Oct 21, 2016


Much ado is all I see
And feel like it's surrounding me
The crowd intrudes all day
'Til I'm finally swept away

A few weeks ago I had the extreme privilege of going to a meeting in Washington, D.C. at a building called the Eisenhower Executive Office Building. This the building that houses the offices of the executive branch of the United States government. It is a great old building the majesty of which you feel as you enter it via the multiple layers of security.

Then inside, there are . . . offices. Some of them reflect the architecture of a building built in 1917, but they are otherwise for the most part nondescript and surely less opulent or fancy or technology-laden than the average mid-sized venture capital firm. There are simply rooms designed for groups of people to meet with each other.

Which took me aback at first until I thought to myself that, at its core, the business of government is just groups of people attempting to make decisions - negotiating, cajoling, arguing, attempting to build consensus. It’s just people.

As a venture investor, one obviously gets the opportunity to back entrepreneurs - people - and different firms place different levels of emphasis on people, ideas, stage, and other things. Regardless, the people part is one of the best aspects of the job.

Which brings me to the blockchain. Our firm has what is now a well documented, ongoing and evolving thesis and related ideas about why we believe the blockchain is one of the most exciting technology shifts (movements?) we’ve seen in a long time. But there is also another aspect of it that is as exciting as the transformational nature or potential of outsized investment gains that may result therefrom.

It’s the people.

The blockchain and its evolving ecosystem and community (Joel and I called it “True Believers” the other day) are a wonderfully smart, intense, focused, weird, open, fun group of people. Almost across the board. Some are capitalists, some may not be capitalists, some cannot figure out which way to go, but all are curious. They are interested in finance, medicine, protocols, storage, music. But virtually every single person I’ve met is as open to conversation and debate, is transparent about their ideas and biases, as anyone I have professional come across. And, every single one of them smiles and laughs, simultaneously taking this blockchain stuff really seriously, and not seriously enough.

I’ve seen this before - when I worked at AOL in 1996 and in the early days of the social web 2006 or so.

Clearly, smiling, engaged entrepreneurs do not an investment thesis make.

Yet, almost weekly I’m coming across articles online making valid points about the unknown and dislocating changes that will be wrought when computers continue their march towards replacing tasks that people do. These concerns feel real.

But at the same time I also can't help but allow myself to get swept away in the enthusiasm of these people I am meeting - the humans - building blockchain software. That their enthusiasm, openness and sense of humor will in fact show us the way towards finding am amazing middle where technology and humanity do in fact meet.

Jun 14, 2016

The Reordering of Medicine

When you wake up in the morning
You'll have a brand new feeling
And you'll find yourself healing
-Daniel Johnston

The nature of the way we interact - or desire to interact - with medicine and our medical care is starting to change fundamentally. This is less about the unbundling of medicine (which may also be happening) but instead the reordering of it. Stemming from a combination of user desires (driven by the mobile transformation of the last 10 years) and software and device capabilities, the reordering can be seen acutely in some conflicts that are now occurring.

Take just one example: UnitedHealthcare recently decided to make equipment by Medtronic its preferred in-network device for insulin pumps. This is a Medtronic device.


The diabetic community was incensed by this decision. Why? Because alternative device manufacturers had been delivering insulin pumps with different features that users wanted. Like touch screen devices from Tandem or color screens from Animas or Omnipod:

Screen Shot 2016-06-12 at 7.54.54 AM.pngtslim_Hand_View.jpg

Of course, people took to social media to express their feelings: #mypumpmychoice and #accessmatters are just two of the relevant hashtags here.

Underlying this all is the simple idea that “technology is intensely personal.” No longer does technology being personal solely apply to our creative modes of self expression (our cameras, pictures, videos, tweets and Snaps) - it now also applies to how we manage our lives and health. Our phones may not be becoming our new doctors (though I think they can), but they are shifting the ways we interact with and track our health care.

This has the potential to put people at the center of the medical universe (in the same way people have become one center of the media universe).

This isn’t unbundling but more like reordering. Unbundling refers to the phenomenon whereby a market or industry that is tightly coupled, or otherwise concentrated or vertically integrated, is then later transformed when it splits into component parts. The components of healthcare are already fragmented, however. Instead, what is happening may be that the components of medical care are being reordered into something new - patient demanded and patient centric. Defined by the user and user needs.

This isn’t totally new. Jay Parkinson, MD, has been writing about this for years, my favorite quote of his:

People are the CEO of their health, and doctors are just consultants.

What may be new is the technology and services have finally caught up to make this a reality.

