Revolutionizing Healthcare: The Future of Health Tech with Max Marchione and Dr. John Dayton

Hey everyone, welcome to the Venture Capital Podcast. Today Peter Harris and I are joined by Max Marchione. Am I saying that correctly?

Uh, yep, that's close enough.

From— he's the CEO and co-founder of superpower.com. They provide health and data intelligence through very important blood tests. Uh, Peter has, has taken it. And we have John Dayton. He's an MD MBA. He's with the IHC Venture Fund. He's with Springtide and a few others. And so today we're just going to kick off and get started. So welcome, guys. Uh, before we begin, Max and John, do you want to give like a brief intro of who you are and what your background is?

Go ahead, Max.

Totally. Um, so Max Marchione, one of the co-founders of Superpower. We're building a new healthcare system focused on preventing disease and enhancing human capability. And, uh, previously I spent a little bit of time starting other small companies, and I've done that for several years. Lots of things, some are alive, some are no longer alive. That's the nature of starting things. I spent a little bit of time on the investor side. I am still a founder of a fund. I invest in around a company a week, and then I spent some time on the finance side as well. And, oh gosh, what else is interesting? So I don't know. I think that Basically around 2.5 years ago, I was thinking, what kind of problems actually really matter on Earth? And there were really only two things that I thought really mattered. One was human health, and the other was things that happen in the physical world. They still matter post-AGI. And I think in a post-AGI world, health is potentially the most important thing, enhancing and extending human life. And hence here we are.

Awesome.

Thanks, Max. John Dayton, do you want to give your background?

Hey, everybody. I'm an emergency doctor. I work with Intermountain Health and on faculty at Stanford, where I'm involved in research that has to do with innovation, particularly bringing acute care innovation into the ER. As John mentioned, I'm an advisor for Intermountain Ventures, and then I'm a venture partner with Springtide.

All right, well, today Peter and I, we want to talk about what's the future of health tech from the founder side, from the VC side. And the first thing is, like, let's talk about first what's broken in the system. What do you guys see?

So as a ER doctor, I'm happy to take that. Our system is based and reimbursed on fixing problems. It is not based on prevention. It's not based on longevity. It's not based on healthspan. So that's one of the major issues. But also, that provides lots of opportunities. Very nice.

John, have you looked at systems like Max Marchione's company? What are your thoughts?

Yeah, it was really interesting to look at it, particularly, you know, you take different business models. You know, we saw these startups with 2021 that were focused on digital health and making things work. A lot of money was spent on those. Not a lot survived, except lately. Omada and Hinge have turned the corner. And the reason for that is they were able to say, all right, well, how do we fix something in the system? How do we make people get better? But how do we work with the existing reimbursable models? And so I'm always interested when someone has something— may start out as concierge, or may start out as something within the insurance system. Focused on longevity and health. That's always very interesting to me. I'm always curious, you know, when people say we're going to look at all these biomarkers and these monitors, what specifically they're looking at and what data and research informs those choices. But I always think that's a good way to look at like forward-facing health approach.

What do the two of you think are the most important metrics to be looking at right now in 2025?

I think what's really interesting is how do we summarize a lot of different biomarkers into one, right? The reality of how healthcare has always evolved is let's have, um, static single biomarker cutoffs that we look at, and we try to predict things based on a single biomarker. And it's quite binary. You have something or you don't. You're in range and you're out of range. I think that makes a lot of sense in a human-led paradigm where we try to simplify things to a smaller number of data points because it has to be comprehensible for the human brain. I think what we fundamentally get to is the fact that we can ingest many data points and look at them simultaneously, and we can create scores that are the aggregate of many biomarkers. So one example of that are some of these biological age tests. They're not actually telling you your biological age. Instead, they're saying, here's 10 or 20 biomarkers regressed against time to death, right? And that as a predictor is typically better than just a single biomarker. So I think that's one thing that is quite interesting, biological age. Um, we built a superpower score which says, look, the biological age, um, uh, algorithm takes into account 10 biomarkers. Let's take into account 40 biomarkers and work with a scientific team to say, how do we weight these different 40 biomarkers into some sort of linear algorithm to give you a score out of 100? And my general belief is that those biomarkers often reflect or proxies for the foundations of health If you improve the foundations of health, you improve many of the diseases that sit on top of the foundations, and therefore improving your superpower score correlates strongly with improving overall health. So that's, that's probably my answer.

Peter, what are your thoughts?

So I'm curious from John's perspective. So traditional medicine has a ton of data, right? Collecting all kinds of stuff, the diagnostic tests, blood tests, you have procedures that have been done, medications that have been done. There's a lot of universities that are doing studies on patients. You've got clinical trials. So there's this huge wealth of data. Why is that wealth of data not being used in a, you know, multilinear regression analysis where you're pulling in lots of these datasets and data points in the way that Max Marchione is talking about, right? Why is it always so point solution? Solution-focused, if that makes sense.

