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Tim’s Founder Kitchen — From Brainstorm to the President’s Office in Two Months (Featuring Jake Becraft, Strand Therapeutics)

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Tim Ferriss: What does Strand do?

Jacob Becraft: So Strand designs what we call next-generation genetic medicines. You have DNA inside of your cells, the DNA makes RNA copies of itself, and then that RNA makes proteins. And actually life is all proteins. Your skin, your hair, your organs, every cell is basically just proteins stacked together. That is everything that we are. You don’t really see the DNA and the RNA. It’s very small. The protein is what we think of as our being, right? And so the way to actually intervene in disease, the way to get to its core is to create the correct proteins.

If you have a deficiency, everything from an enzyme problem, to a rare disease, to cystic fibrosis, it’s usually a problem with a protein that is being incorrectly made by a cell. And so what we have figured out over decades and decades is what’s gone wrong with that protein, and what would need to go right to fix that protein or how you would replace that protein correctly. What we have not figured out is how to make the cells do that, right? And that’s because it’s a very complicated problem to tell certain cells in the body to do various different things. And so what we are really focused on building, we know what proteins need to be made. We know where they need to be made. What we need to do is get the message of what type of protein to the place in your body where they need to be made, and we need to do that effectively and safely.

And so what we have essentially figured out a way to do is take that message, which is in the form of a molecule called RNA. A lot of people are familiar with it from the COVID vaccines, but those are very small examples of what RNA could actually be utilized to do. And then we have found a way to send those messages into the body, into diseased areas where they can access the cells and essentially return the cells to a state of homeostasis, which either corrects the problem or in the case of cancer, removes the problem, any of those pieces. And so that’s the base case of what we’re trying to accomplish.

Tim Ferriss: Mm-hmm. So let me back up and give people a little bit of context. So the first time we met was in Boston at a dinner. Do you want to describe, I don’t think they’ll mind, who else was there? Who else was at the dinner?

Jacob Becraft: Another biotech CEO, Phil Strandwitz, and a — I don’t know how to classify Jamie’s job.

Tim Ferriss: Bit of a polymath.

Jacob Becraft: — professor at the MIT. Yeah, polymath, MIT Media Lab, professor, healthcare entrepreneur, advisor to anyone who wants to know fancy things.

Tim Ferriss: Mm-hmm. Great guy. Yeah, so I’m already an investor in Holobiome, Phil’s company, love what Jamie’s up to and very interested in what he’s building as well. We can put that in the show notes. We’ll put all that in the show notes. And then we met and part of the reason I became very interested in Strand, there were a lot of reasons. So one is the technology, the results, the photograph, or I should say, images that you showed me, which we’ll get to in a second. The second is founder, builder who is technical, but for whom also this company, this is going to be a strongly worded statement, but is existential, right? You’re not a hired gun CEO who has been brought in, right?

This is very much entwined with your identity and personal mission, which I find very attractive. And quite interrelated with that is the fact that I found you to be a very good communicator over that dinner, right? I learned a lot. You recommended a number of books to me at the dinner and then afterwards. I’d say chief among which was the Genentech —

Jacob Becraft: Fantastic book.

Tim Ferriss: — origin story, which is one of the best, I would say, business books I’ve ever read. Just unbelievably good because it also, and I can’t believe it made it past all the Genentech censors, but it’s actual contracts, screenshots of contracts, negotiations, mistakes, all of the serendipitous, lucky moments and unforced errors by universities and so on, that had to coalesce for Genentech to even survive. It’s just an incredible story. And I also, just again, this is more for people listening than for you, but I’ll continue to fluff a little longer, which is also that you seem to me to be very aggressive without being haphazard, right?

So you were just furious at this dinner when I started to try to get an idea of the general biotech scene in Boston, and asking questions about various startups, and figures, and companies, at how conservative and dogmatic, maybe would be a very generous way to put it, you view a lot of folks, not all, but the default, right? The status quo. And in contrast how you’re going, you’re taking big swings, right? You are taking big swings. So all of those things were attractive.

When it comes to Strand, let’s talk about the image for a second. What was the image that you showed me, or images?

Jacob Becraft: Yeah, so I happened to show you a photo of one of our patients, one of the very first patients that entered our trial, the way that these early-stage trials work in oncology, so then a patient with stage 4 melanoma, in early-stage trials, you end up with patients who have been through every, exhausted every option by the time they end up in your trial. And they often have pretty progressed disease, right? And so you hope you can offer something to these patients.