And it’s not just insulin pumps, but also many other services. For example, apps to track fertility (like Clue) only indirectly implicate a physician, but for sure help a person collect vital signals about their bodies and health. Parkinson’s very own Sherpaa tackles the problem of the complexity of employer managed healthcare by viewing it as a user experience problem to be solved. Smartphone accessories can now perform tests to detect HIV and syphilis from a finger prick of blood and in just 15 minutes. AliveCor allows you to perform an electrocardiogram at home. Services like Lemonaid and Nurx dramatically simplify the diagnosis experience (and cost) by providing computer-assisted mobile-only medical care directly to users.

This user-centric approach to medicine is also occurring in more b2b oriented services too. Eligible has created an API that enables a healthcare service developer to focus on user experience and not payment and insurance infrastructure (in a similar manner to, for example, Stripe). Lumity uses employee data to help companies provide the best benefits.

USV has, natch, invested in a bunch of these companies, some listed above.  

The thing that ties all these together is putting the user - the consumer of the healthcare - at the center of the universe and building out from there. There are, of course, other vital players in this medical matrix - but this reordering may be the beginning of a user-centric approach that has been largely absent so far at scale. One that feels consistent with trends we have seen in other markets and also one that could result in real change in the economy and society.

Apr 17, 2016

Bots, Messaging and SmarterChild

If I gave you my love, I tell you what I'd do
I'd expect a whole lot of love out of you
- Al Green

Smart people believe that messenger type interfaces and associated “bots” will become a primary way people access new services going forward. We at USV certainly find truth in that, see both Kik and Koko and Libov’s thoughts here.

There are a bunch of reasons why this could be the case. First, the primacy of messaging - in all its various forms - appears to be growing as fast as ever. The conversational nature of messaging and chat also feels natural. Finally, the reduced load on a user from having to switch contexts to do different things appears as a major benefit to the different interface.

I’ve seen this before, as one of my first investments ever in 2000 was leading the first financing in SmarterChild, where that product and company faced many of these same questions. What did they see and do?

  • Given that it was 2000-2001, SmarterChild launched on the then dominant (only?) messaging platform - AOL’s instant messenger (AIM). In no way did we think this was a wholly original idea - it was inspired by Eliza, Alice, and many others. Instead, the implementation and technology were more unique.

  • SmarterChild was not designed to live as simply one of many names on your contact list delivering services. The goal was for it to be your primary portal into the world - to be the one “bot” that ruled them all.

  • As a result, the company spent an inordinate amount of time upfront building personality libraries. The idea was that since SmarterChild was interjected into a place that was exclusively where personal conversations occurred with friends, the service (or bot) had to act like your friend in addition to being a utility service. Otherwise it would too interruptive or, worse, easy to ignore.  

  • This required SmarterChild to be able to respond to not only informational queries but also, well, sex and profanity. Chris Bray, one of the original developers, was once asked how people were using SmarterChild. He replied:

  • The implicit assumption here was that the utility services would take time to perfect, so you had to give people a reason to stick around while that happened. A domain library that responded to profanity was thus a necessity, along with weather, sports scores, stock quotes, news, dictionary, yellow pages and search.

  • Making SmarterChild appear as a friend (albeit a strange one) would become the primary way people would then tell their other friends about it. And alot of people told their friends. At the peak, SmarterChild had tens and tens of millions of followers on the IM platforms. I am pretty sure this was - at the time at least - the most followed “user” in the history of AIM. People posted thousands of screenshots of their interactions with and feelings about SmarterChild:

Screen Shot 2016-04-16 at 3.38.39 PM.png

Screen Shot 2016-04-16 at 6.38.55 PM.png

  • The other area that the company invested heavily into was response time. A first principle was that unless the bot could answer in under 10 milliseconds to each and every request it would be a failure. Speed, speed, speed.

SmarterChild worked well until it didn’t work well. For one, at some early point it needed explicit agreements with the platform owners because it quickly ran into rate limits. The volumes were also so massive it needed technical cooperation with them. And, finally, there was the constant tug back and forth with the platforms. 

ActiveBuddy, the parent corporation of SmarterChild, lived virtually every day with both the excitement of massively increasing user numbers and fear that they would be shut down because they neither owned nor had any control over their distribution. Ultimately, that tension was too much to manage against.

Dec 30, 2015

Somewhere In The Middle

Change, nothing stays the same
- Van Halen

2015 was in some ways the year that the science of gene editing - or Crispr - came into the public consciousness. As part of that, large incumbent players made big moves. For example, this joint venture involving Bayer (a $40B company).

