AHA: Ask Harry Anything

Harry Glorikian: Hello. Welcome to the Harry Glorikian Show, where we dive into the tech driven future of health care. This week we’re trying something new. Usually I interview a guest from the world of healthcare or life sciences about what’s going on in their field. I’d like to put the spotlight on my guests and be a facilitator rather than add my own comments to everything. But this means listeners don’t always hear my own personal perspectives on the topics the show covers. But this week the guest is. You might have guessed me. Many people ask me about where I’m coming from on these issues and where I think things are going. So we thought we’d gather up some questions and add in a few that have been asked over the time that listeners would want to hear me answer. And here to pose the questions to me is our behind the scenes producer, Wade Roush. He’s the guy who’s been here with me since the beginning, helping on every aspect of the show. He also has his own podcast soonish, which is focused on the future technology and the people shaping both the Wade, welcome to the show. Great to have you on the show to help me out with this episode in a totally new and different way.  

Wade Roush: Hey Harry. It’s great to be here. This is a very new experience for me, too.  

Harry Glorikian: Yeah, It’s great to have you here. I was just thinking, you want to just roll right into it and we can sort of start hitting some questions and seeing if we can get everybody some interesting views on this.  

Wade Roush: Yeah, let’s dive right in. For sure. Okay. So, Harry, you’ve had a lot of guests on the show recently, meaning in the last year, I think talking about the growing role of AI in health care, in delivery of health care and in drug discovery and in radiology and a whole bunch of other areas. And so as you look back at those conversations, are there specific developments in AI that you’re most excited about? And are there developments around AI in health care that you’re most worried about? 

Harry Glorikian: Yeah. I mean, when I think about all the conversations that I’ve had, my experience in health care and life sciences over the years, I’m super excited. So, you know, let’s just put that on the table. I’m generally optimistic about this, but at the same time, I’m a little cautious. I want to make sure that these things, as they get to market and as they get implemented, they’re rigorously tested and we hold them to, you know, an appropriate standard so that we get people what they what they need and we get the physician sort of the help that they need. But if I was sort of to. Highlight the main areas. And for those of you that that listen to the show regularly, you might not be surprised by any of these answers. Is one is personalized medicine right where. I can help analyze vast amounts of genetic biometric clinical data to help tailor treatments to individual patients. You know, this can overall, like really lead to more effective therapies and I believe decrease the side effects as well as you know. Get people to a better place much faster. You know, the next is the predictive capability of R or predictive analytics, right where I can, if set up properly, help predict disease outbreaks, see patients deteriorating before a human identifies it and can interfere with it or improve it in some way or readmission risks based on the patterns in data. And so this could really enable early intervention and improve patient outcomes. 

Harry Glorikian: And if we do that, I think we can dramatically decrease cost. Another area would be drug discovery. As as people who listen to the show know, I’m talking to people about that all the time is I think that I has significantly sped up the drug discovery process by predicting how different compounds will interact with targets in the body. And this just could lead to faster development of newer treatments and reduce the cost of bringing a drug to market. And I believe the companies that are best positioned for that are going to be the the smaller companies that are nimble, that have the right teams, not necessarily big, you know, bloated pharma, which, you know, is going to have to go through a major retooling if they want to actually effectively play in this game, unless they’re just going to be a marketing arm for these drugs. Um, another area is radiology and imaging, right? Um, I think we’re, we could be, you know, the farthest on that first, and it’s only because I think we’ve been looking at images for such a long time. If you think about all the other areas where we have experience and AI algorithm can really assist in interpreting the images with high accuracy, reducing the workload for radiologists and potentially catching conditions that just might be missed by the human eye. I mean, there’s a lot of systems that are out there that are, you know, here’s the list of, of of the scans. And but look at image number ten first, because there’s definitely a problem you need to address immediately. 

Harry Glorikian: And I think patients would appreciate that if they knew that was happening. But I think doctors would appreciate that because they don’t want to look through the mundane ones. They want to look at the ones that there’s something to do. And I can I can put something into play to help that patient. Now, the other side of this is obviously, you know, data privacy and security has got to be seriously considered. People are always asking me about the bias in AI algorithms, and I believe that’s just going to take, you know, people testing it, people testing it with a different population, making sure that it robustly works. Um, and even having these things maybe be trained in sort of federated ways. So we get lots of different data from lots of different locations to get them trained the right way. And then. You know, this lack of explainability that people talk about. I mean, there has got to be a way to sort of. Follow the logic. If you wanted to dig in to understand how these systems get to the answer that they get to. Although it’s funny because a lot of times nobody ever questions the doctor about how they got to their conclusion. So maybe there’s something in between, but at least directionally, somebody’s got to be able to understand how this system got to the answer that it eventually put in front of a human. 

Wade Roush: Yeah. You know, one of the areas you just touched on a couple of minutes ago was drug discovery. And one area that’s within that that’s been getting a ton of attention lately is the progress in using deep learning to understand protein folding. And I think Alphafold winning the protein folding challenge kind of was like a an eye opening moment in the same way that the arrival of ChatGPT kind of woke up the rest of the world to the power of large language models. And there was a fascinating interview recently with Demis Hassabis, who’s the head of DeepMind, and now the head of all of AI at Google, about how they created Alphafold. And I’m just wondering, you know, to dive in a little deeper on that, what impact do you think like the ability to understand and maybe even make up new proteins is going to have on drug discovery? Do you think how many companies are equipped to even take advantage of that kind of technology?  

