Bio+Tech was started as a monthly gathering to bring together the best and the brightest entrepreneurial minds in biomedicine and combine them with leaders in the SF tech start-up world.  The idea was that we have an amazing collection of biomedical entrepreneurial minds in SF and with the advent of bio-incubators and tech breakthroughs, the barriers to starting a bio start-up continue to drop.  There’s also a curiosity about biomedicine in the tech realm.  Who better to infuse biomedical and informatics start-ups with entrepreneurial energy and push biomedicine start-ups over the entrepreneurial hump than folks from this bastion of entrepreneurial energy? Plus, the biomedical start-up world doesn’t network nearly to the same degree as does the tech start-up world – that’s critical to the tech start-up world’s success in the SF Bay Area.  Thus Bio [plus] Tech – not just the same old biotech complete with high barriers, lack of networking and support.  Six months in to the Bio+Tech experiment I’d say that so far it’s been a success.

As a note: When I talk about biomedical entrepreneurship I mean that broadly – whether informatics, biotech, pharma, bio-energy, etc – it’s all welcomed and encouraged at Bio+Tech. And, I can’t emphasize enough that not only are we looking to bring together biomedical folks, we’re also looking to bring tech folks – developers, co-founders, start-up managers, etc – in to the mix.  You absolutely do not need a PhD in biophysics to join the group.  Just a healthy interest in bio or medicine – trust me, you’ll blend right in to the group!

Bio+Tech has grown from a group of 10 in January to an average of about 30 people at each monthly gathering.  To boot, that growth has been achieved solely through word of mouth.  I’ve been to a lot of meet-ups and gatherings where there’s lots of noise and very little signal – Bio+Tech has been purposefully kept small to keep the quality of the level of interaction high.  This set up was inspired, in part, by the SF meet-up Founder Dating, which requires an actual application and recommendations from other start-up folks.  Jess Alter and her crew do an amazing job!  Go check it out if you’re looking for a tech start-up or a techie person to help you build your start-up.  I also want to give a shout out to Vinnie Lauria and his Silicon Valley NewTech Meetup as the founding source of inspiration behind Bio+Tech.

Bio+Tech isn’t quite as complicated as Founder Dating and not as large as the SV NewTech Meetup, but to join the invite list you do need to demonstrate a basic interest in biomedical, tech or bio-energy entrepreneurship.  All too often a lot of biotech meet-ups are crowded with sales people and other vendors who are more interested in selling than sharing ideas, tips, contacts or starting businesses.  That’s not to say that we don’t accept sales people in to the group – you just need a genuine interest in creating a company or joining a start-up.

Michael Shuster speaks on the changing IP landscape and how that affects biomedical entrepreneurship.

Want to join us? Each month, the time and date of Bio+Tech will be posted on its webpage, with the location in SF to be announced. If you’re not already on the invite list, feel free to contact me at windmiller@gmail[dot]com and let me know why you’d like to attend.  Just a little paragraph with your interests and what type of company you’re looking to start or join, and a link to your LinkedIn profile – nothing too complicated.  In return, I promise to do my best to connect like-minded people at the meet-up.

We’ve had a couple bio start-ups find co-founders or developers – heck, there’s even been cross-pollination of neuroscience-principles back in to a tech start-up’s social media algorithms!  Yes, it’s a bit nerdy, but I can honestly say that out of the 6 gatherings so far, everyone who has attended has been someone I’ve really enjoyed talking with and sharing ideas.

Each Bio+Tech starts with a good bit of mixing and conversation.  It’s kept that way to maximize interaction and to warm things up.  We then get together to introduce each other to the group – with 30 people I’m always amazed at how efficiently we get through the group.  This is an opportunity to introduce yourself to the group and also spot others with like minded interests.  And, of course, we welcome solicitations for co-founders or technical help or any other start-up needs to the group.  This is a chance to network and find those you’d be interested in working with.

Starting in August we’re going to try to have monthly speakers as well.  It’s a highly informal 10-20 minute talk from people in the biomedical start-up or in the tech start-up world designed to bring ideas and prime the conversation.  We’ve had Michael Shuster, partner at Fenwick & West, speak on the changing landscape of Intellectual Property (IP) and how that’s affecting start-up strategy and execution.  A lot of biomedical start-ups are realizing that execution is just as important as securing IP to start-up success.  This isn’t news to tech start-ups, but this shift in perspective is somewhat groundbreaking in biomedicine start-ups.  We’ve got John Wilbanks, VP of science at Science Commons speaking at our August gathering on the open sourcing of biomedical data sets and tools and how that is altering and encouraging opportunities in the biomedical start-up scene.