That's one of the big problems in healthcare right now is pointillism, right? Everybody wants, well, I'll build this system, and this will help solve this GI issue. And I'll build this system, and this helps with mental health. One of the biggest issues is we need to have data that works together. The big issue is interoperability of data. And to take that one step farther, not only do we need to have the EHRs connect to the clinic records, which connect to lab records. But we also need to overlap that with data from remote patient monitoring. And that's— the next step of that is multimodal AI, right? How do we take the text from the charts? How do we add that to the imaging data, like the CNN data? And how do we utilize that? Ultimately, the big issue right now is there's a lack of interoperability. It's a major issue of fragmented data. And so that's why I'm really interested in companies that focus on interoperability or when Epic says we're going to do something that brings data together or brings that in a way that's usable. I mean, it's hard, right? What you think about from a patient perspective, if you're watching your blood pressure, you're interested what your blood pressure is on average. If you start a medicine to address it or a lifestyle change, you want to know if it's coming down.

But—

and so there's a lot of data points that are available to you. Unfortunately, the only data point you get is Well, I ended up in the ER because I had a high blood pressure and I had a headache and my blood pressure was really high there. That's compounded by so many variables. You know, you're nervous about being in the ER, you're uncomfortable. So rather than using all that trended data, you end up with one data point that's, you know, not very accurate and representative of multiple things. And then, you know, hopefully that trends down while you're in the ER, but that's the issue. You have to have, components that can bring things together and inform others. And, and that's, that's one of the major processes, one of the, one of the critical aspects we need, but also like very, very challenging. How do you take all these trillion data points and, and make sense of it? And I think multimodal AI is going to be the way to do that.

Yeah, I agree, agree with all of that. And then I'd also add that we have a lot of data relative to where we were 2 years ago or 5 years ago. And this is an exponential curve. So we actually have no data today compared to what we're going to have in a few years' time. And I think that as a result, many limitations actually come from a lack of data still. And many of the things that we would like to do, for example, trying to predict disease, not just— or trying to predict health, not just based on a single biomarker, but based on clusters of different biomarkers in an embedding space, that's not possible because we don't have enough data. And many problems are actually limited by the lack of data. So I think that we're actually still early in collecting all of the things we need to move to a model of medicine that is more algorithmically driven rather than human-driven.

I'm curious, Max, to build on that. What areas do you feel like we're lacking in? You know, where maybe for the people that are listening that want to build startups and start collecting some of this data, right, to integrate into a platform like yours, where, where's, where are the holes?

Uh, like everything. So I think that we still lack omic data, meaning biological assays. Um, there are all sorts of modalities that are, uh, of, of omics. Uh, there's the microbiome, there's the genome, um, there's metabolomic data. Um, 23andMe has 0.2% of your genome for only 15 million people with very limited clinical data on top, and they sold for $300 million out of bankruptcy. Right? Like, now we can assess the entire genome, not just 0.2% of it. And we can hopefully do that for more than 15 million people around the world. There's 8 billion people on this planet. So omic data is one. Clinical data is the second, and it's maybe even more important. Clinical data is what has happened to someone over time. And the over time is very important because we want to be able to map from what we know at the level of biology or the ohm, to what actually has happened. And that allows us to perform prediction. And then the other thing that's interesting is continuous wearable data, or like ambient data. I mean, the reason that's interesting is today we try to go from biological assay to prediction. In the future, what we might be able to do is go from continuous wearable data to prediction. And that means that we can actually predict things continuously rather than requiring a blood test or some sort of biological sample.

Max, just to add to that, I just got back from Amsterdam from the Health Europe Conference. Really interesting, but one of the best talks was Tom Hale from Oura and another device expert from a company called Metabolite. But they were saying the ultimate goal is we want two-thirds of what is going on to be monitored data that we can put into a predictive model. And then, you know, 1/3 of that's your physician, but the 2/3 is, you know, coaching and what should you eat that day and what exercise should you do? And you have levels that are trending that are in the wrong direction. You know, when it started out, it was like a sleep aid, right? It was interesting. But now they've got glucose monitoring and now they have temperature and they went through their first FDA trial. To predict when women are most fertile based on their temperature. And what's interesting on top of that is we've seen companies in the value-based care space say, well, let's use some of these wearables to inform this. Let's match that with clinical coaching. Let's match it with a diet. And we have only so much money to take care of so many patients of so many ailments, but if we can prevent these issues, we're paying for, you know, wearable instead of an ICU stay. And that's such a better model.

How do you look at the effectiveness of a wearable like an Oura? Is it accurate enough, not accurate?

