Should a physician do an MBA? Saumitra Thakur - Med Mountain Ventures

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Hi everyone, it's Rashad here. Thanks for joining us today. Today I'm talking to Samitra Thakur. He's a physician and a venture capitalist. Samitra, thanks so much for being here today. If you could give us a brief introduction into your background and we can get straight to it after that.

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Absolutely. Rashad, awesome to be here. Big fan. Thanks for having me. I'll keep my background brief and then we can double click on whatever is interesting. I split my time running my VC fund, which is a first time fund. We have about 10 million AUM.

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And working as a hospitalist part time, an adult medicine, internal medicine hospitalist in the US. I went to medical school, had a startup unrelated to healthcare, got my MBA at Stanford while I worked on it.

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Really missed clinical medicine, like really missed being at the bedside, being with people. So decided to go back to residency and then through a sort of convoluted series of events, some sort of actually pretty unfortunate.

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I found myself helping out someone with a VC fund, becoming much more active, falling in love with it, and then stepping away from full time clinical medicine to do this as well.

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Okay, perfect. Thanks for that introduction. I think let's start at your childhood.

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There's a general philosophy I found that entrepreneurship is innate. Let's talk about Samitra as a five year old in kindergarten, in middle school. Were you hustling back then? Were you trying to sell your friends CDs or what was life like for you back then?

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You know, that's a good question. I think that I always really loved obsessing about ideas, trying to understand things, trying to understand structures, rules, rationales, and then thinking of like what the edge cases where the frontier is.

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Like I remember loving watching really old cartoons that seem clearly like, you know, it was like the 90s, like these like old reruns stuff, like Weird Hours on Nickelodeon and being like, what was America like in the 70s?

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And like, you know, the kind of thing you could laugh at, like, why is it that like this was a joke in this era, but not a joke in that era? As a kid, I remember watching so much TV.

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I used to like wake up at 3am, sneak downstairs and watch like the trashiest, least popular cartoons that Cartoon Network would show from like, you know, some like crazy early hour until 7am when I pretended just to wake up.

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And it was just like indulging in nostalgic American culture and being like, what is this weird country that we move to? And what is it that they like, where were they and where are they now?

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And what are these sort of like, you know, institutions and ideas? I think that that was like a really big part of my childhood.

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And it kind of, you know, you know, I was five, so take like sort of trivial forms. And I think that that was the thing that stayed with me throughout.

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I would say that I've always been really bad at selling. I've been really bad at like closing, but I always just loved ideas, theories and possibility.

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And I feel like as a VC, like what I really love about very early stage stuff is someone will come to me and be like, you know, I got a weird way of doing things.

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And it's cool just to sip tea, stare at a wall and be like, huh.

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Does this make sense? Does the science make sense? Does like the politics make sense? Does like how's it fit into like a regulatory culture in this country?

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Like what would the world look like? I feel like that's like the adult version of that weird thing I did as a kid. No one knows about this.

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I think my parents had a suspicion that I was doing this, but no one knows about this early morning cartoon thing that, you know, basically went to the Sabbath now.

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Well, thanks for sharing that with us. And, you know, if Ma, Samitra is listening, your secret's out.

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I think the next question that I'd like to ask is you talk about, it sounds like you had a keen eye, almost an engineering eye to break things down into their first principles.

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Danny Kahneman talks about using a structured approach versus intuition for decision making. You know, investing generally, as per his decision, would fall into a low validity environment.

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You're not getting repeated feedback and you need a structured approach, but, and you can offer that intuition.

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What are your thoughts on how much intuition you use in your investing thesis and how structured are you?

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Totally. We're big Kahneman fans. We, whenever we do deal meetings, we take all of the startups that we're considering, we score them based on different metrics.

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We predefined ahead of time what the metrics are. We each assign our own weights, being like, you know, for me, this is really important for like, you know, Brandon, these things are really important.

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And then we rank them and we try to get a sense of directionally, where does everything fall? We do that to get a lot of, to sanity check what we're doing, to make sure that we're really chasing quality.

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We're not chasing, you know, shiny things, just being shiny. We're not chasing hype or like really doubling down on what we identified during a calm, rational, you know, system two period as our strengths and investing along those lines.

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We don't take it literally. So if something is a 34, which is pretty high on my scale, and there's another deal, which is 32, you know, I see them as approximately the same, even 28.

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It's like, you know, kind of arbitrarily precise. So it's good for getting broad buckets and being like, these are better deals. These are worse deals.

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It's been needle moving. There have been a lot of deals that I thought, this is awesome, and I'll do this and I'll say, this is a great deal for somebody. But, and you know, I could probably grow money doing it, but it's not part of my thesis.

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It's not part of my strength. I'm not particularly confident that my vision in this bet is good, that I'm going to be value add. There are better bets that I can make.

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So I found that to be the first Kahneman principle that was really helpful. The other is if you want to source the best founders, you're going to have a portfolio of people who looked like, you know, all sizes and shapes of people.

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It's going to be diverse by virtue of being good at sourcing and really getting into the best deals and being truly based on merit. Your deal founders will all look different from each other.

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And I found that my first impression is often very wrong, especially folks aren't from my in group, which is a super narrow, very snobbish lead in group.

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They may miss certain things and they may like not nail the first impression, but they may have an awesome deal, especially in our field, which is so technical.

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I make it a point that I never put a lot of weight on first impressions. One of my favorite portfolio teams really irritated and upset and offended me for like our first several interactions.

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And it was entirely just like a mismatch of how we communicated. And I made it a point being like, you know, irritating, but I'm going to set these feelings aside.

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I think it's a bad first reaction. I'm going to keep an open mind. I think there's possibility here and now I love working with them. And in general, I think this is something we do really well.

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We're like, you know, not first impression, not gut, like, you know, pattern fitting. This is someone who looks like someone famous. I'm going to invest in them.

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We're really doubling down and being like, who is this person? What is their specific kind of company? If they do things I don't like, is a part of a coherent strategy that makes sense.

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Perfect. I'm really happy you mentioned the communication mismatch because I feel like so many people overlook potential great deals because they meet someone who doesn't communicate like them.

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I feel like we are pretty good communication match, but maybe you could go deeper into what are some different kinds of communication styles or philosophies and where exactly was the mismatch?

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I think that there are three really broad axes. One really big axis is age. One really big axis is geography and a third is sector specificity. I may need your help reminding me of these three.

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I kind of made this up on the fly. For age, there's a way that people who are in their 20s and 30s generally build a company, a certain approach and attitude and like system they take.

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There's another way that people who are in their 50s or 60s, especially people who've been serial executives who've done it a lot, will build their companies.

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The difference is huge. Everything from how they communicate to what they emphasize to how they make trade-offs in terms of spending and bringing on certain senior hires sooner.