Harry Glorikian: Well, I think if you if you step back. Right, the fact that they did that is, you know, amazing. But the other fact is they made all the output from that available to everybody. Right. So you want to say a gift to humanity? I don’t think people, many people even understand or appreciate, you know, what they did for everybody. So everybody working in the field, that’s who needs to understand how their protein of interest, you know, folds and how they might attack it. Now, all of them are just moving. You know, they should be moving light years faster than they would have been moving. And people who thought, well, let me look at this protein and maybe I can find a kink in the armor to then create something that can perturb that protein. Now all of a sudden you might be spurring, I don’t know, 100, 1000, 10,000 new projects that are only going to be obvious once the papers start to, you know, flow that we can actually see. So I think their gift to the world is much more than I think people might realize right now at this moment. But I think a lot of these companies are. Not necessarily utilizing it in a new way, but understanding the proteins that they’re currently looking at so that they can figure out how to attack them, I think is the way they’re looking at them currently. Now there are probably startups out there that are utilizing this along with their own software to understand can they design a new protein as some of the people that I’ve had on the show are talking about creating a new series of amino acids so that you can create a new protein that you can then introduce into the therapeutic regimen.  

Wade Roush: You know, having edited at this point, maybe scores of of interviews that you’ve done with CEOs and CTOs from health care and technology companies using AI, I think all too often AI is let’s let’s admit it. I mean, there’s a lot of hype in in biotech and especially in the crossover between biotech and AI and the Alphafold thing. And the company’s using that kind of technology strike me as maybe like the first time when it’s like clearly not hype. I mean, the actual scientific accomplishments so far are kind of mind blowing in terms of unraveling the 3D structures of these proteins and the and the prospects of what you could do in the future are mind blowing. And so I just wonder whether you feel like, hey, we’re finally reaching this moment after maybe 10 or 15 years of really hard work in deep learning and its applications to life sciences, when this stuff is actually going to start bearing fruit and you know, it’s not going to be instantaneous, but, you know, within a few years we might start to see, you know, new drugs coming onto the market or reaching clinical trials that have been discovered this way. And it could it could change everything.  

Harry Glorikian: Yeah, I mean, I think, you know, we’re starting to see it. We’re seeing the first FDA cleared therapeutic that was designed by an AI being allowed to enter a clinical trial. Right. So, I mean, at some point, you know, the process is, you know, at some point things slow down because you have to put it into a person and you have to wait. And so there are things that don’t move as as quickly as we would like to. But I do see that more and more therapeutics are starting to come to the point where they’re about to enter clinical trials or they’ve already entered clinical trials and they’re moving forward faster. Now, here’s the funny part. What I’m hearing is that front end, I’ve actually got targets. And now I think what’s happening is they’re going to have to pick and choose because you can’t do all of them at the same time. The thing that I find fascinating is I talk to people and they’re like, well, there hasn’t one that’s been FDA cleared yet. And I’m like, Well, if you wait for this technology to get one across the finish line, you’re going to be super late to the party. I think that I see the. The pendulum flipping. I see the smaller companies, you know, with the Clay Christiansen Innovator’s Dilemma perspective. I think some of them are going to move way past the existing entities only because they can’t grasp that that little company is going to overtake them. And you know, as a as a venture investor, like that’s how I have to think about betting on some of these things that they’re going to be significantly larger than the existing status quo or they’re going to get acquired. But at some point, you can’t acquire something that’s moving that fast. 

Wade Roush: Okay. Let’s move on to a different question. So, Harry, again, from getting to know you, editing the show for a while. I know that you’re somebody who likes to try out a lot of the technologies that you talk about on the show. And one example is continuous glucose monitors or cgms, which are getting way more sophisticated, you know, lighter, longer lasting, less obtrusive to actually wear around all the time. And then they have a, you know, a real time wireless connection to your phone. So you can pretty much see the effects of what you’re eating on your blood glucose levels in near real time. So that’s like an example of a technology you’ve tried out and you’ve been enthusiastic about it. And I just wanted to ask, you know, what drives that? Why are why are you personally interested in trying out some of these technologies? And are there particular gadgets or apps or health care technologies for consumers that you think more people should should be trying or using in their everyday lives? 

Harry Glorikian: Yeah, I’m I don’t know, maybe I’m a little kooky in that way, but I do try a lot of different things. You know, I’ve tried the you know, obviously I have an Apple Watch. I’ve got a loop. I’ve tried the the aura ring. I’ve tried the, you know, the January I glucose monitor, the levels glucose monitor. And I keep trying. I’m trying more and more things as well as I’m sitting in on classes where they’re hands on, like how do you put this to work in different situations. Right? And so why do you do that? It’s like, well, I think sometimes if you’re not playing with it and you’re not using it, you don’t see how it communicates with you or how are you going to put it into play. I mean, it’s. Really hard to a be an investor and do a good job at B. You know, talk about it and ask the right questions and understand where these things are going to make an impact for the average person. But also, if you make an investment in one of these companies, how do you advise them if you’re not understanding the system and how it’s being used? So those are sort of the things and it’s funny because my. My family will make fun of me. Right. Is there is there any thing that any anything else that you’re going to prick yourself with? Right. Or strap on that will, you know, do some sort of thing. But, you know, it’s funny. You asked me about which systems. One of my friends texted me and says, Hey, I want to get like a smartwatch or a tracker. Which one should I get? By the way? Make the answer short, because he knows I’m going to go through a big explanation. 

Wade Roush: You’ve become his personal ChatGPT. 