There were other examples of the “incumbents” in the health and medicine space making significant investments into innovation in 2015: Memorial Sloan Kettering Cancer Center built a $300 million, state-of-the-art outpatient surgery center that uses beacon based tracking of patients, HD based anatomical imaging, and an Xbox for fitness activities.

Yet, at the same time things are happening at the same or a faster pace at the edge - in a “bottoms up” manner - businesses and products that could potentially be major transformations. Amino is a desktop bioengineering system that will cost less than $700. There is also the frugal science movement, "the endeavor to create low-cost, easy-to-use tools that address serious problems."

This dynamic - with incumbents making what appear to be aggressive, risky and expensive moves and at the same time new entrants chipping away at the margins and edges - is also being replicated in other industries.

Take the beer business. On the one hand, the number of craft breweries in the U.S. surpassed the historic high set in 1873, topping 4,100 (see: America Has More Breweries Than Ever Before).

Then look at the M&A activity from incumbents in 2015 alone (from “Why 2015 Was Such a Historic Year for Craft Beer”):

Screen Shot 2015-12-29 at 8.52.46 AM.png

Business moving from the top down, and from the bottom up, simultaneously.

In the technology world things look the same. Google, Microsoft, Apple, Facebook, Alibaba, Tencent and Amazon, to name just a few, are moving on many, many fronts. “There’s one theme this year that seems to run horizontally across many of the top tech companies we cover: everyone wants to do everything” (Lauren Goode in the Verge).

Or, as Jeff Bezos, CEO of the “retailer” Amazon.com said just the other day: “We want to win an Oscar. Amazon has already won Golden Globes and Emmys. Our current target is to produce 16 home movies a year.”

But not only are the big firms expanding - dozens of new companies are being started yearly. In 2015 over $4B was invested in digital health startups alone by over 300 venture firms. Similarly, about $4 billion has been invested in VR in the past few years.

And while Silicon Valley is the gravitational center of technology industry, Stockholm is “the second largest producer of billion dollar start-ups after Silicon Valley on a per capita basis.”

What is going on here, is this anything new? Who knows, for sure, but I do think there is a potentially new dynamic playing out. That is, the terms “innovation” and “disruption” (as vague as they may be) have become mainstream, and are no longer the secret, province, or modus operandi of a smaller subset of businesses. As Jonathan wrote in an email to us the other week - the leaders of this era have been trained in the art of disruption.

This is a sign of market maturity but it also feels like something more - because while the players at the top move aggressively, the ones at the bottom do not appear to be slowing. To the contrary, they too are aggressively trying new models and businesses. It’s like full stack innovation being played out on a global scale. :-)

The next few years are going to be interesting.

May 6, 2015

No Stack Startups

“Who can unlearn all the facts that I've learned”

One way of looking at a publisher’s chain of business operations is that there are five core things it must do: (1) produce content; (2) market/promote content; (3) distribution; (4) figure out the best user interface or experience for its content; (5) and monetize the business. This applies, really, to any publisher: both content and commerce, for example. So, to maximize end user experience and value, and from there enterprise value, a company needs to maximize its ability to deliver across those components. Of course, technology infuses them all.

One way to accomplish this was suggested by Chris Dixon last year. He called it the “full stack startup”:

"The new approach is to build a complete, end-to-end product or service that bypasses existing companies. . . you need to get good at many different things: software, hardware, design, consumer marketing, supply chain management, sales, partnerships, regulation, etc.”

“You need to get good at many different things” being the key proposition.

But maybe, a year or so later, we are seeing something different emerging. Something closer to the actual unbundling of content and commerce businesses themselves from the web at large (and the apps thereto). The unbundling of the full stack startup. Where instead of being good at many things, companies can just focus on the last mile of value they provide, the one thing they can excel at better than anyone else. Maybe this should be called the No Stack Startup - services that can focus on doing only one thing - hopefully well - and utilize other services for everything else.

This is not totally new but is challenging some of established orthodoxy by assuming there are some things - design for example - that may not be core competencies.

Some examples made me think of this:
The Shade Room - an Instagram based entertainment publisher, that only does the content sourcing and production 
Stefan’s Head - a text based commerce company, that only designs the products and uses Twilio (I think) on the front end and Stripe on the back end, to deliver via SMS its offers 
Weiguofang - a fruit seller that operates on WeChat 
TextRex - restaurant recommendations over SMS 
Some characteristics all these share is that they use other platforms and APIs (or protocols, in the case of SMS) to cobble together a service and in doing so rely almost wholly on those platforms and APIs for every function of the business other than the one they can be the best at. And, maybe more importantly, they all are using those other platforms to define their users experiences. 