And, Bio+Tech is purposefully kept free.  Whether you’re an undergrad or grad student, or on your 5^th start-up, everyone is welcome and encouraged to come.  I believe firmly that cost should not be a barrier to attendance.  And, please pass this along to people you think would be interested in Bio+Tech – that’s how we keep new, fresh ideas coming in to the group!

iPhone 3G not working so well? Downgrade before you throw your phone against the wall!

• Unburied lead: Lifehacker’s great post on how to downgrade your iPhone 3G. Super easy and takes 20 minutes.

The Scoop: This morning I finally got tired of the start, stalls and stops of iOS4 on my iPhone 3G.  The Unofficial Apple Weblog has a great parody of what I was experiencing after “upgrading” my iPhone 3G to iOS4.  From feedback that I was getting on Facebook and Twitter, seemed like most of my friends were experiencing the same things.  While there’s comfort in numbers, I’d rather have comfort in my phone working right.

I was reminded of a story where one of the big luxury car brands had been accused of engineering parts to break just after the warranty expired.  Forcing their customers to foot the bill for expensive repairs.  Ball joint on your car breaks at 50,001 miles on a 50,000 mile warranty?  Things to make you go hmmm. . . yes, I linked to C+C Music Factory.  Enjoy.

Goblins actually hexed my iPhone 3G running iOS4.

In the same vein, I find it a little convenient that as the iPhone 4 comes out, with a brand new operating system, we’re all encouraged to upgrade to the iPhone 4 from our slow, passe, old school iPhone 3Gs.  Seems all too convenient that the iOS4 essentially cripples iPhone 3Gs at a time when Apple is pushing iPhone4s. Upgrade or Die!

And, as an added note, I also did a complete restore of my iPhone 3G to iOS4.  That is, I first upgraded and then when that got kludgy I completely wiped the phone and started from scratch.  This has worked for some people, but when I did it my phone ran great for 3 days and then became all kludgy again.  Ugh.

How’d the Downgrade Go?

What I can report is that there’s a super easy way to downgrade your iPhone 3G to iOS3.1.3 (AKA the last stable build of iOS3 for iPhones).  I found Lifehacker’s post on how to downgrade to be the simplest and worked just fine for me.  Surprisingly, it didn’t really require any serious hacking – just following the simple instructions on Lifehacker.  Thanks guys!!!

It took about 20 minutes for the total downgrade and I’m happy to report that my iPhone 3G is working.  Well, working just as well as it did before the kludgy upgrade.  It’s nice to play a song when you want to or type a text in real time.

Of note – this process is a complete restore of your phone – YOU WILL LOSE ANY STORED DATA OR PHOTOS OR ANYTHING on your phone.  Go and back up your contacts and photos and make sure you’ve got all your songs and shows backed up in iTunes.  Follow Lifehacker’s super easy instructions and good luck!  Enjoy your newly restored iPhone 3G – Back to the Future!

It’s almost enough to get me to switch to Android.  ALMOST.

The smartphone battle rages on. Dammit Android, you're almost there

Been busy working on some consulting engagements recently.  That’s a good thing for me, but bad thing for Medicine Think.  I’m working on a new entry for later this week, but for now I’d like to share one of my favorite graphics from Bud Caddell over at What Consumes Me created this awhile ago and I’ve been meaning to share.

Sometimes, as a one-man consulting business you feel a pressure crunch that most big firms don’t face.  It almost feels like what an artist or graphic artist must feel.  Most folks want things for free, they have some sort of expectation and only few ever plan on compensation.  The trouble is that I find most of the consulting problems that come my way to be really, really interesting.  I’m happy to report that I’m bringing Square6 closer to the middle!

And, for those of you who love infographics – head over to What Consumes Me! Fantastic work!

The Tesla Roadster Sport - really, there's nothing like it

Here’s a non-traditional Medicine Think entry, but I wanted to share my first drive of an all-electric car – the Tesla Roadster Sport.

I feel like last night I had one of those rare experiences where you feel like you’ve seen the future.  It might sound like a hyperbole, but that’s what it felt like to test drive the Tesla Roadster Sport.  And, no, I’m not in the market for one, but after driving it, I really wish I had about $110,000 in disposable cash laying around.

