I honestly think it’s going to blow up. But there’s a problem–

Monetisation.

My worst nightmare is becoming a MedEd resource. Medics hate paying for things, but love thousands of hours of work bundled up into a free resource. Maybe with one of those ‘buy me a coffee’ links at the bottom (at a push).

So charging medics is a no go. And honestly, the whole point of this project is to open up science — making another paywalled resource is hardly achieving that.

So here’s what I thought: Who has money? Like lots of money?

Investors.

OK cool. What can we give investors? Well investors in the Life Sciences need to understand the science around their investments, right?

The Minimum Viable Product (MVP)

Business books taught me an important lesson: Test an idea –> then build it.

So I made a fake version of what I envisioned, put it into a 90 second pitch and sent it to 6 investors.

The Reckoning

You know when you have huge expectations for something… and then it just flops?

Yep.

The feedback was pretty negative. Some was overtly negative, like what the f**k is this? And why are you emailing me on a weekend, loser?

The rest was dressed up nicely, but basically said the same thing.

Learning Points

After a couple of calls and emails back, I worked out where I missed the mark:

1) My core assumption that Life Sciences investors are interested in reading research, was wrong. They don’t make investments by reading papers and then contacting relevant companies. They network, go to events and are introduced to interesting founders. It’s more relationships than science.

They might do some scientific due diligence, but this doesn’t really go beyond a Google Scholar search.

2) There are some investors who are really clued up on research. But they’re often PhDs/medical doctors themselves. They don’t need a 200-word summary filled with emojis. They can read the research themselves.

3) Even if they did need someone to consolidate the research for them (which they don’t) — they would need different types of information. More like a high-level document summarising the whole field, with tables comparing different interventions.

4) Some of the ballers in Private Equity do outsource scientific due diligence, but they would just pay a Key Opinion Leader — not mess about with paper summaries.

What's Next?

I still think this is a really good idea. But I’m also really glad we got this feedback before putting loads of effort into it.

There’s a Henry Ford quote I really like:

If I had asked people what they wanted, they would have said faster horses.

I think with the right execution, this could be something awesome.

//

Want to hear from me every Sunday? Sign up for my newsletter.

I've been dying to interview Ali — and it wasn't easy, seriously. In this episode of the Big Picture Medicine Podcast, Ali gave his advice on personal branding, productivity and doctorpreneurship. Here are my notes from the interview. I've paraphrased for clarity and brevity.

If You Had To Restart From Scratch — What's The Plan for the Next Year?

I would make a personal website under my own name and start writing online. I'd write about two things:

1) Write notes on all of the articles and podcasts that have resonated with me. I would create a curated one-stop-shop for people to find interesting book and podcast recommendations.

2) Summaries of interesting papers in psychology. Most medics can condense academic papers into bitesized bits of information for a general audience.

Create Once, Shop Multiple Times

This is Gary Vaynerchunk's advice. Create content once — and disseminate into multiple forms. For example, one long blog post can be clipped into multiple Tweets and a script for a YouTube video. That video can then be clipped into multiple posts on LinkedIn, Instagram Stories and Snapchat.

Do You Think This Formula Would Work For Everyone?

I can't imagine a universe in which it wouldn't work. You need two things: faith and consistency. Provided you have both, It's absolutely bound to work. I can't imagine a world in which a well put together blog with nice summaries of books and podcasts doesn't succeed. Trust the process and do it for two years and you're bound to be successful.

What Does Consistency Mean? How Often?

At least once a week. Start a weekly email newsletter to keep yourself accountable. Sometimes your best content will come from when you're scraping the bottom of the barrel.

Scraping the barrel for content one Sunday, I made up a term called the 'write off principle'. Except to make it sound like a wise German philosopher had made it — I called it the Reitoff Principle. Weirdly, it really resonated with people and blew up.

You won't be able to predict what resonates with people, but by putting out content every week — you'll build a body of work which increases your chances. David Perell calls this the serendipity vehicle.

If you publish content (blogs, podcasts, videos, etc.) regularly, people will discover you and initiate unexpected opportunities. They’ll open doors you didn’t even know existed.

David Perell

Email Sounds Archaic — Why?

Everyone should have an email newsletter and build a mailing list. On every other platform, someone else owns your audience. One change in the YouTube algorithm and my audience is gone. An email list is yours though. In the future, when I want to launch a book — I have a mailing list of tens of thousands of people who want to hear from me.

If you could deliver one 6-week course to medical students — what would you teach?

Week 1: I would teach good design. Just knowing the basics adds so much production value. If you look at posters at most medical conferences — they look awful. This is because people use 1) bad colours and 2) bad typography. Spending an hour researching these will make everything you do for the rest of your life 'look pretty'.

This relates to the law of diminishing returns. When learning a new skill, small amounts of initial effort will result in disproportionately large results.

Install the Chrome extension Muzli. It shows design inspiration every time you open a tab. This will help you develop your taste so you can spot good design. That's the first step.

Week 2: Next, I would teach video editing. I think video editing is the new coding. Applications increasingly ask for video submissions — and you can set yourself apart. It's a basic skill that's very easy to learn.

