute you can frame your mind to understand why that is so, most of the companies will spend 1-2% of their revenue on AWS. It’s a tax. You are better off making small amounts of money off of everybody than large amounts of money off of a few people. Simple economics.

It is the single biggest stock I own. I am fearless about owning it 30 years from now. It’s impenetrable.

https://www.recode.net/2016/3/21/11587128/silicon-valleys-homogeneous-rich-douchebags-wont-win-forever-says (57:30)

Make the Scarce Abundant

On and on, this cycle of taking something that was a problem, and that was limited and scarce, we would solve it in a way that made it abundant. And that kept going on for centuries. What’s amazing is, two really important things happened in the last several hundred years.

The first was asking the following question, which is, now that we’ve solved all these problems what is the next most obvious, limited, scarce resource? And someone said, it’s our bodies.

If I tried to lift this entire table, I couldn’t do it. I don’t have the physical strength. If I tried to build this building, I could not do it, I don’t have to physical strength. And so we invented machines, and all of a sudden, what did it abstract away? It abstracted away our bodies, because our bodies were a limited resource. And now these machines could do the work of millions, or hundreds of millions of humans. But operated by, a few humans.

And then most importantly, what’s happened is that we’ve now done what was probably, several hundred years ago, unthinkable. We’ve started the process of abstracting our brains. If you think about it, now we are at a point in time where the most precious, scarce resource, is our brainpower. And we have realized now that if we actually take just the smartphones in this aisle, there’s more computing power in these seven phones than in the collective capability of all of our human minds. So then now imagine what it’s like if we took all of the phones in this room and put them together.

So this process of abstracting problems has been happening for centuries. But because now we’ve started to really abstract our mental capability, the ability to think and calculate things and perform tasks, the evolution is happening very quickly. Again, hundreds of thousands of years ago, we were trying to figure out how to do things that were very low level: how to protect ourselves, how to start a fire, how to clean water. And now we’re at a point where we’re talking about AI, machine language, data science, all these very complicated things that are highly computational. And as a result, the rate of change is so rapid. And the reason is because we’ve invented, now, an entire industry of people, whose job it is to find these limited, scarce resources, and make them abundant.

And that is what we do in Silicon Valley, that’s what you’re doing here in China. That is the point of being an entrepreneur. Find something that’s difficult, find a scarce resource, build a solution, make it abundant.

https://www.youtube.com/watch?v=6H37iyvEZJ8 (10:40)

Identify Scarcity

There is always a scarce resource somewhere. So whether it was all of us deciding to organize around safety, inventing language, creating money, building a machine, creating a smartphone, somewhere along the way, someone was asking the question, what is the next great problem that needs to be solved? Where I stand today, what is the scarce resource that exists? What limits progress?

That is the thing that you need to focus on. And what’s interesting in technology is that answering that question has always been true, and has always been the path to build immense success, wealth, and value.

https://www.youtube.com/watch?v=6H37iyvEZJ8 (18:50)

People Won’t Validate Uniqueness

Most of the time you will want to go and tell your friends, or tell other people, and have them validate — have them tell you, “Oh, that’s really smart. Oh fantastic, that’s a really good idea.”

That is not right.

And this may feel really difficult for you, but the most important lesson is that when you identify a true, scarce resource, everybody will think you’re crazy, and most people will laugh at you. Because most people aren’t motivated to think about the future.

Most people think about the present. So it’s very important that when the signals that you get back are positive, that should be a sign, that people have already thought about it as well. But when it’s some combination of negative or confusion, that’s a good sign. That means that you’ve probably started to identify something that is very unique, that nobody else has been thinking about.