Take Facebook, for example. At some level, the Facebook is a very good platform to market, distribute, promote, and - now, maybe - monetize content on. The UX is well known to its users - and optimized over years through billions of interactions for commenting and sharing. In this way, Facebook performs 4 of the 5 components listed above. All, except making the content itself. Similarly, take other platforms, such as Instagram:

“If you have an Instagram account, you can slap a price tag on anything, take a picture of it, and sell it. For instance, you could take this can of San Pellegrino, paint it pink, put a heart on it, call it yours, and declare it for sale. Even my grandmother has an Instagram business! She sells dried fruit. A friend’s cousin is selling weird potted plants that use Astroturf. People are creating, you know, hacked products.”
These No Stack businesses may not offer a “great experience” (traditionally defined) but they likely are “good enough” (see this presentation for a great overview of how this is happening in Asia).

Of course, most of these are not even "mobile-first" businesses - they are "mobile-only". They often don’t even have web sites (or, apps for that matter): "the homepage once conferred some sense of reaching your canonical destination, it’s now your name on Facebook, Instagram, Twitter, Amazon etc. that consumers are searching for” (Jonathan Libov).
Historically there have always been services and APIs to string together capabilities.  Until recently, most of these have been back-end infrastructure types.
Now it feels like there is something additional going on. For one, the back end services have gotten really, really good and really varied (see, Stripe, Twilio, Shippo, Kabbage, Ziggeo, Layer as just a few examples covering payments, messaging, shipping, financing and video).

But moreso, the No Stack services are utilizing other front ends layered on top of the back end services. They are utilizing front ends that may not have even been initially designed for those purposes. But they work because in many ways they are optimal user experiences that are already market tested.

The No Stack Startup thus does not attempt to recreate a user experience, instead relying on other UX that are good enough, and getting better. This obviously inverts the notion of user experience and even design (my partner Albert's great TEDx talk is all about inversions in fact).

Even better, in relying on the UX of other platforms, the No Stack Startup also relies on the users of those platforms. In some ways, and to paraphrase Jeff Bezos, this new class of services looks at other platforms, builds upon them, and thinks: "your users are my opportunity."

I have been trying to figure out what the implications of this might be. A few ideas:
* the platforms themselves may have different and even stronger network effects than previously imagined (though in different ways), as springboards to other services 
* it feels like it is an amazing time to be a creative entrepreneur utilizing emerging no stack techniques, though it is wholly unclear how to measure the sustainability of the no stack approach via the full stack approach 
* the environment for incumbent publishers is even more competitive with a faster feedback loop then we probably realize.
Regardless of the implications, it seems that when there is continuously less "there" needed to create value, we might at a minimum require some new definitions.

Apr 10, 2015

Changing Metaphors

"Photograph - all I've got is a photograph. But it's not enough"
Def Leppard

Wikipedia tells us that the word "photograph" derives from the Greek words phos and graphĂȘ, together meaning "drawing with light."

I suppose that for a hundred or so years that general definition worked as a metaphor to describe a new technology and medium and what could be done with it, whether that be still, animated or in motion images.

But sometimes metaphors stop working as a way to mentally conceive, and build off of and from, new technologies.

When the "web" first came into mass consciousness and culture, the metaphor that was initially used was the web "page". By using the word "page" as the defining principle, we then logically used other pages that we knew - magazine pages, in particular - to define what web pages were and could be. Interactive magazines, in a way. So, perhaps, the initial wave of web innovation was about making better magazines - interactive, specifically targeted pages for sure, but pages and the attributes of pages nonetheless. Design - user interface and experience - then also followed this line of thought. Thus, it's no surprise that the first search engines used directories - indexes, of a sort - as their jumping off point metaphor for organization.

It took a while to bust out of the "page" metaphor for web services experiences, maybe 10 years or more. And one could argue that the page metaphor itself was limiting, and then the results therefrom were also limited. Ultimately, the stream and other ideas became dominant, and what was (and still is) exciting about those is that they feel more native to the Internet (and mobile). There is no strong analogy for an analog stream experience.

I think we are in the same place right now with "drawing with light." While functionally that definition may still be correct, what words do we use to make sense of a "drawing with light" that later disappears (Snapchat)? Or that moves and is remixed (animated gifs)? These things are no longer designed per se to capture and be archival. They are meant to enhance current experience.