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Oftentimes, the whole approach to the company is very different. Both can be really effective. Both can be very potent in a very technical field that favors insiders.

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There's a really strong advantage to being good at it before knowing everyone and doing it, but it's going to be a company that looks very different from how a consumer tech Silicon Valley company may look that's incubating down the road.

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The difference is often very subtle. One company will send me beautiful material made in Canva. It involves a lot of really cool pop art, cool colors and things.

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The other one will send me an investor update and it will be a well-formatted PDF that's included as an attachment.

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And they'll be like, hi, this is our investor update. Please see it as an attached PDF. It's very subtle.

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It's a very different way of communicating. Both are fine. Both can be effective, but they make very different first impressions.

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If you're not mindful, you may be turned on or off in a way which is detrimental for assessing the merit of the company based on that.

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By geography, growing up in the Midwest, very much identifying as a non-coastal person, really having my identity being small town Ohio, Rust Belt.

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There's a certain attitude and pretension that you see in certain regions. There's certain university cultures that are quite powerful.

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And when you leave those ecosystems, oftentimes founders have to, they often speak in a very different way. They build their company in a different way.

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And the third is when you have folks who are deep insiders, who are like very subject matter experts, the way they talk versus say generalists who are new to health care and the way they talk, it could be quite different.

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The actual fundamental thing they're doing may be quite meaningful, may even be identical, but they may tell it in two different ways.

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One may speak in abstractions and archetypes. One may speak in such incredible detail that you sort of lose track of the big picture.

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They make very different first impressions. You have to check who is this person, where are they coming from, where do they assume I'm coming from, what kind of story are they telling,

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how do I really dive down from the way they're framing it to the specific engine of what they do and how they create value.

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And for me, I have a lot of baggage around. Sometimes I'll hear something and I'll say, like my gut will go in the wrong direction. If someone pitches me and it's too abstract and conceptual, it's very easy for me to dismiss it and be like, you know, this seems fluffy.

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I don't see this as being valuable. I really have to dig deep. I think, you know, by virtue of like med school and being very much like, what protein are you drugging?

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What like secondary messenger cascade are you? I skew better towards details. But, you know, there's a lot of people where they're doing something quite detailed. Just the way they storytell is quite different.

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So those are some of the areas where I feel like for me personally, I have to check my first impressions. I've been way more effective by looking beyond this and finding founders who are awesome, seeing them for where they are instead of where I think they are.

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Okay, perfect. It sounds like you've, and I just have a question I want to ask before we get to this point, but it sounds like you have a very clear understanding of your own biases.

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So I would like to ask you how you got to that. But before, I want to clarify, there's a lot of noise in the space that you must talk slow. You must be almost monotone and emphasize each word.

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And it drives me nuts because I like when founders are excited when they're talking at a million miles per second. So I just want to get your perspective on, you know, do I need to really tone down my voice and talk like this? Or can I be excited?

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Can I talk fast? Is that okay? And how do you perceive people who talk in each manner?

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I, you know, full disclosure, I once saw an executive coach in business school who told me that I have no executive presence, that I speak both way too quickly and monotone, and it was the worst of both worlds.

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So I'm, I do my best to not be influenced by these factors. If I'm talking to someone and they're very brilliant, they're very effective, they can lead their team. They don't like making eye contact. They tend to space out.

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They tend to space out. They have certain communication idiosyncrasies, but they're effective at their job. It works for them. I'm like, you know, that's fine. That's fine. And I'm happy to work with you.

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I do think that there's a friction where I do that in my practice because I want to find the best talent. I want to bring them into my fund. I don't want these biases to hold me back.

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But I also acknowledge that the world itself is very unfair, that there are a lot of people, probably most people who don't want to change. And if I feel like there are factors that are undermining how one of my founders comes off, I like to communicate with them and say, you know, one point of view, I worry that the way you come off may be undermining your efficacy.

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It doesn't mean that you should change who you are. But, you know, it's golfing, you've got a lot of clubs, you have to know how to use the different clubs in different contexts. It's a skill. This is a way of communicating in this specific context that will make you more effective.

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Don't change who you are. Don't change your values. Don't change, like, you know, this part of you, but see it as a way to, you know, meet people who aren't willing to meet you where you are. And probably they won't change on a human time scale that's meaningful.

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So, you know, it's like a situation we got to deal with. I don't enjoy that, but I find that fair.

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I think that's fair. Let's talk about it's really difficult. That's something I've been working on. And the Vipassana I did, I think we spoke about that before.

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How do you know your intuition is leading you wrong? And how do you obtain such deep knowledge about your own biases?

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The most painful thing to find out is something you don't know, you don't know. The normal reaction when you find that is to panic and to feel really unnerved.

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I really enjoyed business school where I did it because there was this very strong culture of getting that kind of feedback and being getting really hard feedback that gets under your skin of how you come off.

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I try to recreate that as much as I can. For example, if I'm in the car and I'm talking to someone on speaker and I have a friend totally outside healthcare who's listening in after the call, I'll say, you know, you listen into that phone call.

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Candidly, how did I come off? Was I effective? How did this land? If I send a very difficult email or communication, I'll sometimes sanity check with my wife, who I think is a great communicator, and also works in a very different professional context and say, you know, I wrote this email.

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It was a confrontational email. I had to do something tough. And this is how I worded it. Do you think I was too tough? Do you think I was effective? I tried to seek out a lot of that feedback. It's tough because you never know what you don't know.

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So there are probably a lot of blind spots that I have, but I've tried to model that. The hard part of building a fund is that you don't have people necessarily who've done it for 20, 30, 40 years who can give you the really hard performance feedback.

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So we've been very, my co GP and I, we've been really proactive in building up like peer mentors, folks who work with us who can give us you know who see our workflow and can kind of like talk us through things, and even building strong alliances of VCs I really

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respect or I tell them, you know, I'd love just to have you as a mentor just someone I can get advice from time to time, as I think through how I do these things.

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It's very similar to going to the gym, it sucks, you know, it's painful. And you do it because you end up better because of it.

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But you know, even just talking about it, I can feel my heart racing, I can see myself holding something like you know it'll hurt. It hurts to find out this stuff, you got to run towards it.

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I've also started at something where I sit down with all my portfolio companies to get feedback at the end of the year, and it's very much you know, what is your feedback for me, what did I do well this year that helped you, and like where didn't I show up or where could I show up next year for you.

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Okay.

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And what are your thoughts on.

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And so Ray Dalio records, famously records all these meetings. Is that something you have thought about, and just Frank thoughts on that.

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Big fan of it. Very useful to go back and hear. It's very good to play back things we often remember things really poorly, and it's really good to go back and think, how did I come off, how did they come off.

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Was I thinking, maybe I misread something. I suspect when I listen to this podcast, there can be a whole bunch of times and I'm like, you know, long answer should have been shorter, kind of missed the point, should have read the room a bit better.

