Welcome back to StartUp Health Now, the podcast where we celebrate the entrepreneurs and innovators who are transforming health. My name's Unity Stokes, co-founder at StartUp Health. Welcome everyone. We're so grateful to be with all of the amazing health transformers. There's lots of great members, investors, and most importantly, Esther, we're excited to welcome you. Just a note, Esther Dyson is traveling today. So, we will make do as best we can with technology. Today is going to be a wide-ranging conversation. We want to make this an interactive conversation. But maybe just to kick things off, where are you today?
Okay, so I delivered my book last week, which doesn't mean, 'Oh, you can read it now.' It means it comes out early next year. And suddenly I'm now back on the road where I was. I'm in Lansing, which is the capital of Michigan for a Boys & Girls Club meeting. And the book is called Term Limits, Human Time and AI Scale. And so, it's about the value of human life and of course, Boys & Girls Club is the epitome of helping underserved children be mentored, learn their own true value, become amazing human beings despite growing up in hard circumstances. And the epitome of what my book was around and I was there for the selection of the Boys & Girls Club Youth of the Year for Michigan. I know the one from Muskegon and so, it was just the whole notion of charity is not about donating a lot of money and having your name on the building. Charity is about being engaged and caring, not donating. So, it was I had to be there. And here I am, and now I'm heading to Detroit Airport.
Thank you for sharing your time with all of us as well. Maybe let's just start with term limits and your core thesis. The titles have all slightly over the past two years. So, it sounds like it's term limits, human time, and AI scale. I think that kind of subtitle's really fascinating. Can you tell us what the core thesis is and how that might also relate to a lot of the innovators that are building and on the Fireside Chat?
Yeah, so the core thesis in a sense is, you think you know what term limits is, right? It's like politics. No, it's also term limits of human life. And the whole idea is, can we rethink what you thought you knew? Rethink. Oh, things shouldn't end. Good things should last forever. No. Good things have a time. And then there's probably time to do something new. Things can change, but the very fact that we have term limits as humans gives us, if you like, permission to say, 'I can't do everything. Let me find my priorities rather than, oh, I'm going to live forever. I got to do everything.' And it also means you can't do everything, so you got to share. And you have to pass things along. Don't delude yourself you're the only one that matters. You want to make a dent in the universe. You don't want to control everything. And if you take it the right way, it's very calming. It's okay, dude. Do what you can. Figure out what you can do best. And then find other people, help them do what they can do best. And then there's a whole lot more about what AI really is and what it isn't and how we can use it and not let it manipulate us and stuff like that.
Tell us more about this concept of human time and then AI scale. There's this paradox going on right now where AI scale, it seems so fast. We're changing, the scale is epic and awesome, and then there's this constant of human time, which obviously is much slower. And then you mix all this together and it can be very confounding, in particular as you're trying to adapt, as you're trying to build, as you're trying to innovate within this paradox. How should we all be thinking about this transition today?
The first thing is I'm so important I need to live forever. I need to do everything. I need to control everything. I want more. And in a sense there are two diseases of time. One is time is too short. I need it now. I need it again. I need more. In real time and that's addiction. And then the other is the yearning for more and for forever. You have some sense of I deserve not to die. And writing this book wasn't, oh I know all this stuff I want to tell people. It's more like I have all these questions I want to understand. And it turns out lots of these questions were addressed many millennia ago in various religions and so forth. But this notion that yes, I will give you the knowledge of good and evil, but your life will be finite and so forth and so on. The very... Yeah. It's the value of human life which you can't measure. And then it's the valuation of money of everything else that you... And it goes back to a quote from Oscar Wilde. He knew the price of everything and the value of nothing. And yeah. Every chapter has a different epigram.
So it sounds like it's relevant to everyone, not just innovators, not just investors, but everyone has term limits.
Yeah. Whether you like it or not, you have term limits. So whether you like it or not, you have term limits.
So will you advise, as an advisor, as an investor, as a board member to builders to keep that human-centered approach?
The most important thing is don't outsource what's important. And what's important is the ethics of your business. What's important is... Yeah, again, yes, your business is important, so is your family. You need to juggle that. You need to juggle long-term versus short-term. And but don't expect the AI. You still need people to have a company. And the most important thing in a sense is... but there's also theory of business lines, which is they want more money. And you need to understand with the people you're working with, the people representing the companies you're working with, understand what motivates them. And don't be a sucker, don't be a cynic. Again, don't be too skeptical, but don't be too trusting. Learn to earn trust. Learn to give trust where it's deserved. And just don't be too bedazzled by AI. Use it. Don't let it use you.
Yeah. I'm going to bring in a couple of transformers. Matthew Swanson, if you're there from Clutch Health, I think you have a related question or comment.
Yes. Esther, really nice to see you. I think I was on one of your earlier calls a couple years back. I spoke to the group as well, so nice to see you again. Clutch Health and as I founded the company Reciprocity Health is really focused on finding the best ways to engage people in their health care and bring them into their health journey in a much more meaningful way. And so I was just really just wondering where maybe you've seen companies either go too far in building that layer of technology in the relationship building and maybe where you've seen it done well.