Or, how do we think about new forms of medical imaging, like figure 1, which take an image (or an ekg, or xray) that is about a local, health experience, and broadcast it all over the world for advice, consensus and, yes, ego? Or Epibone, which uses 3D images to grow bones. What about
 Mapillary - crowdsourcing street level photos of every place in the world. What do we even call a map once we have that? Similarly, Hivemapper, which is a network of social flying cameras. Finally, the idea of "drawing with light" hardly captures something like Cornar which attempts to record what is beyond the line of sight.

And, once images are digital, and copying them becomes trivial, how do we think about ownership, attribution, and things like that?

Luckily, smart people are thinking about this. Evan Nisselson's LDV Vision Summit (http://www.ldv.co/visionsummit/) on May 19 & 20 in NYC, for one, is two days exploring specifically and only this. New metaphors - computer vision, artificial intelligence, deep learning - that may help. It should be really interesting, and Evan and I will be talking about these themes at the event.

What's great is that we are busting out of the limited, existing "incumbent" metaphor, and inventing new things based on what may now be possible. We'll just need some new words to describe them.

Feb 13, 2015

The Chaos Theory Of Startups

"Since we don't know where we're going, we have to stick together in case someone gets there" - Ken Kesey

I was flying from NY to SF the other day and at one point the gentleman I was sitting next to asked me if I was flying towards or away from home. I told him NYC was my home and I was on a business trip. He then said, "let me guess, Internet business." I was momentarily self conscious (was it my shoes? laptop stickers?) but then figured it was a nice bit of self-reflective cultural commentary: everyone flying to SF is going there for the Internet.

We chatted about it and he asked me something I've been asked many times over the years - "how do these Internet companies make money." Which was nice because we discussed all the "Internet companies" that actually do make money because they are, in fact, good businesses. Points scored.

But then we got talking about what startups are, or aren't, and what that word actually means, or doesn’t mean. At that point I got more tongue-tied then earlier in the conversation. I couldn't totally describe the meaning of the word.

I still can't. But I thought more about it overnight and then had a notion this morning that maybe startups are actually about chaos. Not necessarily chaos meaning "a state of confusion," but instead chaos meaning systems that are explicitly designed to be dynamical and highly sensitive to initial conditions. Indeed, chaos theory provides an almost-perfect description here of the outcomes of startups:

"Small differences in initial conditions yield widely diverging outcomes for such dynamical systems, rendering long-term prediction impossible in general."
The process of starting something up, then, doesn't view that chaos as a bug, but as a reality. Even as a competitive advantage, if you will, because if the conditions are actually right, the outcome and its impact will be oversized (indeed, massively oversized). 

In chaos systems, one of the challenges then is to determine what is random, or chaotic, and what is meaningful. One of the hard things about being in a startup in this state of chaos is to actually figure out what course of action leads to randomness or instead leads to signal to build upon and grow into and out from. In short, the difficulty is how to decide what to do.

If one believes this, it probably follows then that the decision making process itself that goes into startups is primary: it's less about the actual decisions themselves then it is about the process used to make those decisions. In any given scenario there are three potential outcomes. The best outcome is that you make the correct decision. The second best is that you make the wrong decision. The worst outcome is when you can't make a decision.

So then, “process” becomes a defining characteristic. Your framework for making decisions matters as much or more than the decisions themselves, because the "chaos" of the system makes most outcomes indeterminate (again, chaos theory: “long-term prediction [is] impossible in general”).

So you need a framework, a set of first principles. That then guide your decision making and problem solving.

Taken a step further, I've always thought the most useful thing a venture investor can then do for a company is simply help them come up with that framework, that scaffolding, to throw all those choices into. And not specifically to help make the choices themselves. After all, one of the primary ways venture investors can add value is through having seen dozens and dozens of these chaoses. Presumably, we are well-suited to help determine frameworks for decision making in future, similar chaotic scenarios.

I think there are lots of different frameworks or first principles for decision making; it’s not a limited set. This may mean that figuring out the framework may be the hardest question of all. Determining what successful startups are outliers or are patterns may be less relevant, as we only need to look for the frameworks they use and then copy or fork them for our situation.

Phil Jackson believed this too. He wrote "the road to freedom is a beautiful system." The winningest coach in NBA history believed that his success was developing a framework for his players to guide the dozens and dozens of decisions that they have to make each game, each play. He actually believed then, that his job as a coach during games was just to watch. If he had helped the team develop the right framework, then his role would at its optimum - at decision-making time – simply to sit back and let them process. 

This doesn't always lead to the right decisions, but has reminded me that maybe our role as venture investors is precisely the same.