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You just get a lot of time to go back.

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Yeah, I think this is going really well, but I'll see when I go back and listen.

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Let's go back to when you were 1617 in high school, deciding what to do. Were you a good student, what was life like back then, you know, what was your SAT score, you don't have to answer that.

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And did you want to go to med school at that time or just, you know, talk me through a day in your life then.

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Totally in candor and I think this will land for a lot of DC folks listening into your podcast. I tried to do everything to be anything but a doctor and somehow there's really strong gravitational pull that pulled me toward it.

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When I went to business school actually thought I would never come back and it was this strange delightful feeling where I was like, you know, it was actually pretty cool to walk around the hospital and heal people with medicine.

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It felt like Harry Potter, where I could say, you know, this thing that would have killed you 100 years ago will definitely 100% go away.

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You will walk out and live as if nothing happened a month later. This will be a tiny footnote, you know, in your life would have been fatal 100 years ago, literally just using knowledge and physical exam and drugs.

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We can like heal you. It was cool. It was cool to hold people's hands and cry and like, you know, really get through it.

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All of that stuff that made me love medicine. I didn't really know or appreciate when I was 16.

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I really loved things like speech and debate where I spent most of my time totally loved science research competitively you know going to science fairs, etc.

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For the same reason, really, really love mock trial just to get thrown into this world of understanding this hyper logical totally arbitrary system that was constructed.

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Those are things that gave me the most joy and I really loved hanging out at Barnes and Noble and coffee shops with my you know I grew up in Ohio there wasn't really much to do with that and walk here on the mall.

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It's a pretty wholesome place. There's a lot of going to those places and just you know talking to people, getting a really big sense of you know personal color, talking out ideas and things we were like you know very pretentious 16 year olds walk around Barnes and Noble

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pick books off the shelf that we aspire to read to most of which to this day I've never actually read and get lost in ideas. That was a big part of me at 16.

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Okay, that and then when you started med school first day of med school, did you know you would be a hospitalist and if not, what did you want to be?

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I was very sure that I would do neuro interventional radiology it seemed like the coolest field I had a neuroscience undergrad.

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Yeah, like the idea that I could do neurosurgery but I could have the option to sit in a chair, and I love that it was anatomically complex hyper acute and very satisfying.

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You have a stroke, your hemiparalyzed the stroke is gone, you can move your arm. Cool. Cool.

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And then tedious, you know, 12 hour procedure where you sort of pick away at it, you know, with your fingers.

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But everything about that I just thought was awesome. It was where all my research was it was where all of my extracurricular time not working on my startup was.

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It was painful to leave that behind but I had this moment of truth where it was like you know there are other things that give me joy.

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There's this field that will make me happy even if it's the field that like in my head I really want to want to do.

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That makes sense. I think that I don't think I knew when neuro interventional radiology was first of med school.

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But that is a field where you have to be on call so much it is your life it's hard to do it as just work.

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Exactly. That was exactly my problem. It would be I could do it and mentors told me you know if you do this, the people who succeed are happy to have no life.

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They're happy to be at peace knowing your marital life will never be important, your family life, your social life.

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They'll all come second. If you truly are happy with that then this is a life for you.

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Okay and tell me about when did you meet your wife and how was the first date and how did you were?

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We met right as I was leaving Stanford. I was in business school at Stanford. I was leaving to go back to med school in New York.

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I met her through an online dating platform and it was entirely by coincidence because she was based in San Francisco but her office was in Mountain View.

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I was in Palo Alto. So we connected. We talked. I think she started off by saying something like you know I see you have a lot of degrees.

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It makes no sense. You know what kids like you know dude like what's your deal. Why you.

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Which was a great intro and it worked out and we went we had coffee and we just talked about all the books we love.

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Pretty sure Kahneman came up a few times during that. We just talked about all of the stuff we love, the ideas we love, how we feel about life, how we feel about work.

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It was a very fun intellectual deep sincere candid conversation and we had a blast and then we were like you know let's throw caution to the wind.

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Second date you know I'm moving you're here who knows who knows. And then afterwards I was out of the area and she hit me up and she's like you know who knows.

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Who knows. Let's give it a shot. Let's keep dating. Let's just see what happens. Let's do long distance for a minute and see where it goes.

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Long story short it worked out. Married now happily for two years.

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Congratulations.

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How do you balance. This is something I found incredibly difficult when I had my startup.

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How do you balance marriage and working such insane hours.

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Do you set aside date nights or time for each other every week, or do you guys kind of accept when we are working we're working, and then we have a rest period where we will be with each other for a couple days straight.

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We.

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To do this well, you got to do it actively if you take it for granted, it will. It's like a garden where if you want it to look beautiful, even if it looks wild and natural and organic, you got to put a whole bunch of time taking care of it.

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We both really prioritize that we talked very openly about what our needs are where boundaries are.

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We both try to stay very tuned I think we both have a tendency where sometimes we get carried away and then we bite off more than we can chew, and we burn out.

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So I think that we found a really good rhythm of figuring out how to pull each other out of that she pulls me out of it I do my best to pull her out of it.

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We spend. We make it a point to work during our day, fairly hard and as best as we can to maintain proper time off the clock together to recharge.

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We've gotten to the point where we're happy to recharge in ways that are authentic to us, instead of being performative, it may actually look quite lame, but they're very intimate moments, it may just be, you know, us.

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We're on top of each other, you know, she's reading a book, and I'm, you know, doing something mindless, but we're next to each other around each other, talking about our days off the clock, we're charging doing parallel play.

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We make it a point at least once a quarter to do some kind of more ambitious vacation that we're really excited by, and at least once or twice a year to do kind of a bigger vacation and always have something that's more big and formal that will sort of blow up the routine.

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Okay.

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I think that will give our listeners and myself a good framework.

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We have tried different strategies, and what works best for us I think is just taking things organically, but ensuring that if we have enough time for each other for a couple days, then we have to almost schedule it in.

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It gets more difficult with kids as well.

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Let's go back to medical school.

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How did you decide to pursue the MBA?

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And would you recommend it to physicians who are looking to, A, just venture out of medicine, and then B, go to start a fund down the line at some point?

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Totally. This is a great question, Rashad.

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I did the MBA originally because I had a startup unrelated healthcare. I thought very seriously that I would pursue it and leave med school behind, and I couldn't convince my parents to let me do a gap year, but they were very open to me doing a second degree.

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So I decided to do the MBA for those reasons. These are bad reasons to do an MBA.

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I would just say that for most people, the MBA is very expensive. If you don't have a very tight use case for how you will use the MBA, there's a good chance that you won't get value from it.