This is an example of when you identify something that isn’t unique. This is a picture from a company called Accenture, a very big company. These words are in English, but I don’t know what they mean. This is spam.

https://www.youtube.com/watch?v=6H37iyvEZJ8 (22:35)

Why People Are Skeptical of Scarce Resources

Things that are scarce are not in abundance. And so most people aren’t thinking about it. Most people can’t think about it, and most people are very skeptical about it. So, if you propose something that tried to solve a scarce problem, most people would have a very negative reaction.

https://www.youtube.com/watch?v=6H37iyvEZJ8 (1:31:29)

Abstract Uniqueness for Understanding

Here’s the problem with working on things that are unique:

If nobody else understands it, most people will not be interested in supporting you. Not because they dislike you, not because they want you to fail, but because it’s very hard for them to understand. And so you have to find a way of building products to solve this problem in an abstracted way. What does that mean?

In a way where you create leverage in your product. In a way where there are simple ways for the customers that you have, or the users that use your product, to help you make that product better. Because these abstractions give you the ability to get hundreds, and thousands, and hundreds of thousands of people helping you. Because otherwise it’s only you and your employees, which is a very difficult proposition.

So let’s take this example: What’s amazing about Winamp, again, this is in 1997 through 2000, until it got acquired for $100 million by AOL. This was a very very good product, used by 100 million people every month. But there were only nine of us.

And the reason is because, when we were building this product, people would tell us, “This makes no sense. Nobody needs this. Why would anybody use it?” And so as a result, nobody wanted to work with us, and no one would give us money. So what did we do? We came up with two very clever abstractions.

The first abstraction was getting our community to help us develop this product. And so even though we were nine people, we created some very well-documented interfaces, so that third party developers can come and build anything. And they made our product excellent. We made our product pretty good, but they made it excellent. Because by using our community or company, even though it was nine people, it now became like a 250 person company, a 500 person company, a 1,000 person company. And now we could compete. Against Microsoft, against AOL. Eventually, AOL had to buy us.

The second abstraction was in our business model. We needed to make money. We didn’t know how to make money. There was no advertising ecosystem back then. So what did we do? We asked our users to donate money if they wanted to. And so they would send us a cheque, in the mail. And once a month we would collect these cheques, and we would go to the bank, and we would cash them.

And we were making millions of dollars a year. In fact, funny story: after we were acquired by AOL, they said to us, tell your users to stop sending these cheques in. And even years later, the cheques just keep coming. Because people had a very emotional attachment to our product, and so they wanted to see us succeed.

https://www.youtube.com/watch?v=6H37iyvEZJ8 (24:40)

The Three States of Users

Whenever you build any product, any product in the world. It could be a pair of pants, it could be a pair of shoes, it could be a smartphone, it could be an online product… Users are only in three states.

#1, people who have never heard about your product.

#2, are people who have tried your product, but have stopped using it.

And #3, people who use your product and love your product.

This concept of leverage is about managing these state changes. How do you go from someone who’s never heard it, to try it? How do you go from someone who’s tried it to, to someone who loves it? And any successful company, offline, online, B2B, B2C, it doesn’t matter, the point is always the same. People who manage these state changes build great companies. And people who don’t understand state changes build failing companies.

https://www.youtube.com/watch?v=6H37iyvEZJ8 (29:30)

A Platform’s Economic Model

Bill Gates said to us once, “This will be successful when the economic value of Facebook platform exceeds the economic, or is exceeded by, the economic value of those participants within it.”

And that’s what Microsoft did, right? If you sum up all the folks that live in the Windows world, their economic value is greater than Microsoft’s.

So why do you think Microsoft’s been around for 30 years? There are so many people working to keep it going; the incentives are there. You can debate whether it’s good or bad, that doesn’t matter. Winning is what matters, and those guys figured out how to win. Google is doing that now. Facebook is doing that… I think it needs to do that better, but, you know.

https://www.youtube.com/watch?v=pDVDWNguPs4 (15:33)

Hail Mary and Ambition

Anything you start: it could be a pretzel business, it could be a home printing business, or it could be Facebook, probably has a 1% chance of success. It really just doesn’t matter what it is.

If you have a 1% chance of success, why aren’t you throwing the Hail Mary on something crazy? By definition it is a Hail Mary. On the off-chance that it works, it’ll be transformational. For you, for the people that work for you, your community, how it inspires other people, the world. All that shit is so much cooler than just working on something small. And right now, what’s happening is we have too much small stuff, not enough big stuff. They all have the same mortality rates. That’s just a waste, it’s a waste of intellectual capital.