Yeah, so that's— I'm a Whoop guy. They really only did their first FDA trial. I got one of the initial ones and it always said, well, your sleep's bad. I'm like, I'm an ER doctor, of course my sleep's bad. That's not very helpful for me. But I think if you can move beyond that to something like, you know, you get a continuous glucose monitor, you pair that with A1Cs, and you pair that with your diet coach, and you pair that with your physician and modulating your meds, I think that's where you get the value, 'cause those are endpoints that are clinical, right? You can say my A1C went from 7 to 5, or my average glucose went from 200s to 100s. But not just that, that's the part that's critical in the way that healthcare is built. Unfortunately, it's built in a reactive model as well. But now with using RPM tools, we can say, with this many data looks during the month, this glucose is coming down, it's better, and then the physicians can get billed for that and build a healthcare model around that. So I think you have to take very specific, data points, very specific biomarkers where there's reimbursement available and kind of build around a value-based care model. That seems to make the most sense right now. But ultimately, it'd be nice, like, you get the results that you're judging for, you're reimbursing for. So no surprise that we make a lot of money in the healthcare system with surgeries or ICU visits. But really, there's so much more value keeping people out of the hospital or doing remote care or hospital at home. And so it would be nice to see more of the funding shifted to that side. So that's why I'm interested in companies like the one Max is building.

So John, just to dig in on that a little bit more, why is it, 'cause I mean, it does feel obvious, right? Like why wearing an Oura Ring and wearing a Whoop device, whatever it might be, my primary care doc doesn't have access to that, nor I would argue in some cases wants access to it, right? Like, like, it seems the most obvious thing in the world, and yet it doesn't get done. And the devices that are implemented are, frankly, like, pretty terrible on a comparison basis to, like, usability, portability, UX, like, a lot of these things compared to an Oura Ring, right, that are out there. And why is there that breakdown?

What— yeah, I mean, let's take the Oura Ring specifically, right? It's only reached FDA clearance for temperature modulation.

Yeah.

Right? That's the only one that stood up to clinical trials. So you can say, you know, if you're basing it on usability, absolutely, some of these wearables are much better, you know, than what you use in a hospital. From the data side, though, you really have to value that, but that has to be within the framework of the system that's reimbursing. Well, if you are relying on FDA clearance, you know, to get CMS coverage, you really have to have those high-level data points. And so that's tricky. Unfortunately, like the FDA, there's a lot of modernization taking place specifically with like software as medical device and AI. But really it's based on is this healthy, you know, are these results replicable? And that's kind of the standard that they're going on. It would be nice to see a little bit more of where's the ergonomic or usability component. But I mean, that's— you've got CMS with a certain amount of money, you know, for their Medicare and Medicaid patients. And they can say, Well, we're going to— we have this much for heart patients. Let's figure out the best way to utilize it. You really have to be stringent on the data that you're using. So I totally understand usability is not valued by the FDA as much as they should. But at the same time, you know, withstanding clinical trials, that's kind of the benchmark.

Yeah, I mean, it's a bit of a catch-22 because if the usability is not there, nobody will use it and you don't get the outcomes, right? Even if— it did go through rigorous FDA approvals. I'm curious, Max, do you have a perspective on this? Like, you know, why has there been a need for you, frankly, to start Superpower, right? Because it feels like you're trying to solve this problem.

Well, our fundamental belief— there's a few. One is that there's a big gap between the best of healthcare and what most people have access to. and some people don't agree with that. I think if you go deep enough, it's probably true. The second is that the only way to close that gap is going to be through technology versus trying to hire and train and pay more doctors, partially because of the limitation of the human brain, partially because of cost, partially because of just supply scarcity. I also think that in an AI paradigm, we don't just match the best of medicine. We don't just close the gap. We actually far exceed it. And look, these AI systems may be a little bit off that today. They're better than the average doctor. I don't think they necessarily are as good as the very best doctors yet. But that's today, right? Again, these curves are exponential, not linear, and we're very bad at predicting the exponential. And the implication of these things is that the structure of healthcare starts to fundamentally change. And I would contend that we actually have a new consumer front door, a new first place people turn for their health. Today, people might say it's the primary care doctor. I'd contend it's Google or ChatGPT. And I think that Google or ChatGPT don't do an awfully good job because they don't do that, they don't know that much about you. They frankly don't know that much about medicine and they can't take action, right? They can't prescribe, they can't diagnose, they can't refer out, they can't actually take action. So the implication is I think we get to a world where we have a new consumer front door, a place people go to first that knows about them, that knows about medicine, that can close the gap between the best of healthcare and what most people have access to, can do that largely using technology, and can also do that with a fantastic consumer experience, a brand that people love. There's no one walking around wearing UnitedHealth t-shirts or like One Medical t-shirts, right? Like we have people sending me text messages and hoodies around the world, Superpower hoodies around the world like every day. There's no real software that people love. Everything is kind of confusing. Using. You never really have your data in one place. There's a lot of frustrations that customers have as a result of this. People like, well, I heard about the gut microbiome on, on Instagram. Then I went to my doctor and I was told the gut microbiome is not a real thing and it's pseudoscience. Or there's the Oura Ring problem, which is, I use my Oura Ring to track my sleep. I saw some problems with my sleep. My doctor refused to look at the data. So all of these consumer problems as well. And I think if we fundamentally start by saying what is best for our members, or the customer or the patient. If we start with that, how do we work backwards from that? Whereas I think the way healthcare has evolved, primarily because of incentives, is instead starting with payment mechanisms rather than customer experience.