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If you want to do a surgery subspecialty or certain other fields, there's a decent chance that the MBA will be a liability. I've heard this from a lot of folks where it's frowned upon, it's seen as suspicious, they're fairly intense programs, and you're more

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likely to drop out. I've had a lot of friends who are all out elite applicants for their surgical subspecialties not match because they did an MBA and it alienated a very key department chair or someone else.

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So I would recommend for most folks, think very hard. Think about if instead of taking out six figures in debt to do a graduate degree, what if you use those six figures of debt to do 20 angelist investments sometime down the road?

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That would probably be more material and more helpful. What if you take that time and you do a research year and you end up going into a field of medicine that you really love?

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What if you take that time, you just do a straight up sabbatical and you throw yourself at a digital health company or something else, doing something operational and getting hands on experience?

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If you really want to leave healthcare and do something else, I also think the alternative is go work for Bain, McKinsey, or BCG instead of paying $200K, get paid $200K, get this equivalent credential and avoid, you know, taking off time.

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I would say a lot of the folks who push you to get the MBA, I think, are administrators who see it as an awesome revenue source.

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Like you're very credit worthy. It's so easy to add another, you know, 200, 300K of debt onto you. It's not their problem because you deal with it 10 years later.

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And I feel like for most people, it doesn't make enough of the Delta. With that said, totally love Stanford, awesome program. I got a lot out of it. A whole bunch of my MD MBA friends are awesome and very happy that they did it.

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But I think that many people fall victim to an industry that over promotes the MD MBA.

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Okay. So I think a common mantra almost is the MBA is worth the network and provides you with. For yourself, how much did it help raise your fund?

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And if you did not do the MBA, would you think you would still be successful in raising the fund?

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It's a good question. I think a very elite MBA is worthwhile. I think that a prestigious but not hyper lead MBA loses valence.

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And it's like an inverse power law. There's a pretty big drop off, especially because elite versus slightly less elite is still extremely eye poppingly expensive.

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It's worth really scrutinizing and thinking, am I getting my money's worth? Is it totally worth it?

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It's hard to say. I think that it adds credibility to strangers from afar.

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And it's definitely one tool that I have. A lot of being a VC is reputation management. It's thinking, how do I present myself a certain way? And it's definitely a shorthand to say, I did my MBA here.

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I did this. These are the schools I went to. The further along you go, the sillier it feels to say several years ago, I was here. That's cool.

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It's like being in kindergarten, people said that I had the nicest smile. Cool. That's great. But a lot's happened since then.

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And what did you do with your great smile since then? It's cool. You did your MBA back in the day from there. But lots happened. The world's moved on. What have you done since then?

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I think that it's a good tool to have in my arsenal. I think that it definitely helps. What leads to my best conversions, if you will, is people who know people who say that I'm really smart and really good at what I do.

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And that's the source of credibility that I want to double down on. Doing the whole, this dude, he's like a GSB guy, he went to Stanford. It's definitely something that's better than nothing.

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It's a good calling card for other people who seem to be in group to that business school. But it loses power over time. It's not as good as saying, this person's a subject matter expert.

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When I see friends who are pure physicians building their careers, what really makes them effective is, I think you're a great example of this, or a lot of other folks too, where it's not this is their pedigree, this is that.

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But it's like, yeah, they were in the field. They saw it. They work with their hands. They're really smart. You should hear them talk about their subject matter. They're experts.

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That's the source of credibility long term that I think is gold standard.

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Okay. Yeah, I think it can be a signal if you went to an excellent school like you did.

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Let's talk about signals a little bit, and specifically FOMO. This is something I've been recently battling with as I've been getting better deal flow, is how much does FOMO factor into investing in, say, to use an extreme example, A16Z or Sequoia,

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invested in a company you have an opportunity to invest in? How much is that scoring in your structured approach, or do you completely ignore the fact that these bigger market leading firms are investing?

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If it's around, which I have access to, and one of the tier one VCs invested prior, then oftentimes there's some secret adverse selection going on.

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There's a good chance that if A16Z has a port co and they're doing a bridge financing and A16Z didn't take the entire bridge financing, that this is one of their lemons.

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I'm very cautious about it. What really helps with the condiment index is it takes you back to your basics. For us, we're very valuation sensitive.

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If there's a deal which seems the fundamentals are good, but disproportionate to the incredibly high hype based valuation, if they're non short term financial things driving the valuation of the company really, really high,

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we're particularly good at saying, awesome deal, too buzzy, not for us. Oftentimes when I see deals that are very pedigree founders, super prestige, and they have valuations that I think are, they give me trepidation.

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I've been pretty good as a fund and culturally as a fund saying, this isn't a good fit for us. It worked out well because when the market imploded from 2021 to 2022,

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a lot of these deals ended up being unfundable and they're in this weird position where the expectation for their next round without down rounding is preposterous.

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So you feel validated, but it is very hard.

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A big part of it is thinking this is my job to grow money by placing it in places that will grow or is it to do more and to take very specific bets on top.

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And I like to think that if I'm just co-investing with a 16 Z because they 16 Z like correlates to good returns.

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I'm doing a very guy on street gambling approach and I don't have an advantage there and I'll probably end up losing more times than not.

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So I should avoid those investments and focus on where my strength is.

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But it's very exasperating and you definitely have a lot of nights going to bed where you feel the FOMO and you're in bed thinking, am I an imposter?

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Did I miss this? Everyone else is there, especially if the company does well for a year or two, then you're like, was this a mistake?

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Yeah, I feel like things you miss, you regret more than failures you had from things you invested in.

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It's easier to say this was a learning opportunity and I won't do it again when it's an action you took.

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Talking a bit more about the aspect of FOMO, how often are you going back to deals you passed on or companies in general?

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So I was looking at Cerebro and Romans and their previous rounds.

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And I am not sure if I would have invested in them, to be frank with you.

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And obviously I could have made a lot of money in both those companies.

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How often are you looking at that and say, okay, should I change something about my core thesis or I'm okay missing a couple of these in the hopes that I will see different ones that fit my thesis down the line?

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Whenever I pass or invest in a company, I like to have a sense internally of a theory for why.

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Oftentimes it's something very specific.

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And I think it's an awesome idea to go back and see not only did the company do well, but how did that fit into my rationale?

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It could be that the rationale was like I was empirically wrong, I said blank, and then the opposite ended up being true.

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And that's really good feedback because you can do something with that.

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Sometimes it's about legibility of risk where there's a venture bet here, but I can't read, is it a stupid bet or a smart bet?

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It's not legible to me.

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I think I passed because this access of the company, this complexity is ambiguous to me in a way where I'm not particularly sophisticated.

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And if the company ends up working out, that's cool.

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And I'm the first one to say that's awesome.

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The feedback there is I should develop skills to see deeper into this kind of ambiguous risk.

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I should try to get more clarity.

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It doesn't necessarily mean that my thesis is wrong.