I would say too many people building incremental, consumer-focused product features, and not enough people building really ambitious products in any category. In consumer, great. Do it!

In enterprise, in storage, in healthcare, in energy. I don’t know. The point is, that we’ve now fallen into this trap where it’s, again, en vogue to be an entrepreneur. You know it’s en vogue to live this lifestyle, run around in jeans and talk the talk. Blah-blah-blah. No socks. All of that is en vogue.

As a result, what happens is you get this long tail of folks who want to be there because of what it represents vs what it really is.

And when that happens, again, people get distracted. It’s about people having funding parties talking about the angel round that they raised. And blah-blah-blah. All these random people coming in, and investing dribbles and drabbles of money, and every random other person starting an incubator.

In my opinion, people do better if you spend a couple of years working around really good people, learning, and then going off and starting something. You can still start something from scratch, but I think you need the influence of some folks around you, and right now I just don’t think that the infrastructure is set up that way.

So for example, if you’re just, “I’m gonna drop out, I’m gonna apply to an incubator, I’m just gonna sit there with my other buddy.” Okay, you’re either gonna have a crappy idea, no offence, because I don’t think your ambition is that big. Maybe you’re like the 1-in-1 million thing where you stumble into something accidentally, but I really think it’s accidental. It’s not even like, “I have a really big vision, let me start with something small.” I think it’s literally accidental.

Okay, and, that’s great, but you could flip a coin and you could just as easily be hit by a car.

To Pinterest, Ben and those guys actually spent time working in places where they saw ambition. They then, themselves, became ambitious. They saw product quality, they saw code quality. Like, you can’t work at Google and land really, really, shit code. You really can’t. Not for a long time, maybe for a little bit.

When you spin out of a place like that, your bar is set here. You just came out of a company that’s worth $100 billion at the time. And so, you’re thinking big. But if it’s all of a sudden it’s cool to drop out of school with my buddy, and all of a sudden go to some stupid incubator, guess what?

You’re gonna work on something stupid, it’s probably not going to be that interesting, and you unfortunately see it, by and large in the results of these things. And so people then get disillusioned, they become acquisition fodder for a bigger company, and that’s a vicious cycle.

So, instead what needs to happen is folks need to say, “Instead of this, what about this other thing?” Or, why don’t you actually go work at Facebook or Google for a year. Find a co-founder there. And then spinout. And then when you land crappy code, he’ll basically say this doesn’t cut it.

So you just want stuff like that to happen more. Otherwise we’ll just be a bunch of really, really smart people working on really, really stupid things. And that is a huge waste of time for the world.

In general, the knock-on effect is pretty bad right now. Meaning: you see a few companies that do something interesting, at a point in time, and then you see n+1 copycats of that thing. That’s not a healthy environment to be an entrepreneur in.

You want to be in an environment where, by and large, you’re doing something that’s relatively unique. By and large, it’s technically challenging, which inherently creates some kind of a moat. By and large, you’re creating something that has a potential to scale, and have massive impact. And as a result it allows you to recruit better, the people that come work for you will do ungodly things on your behalf: they’ll work for zero pay…

It’s because you’re working on things that are ambitious. Ambition for most people trumps all the other superficial shit. Title, salary… none of that stuff matters for most people. And so how do you clarify what you’re doing in a way where you can get those folks? They’re everywhere.

https://www.youtube.com/watch?v=pDVDWNguPs4 (30:10)

Three Characteristics to a Good Investor

Picking a good investor. There are, I think, four things that matter, and you should do your own diligence because these things are critical, especially when times are tough.

The first is, are they good pickers? And there’s now exceptional data from places like CB Insights and Mattermark. They will go and literally rank every single portfolio of every single venture capitalist to answer the question, “Is this a high-growth portfolio or not?” And I’ll tell you why it matters. But that’s number one.