Harry Glorikian: Yes. So in reality, I mean, I would tell everybody should have some sort of fitness tracker or smartwatch, whatever they’re comfortable with. Right. Or whatever their budget may allow. Um, and I think if nothing else, you know, tracking your how much you’re moving and how much you’re sleeping. I mean I don’t think people give sleep the level of attention that it deserves but you know Fitbit, Apple Watch, Garmin, all these things can do so many things for the average person that can give them insight into their health and wellness. Meditation and mindful apps. Now, I must admit I probably don’t do this as much as I should, although I’m trying to work it into my schedule early in the morning. Um, because it just. Helps you reduce stress and improve your mental health. Some people who want to sort of live forever or maybe lose a few pounds or the diet and nutrition apps help you? Sort of. You know, if you don’t measure it, it’s not important. Right, because you can’t improve it if you don’t measure it. And then, like you said, you know, the continuous glucose monitors, which are. I think, incredibly insightful. I think you don’t have to have diabetes to use one of them. It really gives you some insight on the foods you’re eating and actually the reaction that’s happening inside your body. And so you want to know that that thing you just ate, just not just spike your glucose, kept it up, and right after that, you’re exhausted. 

Harry Glorikian: Maybe that’s a clue that you should stay away from that food or find an alternative. And then finally, you know, there are more and more, especially during Covid and post Covid people that are having sort of mental health issues that there are a number of of apps out there like Betterhelp or Talkspace and many others that people may want to look into or ask their physician to make recommendations so that. They have a constant counseling that’s going to happen. And then the irony I’ll throw this in there is like it’s not ready for prime time yet, but, you know, I can see a ChatGPT like. Platform out there that will take the data from these devices and then. Have a conversation with you of, Hey, what are your goals? What do you want to improve? Help you put together a workout routine. Put together a diet. Communicate with you about how you’re doing as opposed to it being just a one way communication stream. I can see the data from these integrated with systems like ChatGPT, and now it’s a sort of a circle where you’re having the conversation, getting the data and constantly being able to improve and have a system coach you along. 

Wade Roush: That would be really cool. I mean, there are already apps or chat bots like Woebot, for example, which is programmed to understand cognitive behavioral therapy. There’s one called Pi, at HeyPi.com, that is really actually very good at all kinds of conversation, but seems particularly tuned for kind of therapy style conversations. And but neither one of them is connected to any data about you. It’s all it’s a purely conversational interface. It’s sort of like having a real life therapist. So but if those apps or services actually knew like, Hey, I noticed you didn’t sleep very well last night, maybe that’s why you’re feeling so grumpy today. You know, if it could have a dialogue with you and it was more data driven, I can see people being able to make progress faster. 

Harry Glorikian: Yeah, it’s interesting. I mean, you know, for the average person, I wouldn’t I would not say do this right. Wait till somebody comes out with more of a bullet proof solution. But for a lot of people who are interested in like this area and playing the technology has become so inexpensive. There’s a group that I’m part of that is, you know, you just fafo and I’ll change the first F to fool around and find out because we want to keep this family podcast but family friendly. But you get the idea of like, you know, if you’re paying, what is it, 20 bucks a month for ChatGPT you can get something called Zapier that allows you to connect, you know, pieces of information. You can you can actually create systems that you can fool around with that may actually work for what you want it to do. I wouldn’t do this for mental health, but I might do this for sort of a workout process or maybe even a diet process to have the system interact. And I feel comfortable with the information that I’m sharing through, you know, an API into something like ChatGPT. But, you know, we’re at a point where anybody can play with this stuff and create things. And I’m expecting a lot from high school students because I think that they’ll be pushing the envelope on how new apps and new ways of connecting these systems are going to come about.  

Wade Roush: Sure, sure. I get high school students, digital natives. Absolutely. But like, you know, what about older people? You have an early adopter mindset and you’re not scared by these technologies, but do you think that they are actually user friendly enough and usable enough and well-designed enough at this point that literally anybody can try out these personal health care apps and devices and get up to speed pretty quickly? 

Harry Glorikian: Yeah. I mean, for the for the most commonly available ones, Yeah. I think they’ve done a pretty good job of of. Figuring out a way to effectively communicate what they’re trying to say to the individual. And they’re getting better all the time. You know, if you were really early adopter, what is this thing trying to tell me? And now, you know, the colors, the charts, the communication of the system has gotten much better at sort of thinking to someone. And it’s funny, you know, when we say older people seeing some pretty, pretty sharp older people that are adopting technology and moving along, it’s funny. Older people will tend to adopt it and stick with it, whereas younger people will. A, you know, take something on and then get rid of it and then get the next one and then get rid of it. They they don’t tend to stick with something very long compared to an older person. 

Wade Roush: Good point. Okay. So related to all this, I want to relate it back to the actual health care establishment. You know, so we’ve been talking about how you can use technology to take better care of yourself for yourself. But what’s weirdly going on on the on the side of most health care institutions is like the number of primary care physicians is dropping. It’s getting harder and harder to find a new doctor or even get an appointment with your existing doctor. The health care industry is still bouncing back from Covid 19. The rate of burnout and and employment losses in the sector was gigantic. Hospitals and clinics are still struggling to take care of everyone, especially in economically depressed areas. So I wonder whether you see a way out of this paradox, like with the help of technology, is it possible we’ll basically start to become our own primary care doctors or wind up like sort of working, collaborating with Dr. Google, right, to figure out what’s wrong with us and skip over the primary care part and and have enough data that we know. Oh, it’s it’s time for me to go talk to my nutritionist or my mental health care professional or my, you know, my gastroenterologist. Like, I know enough about what’s wrong with me that I can just go straight to a specialist. 