So, what is it about the Tesla that makes it feel so futuristic?  It’s an all-electric car – there’s no hybrid or gas component – it’s a 100% electric motor.  That means that from the moment you put your foot on the “gas” (is it more appropriate to call it an accelerator pedal? The “electric?” The “juice?”) it’s a different driving experience than you’ve ever had.  The only similarity is that there are four tires, the car looks like a Lotus Elise, and there’s a steering wheel – most other experiences are different.

There’s no engine noise.  Honestly, you don’t miss it.  An electric motor, by nature, has 100% of torque at 0 RPM – that means the thing accelerates so rapidly that it’s hard to believe.  0-60 in 3.6 seconds – that’s Lamborghini fast.  Instead of having to “rev” the car up, all the power is there and ready to go when you push down on the pedal.  It’s unlike any car I’ve ever been in.

There are no gears – nothing to shift, no transmission beyond forward and reverse.  After the car bolts to speed, the engine itself has a tremendous amount of braking power.  The moment you let up from the accelerator, the car begins to drag to a stop.  You literally don’t need a brake other than to come to a full stop at stop lights.  Put another way, to maintain speed, you have to keep the pedal down – even on downward slopes where gas power cars would shift to neutral or have a very low factor of engine braking.

Apparently, a lot of Tesla’s patents and intellectual property in how the car electronically mimics the way we drive today in gas cars.   By that, I mean it’s not in the nature of an electric car to cruise forward when you let up on the brake.  But the Tesla does – that’s a purposeful design and apparently very hard to do in an electric car.  From my understanding, this technical achievement will be difficult for others to mimic.  Apparently this technology bleeds over in to how the car accelerates smoothly and the car reaches cruising speed.  Whatever they’re doing it’s definitely working.

With the electric engine comes the need to store the electricity to power the car.  The battery “pack” alone weighs just shy of 1000 pounds.  That’s a lot of weight.  It’s positioned mid-car just like in a gas powered sports car, which helps balance the handling overall.  Regardless, the 1000 pounds is a lot of weight, especially when the car weighs a mere 2,700 pounds overall.

Otherwise, the car is definitely a stiff little roadster and to be honest I had a hard time seeing through the windshield.  I’d love for the car to have a few more inches, and I hope that comes at a later date.  Maybe by the time I can afford one.

It was truly an exhilarating ride, and I don’t think it really hit me until I stood up and I felt like I had just stepped out of a rollercoaster – the same shakes and legs feeling almost like rubber.  I don’t know if that was because I’m a pretty novice sports car driver, or the all-electric roadster really is that cool.  My gut sense is that the car really is that cool.  I was on a high for the entire rest of the night – I’m not kidding.

And, this sense had nothing to do with the environmentally friendly nature of the car.  That said, I’d be really curious of the overall carbon footprint of a mile in a Tesla versus an efficient gas car.  How many carbon emissions are released during the production of the electricity to power the car?  Is it really less than driving a mile in a gas car?  Either way, the electric car really is that cool.

Heading back tomorrow to get a behind the scenes look at the dealership and shop in Seattle.  More to come!

Biology and technology have much to learn from each other - concepts from each discipline can inform and help create breakthroughs and new businesses. Image courtesy of Scientific American

I recently sat down with a friend who’s developed an ingenious way of using neuroscience concepts and neural networks as the basis for an information filtering algorithm. He’s taken that algorithm and created a personalized and customized news feed from Twitter.  In short, he’s helping to actually make sense of the Tweetstream.

So, what do I really mean by saying that he has employed neuroscience concepts as a foundation for his algorithm? First, think about the brain and how it processes incoming signals and stimuli – if it’s an important signal, say a pouncing mountain lion, it’ll get through all the other noise and register with you.  Much the same way, my friend’s technology uses a couple “filters” that determine whether the incoming tweet is relevant to your interests. If it’s relevant and important it’ll pop up in your news stream. In works much the way that neurons in the brain work – in order for a signal to pass along it’s gotta make the next neuron fire.  The same can be said about tweets this technology filters – if it’s relevant and important it makes it through the algorithm.

The second instance of neuroscience inspiration in this friend’s Twitter algorithm comes from the basic premise that how and what we forget is just as important as the things that we actually remember.  Think of it this way – if we remembered EVERYTHING that we see, hear, touch, smell and taste our brains would be overloaded and wouldn’t work efficiently.  We’d have trouble actually finding memories in our brains if we stored too much information.  The same goes for computer systems – learning how to forget, to get rid of irrelevant or increasingly irrelevant information is just as important as figuring out what to keep. However, the tricky part is figuring out what to forget and what’s worth remembering. That’s part of his trade secrets.