Weeks 3–6: I would get everyone to set up a personal domain and an email newsletter. For the rest of the four weeks, they would send out a newsletter every week.

Do you recommend monetising your hobby?

I'm a big believer in monetising your hobbies. In addition to the hobby, you then have the added fun of trying to make money from it. You learn so many skills from doing that. So yeah, I'm very bullish about monetising your hobbies. Making your first dollar on the internet feels amazing.

But I think relying on making money from your hobby is when it goes wrong. At that point, you're spending 90% of your time on the business side and only 10% on the hobby.

Desert Island Book

Show Your Work by Austin Kleon. It's what convinced me to launch my blog and YouTube channel.

Forget about being an expert or a professional, and wear your amateurism (your heart, your love) on your sleeve. Share what you love, and the people who love the same things will find you.

Austin Kleon

Think About the Game You're Playing

Think about what game you're playing. A lot of medics spend their lives playing the academic game. “If I just get good results at school, and then do well at med school and then get that cardiothoracics training post — then I'll be happy”. But if you speak to most ST3 cardiothoracic surgical trainees and ask them if they're happy and fulfilled — are they?

Question — why are you playing this game? Is it worth pissing away years of your life for the end goal? (Maybe it is — in that case go for it — but at least you've thought about it).

With a lot of board games, there are different victory conditions. Either you can have the highest number of victory points, the biggest army, conquer the most land...

A good piece of advice for those board games is — always look at the rule book and rethink the victory conditions. Is there another victory condition that I could be optimising for instead?

Did You Enjoy this Article?

Listen to the full conversation here. You can find Ali on Twitter @AliAbdaal. You can find me @MustafaSultan.

Want to hear from me every Sunday? Sign up for my newsletter.

//

Want to hear from me every Sunday? Sign up for my newsletter.

I was fortunate enough to interview Pearse on the Big Picture Medicine Podcast. Here are my notes from the interview. I've paraphrased for clarity and brevity.

Just Look For Cool Stuff

If you see someone doing something cool — in many cases, those people are approachable and you'd be surprised at how far you can get by just sending an email. Pearse started a fruitful collaboration with DeepMind by taking out a month of LinkedIn Premium and sending Mustafa Suleyman a message.

One Major Area

Pick a major area of expertise and gain a working knowledge in multiple other areas — just enough so that you can have meaningful conversations with people in those areas. Pearse has picked up working knowledge of statistics, health economics and machine learning.

A doctor with some knowledge of coding is more useful than just a world leading doctor, or just a world leading coder in terms of translation. This concept relates to Scott Adams' career advice.

Life is Too Short to Work with Assholes

You may find yourself in the position in which you can work with a world esteemed professor who has a reputation for Nature papers or the like — but of also being an asshole. Just don't do it. Just work with people who are cool and you'll enjoy yourself and be more productive.

This loosely relates to Max Joseph's excellent short film: DICKS: Do you need to be one to be a successful leader?

One Regret

I think back to all of the time I wasted learning operations I would never perform again. If I could have spent a couple of those years doing a data science degree I would.

Books

Originals: How Non-Conformists Move the World by Adam Grant. Grant finds that there are two paths to excellence: originality and conformity. Child prodigies (usually) don't become great originals because they follow the conformity approach: extreme repetition and practice over original thought and creativity.

Although child prodigies are often rich in both talent and ambition, what holds them back from moving the world forward is that they don’t learn to be original. As they perform in Carnegie Hall, win the science Olympics, and become chess champions, something tragic happens: Practice makes perfect, but it doesn’t make new. The gifted learn to play magnificent Mozart melodies and beautiful Beethoven symphonies, but never compose their own original scores. They focus their energy on consuming existing scientific knowledge, not producing new insights. They conform to the codified rules of established games, rather than inventing their own rules or their own games. All along the way, they strive to earn the approval of their parents and the admiration of their teachers.

Originals by Adam Grant

Medicine, unfortunately promotes conformity. Entry requirements, medical school exams and specialty exams mean that you can never go too off-piece. Then by the time you become a consultant you're just tired. You have no more energy for originality.

But this doesn't mean taking reckless all-or-nothing risks either — which is sometimes perpetuated by myths of successful originals 'dropping out of Harvard'. Grant finds that instead, great originals create a balanced risk portfolio. They take risks but take steps to mitigate them.

And what about Bill Gates, famous for dropping out of Harvard to start Microsoft? When Gates sold a new software program as a sophomore, he waited an entire year before leaving school. Even then he didn’t drop out, but balanced his risk portfolio by applying for a leave of absence that was formally approved by the university—and by having his parents bankroll him. “Far from being one of the world’s great risk takers,” entrepreneur Rick Smith notes, “Bill Gates might more accurately be thought of as one of the world' greatest risk mitigators”.

Originals by Adam Grant

The Patient Will See You Now by Eric Topol. This is Pearse's desert island book. It's a book about the future of Medicine which is grounded in patient benefit. “It's got loads of cool stuff in it... but you can really tell that he's a working doctor and would do absolutely anything for his patients”.

