This Week in Startups - E1022: One Drop CEO & Founder Jeff Dachis helps people with diabetes manage & improve their blood-sugar levels, shares insights on making data actionable, recent strategic partnership with Bayer, issues with US healthcare & potential life-expansion

Episode Date: January 28, 2020

0:47 Jason intros One Drop CEO Jeff Dachis 2:37 What was Jeff's original vision with One Drop? How has it evolved over time? 5:39 How did One Drop go from collecting data to making it actionable? 8:09 How important was getting the One Drop retail products into Apple stores? 9:46 Raising money as a hardware healthcare product 15:23 How did the Bayer partnership come about? 17:57 Have any major drug companies built software to manage what happens after taking medication? 21:19 What is the One Drop business today? How does coaching play into their product? 30:27 Who are One Drop's enterprise sales targets? Why don't more companies have health practitioners in-house? 36:37 Should employers be tied to healthcare? 40:04 What contributes most to the diabetes epidemic? 44:46 What are continuous glucose monitors? How do they help? 48:34 Why is insulin so expensive in the US compared to other countries? 51:47 Will we ever be able to know our blood sugar levels without intrusive hardware? 57:47 Will humans see average life-expansion into the 100's over the next few decades? 1:02:12 How gene-therapy becomes dangerous

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and Captera, the leading free online resource to find the best software solutions. Visit captera.com slash twist for free today to find the right tools to make 2020 the year for your business. Hey everybody, hey everybody. Welcome to another episode of this week in startups. Healthcare is the most brutal space to start a startup in right along with education and construction. If you're an entrepreneur and you decide you want to build houses or apartments, Or you decide you want to try to teach people something over the internet or with technology, or God forbid, you jump into the healthcare space.

You are in for a world of pain. Almost all the investments I make in the healthcare space, let alone music or construction or education, they go to zero. But we're starting to see some founders, the dogged ones, the self-possessed ones, who will not give up breakthrough. And when they do breakthrough, there is a huge prize because there are huge problems to be solved in the world in housing, in education, and in health care. Music actually, Spotify figured it out.

Before that, everybody went out of business. And this is why I encourage founders to find those hard, hard categories and to do the work. Today on the program, Jeff Dodgers is with us. He is the CEO and founder of One Drop and one of my oldest friends in the industry we met back in 94 and 95. Good to see you, my friend. You too, man. Thanks for having me on.

Well, you heard my preamble. You masochistic, insane person. Five or six years ago, you came to me and said, I have diabetes. I collapsed in an elevator. And you were on episode 547 back in June of 2015. And we talked about your vision for One Drop, which everybody can go visit right now at OneDrop. And I believe in the Apple Store. Yep.

So you can go visit in two places online and off. And you had a vision. for solving diabetes and helping people manage it. What was the original vision and how has it turned out since? It's a great question. And as you know, I was diagnosed in 2013 with type 1 diabetes, which is really strange for somebody my age. And I got about six minutes with a nurse practitioner and an insulin pen and a prescription

and a pat on the back. And I was out the door with this diagnosis. And I freaked out. You know, I went home and I cried. and I threw a pity party for a couple of days. And then I kind of pulled myself up by the bootstraps and thought, you know, I wonder if there's a way to bring together all the pieces of information that I need to make better choices and have all that in one place,

bring together a professional coach and do so in a way that is really user-friendly and can provide, you know, accessibility to people. And so we started out with this idea that if we started collecting all this data, that the data could provide insights to people. But we first had to solve the problem of getting the data. Right. So there's all. And the data in diabetes specifically is doing a blood test.

It's glucose information. It's food. It's medication. It's physical activity. It's sleep, stress. All of those things play a part. Yeah, a huge part. And yet in the diabetes industry, there's nobody that's bringing

all those things together to look at them in one way. They're all disparate silos of data. That's right. Your Fitbit or your watch tells you how many steps you did, maybe how many calories you're burned. You have a, what do they call it, a glucose meter. Glucose meter. That has one set of data.

That's right. Your diet, you have to self-report. That's right. And medication, I guess, you have to self-report as well. Yeah. And so once you have bits and pieces of those information, which we didn't, this was the hypothesis. You know, if I had all that information, could I make it useful to people in a way that could become preventative?

Like Elon Musk, right? Advanced collision avoidance systems on these cars, right? Right. Can we provide advanced collision avoidance systems for people with health problems, you know, where I'm telling you what's going to happen to you in advance of it happening so you can avoid the collision? Wow. And that was a hypothesis in 2015, but we had a lot of steps to go through to get to a place where we had, you know, the right. amount of information where we could start to do those kinds of predictions and now we do. And that first step was making an app where people, a beautiful, stunning, gorgeous app that

motivated people, the design was so beautiful I remember, that motivated people to log data. Correct. And at what point did the logging of data lead to enough data for you to start making inferences and give advice? And then what did you have to do in order to? to sort of get there. Because a lot of people, when they pitch me on an investment, say, oh, we're going to have the data.

We're going to give advice. Oh, we're going to get all this data. We're going to tell people what to do. And then they never get the data or they get the data and they never able to make it actionable. How do you go from collecting data to then making data actionable? The collecting data, I think, was the hard part, right? We way underestimated how hard it would be to get different players in the industry to allow us to partner with them to get the data.

or to get people to log stuff, right, or to enter the data. So we started looking for ways to make it simple, like Siri or Alexa commands, or integration through HealthKit, through thousands of other apps and devices that are out there, or by, in the end, you know, manufacturing our own glucose meter. Because we didn't want to get locked out of glucose information that, or be beholden to the healthcare industry's slow bureaucratic bullshit pace. Yeah. And those glucose meters were expensive and dumb when you got into the industry, or were they getting smarter?

Were they connected devices at all back in 2015? They were expensive and dumb and not connected. So there was, I think, not even one connected glucose meter at that time. And when you decide to build a company and you start with software and then you've got to go into hardware and you're in health care. You now have increased a degree of difficulty to a level that is just seemingly insurmountable. Hardware is super hard. How long the app you got done in six months, a year or something like that, I remember. And it got cranking.

