#17 - Three Breakthroughs: Are Doctors Doomed, Space Breakthrough, and Is a Cure for Diabetes Coming?

AI doctors, Starship, and a cure for diabetes. I'm Sam, and this is The Tech Optimist.

AI doctors, it's coming. I think it's a great venture capital opportunity, frankly.

And Starship to me is probably one of the, if not the biggest breakthroughs in space ever.

At the end of the day, there are still people that don't have a working blood sugar management system anymore.

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Hello everyone. Welcome back to the Tech Optimist podcast segment on 3 breakthroughs. I'm Drew Wonsalak, a senior associate here at Alumni Ventures. And with me, as always, is Mike Collins, founder and CEO of Alumni Ventures. Mike, I think you're kicking things off today with your first breakthrough.

Yeah. Hi, Drew. Mine is a little more thematic than a specific announcement, but I visited my doctor this week and I kept thinking to myself, is AI going to replace My doctor. That's an exaggeration, but I could see where more and more of this is going to be taken up. And, there are definitely— I mean, you think about what medicine is, right? They're taking measurements and data and signals From, I have a sore throat, take a temperature. There's a bunch of inputs there. And then basically a doctor is running kind of a computational decision tree based on that, which is well known and somewhat formulaic. Right. And there have been some tests done where the quality of the diagnosis

Mm-hmm.

Is better with an AI system. And then you jump to, oh, but bedside manner, right? AI outscores in bedside manner. You know, the AI system doesn't get frustrated because of being— they're being second-guessed by an insurance company, isn't at the end of a 14-hour shift. Feet doesn't hurt. All the things that we as humans have to deal with, not really. So it was surprising to the people doing this initial research that in bedside manner, blind, the AI system outscored the human in almost all dimensions. And again, this is This is as bad as these systems will ever get. And so, you know, there are companies going after this space. We're involved with some, we're not involved in others, but I think it is a very interesting space. Plus, you think about the system can be reading all the latest medical journals, all the latest clinical trials. It can be, you know, again, I'm sitting there with my doctor and he can't remember stuff, so he's looking it up on his laptop. And it just struck me as, you know, if you're in college, And you want to become a doctor.

Hmm.

You want to become a doctor because you want to work with these systems and you're going— and you're doing it because you love the idea of going into medicine. Do not go into medicine because it's a job that you think is always going to be in demand and safe and well-paying because the world changes. And I think this is an area where I think there are some other benefits with costs, availability. And again, I'm not talking about it goes to zero, but can it become part of our healthcare system in a very meaningful way? I think so. And again, I'll bring it back to some issues with my own mother. And that, you know, helping her prepare for her appointments with a list of questions, I use AI today to do that. She is going in for a procedure. She got 10 pages of documents. I loaded those into an AI system and it gave me a summary and a list of questions that she could understand.

Hmm.

So already it is a tool for an individual today to help them navigate the system better with good questions, with translating things. And a lot of medical records are now available to us, but it's like, I can't understand what this medical ease is saying, but now the AI system can translate it for me.

Really quick, I wanted to jump in here to do a little bit of research on, you know, some of these technologies and some of these, uh, AI technologies that Mike is talking about here. When, you know, he talked about bringing his mom to the doctor, um, her getting a bunch of paperwork and then him using an AI software to essentially summarize everything that was in those documents and, you know, summarize some questions that his mom could bring with her to her next doctor's appointment. And I thought this was just like such a really cool, uh, and like fascinating way of thinking about how to help a loved one. Um, and I think Mike, you know, being in the tech space and being in the tech space and the startup space for so long, his brain is kind of wired that way. Right. Uh, and I found this one really cool AI service. Um, it's called AI Hub from Instabase. Um, and I tried it really quick. This is just an internal document we use. These are actually some of Drew's picks from the past Breakthrough episodes, and I threw it into the AI software. I had it summarize the document for me, and I tried it out myself, and I thought it was really cool. So this is a tool that, you know, I'm definitely going to use from now on. And if anyone else listening to this show wants to use it, please feel free.

So again, where we are today, it's a tool. But I think it's going to be part of our medical system sooner versus later. And that's exciting.

Yeah. I mean, whenever we see kind of new innovations like this, I always try to look, are there any recent kind of comparables, similar markets that have gone through that same trajectory? This is very similar, I think, to what's kind of happened in fintech, especially with like financial planners.

