Health Entrepreneurship: How to Really Make a Difference

Health Entrepreneurship: How to Really Make a Difference

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- Good afternoon, everyone. Hope everyone is safe and well. And welcome to our speaking event today about Health Entrepreneurship and how to really make an impact. My name is Kaveh Khoshnood I'm an Associate Professor at Yale School of Public Health the Partner of Epidemiology of Microbial Diseases. And I'm the Faculty Director for Innovate Health Yale a social entrepreneurship program at our School of Public Health.

Our featured guests today are Roger Barnett the Yale College alumnus from the class of 1986 and the Yale Law School alumnus from the class of 1989. Roger is the Chairman and CEO of Shaklee Corporation. We also have Chris Larsen who's the Co-founder and Executive Chairman of Ripple. Chris and Roger are leaders in their industries and we are excited to have them here today. They have partnered together to make generous gifts that helped launch the School of Public Health Rapid Response Fund early on in the COVID 19 pandemic. Those funds have provided critically needed funding to researchers working on pandemics frontline.

I'm not now let our two other discussion hosts, introduce themselves Howie and Fatema, Howie. - Thanks, Kaveh and thanks all of you for coming here and for our guests, Chris and Roger really appreciate you joining us for this. I'm Howie Forman, I'm a practicing diagnostic radiologist and also the Director of the Healthcare Managing Program in the School of Public Health and a teacher of policy in the Yale College. And I'll turn it back over to Fatema.

- Hey everyone, thank you so much for joining us. My name is Fatema Basrai. I'm the Assistant Director of Innovate Health Yale and the Innovation Manager for our Sustainable Health Initiative. And really excited to lead this conversation with Roger and Chris and Kaveh and Howie as well. So Roger, Chris, thank you so much again for joining us and taking time out of your very busy schedules.

We'd really like to get started and kind of hear a little bit about each of your personal career journeys. So my first question is what is the story of your professional career and how would you best describe the work that you do today? Either one of you feel free to jump in. - Roger, go for it. - Okay, well thank you Fatema.

Thank you, by the way everyone for both watching and for what you do in the field of public health, it is never been more important. And so for you to devote your time and energies to that is a great gift to all of us. So I think if I were to describe my journey of my career it is a journey, a kind of meandering wandering one that at the time I just did things that I was passionate about and they seemed fairly random, but looking back they all fit into a pattern. And at the end of the day what's driven me through that is sort of a curiosity, an element of science and a desire to help people.

So when I was in high school between high school and college, I went and I lived in the bush in Africa kinda to do animal behavior research. And then I studied wheat genetics in Israel. And I spent my senior year at Memorial Sloan Kettering doing work on leukemia research. And then I flipped a little bit. I was actually in New Haven when I was at the Law School and an alumni named Bill Drayton came, he founded an organization called Ashoka, and he talked about this idea of social entrepreneurship and he coined that term. And it was really a pivotal moment for you, so I encourage you by the way, to go to different lectures while you're in New Haven take advantage of them because you never know when someone's gonna give you an idea that really motivates and inspires you.

And I think the question there was to sort of segment out between NGO, nonprofit work and profit work, and the art to these two distinctions of these different worlds. And the question really is how do you make an impact? And being able to have the same characteristics as a private sector entrepreneur, vision, charisma, persistence, but just for public sector goal is how he defines social entrepreneurship. And again, I've seen this distinction between NGOs and for-profit collapse a little bit, and I know we'll talk about that later in the session, but it got me going into a journey of saying, okay I wanna go into business and use that as a vehicle to change. And being an optimist and somebody who wants to make an impact, I sort of looked in the good in everything I did. So I started in the beauty business and I'm like, well I'll make people feel good about themselves and that's good. And then eventually I got into the health business which is the business that I have now.

It's one sort of the pioneer of the nutritional supplement industry but it uses a peer to peer network or company to educate people about healthier choices and decisions and delivers convenient product solutions to both make people and our planet healthier. And once you're involved in health you realize how transformative that is, and I've been doing that for the last 16 years. And so when I look back my time where I was doing these little scientific things helped me work with our research and development scientist and understand how to interact with them. My travel internationally allowed me, we have a global business today with 2 million people around the world that represent us, allowed me to understand the common elements between humans.

But essentially health, I just feel before the pandemic we had to maybe make an argument or explain why it was central. I've been talking about the centrality of health for decades, but right now it needs no explanation. And I think it has created incredible opportunities and incredible challenges, and with all these challenges and disruptions creates a lot of opportunity. So anyway, I will let Chris speak as he has an incredibly interesting, Chris is one of the great entrepreneurs that I know and I think you'll enjoy hearing from him.

- Oh, well, thanks Roger. And Roger is a dear friend, just a fantastic guy, and just an honor to be on the same screen as him, I wish we could be in person. Al right, and I also wanted to thank Yale for all the great works that they've done. You guys really stepped up here with this crisis, this pandemic, and you showed great results for the relatively modest amounts of money that it takes to get things rolling. So tremendously appreciate everything you guys have done.