By merging his knowledge of computer science with a dabble of inspiration from neuroscience my friend has been able to pull together a really, really compelling product that might actually make Twitter useful for the 95% of the population that’s not on it. Where other techniques have failed to make sense of the Tweetstream, my friend’s inspiration from the fundamentals of neuroscience has greatly aided his product.

In the above example neurobiology has inspired and informed computer science design, but it’s also a clear case of how this interdisciplinary approach can help both fields make advances.  Another example would be 23&me. I clearly don’t think much of their business model or clinical relevance – but they did inspire some advances in bioinformatics through employing experienced techies to help build their data systems.

See, this is what you get when you mix biology with technology!

What I mean is that (as I’ve been told anecdotally) one of the things 23&me did absolutely right was hire a number of engineers from eBay who were fantastic at database engineering and management.  Instead of bringing in data folks with 10 years of background in bioinformatics and creating databases the way a biologist would, 23&me created an extremely efficient and scalable system for their genomic data.  This type of insight will enable science to make more advanced breakthroughs all that much quicker and effectively. It has also enabled 23&me to have a more feasible business model as well. Technology enabling and inspiring the advancement of biology.

All of this to say that in the world of entrepreneurship and design there’s a lot that the intermingling of bio and tech can bring to help inform and advance both fields.  I’m hoping that Bio+Tech can be one of those ways that technology and biology can intermingle to bring about not only a more vibrant start-up community here in San Francisco, but to help create breakthroughs and inspiration for the next generation of technologies. Drop me a line if you’d like to attend the meetup on February 17th!    windmiller[at]gmail

Biology and technology coming together isn't really a new concept - it's clearly been occurring for thousands of years. We just need to continue to encourage new interdisciplinary approaches as see what comes of it. A beer along the way doesn't hurt, either.

UPDATE: Please RSVP to: windmiller [at] gmail

This Wednesday night – January 20^th at 7pm I’ll be hosting what I hope will be the first of many meet-ups for entrepreneurially minded biotech and bioinformatics people here in San Francisco.  It’ll be at Crossroads Café in SOMA. In February the meetup will most likely be moved to a more permanent location at i/o Ventures, a start-up incubator space in the city.  Information will be updated on the meet-up’s page on Medicine Think and on my @medicinethink Twitter account (follow me!).  Feel free to pass this info on to interested friends.

Genome Valance by Ben Fry. Ben's expertise is helping to graphically represent and interpret massive data sets and information. This piece represents genomic analysis using BLAST. I picked this piece specifically because it takes a new look at how to represent and understand genomics and informatics - something I hope this meetup will help to encourage more of. More about his work from Ben at http://benfry.com/genomevalence/ (click to enlarge)

So, why the meetup?  I’ve spent the past 4 years in San Francisco in both the tech and biotech realms.  Actually, I’ve been a passively active member of the tech community – out of interest I go to events and meetups with friends.  I meet people through my wife who’s in tech PR.  I’m actually pretty well immersed in the community without really trying that hard – it’s a pretty open and warm community.

But as I’ve actively tried to network and attend events in the biotech and genomics space, it’s been much more difficult.  While I’m just about one or two degrees from most of the tech crowd here in SF, I can’t say the same about the biotech space.  And, perhaps with some good reason – the biotech/life science/genomics space rely pretty heavily on intellectual property and trade secrets, so that stunts people’s ability to be social.  Despite that, I think there’s much more room for building a more solid general community outside of the big players and established start-ups.

One of the beautiful things about the tech community in SF is the intermingling of different specialties and cross-pollination of ideas.  This leads to start-ups, improved technologies and a more healthy and vibrant tech community.  Often, these ideas, through start-ups, are passed up to the larger players through acquisitions – so from early start-ups to big behemoths the entire community benefits from this networking and open community.

The biotech community here could use more of this attitude and community.  San Francisco and the University of California has made a substantial investment in the Mission Bay neighborhood – there are very, very few areas in the country that have the foundation for success as does this very special part of SF.  And with visionary institutes like QB3, which is based at UCSF and Berkeley, I see a whole new generation of PhD and other grad students with an entrepreneurial energy that hasn’t been created at other campuses.  Combine that with Stanford’s legacy of doing the same thing and you’ve got the seeds for an amazing industry and community.