It matters because, now, success begets more success. You are then surrounded by a portfolio of other great exceptional leaders. As they learn things, they can pass them off to you. It’s better to be within a group of winners. So it’s better to be, you know, the eleventh guy on the Warriors than it is to be the second guy on the 76ers. Always. So that’s the first thing.

What I would say on portfolio quality actually, 7 out of 10 companies are high-growth companies according to [CB Insights and Mattermark]. We’re number 1 in the entire industry. And I think what that means is we’re good pickers. So the diligence that we do and the thoughtfulness that we take to understand people and their businesses… sometimes it takes us a little bit longer than we would like, and maybe you would like, but I think we generally we get to good answers. And even when the answer is it’s not a good fit, we try to give as much feedback back to make it a fit. That’s the first thing.

The second thing then that I think you need to look at is, what is the percentage of that VC’s portfolio that gets follow on financing. And it’s so crucial. So as an example: Sequoia has the single best percentage of getting A’s financed to B’s. The single best. Spark is second, we’re third. And then everybody is a distant also-ran and we are like, two sigma above the industry average. Why is it important?

So, obviously, Sequoia has a fantastic brand. When they pick you, there’s a bunch of folks out there that will give you the benefit of the doubt. Hugely important when you need to raise more capital. But then you have to ask yourself, but what about from B to C? And there, what’s interesting, is Greylock is the best. We’re the second best, and everybody else is a distant also-ran, and Sequoia’s actually right below the industry average.

So what does that say? What it says is:

  1. a) you have to construct and be good pickers, and then,
  2. b) you have to help the portfolio companies in very specific ways so that you continue to get to that next tier of capital.

It’s not sufficient to just pick somebody because they can get you from the A to the B, if, from the B to the C you’re just as fucked as everybody else. That doesn’t work. And it’s not sufficient to pick the wrong person in the A, and then all of a sudden hope it’s going to work out in the B.

So it’s really important that you’re maximizing both those probabilities. So, again, CB Insights, Mattermark, look at the data, multiply those two things together and rank them. And it’s important for you, because you cannot afford to be in a situation where, in the absence of operational help, you could run out of oxygen accidentally.

And then, you want to have a situation where your venture investors have the benefit of the doubt with other investors. Because over a period of making enough good investments they will say to you, “Alright, I will give you the benefit of the doubt.” So I can call at the eleventh hour and say, “Listen, I know this is on the fence for you, but put in the five million. I’m telling you, we can help make it work.”

It fucking matters. Especially in times like this.

And then the other two things which I think are important to me, personally, is, number one is, are the people that you’re working with mapping to what you are as a person? Whether it’s your gender, race, ethnicity, or whether it’s your perspective and philosophy on how society and life should work? Because if you are going to be successful I think it’s really important that you pick people to bring along that are like you so then that your values are then further reflected.

Because success begets success.

And the last thing you want to do is create a successful person in someone you morally disagree with. And you do that by picking the wrong investor.

Anyway, you put these all together… I think we’re doing well. It wasn’t enough for us, and so we made the decision last year that we were going to migrate into not just being a venture firm but being more of a company. And in building a company, our model looks very similar to what Berkshire has built, or what Alphabet is building… which is basically, in our perspective there’s an opportunity to build a master brand in technology. Someone who has a really huge capital base, but a big vision around building things that create change in ways that we think are important.

And the way that we frame our mission is, what we are trying to do more than anybody else, is to basically advance humanity by solving the world’s hardest problems. And so we work backwards from, “What are those hard problems?”

Energy, healthcare, education, gender equality, whatever it is. And we try to find businesses that do that. We think that will create a lot of capital and wealth, and it’s important that then we control that versus somebody else who doesn’t have that sort of moral persuasion.

Because otherwise, bad things happen. And so we have to basically reallocate that in constructive ways. So over time, we’ll look like that. We’ll look like a company with a huge amount of capital that invests, that builds, that buys, private companies, public companies, minority investments, majority take outs.

https://www.youtube.com/watch?v=Njj6HZvixK8 (29:10)

The Journey of a Startup

My dad is in renal failure, he’s in end-stage renal failure. Three times a week, he has to go to the hospital, they drain his blood, they clean his blood, they pump the blood back into his body.