So a little bit on my background. So over the last couple of decades, I've really been focused in the financial technology area. We like Fin Tech a lot because we really see kind of the access to best of finance as being one of the three core things that determines whether or not you're successful in the world today, right. And really is around access to healthcare, access to education, and access to finance.

I mean, I think those are really basics. And you've had a real problem in the world of finance, around access, and around cost, and around fairness and so we always thought with the advent of the internet that that was gonna fundamentally break down these barriers. I think what we found out actually is finance is kinda one of the slowest areas to kind of evolve. The first dot-com wave you saw applications developed but they were really trapped in individual countries. U.S. was different than Europe or Japan for example. The thing that's really exciting now is I think we're seeing the first kinda waves, what we call an internet of value kind of globalized finance through the web.

A lot of that's being driven by blockchain and obviously the company that I just, I'm so excited about obviously Ripple it's just that it's involved in the global reordering of infrastructure around finance. And at its highest level we've sort of see this as completing globalization, kind of the third leg of the stool, right. So globalization doesn't work unless you have a global infrastructure for data, for goods.

We have that obviously with the internet and data we have that with globalized shipping. You can ship a shirt clear across the world now for 4 cents, that's awesome. But until now you didn't have that flow for money and finance and we think that is kind of really what blockchain and cryptocurrencies really represent. The other thing that we like about FinTech is it's really complex, right. So you actually have to weave together three completely different disciplines, technology, capital markets, and compliance and regulation.

All three of those things are complex, all three work on different cycles and in our opinion, that provides a ton of opportunity because it's really hard. It also provides the ton of difficulty and complexity. And for people that are keeping up on the news and all the current events you will know that Ripple is now involved in a really intense fight with one of our key regulators, the ACC, on how you define a currency or a security. We think it's a really important fight and in some ways it's frustrating because this was already made clear.

The currency that we use was made clear that it was just that a currency by Obama's treasury in 2015 five years ago, and this thing has operated for eight years now. But I think it's an example of how a lot of these technologies and this healthcare and in finance kind of move well ahead of where policy and regulation is. So those sometimes are fights, hopefully you work together, but sometimes a fight is necessary and we're very confident about our position there, but it's exciting in that way. The other thing I would say is that, and I'll stop in a second here, we love infrastructure plays so I think the world really needs that. So there's lots of ways you can contribute, but setting up a new infrastructure that will enable billions of people to participate in very low costs, in finance, or in healthcare, we love that kind of stuff. And I would also give, people ask for advice sometimes when starting businesses, don't forget that enterprise.

A lot of times we just focus on the consumer because it's kinda right in front of us but there's so much going on kind of below the surface in enterprise and that's where we're focused on as well, so we really like that. And that took me a while to learn that, my first two companies were consumer focused. Anyway, I'll stop there, but again, really really excited to be here and thanks for what you guys are doing. - Thank you so much, Chris and Roger, great insight.

So my next question is what does health entrepreneurship mean to you? - Maybe I'll start with this one. So the definition of an entrepreneur is actually technically somebody who owns their own business. And it's used as a phrase entrepreneurship or entrepreneurial is used as also kinda like a mindset. So within our company, for example, I keep trying to get all of our employees to think in an entrepreneurial way. And I use that a lot and then people are like, well, what does that really mean? And I think it's a question of acting in a way that is if you owned the business, where you basically instead of when you see a problem you don't just identify the problem you try to figure out a solution for it and be proactive about that.

And I think in our healthcare system we're going through massive change. I think that the dialogue it's only really recently that the concept of equity in our healthcare system or the inequity the structural disparities in health outcomes and how we cannot have an equal and just society without having equal access to the same kind of healthcare, and it starts with all these social determinants as well. So it's a whole ecosystem of how to get it there.

Our healthcare system in the United States, we're number one in terms of absolute dollars, we're number one in terms of GDP, we're like 26th in delivery behind Costa Rica and so there's something very wrong. I think in part there's the inefficiencies of the system, I think in part there's too much focus on waiting till people get sick and not enough on prevention. And so this dialogue now with the pandemic has just shown such a bright spotlight on inequities and also structural challenges in our system that it creates very substantial opportunities, okay. And the lens that I come from it and everybody has their own angle. There's tremendous work that's being done through computational biology and other aspects of figuring out drug therapies and interventions, and understanding, and modeling, and computing power, and all that about how our bodies work. My lens is how do you engage, as Chris was saying, millions of people, tens of millions of people into living a healthier life that requires it's education, which is an information one and I think that's so important.

The internet science and the real science is diverging, and I believe very strongly in the role of the public health institutions in our country to communicate clearly with science-based, evidence-based information about choices and things in that way. And then the next part is that people are just beginning to focus on the power of the peer to peer communication between consumers. So our whole business depends on somebody who has been exposed to good things about how to take care of their health and sharing that knowledge and products to other people, peer to peer, consumer to consumer. And I think trying to engage consumers in this dissemination of information is just beginning to start.