Yeah, it makes sense. I'm curious, what do you both think is driving the interest in this? So if you look at companies like LifeForce Function, you know, somewhat competitive to what you're building, have grown incredibly fast in a relatively short time period. We're seeing tons of different companies and all kinds of diagnostic testings, new therapeutics, right, get funded. I'm curious, what's driving all of this now from your perspective?

I think you have two things. On one end, patients just used to be very passive, and it was a very paternalistic system. Doctor would say, "Do this," and they'd say, "Okay," and that was kind of the end of it. It's much more common for me to see a patient in the ER and say, "Not only did my heart feel funny, but on my Apple Watch, I actually have it," or they'll bring in their cardiac tracing. They'll say, "This is what my EKG looked like while it looked funny." And cardio is very like, that's something that we utilize, we recognize. The big issue with the data is it has to be reliable to both parties and in a way that's shareable. And so, when someone can say, my heartbeat felt funny, they show me the EKG tracing, I'm like, oh, yeah, I could keep you on a cardiac monitor here for a couple hours in the ear, and I'm probably not going to see this. But now that you have it, it's totally verifiable. We don't need to keep you overnight. We can get you on a monitor. We can get you on medication. And so, I think you have a rise of consumers that are just more knowledgeable and more involved in their healthcare. And at the same time, while there's like, you know, very traditional medicine and very, you know, patriarchal kind of mentality, most of young doctors, you know, they use these devices themselves. They're familiar with it themselves. And there's a goal in medicine to kind of upskill. You know, we're facing a situation where we went through med school residency and AI didn't exist. And, you know, there's an interesting quote out there from the AMA and it says, AI is not going to replace physicians, but physicians that use AI are going to replace the ones who don't. And it's like, we need to make sure we're maximizing our ability. I'm going to have no— nowhere near the ability like a large language model does to bring correlations and bring that together or give like a patient a discharge instruction in their native language according to their educational level. But I can totally utilize those in my process. In my care to personalize care. And I think you have kind of a wave of patient superusers and then physicians wanting to provide better care. That's why they wanted healthcare in the first place. And they're realizing, boy, we need to understand how these tools can help us in our roles.

What are your thoughts, Max? Just like timing, right? Why now?

Yeah, it's really interesting. And I remember In 2016, I would wear an Oura ring and everyone would make fun of me for tracking my sleep. And in 2019, I wore a CGM, continuous glucose monitor, and people thought I was actually psychopathic putting a microneedle in my arm. Right. And then so this has panned out time and time again. And so many of the things that I've been obsessed with for 10 years that everyone has made fun of people now are constantly messaging me about and texting about and asking about. I think I do believe to an extent in like the technology shift version of history as well as the key man or key person version of history. I think the key person version of history here is that Huberman and Bryan Johnson came along and started popularizing health. I think the technology shift version of history is, uh, is prob— social media to an extent, which valorizes health and aesthetics, and then also AI to an extent, where 8 to 12% of questions are, are about health. Um, so there, there are a few of the things that are catalyzing this push towards, um, uh, preventative medicine and what, what many are calling like longevity medicine, um, it's really interesting. Like, if you look at why people follow Bryan Johnson, it's very rarely to know how to live longer. The stuff that he's actually selling and they're following him for is very basal needs. How do you not lose your hair? How to reverse your skin age? Um, how to sleep good and feel good? How to like maybe put on a little bit more muscle? They're, they're actually surprisingly like basal needs. Um, and this is a —people have now realized that health is a tool to help you achieve those base needs. And just as new consumer products come along when someone sees a new tool, I contend that there's a consumerization moment here. And some people say, oh, we're consumerizing healthcare. I don't actually think that's what's happening. I think we're just like health-erizing consumer, which is the way consumer works is someone takes a consumer product, let's package a new CPG product, and they find one that they think people are going to like, and they realize you can sell it. Hims realized that with pills, um, Function realized that with blood tests. I think many of these companies, at least in the short term, are well understood as CPG companies doing CPG marketing. And then the big bet has to be, can they actually turn into health companies in the long term? Because CPG caps you at billion to maybe $10 billion market size, whereas if we can build a new health system, that becomes a little bit more interesting. Oh, for sure.