The

rise of robo-advisors.

Yep.

And there's obviously a technical element where it's a time suck, a lot of it, right? The one piece that's similar is I talked to my parents about some of these robo-advisors, and it's, you know, they want to hop on the phone and talk to their financial planner.

Yep.

I'm different generation, happy to, like, log into my Wealthfront account, you know, and manage it myself because a lot of it is, it's systems and processes that AI would do just as well as a person would. What does, in your mind, I mean, kind of the future of healthcare look like then? Is this something that kind of shifts? Because there's a cultural element and there's a technological element here. Do a couple generations have to pass by and people just kind of grow up in this environment where, you know, it's maybe they have a nurse practitioner or, you know, a nurse that's like the human touch and then everything else is, you know, technology? Or, you know, how do you kind of view that balance?

Yeah, I think there's much more power in the hands of the individual to be informed. And again, some of this is generational. My parents go to the doctor, and if they say take the blue pill and stand on your left leg, they take the blue pill and stand on their left leg.

Yep.

You know, my generation, kind of— I'm on a— I'm a kind of a cusp boomer, um, is much more skeptical But still put great power in the degrees and that. So I do think with each generation, there is a very different attitude toward things. So some of it, it will take time. And obviously there's areas where, you know, and you have a company that's also just continuing to knock things off with robotics, right? Because it's like, oh, then I'll be a surgeon. Right? Because it's like the AI can't fix my bunion, right? Kind of thing. But you have a company like Intuitive Surgical that is robotically doing more and more procedures robotically or aided with robotics every day. So again, these things don't happen overnight. They don't You know, some of it is generational and takes time, but I think it will move quite quickly. And I think it'll be good for the system. I think there is efficiency that can be had. And I think there are going to be startups that absolutely become unicorns in this space of robo— of what I'm going to call AI-aided medicine.

Robo doctors.

Promo doctors, right? I mean, you also have to say to yourself, you know, what are markets that are ripe for disruption?

Yep.

From a standpoint where there's things that are very expensive, there's a part of the population that isn't happy being served well, you know, and there's enormous value capture. Where there are, and a lot of frankly dissatisfied parties. It's education and healthcare are 2 big ones. And listen, there is a lot of regulatory constraints for sure. Some of them very justifiable.

Mm-hmm.

Some of them, I think, kind of protecting the old guard a bit. But, you know, the market wins. over time. So I do think the idea of AI doctors, it's coming. I think it's a great venture capital opportunity, frankly.

And the last thing I'll add is to your point of kind of what markets are ripe for disruption, I'll add the extra phrase of like ripe for disruption by AI and artificial intelligence. And it's, I think, not only those markets that are highly bureaucratic, they're multi-trillion dollar industries, But where is there kind of additional value to be had when we can actually understand more data, right? I mean, that—

Yeah.

Try to like boil this down to like, you know, because there's AI in video games, there's AI in like consumer apps, and that's great, right? But the real unlock is now we can ingest kind of massive amounts of data and actually pull actionable insights. We can have, you know, computers make decisions based on that data. And so where are the biggest unlocks for that? And I think you're spot on, it's healthcare. I mean, there's so much personal health data that we just wouldn't spend the time to capture because we wouldn't know how to analyze it or be able to kind of analyze it, especially if it's unstructured in kind of different formats. So—

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Um,

I mean, there's a, there's a, I mean, again, this is just a category that is perfect for this. I mean, there's a, there's, there's a, uh, a social media medical student, I believe. And they're basically given 60 seconds to ask, to play 20 questions.

Yeah.

Come up with a diagnosis, right? He has basically a minute to do Q&A. And I'm saying like, an AI system is gonna crush you.

Yeah.

When Mike here was talking about this sort of TikTok social media trend here, I knew exactly what he was talking about. You know, my generation being so involved within social media, TikTok, Instagram, I have seen them personally on my page come up and are sort of recommended to me through the algorithm. And I figured I would share some for anyone who was unfamiliar with this. But here's an example right now. This is an audio from a post from that. 60 seconds to

make the diagnosis. All right. Well, tell me about the patient.

A 42-year-old male presents to the ER with increasing shortness of breath, wheezing, and coughing.

Okay, uh, does the patient have any history of asthma, allergies?

Nope.

Uh, history of smoking?