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Whenever I invest in companies and they're successful, I want to make sure are they successful because of dumb luck or were they successful for the reason that I thought they were?

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And that's a different kind of hidden thesis feedback.

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Are you getting dumb lucky?

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Are you actually having wins because your thesis is correct?

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I think that that's the right approach.

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Breaking it down from binary one or zero to if successful, what made it successful?

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If you thought that it wasn't a good investment, was it because you positively thought it would be unsuccessful?

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Did you think that it was ambiguous to you?

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What's the specific thing to feedback?

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Okay.

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Boring from Buffett and the theory about staying within your circle of competence.

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Do you stick to health care?

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And if so, are you planning on branching out of health care and gaining competence in different circles?

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I like the idea of building a fund, which is very sector specific, but ideally building it is an institution where we have a lot of GPs, all with radically different backgrounds, different expertises in the field.

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For us, I think that growth would involve going out of health care where I think we're really strong and getting more into certain kinds of life science like computational bio, maybe synthetic bio, fields that are very health care adjacent, where it's similar enough that all of us can collaborate together and be more successful.

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A lot of deals may touch different kinds of revenue and may span both categories, and we can get a lot of synergies.

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For me personally, the kind of organization that I have a lot of fun working in, I don't see it being one that would do things that are truly unrelated to health care.

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If it's like a pure fintech company, if it's a pure consumer technology, a pure enterprise SaaS, something irrelevant to health care, awesome opportunities.

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All of these fields are probably as fields more economically successful than health care. Health care I like to think of as one of the most unattractive places to invest capital and one of the most tedious and most irritating and infuriating.

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So I would love the idea, probably make more money doing enterprise SaaS all day, just enterprise SaaS, game respect game, wouldn't be my joy. I'd rather build and really focus in health care.

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If I broaden, I see it as expanding into life sciences, but probably not, maybe depending on where the world goes, maybe into adjacent health care, dental, veterinary, vision, but not fundamentally beyond things about human beings living and dying.

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Or living and dying.

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That makes sense. I like to think intelligence is industry or field specific, and I am much more likely to fall to my biases when investing outside my expertise.

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So, this is why I stick to health tech in mind, investing as well.

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Everyone in crypto is a good example of that.

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Yeah. Let's talk about your startup, College 100.

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How did the idea come about?

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And I really want to go deeper into your relationship with your co-founders. As a first time founder at that point, I would think that there were some, some learnings from that time that would resonate with myself and our listeners as well.

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Totally. As I was leaving college, I fell into this startup at the time called the College 100 or C100.

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A whole bunch of very awesome random events happened to me. The State Department sent me on a junket trip to Russia with a bunch of student body presidents.

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It was the first high level civilian exchange between Russia and the US since the end of the Cold War. I was part of Obama's reset with Russia. And we, you know, a whole bunch of student body presidents from elite colleges hung out with a bunch of big wig Russian oligarchs and Duma members and, you know,

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like famous ministers and other powerful folks in Russia for a week. And we came back and then I was approached by someone who really wanted to organize the community of young people on track for major political, economic and social capital.

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Get them as a sort of cohesive group and then use that for power networking between them and with people who hold power now. So student presidents and Rhodes scholars, kids of billionaires and Nobel laureates, folks who are founding companies.

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Get all of those young people between 18 and 25. Get them all hanging out together. Get a bunch of famous people, you know, heads of state, Nobel laureates, tech icons, ex-intelligence chiefs, other folks to come and speak to this audience and then use that to connect with them.

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And we made it up as we went. We very quickly became really good at super connecting. If anyone needed to build a movement around anything, we could do it. We could launch it a bunch of universities.

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We did a lot of wheeling and dealing being like, hey, you know, famous person really wants to build a movement around this. If you help this person do an event at Yale and you fill the room with 150 people, then we will do a personal intro to you.

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And this ex-Obama official who's a big deal and you can have a baller summer internship. There's a lot of hustling in that. It was very political. And it was, I would describe it as all bark, no bite.

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So we would do things that would seem cool. Like you'd throw a party and, you know, famous, you know, condom would come to our parties and like a trayist would come and like billionaires would come and it would be cool.

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But we wouldn't feel at the end of the day, like we actually did anything. We just introduced people. We created a lot of value. We captured it.

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The work was political and it involved to be good at it. You had to be a kind of person that was not authentic to me. You had to be to do effective politics. You had to get into conflicts, burn people.

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You had to be very cold blooded. I was bad at it. My person I did this with was extremely good at it. And it just made me a miserable person. It made me do things I hated. I spent my time.

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The more successful I was, the less happy I was. And I hit this breaking point where I thought, you know, I don't want to be famous. I don't want to be in political playbooks, you know, spotted section anymore.

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I hate it. I hate the person I've become. I just want to, you know, take care of the sick. I want to go hang out and tell people, like, you know, sit down with families and have a good cry and like help them do what's right for their loved one and heal people, meet people on the worst day of their lives and show up for them and, you know, do something very sacred and soothing to the soul and get away from it all.

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So that was like the headspace I was in as I was leaving business school. And it was the liberating thing for me was chase the things that you want, even if they're not high status things, even if they're not prestigious, do them because you actually thoroughly enjoy the work of it.

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And I think that gave me the confidence to go and do a bunch of things that would have been very risky to other people, but were not risky to me because even if I didn't succeed, just doing it would have been very satisfying.

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That is a very profound lesson about doing the things that you enjoy doing and that resonate with you. One of the things I'm changing in my philosophy of life is I've always wanted to leave a big mark on this world, to leave an impact that not because I'm remembered or my name is remembered, but just because I feel like I've been given the opportunity to have the skills.

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And I may be talking, my ego is talking a little bit here to change this world in some aspect and I should do that.

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But it is very stressful to think like that and it does not bring me joy or happiness. So I'm shifting towards, I would like to have conversations such as these and do what I can and be there for my family and friends.

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Why do you think that is the playbook in politics of why is the playbook backstabbing and dishonesty and why does radical honesty lose in politics?

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Oftentimes in politics, to be effective, you have to be at peace with things being transactional. If you have something of value, people will value you. If you give them things of value, they will do favors in return as a price to pay.

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If you're not bringing anything to the table and you're taking, there's a good chance that no one will say hard no, but they will give you such a soft yes that will never turn into a no.

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I think that it's a very hard equilibrium to disrupt.

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You maintain a lot of optionality by being vague and being cold.

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If you're playing at state, national or international politics, it's like the Olympics. You have to be the best at doing what you do.

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So much of what you do is building coalitions and alliances between people who back you to get you where you are that you have to be very good at weaponizing your soft yeses and nos,

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maintaining your ambiguity, operating in this very transactional way.

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It's an equilibrium that's always been true. If you read the Stoics and you see how they talk about politics and classical times, if you read basically ancient stories from anywhere, a lot of it is palace intrigue stories.