It definitely feels, especially when you look at like an Oura Ring, right? They're, they're trying aggressively to make that transition, right? It's like we used to sell ring, now we sell all of these, you know, services down to helping you get pregnant, right? That are more health-related. Um, I'm curious what your perspective is on Brian Johnson. Talk about him for a second because he is a little bit of a controversial figure. Out there with all the crazy things that he's done. And I'm curious to get John's perspective on him from maybe the medical perspective first.

So he's actually a really interesting figure. I'm part of a group called Clinicians Who VC, and we had him as a guest, and people wanted to talk with him. And some of the things he doesn't stress as much as he used to, but ultimately I like where he's coming from that age isn't inevitable. We're not going to get worse, or if we are, there's preventive steps that we can do to make that happen. He's kind of like on the shock value of that side. Someone in that space that I put a little more credence behind is Eric Topol just wrote a great book called SuperAgers. And that talks about we have all these problems with healthcare, the fragmented data, all these things. We could use more immunology, and we could focus more on things like community and meaning that make people's life last longer. And you know, that's, obviously we're not in a situation where the healthcare system reimburses for meaning and community, but if you're focusing on what helps people live longer, you're focusing on longevity. You know, it's hard to ignore the data that he has associated with that. So I, you know, Brian's kind of like the rock star. He's interesting to me also 'cause he's like, you know, I think he's a BYU grad, isn't he? He's a former— He's from Utah originally. Oh, yes, yeah. So I'm always interested in folks from Utah and BYU doing interesting things. But at the same time, Eric Topol will write a book every 5 or 6 years. And then the next decade goes on to prove that everything that he said was exactly right. He wrote The Patient Will See You Now, the start of digital health. He wrote DeepMind right before we started using AI or even comprehending how to use it. And now he's writing SuperAgers. And so I put a lot of stock in what he says. If he's focusing on utilizing components of immunology and recognizing that and recognizing what keeps people alive, he's got a lot of street cred, I think, on any spectrum you're working with.

Any perspective to add there, Max?

I have a lot of respect for Bryan. Um, I reflect a lot of the things John said. I think that Bryan thinks very deeply. I think that he has created a religion with really syllogistic underlying beliefs and principles. And I've come across many wannabe messiahs that don't have strong underlying beliefs and principles. I think he thinks very deeply about the world post-AI. And I think very few people have thought as deeply about that or have come to conclusions that I think map as accurately to where we're going. Um, and the one of the conclusions is that we do not know, right? And then the implication of we do not know is what do we know? We know at this very moment I do not want to die, and that is a like really powerful foundational belief. I think that he's learning when it comes to health. I won't say I'm any better, but I think that he's not quite at the frontier yet. Right. I see a lot of people, a lot of my doctor friends, like, why is Bryan doing that? It's so dumb. And then 2 months later, Bryan will update his beliefs. I think he focuses a little bit too much on data. I do believe with the fundamental principle that we should just follow the data, assuming we have all of the right data points. But we do not, right? We do not have data to capture everything yet. And as a result, you cannot just follow the data. I do think that the subjective is also an important— we cannot be purely objective here. The subjective actually matters. I also think he's rotated too far in the direction of, of homogeneity. And I would contend that one purpose of life is experiences per unit time, right? And what he has basically said is no experiences inside, same place every day, same time, same meals, same everything. And, um, is that living? If we draw that to the extreme, like you eat through a test tube and you sit in the chair, um, so I think he's rotated a little bit too far in that direction. I think the marginal utility of some of these things is quite low. Um, so that's, that's kind of my read.

He's rotating back a little bit right now though. He's not having his Whoop perfect sleep days anymore.

Yeah, look, I think there's a strong— if I had more time to do Twitter, I would love to create a strong opposing narrative, which is like reasoned and comes from a place of productive discussion, which is what happens if wine is actually good for you? What happens if not fully obsessing over sleep is actually fine for you? If we look at just epidemiology alone, we can look at Blue Zones and they do not have perfect sleep. They drink wine. They do a lot, they get some of the meat, like they're not perfectly optimizing these things, but they have meaning and purpose in life. They're positive. They're not constantly judging. They have a positive mental attitude. So I do think that there's an opportunity for people to rotate slightly back in the direction of what a lot of people would call living rather than the purely objective follow the algorithm.

Yeah, it is interesting. He came and spoke at an event that I was at. And I mean, he made the argument. He's like, I've never been happier. He's like, people ask me like, hey, you're doing all of these things. You cut out all of this, you know, all of these things that bring a lot of other people happiness. Right. And he was like, yeah, but I just have never felt happier in my entire life. So I don't know. It is interesting because I hear what you're saying and resonate with it, but also not sure if what he's saying is actually accurate or not. I don't know if I'm ready to make all the sacrifices to test it and see either, right?

I can relate to his focus and meaning a lot though. He's found something he's after. He is definitely goal-oriented. He's definitely setting metrics for himself and he's achieving a lot of them. So I think there's something to be said for that.