Did You Enjoy this Article?

Listen to the full conversation here. You can find Pearse on Twitter @pearsekeane. You can find me @MustafaSultan.

Want to hear from me every Sunday? Sign up for my newsletter.

//

Want to hear from me every Sunday? Sign up for my newsletter.

One of the judges was a venture capitalist from California. At the open, he asked a roomful of ~100 nervous students to pitch our initial ideas. I’d later find out amongst one of many eccentricities, he carried around a wad full of cash. If he liked your idea he would give you a $100 bill.

I jumped at the opportunity to pitch first (probably hyped from my latest self-help book). I pitched my idea, an app with which HIV patients could track their CD4 count and thus infectivity (this was back when apps were cool) 🦠

He didn’t give me a $100 note.

Later I saw him looking annoyed so I approached him to introduce myself:

“Who are you?”

“I pitched the HIV app idea”

“Oh yeah, your idea was total garbage”

“Ok”

“Why would anyone want to use that? That’s spam, seriously”

A couple of years later and I agree with him.

Bridgewater Associates 💰

Ray Dalio believes in radical honesty. At Bridgewater, they manage $160bn of assets — so there’s no room for poor decision making. Google trialled 41 shades of blue to decide on the colour of hyperlinks with the highest click-through-rate. At scale, little things matter a lot. Consistently making 10% better decisions at Bridgewater can mean ±$16 billion.

But sometimes companies say things you know they don’t mean. Not the case at Bridgewater, they live radical honesty — this is an email a junior associate sent to CEO Ray Dalio following a meeting:

From: Jim H To: Ray; Lionel K; Greg J; Randal S; David A Subject: Feedback on ABC Meeting . . .

Ray- you deserve a “D-” for your performance today in the ABC meeting and everyone that was in the room that saw you agrees on that harsh assessment (give or take half a grade). This was especially disappointing… [because] we held a specific planning meeting yesterday to ask you to focus tightly on culture and portfolio structuring because we had only 2 hours to have you cover those two topics, me cover the investment process, have Greg do the observatory and have Randal do implementation. Instead, you took a total of 62 minutes (I measured) but worse, you rambled for 50 minutes on what I think was portfolio structuring topics and only then got to culture and you talked about that for 12 minutes. It was obvious to all of us that you did not prepare at all because there is no way you could have been that disorganized at the outset if you had prepared.

Principles: Life and Work, Ray Dalio

There are benefits to this approach. Dalio saw a traditional work culture plagued with groupthink and politics. He wanted to get past the niceties and hierarchy, and install an idea meritocracy — a management structure in which the best ideas come through no matter who has them.

For this to work, anyone needed to be able to challenge anyone else. And no secrets either, almost all meetings are recorded and are available for anyone in the firm to watch.

The Problem in Medicine 🏥

I once heard a story about a hospital consultant who walked into an MDT meeting late. Instead of taking the one free seat — he asked a nurse to stand up. He then stacked her chair on top of the other chair and sat on both of them. He liked sitting on two chairs, apparently.

At Bridgewater, he would have been called out. But in Medicine, no one challenged him — there’s a strict hierarchy. This has benefits, there’s no finger pointing when something goes wrong — it’s always the consultant’s responsibility (save the Bawa-Garba case).

Google have a flat hierarchy, meaning that every engineer they hire becomes a ‘project manager’. But when everyone’s a project manager, who is the project manager?

I once tried radical honesty in a 'work environment’. It went just as well as you might imagine.

The Rest of the World 🌍

Not everyone believes in radical honesty. Whilst Tesla was flirting with bankruptcy, Elon Musk kept quiet:

To the extent that the financial situation unnerved Musk, he rarely if ever let it show to employees. “Elon did a great job of not burdening people with those worries,” said Spikes. “He always communicated the importance of being lean and of success, but it was never ‘if we fail, we’re done for.’ He was very optimistic.”

Elon Musk by Ashlee Vance

Neither do Instagram’s founders:

He and Krieger weren’t sleeping well. There were plenty of strong competitors. But pretending things were going more smoothly than they actually were was part of the job of being a startup CEO. Everyone needed to think you were on the right track.

No Filter by Sarah Frier

Some people call Bridgewater’s radical honesty a cult. Dalio says it’s the opposite:

Cults demand unquestioning obedience. Thinking for yourself and challenging each other’s ideas is anti-cult behavior, and that is the essence of what we do at Bridgewater.

A Gift 🎁

Radical honesty is the antithesis of a Trojan Horse. It’s a gift wrapped up in an insult and large companies realise this. As part of the creative consumer phenomenon, firms see customer complaints as a treasure trove for innovation.

Your most unhappy customers are your greatest source of learning

Bill Gates

A (white) teacher at school once told me:

You Asian boys are very good. But you don’t present yourselves’ very well in [medical school] interviews

(followed by advice on how to improve)

One tweet and the mob would have cancelled him. Was it politically correct? No. Helpful and well intentioned? Certainly.

I like radically honest people.

//

Want to hear from me every Sunday? Sign up for my newsletter.