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There's something very fundamental and human and natural that when it comes to leading people, this seems to be the dynamic that prevails.

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Jeff Pfeffer at Stanford does really good scholarship in a very descriptive, not prescriptive, like totally descriptive way of people who accumulate power.

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It's ugly and it's quite monstrous and sometimes rather heinous, but there are common things that they do and we should empirically study it. We should understand it.

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We should describe it and we should do it in an honest way because oftentimes when powerful people tell their own stories, they deliberately tell it in a way which makes them out to be lion hearted heroes.

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I think that is very well said, Samitra. And this is one of my biases. When someone is charming, I instantly do not trust them.

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That's why you and I talk so well. We connected early on. This guy.

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Building on that principle, and I think we're getting outside my realm of expertise anyways, is a democratic republic the best form of government?

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In theory, a benevolent dictator would be the best form of government, but such a thing does not exist. Can such a thing exist?

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So my frank thoughts are true democracy is mobile. It's not a good form of governance. We have found a good balance in having some checks and balances with the Constitution and it's using some experts who get to choose who the candidates are to an extent.

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What are your thoughts on governance and democracy in a democratic republic and how to build an idea of meritocracy where the best ideas will, which might not be the most democratic ideas?

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Totally. My political framework is really based on the work of three authors, Karl Popper, who we often know as the philosophy of science, but also wrote this really seminal work called The Open Society and Its Enemies.

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It became the namesake of George Soros's foundation. I'll talk about him for a moment. Francis Fukuyama, who was infamous for the end of history 20 years ago, but did a lot of work on institutions and free society and what it means for a society to be modern.

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And Renald Niebuhr, who is this very strange Catholic theologian, pacifist, Marxist, anti-communist, who somehow alienated everyone in the normal political spectrum by being orthogonal to all of them.

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Popper talks a lot about how the best society is a free society and a free society is one that inherently is built on checks to power. All societies have a tendency to err and decay over time.

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No society is perfect consistently in every decision over time. The best society is one that's really built to handle that by having checks on power. It's what, you know, an esteemed to love would call a very anti-fragile system, one that learns from chaos, one that tames, that has a lot of ways to restrict movement.

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It makes a process much more frictional. It makes moves slower and more tedious, but it makes moves better over time. Fukuyama writes a lot about institutions and what really good civil institutions look like and how institutions really grow over hundreds and thousands of years.

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To change an institution is patient work and it's the kind of thing that requires both top-down efforts and a lot of bottom-up efforts. The work of a lifetime of knocking around doorbells and building civic engagement, educating people.

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But this sort of way that you build your society, the institutions that run it, the social institutions, they require a certain kind of investment and upkeep. But if you have a society with very powerful checks, if you have a society with institutions that you maintain very heavily, you live in a world that I think will,

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I think that you live in a world that will, in a very powerful way, respect individuals, respect human autonomy, the rights and liberties and freedoms of people.

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I often have a, when I think about politics, my sympathy is for the bullied of the world, the ethnic group that may be getting culturally decimated in the Far East, the, you know, groups like that, entities like that. I love the United States as being a very frictional, chaotic place,

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filled with social tensions, filled with very radical, strange groups that really, really despise each other, yet choose to stay because it would be untenable to have this fervor of tension in many other places.

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Reynald Niebuhr has a very interesting, and I say this as a very secular atheist person who comes from a very Vedic background, he has a very interesting take on Christianity where it's very much, he talks a lot about original sin and the corruptibility of man,

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and his idea is all institutions that are human institutions will always have decay, and the best kind of institution is built as a hedge against the decay of the future. A benign dictator is really a matter of timeframe.

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If you take a benevolent dictator and you extrapolate it over 50, 100, 150, 200 years, no one maintains a hot hand, and you see a certain kind of radical decay.

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There's a really good empirical work by Ruchir Sharma, who I believe does emerging markets investment at Morgan Stanley. He wrote some books that are both investment overseas, like how do you invest in other countries, but also it just breaks down a lot of amazing social science research on what are the economic returns of a developing country with a radical reformer.

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What if that radical reformer ends up staying in power for 30 years? When do economic returns go away? How do they outperform peers during that time? How do democracies do?

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Democracies never have runaway, rapid, super growth, but they have steady growth, and they reliably have steady growth. The mean is lower, but the standard deviation is a lot tighter, and it works out so that over long periods of time, they become more prosperous societies.

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I think they're fairer societies. I think they're more just societies, but the hard part of being a just society is you have to shovel your own waste, and I think that that's the part that you and I win that.

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That's the stuff that creates all of the social tension in these countries, but the social tension that weighs me down, that weighs you down, that makes us wish, you know, if only we lived in a benevolent dictatorship.

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That's the fact that we're dealing with that tension is what will revitalize these systems over the long term. I'm sorry, Roshad, that was a really long political manifesto.

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No, that was perfect, and it was amazing. I would love to go deeper in all three points. I'll take a pause because we are over time. Do you want to keep going?

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I'm okay if you are.

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You know, the one thing I would really want to talk a bit more about is the experience of going to Russia. So let's bring our listeners back to how old you are. How do you find out that you have this opportunity? What your initial reaction is? And just talk me through as much detail as you'd like to what that experience was like.

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Totally. So I was 21. I was a senior in college. I was taking a shower. I think I was on some waitlist or, you know, B list or something because I was like the last person added to the trip. And I got an email from someone claiming they were from the State Department and that I needed to come back and to mail them my passport. And it seemed like a scam.

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But also I was 21 and an idiot. And I thought, you know, what are you going to do? Like steal my identity? All I got is student loans. You can steal those all day. Good luck opening a credit card in my name, you know? So I mailed my passport and talked to this guy. And then a week later, I was on a plane to Moscow to hang out with a bunch of other student body presidents and meet a bunch of famous Russian people for lunch.

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It was out of nowhere and surreal.

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And how was the, how were the interactions with these Russian, I'll use the word oligarchs because I think it resonates with people quite a bit. How were there any cultural differences? And did you get a sense of how things might be different in Russia and what works and what doesn't work?

318
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Totally. I would describe Russia is a country where elite culture is uniquely out of step with popular culture. Fukuyama really talks beautifully about how this is a very old and ancient feature of Russian civic life. The elites are so separated from the life of the masses.

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Amazingly, in a communist and post communist country, that didn't change. The, we see it now when we talk about sanctioning Russia, where people say you can punish the Russian people.

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It can't possibly be worse than all the things they already lived through. But also, there's such a gap between what public sentiment actually is and what actually happens to influence government. The elite class is so incredibly separate.

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We got a very deep sampling of the elite class, and I would call it the pre-elite class, like the places that generate the elites of 10 and 20 years from now.

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There was a lot of frustration about how frequently the US held elections and how the direction of foreign policy would change. There was a very strong reaction against, even at that time, against things like race equity and feminism.