And again, I know that some of the alumni or awards that are being given from this innovative health are doing fantastic things in different parts of the world. It's really incredible to see what they're doing. So I think the concept of owning a solution to problems in a world where everything is being disrupted and re-evaluated creates enormous opportunity for impact. And whether you're private sector or public sector, I'm gonna talk later I think that line doesn't matter, you wanna be self-funding, you have to create enough value that you don't have to rely on philanthropy to survive. And I think that is a model where you can increase your impact over time because you're self-funding and self-reliant, and in order to do that you have to create a value or a service that's not needed. And again, I think the lines blur between whether you're an NGO or private sector one.

But so anyway, health entrepreneurship I think is one of the categories that if you were to be an entrepreneur today there's so much room to do it on a global basis and not only create value, but economic value but impact. - Yeah, there's something I kinda wanna piggyback on what Roger is saying there. This idea that things are kind of jumbled up right now and well, you can be kinda be afraid of that, right.

It's like well everything is just chaotic and there's just too much going on but there's a tremendous amount of power than that. And I think that's why I'll be really optimistic about how things are gonna play out going forward. And if you're just starting out today I think why you have so much more opportunity than anybody has had in history. So kind of starting businesses, it's a for-profit business, but there's tons of room to be doing social impact at the same time. And I think every company should be moving in that direction and I think they are right. So, we have a social impact arm built in to our company.

We kind of think about product market fit both from profit and from is it gonna do good out in the world, right, so you can kinda mix all those things together. And I think for entrepreneurship in health it's the same as entrepreneurship anywhere. You're mixing again, the ideas around data science and being very focused on data and trying to be super pragmatic about that. But at the same time you're taking all these leaps of faith. What I like is this idea and this is what you've got everything at your fingertips now, kind of a wandering around, go into a subject wander about.

And the idea there is when we start our business we always talk about you're wandering in the desert, right. So hopefully you have enough water we're not gonna die in the desert. So you have to be somewhat focused and face the harsh reality, but at the same time, you can kind of just explore and piece these things together.

And then when you find something, and when I say find something, not just because of the data shows it, but because it grabs something inside of you and you just sort of know that this is a nugget I gotta dig on, go for it, don't be afraid that the data is not there. There are just tons of things that become really successful where it's not obvious what the product market fit is for some time. And I think, a lot of venture capitalists say, well, I've got a product market fit on that, that's hogwash. Just throw that out for the first couple of years, just wander around and then hopefully you get your product market fit before your C rounds, but you don't need it right away. And I think that's really powerful. So the trick there of course is ignoring the advice of people you respect, right.

So it's learning from your elders, learning from these geniuses, that's the data side but don't go too far with that. You gotta ignore the common conclusion otherwise things never progress, right, so you should feel free to be that way. - Thank you so much. - Let me just rub in - I love that.

Oh, go ahead. - On Chris, so that's why Chris is a real disruptive entrepreneur, right. It's actually really hard to follow that and ignore what other people are doing to see something. And I think Chris has had the fortitude and the confidence to be able to to go on an independent track.

I just wanna say for our audience to make sure that everybody understands what product market fit is for some of you who may not experience it. It's a phrase which is widely used in Silicon Valley to sort of say, when you're starting a business how do you know that the product or service that you're creating there's actually a demand. So you can sit in your dorm room or your room and you can dream up an idea but it doesn't mean necessarily that anybody's willing to pay for that service or it's solving a problem. And so venture capitalists will often say, show me evidence of a product market fit.

Then Chris is kind of counter-intuitive advice there saying that take your time a little bit of it if you really have passion and conviction on it, go figure it out and you can wander for a while. And a lot of the companies that you see today that are, one of the insights that I learned is Google and Facebook they didn't all start out with what they eventually became. So there is a lot of pivoting that goes on in it and evolves over time. So you start with one insight you may end up 10 degrees or 20 degrees differently or you may end up 180 degrees differently from that.

But again, I think in this area of the field of health which everybody's part of it, there's plenty of room to start, innovate, pivot, and figure out. But at some point you will sort of have to make sure that your service is filling a demand and a need for it, and that's what, for those that aren't as steeped in the language of startups that's, I just wanted to explain that to people. - No, that's really a great point. In fact one more nugget which I always try to latch onto and is important.

Silicon Valley uses were disruption a lot and I've actually learned to hate that word, because it's a negative word. It's like breaking stuff and I think we all know kind of move fast to great things that probably doesn't work all that well in healthcare or in finance, right, maybe in gaming and that sort of thing. So we like to think of it in terms of being builders rather than disruptors, 'cause that's always good, and that actually plays better in many parts of the world as well where disruption probably doesn't sound like a good thing. - Thank you guys, that was really, really insightful. And as I'm looking at the attendees I see so many current Innovate Health Yale Award Winners, past and present watching. So this question I'm hoping will be of interest to them and to the rest of our audience.

