Episode #17: Three Breakthroughs: Are Doctors Doomed, Space Breakthrough, and Is a Cure for Diabetes Coming?

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  Sam:
  AI doctors, Starship, and a cure for diabetes. I’m Sam, and this is the Tech Optimist.

  Mike Collins:
  AI doctors, it’s coming. I think it’s a great venture capital opportunity, frankly.

  Drew Wandzilak:
  And Starship to me is probably one of the, if not the biggest breakthroughs in space, ever.

  Mike Collins:
  At the end of the day, there are still people that don’t have a working blood sugar management system anymore.

  Sam:
  In a world captivated by criticism, it’s easy to overlook the groundbreaking technologies shaping our future. Let’s shine a light on innovators who are propelling us forward.
  As the most active venture capital firm in the US, we have an exceptional view of tech’s real-world impact. Join us as we explore, celebrate, and contribute to the stories of those creating tomorrow. Welcome to the Tech Optimist.
  As a reminder, the Tech Optimist podcast is for informational purposes only. It is not personalized advice and it’s not an offer to buy or sell securities. For additional important details, please see the text description accompanying this episode.

  Drew Wandzilak:
  Hello, everyone. Welcome back to the Tech Optimist podcast segment on three breakthroughs. I’m Drew Wandzilak, a senior associate here at Alumni Ventures, and with me as always is Mike Collins, Founder and CEO of Alumni Ventures. Mike, I think you’re kicking things off today with the first breakthrough.

  Mike Collins:
  Yeah, hi, Drew. Mine is a little more thematic than a specific announcement, but I visited my doctor this week and I kept thinking to myself, is AI going to replace my doctor? That’s an exaggeration, but I could see where more and more of this is going to be taken up. And there are definitely—I mean, you think about what medicine is, right? They’re taking measurements and data and signals from “I have a sore throat,” take a temperature, there’s a bunch of inputs there, and then basically a doctor is running a computational decision tree based on that, which is well-known and somewhat formulaic. And there have been some tests done where the quality of the diagnosis is better with an AI system.
  And then you jump to, oh, but bedside manner. AI outscored in bedside manner. The AI system doesn’t get frustrated because they’re being second guessed by an insurance company, it isn’t at the end of a 14-hour shift, feet don’t hurt. All the things that we as humans have to deal with—not really.
  So it was surprising to the people doing this initial research that in a bedside manner, blind, the AI system outscored the human in almost all dimensions. And again, this is as bad as these systems will ever get, and so there are companies going after this space. We’re involved with some, we’re not involved in others, but I think it is a very interesting space. Plus, you think about the system by reading all the latest medical journals, all the latest clinical trials. Again, I’m sitting there with my doctor and he can’t remember stuff, so he’s looking it up on his laptop. And it just struck me as—if you’re in college and you want to become a doctor, you want to become a doctor because you want to work with these systems, and you’re doing it because you love the idea of going into medicine. Do not go into medicine because it’s a job that you think is always going to be in demand and safe and well-paying, because the world changes.
  And I think this is an area where there are other benefits with costs, availability—and again, I’m not talking about it going to zero—but can it become part of our healthcare system in a very meaningful way? I think so. And again, I’ll bring it back to some issues with my own mother and help her prepare for her appointments with a list of questions. I use AI today to do that. She is going in for a procedure, she got 10 pages of documents. I loaded those into an AI system and it gave me a summary and a list of questions that she could understand. So already, it is a tool for an individual today to help them navigate the system better—with good questions, with translating things. A lot of medical records are now available to us, but it’s like, I can’t understand what this medical-ese is saying, but now the AI system can translate it for me.

  Sam:
  Really quick, I wanted to jump in here to do a little bit of research on some of these technologies and some of these AI technologies that Mike is talking about here. When he talked about bringing his mom to the doctor, she got a bunch of paperwork and then he used AI software to essentially summarize everything that was in those documents and summarize some questions that his mom could bring with her to her next doctor’s appointment. And I thought this was just such a really cool and fascinating way of thinking about how to help a loved one. I think Mike, being in the tech space and the startup space for so long, his brain is wired that way.
  I found this one really cool AI service—it’s called AI Hub from Instabase—and I tried it really quickly. This is just an internal document we use; these are actually some of Drew’s picks from the past breakthrough episodes, and I threw it into the AI software. I had it summarize the document for me and I tried it out myself, and I thought it was really cool. So, this is a tool that I’m definitely going to use from now on. And if anyone else listening to this show wants to use it, please feel free.

  Mike Collins:
  So again, where we are today, it’s a tool, but I think it’s going to be part of our medical system sooner versus later, and that’s exciting.