Harry Glorikian: So the short answer is yes. I believe that, you know, that’s going to happen. I mean, the paradox you’ve highlighted is. It’s a significant challenge today in today’s health care landscape, but I do believe. That these technologies, particularly, you know, artificial intelligence and the toolbox of of artificial intelligence, can play a pivotal role in addressing many of these issues. Now, let’s face it, the system is. The system is very rigid and not designed for change. You know, I have this pet peeve with emirs. I just think most of the time that the greatest impediment to to shift is the fact that these things are just not designed for the modern age. 

Wade Roush: Electronic medical records, EMR. 

Harry Glorikian: Yeah. Electronic medical records. I mean, I just think that they’re going to you know, I was talking to someone that I know runs three hospitals. They installed one of these systems which I won’t name. The implementation went so badly. They’ve literally filed for bankruptcy. Right. I mean, that is just. Mind boggling when you think about it. Insurance companies. You know, I think like, you think about them like the dealer in the middle, right? It’s, you know, the cards are going back and forth and they’re just they’re playing in the middle. You know, there’s no necessarily incentive. Um, for them because they’re not. Cashing in on the end and you’re still paying your premiums. So the way the system is designed is just perverse. Like you would never wake up in the morning and go, let’s design a system. And you would actually draw this out. Like it’s just would be mind boggling. It would not happen from any rational human being. But I think the advancements in AI. Have the potential to revolutionize not just delivery, but accessibility. Right. I think you can streamline administrative tasks. Free up more time for health care professionals to actually focus on patient care. Right. You can tremendously, like significantly enhance diagnostic accuracy, you know, with the right data, predict patient outcomes and personalize that patient care.  

Harry Glorikian: And nothing that I’m saying is not being well discussed in many journals and reviews. I mean, I can also help detect diseases early. And, you know, there was one recently where I was like pleasantly surprised that about how AI is being used in dentistry, not just in what you would think would be normal dentistry, but identifying other diseases that you were able to see in the data that they were capturing at that moment. So the shift is not just happening in the traditional hospital setting, but you know, what I see as outside the hospital setting. When you say primary care. Uh, you know, there are companies out there that are trying to implement more affordable, high quality primary care right. To the patient’s smartphone. Um, I guess one example would be a company called 98.6, right? Their technology helps doctors by automating tasks that don’t require, say, direct physician physician interaction, which gives them a lot more time to spend time with the patients. Now, it’s really important, though, to to mention that. This technology isn’t there to say take a physician’s place. It should be seen as supportive, supplementing, not supplanting and not stepping in the way of the judgment of medical professionals.  

Harry Glorikian: But as you said, and I interviewed Dr. Isaac Kohane recently on the show. These technologies can be second opinions or give the patient more information so they can be a much more informed patient slash consumer. And I think that. Those two things together can be quite powerful when you’ve got a physician utilizing these technologies and a patient that is more informed and therefore hopefully will take care of themselves better. I think what we’re going to see a better outcome as time goes on and I’m really at the point of saying. If you go to a system that is not employing these things. Don’t go there if you can’t find someplace else to go that is utilizing these things because. You should be getting a better standard of care by what these technologies can offer than, you know, the older systems. I think it’s a, you know, seeing the Starship Enterprise up there over your right shoulder, their weight, I could say it’s like when Bones, the doctor said, you know, my God, this is like, you know, treating people with leeches as opposed to using a tricorder and and helping figure out what’s wrong with them. 

Wade Roush: Yeah, but leeches actually work for some things. And they’re still used, right? 

Harry Glorikian: Yeah. Yes, they do. I was thinking about it as I was saying it. I’m like, if you want to reattach an ear, at least is what you want. 

Wade Roush: Yeah. Yeah. So do you think, though, that I might help to address the underlying problem I was getting at, which is primary care is a very challenging field. Fewer doctors are going into it for all sorts of reasons, but like among the biggest reasons are that it’s it’s just completely overwhelming to deal with the the paperwork and sort of bureaucratic and insurance overhead and requirements that every primary care doctor has to has to deal with. And all of the notes you have to create after every single encounter or sometimes during an encounter. I mean, could I make the lives of primary care docs easier and maybe make that that profession a little more attractive? 

Harry Glorikian: I think it would make it easier. I can’t speak necessarily to the attractiveness, but, you know, I talk to my friends who are primary care and they’re just getting hammered. I mean, hammered, hammered from a paperwork, hammered from, you know, how much is the insurance going to pay, hammered us to how they’re being measured. Sometimes they talk about the calculations about how they’re going to make money. I’m like crazy calculations about how you’re going to figure out how much you’re going to make. I think the system is in some ways rigged to make it harder. It doesn’t. I don’t think it always has to be this hard. I think that technology can be implemented to make it more streamlined and easier. I think the. There is a tremendous impediment to change some of it for good reason. But a lot of it, I think, is just because that’s just the way we do things. But. You know, these systems that can actually listen to your conversation, record the conversation, transcribe the conversation, then look at the patient record, take critical information from the patient record, and form a more finished note for the doctor at the end. I mean, these systems exist now. And from the numbers that I’ve heard, it’s like, save you. I think it’s 5 or 10 minutes per patient note. So if you’re seeing ten patients a day. Right. That’s that’s a huge shift. Right. As Doctor Cohen said, you know, if you could get these AI systems that are, you know, you know, right now in the put them in the basement and they write the letter to the insurance company about why something got rejected and go back and forth with the insurance company. 