So what do each of you look for in an investment and what are some current areas of interest for you? - Chris why don't you start. - Sure, so, and again kind of combining some of the for-profit with philanthropy. So some of the areas that we're really focused on right now, refugee solutions, my wife was a refugee. So we're really focused on how can we encourage innovative approaches to the refugee crisis. Never been more refugees in the world than we have today and there's never been more and more closed doors.

So we have to have a competition going on to find what are the new innovative solutions that should get funding. And we've committed $10 million to that and hopefully then that will be to others contributing once we find the winners or a winner of that competition. And we can talk a little bit about competitions in philanthropy as well. I think we'll talk about that a little bit later, that is kind of one route we think is pretty helpful. Other areas are in eye issues. So sort of glaucoma, particularly in some of the poor parts of the world.

We like that one because that's a real problem, people go blind, I mean, fundamentally it changes your lives, holds back families, and it's actually really easy to solve at very little cost. It's kinda like the malaria problem. I know many of you might be aware, but you know a thousand people are dying every of malaria and you could probably solve that for five bucks on the malaria nets. So those are our areas. A big area is also around climate change.

And what we're looking for there is things that can scale big enough to solve the problem. So we love mineralization and we also like the mineralization, because you can get up to get your tons of carbon captured and put away forever and things like aggregates and that sort of thing. And that's a big need we can't just go to our neutral we have to get a negative.

But the other thing we like about that is there's lots of projects that have decent ROIs, they can be for-profit, some of them can be philanthropic, but they're kinda being shunned by traditional VCs and green tech. And it's because those VCs were burned 10 to 15 years ago by that first wave of green tech investing, unless you invested in Tesla, obviously. So too many other green tech we see they're just focused on sort of software and data and electrification and they're kind of staying away from the so-called heavy stuff like aggregates and concrete and the only thing that could scale at that level. So we liked that just because it's kind of ignored, so there's a social impact element to that but they also have pretty decent futures economically. So that's an area we like as well, Roger.

- Sure, so the general criteria for me is impact, and scale and sustainability. So those are the three things. And when I say sustainability I'm not referring to environmental sustainability alone as an attribute, is this scalable impact thing sustainable on its own? And I think if you wanna make a meaningful difference, I'm really trying to make a meaningful difference again, in the tens of millions of people if not hundreds of millions of people and so that's the scale component to it. And the sustainable part of it is kind of a requirement in that it's where my mind goes. I just believe in the power of business models to fund change, and my passion is marrying the two, marrying the impact with the benefit of a sustainable business model at the same time.

And then the other part of it is the entrepreneur. What I've learned from investing at the end of the day the idea can be great, the business can be great but if the entrepreneur is not great, it doesn't work. And sometimes actually one of my more successful investments was when Chris started his company I didn't even know what it was that he was going to do but I just had a philosophy of supporting friends and then other ones I prayed over the investment, and did the theory, and they just didn't pan out as well. So you gotta find a great entrepreneur.

And if you're looking to raise money as a innovate health thing I think the successful entrepreneur is the one that understands the essential part of value creation of that business. Let me see if I can provide a little more color. There is an overwhelming amount of stuff that will come your way, whether it's, and there's an infinite amount of choices of what you do in your business, but there's only a very, very, very small number of things that you must do right in order to create the value and if you don't do them nothing else matters. And I find the great entrepreneurs are the ones that understand intuitively what that is, and they'll relentlessly focus on moving the needle on that particular KPI, whatever that metric is. And not getting overwhelmed and distracted by all the other stuff that is nice to have but fundamentally irrelevant in achieving the impact.

And that, I don't know how, I'm trying to say, well, if I was listening to the audience how will I know how to get that right, how would I do? And I think may be it's just, I believe in writing things out as well, shorter is better. Like it's harder to write something short than it is to write something long. So like on one page, what's the impact that I wanna have. And Amazon uses this technique whenever they do a product launch or any kind of, they make people, before they fund a project, they make them write the press release of what would happen if success.

Just a technique to say, what does success look like. So make sure you know what success looks like, right. And then before you got involved in all of these, what are the one, two, maximum three things that will lead to that outcome. And just put them, if you have a desktop, laptop, computer, whatever, on your phone and put them in, put them so you're staring at them every day and you don't get sidetracked and you just make sure you're working on progressing those things.

- Thank you both. And we will keep the conversation going with Howie jumping on. - Al right, thanks for keeping the conversation going. This has been great to listen to. One of the things that strikes me is that both of you are enormously successful. And since you're roughly my age I would also say that you're quite young.

And so it makes me think of like, when I think of that even for my career what do I wanna do in the next 10 years? And how do I judge my own success given where you are right now, you're both very successful and if you did nothing else for the rest of your life, you should be very successful. But how accountable do you hold yourselves to moving the ball down the field, to use a sports analogy, how do you judge yourself, what are you thinking about, what do you wanna look back in 10 and 20 years and feel like you've accomplished? I can start with Roger or Chris whoever wants to go first. - So I think this is fundamental.

