“Hey doctor, what do you think about this product/solution/service?”
These days, I look at a lot of websites describing some kind of product or solution related to the healthcare of older adults. Sometimes it’s because I have a clinical problem I’m trying to solve. (Can any of these sleep gadgets provide data — sleep latency, nighttime awakenings, total sleep time — on my elderly patient’s sleep complaints?)
In other cases, it’s because a family caregiver asks me if they should purchase some gizmo or sensor system they heard about. (“Do you think this will help keep my mom safe at home?”)
And increasingly, it’s because an entrepreneur asks me to check out his or her product.
So far, it’s been a bit of a bear to try to check out products. Part of it is that there are often too many choices, and there’s not yet a lot of help sifting through them. (And research has shown that choices create anxiety, decision-fatigue, and dissatisfaction with one’s ultimate pick.)
But even when I’m just considering a single product and trying to decide what to think of it, I find myself a bit stumped by most websites. And let’s face it, if I visit a website and it doesn’t speak to my needs and concerns fairly quickly, I’m going to bail. (Only in exceptional cases will I call or email for more information.)
So I thought it might be interesting to try to articulate what would help me more thoughtfully consider a product or service that is related to the healthcare of older adults.
Health VCs: Desperate…
As a tech VC recently told me, refuting the latest flimsy rumor of a huge tech-dominated fund contemplating significant new investment in life science, “Wow, you healthcare guys are really desperate for some good news!”
It’s true; not only are LPs looking ever more critically at VC as an asset class – especially since the publication of the Kauffman report – but the life science sector, in particular, has been devastated, and health VCs have been hurting. (Added Sept 27: See this fascinating, just-posted Xconomy profile of Avalon’s Kevin Kinsella and discussion of the current sorry state of healthcare VC.)
Part of the issue, as Bruce Booth and Bijan Salehizidah have described previously, and as Sarah Lacy summarized nicely this week in PandoDaily, is that the return profile of life science venture investments looks very different than tech in general, and consumer web (the focus of Lacy’s article) in particular.
The sex appeal of tech investing is that a relatively small initial investment can blossom very quickly to yield huge returns; the catch, of course, is that this happens very rarely, and much like at a casino, and the tremendous attention lavished upon these winners can almost make you forget how infrequently they occur.
When I entered the VC business 10 years ago, I tried to keep thinking about venture capital as a business, where the key focus area was on meeting the needs of our target customers — entrepreneurs and limited partner investors.
In the case of entrepreneurs, those needs have changed radically in these last 10 years. The surge in seed investing over the last few years has been well-reported and analyzed. With advances in cloud computing, open source infrastructure, development tools and general “Lean Start-Up” techniques, entrepreneurs need less capital than ever before. And when entrepreneurs’ needs change (i.e., requiring less capital), smart investors adjust to meet those new needs. Hence, the rise of angels, super-angels, incubators, accelerators, micro-VCs and VC-led seed programs.
But as the “Great Seed Experiment” (as my partner, Michael Greeley, calls it) matures, a new trend is emerging. Entrepreneurs are beginning to learn the difference between what I’ll call Passive Seeds and Activist Seeds. And entrepreneurs are learning that the difference between the two, although somewhat subtle, matters greatly.
Passive Seeds are when a VC invests a small amount of money (for a $200-500M mid-sized fund, typically $250k or less, for a large $1B fund, perhaps $500k or less), to achieve a very small amount of ownership (typically less than 5%) to simply create an option to participate as a more meaningful investor in the future. Passive seed programs get most of the press attention because of their sheer volume.
In 1990, when I got my first health care job driving ambulances, not a soul in the New Orleans EMS department had a cellphone. Not even the head of the service. The mayor, his chief of staff and the police chief each had one. That was about it. These phones weighed like 15 pounds and were hardwired to a car battery. And we ambulance drivers documented our care on “run sheets” found on metal clipboards but, since so few people bothered to read them, we also wrote key vital signs and other metrics on a three-inch-wide piece of white tape smacked across the patient’s abdomen.
Today, everyone in New Orleans — and everywhere else — has a cellphone. These cellphones have the computing power to find, and add to, and direct everything that anyone would need to know about a patient anywhere in the world… but they don’t do it! Today’s “do-everything” cellphones are the size of your wallet, yet most ambulance crew run sheets are still paper, found on metal clipboards. And most good patient data is still found on those three-inch-wide pieces of tape.
Why? I’ll give you one good reason and one bad one.
Last week I found my usually-diverse Twitter feed had coalesced into a single hashtag, the trolley buses chugging through the streets of Washington, D.C. were sporting bold logos on their sides, and all around the city people were wearing giant nametags bearing their name, face, and three things they liked to talk about. There was no mistaking it: TEDMED was in town.