They had melanoma, so that’s a skin cancer, but they had not only aggressive, what we call cutaneous metastasis, which is across their surface of their body in the skin, but they had what’s called visceral metastasis. That’s actually what kills you in melanoma is the metastasis to the organs of your body and it was in their lungs. It was in other sorts of areas, so I think muscle deposits and bone deposits. And in addition to that, this patient had had multiple other therapies that historically actually respond very well to, melanoma responds very well to.

What’s unfortunate about the current state of affairs in melanoma and in some cancers is we have these immunotherapy drugs. What the biggest blockbuster of the last few years is a drug called KEYTRUDA from Merck. Incredible miracle drug, won a Nobel Prize a few years ago. In melanoma, if you respond to that drug, a lot of patients do. That’s great. If you don’t, the likelihood of survival begins to diminish very quickly. And this patient had had KEYTRUDA. They had had a whole number of other drugs through many, what they call, lines of therapy. You’d get a drug, your cancer responds or it doesn’t. If it doesn’t respond, you go to the next and the doctor, the oncologist cycles you through a number of drugs. And this patient was at a fairly advanced hospital that not only had given them the, what they call the standard of care and then the second line standard of care, they had given them actually a number of other, just like, maybe this will work, maybe this will work.

You’re trying to help the patient stay alive. And the picture that we have, and this is in, if someone, if you Google our ASCO poster, which is a big clinical oncology conference.

Tim Ferriss: Can you spell ASCO?

Jacob Becraft: A-S-C-O.

Tim Ferriss: Mm-hmm.

Jacob Becraft: It’s an abbreviation for the American Society of Clinical Oncology. It’s a meeting every summer in Chicago that is the big breakthroughs in clinical medicine for oncology, right? It’s the top of the top in a lot of ways for people. Big results, small results. We had presented this photo there, and I had met you a little bit afterwards to show — the photo itself is quite striking, and it’s in that poster, right? Which is this —

Tim Ferriss: Yeah, it’s basically a body riddled with cancers, right? They’re everywhere.

Jacob Becraft: You don’t have to be an oncologist to look at that scan and understand the extent of which this patient responded, just riddled and then no more. And one of the things, as a scientist, right, Tim, you mentioned something earlier, which was that this is more than a company for me, and actually a company is only about one third to one half of the time that I’ve spent on this mission to make genetic medicine work correctly for patients. One of the greatest accomplishments in that career that I’ve had thus far is being able to say that you did help a person. If that was just one person, one patient, I’d say, “Wow, what a career.”

We dream of more. We have big ambitions here at Strand. I have ambitions for what we’re going to, how many people in the scale at which we’re going to be able to help people. However, that was the first time that I really felt like our science went out into the world, and it took someone’s grandmother and not only kept them alive, but we’re a year and a half in, and they still have no detectable lesions.

Tim Ferriss: Yeah. Yeah, it’s wild. So in the investor deck, right, the pitch deck that I initially read and had, I apologize for that, but 1,500,000 questions about, what, for the non-technical folks, right, the muggles. They can look things up and are curious, what are things that stuck for them? Particular slides or phrases, certainly the images, but is there anything else that comes to mind that really resonated with people from that deck?

Jacob Becraft:I think there’s one other bigger generalist investor who had come into the round personally, and I had been having a conversation with them about something in oncology that we call the Kaplan-Meier curve. Kaplan-Meier curve, if you’re looking at oncology results, is a survival graph. So you maybe look at two years, and you look at, from 100 percent where you start the study, and then it looks like a step ladder going down. The standard of care line has some amount of people, steps down, and you want to have your drug be significantly above that, right? Either having more people alive longer or you have, what they call, the long tail where you, everything goes to zero in standard of care at a certain time point, but you have an amount of patients that just look cured. They continue on for many years.

In drug development, we get very used to looking at those graphs, and making very statistical calls, and saying, “Oh, this doesn’t look like it’s active,” or, “This drug’s there or isn’t that great.” But I think one of the things that I’ve spoken to some generalists, some of our larger investors who maybe aren’t from the biotech world, and I’ve tried to zero in on some of those survival graphs with, is to say, “When we look at these steps, these are lives, right?” The lines that go down on this, that the vertical part of the step is someone’s loved one dying. But the ones that go horizontal, and every time you see something go further along, right, that is someone who got to, even if it’s just three months, right, you have no idea what that means within that person’s life.

