WHTC 2024 | Keynote with Esther Dyson with Q&A

Thank you. After that intro, I think I should just be quiet. So good afternoon, good morning everybody. I will tell you just a little bit of background, and then I'd much rather answer your questions because answering questions is more interesting than repeating a speech you've written for so many people already. In a sense, I need to do not a land acknowledgement but a luck acknowledgement. I grew up privileged. My father worked for Oppenheimer. I knew Nobel Prize winners and stuff like that, but I knew very little about the real world. Sort of following in the footsteps of science, I started asking questions. I went to live in England the year I was 13, and among other things there, I spent a fair amount of time with my aunt who used to work for the National Health Service in England. She was what they called an almoner, essentially a doula, and her specialty was unmarried moms. Probably the best way they would describe those unmarried moms at that time would be shameless hussies. Her job was to guide them, kind of like some of the companies we heard this afternoon, to deal with a society that rejected them, to try and be healthy for their babies, to try and get through the process, maybe reconcile with their families, or find some way to survive in a world that was pretty hostile. That piece of my life lives with me for many reasons. When she died in the early 2000s, a bunch of the kids whose birth she had assisted showed up at her funeral. That whole transition of generations and so forth is in some sense what I'm still working on. A few other things, and then please just ask questions about what interests you. Wellville started as a five-year, five-community, five-metrics contest. I was going to get funding for it. As I said, I've been extremely lucky. I made a huge amount of money in the stock market just by being lucky. I also, you could say, was unlucky. I was, as you noticed, on the board of 23andMe, and financially that didn't work out so well, but it was an amazing education. I learned a lot about genetics, the space training, I learned a lot about space travel. Again, you need to be lucky to be able to do this, but my motto is never take a job you wouldn't do for free, but then try and get paid. By being able to follow that, I've had an amazing life and learned a ton, and I'm still doing stuff. Wellville, I was going to go out and raise money for that, but it was too weird because we weren't focused on medical care the way it started. There's this company called RealAge. I can't really see a show of hands, but its business model is selling vitamin supplements. It asks you about your social determinants of health in a sort of polite way: do you live with a partner, do you have pets, you eat well. It doesn't go into the tougher social determinants of health like poverty and racism and parents who were addicted or absent. I will say I'm a childless cat lady, but without a cat, but I care a lot more about parentless children, whatever sense that might be. Anyway, Charlie Silver who ran RealAge eventually sold it to Hearst, who sold it to Sharecare. But what was interesting was who he sold his first company to, and that was Jiffy Lube oil changes, as in maintenance. It occurred to me: maintenance. We should maintain human beings better because so much of healthcare is just a repair job for things that shouldn't have happened. So much of what we were hearing about today is about keeping people healthy, whether it's babies or bones, rather than fixing things that went wrong. That in a sense was the purpose behind Wellville. As I mentioned, it was too weird to be funded. We weren't going to hand out money, we weren't going to come in with a program or a playbook. We were going to basically be counselors and advisors to five communities that wanted to become more healthy places for people to prosper. Over the first thing I learned was five years is not long enough to earn people's trust, so it ended up being 10 years. It's ending at the end of this year. The five communities didn't want to compete, they wanted to collaborate and learn from one another, so it was not a contest. We couldn't raise the money for a prize. Ultimately, the metrics are useful and we are collecting some data, but what we were really trying to build was less a clinical trial of some precisely defined intervention, but more to help five communities fulfill their own desires, use their own intrinsic motivation. We learned quickly that telling people what to do if they're not fundamentally interested in doing it is not the right way to either raise children or help a community come together. So that's probably enough for prompts. One more: at the end of this, my next challenge is going to be to write a book, not about Wellville per se because that's kind of like writing a book about marriage by writing about your own marriage. There's just too much detail, too much personality. It's more what did I learn with some anecdotes that could be applied more generally. Second, as I mentioned, Wellville was unsustainable. I love what we were doing, I think it was very helpful, but you're not going to find a lot of lucky people like me funding this kind of thing all over the place. Ultimately, we need collective investment, not spending, on the health and well-being of our future generations. So I'm going to let you do the questions.