Harry Glorikian: You know, instead of it taking weeks or months, it could take seconds to minutes and alleviate that as a bottleneck. I mean, these are the things that I think that are. Low hanging fruit that can move the process forward or remote patient monitoring systems where your chronically ill patients are being monitored in the field. This information is coming back to your electronic medical record. You are managing them even before they come in the door. And when they come in the door, you’re way more informed rather than that one measurement that you’re about to take. So it’s just a complete shift in how you can manage those patients. And oh, by the way, when you have one of those systems, you can actually bill so you’re making more money by managing a larger patient population. I mean, I think all of these things are possible except the existing. Institutional rubrics. The Emirs, as well as the insurance companies, make it incredibly difficult to move that ball forward because nobody wants you to touch their profit pool. And people think, no, this is the way we do things and I’m not going to. Necessarily change that easily. Whereas in the world that has a competitive environment, which medicine has is not competitive at all. 

Harry Glorikian: You’re constantly playing and implementing new things because you need to keep that cutting edge to stay at the head of the game. Let’s pause the conversation for a minute to talk about one small but important thing you can do to help keep the podcast going, and that’s leave a rating and review for the show on Apple Podcasts. All you have to do is open Apple podcast app on your smartphone, search for the Harry Glorkian show and scroll down to the ratings and reviews section. Tap the stars to rate the show and then tap the link that says Write a review to leave your comments. It’ll only take 30s, but you’ll be doing a lot to help other listeners discover the show. And one more thing if you like the interviews we do here on the show, I know you’ll like my new book, The Future You How Artificial Intelligence Can Help You Get Healthier, Stress less and Live Longer. It’s a friendly and accessible tour of all the ways today’s information technologies are helping us diagnose disease faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place. The book is now available in print and e-book formats. Just go to Amazon or Barnes and Noble and search for the future. You buy Harry Glorkian. And now back to the show. 

Wade Roush: Okay, Harry. A lot of the people you have on the show, a lot of the companies that you look at and the entrepreneurs you talk to and the researchers and executives you talk to are based in your area, Boston, greater Boston. And there’s no question that these days, the Boston area is the world capital of life sciences, research, biotech, startup activity, biotech, venture capital, investing activity. All of these measures, like it has surpassed the San Francisco Bay Area and other clusters. And and in fact, like if you wanted to like, localize it even more, you could probably like just narrow the bull’s eye around Kendall Square and you could say like the the square mile around the MBTA red line stop at Kendall Square is probably the densest biotech and life sciences hub in the universe, the known universe. And so how did that happen? Like, what’s your explanation for how Cambridge and Boston became so successful compared to other regions? And here’s the classic question that delegations of people visiting from other countries and other cities ask every week How can we do this? Is there anything about the Kendall Square, the Cambridge, the Boston formula that other cities could try to emulate Boston’s success? 

Harry Glorikian: Growing up in the Bay Area, San Francisco proper, I remember there were, there would be these pieces that would come out that would show like Boston and, you know, the Bay Area sort of what I call neck and neck of, you know, biotech and life sciences activity. And then. You know, at one point, I’d say over the last 10 or 15 years, you know, the Boston area just exploded with activity and. Although there is still activity in the Bay Area, it’s nothing compared to what we have here. Right. I mean, I moved here for a job 27 years ago. And to my mother’s disappointment, I never left. I ended up staying here, right? And when I started my one of my last companies in Kendall Square. When we were looking for a space. Some of my some of the employees just. We’re nervous. They were like, Well, we can’t. No, that’s not a good place. Because at night when we walk home, it’s not safe. And now it’s a totally different story. That neighborhood looks nothing like what we moved into when we started my last company and before we sold it. So it’s dramatically different, I think. I want to say BG did a study on this and published something, although I don’t I’m not 100% sure about that. 

Harry Glorikian: But the ecosystem that got created, the investments that got put into place, the zoning, the all these different pieces of the puzzle, it didn’t happen by accident. Right. As well as all the classes and everything everybody could take and so on and so forth. I think all of this caused. This explosion to happen. And then at some point your you have enough startups that even the big farmers were like, what are we doing in this big compound with lots of grass and deer running by like the deer are not going to help me come up with the next molecule. Maybe I should move up to the Boston area where we can have, you know, intellectual ideas moving back and forth as well as if we need to hire people. Nobody wants to move to this grassy knoll in New Jersey or Connecticut like they want to be where the action is happening. So I think, you know, those are some of the things that that that exist. I mean, I’ve always joked with my wife that. The rich academic environment we have here. I mean, honestly, I don’t know any place on the planet that has. This the number of universities and research institutions as densely co-located as as we do. 

Harry Glorikian: I mean, when I moved here, somebody said to me that we’re like 90 higher learning institutions inside the 128 belt. And I was like, if I throw a rock, the chance of me hitting one is extremely high. And depending on where you are geographically, that’s actually a true statement. So I think all of these things have been a factor in contributing to this. I mean, I think that there was a lot of thought put into this and supporting the biotech sector. The compact geography also lets you get to, you know, lots of different companies very quickly. All of these things, I think, are what. Contributed to the success of this cluster. There is a group called. Start up nation, which is run out of the San Francisco area. A friend of mine, Jean-Francois Gauthier, is the CEO of the company. And what they’re always doing is, is they’re doing analysis of different cities and different geographies to sort of highlight what. What makes something work and does it work. So I think if somebody is looking for data, they might be a good group to look at for data that they need to to to see what’s working and what’s not working in this area. 