But the hardware, that took a couple years, didn't it? It took two years. We were designing the hardware at the same time. We were building the app. And then you have to start to sort of imagine what FDA process would be like, what manufacturing. you know, prototyping, getting machines tooled, all that stuff. And so fortunately, I mean, I got to knock on wood,

we found a manufacturing partner to work with that was really great. Here in the United States or China, Taiwan? Here in the United States. Yes, with Chinese factories. Got it. And we worked out, you know, no one would talk to us originally. So I went to all the big, you know,

glucose meter manufacturers and no one would even have a conversation with us. They wouldn't even take the phone call. Really? And then, you know, we found a high-quality, super-accurate glucose-meter manufacturer that would work with us. And they've been a great partner since then. And then people started subscribing to it. And then eventually you got it in the Apple store, the Apple store, not the app store, but the actual physical Apple store. Was that a big unlock or was it a victory for, you know, just PR?

People are always curious about that. Yeah, I think our hardware product sold through retail. And so we're in Apple stores nationwide in the U.S. And then now in Walmart stores nationwide in the U.S. And you'll see us in a whole bunch of other retail stores. But getting into the Apple store was in a way like a vote of confidence for the consumerization of health care. As you started to see Apple bring health to the phone and health to the watch, right? And who knows what's going to happen with AirPods?

or some of the other Apple health efforts, their commitment to these consumer-friendly, you know, health products by putting us into the store, you know, we're in physical retail stores where there's very limited shelf space and there's very few products at the Apple store. That vote of confidence for us felt so validating in so many ways. You know, we're struggling all this time and trying to grind it out and finally get FDA approval and then finally start selling subscriptions. and then Apple, you know, selects us to be in the store.

And that was really a confidence-building, validating moment. I'm sure investors, we were early investors. I forgot to say that at the beginning, full disclosure. Thank you. Oh, thank you for having us come along for the ride. It's worked out pretty good so far. You, when you have to raise money and you go to investors and say it's health care and it's hardware, it's regulated,

how many investors are just like, you know what, and it's just too hard, I'm not down. A lot. I mean, you know, there's a certain type of investor that's willing to go on the ride with you. Yeah. And we're very fortunate to have some great investors, you know, on board.

RRE, you know, in New York has been amazing. Stu Elman, shout out to you, Stu, he's been fantastic. Yeah. And the whole RRR. Since the 90s. Yeah. I mean, outstanding.

Great investor. And then Bayer, you know, came in on the series B recently, you know, with a huge vote of confidence for us. So that was a, that was a, so having investors that are willing to either ride along with the journey, you know, you've been fabulous. Oh. You know, some of the other folks. And then have that validated by, you know, one of the largest healthcare companies in the world

has been humbling. All right. When we get back from this quick break, I want to know how this Bayer $40 million series B, or they let it, went down because there's a big controversy in Silicon Valley. Do you get involved with strategics? Do you not? I want to know how you came to that decision, how it happened, how you negotiated it and why they didn't choose to just buy you versus, say, investing and letting you remain an independent company when we get back on this weekend startup. I met an amazing company. I had coffee with the founder, and I was totally inspired. called Masterworks. And in 2018, you know VCs invested over $100 billion in startups. But did you know there is a $1.7 trillion T trillion dollar asset class that is uncorrelated to public equities and has outperformed the S&P and has no institutional investors allocating to it. That company and that category is art. The company is masterworks.io. It's the first company to allow any type of investors, whether retail or accredited.

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Okay. Let's get back to this amazing episode. All right, everybody, welcome back. Jeff Doshis is here. One of my oldest friend, the founder of Razor Fish in the 90s when I met him and was the first advertiser to my first, my, on my second magazine, Silicon Air Reporter,

Sabersurf, it was the first. Thanks for doing that. Took me a couple decades to come back and pay you back and invest in your company. But boy,

is that one of the great joys in life is a friendship that goes on for decades? 100%. Get to support each other. And it's funny, you know, I have all of our old emails. Like,

I literally have all the emails since 1994. Oh, my Lord. And so, I'll pull up some of the emails. That'd be hysterical. That's hysterical. That's hysterical.

It's so funny. I got to see that. those. You don't want to see him. You don't want to see them. I'm a crazy person. You and I arguing. I'm a crazy person.

Oh, you and I arguing over something. Something. Yes, probably because I was, not only were you an advertiser, but I was covering your company. And then, you know, obviously when you're a journalist and you cover something, you don't get everything right or, you know, the truth can be interpreted and you get something wrong and it can be a little back and forth. And, you know, it was new at that time, so you have a long back and forth.

Trust me, there's a lot of those emails out there. I was a crazy person, too, too, back in my eyes. We were crazy people in our 20s and 30s, but boy, what a run New York was, huh? Everything. Oh, God. New York in the 90s. I'm grateful for every minute of my careers and my life so far. It's been just all a blessing.

People just don't understand how awesome that period of the 90s was. 90s in New York when the Internet hit, it was like art, culture, tech, everything, business, fashion, everything, yeah. Advertising, marketing, and all just came together and everybody felt so hopeful. It was really hopeful. It was really hopeful. I felt like, well, we can solve a lot of problems and everybody's going to win. Yep.

Yeah. It's funny, you know, our office now today is on 166 Mercer Street. And it's my, it's a full sort of floor. And on the Mercer Street side, but on the Broadway side, it looks out directly on into our old office, our first Razorfish office. Was that Bond Street? No, no. The first Razorfish office was 580 Broadway. Oh, right, right, right, right.

And we look, I look right into there, you know. And so it's really. energy like it's a good energy in soho it's uh it always yeah yeah yeah it's amazing so you you how did this bear thing go down and how does one make the decision you know to have a strategic in there um and why didn't they just buy it because they have tons of money and usually when they see something as innovative as one drop they just decide hey let's just you know let's just buy it was that you just didn't want to sell yet or um they wanted you to be independent how did you find them How did the decision go down?

Take the audience through that because they're founders who can't imagine in a lot of cases how one would ever negotiate with the company as big as Bayer. So let's see. First, there's a personal relationship. The CEO of Bayer Pharmaceutical used to be the CEO of Sanofi, the French pharmaceutical company Diabetes, Sanofi Diabetes Unit. And so I'd been doing work with Sanofi for several years. now and their teams and everything. And so that CEO and I developed a personal relationship. That's simple.