Don’t get me wrong, the Bay Area is already a leader in biotech – clearly there’s a lot going on.  But to take it to the next level, the community also has to kick it up a notch.  I hope this meet-up can serve as a partial catalyst (of course, there will need to be many, many more events, etc) to tap in to both the tech and biotech communities here and bring together a diverse and energetic crowd.  Ideally, I’d like to promote an interdisciplinary meetup – between not only biotech and bioinformatics people, but to bring in members of the tech community.  I think tech could greatly inform how bioinformatics and biotech does business – from improving how data is handled, to user interface and analytics and beyond – there is much room for tech to impact the biotech community.  And, to a certain extent, tech would also benefit from some of the thinking from leaders in biotech.  From algorithm and natural language specialties, to managing massive data sets and making meaning, to scalable software, SF and Silicon Valley is well positioned to inform biotech and informatics and help solidify the Bay Area as a leader in biotech and informatics.

If you’re in SF or the surrounding areas, please come by Wednesday at 7 to the Crossroads Café. Even if you are a tech person with a curiosity about biotech, genomics, personal medicine and the like, without a super deep background or expertise, we’d love to have you.  I think these two groups have much to learn from each other and that this type of social interaction will lead to new ideas, energy and companies that will help take the Bay Area to the next level and retain a leadership in the life sciences.

What do you think?  What would you like to see at these types of meetups?

In the past I wrote about getting a start-up off the ground. More precisely, about how to take an idea and give it legs and maybe get it running – how to mold an idea and begin to improve it. I call this socializing the idea (with the next steps being socializing the company/concept). But, how do you take it to the next level? Making that transition between idea to fully operating start-up is tough, particularly if you’ve not done it in the past (read: if you haven’t been a successful entrepreneur in the past).

A good friend, who has successfully sold two pretty large start-ups, gave me the advice that angel (or seed) investors tend to only invest under three conditions: 1) you’ve been successful in the past, 2) they know you personally (worked with you, are a family member, want to get in good with your family, etc), or 3) are intimately tied and invested in the space you’re working in. While I took in his advice, I’m not sure we followed it well in my first start-up. None of us in the venture had successfully launched a start-up, we didn’t come from money and most investors didn’t like to invest in the healthcare space (at least at the time). Turns out my friend was more right than I could have guessed. This made it incredibly hard to pitch to angels, and ultimately we didn’t get funding (but that’s another story).

One other thing about starting that I’ve learned over the past 4 years is that often times it has taken companies a lot more effort than they showed or they had some sort of secret weapon to getting started. Almost no one company starts go smoothly or easily. One company in particular that comes to mind was lauded as having been an amazing story and elevated its founder to a great reputation. They raised a little under a million dollars and sold for $25M. That’s a great story. Then you peel back the layers back and realize that one of the co-founder’s father invested a majority of that initial $1M (they didn’t raise it from a typical angel investor) and that father was also an executive at the company that eventually acquired the start-up. Don’t get me wrong, this start up still took a tremendous amount of work to get the product to grow and to accumulate users. But, as a note to up and coming entrepreneurs, stories like this one, including the message that was told to the public and meetups regarding the ease they had fundraising are often misleading. It’s still a success story, but definitely not as shiny as it initially seemed.

But where does that leave first time entrepreneurs without a track record or the good fortune of befriending a Silicon Valley maven or a PhD in computer science? A couple new efforts have really filled that niche for talented, but new entrepreneurs. The most well known and a pioneer of these efforts is Y-Combinator – a Silicon Valley and Boston based effort that hold biannual “try-outs” for new start-ups. Essentially, you make an appointment for the try-out session, pitch to Y-Combinators’ board and if they like you they’ll give you some minimal seed funding ($10k) and help set you up with the resources you need. More importantly, being accepted as a Y-Combinator company pulls you in to their social circle which works wonders in being connected to partners, customers, getting advice or going for a larger funding round. Perhaps most important in this effort than having a great idea is who you know and who you have access to – funding from Y-Combinator can help you gain that toe-hold and help you jump in to the game. They also have great partners, including Paul Graham who has a widely read start-up blog. In other words, it’s less about the amount of funding and much much more about the connections being one of their companies brings you.

