Welcome back to Startup Health. My name is Unity Stokes, co-founder at Startup Health. This is the podcast where we get to have deep and meaningful conversations so we can get to know the change makers, the entrepreneurs, and innovators who are transforming health. Stick around. It's going to be another great show.
So, we're here with Esther. How are you first of all?
Very well. We're in Oakland to set the stage overlooking the beautiful port which is just a beautiful scene because we're going to be talking about a lot of things but this port's been here a long time and a lot of stuff comes and goes through here and I was just realizing the first topic we want to talk about is term limits right and the new book that you are writing and publishing. So just to start what is the message and why did you write this book?
The reason I wrote this book was not oh I know all this stuff I want to tell people. It was more wow I have this concept and a lot of questions about how it applies more generally. So it's not really a single message. It's maybe a single premise which is that human beings are finite. We get born, we live, we die. And I believe we need to be comfortable with that and see all the benefits of it. And at the same time, we come and go, but the universe lives on. We have a history. And ideally, we leave something behind.
And one thing I discovered during the writing of this book is this old Russian custom of sitting for the road. You're leaving, you've been at somebody's house or maybe you've been in the world and the first question is what did I leave behind on purpose because I wanted to thank the host, by mistake I left my glasses or my cell phone. And then you think about the journey ahead and of course when this all started eons ago, if you went on a journey, you might not come back. You need to be prepared to leave more broadly. And that's what our lives are. But we don't. We are now living in a world where exponential growth, immortality, if it's good, we need more of it. If it's bad, we should shun it.
Yeah. Living forever. But also living for... there's a book, a picture I want in the book of the Lonear Cafe in New York City, which has an iguana statue on the roof, and on its side it says, 'Too much ain't enough, but enough actually is enough.' And that's the trick. Nothing's so bad you should shun it entirely. Nothing's so wonderful you need an infinite amount of it. And the whole notion humans are unique and there it goes back to Oscar Wilde and long before who said he knew the price of everything and the value of nothing. And we have value but we're in an increasingly transactional world and we get disintermediated. We have people to spend our money, people to raise our children. We give them cell phones. They're being... I got this pitch for a software product that would ask your kid questions and then you could put it on your website or on your TikTok or something and it would answer questions to save your child the awkwardness of having to communicate with you or another real kid too. And in my life people... I swim and do you go to swimming? No, I don't go to swimming matches. I don't want to pay people to swim for me. I want to swim myself.
But so much of what we're doing is now allocated, optimized. Oh, you can make it more efficient. I don't want an efficient conversation with you. I want a meaningful one. So, is it a book of philosophy or is it about the world we're in or all of that?
It's all of it. It's the basic premise, a little bit about evolution and what AI is and what it isn't, and it's full of... because I've been in tech and all these things. It's a fair amount of not personal history but personal examples. I talk about people I know, some of whom I don't name for various reasons. And then it's less 'you never knew this.' It's more, 'oh, I knew this, but I never really saw it. I never really understood how I was distancing myself from the things that give me the most pleasure because I'm trying to optimize. I don't know why am I trying to optimize.' So, I started out with questions and found more and more questions. And there's a chapter on money and power and how they interact. There's a chapter on philanthropies, a chapter on AI and business structures. And then in the end...
Yeah. And I don't talk about formal education. I don't talk about religion. There are lots of other things you could talk about and I hope people will. And it ends with the notion of we've talked about term limits and we've talked about power. Sense of agency is good. Power to versus power over. And maybe you need the power to end your own life. That's fraught with so many things with possibilities of predatory behavior and so forth.
And humans are designed to want more. It seems like that's like part of the DNA, but then at the same time, we're also designed to know when time's up.
We should be. And partly we evolved in a time of scarcity when basically you could never get too much because everything was in short supply and things were hard to do. And power is one of the interesting ones. We need people who want power, but we need a balance between those who want it desperately and those who don't. And in our current era of abundance, even though the abundance is very unevenly distributed, there are too many people who want too much power and they also want pretty much too much of everything. And so what they're getting is ultraprocessed food, ultraprocessed information, and even ultraprocessed humans in some form or other.
Yeah. And then you can just take the pill and solve everything.
Yeah. Or some of us, the ones who deserve it, can live forever.