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I recall one person who ran a popular polling agency who was very pro-Putin talking about, she was a lady who kept saying women in Russia like Putin because she, like, he gives them what Russian women want. He's a very powerful man. He protects the country and he provides.

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And this is what they strive for.

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The character described as the manifesto visionary behind Putin gave us a screed where he said that Russia is a country that has no heroes.

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He's like, you know, heroes are very American. We're a country that's jaded and cynical and real. We have no heroes. The average Russian, for them, a heroic outcome is just having a house and being left alone.

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And this is the political ecosystem where we play. This is what our people strive for, and this is what we aim to provide them. That was interesting and candid, and I think it was very sincerely shared.

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Okay, I think that gives us a little glimpse of a window of Russia. Do you think immortality would be a net negative or a net positive on humanity?

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I think that immortality with a way to elect out of it would be liberating. We see this in the hospital, you know, people dying and sad and full stop. I think people dying it sad on the margin, letting them live would be amazing.

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We've lost loved ones. I'm taking it for granted. You've lost loved ones. Everyone has and everyone will forever.

331
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And there's something beautiful about giving people the choice to live forever. I think that in any scenario where people live forever, that you should give them the option in a very dignified way to tap out when they're done.

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I think that many people would, and I suspect that there would be a, everyone would be different, some for quite a long time, some for a lot shorter.

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But I suspect many people would say, you know, I've experienced existence and I've enjoyed it. I've had my share and it's time for me to, you know, create space for more sentience to exist, more indifferent sentience to initialize and to experience life.

334
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That would be my take.

335
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So going deeper on the concept of there is an expiration date on benevolent dictatorship. Do you feel with immortality, people would come to realize that we are sharing this world and we should share the resources, or will there be a greater divide in wealth with people who have figured out the game, hoarding more resources and compounding their wealth?

336
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In a world where

337
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I would,

338
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I tossed this out. It's sort of opting out of your riddle with a separate riddle.

339
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A world that would have immortality probably would be a post scarcity world. A post scarcity world breaks all of the things we're wired to do and all of the, like, everything kind of breaks down. I'm not sure what people would do or how they would be or if they would be happy.

340
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Or if humans could even be happy in a post scarcity world endlessly.

341
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I think scarcity is subjective. I don't think there's an objective measure for the ideal amount of resources as it's very different based on our lifestyle.

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And you know there's a couple of studies that have come out, the happiest people are in Burma and Bangladesh and you know in Bangladesh they're very poor.

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Oftentimes they don't have electricity, they don't have running water. The six of them sleeping in a four by four hut.

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And if they're the happiest and they are not fighting for the very scarce resources they have by our definition, I wonder if, as is something I'm thinking right now, as of two minutes ago I thought there was resources that was the trigger and that's why I phased my question like that.

345
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But I wonder if it's something else.

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Status will always be scarce. You make a really good point. There will always be scarcity of status, because it's so fundamental to people.

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And money in our culture so closely approximates status that it's easy to think of people will hoard wealth, but almost certainly people will hoard status, there will be in groups, it may be money facilitated, it may not be money denominated, but it'll definitely be a

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world that has some kind of status game.

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The happiest version of that that I could imagine this is stealing a Malcolm Gladwell point is a world where status is limited, but there's a lot of heterogeneity and what status games people play.

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And there are maybe 20 different status games and some people are playing one and some people are playing another, and it gives a chance for everyone to be wealthy in something. And I think that would be a very harmonious world.

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His example was elite undergrad. He used Harvard as an example where he's like, you know, you can't have everyone be the smartest person in the room, you have to have a bunch of people who are really good at sports and are mediocre athletes, but are prestigious because of their sports and are happy in a piece with that because this way you get a world where everyone can play their status game and win.

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Kids who want to be good at school can be good at school, kids want to be good at non school stuff can be good at non school stuff, and they all play nice and everyone is like winning something.

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But if everyone played a single scorecard, it would be brutal and exhausting, it would be a constant mental health crisis.

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Interesting. I mean, I think we could talk about this forever. So I'll say one point and we'll move on.

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Status is a multiplayer game, you need multiple players to achieve status.

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And I think, you know, boring on Naval's framework.

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You should really try and boil your life down to a single player game and have status to your previous self.

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That's how you should measure yourself I feel and it's probably the path to being happiest, you know, unless you keep becoming a worse version of yourself.

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Let's talk about Epitel and let's talk about the diligence process there and how that deal came to you, why you decided to invest in them.

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I first heard of Epitel through my wife, she was a software engineer at Google. She sent me an email from a listserv of some folks talking about some kind of crowdfunding thing that Epitel was doing a whole bunch of parents were saying you know my kid has epilepsy I would really like this so I clicked on the product.

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It was a wearable wireless EEG sensor you could wear anywhere from one to four easy to put on, you know, one over here one over here and then two behind the ear, non hair parts sticky very simple platform arm could be equivalent to a 10 lead EEG would let you do really simple placement

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potentially could do ED placement or outpatient placement could potentially do ambulatory EEG outside the hospital. I am a really big stickler for doing things by the book, following rules, really working up broad differentials following schema.

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So, in my medicine practice, there would be a lot of times when I'd worry about non convulsive status. Think about every older person who's dehydrated and in some kind of hyperactive delirium, and their view on his 90, you know, are they delirious, are they in non convulsive status

364
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it's non convulsive status kind of a big deal. Time is brain really needs an EEG, but in even in all the academic centers where I worked, where these were tertiary, modernary centers, I couldn't get an EEG very quickly it would often be a huge pain.

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And oftentimes for most people, as I know now post investment in epithelin roughly five of six people, the hospital they would go to can't even do EEG like you'd have to transfer out to a different hospital, just to rule out say non convulsive status.

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So, I saw this and thought, this is awesome. I love this form factor. I've used all of the competitors in the space I've used them with my hands I've talked to neurologists I've talked to epileptologists beautiful form factor, very convenient, I reached out to the founder, well before he was fundraising and said, awesome product.

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Consider me a friend and a well wish or if you ever want to raise venture money hit me up. And if you don't that's cool but I'm always happy to give advice I'm always happy to offer you a point of view. This is cool.

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He originally told me he had several million dollars in grants he had seven years in, like, RND he had 10,000 hours of human recordings, and he said for now we're good we're just going to do this grant funded it's fine.

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And we kept up the conversation we kept talking and at one point he said, we're hitting a point where I can commercialize this I can take it to FDA. I'm thinking of doing a small raise.

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How do I structure the company, how do I recap the company, potentially, how do I diversify the founding team I'm really good at this how do I get someone who's really good at things that I'm not good at and bring them on board.

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And we started this conversation.

