Final Podcast of the Year

“Lessons learned, possibilities explored, thought experiments, and a bit about problem solving”

Download the full transcript: P5 Protocols – Final Podcast of the Year – DLE solo act – Final

INTRODUCTION

As I go to record this, I am now on day 6 of a 7 and a half day water fast and bitcoin is down over 30% from its recent high; all of this complemented by a little Chinese Pu erh tea, which I started drinking 23 years ago, and my pup, Taser, lying next to me.

Now that we have reached the end of the year and the first “season” of P5 Protocols, I thought it would be beneficial to share some lessons learned, possibilities explored, thought experiments, and a bit about problem solving.  As an investment firm and podcast host, we have spoken with or interviewed hundreds of people.  That includes researchers, company founders or CEO’s, practitioners of all stripes and more.  We are also voracious readers, looking to find insight in various places that help us anticipate the future.  We make great effort to think, see how things correlate, and find patterns that arise among multiple disciplines.  Lastly, we discuss a new non-profit initiative whose mission it is to solve most diseases in the next five years with the tools that are currently available; for that endeavor, it would need to be a truly global collaborative effort.  And at the very end, we have a few wonderful quotes to ponder.

Over the years, I have found multiple patterns that arise across many seemingly unrelated disciplines.  Stephen Wolfram’s effort to find the unified algorithm may have a truly foundational basis.  The doctor can learn from the nuclear physicist or economist and vice versa.  The top performing hedge fund, likely of all time, is a quant fund that uses scientists and economists and others across every discipline and sub-discipline to program their machines to find patterns and beat the market.  Diversity of thought and perspective is king.  Intolerance and fixed thinking belong in the dungeon.

So, this has a summary of several of this year’s P5 Protocols wisdom as well as requests for the personal, healthcare startup and general business worlds.

One thing I must first say is that I have no permanent answers.  I only have current thinking and I reserve the right to change my mind, as you should too.

If you want to think about how to manage your or a patient’s health, I strongly suggest you listen to Sid Baker’s interview, again if need be.  Or read through the show notes.  First, he asks the most logical question: “Have we done everything we can for this patient?”  In chronic care including autoimmune, cancer, diabetes and other diseases, that question is often asked and answered yes.  However, it is based on a practitioner’s limited knowledge.  Perhaps, the question should be: “Has the patient had everything done for him or her that could, in fact, be done?  And that answer is almost always no.  More on this later.

At the top of just about any decision in life, work or personal, should be Sid Baker’s rule about risk management, which include the five considerations with the acronym B-R-O-C-S

• B is for Benefit
• R is for Risk
• O is for Odds (that it will work)
• C is for Cost
• S is for Stakes

The thinking is: If stakes are really high and risk is 0 then you go for it – even if it is a 1 in 100 shot and if Odds are 50/50 then that’s a real bargain!  So, I ask: why don’t doctors encourage sick patients to try various diets, or exercise routines?  Is it logical to say: don’t do that, when the doctor has zero knowledge of something’s value?  I have seen that over and over, including with my dad who passed away six years ago after his second bout with cancer.  Nothing with diet or exercise.  If you are waiting for clinical trials there, good luck!   Who is going to fund that?  Hopefully, more on that with our foundation discussion below…

Sid also talks about how medicine is not just about adding or doing things, but also about what to remove.  Sometimes, you just need to remove the toxin, bacteria or food or stress.  Thus the use of antibiotics.  But, why isn’t that same theory used on food, stress, etc.?  Why should it be limited to known bacteria, viruses and the ilk.

I have one friend who had debilitating back pain for seven years.  He finally separated from his wife and when he left the house and got in his car, he noticed his back pain was gone; never to return.   I have another friend who had clinically diagnosed MS for years.  She took out gluten and she soon became clean on all scans.  She now is extended to two years between scans.  And look at John Sarno’s work, led by his first book, Mind Over Back Pain.  His lectures and mental exercises cured my dad’s over 20 year debilitating back pain.  Do I think divorce or cutting out gluten will cure everyone?  Of course not!  But there is some subset who it is relevant to and thus we need complex adaptive systems to help figure out your N of 1, which is also the name of a company founded and run by a friend.

The lesson here: experimenting with low risk options is a highly logical thing to do, especially if the cost is low.  As Sid says, sometimes the treatment is the most powerful diagnostic.  After all, we are individuals with unique DNA and microbiomes and stressors and neurological patterns.  The age of “one size fits all” medicine is over; it’s just that many have not processed that message yet.