Nope.

Okay, um, is the cough dry or wet in nature?

Dry.

It's dry. Um, what about the chest x-ray? What are those?

Marked hyperinflation.

Marked hyperinflation. Um, is the AP diameter also increased?

Yes.

Okay, um, and can you tell me about the ABG report?

It's PaO2 63 and PaCO2 54.

Okay, so they're hypoxic and hypercapnic. What about the spirometry, the FEV1? 0.6. 0.6, okay, so obstructive in nature. And what about the bronchodilator response? No. Significant? No. Okay, and for the CT scan, was there primarily upper or lower lobe involvement?

Lower lobe.

Lower lobe involvement. 10 seconds. Okay, and then for the blood workup, is there deficiency in alpha-1 antitrypsin? Yes. It's a penicillin orifice hematoma.

Got it.

Because it's basically matching, you know, the symptoms, the interaction. And obviously there's reading the room and there's some human judgment in there, but there's a whole lot of understanding the corpus of data. Hmm. That is very knowable by an AI system and frankly, beyond the capacity of one human brain to do well. So I just think, you know, it's inevitable. AI doctors are coming. So on to you. What's yours?

Yeah, so we're recording this on the 7th. On the 6th, Starship successfully had their kind of most recent test flight where they were able to land both the booster and the rocket itself back into the ocean. This is a massive step for the company. Huge. Yeah, huge. And Starship to me is probably one of the, if not the biggest breakthroughs in space ever, um, by, by orders of magnitude. And so I just wanted to put that into perspective a little bit. The goal of Starship, it's a rocket bigger than the Saturn V, which is what brought, you know, our Apollo astronauts to the moon. It's larger than the Statue of Liberty. And the goal is, can we take 100+ tons of payload to space Um, reliably. They want to launch these like once every couple days, you know. Eventually at some point maybe it's, you know, daily.

Ever since Drew had said that the Starship is larger than the Statue of Liberty, I just had to grasp how big that is. So I'm going to spin you guys some facts to help sort of understand how big this thing is, right? Okay, so The Starship is 165 feet long, right? The Statue of Liberty, from tip to the end of the base, not the end of the statue, is 305 feet. But just the statue itself, from, you know, the bottom of her shoe to the very top of the torch, is only 152 feet. Another few fun facts about the Statue of Liberty to then help grasp the scale of this thing. 5,000 sheets of heavy gold leaf cover the copper skin of the flame in the torch, and the length of the statue's index finger is 8 feet long. Okay, Drew, let's keep going.

And the way that we measure things in space, just to illustrate kind of how big this is, is cost per kilogram launched. What is the— what is that price that's kind of to the end consumer? About a decade ago, it was probably in the $10,000 to $20,000. 2 decades ago, it was way higher than that, almost in the millions. Last year, we got that down to just under $2,000 per kilogram. The end goal with Starship and what it's on pace to do is be able to offer these launches for $10 per kilogram. Mm-hmm. So when I say orders of magnitude and kind of democratizing access to space, Starship is what's gonna do it. And it's not just bringing small Starlink satellites to low Earth orbit. This is 100 tons of payload to the moon, to Mars, farther out in the solar system. I mean, like the ancillary effects of this are massive. The number of things that we can do, the costs it drives down of energy production, of in-space services, This is going to be huge and we're going to look back on it, you know, in a decade or two. And this is a really pivotal moment for the industry.

Yeah, I mean, there's a couple of things that the technical achievement— amazing. It also, to me, reminds us of the power of the private sector working with government. So Nat 1 alone, but it's like, would we be where we were in space as a planet today if there weren't private companies pushing and experimenting and frankly, sometimes failing? No. Could we have gotten there without some of the enormous societal investments made 50 years ago by the government? No. And again, I think people can dismiss space as being you know, frivolous or— but it really is pushing. People said the same thing about go west in the United States. Like, why the hell do you have to, you know, cross the Mississippi? You know, so, you know, humans push boundaries. We experiment. I think within the decade we are going to be mining very important things off of asteroids. Yeah. I think we're going to have, you know, permanent— a permanent base within 10 years on the moon. And I think it's— I think it's great. And I am agreeing with you. Big deal. Super exciting. You can't help but notice, like, it was about number 7 on the list of major media publications behind— You know, the political story of the day, the, you know, the pop culture story of the day, you know, because it didn't blow up.