  Drew Wandzilak:
  Yeah, I mean, whenever we see new innovations like this, I always try to look—are there any recent comparables, similar markets that have gone through that same trajectory? It’s very similar, I think, to what’s happened in FinTech, especially with financial planners, the rise of robo-advisors. There’s obviously a technical element where it’s a time suck, a lot of it. The one piece that’s similar is I talked to my parents about some of these robo-advisors, and it’s—they want to hop on the phone and talk to their financial planner. I’m a different generation, happy to log into my Wealthfront account and manage it myself because a lot of it is systems and processes that AI would do just as well as a person would.

  Sam:
  What does, in your mind, the future of healthcare look like then? Is this something that shifts because there’s a cultural element and there’s a technological element here? Do a couple generations have to pass by and people just grow up in this environment where maybe they have a nurse practitioner or a nurse that’s like the human touch and then everything else is technology, or how do you kind of view that balance?

  Mike Collins:
  Yeah, I think there’s much more power in the hands of the individual to be informed, and again, some of this is generational. My parents go to the doctor and if they say, take the blue pill and stand on your left leg, they take the blue pill and stand on their left leg. My generation—I’m kind of a cusp boomer—is much more skeptical, but still put great power in the degrees and that. So I do think with each generation there’s a very different attitude toward things.
  So some of it will take time and obviously there are areas where… You have a company that’s also just continuing to knock things off with robotics because it’s like, “Oh, then I’ll be a surgeon,” because it’s like, “The AI can’t fix my bunion,” kind of thing. But you have a company like Intuitive Surgical that is robotically doing more and more procedures robotically or aided with robotics every day.
  So again, these things don’t happen overnight. Some of it is generational and takes time, but I think it will move quite quickly and I think it’ll be good for the system. I think there is efficiency that can be had, and I think there are going to be startups that absolutely become unicorns in this space of what I’m going to call AI-aided medicine.

  Drew Wandzilak:
  Robo-doctors.

  Mike Collins:
  Robo-doctors, right. I mean, you also have to say to yourself, what are markets that are ripe for disruption from a standpoint where there are things that are very expensive, there’s a part of the population that isn’t happy being served well, and there’s enormous value capture and a lot of, frankly, dissatisfied parties. It’s education and healthcare—two big ones. And listen, there are a lot of regulatory constraints, for sure. Some of them are very justifiable, some of them I think protect the old guard a bit, but the market wins over time. So, I do think the idea of AI doctors is coming; I think it’s a great venture capital opportunity, frankly.

  Drew Wandzilak:
  And the last thing I’ll add is to your point of what markets are ripe for disruption—I’ll add the extra phrase of “ripe for disruption by AI, artificial intelligence”—and it’s, I think, not only those markets that are highly bureaucratic, they’re multi-trillion dollar industries, but where is there additional value to be had when we can actually understand more data? I mean, I try to boil this down to… because there’s AI in video games, there’s AI in consumer apps, and that’s great, but the real unlock is now we can ingest massive amounts of data and actually pull actionable insights. We can have computers make decisions based on that data. And so, where are the biggest unlocks for that? And I think you’re spot on—it’s healthcare. I mean, there’s so much personal health data that we just wouldn’t spend the time to capture because we wouldn’t know how to analyze it or be able to analyze it, especially if it’s unstructured in different formats.

  Sophia Zhao:
  Hey everyone, just taking a quick break so I can tell you about the AI fund from Alumni Ventures. Alumni Ventures is one of the only VC firms focused on making venture capital accessible to individual investors like you. In fact, Alumni Ventures is one of the most active and highly rated VC firms in the US, and we co-invest alongside renowned lead investors. With our AI fund, you’ll have the opportunity to invest in a portfolio built entirely around advancements in AI. This fund consists of 15 to 20 investments in multiple fields where AI is making a huge impact, including areas such as machine learning, healthcare, education, transportation, and more. To get started, visit us at av.vc/funds.aifund. Now, back to the show.

  Mike Collins:
  I mean, again, this is just a category that is perfect for this. I mean, there’s a social media medical student, I believe, and they’re basically given 60 seconds to ask 20 questions, come up with a diagnosis. He has basically a minute to do Q&A, and I’m saying an AI system is going to crush you.

  Drew Wandzilak:
  Yeah.

  Sam:
  When Mike here was talking about this sort of TikTok social media trend, I knew exactly what he was talking about. My generation, being so involved within social media—TikTok, Instagram—I have seen them personally on my page come up and are recommended to me through the algorithm. And I figured I would share some for anyone who was unfamiliar with this, but here’s an example right now. This is audio from a post from that.

  Speaker 5:
  60 seconds to make the diagnosis.

  Speaker 6:
  All right, well tell me about the patient.

  Speaker 5:
  A 42-year-old male presents to the ER with increasing shortness of breath, wheezing, and coughing.

  Speaker 6:
  Okay, does the patient have any history of asthma, allergies?