Now, utilizing efforts like Y-Combinator doesn’t come without a price – namely that it’s reported that they take 10% of equity in a company. That’s definitely very, very expensive. However, at the same time it’s indispensable if you are new to the start-up game, particularly in the Bay Area. Other, less well known efforts are also taking root, including Adeo Ressi’s The Founder Institute. Their model is a little different – they take a smaller chunk of the company if it gets funded and then splits the profits from this equity pool amongst other founders. It’s too much to really explain here, but suffice it to say that the Founder Institute is more about gaining connections than anything else.

A third option is a location in San Francisco named Dogpatch Labs. Run by Polaris Ventures, Dogpatch Labs gives entrepreneurs very inexpensive, shared workspace with other start-ups. It’s more about community and connecting with your fellow entrepreneurs, but it’s also a great networking tool. In this case, entrepreneurs and young companies need to pony up some cash for the space, but in a place like San Francisco, a resource like Dogpatch Labs is invaluable to the start-up community.

Last and certainly not least is i/o Ventures. Just announced today (January 6, 2010), i/o Ventures looks to be both a small seed round along with a new, open workspace in SF. It’s got an impressive list of advisors and other folks surrounding it, including the likes of Michael Arrington. Pretty amazing exposure and a mashup of some of the concepts from other incubators/labs. Sounds like they’ll be shelling out more money for a smaller percentage of the company as well (compared to Y-Combinator’s $10k and 10% take). Watch out for these guys in the future.

Overall, these efforts give an amazing amount of camaraderie, work space, inspiration and most importantly legitimacy in the eyes of potential users, customers, and funders. It’s a fantastic way to start if you’re new to the game. I’m sure there are other spaces like these, including Hacker Dojo in Mountain View, CA – more of a meeting of the minds and place for work inspiration and perspiration. Did I miss something? Who else should be included in this list? Leave a comment about them below!

In PEHub yesterday an article about 23&Me and the financial issues it’s been having.  As an entrepreneur and having had plenty of great ideas poo-poo’ed by investors and industry folks alike, it’s really hard for me to understand why anyone would have invested in 23&Me as a company.  What I don’t understand is why highly skeptical VCs have invested in a business who’s central premise, while certainly desirable, is so far from reality at this point that it’s amazing anyone would invest. It’s certainly an important idea – scanning our individual genetic make-up to discern health risks and prevent them. Who wouldn’t want to understand what preventable diseases they’re prone to? I certainly would (well, to an extent – but that’s for another post).

For the uninitiated, 23&Me is a personalized genomics company that will take a couple drops of your saliva, extract your DNA and screen it for hundreds if not thousands of genetic disease markers.  The company name is derived from the 23 chromosomes humans contain – 23 from mom and 23 matching from dad. But the company over promises and under delivers.  At the end of the day, the fact is that biomedical science isn’t advanced enough yet for us to make meaningful predictions off of the information screened by 23&Me. And, to boot, there are other companies like Navigenics that have a little better model of screening, but they’re still pretty far off mark – as of yet. That said, Navigenics’ science and results are much better than 23&Me, but that’s like saying Peet’s is better than Starbucks – Peet’s may have better beans, but the coffee’s still not all that good.

A gene chip by the company Affymetrix. That little square on the chip can yield information on 500,000 different genetic variations.

Let’s dive right to the core of the issue – the biomedical science behind 23&Me. 23&Me (and Navigenics) use “gene chip” technology , which can screen thousands of genes at once and tell you where you have variation (mutations)  that are known to be correlated to disease.  In other words, if the gene chip picks up that you have a variation in a gene that has been correlated to a heart illness, 23&Me argues that you have a higher chance of developing heart disease. While that certainly seems logical – “I have a gene that shows a higher risk of heart disease, I better do something about it” – it remains somewhat misleading.

A closer look at that square on the gene chip - this is what the chip looks like under magnification when it's read by a computer. The different colors indicate different gene results.

We have to dive a little deeper here to understand why the findings from these tests don’t correlate to real disease risk. When researchers do genetic studies (the type of studies 23&Me base their tests on), most of the time they find correlations between gene variations and a disease. And I want to stress – these are correlations – and are not purely 100% causative like the genetic testing companies would like you to believe.  Put another way, these genes are found in these diseases, however they are not the root cause of the disease.  Most diseases are due to multiple genetic mutations, which means the underlying causes for these diseases are much more complicated than just one genetic mutation.