I have discovered that my level of happiness and satisfaction in life is very tied to the level of impact that I'm having, that's what drives me as a human being, I'm just motivated to do an impact at scale. So my measure of success is, am I involved in something and channeling my energy, my experience, my passion, whatever assets that I have into making a transformational impact. And there's the personal side, which is I'm married, I have three children, what are my relationships within my family.

And you can only be happy if those are in a good shape too, but from a career perspective the impact is really my yard stick. And there's various points of time in my career where I'm making a smaller impact or a bigger impact. And I just keep trying to figure it out how to keep going to scale more of it. And it's a never ending journey for me, it's a quest that will never have an ending to it.

But you start with what you do, then the question is, who do you have influence? And I always sort of said that, one of the great influences is convening power. Do you have the ability to convene like-minded people or people who can move through the combination of whatever they do in their life. And there's a question in the chat about networking. Very interesting I went to Yale for college and law school, I went to Harvard for business school, I never did business with anyone that I went to school with until only recently. And so the network there wasn't really a business network for me but the advantage of a network is that so many large institutions can move things.

So if you think of, if you wanna make a change on something, the ability to convene people. I was interested in the School of Public Health, Stan, awesome, great job in doing it. He came up with this Rapid Response Fund I call Chris. Like Chris is a super interesting, high impact, high IRI, a hundred times ROI investment on changing something.

But it's the power to convene people that you can do something with. So trying to figure out a problem that you're committed to, trying to be able to get to know others who can help share the impact, I know that's kind of what I'm just keep trying to elevate over time. - Chris. - Yeah, yeah, I think, it obviously changes with where you are in life, right.

So, I mean, honestly, the first thing that motivated me, my first business was kind of frankly the need for respect. I felt like my father wasn't respected as a super hardworking guy that kind of never really advanced the way you maybe should have, again he was a airline mechanic, the union guy. And that created a lot of kind of personal, like, I don't know anger or something like that, but I think what's important there is like that did help. So I think for someone starting out you kinda use what you have to motivate you. And if it's you're angry at somebody, you're angry at the world, or if you feel like you're not being respected enough, great. Kind of try to be constructive about it, right, that can obviously go in the wrong direction.

But that was the chief motivator frankly, for a long time. Now it's very different obviously 'cause I have what I need and I have kids and now it's very much on how would my kids look at my life 20 years from now, 30 years from now. Well, the nice thing there I think that's pretty aligned with kinda what you need to be doing in the world on impact and contributing.

It's kind of the great thing about having kids, it's pretty pure, and it's pretty aligned with they're the future. So in the philanthropic work and also in the company work, that is definitely the focus and when I leave this earth how will I be looked at. I think another part is kind of, did you make good on what you promised your team members and that includes your investors, your employees, everybody in your family.

Did you come through for them, did you handle setbacks with grace? I think those are kind of the key measures. - We're gonna combine some of the questions from the chat with some other ideas about what would you recommend to either your younger self or any of our students? I'm really pleased to see in additions here, as Kaveh mentioned, so many of our innovative health students, we have a lot of our healthcare management students our health policy students, many of our alumnus on this call. And as Kaveh pointed out this is just an amazing turnout for both of you. What would you tell your younger self? What are the skills and strategies you would recommend be acquired by our current students? And in Roger's case, since you went to Yale, what were some of the greatest lessons you learned while you were at Yale. And for Chris what were the greatest lessons that maybe you didn't use right out of college or even business school but that you came to appreciate later on maybe decades later.

And I'll start with Chris this time. - Sure, so I think back a kind of key influences, one individual stands out, Jim Collins, he was our entrepreneurship teacher at Stanford Business School. And he always used to say, ''cut the lifeboats.'' It's like look students, and the same Yale and Stanford, you are so fortunate like you haven't like zero risk profile. Like if you start something and fail, it's like, who cares? In fact, in today's world I think, people have gone through failures sometimes or more sought after for kind of the next investment. So I think we way way overestimate our risk profile as young adults with the kind of mind power, the kind of connections that everybody here has, right.

So I think that's the one thing, I would take that way back earliest I could in my life when I was even 15 or you know started my business then, but that didn't come until late twenties. So I think that's really, really important. I think in starting your business, it's like, okay, are you starting a product or are you starting a culture? And I would definitely weigh towards culture. And I know that's a little more difficult in healthcare because so much is kinda focused on the actual solutions, the science of the solutions, but I think if you look out there kind of all the really successful organizations they really build great cultures and those cultures can then kind of they can pivot or they can adjust the world is changing so fast, right.

That's probably more valuable than focus on a product that might completely change and new competitors and that sort of thing. The other thing that I do think having a co-founder is really important but only one co-founder. Three co-founders is like 3D chess, just impossible, right. And make sure you're really clear about who is a co-founder and who is an employee, right. As a co-founder you're equals and you have equal share. Don't donate this nonsense with one co-founder has this and one co-founder has that.