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Diligence involved, partly, a lot of lived experience on the actual use case, the actual flow in the hospital, the failure in the status flow, a lot of understanding who cared a lot about this and who cared very little.

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The hospitalist cared a whole bunch about this the ED doctor the transferring provider the transferring medical system cared a lot. The, interestingly, you know the academic epileptologist may care very little because you know they barely even round on patients in the

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hospital when they do come in so for them, the irritation of not being able to get EEG leads at 1am. It's not that on the nose for them as it is for me where I'm the one who's like, you know, is this person going to be gravely disabled because I missed a really

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catastrophic diagnosis. Could this precipitate the person's end of life or something reversible if I caught it a day or two earlier than I'm going to catch it, just because it's so tedious to do this study.

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So, a lot of my diligence involved, knowing the products knowing the space knowing the workflows, a lot of clinical intuition, seeing it early on reading the studies, meeting the founder getting a sense of this person is very strong in these things, this is where I can round them out, getting a lot of trust, knowing this person over a really long period of time was really fundamental to my diligence.

377
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Absolutely. So a lot of it was finding the opportunity reaching out early on, even before a round and saying this specific idea seems like a winner. A lot of it spent deliberating looking at all the competitors and thinking, what are all of the other EEG, para EEG, other alternatives out there.

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A bunch of investors as I shopped this deal around said, you know, there's this, but what about blank and I looked at a whole bunch of blanks and all of them had fairly fundamental flaws and the flaws were sincere flaws.

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I made it a point to make sure that it wasn't just me being a homer for the deal that I source that I really liked. I took a really deep dive and I thought, you know, this product, it's like years behind in development and compared to this.

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This is a very technically hard problem to solve, you know, to masters of engineering students spending six months on this is less than the person who was doing their PhD when I was 10 years old, who spent, you know, their entire life like thinking about this problem.

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This product is just like so far ahead. A lot of it was looking at incumbents and thinking, if we bring this product to market, there's already a very dominant traditional EEG alternative there.

382
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They've raised hundreds of millions. Do we have a very clear strategy for how we can compete with them? I spent a lot of time thinking about that as well.

383
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And Med Device in general is a very unattractive asset category. It's very hard to do deals. So I also spent a lot of time thinking about how are they going to use capital? How can I reduce the capital they use?

384
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How do I make sure that this is the most efficient operation, the lowest cost operation? How do we get as much non dilutive funding as we can?

385
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Okay, perfect. Thanks for outlining that, Sametra. I'll ask two more questions.

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The first one, what is the ratio of your inbound to outbound deal flow? And is one of those, or one of those better deals, you think?

387
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Totally. Let me clarify. What do you mean by outbound deal flow? Like deals were outbound or outbound.

388
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Yeah, like EPITEL would be, I would define as outbound.

389
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That's a good question. I would say that inbound, in terms of cold outreach to me, the ratio is very poor. It's approximately zero, mostly because an overwhelming number of it is wrong sector, wrong stage.

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Anything brought to me by an investment banker for pre-seed or seed is usually a company that's essentially failed already before launch, or is a company where the founders probably are not able to operationalize and build their company.

391
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Most inbound I get, otherwise, that's truly from the company. I always try to keep an open mind. I could be better, but I always do try to click through, read through everything.

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I'm doing one of my growth areas is to close the loop and give feedback to people when I say no. But in general, it's fairly low.

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From inbound from friend investors is fairly high, just because if someone put money into it, it talks, it's been diluted, it's been thought out. So that hit rate is fairly high.

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I make it a point to regularly check out all the big accelerators, check out all the campuses.

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I do the thing to try to spend some time just sitting around Stanford being around and people can come up to pick me up to keep a pulse on what's happening.

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I also hit up my portfolio founders all the time to say, you know, let me know what you hear. What are your friends doing? Who are you mentoring? Keep me posted.

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And I try to volunteer for anything I can where I just get exposure to folks building companies so I can get a sample of what's interesting that's out there.

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So I think that I do a modest amount of outbound. There are probably VCs who are a lot better at outbounding than I am.

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But that's my general approach. I try to have circles that I kind of wide, non overlapping circles that I see gold from.

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I we make it a point to bring in GPs who have very non overlapping personal and professional networks so that when we all go out in stores, we're all hitting up very different places.

401
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Okay, perfect. Last question, so I'm a thread. Do you think health care should be profitable?

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In a good world? No.

403
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In the flawed world that I think you and I are probably on the scale of my lifetime and yours forced to live in.

404
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Done right. It can align incentives and make everyone better off.

405
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Done poorly can lead to a lot of regulatory capture, rent seeking, and professional society extortion.

406
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It's one of the things that made me really love health care is that it's all political risk and political economy. In a sense, I never really left politics.

407
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This is just the most political part of our sector. It's very fun to support people who are doing something cool and subversive, where you get to eat the lunch with bad actors who are extracting rents and status quo.

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You can unlock a lot of consumer surplus. You can break up a lot of cartels. You can make the world better off. This is a lot of the sort of free society politics stuff that I really loved doing back then.

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I loved doing health care for this reason. Profit is a double edged sword. We should see it with nuance. In a very flawed world, it can get many people to do things that at least move us forward.

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Would you rather be on a flight to Mars to establish a colony there or cryogenically freeze yourself for 100 years and wake up in 100 years with your family? You can take one person.

411
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Interesting. For both, but no dogs.

412
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Sure. You can take your dog.

413
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I didn't think about that scenario. This question I asked because of the way you said we're forced to live in the time we're living in.

414
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I wonder if you would want to live in the future. I suspect you would not want to live in the past. Or would you want to live right now in a different world and start over, given that you will be under the rule of Elon for better or worse?

415
01:18:19,000 --> 01:18:44,000
That's a good question. If I had to pick between those two scenarios, I would be curious about Earth in 100 years because of the potential for 100 years of technology to reshape people, for people to reshape the environment we're in.

416
01:18:44,000 --> 01:19:05,000
It would be probably weird, probably worse in many ways, maybe better in a few. And I think it would be really fascinating to explore that. I think that if we were to renorm society on Mars based on where people are today, it would be flawed in ways that are really familiar to me.

417
01:19:05,000 --> 01:19:18,000
I'm seeing it in new ways, but it would be like the same flaws. And I'm curious if in 100 years, maybe the flaws will be different, the world will be different, and there will be something intriguing and exciting.

418
01:19:18,000 --> 01:19:38,000
I think that's an excellent answer, and I'm completely on board. We have come a long way, even in the past 50 years, I'd say. Speed of execution and our acceleration and how just and fair society seems to be accelerating, even with all the tension that exists in the current world.

419
01:19:38,000 --> 01:19:45,000
Well, this has been amazing, Matt. And maybe we can do it again in the next few weeks.

420
01:19:45,000 --> 01:19:49,000
I would be honored, Rashad. Thank you for having me.