When we take that Kaplan-Meier curve, and those steps, and we zero in on each patient, we start to look at them and we start to say, “This is a patient that didn’t think they would see Christmas in 2024 and they just celebrated the new year of 2026,” that I think is meaningful in what we’re doing. Now, whether or not that will be a good product, right, there’s a difference between a good drug and a good product, right?

Jacob Becraft: I’d say the good drug is, can someone take this and it does something. Injecting a therapy into someone in a way that is very hard to replicate but did a great thing for that individual person is a good drug fundamentally. It is a good drug. It helped that person. And a good product is much more — this is where the idea of how we get medicines to people come into play. I’ll give you a different example. There’s something else that we’re working on called in vivo cell therapy. Essentially, there’s an entire type of science that we have discovered how to take the immune cells out of a patient, take their immune cells out, reprogram them so that they learn how to attack cancerous blood cells, and then put them back into a patient.

They are phenomenal drugs. There are people who are about to die of myeloma and then they get this drug. But the drug costs, not making money, the drug costs $750,000 to make, just to manufacture. It costs three months of time to manufacture. It’s very hard to see a world in which that drug has a large impact on the patient population because of the fundamental cost, the COGS, the cost of goods sold. Not biotech, just straight business. The cost of doing it and the time it takes to get it to people, that’s a bad product.

And so if you could, say, instead of taking the cells out of the body, if you could reprogram them while they’re still in the patient, now you have a good product. If you can make the cells recognize the cancer, the immune cells programmed to activate against the cancer in the same way, but make it an outpatient procedure where a patient just gets hooked up to an IV bag for two hours and then goes home, that is a phenomenal product.

Tim Ferriss: I have to look at this from the perspective of a non-specialist because that’s what I am.

Jacob Becraft: Yes.

Tim Ferriss: But if you were giving a TED Talk on this and had to get across at least part of what you’re doing, I feel like what you just said hits the nail on the head within the first few minutes.

You’d have to talk about the central dogma, so to speak, of DNA as master copy, so to speak, mRNA, and then protein. But just in brief, could you describe the treatment? What the treatment actually looked like for the patient in those photographs, the before and after? Like dots everywhere representing tumors, and then holy shit. I think everyone, whether they’re technical or not, that looks at that deck, probably had the same response to those images.

Jacob Becraft: So in cancer, you have chemotherapy. I think people are fairly familiar with. You also have immunotherapy, which is the ability to activate the immune system to attack the cancer directly. And that’s what some of the biggest blockbuster drugs of all time are currently Merck’s Keytruda, Bristol Myers Squibb’s Opdivo. And then there’s a number of other types of immunotherapies which are classified as checkpoint blockades. So what that is, is your cells essentially have a way to tell the immune system that they are your cells. So you don’t want your immune system to attack your own body, obviously.

And so one of the mechanisms that you have is this “I am you” signal that you can send to the immune system, your cells can send to the immune system. Cancers hijack that mechanism to protect themselves from being attacked by the immune system. And what we figured out was a way to block those signals. And that’s the entire field of immunotherapy. Not the entire field, but I would say a vast majority of the field of immunotherapy. And the successes of the last decade of treating cancer and also commercial success for a lot of these companies has been based on further refining better checkpoints.

The problem with that is that they’re all very similar mechanistically. And so if one doesn’t work, if you have cancer and I give you Keytruda and it doesn’t work, the chances that the next types of therapies will work, since all of them are very similar mechanistically, the chances diminish quite drastically. And there’s some nuance here. And I’m sure if there’s oncologists listening to me, they’re like, “No, but you don’t know. And double negative this cancer if you combine with these.” It doesn’t matter. In general, these mechanisms become degenerative and we don’t have good additional options to excite the immune system.

A second theory for going back to the ’90s was, if instead of just blocking the cancer’s ability to hide from the immune system, if that’s not enough, what we actually need to do is we need to activate the immune system directly. And it would be best if you could send that activation signal from the tumor itself. So now you have a tumor. Instead of just blocking the tumor’s ability to hide, you actually have a tumor that’s screaming like, “I am a foreign object, please come and eat me.” That’s how immune systems kill things. They eat the other cells.