And if not, then they're overpaid and employed so being really clear about that, right. And set up your organizations super early, don't wait too long. So those are all kind of important things. And raise money when you can, right. Like this is a phenomenal fundraising environment we're in today, it can change in a blink of an eye so you raise it when you can.

- Yeah, I'll just say my friend Jonathan Rosenberg has a cartoon that he throws up whenever he gives a talk that says, ''please God, just one more bubble,'' Roger. - Well, I think my advice would be first get to know yourself. Figure out what motivates you and well, what you're striving for. 'Cause you're gonna put that huge amount of time and energy into anything that you do and you have to, I think be self-aware. So Chris was talking about respect as a motivation, mine was sort of early days about impact, some other people might be they wanna make money.

And I think those different pathways depending upon what motivates you. So you really have to get a clear sense of if you're unclear about some of your fundamental primary motivations I encourage you to spend a lot of time thinking about it. Okay, that'd be number one. I think the second thing is that there are, I think, two fundamental pathways to go down. And no one ever talked about this when I was starting out. There's an institutional pathway and an entrepreneurial pathway.

And institutions are incredibly powerful. When I talk about institutions I'm talking about large companies, large academic institutions, big multilateral organizations, right. They have the power and along with it comes a platform and there comes a certain level of respect and prestige and scale of resources in order to both convene and make an impact. So institutions require time, and whereas you can be, my first job I went to an investment bank 'cause I didn't know what I wanted to do and I wanted to go to the smallest place where like I found the most diverse amount of bright people and I went there.

And there's people that I was in charge, I became in charge of recruiting the kids out of college to be part of the analyst program and the people who came and stayed are now in leadership positions on the farm 20 or 30 years later, whatever the time period is. So if you stay with an institution, right, and part of that comes with bureaucracy and other things, you can grow and you get the power and leverage of that institution. If you go onto the entrepreneurial track you're a little bit more on your own. You generally will start smaller, you won't have this scale, you may not have the respect, you may not have the platform, there's a high rate of failure on one level, right, and it's very hard to navigate.

It's a one-way street in my opinion, you can go from the institutional to the entrepreneurial than it's hard to go from the entrepreneurial to the institutional. So think through that a little bit. In general, you can try by starting in an institution, you can get training. A lot of the more entrepreneurial ones didn't have the patience to stay because you kinda gotta be in your hierarchical element and there is limits to how far you can grow. And so, but no one really framed it for me that's a lot of advice I give friends, right.

You have to have a high degree of confidence that you can be an entrepreneur and you can go out there on your own. It's hard, it's just hard. It's great, but it's hard. Okay, so I think that some of the lessons and I my only advice to you when you're in for those of you that are on the Yale Campus today just make sure you're devoting as much time and energy to the students and other community members that are there not just in the School of Public Health, but across different functions as you are in the classroom or the work that you're doing. At the end of the day, the classroom and the work that you're doing in my opinion is not as meaningful as the conversations that you have, the stimulation of the ideas, the formation of your thoughts, the self-reflection of what you wanna do, understanding different pathways and opportunities. I mean, the great thing about Yale and Yale is privileged institution, but it's true of many different schools but especially Yale is what makes it special is the student body.

I mean, the great faculty create an environment to attract great students. And the students are your peers, will push, inspire, motivate, reflect what you wanna be and not wanna be and I just would spend and devote a lot of time and energy to meeting everyone you can. - Right, so getting back to that question from earlier. The network does matter and it's not just about networking but it's about just learning from each other and the co and extra curricular activities that you share. I'm gonna ask my last question 'cause we're gonna run tight on time.

But one of the reasons that I've even come to know you is that you've both been generous with Yale during the pandemic, as was mentioned earlier in the conversation. What has COVID taught you and what do you see as the role of entrepreneurship and philanthropy after we get past this pandemic? And I'll start with Roger this time. - Well, I mean, there are many thoughts of COVID. I don't think there's a new insight from COVID, I think it's just bringing to the forefront things that we know right.

One, time is precious, right. You just don't know when something comes out of the blue and disrupts everything for everyone. And that's number one.

Number two, health is central to human existence, without it we don't have anything. So those are things that we're aware of. I've devoted the last 16 years of my life to health so that was an easy one that I was activating. I think that time is precious, you take for granted a little bit, right.

So I think that's a healthy reminder. Human connection the importance of it, how do you foster it and how do you create it when you don't have it you kinda recognize that it's important. With respect to health entrepreneurship, I mean, again, I think what COVID has done in every business is accelerate the transformation to the digital world by at least five years.

And that acceleration is permanent. I mean, I'm still working at, we're re-imagining every aspect of our business. And we create community with people and we're now really thinking hard about how do you create community online. But I think, and there's a question in the chat about digital hub. The concept that, you carry, sorry, you carry this with you, okay.