And so he ended up, he was at Bayer, he went to Sanofi, and then he went back to Bayer as the CEO of Bayer Pharmaceutical. And so when he shifted roles, I started talking to him about what we could do together. And he, you know, to me, and we kept our kind of energy and our rapport going. and that's really was the sort of the seed and the germination of how we started to, you know, get there with the Series B. And then as they were working through their strategy about what do we want to do in digital, do we want to be doing digital therapeutics as point solutions inside each, as a companion to every drug that we have, or do we want to have a broader digital platform that can focus on health and well. you know, for people or what, whatever. They're working through their strategy. And then I just said, hey, you know, I think we can fill a very big chunk of your strategic whole if we can

work together. And so that's really was how the deal sort of germinated. It was a series B investment and then there was a huge commercial licensing deal that they did with us. Got it. There's a big gap between making a drug and making a service that complements the compliance, the compliance, the other data, the behavioral data around it. Have any of the drug companies started building apps and stuff like that to manage what the drug, what happens after you take the drug? Is that even exist? Or is it just up to doctors and nurses and health care providers to like give you a sheet of paper and say, hey, follow this protocol? Because compliance with an app and compliance with email or SMS, it works so well. And full service works so well. If you,

you just think about getting an Uber or a postmates or Amazon delivery, you're getting updated all the time. But we update a taxi ride and an Amazon delivery to the point of absurdity. And when you take a drug, a powerful drug to handle an important disease and an important life effort, there's nothing surrounding it. There's nothing. No technology. No compliance. No SMS. But if you're packaged derived and it's in the depot.

You know it every step of the way. You know where it is, right? You know exactly where your driver is with that Chinese food, right? Exactly. Yeah. And you get to rate the wontons versus the Mughal Guy Pan. That's right. They want to know.

And the pharmaceutical companies, not that you take a pharmaceutical and you're like, they don't want any feedback. They get no feedback. So, you know, that's in a way what we did, you know, sort of realized was so fucked up about health care. Yeah. Was you've got a system that is extracting an enormous. amount of rent from society.

Right. Right. But it's only accountable for delivering the service, not for what the, not the outcome of the individual that's receiving the service. Right. There's no happiness. There's no, there's no satisfaction associated with, or care about satisfaction. As long as they get paid.

No, nothing, right. There's nothing. So that's where kind of a company like One Drop and many others, there's a lot of other great companies out there that are, that are really making some headway in the digital space for, for healthcare, but, but this healthcare system and then doctors prescribing and reimbursement and insurance and that's, you know, we're here at JPMorgan health tech event. Here in San Francisco's going on this way. Right now. Massive event. Everybody's here for this thing. And all they really are worried about is, is extracting rent from this system. Right. What we're about at One Drop is so

rooted in a level of sort of humility and respect and gratitude for the people, that we're touching, the users. Yeah. Yeah, I have diabetes, right? And so I know what that person's feeling. You know, some of our staff has heart disease or hypertension or hyperlipidemia or dealing with a whole suite of other health issues. And so we're coming at this from such a profound, you know, level of empathy and humility.

And we bake that into every touch point that we have for that individual. and in the end, when we help that individual, we're going to find out how to get paid for that. Right. If we focus on that user, if we focus on making that user healthy, giving that user data and insights to make better choices, giving that user the opportunity to live their life,

to dance at their granddaughter's wedding, to engage in all the blessings that we're offered in life today. When you give somebody that, you know, there's a business. That's the business. The business will be there. And here, for those people watching,

see the stunningly gorgeous kit, beautiful leather case, amazing industrial design, looks as if Apple built it themselves. And I guess the business model today is simply a subscription. You buy the hardware, you get a subscription to the strips and the software. Is that the business today? The business today is twofold. Direct to consumer via retail stores. So you just buy the hardware in the store.

And then if you want the supplies, you can either buy the supplies from us, subscribe, buy them one-offs. Sometimes you can buy them in specific stores. That's hardware and physical retail. You can also subscribe to OneDrop either via our app or on our website. What is that? 10 bucks a month? 20 bucks a month?

It depends on the subscription, but 25 bucks a month at the low end, 50 and change on the high end. And that gives you a variety of different sort of service sets. You get the strips, you get the meter, and you get coaching. Explain the coaching because that's something. that when we talk about full service and the 360-degree customer experience, something that you started to pioneer at Razor Fish, in fact, is thinking about that whole life of the customer doesn't exist. Or if it does exist, it's just some receptionist calling you reading a script. Tell me about compliance and the, just the efficacy, actually, even about compliance,

the efficacy of a chat coach, because this is occurring in chat. It's a chat coach, yeah. the efficacy of chat versus the phone call versus the doctor visit. So there's a couple different reasons why we went with chat versus in-person video conference versus phone call versus a variety of things. One, we can deploy coaches in a scalable way if the communication is asynchronous. Right. So if it's synchronous, if you have to make a phone call, then I need a time slot. Right. And the number of time slots are limited in the day. And so then you're limited to basically a coaching utilization problem, right? And they're sequential. That's right. There's no concurrency. Exactly. In an asynchronous communication environment and especially in an environment where we can send, let's say, group messages. And I use that term loosely because I'm not, I'm not thinking group chat. I'm saying, let's say somebody has a high blood sugar reading of over 300. And I can search my.

entire patient base, I'm, let's say, managing 2,000, 4,000, you know, users as a coach. I can search all of them for users that have had blood sugars over 300 in the last 24 hours, right? Wow. And then I can send a message to them saying, hey, it seems like you've had a high blood sugar in the last 24 hours. Do you want to talk about what went into that? So it's a one-to-one message but sent to a sort of that data set. Triaging the data set for problems, right? And I can reach a lot of people in a very efficient way utilizing the coach's time and asynchronous with the sort of software that we built to support that.

And so then I get a lot of mileage out of coaching utilization. Right. Whereas a doctor phone call, a doctor video conference, any type of direct coach experience is just a sequential time utilization problem. And it can't scale. It can't scale. And people give up. It can't scale. They wake up and imagine you woke up in the morning.

and you got handed a piece of paper that said, here's 13 people who had over 300. You'd be like, okay, well, there's my day. Done. Yeah, 13. That's it. I'm done. That's it. Whereas the same person can say, okay, send this message to all 13.

We want to know if there's anything that occurred, if they're aware of the fact that they're at 300. Yep. And here are five things to do. And those five things are obviously going to be standard. Or somewhat standardized. Or someone said they could edit them right down to three. Or text me back and let me know if you want to engage a little. further, right? So then some of my day can be spent in that kind of one-on-one, you know, real-time

chat. But a lot of the day can be spent triaging problems in an asynchronous way, and it's really scalable. Two, the other thing about coaching is it's super effective. So when you have somebody that you're accountable to, so accountability is an issue, whether it's a social accountability to a group or accountability to an individual, you end up driving behavior change, which is crucial in all of this. Our coaching services, as part of the one-drop service, in over 20 clinical studies now have proven to drive outstanding reductions in A1C, which is the value that a person with diabetes is thinking about, at least, outstanding results in terms of health efficacy.