And so the issue. This is not new. This is basic science from immunology from the ’90s. The problem is, we haven’t had a good way to get the tumors to send those signals. We’ve tried to make the signals in the lab and then inject them into the tumors. And the problem is the signal just goes away immediately and then it’s circulating in the body and the immune system doesn’t know what’s sending the signal. We’ve tried everything we can to make this signal artificial and get it into the tumors. And every single time we do it, it’s either not enough in terms of no efficacy, or it activates the immune system in all sorts of places we don’t want it and it causes all sorts of toxicities.

And so what we are doing with our medicine is delivering the instructions into the cancer cells in a way that causes the cancer to basically send its own signal out. So it’s artificial in that we have made it in a lab. But instead of making the signal, we’re making a message that tricks the cancer into sending the signal. And so that is drastically different. It makes a huge difference in both safety and efficacy. Because now you are recapitulating how the signal works naturally. If the cancers weren’t cancerous, if they were just deregulated and cells were starting to grow out of control, your cell would naturally send the signal and be like, “Oh no, something’s wrong.” And your body would take care of it.

You actually generate cancer all the time in your body in terms of dysregulated cells. Your immune system just comes in and takes care of it before it becomes like a — when it becomes a real problem, that’s when you get tumors, that’s when you get the disease we call cancer.

And so what we’re doing is we’re resetting that system. We’re having the tumors resend the signal out. And so what we created in that first drug was a very simple administration procedure. You take our genetic medicine and you inject it into the tumor directly. And what that does is the immune system comes into the tumor and it kills it. But then it gets activated by that killing process and it learns what the tumors look like and it can better identify the other tumors that have been hiding throughout the body.

Tim Ferriss: That’s the point that I was hoping to get to. It’s basically like, in the case of this patient, not to belabor this point, but it’s like you injected, if I’m remembering correctly, into cutaneous, meaning just under the skin, I’m not sure what the right term is, nodules, like instances of cancer. So my follow-up question is going to be like, well then how do you suddenly get to the visceral instances, right?

Jacob Becraft: Yeah.

Tim Ferriss: And I think that’s what you’re describing, right? And within the world of oncology, is that a novel observation? Is that something that is new in terms of being able to do that?

Jacob Becraft: So it’s something called the abscopal response or the abscopal effect, which means that one tumor is what you’ve put the activating drug into, and that’s where the immune system will attack first. But now the immune system is activated and educated to go and kill the other tumors. It’s not new in the fact that I didn’t come up with that name. It has been observed in limited other settings of a few other drugs that people have gone out with. I guess the problem has been that it’s been very, very limited in terms of the abscopal response that other people have seen.

So for instance, you would have a patient with a tumor, maybe melanoma patient, so they’d have a cutaneous lesion, a skin lesion on their chest. And then they’d have another one on their shoulder. And you would inject the one on the chest and the shoulder one would also shrink. And they’re in the same region, right? The immune system is fighting the cancer in the same region. But you wouldn’t necessarily see that happen in the lungs. And so, one of the big pushbacks on a drug, like the one that we took to the clinic two years ago was, you don’t die from having tumors all over your skin. You die from when they metastasize into your lungs and into your liver and impact the organ functioning, right? That’s how patients die of melanoma.

So if you are only able to address the tumors that you can either inject or that are near the injected tumors, you won’t have an effective drug if a patient already is further along. We are, to my knowledge, one of the first companies, if not the first company, to demonstrate that a direct injectable drug into the tumor in a large number of patients — this isn’t a one-off. It wasn’t one miracle patient that had… That is a beautiful photo of that patient. And I’m so happy that they’re still on the trial and still doing great and it’s amazing. But this is about being broadly applicable because that’s how you actually impact population level lives.

And so we are the first company that I’m aware of to show this extent of abscopal response in visceral, deep organ metastases in a multitude of patients. And really right off the bat. I mean, this is from the very first patients we put on this trial, at the very beginning of it, began responding. That is very uncommon. It’s very uncommon to have patients on a phase one trial on the drug six months later. And of our first three patients that ever entered this trial in the summer of 2024, two of those three are still on the trial 18 months later. That is something that, I think, is fairly shocking.

Tim Ferriss: Yeah.