So, here are some of the other things we learned this past year or so coupled with several things we hope you will ponder.  I have broken it into several sections, the first one is for healthcare entrepreneurs and maybe a few investors.  The next section is about how I think you should think about health in general.  Please note that I pull from disparate places, but the patterns rhyme.

A FEW LESSONS

Before I go on, I will give you one quote that rings true with the below and anything else for that matter.  It is a quote attributed to Mark Twain and first introduced to me years ago by Sturgis Woodberry, my former partner:

It ain’t what you don’t know that gets you in trouble

It’s what you know for sure that just ain’t so.

Ironically, I have seen comments that it really isn’t even Mark Twain’s quote – rather, it is a case of mistaken attribution.

So with that, let’s dig into these questions or lessons that we learned this year.  Some may seem overly simplistic, but many entrepreneurs still don’t sufficiently think things through.  Let’s start with (possible) lessons for entrepreneurs and (some) people in the business of healthcare:

1. From day one, focus on providing a solution to a real problem.  Don’t start with a technology in search of a solution.  This is a human business.
2. Life is not about time saved so much as about energy expended.  By example: In January, I got a new wifi network for our house.  I thought it would take an hour to install.  I waited until August, seven months, to do it.  It took less than 10 minutes.
3. Look at the incentives of your direct and indirect customers, including payers and providers.  If you’re not making their life easier, saving them from expending energy, which means money must flow to them, time and energy must outright be saved, and materially better outcomes have to occur.
4. Here is a quote I wrote on our wall long white board: “Simple is difficult enough.  Complex is f’ing impossible.”  The clear message: K-I-S-S
5. Another word I keep on our board in huge letters: “Good”. So when faced with a problem, follow Navy SEAL Jocko Willink’s approach and just say: Good!  And attack the problem, always moving forward.  Watch a pro football game while you’re at it.  When a top running back gets the ball, his legs never stop pumping.  Such should be life.
6. If you don’t have a software platform approach, and are mainly a hardware business, well, good luck!  You’re going to need it.
7. If you are a founder, give investors a FULL financial statement.  That includes more than your cash burn, but rather includes expected revenue, cash flow and a balance sheet!  It is not tough.  And while you’re at it, in the same spreadsheet, above or below, tie it into a Gantt chart that has milestones, key gating factors and the like.
8. Husband your cash.  Guard it.  Don’t burn it like that $20 million flameout whose CEO gave his dad $18,000 to build a custom 27 foot conference table.  Who gave that bozo money?  If you have done your work, you will know when to invest it and put your foot on the accelerator.  VC’s focus on their winners and too many of them don’t get to intimately know you and your business.  So, when trouble hits, and it will hit, make sure you have the luxury of time.
9. On that note, read Dale Carnegie, Tony Robbins and the old Chet Holmes books and learn how to sell.  There is a reason that flameout with no real business model still raised $20 million.  It’s called salesmanship.  So build that narrative, back it up and sell it.
10. [Early stage] VC’s often don’t care a whole lot about details.  They still make slightly educated bets. We are still seriously considering an investment in a company that already has over $25 million invested into it; the largest investor said I am the first person to ask a lot of questions.   Good thing for the company the CEO is a star! So, just because there are brand names circling a company, don’t presume anything.  Push to learn what you will get from your investors.  Asking lots of questions will give you lots of answers – some by what they say and some by what they don’t say.  References never hurt and it surely does not hurt to ask.
11. If you are creating a drug or implantable device or anything that may take five or more years to get to market, think twice.  If you don’t change your mind, think a third time.  Things may be very different in a few years.  In terms of change and disruptive destruction (redundant?), we are in the vertical part of the proverbial hockey stick – a time of rapid change.
12. Create optionality, i.e. many ways to win.  As John Templeton responded to when asked to give his favorite stocks on CNBC: “If I knew my best stocks, I would put all of my money in them.”  A single way to win is akin to a crapshoot.  Your business will ever evolve.