He’s had diabetes for 30 years. He’s 75, so he’s had it since his mid-40s. 10 years of pills, 10 years of insulin, and now 10 years of dialysis. Now he’s at the end of that, there’s no solution for that, so he’s gonna die. Now, I have all this money, I have all this influence, I have all this notoriety… I can’t do anything about my dad. That’s really fucking frustrating. Like, frustrating.

And so, I started a company around diabetes. Very simple idea. There’s been a lot of literature that says, if you can just understand the data, you can actually control how people’s diabetes changes. Now, does anybody here have a relative, or a mother, father… somebody you care about with diabetes? Look how many fuckin’ people’s hands are raised.

This is an epidemic. It has massive socio-economic ramifications beyond the obvious. If you look at like, inner-city development, no fresh food gets into there. There’s no Whole Foods there, there’s just Chick-fil-A and McDonalds. And so, what happens? Diabetes gets worse, and worse, and worse. We’re talking about whole swaths of populations that are held down. Is that right? It’s not fucking right!

So what do you do? What did I do? Okay, let’s just start by getting the goddam data off the glucometer. You get it off the glucometer, you send it into the cloud, you use some simple machine learning, you apply some heuristics, you save people’s lives. And it’s shown to be effective.

So we do that. It takes us three, four, years. It takes us five or six million dollars. So be it. But at the end of it now, that’s a business that has signed contracts in the last eight weeks, to take care of three million patients in the US, at $100 a patient a year. That’s a $300 million dollar revenue overnight. That’s gonna be a $50 billion company. I own half of it.

So then I was like, “Fuck it. I’m gonna do the same thing in asthma and COPD. I’m gonna do the same thing in chronic heart failure.”

https://www.youtube.com/watch?v=1dUbrL8b9l8 (33:45)

The Startup Dream Team

You need probably two or three really, really, really, sick developers, you need one quasi-developer who’s more of an organizing layer, and you need one person who’s just a maniac and just a bundle of energy.

Ideally, those people are also as different as possible.

When you’re forced to find commonalities beyond the superficial commonalities, it just creates way better teams.

It doesn’t necessarily mean like, you know, four guys and you need one girl, or four girls and you need one guy… You just have to be different. Different in how you were raised, different in how you think.

Different in religion, if that’s your thing. Just differences. You need differences, but commonalities, like, against those four archetypes. Like, I see those three or four people in any meeting, I get super excited.

https://www.youtube.com/watch?v=1dUbrL8b9l8 (1:03:03)

Money is a Lagging Indicator

It’s a lagging indicator of progress. It’s a lagging indicator of change. It’s a lagging indicator of value. But the key word there is lagging. So when you create something that’s structurally important and changes something for the better, it has an inherent value. Some of that is expressed in monetary terms: revenue and profits.

https://www.youtube.com/watch?v=UZn8MEsQwOg (10:20)

The Human Condition is a Winning Bet

Betting against the human condition and spirit has been basically a losing trade, since the beginning of humanity. I don’t think 2016 is the point where you go short. And so a lot of it makes for great headlines, and you can prognosticate either extreme right libertarianism, or tree-hugging, leftist nonsense… neither are true.

The middle path is what’s roughly going to play out. Great people will get easier, and easier, access to capital. Those people will have less, and less, preventable disease. Those people will roughly be able to educate themselves easier and easier, in simpler ways. They will not need to be credentialed. They’ll just need skills, and they’ll be able to build things cheaper, and cheaper, and cheaper (good segue for Amazon by the way).

You’ll find that things exist that we didn’t expect, and those things become the sinks of human labor, where the sources are these other job classes that change for the better. You have to kind of be a little bit more strategic in the aperture in which you define the problem.

https://www.youtube.com/watch?v=UZn8MEsQwOg (29:33)