Jacob Becraft: And if we were a traditional biotech company, we’d be really happy with all of this data and we’d say, “Wow, let’s take this forward.” However,I think the real message of Strand and what we can accomplish in genetic medicine is, we don’t have to stop it just injecting into the tumors. There are a number of concerns with injecting tumors from a product perspective. Not a drug perspective, but a product perspective. The difference between, a drug is all about does this work, and a product is about how will these patients get these drugs? And injecting directly into a tumor is doable and most oncologists can handle it, especially for skin cancer patients. But as you go to rural health communities, it gets harder and harder to have doctors that have that training. And as you get to other sorts of tumors beyond skin cancer patients, some of their skin lesions have been removed by a surgeon. And then you go beyond skin cancer. How are you going to inject a patient with non-small cell lung cancer?

Like you start to get this idea of there’s a limited amount of patients you can access, right? And so you have a product, maybe limitation. In cancer, the way that we actually treat cancer patients is that there’s an infusion clinic. You go to the infusion clinic. The oncologists and the nurse practitioners and everyone, technicians hook you up to some sort of an infusion, and then the oncologist can monitor multiple patients at a time. And that’s what our infrastructure looks like right now of how we treat patients. And if you want to have the largest impact in medicine, you need to make medicines that plug into existing infrastructure.

As much as you want to tell everyone, “Hey, change everything about how you think about treating patients,” the way to have a near term impact is to build drug solutions that can plug into existing infrastructures. If we become a giant biotechnology company that has all sorts of resources, maybe we can talk about changing how everyone gives drugs. But for right now, if we want to be able to help the most amount of patients in the near term, we need to plug into that infrastructure. We need to find ways that we can access organs.

I’d say, in addition, the bloodstream is also a really good way to get around the body, believe it or not. I mean, the bloodstream carries oxygen to everywhere in your body. And so if your drugs can travel through the bloodstream and get where they’re going, very effective. In genetic medicine, I would call it the holy grail. For the last 30 years has been thinking about how do we IV administer intravenous, which means into the bloodstream, administer genetic medicines that can get to places throughout the body. We’ve been trapped in one organ for the past 30 years, and that’s the liver. The liver naturally filters your blood and thus it picks up a lot of these genetic medicines that we put into the bloodstream.

And so what we’ve done for the last 30 years is figure out how we can treat diseases in the liver with this old internet meme, which is like, step one, blank. Step two, question mark. Step three, profit. I remember the old days of FRedit. People used to use that structure. Step one, do this. Step two, question mark. Step three, profit. In biotech, in genetic medicine, the joke is like, step one, prove it works in the liver. Step two, question mark. Step three, we’ll treat all these diseases. And after 30 years, we’ve really nailed step one. And step two has remained this big question mark.

And so when we started Strand, our number one goal actually was not even to get to this first drug, as amazing as it’s been for these patients and as happy as I am that we have been able to help those people in their lives and as impressive as it is. Our main goal was to solve this step two question mark that’s been sitting there in plain sight. And I guess the big piece here is that everyone who thinks they know what they’re talking about in genetic medicine will say, “Well, the issue is delivery.” And it’s like, you need to be able to deliver. And I’m like, “That’s a very hand wavy.” Again, it’s just a cheap answer, which is not wrong, but it is incomplete. And I believe that it’s actually three problems at once. It’s three children in their father’s trench coat pretending to be an adult.

It’s like, “We’re delivery.” And then you open it up and it’s like potency, specificity, and delivery are all here inside. And no one wants to hear that because people want simple solutions, right? They want like, “Oh, it’s delivery, so we’ll just fix delivery.” I mean, just 30 years in, no one has a good idea about this piece, right? And I’d say that the thing at Strand that when I started the company that I just could not understand why everyone didn’t see what I was trying to tell them. And I was very bad at pitching. You think I’m too much of a scientist. Now perhaps. Or maybe your audience does, if they’re listening. But like, man, you should have seen my very technical zero market insight pitch deck of 2018 that is complete dog shit. It is an awful — I can’t believe someone funded us.

I’m a huge fan of Elon Musk’s first principles-based thinking. I don’t know if Elon is the one who invented first principles-based thinking, but I think he’s probably the main evangelist and popularizer of this thinking modality, where if you take SpaceX, for example, his idea was, what is the thing preventing commercial space flight? And it’s dollars per kilogram of launch. It’s just like, dollars per kilogram. That’s it. How do you get it down?

And you start to like, “Well, where’s the cost centers in a launch?” And you go, “Okay. Well, the cost center in a launch is in these rockets, these fuselages —

Tim Ferriss: Trashing rockets.