Wade Roush: Yeah. Yeah. You know, there’s one thing that would be impossible to replicate anywhere else, but I don’t think people understand that the history of Cambridge specifically was kind of crucial here. So very soon after the invention of recombinant DNA technology, the city of Cambridge had a debate about whether that technology was safe and whether it should be allowed. And there was a moratorium for a year or two on that kind of research. But in the end, Cambridge formed a citizen council that did some research and concluded that recombinant DNA research could be done safely if it was done within this particular set of guidelines. And so Cambridge wound up, ironically, even though it was the first place that recombinant DNA became a big debate, it also became the first place with a clear set of guidelines under which that research could go forward. And that kind of explains why companies like Biogen wound up having offices here and kind of giving birth to that whole cluster. So this was the place where you could safely and predictably invest and build a lab and go forward. And so that that gave Cambridge probably a 5 or 10 year head start versus everywhere else. 

Harry Glorikian: Well, if you think about it, right, I mean, I remember when Genentech was on the West Coast. I mean, that was a big deal. And I almost worked there when I graduated from college, and that just didn’t happen. It does take a lot of thought and planning to have an ecosystem like this. It’s not accidental. And you do need a little bit of luck and a few things have to have to happen and fall into place, but it just doesn’t like magically appear. Now there’s a good side and a bad side. The good side is this ecosystem has evolved. The bad side is, is if I was going to start a company again, you know, renting and having space in the Kendall Square area has become ridiculously expensive. So I don’t even know if I would want to start there, depending on what it is that I was starting because of the financial burden that that would put on getting something off the ground. Right. 

Wade Roush: Well, that’s a good point. But to counter my previous question about how awesome Kendall Square is, I mean, there is a ton of new and under-construction life sciences space in and around Kendall Square that when you look at the current downturn in venture capital, investing in biotech and what’s basically amounting to a, you know, a recession or even a mini depression in life sciences investing, you have to wonder whether that space is ever going to get rented. And I bet you the cost per square foot is going to come down pretty soon. And so I wanted that actually leads into a question. I’m just I’m wondering how you think about the current downturn. Is it purely cyclical? Is it the kind of thing that every technology market goes through every so often, or is there anything deeper and more systemic that worries you about the fact that I think the Mass Biotech Council said venture investing in biotech was $13.7 billion in Massachusetts in 2021, and then in 2022 that had dropped to 8.7 billion. And they don’t have the figures for this year yet, but probably going to be even lower this year. And that’s a pretty giant drop. But, you know, industries have have bounced back from those kinds of downturns before. So how much do you worry about this? 

Harry Glorikian: So, you know, whenever something like this happens, in one way, I do look at it as an opportunity so that, you know, depending on the deal, I don’t have to overbid to get in from ecosystem perspective. I do believe like it will bounce back. And I think it’s only because I’ve I’ve had the I don’t want to say pleasure but the experience of going through a few ups and downs over the last 30 years. So I’m you know, I’m not happy about it, but you you sort of look at it and you say, okay, this too shall pass. I do believe that there are some things that are out of our control, like interest rates, you know, interest rates go up and people get a little bit more skittish about this industry, which is much more expensive. So cheap money makes it easier to do or less expensive money makes it easier to do what we need to do over time. Economic conditions. I think a lot of people are very nervous. Geopolitical dynamics are not don’t help in the overall investment landscape, especially when you think about risky areas like biotech and life sciences and how long it takes us to get something to the other side. I think the other thing that’s happening is we’re not seeing. Is as many exits. And if you don’t have as many exits, you’re not returning money to limited partners. If you’re not returning the money to limited partners, they can’t re-up to put it back into the biotech sector. So I think that that that is also playing a role. Like, you know, the public markets have been, you know, not someplace you necessarily want to go and M&A is down significantly. And so if you’re going to have like you’re down to the big companies buying, there’s only a handful of those two. And how many acquisitions and integrations are they going to do? So I think, you know, all those factors are weighing on the sector at the moment. You know, some of them I think we can. Work on improving. But there’s other ones like the macro issues that. You. We just got to ride it through. 

Wade Roush: Yeah, it’s frustrating to have those those short term factors limiting things. I mean, I’m speaking now from the point of view of a tech enthusiast, I guess, or someone who understands the huge impact that technology has had and will continue to have over the decades. I mean, technology is our way to cleaning up the environment, to slowing climate change, to increasing human health and longevity. And so the scale of the the need and the demand and the potential hasn’t changed at all. Like, we need these solutions as much as we ever did. And it’s kind of frustrating when something like the you know, the Covid 19 pandemic proved the the enormous potential of things like messenger RNA vaccines, which came straight out of all the technology that we’re talking about. And so ironically, you know, the pandemic wound up provoking a spending spree that has now bounced back on us in the form of higher interest rates. So all of these crazy economic dynamics wind up depressing investment at exactly the moment when we actually need more investment. And so, I don’t know, it’ll pass, but it’s very frustrating on a on a short term scale. Yes. 

Harry Glorikian: But, you know. Scarcity also drives ingenuity and there was a lot of money sloshing around in the system, right. Some of the funding rounds, you were like, Oh my God. Like, why would you give anybody that much money? Right? To a certain degree, Like, I’m not saying you want to give it to them in bite size pieces, but you want people to struggle a little, right? So that they’re as creative as they possibly can so that they can drive that that next innovation. You know, I hate to say it, but when people have too much money, they just get. A little sloppy in general, not everybody, but in general. Right. Whereas and people think that it’s easy and they’ll just do it again. But a little scarcity drives incredible ingenuity. And I do believe that. And if you I think if you look back in history, whenever we’ve had a squeeze like this, many die off. But the ones that survive end up becoming incredibly stronger and better companies than you would have seen when everything was sort of fatter and happier. So I wouldn’t say that the ingenuity is is going to die down. I think really good things will still get through the system. Good teams will help manage their companies to get to the other side. You know, a little going on a diet every once in a while is not a bad idea.  