I am curious though to double-click on this idea of kind of more of that holistic, right, view on health. It's not just the data, it's not just, you know, getting a perfect night's sleep, but maybe enjoying life. How do you both think about how that fits within kind of the forward-looking paradigm of healthcare? Like, how do we fit that into, how are you fitting that into Superpower? How are you fitting that into your daily practice? As a clinician, John?

That's a tricky thing for me because I'm more likely to treat a heart attack or fix a dislocated joint. And so it's harder to say, now you need to find your meaning with this exercise with your new shoulder. But at the same time, I think that has to be recognized. If you're having a life without any purpose, there's no ICD-10 code for that. You know, there's no billable tool for that, but it's meaningless. And you see that in like the longevity studies. People need purpose in your pain.

But the stress might be the thing that put them into the emergency room, right? I mean, they had a weak heart, but then it was, you know, stress at work or family, whatever.

Genetic weakness, and then he needed that, you know, that component of the stress. No, that's— I think that's fair because What I do is like the quintessential version of the reactive healthcare. I'm not in a space for that, but I think, you know, once we get that guy's heart attack diagnosed, we get that clot buster in, we get it fixed, I think, you know, when that component should take over is, you know, his cardiac rehab, right? Well, let's get some exercise in your life. Let's get these other things that are preventive in your life. Rather than, you know, just stenting a vessel when it gets blocked, let's prevent your other vessels from getting blocked. Yeah.

Where, where do the three of you see the investment opportunities moving forward? All of you are actively investing in one form or another besides like your own company. What, what, like, what, what gets you excited in the health tech space?

I, um, like things that I prefer therapeutics to diagnostics. I like therapeutics that are far-fetched as well. Genomic engineering, peptides, things that don't exist today. I like therapeutics that target performance as well rather than just sickness. I don't spend much time trying to understand biotech, and I think that there are complex incentives there, and I try to stay away from money incentives. Um, so there, there's some of the things that Yeah, some of what comes to mind, I think that people aren't ambitious enough and they don't dream big enough. I like things in the real world. I don't think that they can— I think they often hit a scalability cap, but I think things in the real world matter. I'm increasingly finding manufacturing and those boring industries interesting as well. I just think they're very robust to AI. I don't like companies that are at threat, that are existentially threatened. By OpenAI. And I think most companies, or many companies that I see start now, are essentially threatened. I understand why it's a good short-term arb play by a VC trying to hand off their investment to a dumber person at a higher price, but I think that, um, people should take 10-year outlooks or 20-year outlooks on things versus 2-year game the financial system, um, outlooks.

Yeah, it's interesting you say that because, uh, I was just watching another thing with a private equity investor and he made the point. He's like, total SaaS spend is like $650 billion. He's like, plumbing is $400 billion in the US, right? And it's this idea that like there are these huge industries and like AI is going to have a very small impact on things like plumbing, to your point, right? So a lot of these big opportunities, you know, in the physical world, that I'm hopeful— I'm curious your perspective, but I'm hopeful that actually AI starts automating a lot of the stuff in the digital world for us so we can kind of pull back to creating more meaningful lives in the physical.

That's an area where I'm hugely interested in just seeing like the redundancies in healthcare. Like, what is something that AI can do so that I can spend more time talking to a patient? What is something that, you know, on the operation side or, you know, on the financial reimburse side, I don't want to submit papers, I don't want to go back and forth. What can be automated there so I can just focus on getting my patient to the right care, to making sure they can go to the thing that's going to, you know, help them with their longevity. And I think the operational tools of AI are going to unleash our ability to do actually what we wanted to do, you know. I didn't want to be a physician to to fill out papers and click documents and chart all day long. I wanted to be a physician to help patients. And so I'm interested in tools that help me save that time for myself and cover the administrative, the operative side.

Yeah. Is that space?

John? Say again. I'm sorry.

Is that your next investment?

Are you looking for that to exist? Yeah, I'm very interested in those kind of tools.

Yeah. So Max, I'm curious. You mentioned— you made a point earlier that AI today is better than like an average doctor, but not better than the best. But we're probably going to get there, right? Where do you see the role of doctors in the future? Like, do they go away if we make AI actionable, or is there a role and a place for them? Do they get to do what John is hoping for, which is like I can just spend more time with people, or is it kind of the Replit situation and the doctors get replaced by AI even? I don't know. I'm curious your perspective on that.