And you wear this thing on your wrist. The data that it's collecting, the comparison it's just endless and now, how do you disseminate things efficiently? How do you get information and information is key in healthcare, right. So the opportunities for being entrepreneurial in today's world on a health are greater than at ever at any point in time because we are entering this digital phase and analog companies are super slow to transform. It's just a function that very few are truly nimble to go from one business model to another one.

So the embracing of digital is so important and so transformational that people start digitally native in their thinking, and their concepts, and their delivery mechanisms, and everything are just able to take advantage and move into the marketplace further and make a greater impact and create more entrepreneurial opportunity. - I agree, Chris. - Yeah, I would say it taught some new things that kind of highlighted how philanthropy has to sort of work, sort of a mixture of many things. The biggest thing it taught us is to be flexible. It was an immediate crisis, you need to step up right now and we push dollars out the window right now. We put aside some other long-term things that were sort of just chugging along on, because the food banks needed major dollars, right.

Small businesses needed major dollars so kinda shifting over there. So being very flexible, which isn't data-driven by the way, so, and that's another important point. It's great to be data-driven and in philanthropy but sometimes you kinda have to throw that out of the window and just sort of adapt, move, and like shove funds out of the door. Another reason why we're fairly skeptical on the giving pledge because the data shows, and there's data on that one, not enough money is actually going it's being pledged, but it's not getting out there, it's like 1%. has some great information about that.

We need to get the money going right now. That said, there are certain areas where data is super important in the pandemic and in other areas. And I'm gonna borrow from a phenomenal organization called, really recommend you guys checking out that site.

Great information about how to be an effective philanthropist. But, they give the example of people that want to focus on animal safety or animal rights. And they use the example of, there are 30,000 times more animals in factory farms than animal shelters. Their animal shelters get 50 times the philanthropic dollars. So that's a kinda very simple data shows like, what are we doing here, right, so I think that's important to think about.

And then finally, and this again, Open Philanthropy says great information about this, don't forget about policy as philanthropy. And I'll give an example in California we got big fire crisis so we gave a $100,000 to the folks behind proposition C, which was going to give $20 million to Marine County for fire prevention activities, right. A $100,000, that was almost the entire campaign, the thing won by like a couple of hundred votes because I had like two thirds. - That's right. - And that is worth $200 billion. It was a $100,000 that drove $200 million to the public sector to fight fire, the fire crisis.

So don't forget about policy as philanthropy as well as things like talent. That's another area, it's not money, it's getting talent in the right places. - That's great, I think we're gonna open it up now to take some of the questions. And since all of our panels can see the questions I would ask you even to look at which questions you might wanna answer because I think they're all good. And I'll go with, I think Roger has been paying more attention to the questions than Chris, so I'll go back to Roger and give Chris a chance to look at other questions and turn it over to Roger. And then I'll let Fatema, and Fatema, sorry, and Kaveh also chime in.

- Well, first let's make the call out for more questions, okay. 'Cause a number of them we've answered them about, I wanna answer the question of luck. Somebody asked that question of is luck to do with your success. I have a very clear perspective on this one.

There's nothing better than luck, okay, luck is awesome. And most people who create sort of massive amounts of wealth or something, there's a high degree of luck on top of great skill sets and all that, you just have to be in the right place at the right time to be able to do that. But I really believe that, part of what can be viewed as luck is being able to recognize a moment and being prepared to do so, okay.

So I was in school until I was 27 years old and I'm grateful that my parents helped provide an education for me. I had an opportunity and a lot of different summers to try a lot of different things, I worked in different countries and I did different activities but when I saw an opportunity eventually, right, I was able and ready to jump in and I went from the institutional side to the entrepreneurial side. So you have to keep looking and experiencing things, but you have to have that moment like build up your skill sets, learn as much as you can, and then keep your eyes open that you can kind of run. So in one way, it's lucky there are things I got exposed to but I also try to just continuously be out there.

So and you can make a certain amount of your own luck and then if the gods of fortune shine upon you, accept the gift and embrace it. So that was just the one question that I didn't address yet. - If you don't mind, maybe I'll ask one question that I see. And it's the role and contribution that the academic community could contribute to health entrepreneurship. Right now, colleagues at Yale are having a very active conversation about what we can do about the climate change.

And I'm just wondering whether you have any experience or thoughts about the role of academic community in responding to the climate related issues. - Yeah, I think it's so, so important. So as I started getting into the climate change and started kinda going down the rabbit hole and just consuming just tons of information, but most of the information was from universities, research centers, I mean, just this amazing work that academics side kind of, you could tell they slave over it, and then you have to put these hundreds of pages of just tremendous work online that you can get at your fingertips is like insanely helpful, right. And then you feel like you can get smart enough about something and then reach out to some people cited in those studies, so that's tremendously helpful. That's how we kinda went down the path into carbon mineralization, which again I think is an area we really have to focus on. And again, that VCs are sort of shying away from, again back to that idea that there's another question about how do you know you should ignore the advice of experts.