Yeah. Sure. In that movie Don't Look Up with... is it Leonardo DiCaprio and they try to go off to another planet and then they get there and they're living in this beautiful utopia and this beautiful creature comes up and then just kills the human like as soon as they land there because it's like they think they can conquer what's existent and then there's always some other challenge or this natural term limit maybe in the broader universe.
It's interesting. So my father was an astrophysicist. We knew all about space travel. And why have we not found other intelligent life? Is it... does it in fact happen that the moment society gets sufficiently intelligent to actually create too much of everything, they somehow kill themselves off? And I'm not a doomer. I'm more a... I want people to see more clearly what the bad parts of the good things and the good parts of the bad things. But there is some world in which you get really intelligent but not very wise.
Yeah. And you destroy yourself. Do you... is it almost because we're entering this new era of abundance where you can have more energy and more resources and endless this and endless that, also at the same time you need less time to do things because AI is infinitely reproducible so it can... you know some things speed up, humans don't. Well, and back to why haven't we discovered life? I've just always thought a silly question like, but that just assumes humans could comprehend what that life form is and we even understand what all other life forms are and we're even aware.
You're absolutely right. As I said, it's a question. It's not a proposition. And one of my favorite science fiction stories is where the Borgs look down on Earth and they of course are electronics. They're computer things of some form or other and they think with their meat. They have these orbs full of goo. Very strange, right? And so we look at everything from a porpoise or an orca to an assemblage of circuit and think it can't be sentient and who knows.
And then just this concept of time which seems like it's in the title of your book is just so significant because it could be different for everyone and every species and every place. And you know, how is this book more important now that we're entering this new super intelligent era and is that why term limits become even more significant because...
Because they're being questioned. In some... before you knew you had term limits and you talked to God and maybe you went and maybe you do live on in some other form afterwards but there was... yes there were people who wanted to be immortal but there weren't people who thought it was a real possibility for them. And again just the abundance and the inequality, it's getting very unsafe and it's something I think people should pay attention to.
I guess we met... you wouldn't even remember this but going back 30 years because you were doing... I remember it. You were doing Release 1.0 and you're... you've always been a writer and an editor and coming out of questions, asker of questions. Like to me, you've been so consistent through those entire 30 years in every way. And so I'm so curious about this concept of term limits and then does that mean a moment to change and transform or a moment to reflect or a moment to go on a new journey or...
It contains multitudes. Yeah. It means again it means saying rather than try and perfect... you know it's not leave the job undone but understand when it's time to make a transition. It may be earlier it may be later. Wellville we started out 5 years and decided we needed 10 years and ended almost on time December 42nd of last year. But just understanding that there will be an end. So what you need is to have priorities not an impossible number of tasks because if you had infinite anything then you would have to do infinite things with it.
And term limits should be comforting rather than...
Yeah. It's a freedom. Yeah. So I in the book also there's... I talked to this guy who said used to be when we didn't have so much money helped us make choices where could we go on holiday what could we get. Now we could do anything and so it's so hard to choose because there's no constraints. Any good artist will tell you I want constraints I want a piece of wood or a block of some kind of stone to carve something in or... it's in a very different way. It's hard to go into a restaurant and they say, 'What would you like to eat? Tell me what's on your menu.' And then I'm going to ask for it without the bread or Jack Nicholson or I want the salad but with ale instead of arugula or who knows what.
With AI and the new form of AI, it seems like in a lot of ways there's that open menu. There's this... to me it feels like there's almost an imbalance between the power that these tools really have and the creativity of how people are using them. And part of that might be because it's an open menu and people don't know what to do with them.
You could do anything and you could do it so incredibly fast. What do you really want to do? And you... Yeah. Whereas some people are... and it's great. This is exactly what I want to do and now I know how to perfect it and here's a tool that lets me do it.
I feel like I just wrote a piece on... it's called health moonshots in the age of super intelligence.
And to me it's okay we set the... they're all racing to beat the LSAT or humans last exam. If I'm pretty sure if they all were racing and competing because they all have to win these five people or organizations or people behind the organizations, they could cure Alzheimer's like by next year if they focused all the compute, all the challenge, all the energy on a different benchmark or a different race or a different challenge, then it would reprioritize the goal.