Just not wanting to disappoint another human is a critical part. Totally. And this has come, I see this now with young millennials. They have accountability groups. I don't know if you've seen this trend before We didn't we didn't have it in the Gen X generation Or boomers The snowflakes have it

The snowflakes have it And they're also unique In each and everyone Each and everyone is unique As I tell them They're all unique snowflakes And there's no one like them That's right

None of the other billion snowflakes That fall every hour Are like them They're unique But they all melt when they hit the ground So they'll melt eventually Sorry snowfall We all melt eventually.

We all melt eventually. That's the big realization. But they, you know, it seems really wise because if you're going to be meeting with your group on Friday nights to talk about what happening your startup this week, hey, you may want to put the gas on the pedal on Wednesday and Thursday and cram a little bit and get that last dev push or get that last sell and be able to not disappoint your friends. And we get back from this quick break. I want to know about the trend of. glucose obsession, continuous glucose meters that my friends who don't have diabetes but are obsessed with quantified self are getting their doctors to prescribe to them. And is that a good idea?

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Welcome back. Jeff Dachis is with us. You can follow them on the Twitter. Jeff, Dachist. He's a CEO and founder of One Drop. You can visit them at One Drop. Today. If you have diabetes or a loved one who has diabetes, go ahead and buy it for them. It's the perfect gift. If you miss them at Christmas or they deserve another gift or you just want to be a mensch, go buy a one drop and send it to them. You can see Jeff's first appearance on the pod from back in June 2015 and compare it to today's episode at episode 547. Thanks to our sponsors for supporting the pod. When we left our hero, that's you, Jeff, we were talking about continuous glucose monitors, Kevin Rose, Tim Ferriss, all these cats have been talking about. I'm not sure who has them. I know Kevin had one. I know Kevin had one. At one point, I believe I was watching his podcast or listening to it.

What is the future of those devices? Why do you have to get a prescription to get one? And are they painful to wear? Because it's a needle that's permanently in your belly. Do you wear one? And what's it like? Well, so let's talk about continuous glucose monitors. I want to just circle back right just to a question that you asked me before really quick.

Yeah. You know, we talked about, you know, what's the business model? or what, and we're in retail, we're selling subscriptions, you know, to the consumer. We have a B-to-B business, a huge B-B business where we're selling to self-insured employers too. Self-insured employers means what for people who don't know that term? So most employers today of any scale basically are self-insured. They pay for all the medical claims for all their employees. So instead of getting an insurance company, they put a billion dollars on the side or a hundred million.

And they just pay out all the hospital claims and everything like that. They just pay them all out? Yep, they pay everything. So they have no insurance company. They have an insurance company to administrate that, but not to provide insurance. Wow. So they just become the admins. Correct.

How come, since we're going to go down on this tangent here. No, it's good. How come, this is where we're going down this path, how come they don't just hire a bunch of general practitioners and start their own hospital and have it on their campus? I know that some people have to. They do? Well, like, I'm not a hospital, but like Apple has health services on campus, right? Really? Yeah.

I didn't know that. So if you need to see a general practitioner because you have a cold and you want to get a Z-pack or something? That's right. Right on campus. Really? A lot of companies have that. Yeah. In-house clinics.

Yep. And so those doctors work for some third party who placed them there or they actually work for Apple? Depends. So most of the time there is a third-party contracted service to provide that sort of in-house medical care. And you've got to break this down. You know, all health care is not the same. You've got acute care, right, where I need a brain surgery. Right.

Right. Or a broken limb. Yep, that's like that's emergency room. I got to, that's right now. I'm not waiting until Monday morning. That's right. It's not something I can think about. You've got primary care, which is your, you know, throat and your nose and throat,

my regular checkups and all the normal stuff, right? You've got your chronic care, which is these chronic conditions that we, um, uh, you know, have to deal with regardless of what kind of insurance have, regardless of the doctor. Asthma, diabetes, heart disease. Yeah. And then you've got urgent care, which is that sort of like, right now, I need to go to the emergency room or I'm going to go to the minute clinic at Walgreens or whatever, right? And so of those kinds of care, primary care and urgent care a lot of times is on campus, you know, in some of these companies. But most big companies are self-insuring. They're just paying out the claim. So they have a best thing.

interest in keeping people healthy. So now you actually have a customer who's paying the bill who cares about lowering the bills. It cares about lowering the cost because no one else does. No, I mean, this is the craziness about America's horrific health care. It's an embarrassment because they don't publish their prices. You don't know what you're paying. They've obscurified the payment process from the individuals. The individual has no idea what the company's paying to the insurance company, who's getting billed, and then the insurance company then becomes the customer? It doesn't make any sense to me.

And they don't even have on their website the price. And from what I understand, they're starting to do legislation around publishing prices. And they're afraid. And they are scared to death because it turns out knee surgery has a range of like $15,000 to $300,000, a 20x range to just get your knee scoped for your meniscus being torn. That's bonkers. Crazy. It's bonkers. And, you know, just to add fuel to the fire, you know, insurance companies are obligated to spend 80% of the premiums they collect on services.

And they're only allowed to keep 20% for admin and profit, right? So that's been capped. The 80-20 rule, right? Right. So then how does an insurer increase their profits? Yeah. You increase the cost of care. Just think about the alignment.

You just let the cost of care increase, right? The alignment is crazy. Why don't they make it based upon how happy the customer is and the NPS score or wait times or how long people live or their BMI or something? Yep. So insurers then buy providers, right? So United Health Care, as an example, as an insurer, has a whole set of providers, right? So they're making money on that. They're making money on the provider side, and then they're making money on the insurance premium side.

Oh, my Lord. They allow for the cost of care to increase because then they're 20% that's left over. Yeah, they're double dipping. It's a bigger pie. Oh. Yeah. Talk about it. A crazy space.