Wade Roush: Okay. On this theme of teams and good management and how you survive this kind of squeeze, you’ve been a consultant, you’ve been a CEO, you’ve been an executive, you’ve been in this world of startups for a long time. So what are some of the the worst mistakes you’ve seen startups make? If a CEO came to you and said, like, help me avoid the ten most common mistakes of an early stage startup exec, what would you tell them? 

Harry Glorikian: I mean, the you know, one of the first is always like a clear market understanding and the dynamics of that market, right. It’s a very common mistake of. Not understanding that market, not understanding the unmet needs of the target population. You know, a lot of times this can lead to development of product or services that don’t really address a significant problem or that don’t offer a clear advantage over the existing solutions. The second one, which I, you know, sometimes bleeds into the first one is poor team composition, right? You know, people say location, location, location. I’m like, team, team, team. You want a a strong and diverse team is critical for success. If it’s just the smart scientist. Taking the smart scientist and converting them into an incredible. A person with business acumen. It doesn’t always translate very easily. Right. And and like, you know, it’s got to be science, technology, business development. And if you don’t have it or you don’t have the money for it, is find consultants that can help on the regulatory or the marketing or some of these other things. But. You got to bring those people together and have that conversation about how you’re going to move that company forward. 

Harry Glorikian: And does it ring true for everybody on the team so that you’re testing out your market hypothesis? I see companies underestimating regulatory hurdles. Did you talk to the FDA? Did you get any insight about what they might say about your technology or what you’re about to do? But we don’t want to go to them until we’re absolutely 100% ready. No, I’m like, no, go talk to them now because they might tell you something that might change how you get ready for them. Underestimation of time cost, complexity of what they’re doing and then inadequate funding. You know, I’ll I can speak to sort of the diagnostic side. People say, you know, well, we have $5 million. I’m like, oh, my God, that’s nowhere near enough to get what you’re working on. Over the finish line. So or even on a therapeutic side, depending on what what they’re trying to do. And then rigidity, like the failure to adapt to technology change market conditions. Um, you know, those that fail to adapt can become quickly irrelevant. So those are the things that I look for when I’m, I’m talking to people and trying to coach them, you know, through different stages. So hopefully that answers your question. 

Wade Roush: Yeah, I think sometimes investors pave the way for some of these kinds of oversights or misperceptions. I mean, let’s face it. I mean, if you were realistic in your series A pitch deck and you said like instead of saying like, we think we can get to phase one clinical trials with $25 million, if you were more realistic and you said it’s actually going to take like ten years and we need $200 million, like no one would invest, right? 

Harry Glorikian: So I didn’t say put it all out on the table. But you have to understand that you over time, you may have to raise, you know, a significant amount of money to get it across the finish line and therefore, you know, move appropriately. But, you know, I have people tell me all the time, like we have $50 million, we’re going to get this to where I’m like, you’re just not. I mean, unless some miracle happens, like, it’s just I’ve never seen it. I was talking to somebody the other day who working on a very interesting diagnostic technology, and I was like, okay, here’s what’s going to happen first, this first, that second, this. And I went through the whole life cycle and I said, You’re in this for ten years. And he looked at me and then he thought about everything I said. And it was like, you know, now that you lay it out that way, it sort of sounds right. And I’m like, No, no, no. I’m just telling you, like, if you think you’re out of this thing in the next four years. You’re. You’re fooling yourself. Like it’s just not going to happen. I’ve never seen it happen. And so. For a team to sort of be realistic about what it takes. In having a crazy founder. Is a really, like, important thing, Like somebody that just. Is so used to being punched in the face and then keeps going. You know, those are the things that make a company successful. 

Wade Roush: Crazy in the sense of dauntless. 

Harry Glorikian: Yeah. Mean it has to be undaunted by this sort of thing because it’s it’s a constant, like, you know, slamming the door in your face, a problem showing up, God forbid, a critical person quitting, and then you have to pick up the ball. I mean, there’s just. Every impediment there is like an entrepreneur generally will have to deal with at some point or another. And so you just have to be resilient and. Always keep a smile on your face because you can never And this is the funny part. Everybody glamorizes being an entrepreneur. And I think it’s because we always have a smile on our face. It doesn’t mean that we’re not dying inside in 50 different ways, but you got to put the smile on your face because everybody else can’t think that, you know, it’s so difficult. So it’s it’s an interesting paradox that that that an entrepreneur has to deal with to get a company across the finish line. 

Wade Roush: Let’s go through like 4 or 5 kind of quick questions, lightning round questions to wrap up here. So, you know, you mentioned the smile on your face here. You’re pretty optimistic person at least when you’re, you know, in your public persona on mic. Are you that optimistic all the time? 

Harry Glorikian: No. My my wife will always say, do you always, do you always like save that for everybody else except me? Um, I mean, I’m generally optimistic, especially when I’m thinking about the technologies and where things are going. And I’ve been saying for the past, like maybe 15 years, like, you know, health care and life sciences is just going to it’s, it’s the next software where it’s just going to keep growing and we’re going to keep doing great things. At the same time, like I do really get into these deep moods of thinking about, you know, how is AI going to change how we’re working? How is it going to. Change how people think about what they do. What is it going to do about jobs? You know, our legislature is completely oblivious to these changes and what they need to do. You know, there are a lot of those things that put me in a. Spunky mood every once in a while that I have to think about. But I do think, like when I think about that, it makes me better at what I do on a daily basis. 

Wade Roush: Why did you start a podcast and what do you get out of being a podcaster? 