I love this question. I mean, I hate the thing, but yeah, something like hate the sin, love the sinner. I first learned about addiction well before Wellville, in fact starting pretty much in Russia, which I was visiting. I learned Russian in high school for a bunch of reasons and started going there in 1989. I saw the impact of despair and a sense of uselessness, a sense of powerlessness, and the rampant alcoholism. I talked to one of my friends about smoking and drinking so much, and he said, 'Well, Esther, we don't like the life so much we want to live so long.' In a sense, I would call addiction negligent suicide. But what I also learned about it over the years and also in Wellville is addiction. Ironically, I know some of you are interested in my investments. I have two couples counseling companies. One is about you and your food, and the other is about you and your money. Addiction is about a toxic relationship with something. It could be a substance and there's physical dependency, but addiction itself is more this craving for relief from something, whether it's gambling or a drug or food or for some people shopping. It kind of takes over your mind and it shortens both your vision going backwards and forwards. You've probably alienated your family. You really have no... you're so focused on relieving that addiction, you aren't really thinking about your future. You know it's not good for you, but you do it anyway because you need it now. You also know you should behave better, your family's going to abandon you, you're going to lose your job, and somehow you know that relief isn't coming, but you're just caught in this. It's not just about poor people and poor communities. It's also community organizations addicted to short-term grants. Again, they have no vision for the future. 'We just need the money now to pay our part-time coordinator, and whatever these guys want us to do, we'll do it for a year. Then they'll either say it's successful so they're going to do something more innovative, or they'll say it wasn't successful so they're not going to fund us anymore.' Venture capitalists get addicted not to sustainable companies, which I hope is what you all are building, but to exits. Politicians, of course, get addicted to votes and to staying in office and to being surrounded by people who tell them how great they are. Then there are longevity billionaires who, even though they think they want to live forever, right now they're addicted to sort of almost punishing themselves and not even enjoying their lives by chasing this dream of 'I got to last forever.' So addiction... what do you do about it? There's lots of useful things you can do with short-term treatments, but fundamentally, they're trying to give people back their sense of purpose and of human connection. The thing human beings most need is to be needed by other humans. If you look at the movie 'Her,' which got a lot of press recently, Sam Altman and OpenAI... the problem with that love affair between Spike Jonze and his girlfriend played by Scarlett Johansson's voice... he discovered that she had 1500 lovers and didn't need him. Even though she could pay as much attention to him as he wanted in terms of time, he didn't get the percentage, and he knew she was fine without him. People need that sense of purpose, of mattering. It's the difference between an influencer's audience, which they count in numbers, and the members of your family who are each unique individuals that care about you. It's not quite that simple obviously, but that's what I learned about addiction.

Okay, so first I'll talk about the meta, and then I'll talk a little bit about sort of the business. The meta is everybody's fussing about training our AIs. 'We got to train them to do this and that and the other.' We do, and the great thing about them is they're very scalable once you train. There's lots of issues around embedding bias into the AI because they basically copy human beings. There's a lot of issues around unexplainable AIs, and honestly, I think unexplainable humans are an even worse problem. The solution to this is training our babies, not training them to do things AIs can do, but training them to be better humans, to have that ability to connect that I talked about, that's the opposite of addiction, to think long term, to care, to notice, to have empathy, and to need one another. We've kind of lost this in so many ways in schools. It's not just home ec, but sort of the civic and social parts of school, not just the arithmetic and the writing and reading and your history lessons. It's training a workforce. When you come into a company, interns do a lot of work that can be done by AIs, but the most important work they do is being part of the business, learning from their bosses, communicating with their peers, and having that human creativity and so forth. Now we have a society where people are getting disconnected and it's fragmented. We need more people to do that human work, whether it's paid or unpaid, of being there for one another, being family, but also being neighbors, showing up at the PTA, being human to other humans, and socializing. So that's the bigger problem in a sense. Then there's the problem of so many families that are fractured. We do now have children whose parents are missing or themselves have not been trained to be good parents. This is not training out of a book, it's being trained by human beings. It's lonely elders who are disconnected from their communities and who often don't live with their kids. Avale Care's model is primarily focused on... it's such a huge market and there's a lot of companies in it. We have a very specific but large focus, which is the kids of remote parents who need support, who are probably on Medicare or Medicare Advantage. They need appointments scheduled, they need food ordered from Walmart, which is something they can do specifically through Avale Care. They need remote monitoring of various kinds, they need to be reminded to take their meds, they need to get their visits to the doctor not just scheduled but call the Uber or the local taxi or whatever the local arrangement is for getting people to doctors, and so forth. Meanwhile, these caregivers are themselves not being cared for. I remember talking to the wife of a man who subsequently died. She said, 'My kids come home and they ask how's Dad, and they never ask how am I. Dad has me to love him, but what about me?' She feels guilty for asking that, and at the same time she desperately needs some care herself. We try to support both the tangible, arrange the appointments with the doctor, and the intangible, have a community around you, help you connect with your family. 'Okay, I've been talking to Mom all week, it's time for my little brother to call her, or it's time for my little brother to drive over from the next town and help her fix her washing machine.' Somehow providing a support network, just as we were talking about mothers need support, all kinds of people need peer-to-peer support, adding again that sense that you are not alone. Not only do you have a purpose, you have people who need you, but you also have people who will assist you because the work you're doing is so important. From Medicare Advantage's point of view, an unpaid caregiver that loves the patient, I mean what a deal. Support them up the wazoo. That's basically what we're talking about.