A perverse incentive system. That's right. So some employers have taken that into them their own hands and said, we're going to own the cost of care, but we're going to then work like dogs to keep our people healthy. And so we're selling our services now in diabetes, pre-diabetes, weight loss, hypertension, and high cholesterol programs with. with coaches, with measuring of a scale or a blood pressure cuff or a glucose meter, we're selling all of that into an employer who wants to keep those people healthy for those chronic conditions. So if they pay you $500 a year or $1,000 a year and that person's BMI goes from the 30s down into the 20s where it belongs, that could save them what?

Tens of thousands per year. Yep. Think about that. Yep. And they should be passing along some incentive through their employees. Like imagine if, and I know this is super controversial, but in my world, if, you know, employees at a 35 BMI and they're, you know, seriously obese and they, for every BMI, they lose, you know, point of BMI, they should get some reward, you know, like a day off or a thousand dollars or something. I mean, or if you're, if you maintain a BMI under 26 or something plus other stuff, whatever, you know, because I know it's not, you know, in isolation, it's not the only thing that matters, but it's super important. Whether it's BMI or whether it's A1C for diabetes or whether it's lowering your blood pressure or what that translates into, productivity gains for the for the. Oh, right. You're a better worker. Yeah. You're just a better worker. You know, I keep on the job, right? I'm you're out less. I don't have to retrain somebody. I don't have to bring in a new employee. And you don't have $10,000 in. In medical expenses that I'm picking up the cost of. Correct. Yep.

Should this all be connected to employers? Should employers have to be involved in your health care? This seems to me to be like one of the big, I don't know, flaws in our system. So it's a weird thing, right? So it started off a long time ago where, you know, the employer decided to provide, in essence, a tax-free benefit to lure workers. Right. Right? I'm running all these factories.

and the one way that I can keep people at my factory working is to provide them with this extra benefit that they were having to come out of pocket for before because there wasn't really insurance. And then it became a standard. And it was tax-free, right? So because, you know, the employer's picking up this, in essence, cash incentive to you pre-tax.

Right. And so this sort of pre-taxed employee benefit grew out of a desire to retain employees. I think I want to say in the teens or 20s in the last century. Yeah, it's crazy because now it's created so many perverse. You talk about incentives. I can't tell you how many people I've seen at startups, my own and ones that I've invested in, where they have some amazing employee who can't come work there because there's some crazy insurance issue.

Or they have some employee who they have to get rid of. And the CEO is devastated because they know. the impact that they have a family insurance or they have a family or they have some chronic disease or something acute and they're just like oh my god i i can't let this person go because of their insurance i feel terrible what do we do and then you're in a board meeting talking about you know cobra or how long can we extend this and it just seems to me and you know listen i'm as capitalist as they come that this is some sort of a a basic human right it would be an incredible unlock if companies didn't have to deal with this and people could freely move between

companies without this fear. Of losing insurance. I agree. Of losing insurance. And you're a capitalist too. You're not a socialist. No. But what I do believe is that consumerized,

you know, accessible, affordable care is coming, you know, via the technology you and I all believe in. And when that all comes, then we'll be able to pay a much lower fee. It's going to take out some of this margin and perverse incentives. And so the cost you just naturally come to. down because of the competition of the private markets and people like you creating and solving very acute problems like this or being really focused on it? Yeah.

I think you're going to see consumerized health care become a much bigger part of reality. You're in calm, right? Yeah. Right? And it's helping a lot of people, right? Yeah. I mean, if you just think about mental health, I mean, I hate to be like supporting Tom Cruise's insane rant.

But he's not wrong that talking to people and working out and eating well, directly correlates with a reduction in anxiety and depression. Like, this is known. The first thing a doctor will tell you is like, if you're depressed, it's like, go for a hike with your friends and talk to them and have a healthy meal and tell me how you feel after those three hours. And you know, you don't have to jump up and down on a couch to know that's true. And, you know, calm has just been amazing for people.

They can't sleep. I mean, and how much of all these diseases are just based upon, you know, the amount of bounty we have in the world right now. You think about most people with diabetes. It's because they're eating too much, correct? It's genetic, just to say, like, 100% genetic for every single person. And then what triggers it can be, you know, an excess, you know, gaining weight or other. The epidemic is in some way correlated with this modern diet of...

I think we're all consuming, like, way too many carbs. Way too many. So we're inundated with carbs, right? So then, and this is going to touch on your question earlier about Kevin Rose, et cetera. but we're eating all these carbs and they're in every single thing we have. They're in our bread. They're in our ketchup. They're in our every single thing that we have in society today and processed food, any kind of processed or modern commercial food has excess carbs in it, right? So now your body's consuming all these carbs. Guess what happens? Your pancreas produces insulin to allow for your body to either absorb those carbs or, you know, those carbs turn into fat. And what happens is with too much excess carbs and an overtaxing of your pancreas and insulin production, you end up building up this resistance, you know, and insulin resistance is type 2 diabetes. It's amazing. Like, just think about what we've done to ourselves.

We wrapped every protein and vegetable in flour and sugar. Yeah. It's just like, wow, these things are perfect. How can we make them to go? That's right. And this book, Wheat Belly and Why We're Fat, I read those two books, and it really, I dramatically reduced my carbs. And it's just like, if you think about the modern American diet,

We wanted to take stuff on the go. So they're just like, yeah, here's a hot dog in a bun. Here's a hamburger. And that's progress. And that was progress at the time. It was like, yeah, listen, you can get to work. I got to go to work. Here's an egg sandwich, right?

And here's pizza. And they just wrap everything. And then that corn syrup adding the sugar to it and adding sugar to things that are unnecessary. It's killing us. It's literally killing us. When we get back from this quick break, we're going to get back to that question, the cliffhanger about the continuous glucose monitors. And then I want to know if there is.

a chance in the next 10, 20 or 30 years that we will be able to cure diabetes when we get back on this weekend startups. It is 2020 and you need to start fresh and start thinking about all of those challenges you have in your business inside of your startup, inside of your venture firm, or maybe you're an angel investor. And the way to solve your problems is to have the right software. And there are so much amazing software coming out. How can you quickly find the best one and not make a costly mistake or overpay, which is another mistake. Well, there is a way to do that, and it's CAPTERRA. You know CAPTERRA.

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We're talking about diabetes, one drop, as well as just the overall health care picture, how hard it is to do startups in here. You're in year six. You got what, 60 million into this company raised so far, total? 58, yeah. Yeah. And it's been hard. It's been hard.