Yeah.

If it had blown up, it'd been right at the top. Right. And these things are going to have failure and misses and tragedy. But Um, it's a good one.

It's, it's, it's a good one. And I'm, I'm glad you brought up the kind of moving west, you know, to extend that analogy. This is building the railroad. This is like the first railroad, the promise of that compared to, you know, wagons, you know, cover wagons moving west. I mean, just how much that will do. Um, and, and space is— yeah, it's not frivolous. It's— this is a domain that's already important. It's how, you know, GPS, it's wireless communications, things that are crucial to our society that if they went down, the effects would be massive. So it's a domain that's important, and the cheaper we can get there, the more reliably we can get there, it only opens up kind of more billion-dollar markets for us to enter.

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Okay, the 3rd tech breakthrough of the week, um, comes from the journal Cell Discovery, and this is some very preliminary good news on a cure for diabetes. And so, you know, we've talked on this show and elsewhere about what we think the power of kind of the GLP-1 drugs has been. Clearly a thing that now South Park has lampooned it, which is fantastic, by the way. I urge everybody to watch that. Where I think it's probably one of the untold technology platforms going on over the next 5 years is the The medicines coming to obesity. Hmm. But, that's related to kind of pre-diabetic conditions and issues related to obesity and being overweight. At the end of the day, there are still people that don't have a working blood sugar management system anymore. Their ability to produce insulin and react to the fluctuations there is gone. And it is a very tough condition, leads to premature death, amputation. One does not wish anyone to be diabetic. And so what we saw is some cell therapy, frankly, happening in China.

Hmm.

And so, you know, this was a 59-year-old man, type 2 diabetes, who received cell transplants in 2021. And the patient has now been insulin-free for 33 months. And the procedure really kind of Recreated the insulin-producing cells in the pancreas.

It was his own cells, right?

Yeah, I think it was his own cells. I think it was a stem cell-like therapy. Again, over my pay grade. And again, I think there's always additional skepticism when it is Not the United States, but you know this was a legitimate medical center. This is a peer-reviewed publication. It is not; it needs to be replicated. It was probably extremely expensive. But again, I think there is hope that this again in our lifetime can be a curable disease. So the combination of Getting pre-diabetic people fixed. And then for the people that for other reasons, you know, become a type 2 diabetic, I think that this is again super promising. It affects millions and millions of people and it is a huge personal cost and a societal cost. diabetes in the world. So, um, it's very early, but I think that for me, that, that is— it, it would be such a big win that I had to mention it as one of my, um, uh, breakthroughs. So—

This is a big win, you know, regardless of— I think if, if the study— you made the point, you know, this is in China, so there's some skepticism. And, you know, we have such an innovative and kind of capitalist Dick culture here in the US that it's kind of like if it wasn't here, you know, is this actually— we should be leading on this stuff. Um, but I think it's an interesting concept because we've talked about this before with, I think it was like the superconducting material, right? That was supposed to superconduct at room temperature. It ended up, you know, not being real replicable. Yeah. But it's still a win. I think when we start talking about these things, it's a win because it gets people talking about it. It gets more money flowing into these industries. You know, people are jumping in trying to disprove it, understanding the science. Hey, does this work? Could this not work? You know, if anything, it is creating more publicity. It is getting more people engaged. It is getting more dollars in the door to solve some of these huge issues. So promising. I have no reason to not believe that it's true. But even if it's not, I think it's a huge win when stuff like this gets the publicity it does.

I mean, that's science, right? And it is, You know, that's the process, the discovery, the skepticism, the peer review, the people trying to replicate it, people then trying to make it better. But once, you know, once you start getting some of these scientific experiments, then, then as we've talked about before, when you move it from a science problem to an engineering problem, Humans engineer the shit out of stuff. So, you know, if there is— if there's a scientific way to make it happen, then we can get really good at, you know, making it more accessible, more safer. You know, we get really good at that stuff. And so— and again, when we're talking about something like 40 or 50 million people have to take insulin regularly and I don't know, there's 100, 150 million people worldwide that are kind of dealing with diabetes. It's, you know, that's a lot of pain, suffering, and cost. So again, we're tech optimists, right? So 3 good stories this week.

Absolutely. Thanks, Mike.

All right. Have a good one, Drew. Thanks. Bye.

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