  Speaker 5:
  No.

  Speaker 6:
  History of smoking?

  Speaker 5:
  No.

  Speaker 6:
  Okay, is the cough dry or wet in nature?

  Speaker 5:
  Dry.

  Speaker 6:
  It’s dry. What about the chest X-ray? What are those?

  Speaker 5:
  Marked hyperinflation.

  Speaker 6:
  Marked hyperinflation. Is the AP diameter also increased?

  Speaker 5:
  Yes.

  Speaker 6:
  Okay, and can you tell me about the ABG report?

  Speaker 5:
  It’s PAO 263, and PACO 254.

  Speaker 6:
  Okay, so they’re hypoxic and hypercapnic. What about the spirometry—the FEV?

  Speaker 5:
  0.6.

  Speaker 6:
  0.6. Okay, so obstructive in nature. And what about the bronchodilator response? Significant?

  Speaker 5:
  No.

  Speaker 6:
  No, okay. And for the CT scan, was there primarily upper or lower lobe involvement?

  Speaker 5:
  Lower lobe.

  Speaker 6:
  Lower lobe involvement.

  Speaker 5:
  10 seconds.

  Speaker 6:
  Okay, and then for the blood workup, is there deficiency in alpha-one antitrypsin?

  Speaker 5:
  Yes.

  Speaker 6:
  It’s a panacinar emphysema.

  Speaker 5:
  Got it.

  Mike Collins:
  Because it’s basically matching the symptoms, the interaction, and obviously there’s reading the room and there’s some human judgment in there, but there’s a whole lot of understanding the corpus of data that is very knowable by an AI system and, frankly, beyond the capacity of one human brain to do well. So, I just think it’s inevitable—AI doctors are coming. So, onto you. What’s yours?

  Drew Wandzilak:
  Yeah, so we’re recording this on the 7th. On the 6th, Starship successfully had their most recent test flight where they were able to land both the booster and the rocket itself back into the ocean. This is a massive step for the company.

  Mike Collins:
  Huge, yeah.

  Drew Wandzilak:
  It’s huge, and Starship to me is probably one of the, if not the biggest breakthroughs in space ever, by orders of magnitude. And so I just wanted to put that into perspective a little bit. The goal of Starship—it’s a rocket bigger than the Saturn V, which is what brought our Apollo astronauts to the moon. It’s larger than the Statue of Liberty. And the goal is, can we take 100-plus tons of payload to space reliably? They want to launch these once every couple of days, eventually at some point, maybe daily.

  Sam:
  Ever since Drew said that the Starship is larger than the Statue of Liberty, I just had to grasp how big that is. So I’m going to spin you guys some facts to help understand how big this thing is. Okay, so the Starship is 165 feet long. The Statue of Liberty from tip to the end of the base—not the end of the statue—is 300 feet, but just the statue itself from the bottom of her shoe to the very top of the torch is only 152 feet. Another few fun facts about the Statue of Liberty to then help grasp the scale of this thing: 5,000 sheets of heavy gold leaf cover the copper skin of the flame in the torch, and the length of the statue’s index finger is eight feet long. Okay, Drew, let’s keep going.

  Drew Wandzilak:
  And the way that we measure things in space, just to illustrate how big this is, is cost per kilogram launched. What is that price that’s come to the end consumer? About a decade ago, it was probably in the 10 to 20,000. Two decades ago, it was way higher than that, almost in the millions. Last year we got that down to just under $2,000 per kilogram. The end goal with Starship and what it’s on pace to do is be able to offer these launches for $10 per kilogram. So, when I say orders of magnitude and democratizing access to space, Starship is what’s going to do it. And it’s not just bringing small Starlink satellites to low Earth orbit. This is 100 tons of payload to the moon, to Mars, farther out in the solar system. I mean, the ancillary effects of this are massive. The number of things that we can do, the costs it drives down of energy production, of in-space services—this is going to be huge, and we’re going to look back on it in a decade or two, and this is a really pivotal moment for the industry.

  Mike Collins:
  Yeah, I mean there’s a couple things. The technical achievement—amazing. It also, to me, reminds us of the power of the private sector working with the government. So not one alone, but it’s like, would we be where we were in space as a planet today if there weren’t private companies pushing and experimenting and, frankly, sometimes failing? No. Could we have gotten there without some of the enormous societal investments made 50 years ago by the government? No. And again, I think people can dismiss space as being frivolous, but it really is pushing. People said the same thing about “go west” in the United States—like, why the hell do you have to cross the Mississippi? So, humans push boundaries; we experiment.
  I think within the decade we are going to be mining very important things off of asteroids. I think we’re going to have a permanent base within 10 years on the moon, and I think it’s great and I agree with you—big deal, super exciting. You can’t help but notice it was about number seven on the list of major media publications, behind the political story of the day, the pop culture story of the day, because it didn’t blow up. If it had blown up, it would’ve been right at the top. And these things are going to have failure and misses and tragedy, but it’s a good one.