But boy, is it rewarding. It's immensely rewarding. I wake up every day, leaping out of bed, excited to help all the people that we get to help. Amazing. We talked about those glucose models with continuous ones. Have you worn one before? I have, yeah. What's it like to have a needle stuck in you all day long, and how long can you keep those in?

Does it get infected? And is there going to be a better solution to knowing our glucose and insulin? Is it knowing your insulin level or your glucose level? Glucose level. What is the impact of knowing your glucose level on behavior? So a whole bunch of different things. You know, one, you know, when we eat carbohydrates, our pancreas produces insulin to allow us to absorb those carbohydrates into our body. Yep.

If we don't produce insulin, like me, I don't produce insulin, the carbohydrates, the sugar will just stay in my blood, inside my blood, right? And it'll be circulating. And it acts like sort of like glass shards. Think about really high. And those glass shards circulating through my whole body, start to eat away my capillaries and my eyes and my heart valves and my fingers. Wow. Over years, you imagine this sort of like glass circulating in your body, shredding the insides of your body, right?

That's kind of what it does, right? I never understood that. So if your body either is resistant to the insulin you're producing or doesn't produce it like mine, you either need to take insulin, right? Or take more insulin because the body, because your body's resistant to the insulin, you know, it's already producing. So type two diabetes is insulin resistance. Type one diabetes is I don't produce any insulin.

And so we got to get that sugar out of our bodies, right? or turned into energy or something, right? Right. So you can either start walking up flights of stairs. That burns the sugar. Yep. Absolutely. Yeah.

Which is difficult if you eat a cinnabund. Or you have two slices of pizza. I mean, what does it go up to? What is the, what do you call the number? Is it? No, that's just blood sugar level. Yeah. So what is that when you say 300, is that the equivalent of eating a cinnabund or something insane?

For me, like a cinnamon bun would take me up to like 500. Really? Like one of those big cinnibuns with the frosting on or whatever. I would smell those. four gates away. They're so good. What are they doing? They're so good.

I don't know, man. What in their right mind decides that a cinnamon bun, which was a delicate little three-bite experience, needs to be the size of a goddamn 45 record. That's right. For kids, that would be like a small frisbee or a small like an appetizer plate. But literally, they made one that those things are 1,500 calories or something insane. Oh, it's one more. It's got to be like 3,000 calories.

Okay. Or whatever. For the big one. For the big one. It's bonkers. Yes. And I see people eating these, and I'm just thinking, what are you doing to your body? Like, they're so good, though.

They're incredible. They smell so good. It's like, oh, it's calling me. Like, it's like a zombie apocalypse. So you can't possibly burn that off. I mean, it'll take you like all day, right? Take all days. Yeah.

Hours. Yeah. Yeah. So you just have to take a shot of insulin. So then I just take insulin, exactly. And I have to take a big dose. Now, insulin's like a really blunt instrument. So then you take this big dose of insulin and you might get it right.

You might not get it right. And most people don't get it right, you know? Is there a certain feeling that comes when you shoot the insulin? Does it feel good to get the sugar out of the system or you don't feel it? Do you feel tired? If you're high with blood sugar, if you have super high blood sugars, different people react in different ways. So I, you know, I'll speak for myself only. But I get really sluggish.

I get really tired. I get cranky and irritable. So it's not pleasant. It's not pleasant. And shooting yourself with a needle is not pleasant by default. You know, I don't mind that. Some people are afraid of the needles. None of the needles really bother me.

But if you overdose on insulin, which most people who take insulin do, most people who take insulin are overdosing on insulin frequently. Then you have low blood sugar. And that is a scary thing because you can go into a coma and die with low blood sugar. Oh, my Lord. Yeah. And so you get diabetic ketoacidosis on the high side if you're too high for too long and you have death and coma on the low side if you overdose on insulin. And most people don't ever get it right. and the insulin you take in America is absurdly expensive.

Oh my God. Don't get me started on insulin pricing. It's a whole, like, ridiculous thing. But in Canada, it's essentially like almost free, right? It's like super cheap compared to here. Most other countries have a cap on insulin pricing. Right. But here in America, they just price gouge you like crazy.

Yeah, I mean, yes. Can you have diabetes and never have to take insulin because you manage it so well? Like if you just ate vegetables and proteins? So a type two, a person with type two diabetes can in effect manage and potentially even reverse their diabetes through diet and exercise. But they never do. Most don't, but it's possible. A guy, there's a guy here who in a value here, Sammy, who started a company called Verta Health. And Verta, you know, they have a clinic, a virtual clinic that they deliver in 50 states that,

prescribes a low-carb, no-carb diet, a ketogenic diet. Right. And they try to keep people on ketogenic, and they try to reverse people's diabetes. Wow. And good for them. I can't see a trucking company have all of its truckers go keto and reverse all the diabetes. Like that's not a solution that I think is scale. Do the fake sugars trigger it?

Like if you're at? Somewhat, yes and no. Yes. I mean, it doesn't trigger it the way sugar triggers it or carbs trigger it. But there are some studies that link to diet soda and link to some of these artificial sweeteners that do some weird stuff. So these continuous glucose monitors, are they going to go mainstream? Do you see a time when they become over the counter and people are just, you know, who are obese or who are optimizing their health, just start to know their sugar levels in order to be fit in order to have better focus? Yep.

Because it's going like crazy here. I mean, a lot of people have them here, and a lot, not a lot, but a number of people have. It's a lot, yeah. So, well, let me, let me put it in perspective for you. 500 million people worldwide with diabetes. Yeah. Okay. 30 million Americans with diabetes.

Okay. The total market worldwide for continuous glucose monitors, all in the number of people that are on that product right now worldwide is about 2 million. Oh, wow. So. It's expensive and painful. Super expensive. The needle's about a half inch long.

It's like a harpoon that goes into you. And then the wound that it makes starts to fill with interstitial fluid and fluids. And then the sensor that's on that harpoon in essence starts to interact with the interstitial fluid as the wound heals around it. And that's what you're measuring the blood in the blood glucose in that fluid. Yeah. So it's gruesome. It's not that gruesome. If you move around, do you feel it?

No, no, no, no. I mean, I have to say they do a good job. The two major players are Dexcom and Abbott. Abbott has a product called Freestyle Libre. Dexcom has the G6 right now. And then Medtronic has a product, but it's not really in the mix. Will that ever become possible to know this sugar level in your blood without something so intrusive? Yes.