Yeah. So today, at an abstract level, doctors do two things. One is cognition compute. We call that diagnosis, connecting the dots and working out what's wrong and telling someone what to do. Diagnosis and like therapeutic plans, right? Whatever you want to call it. Um, the second thing doctors do is actually act as an intervention. Similar to how you have a choice to use a pharmaceutical or a supplement or pursue a certain order, uh, eat and change your diet, a doctor is also an intervention, sometimes through behavior change, sometimes through performing some sort of procedure. Going forward, the first role of the doctor, which is compute diagnosis care plan, I think is almost exclusively AI and potentially even exclusively AI. The second role of a doctor, which is a doctor as an option on your therapeutic stack, I think remains. Sometimes a doctor has to perform some sort of procedure. Sometimes they need to, like, touch the human body. Sometimes they need to help drive behavior change and relate to someone. And explain the outputs of the AI and hold someone accountable. And I think that's where humans are here to stay. I don't think that AI replaces doctors. I think it replaces functions that doctors can— that they're doing today. And that means the doctors will just do different things.

Any thoughts on that, John, or is that—

Yeah, I couldn't agree more. Yeah, I would— listening to the talk by the folks from Aura, That was kind of their takeaway. Our healthcare system is going to be multimodal. It's going to be informed. We're going to have data that helps people. They're going to have guides to help them with exercise or diet, and whether that's a physician or a therapist or someone using tools. But basically, it's going to be human using tools to enhance care, to improve care, and to get insights that we would not get on our own. And I'm totally comfortable with that.

Do you find that any of your colleagues are afraid of AI?

Oh, hugely resistant. Yeah. Oh yeah.

And why is that? Is it because they're not going to have a job anymore or?

I think you look at groups like radiologists where you see how different CNN models can not just make diagnoses but make predictive analytics. And so on one hand, you could say, oh, you know, I don't want that replacing me. I'm against it. On the other hand, you could say, I have to look at thousands of images a day. If I have an AI tool that can flag the most important things very rapidly, that's hugely beneficial. You know, you had Cure AI out of India. They trained a model to identify TB. They thought, what's going to make the biggest impact in the world? And in the developing world, we saw a lot of folks with TB. And it trained this model and rushed the positive TB images to the top of their stack and they would look at it. But that sped up their process. It made them more efficient. It made them able to really focus on the most specific things. And then they were able to do the same thing with COVID And then I think they sold to Fujifilm. But that's where I see it heading. I don't think this is a situation where these tools are going to replace the radiologist, but can they make their job more efficient? Can they help them highlight the worst things? Can they— help, you know, bring the work, you know, just overall health of their patients and the folks they're taking care of. I think that's where we need to utilize it. And I think once people realize that's the potential, then you have less fear and you have more, you know, more interest in, all right, cool, how do I adopt these tools?

Makes sense. Do you think that there is a way to bridge our current healthcare system with the more preventative longevity Orring superpower approach to health. Do you think these get bridged, or do you think that one kind of displaces the other, or— I think, I think in front of the other, does that make sense?

I think the way patients approach their health, and I think the way that physicians need to practice as a result, is gonna change how that works. But I think, you know, ultimately, people get paid to do what they're, you know, what they're paid to do. So I think, you really have to change how healthcare is built rather than saying, you know, you get this, you know, large amount of money for this complex procedure for this ICU stay, rather than having that the incentive being say, hey, this is your panel of patients and you get this much money to take care of them. And if you keep them out of the ICU, you know, you keep the rest. I think that's where you're gonna have a lot more innovation. Yeah.

What do you think, Max? Is this bridgeable or? Or not.

Uh, yeah, I think we start to see a lot more of a relationship between consumer health front doors like Superpower, wearable companies like Oura, um, the healthcare system. That's my take. I think the healthcare system's here to stay. I think it does a lot of things exceptionally well. Um, I also think it does— it doesn't even consider several things, right, like prevention and human enhancement and performance. Health and longevity aren't active considerations. And that's because there's no payment mechanism for it. It's not the way it evolved. It's not what the funding is. So I think we'll see a system before the system, but I think the system will still exist.

Sorry, go ahead.

I was going to say just a quick add-on. An interesting way to look at it, like from, you know, tucking you to local models, right? You have a cool, you know, add-on like that that you add to someone's employment package, that makes that job that much more interesting. And so you talk about the folks at Domo, the love that they can get in future fertilization. And then that's, you have a super skilled worker, that's what they're interested in. Hey, that's where they're going to work. And so I think there's a big play as far as you talk about the cost of insuring patients and your panels and that sort of thing. I think as you can bridge these preventive tools to employment situations and add on to the insurance there, I think that's where we're going to see a lot of big major play outside of, you know, changing legislation.

You know, speaking of Utah, there's a health insurance company here that I'm a huge fan of called Motive Health. And so they, they are very focused on high deductible plans with HSAs. And then they're very aggressive. So when you sign up, they send you a fitness tracker. They re— they, they put money into your HSA if you hit so many steps per month or whatever, whether that's like the best measurement, who knows? But like, I haven't seen anyone else do stuff like that. But at least it's incentivized, right? Yeah. So they're incentivizing it. They're tying it— they're tying your, like, health and your longevity and how you approach those things to actual dollars in your pocket, which I've always saw as a really fascinating approach. I'm curious, in the last 10 minutes that we have, I'd love to hear from both of you your vision or prediction on what the future looks like for healthcare. And then what are the big roadblocks that you're seeing that will have to be overcome to achieve that vision?