And five people should do that. And five should do another one. Right? And at the same time I heard someone two three days ago say you imagine we could create a million Einsteins and the first question is that that's nice but is Einstein really... he was the epitome of intelligence but was he really the epitome of what we're striving for versus he was a pretty wise guy too but... and then the second question is how many Einsteins do we have already that simply aren't realizing their potential? We ignore all that human potential and don't fund it. We grab the money for ourselves and we have really crappy school. I can go on.
Yeah. Who do you hope reads this? Everyone or entrepreneurs, investors, teachers, educators? It seems like this is a universal theme that matters to a lot of people.
And as with most books nowadays the real action isn't so much with the book as with the substacks, the blog posts they turn into, the podcast and so forth. The conversation around it. Yeah. And so different people will get different messages. Philanthropy chapter I hope and I hope some people will read the whole thing and then say maybe I'm in college education maybe this applies this way here. For people who are interested in asking questions, not looking for 10 timely tips for living in the age of AI, but it's a pretty short book. It's meant to make you think, not to read a lot, read a lot of pages.
Yeah. Knowledge is not poured into your head. It's more like decorating a Christmas tree to create a pattern.
I love Michael Pollan's book. It's the one... it's the one about eat green. Eat plants. Mostly green and not too much. The one I like is... basically the one that says ultraprocessed crops are a fitness function. They are changing us more than we are changing them. Basically, the whole notion of how people respond to a fitness function. In the old days, the fitness function was get as much food as you can so you can stay alive and not starve, make fires, find mates and reproduce because two-thirds of your kids are going to die. And now our fitness function is being perverted by again all this ultraprocessed food and content and fitness function is get more of everything and that's really not actually good for you.
Are you... you said you're not a doomer. Are you an optimist or... I know it's a weird word now it's been claimed by the techno optimists.
I say I'm a cynical idealist. And I'm also... what I hope to do is help people see stuff and behave better not because I think... I don't want to predict the future I want to influence it. Yeah. And so I'm neither. I'm a... if we can... and defining we is one of the first challenges. But if we can all of us be more sensible, then I think things will be much better. And if we keep responding, if we keep being run by the fitness functions of predatory business models...
Absorbing our time and attention and...
And turning us into addicts. Yeah. And separating us from what really makes us happy because somehow we've absorbed some other whether it's a short-term addiction or long-term goals that aren't really good for humans.
It seems if the past 20 years of technology was all sorts of very powerful, amazing tools that added a lot of value but took us away from our humanity.
They added a lot of valuation.
It drives me crazy in Silicon Valley. Oh, he's worth 400 million. No, he's got a 20% share in a company where the investors actually have a liquidation preference of three times and he's not really in control and he's not worth it. He's got a call on some subset of the current valuation of that asset. And he probably just got lucky and doesn't recognize it.
Yeah. Timing, luck. That begs the question, the difference between perseverance and knowing when to push through something and then knowing when there should be a term limit to maybe a new chapter or a new thing and how the difference or...
Yeah, it's not knowing in a sense because like most advice is useless because good advice is not just about what someone should do. It's about what you should do. What are you good at? What really motivates you? And the best thing about advice is knowing which advice to listen to and which advice to ignore. But there's also no right answer. There are clearly some wrong answers. And you can do quote the right thing, but if it doesn't... it shouldn't make you just happy. I'm happy. At the end of all this, you should have some human satisfaction. Again this whole disintermediation. I've just been talking with people about philanthropy and I don't want a donor advised fund giving my money away. Someone asked me to be at a gala and be honored and the business model for that is give us some money. Yeah. Invite some of your rich friends and you will be... it's the same but a different scale from the oh do you want to be the woman of the year for some magazine you've never heard of for $1,200 and they'll give you a plaque versus... so I got this pitch but I liked the guy better than I thought and I won't name the... it was some kind of student-oriented thing and I said look I'd love to come talk to your students about the book I'm writing. That's an audience. I want some students who are, oh, this lady, she's I don't know, but she's got a whole lot of likes somewhere. We'll listen to her and I want to provoke a few of those kids. And then maybe because of that experience, I'll be motivated to support this nonprofit. Who knows? But I don't want to just give some money so that I can be woman of the year.
How do you think about your next chapter? And if you've been reflecting on one term limit, there's always an opportunity to start the next term, which is the beauty. How do you for yourself think about that?