Harry Glorikian: Why did I start a podcast? I think I called you and I said, Hey, I’m thinking about a podcast, and you were like, Why are you doing this? And I’m like, I think it needs to be done. I wanted to I wanted to cover this intersection of data and biology. And I don’t want to say I think at this point, I can say almost chronicle it’s its journey. But. I wanted people to understand how this area was really going to change everything across health, healthcare and life sciences and I believe have a dramatic impact to the business model. And I think you’re starting to see chips at the edge where people can sort of manage their own health to a certain degree. The second thing was, is I’m just curious and I like talking to these people and learning something. And in every show I learn something from someone and then broaden my network as well as, you know, help me think about new places and new companies that I might want to invest in. 

Wade Roush: Harry do you have an information gathering system or a set of habits that help you keep up with all the fields that you cover?  

Harry Glorikian: Well, one is the show for sure. Right. I’m like, well, I want to understand about that large language model from Google. Let me have them on the show. But I do a ton of scanning, you know, reading the the highlights of a paper or whatever. And then the ones that I like, I throw into a piece of software called Pocket, which then lets me go back and find it and read it. I do listen to some podcasts on some topics that feed into what my area of interest, but I’d say scanning and then putting it into pocket. And then now they’re having pocket read it to me or read it when I have some time later in the day or later in the week is how I catch up on things.

Wade Roush: Are there any recent books or articles or podcasts that stick in your mind, like things you’ve learned from things you might recommend to the audience? 

Harry Glorikian: Yeah, I did. I had a chance to listen to, and maybe it’s just because I just found him Lex Friedman’s show where he was talking to Marc Andreessen, which was great. I mean, I think Marc is, you know, one of those people that’s just crazy smart about how he thinks about and he gets to see all the latest, greatest toys. So it’s always good to get his input. And the other one was his interview with Yuval Harari. And that was a really good one about. I and stories and how to think about things. So those were two that I I’ve recently listened to. 

Wade Roush: Cool. Okay. Last question. I think you’re you seem to be the kind of person who believes in the importance of lifelong learning or a growth mindset, I guess, is what people call it. So I wanted to ask you: if you could go back to school, what would you study and why? 

Harry Glorikian: You know, it’s funny. If you had asked me a year ago, I would have been like, Well, I should go back and really learn how to code. I should, you know, really immerse myself in certain areas of finance and maybe go back and take a couple of classes, you know, in the biotech world, because there’s technologies that I never sort of got my hands on. Post large language models. I’m thinking, what do I really need to learn how to code? Because the damn thing can do most of the coding for me, right? Each one of those things where now you question. Like if I if there was a young person asking me what to do, I would be like. I’m not sure what to tell you right now because I don’t know will the jobs that I’m sort of used to are still going to be there or. You know, what’s the new job that I can’t I mean, if I had said to you a year ago that, you know, wait, you should be a prompt engineer, you’d be like, what the hell is a prompt engineer? It didn’t exist, right? So there’s a bunch of jobs that are going to come up that I can’t even. Think about what they’re going to be right now. But if I went back to school, you know, I have this thing about wanting to go back and get my DBA or PhD in strategy, and I think that’s a potpourri of things that you would learn. But I’m almost in that mode of I just need to constantly be learning how to learn. And consume more. You play more, get my hands on more because it’s ever changing. And so I think if you’re not in that mode of learning how to learn over the next. 20 or 30 years like. I don’t know how you stay relevant anymore. 

Wade Roush: Well, maybe being a podcaster and a venture investor kind of has you covered. Maybe you don’t need to go back to school. 

Harry Glorikian: You know, it’s funny when you’re in that school environment, and I remember when I was getting my MBA, being in a class where you were hearing other people. Was insightful because their commentary their opinion would. You know, make it would be impactful or they be coming at it from a part of the world that you had no experience in. And so I think that that’s super valuable regardless of I and what it can do and how it writes and all the rest of that gobbledygook. I think person to person interaction is is a critical part of learning. I do a lot of self studying, but man, I still crave like interacting with people and hearing what they have to say and and having that spirited discussion so that you can. Get to another place. I mean, when I speak, I. I tend to be very. Uh, emotional when I talk, right? And people are like, he’ll never change his position. And I’m like, Show me some data and I’ll be happily change my position, but don’t come to me with some wishy washy. Counter-argument that you can’t stand behind. So I do look for that interaction between people. So if I were going to go back to school, that’s the part I crave the most. 

Wade Roush: Well, Harry, I’ve enjoyed interacting with you today and over the last five years. I’ve learned a ton from being your kind of behind-the-scenes producer and researcher and writer on this show, and it’s been a real privilege. And so thanks for talking with me. I hope you enjoyed this kind of flip the script episode, and I’m looking forward to many, many more episodes of The Harry Glorikian Show. 

Harry Glorikian: Thanks, Wade. It’s great to great to do this together and I hope everybody who’s listening enjoyed it. And if you did, please don’t forget to subscribe and tell other people. That would be great. Thank you. 

Wade Roush: Thank you, Harry. Take care. 

Harry Glorikian: That’s it for this week’s episode. You can find a full transcript of this episode, as well as the full archive of episodes of The Harry Glorikian Show and Moneyball Medicine at our website. Go to glorikian.com and click on the Tab Podcasts. I’d also like to thank our listeners for boosting the Harry Glorikian show into the top 3% of global podcasts. If you want to be sure to get every new episode of the show automatically, be sure to open Apple Podcasts or your favorite podcast player and hit, follow or subscribe. Don’t forget to leave us a rating and review on Apple Podcasts. And we always love to hear from listeners on Twitter where you can find me at glorkian. Thanks for listening. Stay healthy and be sure to tune in two weeks from now for our next interview.