We now know of 20 genes that correlate to height, but they only explain 3% of variation in height between people. Only 3% of the difference in height between these two men! What about the other 97% of difference? More research!

For example, a study came out in the New England Journal of Medicine that detailed just how little we know about how our genes and how they become translated in to real world physical traits and disease. This review study illustrated that we know of 20 genes that correlate to the differences in height between people.  While that sounds impressive, turns out that those 20 variations explain only about 3% of the true variations in height. I’m 6’5″ – those 20 genes explain only about 1/3 of an inch of the variation in height between my 5’6″ wife and I! 20 genes!! Why then do we then think that 1 gene will detail risk for heart disease or cancer?  The bottom line is that before we can accurately correlate and make meaningful disease predictions based on genomics, much much more research needs to be done.

So, let’s come back up to the surface. I’ve detailed why genetic research to date isn’t as complete as these companies would have you believe. The personal genetic variations they uncover, while using the most advanced technology and knowledge we have, isn’t sufficient to fully explain disease risks. The companies are selling a service based on scientific misconceptions – people are accepting 23&Me’s marketing, rather than good science. And that lack of scientific and clinical substance is why the medical community hasn’t embraced these tests.

I’m going to get in trouble with these companies because they don’t directly make these claims – but I think it’s implied based on their marketing and how they discuss their product. Doing these tests even just for curiosity’s sake is even a waste of money – they don’t truly tell you anything useful.

As one caveat, Navigenics does have a much better platform than 23&Me and how they correlate gene changes to disease risk is much better than 23&Me. They do take a look at diseases more holistically – let’s say they’re screening for heart disease and for argument’s sake that they screen for 25 different genes correlated to heart disease. They take that information and integrate all the risk factors to give you a more accurate risk analysis based on population statistics. It’s a little better, but I wouldn’t spend the money for it yet.

Don’t get me wrong, these types of products and services are the future of medicine. Maybe not in this direct way, but we will be screening people for disease risk.  No, not for insurance reasons, but rather to attempt to prevent diseases before they take hold. It’s just too early for this type of genomic analysis to be accurate enough to truly act upon. Although I’d like to be an optimist, the technology isn’t there, medical practice hasn’t accepted these tests (and they shouldn’t) and the businesses like 23&Me are floundering as a result. All of this to say, as a consumer patient hold on to your money for now, the scientific community has a long way to go before we really have the information necessary to make strong clinical correlations and to make valid disease predictions.

It’s been a little over a year since Sequoia’s infamous slide deck “leaked” to the internet proclaiming the end of the good times for start-ups.  The presentation contains tons of graphs detailing the oncoming downward spiral and suggested that start-ups tighten their belts in order to survive.  Clearly that was great advice, but my main issue with that message is that start-ups should be frugal to begin with and those who need a warning to cut back probably aren’t going to survive anyway.  Bill Gurley of Benchmark also issued a missive at the same time that listed about 10 do’s and don’ts for start-up survival.  Again, aren’t these things start-ups should do anyway to ensure survival?

I bring this up because at the time many commenters and columnists called out these warnings as disingenuous – the message conveyed by Sequoia and Benchmark was something VCs should tell their portfolio companies anyway, and by issuing such a warning (and highly publicizing it through an organized leak) they only served to create a panic.  A panic that tips the scale in their favor – the “harsher” the conditions, the more the risk, the lower the pre-money valuation for companies.  Sure, the economy was down, but VCs artificially raised the level of “economic harshness” through these missives, which actually benefitted them with lower pre-money valuations and thus larger chunks of companies. That or they’re madly brilliant – turning every day entrepreneur advice into a scare that benefits their portfolio.

That said, I think its good advice and good practice to remind companies to reevaluate their spending and burn rate – I object to the way it was done.  I think that Bijan Sabet, a partner at Spark said it nicely in a recent blog post: “we can all do better“.  What made me think of these notes from last year was Fred Wilson’s (of Union Square Ventures) post today that calls out VCs who say they need to command a specific percentage of a company.  He’s “calling bullshit” on VCs who make such comments.  And I believe him – it’s a disingenuous thing for a VC to do – to focus on a percentage rather than the true value they add to a company.  In a way, stating a desired percentage artificially deflates a company’s pre-money valuation, rather than focusing on what the company is really worth.  VCs, by only thinking in company percentages, are overreaching.  I applaud Fred for his message – as does Josh Kopelman of First Round Capital, who takes Fred’s VC greed point even further and says it’s a mistake for a VC’s required returns to drive company’s outcomes, rather than the other way around.  Again, I agree and am happy to see some VCs making this message.