When do we think people, will start to be able to do that. Will you ever be able to look at your Apple Watch and know? So I don't know if it's going to come right from the Apple Watch per se, but I do think that sort of biometric sensing, multi-sensorial products, multi-analytes that can measure multiple things. I definitely think that's on the horizon. And I do think that there's a painless, minimally invasive products that are going to be on the horizon. And I think you're going to start to see people. Five years, 10 years? Within that time frame. Yeah. Yeah. Amazing. When we left, I was curious, you know, the people who I knew 10 years ago, you know, just studying the genome and, you know, who were in the CRISPR space, etc., they said they couldn't ever have guessed we would have been where we are now 10 years ago.

These are people in that industry. They just can't believe how far things have gotten. And fast. And how fast this is all moving and how cheap it is to sequence a genome and to do custom medicine. And is there a possibility in 20, 30, 40 years that something like diabetes could be eradicated somehow? And is that a conversation? Is there research going on about that? Or do, you know, like Alzheimer's and some other things, do people think that's just like one of the last things that will fall?

One of the last things we'll be able to reverse and or, let's say, cure. So, you know, this is just me. Yeah, your personal opinion. Whatever, my personal opinion. On the one end of the spectrum, you've got the genome, right? And so since diabetes is inherently genetic, I have hope that there will be the possibility that we can do something genetically to keep people from getting insulin resistance or from, you know, having type 1 diabetes where their pancreas is attacked by their immune system. Those two things, you know, potentially could be be eradicated. Managed down.

Well, cured. Yeah. Cured that way. Now, on the flip side of it, you've got a diabetes industry that generates, you know, on the order of, it costs, in the U.S., about $312 billion annually. For those 30,000, 30 million people. 30 million people, yeah. $312 billion annually is the cost of diabetes in America today. So about 10,000 a person, 1,000 a month per person, something in that range.

Yeah. So when you add up all the money that's getting extracted. from the system. Right. Right. Those interests, the people that have interest in that money, right. Are going to fight like hell to maintain it.

Maintain. Right. The solution's not coming from them. Right. And that's, I don't think the solution's going to come from them. Yeah. No. They would, yeah.

They're not going to, you're not going to find the cure for getting off of nicotine and tobacco from a tobacco company. A tobacco company any time. But let me say, like one, I have an immense amount of respect for the drug companies and the people in the pharma and health care industries that do their best to try to help people with diabetes and with other chronic conditions. So let me give like all the props and all the respect and all the gratitude for, you know, everybody who's in this business trying. They're trying. They're trying to make a difference in people's lives. Have they come up with drugs that would

increase the insulin in your system orally? Is that possible instead of taking the shot? Is there like a precursor? Because I know. there's metformin. Metformin is a precursor. Right, because people now, these keto people are taking metformin to, I guess, lower their glucose level? Yep. And then have a lower reading and therefore stay in ketosis. So they take metformin.

Which is an interesting twist on that drug. That class of drugs is an SGLT2. And it's really the first line of defense for people with diabetes. That's the first drug you get put on is metformin or some, some, some, you know. form of that. There's another class of drugs, which is really interesting, called the GLP1 class. And GLP1s, you might, you might know the, some people know the names of Saxenda or Victosa. Sexenda is like a double dose. Victosa is a single dose. Usually used to treat type obesity, which is sort of pre, and that's a precursor to diabetes in some ways, right?

because it acts in a bunch of different ways, but one of them is constricting the digestive process so that you feel full most of the time. Two, it does some other cool things. But the GLP ones and the SGLT2s, I think, are really interesting classes and revolutionary drugs that may in effect, you know, be a huge, huge driver in helping people not advance as fast into diabetes.

I was listening either to Tim Ferriss or Kevin Rose's podcast or might have been another one, but I think it was one of their two. And they were talking to somebody who's a life extension guy and he takes metformin. And he says he thinks that every human being is going to be on metformin because of the fact that it's going to let your body rest more and you're going to have less degeneration of cells, I guess. It does some cool stuff. It has cardiovascular benefit.

People in the anti-aging crew absolutely believe in metformin. And then I think, again, this other class of drugs, that's the GLP-1s. There's now, just recently in the last, call it six, less than six months, Rabelsus is an oral version of what had been an injectable GLP1. And rabelsus, I think, is going to be a revolutionary product. So whether you have the way you feel about metformin, you know, rebalysis, I think it's going to be a blockbuster. Yep.

It's made by a company called Novanortus. And you'd think we're going to extend lifespan significantly, like, beyond the one or two years we do every 10 years. But, like, do you think there's going to be a step function where we get to 120, 130 years old, like, where averages go up? And is that going to be our generation or our kids? I keep talking to my son. I'm like, hey, man, you better figure out this aging thing because, like, I plan to stick

around for a while. Yeah. I think we might get the tail end of it. The very tail end, exactly. That would be so cool if, like, we were, like, 80 and skiing. You know, or 90-ish-skinned. Well, I mean, I'm going to skiing with you when we're 80. That would be amazing.

Like, just think about this. There were people who, you know, like our parents and, you know, they buried their parents, what, 50, 55, 60, which is the age you and I are coming up on now. You know, I'm 49 now. Did you hit 50 yet? 53. You're 53. Like, we're at the, it feels like peak age of our life.

And everybody else was winding down and dying of breast cancer, lung cancer, calling cancer. And now that got pushed us out to the 70s, exactly. Now we're getting out to our 70s, 80s, but for some reason, people are just healthier, too. Their bodies are not breaking down and people are skiing in their 70s. Yeah. Can you imagine a bunch of people skiing in their 80s and 90s? Like, this would be a magical thing.

I mean, I want to just say, like, I just spent, you know, part of the Christmas holiday with my mom who's 95. Wow. You know, and she was so in Mexico. And she was amazing, you know, and going to the. the ocean and like like if I if I can only be as lucky as as she is and I hopefully got a bunch more years on her too you know so that's amazing when you think about my my Irish grandparents lived I think 96 and 91 that's amazing and that is that's interesting yeah so it seems like you got a bunch of miles left in the tank I got some good genes in there I think this calorie

restricting thing which I've been I did a 86 days in a row of 13 hours or more a fasting average We did. I averaged 16 and a half hours over the first 86 days. I did fasting this past 86 days. I lost like, you know, whatever, eight, nine pounds. But I wasn't doing it really to lose weight. I was trying to see of this fasting thing and resting your body, the impact it would have on me. And it had a profound impact, I think, on my focus level, my energy level during the day, a lot more focused.