Yeah. There are so many examples of just don't outsource the humans. Outsource the doing of the paperwork. So, I have this notion of there's diabetes, which is sugar destroys your ability to process insulin. There's information diabetes, which destroys your mind's ability to process good information. So, you consume it, but you don't absorb it or digest it. And then there's money diabetes, which destroys your moral fiber by turning it too focused on money, which has no value, only valuation, and get stuck into this vortex. And the people who work for you ultimately get corroded and corrupted if you do too much of that. So, it's using AI too much and losing your moral fiber, but specifically where I've seen it used well is actually two companies I'm an investor in. One is peer-to-peer counseling, and they use AI to support the counselors. Basically, they moderate chats among people. And the actual peer-to-peer support people themselves never see or talk to the AI. They're talking to the moderator. The moderator gets hints from the AI. This one person in the conversation seems to be in need of more serious help than peer-to-peer. It needs a suicide counselor or somebody's being disruptive. And they give hints to the moderator and makes the moderator's job easy. So, what I like about that is it uses human skill, one moderator for maybe five people in a chat. And then there's one AI for several hundred moderators because the AI, yeah, you just duplicate it. And it's kind of like the right ratio. To actually talk to people, one person to four people is great. To talk to moderators, just one AI does it all. The second one is somewhat similar. It's focused on training neurodivergent people on workplace skills and interaction. And the same thing happens there. They have counselors and trainers who are then supported by the AI. All these really wonderful healthcare jobs that you all know require a huge amount of bureaucracy, credentials. How do you get paid through Medicaid? How do you establish your credentials? How do you get registered in this state but not in that state? That stuff that's perfect for AI to do as long as the AI actually is properly trained to follow the particular state laws or registration requirements.
So, AI to empower humans to be better and perhaps more efficient, not to replace them, right?
Yes. And it's like I swim every day and people occasionally, you must really love watching swimming championships. And no, I swim for myself. I don't pay other people to do my swimming and I don't want to watch other people do it for me. I don't want my swimming to be efficient. I want to experience it and it's where I did a lot of the thinking for the book in the pool.
Love that. Thank you. Thank you. I think the next question is related. Amit Shallar from Held Health, if you could ask your question.
It's so nice to meet you, Esther, and also thank you for having me, Unity. I'm excited to be here and learn. I'm Amit Shallar, founder of and CEO of Held. We are a consumer personal health operating system and not unrelated to the topic of discussion recently with Julie Yu as well as your post recently on Substack related to the addictive nature of products that have been built through many technology companies. Right now, we're building our optimization of key features tied to AI and I can't help but try to optimize these metrics and for the key features that we're building toward things like time spent and engagement which it's easy to go down the road of building products that are AI enabled that could easily become addictive. And how do you think about as related to what you're talking about here, how do you think about the benefits of engagement, possible addiction, and whether or not that's a bad thing if it's tied to consumer health and wellness. Can we go too far still if people are consuming more and more health?
Yeah, and the first red line again is consuming versus experiencing. You can consume more stuff but the challenge is how do you absorb it? How do you digest it? How do you make it part of you? And it goes back to this too much ain't enough. Too much is enough. Too much obsession with being healthy. Like I survived cancer of the esophagus a while ago and I try not to eat after 4:00 p.m. Which is difficult especially after COVID and there are now dinners. And I see my sleep score goes down and lower when I eat a late dinner and so forth. At the same time there's social events, there's people you love. I very rarely get sick but my goal is not to be the healthiest person in the world. My goal is to have enough health that I can achieve so that I can enjoy my life and be productive and do all the other things that everything in moderation is a much better principle than too much ain't enough. And there's orthorexia. It's when you get too... Your job is not to follow all the rules to the extreme. Your job is to follow enough rules to follow the other rules. Because life is finite. It's a set of trade-offs. People have said this before, if you really want to be safe, never go out on the street. But then you're going to die of being too sedentary. And so, take a risk every once in a while. And yes, if you have a 95% chance of succeeding, the 5% where you don't succeed doesn't mean that was a bad decision. It was a good decision. And you got the wrong 5%. And at the same time, be very conscious. Most of us here on this call are in the health care business. We're doing something commercially successful. We have all been lucky. None of us died on the way. Most of us might have made a few mistakes and we recovered and succeed. We're here. But a lot of the time we had no idea how lucky we were. And that is what I've learned from spending time 10 years in some of the poorer parts of this country. People who can't afford to take risks, if they really take a risk, they're going to lose their home. It's not, oh, I lost my chance to win the contest. It's I no longer have a home. We all are extremely lucky. We have some built-in resilience that we don't even understand the value of. But take a risk every once in a while. That's good for you, too.
Thank you. Thank you, Amit. Anytime you get an email from Esther, she has a great quote at the bottom, which is I think always make new mistakes. Next guest, next question, next health transformer, Piyush Gupta from Ambrosia. How are you? Nice to see you.
Nice to see you. And hi, Esther. I met you at Apollo House. And it was great. You are the sweetest person I know, honestly. And I have two questions. And first question is what is widely accepted belief in digital health that you think is fundamentally wrong?