For the world of health care, TEDMED was the only party at which to see and be seen. The thousand or so delegates had been specifically “curated” to encapsulate the epitome of health care innovation. For 3.5 days they basked in cutting-edge, quirky talks by people “shaping and creating the future of health and medicine,” punctuated by lavish dinners and parties, TEDMED-themed M&Ms, and morning runs, as sanctioned by the Cookie Monster (one of the celebrity speakers at this extravaganza). Meanwhile, the rest of the medical world followed the #TEDMED hashtag on Twitter or soaked up the inspiration in real time at one of TEDMED’s mostly academic simulcast venues around the U.S.
And as for me? I threw myself into getting invited to the cool kids’ party. Or to be more accurate, the cool, privileged kids’ party. Because as well as being accepted on merit, attending TEDMED in person costs an eye-watering $4,950. A wealth of sponsors paid for 200 people to attend on scholarships (and for the Simulcasts), but by the time I’d realized this and persuaded them of my innovative brilliance, they’d already allocated their funds and I was consigned to their priority waiting list. But at the last minute, delightfully, my persistence and anticipation were rewarded with a pass for the Thursday night party and the final Friday morning session.
When I first entered the venture capital business 10 years ago after being an entrepereneur, my partners warned me that “my bar” for new investments would get higher over time. In other words, the criteria to make a new investment – clearing “the bar” – would get more strict with time as I developed more experience and saw more things. I found this to be very true, and the notion that investors get wiser and more selective over time has become common wisdom in the industry.
But there’s something very new going on in the last few years – something very striking. Simply put, the collective bar of the investment community to fund young companies has recently gotten higher – much higher.
The entrepreneurs I speak to are feeling it every day. When they pitch their new idea to investors, they are told to build a prototype first. When they build the prototype, they go get customers. When they get customers, they are told to show engagement metrics. When they show engagement metrics, they are told to run some monetization experiments. When they run monetization experiments, they are challenged to prove scalability. Maybe I have Passover on the brain this week, but it’s like investors are putting entrepreneurs through a nightmarish version of Dayeinu, where no matter what they achieve, it’s never enough (speaking of Passover, if you haven’t seen this Jon Stewart clip of Passover vs. Easter, it’s a must. I’ll wait.).
Why is the new investment bar so high today? Isn’t there plenty of euphoria and “animal spirits” to go around with the IPO market returning, marquee acquisitions (e.g., Instagram at $1 billion) and the impending, earth-shattering Facebook IPO?
I was always encouraged from an early age to be balanced in everything that I do. Generally speaking, I’d say that’s pretty reasonable advice — but it’s not always right. Sure, achieving a perfect work-life balance should be a top priority for most professionals, but the same advice just doesn’t apply to entrepreneurs — we’re a different lot.
As entrepreneurs, we have zero sense of balance. We’re all in, all the time. It doesn’t matter if it’s day or night, weekday or weekend — each of us focuses on our vision with a single-minded passion. I even know an entrepreneur nearing retirement age who plans on working 80 hours a week until he dies, at which point he says he’ll cut his hours in half. He’s not alone. Many of us skip meals, showers, and social gatherings, meaning we avoid anything that diverts our attention from turning our visions and passions into reality. We’d probably work in our sleep if we could. In fact, I bet some of my more creative colleagues actually do.
If you’ve ever seen Thomas Edison’s laboratory in Fort Myers, Florida, you may have noticed the little cot he kept next to his desk. Edison worked long hours, took small catnaps, and then went right back to work. I wouldn’t be surprised if Edison kept a basin under his desk, and used it for something other than garbage.
Edison, of course, isn’t alone in his persistence. We’ve all heard the stories about Bill Gates and Mark Zuckerberg during the early days of their respective companies. And it’s no coincidence that both Gates and Zuckerberg dropped out of Harvard to pursue their passions. Clearly, the more “balanced” decision for both of them would have been to stay in school and to pursue their projects after graduation. But that’s not the entrepreneur’s way.
When I was a teenager, the older women in my family taught me to cook. I learned it was traditional not to add salt when cooking lentils, because it would slow down the cooking. For some reason, perhaps the sheer pleasure of being difficult, I insisted on taking two identical pots and cooking identical quantities of lentils, one with salt and one without. That caused quite a bit of a stir, and not only because I proved that the salted lentils cooked just as fast. On the one hand, my mother, grandmother, and aunts sensed more difficulties were to come. On the other, they knew they’d participated in something different and important: a scientific experiment.
The women in my family were courageous, smart, and resourceful. They knew many things: useful wonderful things. For the most part, their knowledge was received knowledge, knowledge they’d been given, not figured out on their own. This is a common situation. The idea that anybody can be taught to figure things out, that there is a logic to discovery and invention, would have struck our ancestors as radical and strange. Until quite recently — until science education became institutionalized and widespread — the creation of new knowledge depended on either genius or luck.