  Drew Wandzilak:
  It’s a good one, and I’m glad you brought up the kind of moving west—to extend that analogy, this is building the railroad. This is like the first railroad, the promise of that compared to wagons, covered wagons moving west. I mean, just how much that will do. And space is—yeah, it’s not frivolous. This is a domain that’s already important. It’s how GPS works, it’s wireless communications, things that are crucial to our society that, if they went down, the effects would be massive. So it’s a domain that’s important, and the cheaper we can get there, the more reliably we can get there, it only opens up more billion-dollar markets for us to enter.

  Speaker 7:
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  Mike Collins:
  Okay, the third tech breakthrough of the week comes from the journal Cell Discovery, and this is some very preliminary good news on a cure for diabetes. We’ve talked on this show and elsewhere about what we think the power of the GLP-1 drugs has been—clearly a thing that now South Park has lampooned, which is fantastic, by the way. I urge everybody to watch that.
  Where I think it’s probably one of the untold technology platforms going on over the next five years is the medicines coming to obesity. But that’s related to pre-diabetic conditions and issues related to obesity and being overweight.
  At the end of the day, there are still people that don’t have a working blood sugar management system anymore. Their ability to produce insulin and react to the fluctuations there is gone. And it is a very tough condition—it leads to premature death, amputation. One does not wish anyone to be diabetic. And so what we saw is some cell therapy, frankly, happening in China. This was a 59-year-old man with type 2 diabetes, who received cell transplants in 2021, and the patient has now been insulin-free for 33 months. The procedure really recreated the insulin-producing cells in the pancreas.

  Drew Wandzilak:
  It was his own cells, right?

  Mike Collins:
  Yeah, I think it was his own cells. I think it was a stem cell-like therapy. Again, over my pay grade. And I think there’s always additional skepticism when it is not the United States, but this was a legitimate medical center; this is a peer-reviewed publication. It needs to be replicated. It was probably extremely expensive. But again, I think there is hope that this—in our lifetime—can be a curable disease. So, the combination of getting pre-diabetic people fixed, and then for the people that, for other reasons, become a type 2 diabetic, I think that this is, again, super promising. It affects millions and millions of people, and it is a huge personal cost and a societal cost, diabetes in the world. So it’s very early, but I think that for me, it would be such a big win that I had to mention it as one of my breakthroughs.

  Drew Wandzilak:
  This is a big win regardless of—I think if I study… you made the point, this is in China, so there’s some skepticism. And we have such an innovative and capitalistic culture here in the US that it’s like, if it wasn’t here, is this actually… we should be leading on this stuff. But I think it’s an interesting concept because we’ve talked about this before with—I think it was the superconducting material, right?

  Mike Collins:
  Yeah, yeah.

  Drew Wandzilak:
  That was supposed to be conductive at room temperature. It ended up not being real.

  Mike Collins:
  Replicable.

  Drew Wandzilak:
  Replicable. But it’s still a win. I think when we start talking about these things, it’s a win because it gets people talking about it, it gets more money flowing into these industries. People are jumping in, trying to disprove it, understanding the science—hey, does this work? Could this not work? If anything, it is creating more publicity, it is getting more people engaged, it is getting more dollars in the door to solve some of these huge issues. So, promising. I have no reason to not believe that it’s true, but even if it’s not, I think it’s a huge win when stuff like this gets the publicity it does.

  Mike Collins:
  I mean, that’s science, right? And that’s the process—the discovery, the skepticism, the peer review, the people trying to replicate it, people then trying to make it better. But once you start getting some of these scientific experiments, then as we’ve talked about before, when you move it from a science problem to an engineering problem, humans engineer the shit out of stuff. So, if there’s a scientific way to make it happen, then we can get really good at making it more accessible, more safe. We get really good at that stuff. And again, when we’re talking about something like 40 or 50 million people having to take insulin regularly—and I don’t know, there’s 100, 150 million people worldwide that are dealing with diabetes—that’s a lot of pain, suffering, and cost. So again, we’re tech optimists, so three good stories this week.

  Drew Wandzilak:
  Absolutely. Thanks, Mike.

  Mike Collins:
  All right, have a good one, Drew. Thanks.

  Drew Wandzilak:
  You too.

  Mike Collins:
  Bye.

  Sam:
  Thanks again for tuning into the Tech Optimist. If you enjoyed this episode, we’d really appreciate it if you’d give us a rating on whichever podcast app you’re using, and remember to subscribe to keep up with each episode. The Tech Optimist welcomes any questions, comments, or segment suggestions. So please email us at [email protected] with any of those, and be sure to visit our website at av.vc. As always, keep building.