And now on to how to (possibly) think about health and healthcare:

1. If one thinks about and approaches things from varying perspectives, they hopefully will develop a variant perspective, which can be critical to success.
2. Just because antibiotics cured certain diseases, does that mean that all diseases should be treated in a mono therapeutic fashion?  My belief is that the age of monotherapeutic medicine is over.  Just as when in 1979, Paul Volcker tried to squeeze out inflation but the bond market didn’t feel it for five more years, the healthcare world has permanently changed.  The powers that be have not yet accepted it.  Welcome to the age of simultaneously using multiple approaches to get every edge you can get.  We call it adaptive protocols.  Dale Bredesen, a recent interviewee and Alzheimer’s expert, calls it programmatic medicine, likely a better term.
3. If you have any immune issues, as per Steve Gundry, don’t eat plant lectins.  That means no grains, legumes nor nightshades.  If you want a complete list, he has it at www.drgundry.com, or go to Amazon or Barnes & Noble and buy The Plant Paradox, his recent book.  I keep a printout of his lectin-free list in my kitchen.  When I went off lectins, my shoulder pain dating back to little league baseball went away.  I believe he has passed 800 documented patients who have reversed their autoimmune issues while on his protocol.
4. Mitochondrial dysfunction may be at the heart of an inordinate number of diseases.  Read or listen to Tom Seyfried and get his book, Cancer as a Metabolic Disease, but ignore the scary pictures!  And if you want to learn about the politics of the cancer industry, listen to Travis Christofferson and read his book, Tripping Over The Truth.   So I ask: Is cancer purely genetic or do metabolically induced?  Do metabolic based methods make equal or more sense?  Can they be used in conjunction with lower, thus less toxic amounts of traditional therapies?  Metabolic therapies tend to focus on bringing back oxygen to the healthy cells so they can win the battle with the mutated cells.  All cells need energy!  An analogy: if I am suffocating for long enough, will I die?  And the answer is yes.  And if I’m always suffocating just a bit, will I die sooner than I should have, and I would say yes.  So if your current diet and lifestyle led to or left you vulnerable to illness, why not try something different?  Trying the same thing over and over again and expecting a different outcome is Einstein’s definition of insanity.  At least for now, mitochondria have been crowned the king of medicine.  Long live the king!
5. The most successful immunotherapy drug, yervoy, works on 22% of the patients.  That means that almost all of the other 78% don’t make it.  If you are dying, do you have time to wait for the next generation of drugs?
6. Only work with flexible open-minded doctors.  Even if they can’t come up with your solutions, only accept doctors that want to track and know what’s going on so they can learn from their patients.  Doctors typically don’t have time to learn new things.  They have families, businesses to run, classes to teach, kids to raise. See the end of my Lao Tsu quote below.
7. I recently read Becoming Leonardo, written by Mike Lankford.  While Walter Isaacon’s Leonardo got all of the fanfare, this book delves into how Leonardo became Leonardo and the reviews across the board were better than Walter Isaacson’s book.  I get the sense Mike Lankford is more similarly programmed to Leonardo than Walter Isaacson.  Most importantly, he writes with great humility and thus accepts that he just doesn’t know for sure.
8. Researchers and practitioners may have inordinate incentives not to change a thing.  They may fear losing their grant money, being humiliated in front of their peers, or simply may not have the time, energy and inclination to stick their necks out.  So, never stop pushing for your solution!
9. Diversity is King!  Diversity of your genetic heritage, your microbiome, your thinking, your surroundings and peers…. OK, we have two kings now.
10. The same disease symptoms likely can be caused by dozens or more causes
11. The massive multi-trillion dollar digital and mobile infrastructure is built.  It took a long time, but it is built.  Thus, the rapidly increasing quality and shrinking cost of digital tracking of people, including diagnostics, sensors, and continuous feedback loops that can infer cause and effect is changing medicine.  This change is occurring in exponential fashion.  Beware the laws of compounding.
12. Therefore, the next ten years will be infinitely more beneficial to mankind than the past 10, save for crazy terrorists!
13. Back to Leonardo and thinking.  Leonardo was not a Michelangelo, who was more straightforward and prolific.  Rather, Leonardo was quirky, gay in a world that didn’t understand it and had an inordinate number of varying interests and endeavors; I believe he was greatly underappreciated during his lifetime.  But today, Steve Jobs and every other rock star tech CEO see him as a genius, their guiding light.  Not Michelangelo, Sistine Chapel and all.  My guess is that the world is full of geniuses that do not have a platform.  They are quirky, often introverts, ahead of their time, though only because the world can’t move that fast.  They don’t conform to modern society and many can’t be bothered trying.  But if we can create a virtual platform, one that makes communication and documentation easy, then can we get their help – get their brains and energy to solve these problems and not discover their work a hundred years from now.

 

THE LAUNCH OF THE P5 HEALTHCARE FOUNDATION

This last insight brings us to a concept that in 2018 we will turn into a reality.  P5 Health Ventures is launching a nonprofit, likely named the P5 Healthcare Foundation.  It’s mission is to make most diseases manageable based on everything available – built on the concept of N of 1.  This includes diagnostics, diets, exercise regimens, drugs, vitamins, herbs, acupuncture, mind-body solutions, lasers, surgery and everything else that is available today.  And of course, today is a new day every day, so the whole system will continuously evolve.  So while we wait for tomorrow’s promise, let’s save people today.  We announce this now, because we need your help even at this planning stage.  It must be a collaborative effort.