I think that every single person will have an AI doctor, which is the first place they turn before Google or their primary care doctor or OpenAI. I think that the AI doctor will tell someone exactly what to do. Uh, we won't be— we'll actually have limited choice because the AI will be so good we won't have a choice but to follow it and but to trust it. I think in this world, uh, consumers disintermediate clinicians increasingly because the AI can connect them directly to what they want and do that quickly and seamlessly. And look, even if humans in the loop are necessary, the way they're necessary with hymns. It's symbolic and legal rather than practical and real. I think that everyone will be taking some sort of personalized, potentially compounded therapeutic. It's still a little bit further out, but I suspect we'll see lots of innovation in the world of biotech and a lot of biological enhancement akin to what we see in sci-fi. That might be dystopian or utopian, we'll see. But I do think that it will be inevitable because when some people start doing it, the Darwinistic tendency in us will try and start to create the incentive for all of us to do it. And therefore biological enhancement will be mainstream.

And what do you think are the big challenges to that happening, that vision?

I don't know. I don't like to think of challenges. I just think time, it will happen. It's just a matter of time.

Okay, fair enough. John?

Yeah, to piggyback on that, that same thing, I think in the future the care is a lot more informed. Your genome is mapped, so you have the ability to know whether specific medications that will work for you, and you have more immunologic data to know that things that can prevent you from responding in such a way that ages you faster. And so that data is complemented with tools from your remote patient monitor, your biologic data that informs your diet, that informs your exercise, and that informs your clinical team, which is a combination of physicians, AI tools, and other, and other coaches. And I think that's ultimately how you keep people healthy longer and utilize— rather than having the fragmented data, rather than not putting out all the AI components together, you have like a multi-omic, non-fragmented data experience.

Awesome. And any roadblocks that you see that kind of need to come down before that vision is achieved?

Like we've been saying earlier, the typical roadblocks are you have to change, you know, the incentives for the payers, for the patients, for the physicians, and how that's built. At the core level, that's going to be how things tend to happen. You know, whatever it's done on the Medicare/Medicaid side on reimbursement and what's cleared informs private insurance. And so to get a major shift, you're going to have to move away from that.

Yeah, it feels like to me, and I'm curious if you guys have a different perspective, but it feels like one of the things that's pushing that change is that people are coming out of pocket to pay for their health in a bigger way today than they have been in the past. In the past, it was, I pay for insurance, insurance takes care of my health, and it pays the bills. And now it's, it's You know, people are shelling $500, right, to sign up for, you know, a SuperPower, a Function Health, right? They're, they're buying very expensive devices in some cases to track their health. And, and they're not doing it as a like— it's not just a small percentage of the population. It's kind of the majority, right? Like pretty much everybody is tracking their health in one shape, form or another, right? Even if it's just through their their smartphones.

I think that's what turns the tide. Like in the past, you could say like, "Oh, we can have people do this if you want to build a concierge model," but it seemed like it was only for like very wealthy and people are just more informed. They're more involved in their decisions and someone says, "I can work out really hard and I can buy a cold plunge and I can tailor my diet and then maybe these supplements are helpful to me." You know, people pay for what they value, and people value health.

Yeah, I really liked something Max said earlier, which is like, you know, what is it? The healthification of consumers, right? Rather than the consumerization of health. Yeah, I love that perspective. As we wrap up, any final thoughts that you'd like to share with our listeners?

For healthcare too, start changing. I think we need to create a culture that focuses on what if and the opportunity and possibility rather than one that condemns, criticizes, focuses on challenges and problems, and tells someone why they can't do things. So it's my hope that hopefully we can slowly create that culture. And I think that the amazing part of where we are in the world is that consumers are starting to take care of their health. And what that means is that all of us now understand the customer, right? Like, you don't have to be the health insider to understand the customer. We are all customers and we all have intuitions around what we want to exist in the world. And that is the first thing required to start creating it. So I'm excited. Love it. John?

Yeah, I think we have to look at health and realize it's not luck, right? It's planning. It's collaborating our science and our behavior and our tech and making sure they're working together for longevity, not to stop a horrible aging process, not to respond to preventable illness, but in a way that we're promoting healthy lifestyles. And I think we need to align our incentives and our investments and our reimbursement to match that.

Awesome. Well, Max and John, really appreciate you both hopping onto this episode with us. I think it's been a really interesting conversation. I've learned a lot and have some new perspectives, so I appreciate both of you being on. Thanks, Chris.

Thanks for having us. Thanks for coming.