But, on second thought, VCs are driven by returns – the largest return they can make to their LPs.  I think it’s a mistake to think this means “more altruistic” VCs will take a lower percentage of a company – afterall, they’re in it for the business, too. As an entrepreneur you have to take their points with a hint of caution. VCs are still out to get the most out of their companies, and part of that is taking as large of a percentage of a company as is possible.  A smart VC will balance the yin of the percent they take from the company with the yang of maintaining the founders incentive in making their company successful, but that often doesn’t happen.

It’s semi-noble Fred and Josh to express their vantage points, but it’s also smart business because they improve their image with founders.  I don’t have data, but it would be interesting to compare the average percentage of companies a VC takes versus the overall financial success of those companies.  Or, the macro performance of their funds.  Curious if some of my professor friends have insight on this?

Overall, I have to say thanks to Josh and Fred for making their posts, I think that the message is spot on, but I also feel that founders should take these statements with a gain of salt and always be aware of a VC’s true focus.

For a while now I’ve been keeping an eye on the whole healthcare IT thing and have found just an incredible number of errors in the way we (as a country) approach the use of healthcare IT in our system.  I’ve published academic articles and a white paper on the subject of health information exchange, detailing one of the best cautionary tales for this time of uber-stimulus potential.

There’s lots of talk in publications like the Wall Street Journal that doubt the value of electronic health records/IT in practice, while there’s tons of governmental and industry press that tries to sell healthcare IT, it’s hard to tell who’s telling the truth.  And, if you’re a newbie to healthcare IT, John Halamka, one of the more rational leaders of the effort has a good blog and a great post that details the basic terminology. 

One of the lessons I learned through my research time at UCSF is to really dive in and check where publications proclaiming the value of healthcare IT come from – most articles cite a source they believe to be credible.  But, ultimately, if you trace those citations back, even the best sources of “data” on healthcare IT value are based on experts opinions. These “facts” have gained validity over time through being unintentionally “laundered” through citations in publications.  While some of these estimates and opinions are the best that we have, that doesn’t mean they’re accurate – both sides of the argument are using “proof” of dubious origination.

I have to admit, I’m burned out on the healthcare IT argument, but what does intrigue me about it is the business case around healthcare IT and the mistakes I think people are making with regards to finding a value-based argument for healthcare IT adoption.  Most of the public expects to never again fill out forms in doctor’s offices or tell an emergency room doc their history, and interestingly enough to me is that is enough for people to back hundreds of millions to billions worth of healthcare IT investment.  Guess what – you’re still going to have to do those forms.  Sorry to break the bad news – those forms are more of a CYA for docs in this overly litigious medical profession. Until that changes, you’re still going to have to fill out those forms.

The real value comes in as more and more docs and hospitals adopt healthcare IT – it’s the same value proposition as seen in the internet – it’s all about the number of nodes on a network that give it value.  Metcalfe’s argument, while more of a metaphor than a fact is a good place to start regarding the argument for widespread healthcare adoption.  Therefore, the first step in healthcare adoption needs to be the actual adoption of healthcare IT.  This has less to do with preventing errors or creating other efficiencies through IT adoption, rather it’s about digitizing and therefore “net-enabling” healthcare information broadly.  Which leads then to the second step – networking all that information in a meaningful manner.  It’s not until that step that the real, significant savings realized by healthcare IT adoption.

Here’s the rub – it’ll cost tens of billions of dollars to properly digitize a physicians’ practice or a hospital’s infrastructure.  That investment comes in the first wave of healthcare IT adoption when the ROI for the investment is low.  Healthcare IT adoption has been slow over the years, so it’s not going to speed up fast enough to really get to that second step of networking the data while the argument and passion for healthcare IT adoption is still high.  We need a solid plan now that understands this paradox in healthcare IT adoption and that looks toward long term success and makes the necessary funds available to ensure long-term success.  Otherwise, we’ll find ourselves creating a patchy system that is optimized for no-one and even more inertia that prevents true healthcare IT adoption.

Once we get to the point where we have the nodes on the network and information flows more freely, the ROI will become very apparent and innovations that we cannot visualize or conceive of today will become reality.  I hope we can get to that point.  Until then, just remember Metcalfe’s law of nodes as a guiding principle – I think an argument rooted in that tradition will help drive the necessary adoption.