The details are still being flushed out, but the essence of it is that we expect to launch an entity that eventually will have three arms: a ratings agency that will review others data and verify it, a financing arm that will either commission new research claims that the advisors deem worthwhile, or further prove existing research; and third, an open-source decision systems software platform that will enable any practitioner to move their program or protocol on to it, track their patients and their outcomes and share with the world.  If done right as a full bore platform, it will enable drag and drop protocol creation and customization, easy sharing and annotating of research, and collaboration.  As a platform, it will have an open API, so we hope that independent people or firms will write apps to analyze and visualize data.  Call it the Wisdom of Crowds on steroids.  The good kind of performance enhancing steroids that is.

It will be International in nature.  The P in P5 is for western words, such as personalization, precision, performance, protocols, etc.  But we stopped at 5 because 5 is the number of elements in Traditional Chinese Medicine’s view of the body as a complex biological system.  The ancient Chinese and Indian traditions likely have the most to teach us.

Lastly, we hope that the rating agency can finally get their hands on and analyze the data from major medical institutions and others from around the world and give the transparency that everyone deserves.  This will be a very open, transparent effort so again, we invite you all to help.  It is no small undertaking.

Until it is solidified,  I do not know exactly what it will look like, but as per my Teddy Roosevelt quote below, I don’t want to sit on the sidelines and watch more friends, loved ones and great people unnecessarily die.  The collective world, populated by people with the right incentives can solve this better than big business and medical institutions acting like business people.  Their incentives are not sufficiently aligned with the patients of this world.

 

CONCLUSION

It has been an amazing ride getting P5 Health Ventures and now P5 Protocols off the ground.  And on January 5th, 2018, we launch our weekly newsletter that we promise will not be painful, but rather will be short and sweet, but still give the healthcare junkies the link into great content if they so desire.  Charlotte, who has worked with me for over 5 years, made P5 Protocols happen.  She arranges and manages the interviewee list, helps me edit the transcripts, figured out the RSS feed, got us up on SoundCloud and Apple Podcast, and otherwise manages my life, all while raising a family and running multiple 100 mile races a year.  Makes me think we are all under-utilized, or at least I am.  Sean Doolan, who formally joined us early this fall but with whom I have worked for two years is leading the charge on the newsletter.  He only runs 50 milers.  Somehow, I can’t get past those half marathons.

Since I am a quote nut, I will leave you with a few good ones that I keep over my desk in my home office.  They sit right below a giant ink painting from a famous Chinese calligrapher.  The painting is of a mandarin character that means strategic thinking, for the long-term.

The first quote is the beginning of a long one from Lao Tsu.  To save time, I left out a few lines:

Handle what is going to be rough when it is still smooth.

Control what has not yet formed its force.

Fragile things are easy to shatter.

Tiny things are easy to scatter.

Manage what is hard while it is soft.

Eliminate what is vicious before it becomes destructive.

A thousand miles journey starts from first one step.

Tackle difficulties when they are easy.

Accomplish great things when they are small.

The sage does not insist and therefore never loses.

People do something almost always fail at the point of success.

Only because of losing patience in the end.

The sage learns from the unlearned.

From that same calligrapher, I have that written on rice paper in a scroll.  I treasure it.

 

The other quote is from Teddy Roosevelt.  It has been over my desk longer than the first, but only because I discovered it first:

Far better it is to dare mighty things, to win glorious triumphs, even though checkered by failure, than to take rank with those poor spirits who neither enjoy much nor suffer much, because they live in the gray twilight that knows not victory nor defeat.

 

As to your health, both of those quotes have profound implications.  TR says get in there.  Or as I recently said to someone looking for advice, go find life or it will find you.  As per one’s health, go after the problems before they turn into something big.  If you wait, it or they will find you.

2018 year will be a big year for us at P5 and thus we hope it will have the positive impact on others that we zealously seek.

My dad used to say: To you a healthy, happy and successful new year, in that order.  But, after I saw the statistics on how long happy people live, I would put happy first.

Never ever stop asking questions until you get answers you think and feel make sense.  Don’t ever let stagnation creep into your life.  And stay relentlessly curious, open minded, adaptive and on the move!

So again, I wish to you all a happy and a healthy new year!