My sleep got better. I felt I was sleeping better. And I didn't feel, also you recapture a lot of time. You take out a meal. Like, all of a sudden you recapture an hour and a half. Yeah. And so you're spending four or five a dollar a day. You capture an hour and a half a day.

If you're working for, you know, 10 hours a day, you're getting 15% more work done. It's pretty great. So I recaptured that time, was able to redeploy it and other things. But I also felt like for the first time in my life, I was in control of my consumption of food. I could never control what I eat in the moment, like when there's a plate of food in front of me. But for some reason, skipping a meal seems super easy. It's like, yeah, I just skip a meal and I'll go work and we'll go ahead. hang out my kids and good.

And so I just think that's, do people with diabetes fast? Is that part of the protocol? The same stuff that you're seeing from these quantified selfers, right? Whether it's CGM or whether it's metformin or whether it's, you know, intermittent fasting, all this kind of biohacking is happening right now, right? And I think, you know, not everything is going to deliver the results, whether if I put butter in my coffee or whatever, like, I'm not certain that that's like. Yeah, that's a weird one.

I don't, okay. But like, so that's one of them that might not be a thing. But it sure does taste good. I have to say I love the buttercol. Yeah, you like it? I did the MCT oil. Yep. And let me just say, MCT oil, if you take too much, you're not leaving the bathroom.

I didn't want to say it. I don't mean to get graphing on this podcast. But God damn you, Tim Ferriss and that MCT oil, because I did that one time. And I did a very small amount. And I couldn't, I mean, it was brutal. And I think that that thing is just like for some people, it just has. for me, it's like when they, yeah, give you that drug to flush you out, whatever that is.

Yeah, for the colonoscopy. For the colonoscopy, they give you some drug that's supposed to be hilarious because, you know, you just basically are tied to the toilet for 24 hours. That's what happened to me on MCT. Well, I do not recommend people. Don't add it to the butter coffee. But I think all that stuff's like there's a lot. You know, we're going to crack the coat on some of this, right?

It feels like, yeah, we're getting really close. And there's something about the genome, you know, watching this crisper. stuff and like I don't know if you saw the twins born you know this guy in china oh my god yeah it was crazy he should not have done this obviously he went to grant all ethics and morality but he flipped the switch in the bottle man he jeans out of the bottle and if there's one guy in china who did it and then published a paper on it I'm sure there's a hundred times it's not the first time they've done it and he tried to flip some jeans to make these twins Lulu and I forgot the other twins name HIV resistant which is really great

idea, just maybe not on humans yet. Like, they were CRISPR people were aghast. Like, do not use it on humans. But would you, I mean, just like all cards on the table, if you could, if you had a selection of 10 switches that you could switch off or on or whatever, like that were obvious, like, oh, HIV resistant or, you know, heart disease resistant or cancer, some form of cancer resistant, would you, if you could, if you could, if you could, I mean for myself personally, yeah, yeah.

I was born and my parents could let me make the decision, I probably would take the risk. Yeah, we'd have to think about the actuary table and what percentage. No, no, you're having kids. You're about to have kids. Oh, yeah. And you get to select, you know, six switches you can switch. Oh, my God. Forget it.

Yeah, I'm flipping everything, man. I'm like a, I'm running the light show. Right. It's like you're, right. Put the mixers up to 11. Yeah, I'm at Carnegie, I'm at like Carnegie Hall, like flipping all the light switches in the back of the soundboard. Yeah.

Of course. Like, and then the question becomes, okay, you know, eradicating, diseases, preventing diseases, you know, that's all obvious stuff. But how about six inches taller? I call it. 25% more muscle mass. That's right. 10 more IQ points.

And that's where things get fucked up. And that's where you've got to really start to think, like, well, I think China's going to do that. Because if you're a country that feels competitive. Yep. Like, and you're run by an authoritarian regime who is looking at America and the free world. Yeah, I could see North Korea saying, you know what, let's give everybody 20 more IQ points. Let's make everybody six foot five and let's see what happens. We've got nothing to lose.

And that's where it gets really scary. And, you know, that was the Nazis. Obviously, we're pursuing eugenics and crossbreeding and all this kind of stuff. But the difference between that and now is that that was science fiction and now it's science fact. You can actually do it. It's scary. There's some scary stuff coming. Or brilliant. And it's both. It's both. And when you have countries that do not ascribe to any kind of rule set or common humanity rule set. Yeah, I think they're going to get their first. They're going to get their first. You know, I don't know.

I mean, think about it, like, that's actually the existential problem for the free world, for the democracies, America, etc., like Europe. We are actually thinking about the moral issues. And they're just like, fuck it. Let's just do it. Yeah, they're just like, fuck it. What do we got to lose? Yeah. If we can get an edge, we're getting the edge.

I mean, we're behind the April here. Let's try to advance. It's like the Russians, like, they're like, we're not going to win the Olympics unless we start, you know, doing, you know, some serious steroids and performance enhancers. Wow. Brave new world. Listen, Jeff, you know, it's really, it's been a great friendship. And it's good to know you, Jeff Dantris. And I really appreciate you letting me on the cap table.

And I'm just so proud of the work you're doing it. It's really great to see you doing your best life's work because I saw the first time you doing your best lives work. And it's just great to see you're doing it again. Right? And it's so meaningful for you. And it's so meaningful me to be along for the ride knowing it's meaningful for you. You know, it's a real mis for you did letting me be involved because I get to sit here and watch you do your life's work. And that really is like as an angel investor.

And you supported me in my early day when I was hustling. And it's just great to see. Congratulations on Bear. Congratulations to Bear for doing this. And thank you to Stu at RRE Ventures. If you're in New York and you want to meet a great venture capitalist, like the one who backed Jeff in one drop, you know, Stu Elman. Yeah, Stuart Elman.

Stuart Elman, just a tremendous human being. Great guy. Just a great guy. Yeah, totally. And a great firm RRE Ventures. And let's book them. Hey, Nick, let's book them when I'm in New York, okay? Stuart Ellman.

Jeff Dodge has continued success. If you're listening to the program right now, and you know somebody impacted by diabetes in any way, I want you to go to OneDrop. Today, buy them the kit, send them the link, tweet it out, favorite it, share it on Facebook. Let's get the word out about this very important product. We'll see you all next time on this week. Thanks, Jason.