Well, that's one way where like really smart people, but look there's something that they're afraid of for the people they are raising money for that they're shying away from something that's so obviously the key part of the answer and academics can really help highlight those areas. Academics can help them in things like direct air capture, which it also has this weird kind of anti-politically motivated thing because maybe oil companies are too interested in it, so therefore it must be bad, right. You know that's something academics can shatter that notion, right, so that's really important. And then finally love to see academics working in the field more closely.

Again, back to fire suppression, big problem out here in California, we've now gotten you see Berkeley involved with the private sector trying to come up with new devices for warning people about incoming fires at the micro level, right. Because the big problem, false alarms, and they're working with the County fire chief. So you've now got an individual philanthropists. You got some really interesting people in the room, each brings a different perspective that's how magic happens, that's how real innovation happens. And that's just great to see, I'd love to see like, a hundred X more of that going on.

- Fatema, do you see some questions you wanna bring up? - Can I address the climate one as well? - Sure absolutely. - So, the academia can provide, our company was the first in the world to offset our carbon emissions to have zero carbon footprint, we did that in 2000. The science at the time, it was more instinctive and intuitive rather than the science of it. Then we got into this whole debate between is climate change real or not trying climate change real. So I think to bring in the science that Chris was saying, but I wanna push academia.

I mean, again, I feel that my conversation when I first met Stan and I think the school has been doing a good job on improving on this is delivering the science and doing the research and not communicating it broadly is that old sort of decar question, is a tree falling in the forest and no one hears it, did it occur or not? And I think what happens is that the role is critically important about these research and these nuggets, but I think instead of having to get somebody like Chris to have a team of people dig through all the research to find the nuggets that are relevant, I really think academia, and I'll encourage everybody on this Zoom, has to understand how to communicate and disseminate the idea. And you have to embrace social media, you have to embrace the tools of dissemination of information that are relevant in today's world. And you have to figure out how to get influencers of time to adopt the science, the research, and all that and you have to deliver them in sound bites to make an impact. And the old days of doing scientific symposiums, and the whole metric of success is publishing in peer review publications that nobody reads. I know I'm gonna be a little harsh about that.

People do read them, but at the end of the day, the world is being influenced by, I call it internet science and communications, and we need you. Academia needs to find a way to start to communicate broadly. So for those who are in policy roles it's not enough to come up with a policy ideas or do the really insightful research, you have to understand, and work, and partner with people who can broadcast it in a digestible form that is available for mass consumption, that'd be my push. - Thank you for that.

- By the way, if people have any things that they're looking at businesses at all there. If they were to send it to somebody on this forum Kaveh, who could they send it to and maybe Chris and I would look at them, if they're interested. I see something from Wendy Prices doing something which is trying to create community online, I think it's very fascinating. I'd love to get a sensibility of some of these ideas that people are doing, just to understand it and perhaps it could be of interest that we can could help support without making a blanket commitment on the phone.

But I just be wondering if you could gather them and share with us later. - We will absolutely do that. - Yeah, I'd be happy to collect those.

So thank you, Chris and Roger for that generous offer. So if you're listening and you're interested, you have an idea, if you want to share a brief scope of your idea and send it to my email, I'll put that in the chat. Feel free to do that. - Yeah, but they just have to agree to ignore our advice. (Roger and Fatema chuckles) - Yes, that's gonna be the test everyone.

So, and Roger, Chris, any last words before we wrap up. - Be optimistic things will trendy well. - I just wanna say that everybody who's listening to this is likely in one of the most interesting dynamic places to be where you can have the dual benefit of making change and helping people, and create business opportunities at the same time if you're doing it so thank you for your dedication to this. The pre and post COVID world in the field of health is transforming all, it's like pre and post internet in the world of existence. And I think the acceleration of all these trends just means that what you do is important.

So I'm sure somebody and a number of you that are watching this are going to create stuff that didn't exist before that are gonna make a real difference whether it's on the policy side, on the administration side, on the entrepreneurial side, on the innovation side, like just go for it, it's worth it. And then just try to think of sustainability. How do you sustain it over time so that you don't have to keep asking to have others believe and support you the whole time? Like, go try to create that but I'm excited to watch what you do. I wanna thank the school. But I wanna thank Chris, my friend for being honest, it's a great listening to him I've always learned when I do that.

And I wanna thank Innovate Yale for existing. I think it's just truly a distinctive feature from the Public Schools of Public Health. I think it's an awesome opportunity that we should scale and get more people involved in it. And I'm just grateful for, again I believe everybody who's part of the old School of Public Health is doing it for a reason that they're inspired by the mission of the school is to make a transformational impact. Take advantage of the resources at Yale at large, like there is a fantastic set of people in SOM, and the law school, and the medical school, and the environmental school studies and undergraduates.

And everybody will want your engagement because right now you're the center of the universe which is how it should always have been but now it finally is. So good luck with everything and thank you for the opportunity to talk. - Thank you so much. - Thank you, thank you everybody.

Thank you Roger, - Thank you everybody. - Thank you Chris, thank you everybody. - Have a great day. - Take care.

2021-02-07 14:13

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