Jacob Becraft: They were trashing — we’re trashing 80 percent of it. And you go, “Well, why don’t we just reuse them?” And people are like, “Well, they do this, they do that. They’re hard to retrieve. They’re in the ocean. They’re floating. They can’t…” And he goes, “What if they land themselves?” And it’s like, that’s an insane person thing to say.

What I want the world to understand is that we are standing right now on the precipice of a revolution in genetic medicine. And that’s important for a number of reasons. One, it’s important because there are near-term diseases that we’re going to be able to solve. We’re going to be able to get to a point in the not-too-distant future where I think a lot of types of cancers are, at the very least, chronic diseases instead of death sentences. We all want to get to cures. I want to get to cures. But we are getting at least to a point where it’s a manageable disease, right? That’s, I think, a near-term piece.

There’s multiple lines of technology that are coming together that I think people are not fully appreciating what they’re going to mean for the future of medicine. And so, there’s a lot of focus right now on AI-based drug discovery. And people, they’re building proteins and antibodies and all sorts of stuff with AI models that are doing incredible things. We have decades of work on designing exquisite proteins that do all sorts of stuff, from edit genomes, to cure whatever in some sort of mouse model.

What we don’t have is the infrastructure, the biomedicine infrastructure that gets any of these things, these discoveries, whether they’re made by a human with Microsoft Word stitching amino acids together, whether they’re made by an LLM that knows exactly all the pieces that are going to make this, whether it’s made by high-throughput screen of 14 different robots in concert. It doesn’t matter. What matters is how we’re going to get those into patients, how we’re going to get them into the places they need. And I think about this as this infrastructure of medicine comes forward and what this will actually mean for the future of healthcare.

Anyone in any sort of a place of power throughout the world, I think, needs to understand where, in the next 10 to 20 years, we very well may be headed with medicine. Which is smaller indications, niche indications.

So what’s important for folks to understand, and what I want people to see is, we are moving in a way where, I think, medicine becomes, maybe not completely bespoke, but much more refined. And the way that we get there, we’re going to get there technologically and we’re going to get there from a design perspective much quicker than we’re going to have the infrastructure to actually deliver those medicines to people safely, effectively, at scale.

And so our goal at Strand, and our challenge, is building drugs today that impact patients’ lives. We’re not a research institute. Our goal is not to do really cool research on mice and join the ranks of people who have cured mice of cancer. There’s millions of them. There could be a Nobel Prize every five minutes for someone who’s cured a mouse of cancer. Our goal is to cure human beings of human-being cancer. Our goal is to cure human beings of human-being diseases, and do so in a safe, effective, scalable way that impacts a person’s life as little as possible. And that is what we’re building. We’re building as a commercial organization. We’re building drugs today, but what we’re doing is we’re laying the groundwork for this infrastructure to where when we’re successful in tumors with the new trial that we’re running this year, when we’re successful with being able to IV deliver, infuse a genetic medicine that goes to the tumors, we have an instruction manual, what we call a payload, the protein that we’re tricking the cancer into making. We have one that we’ve chosen. But success there actually means that I could now, in six weeks, design a completely new protein to be delivered to the tumors. And I could just go over and over and over again. I’m only going to be gated by the infrastructure I have to build, like new ones of those, and the FDA’s ability to move quickly with us as we try to test new and newer things, but we know the general high level safety of this.

That’s coming, right? That’s coming in a lot of other areas of the body where we’re designing things to get into T-cells, so we can help temporarily influence the immune system so you could take out things like autoimmune disease and allow patients to revert back to their pretreated state without doing any sort of genetic modification. We’re trying to get all sorts of these therapies forward. And every time we have a success, we lay the groundwork for this infrastructure going forward.

I want people to understand it, one, because we have large ambitions. A lot of people have thought, first, they thought that the first principle-based approach we were taking was incorrect. They’re like, “It’s a delivery problem. You need to build a better delivery vehicle. Why don’t you focus on that?” And I’m like, “Okay, everyone’s done that.” Right?

Now, we’ve shown this complex solution actually fixes this age-old problem and we’re going to be continuing to move that forward. I’d say the biotechnology industry will be dragged kicking and screaming into the future, or it will be built up in a new way from new players. For us, I want to find the people throughout the globe who want to partner on these things, the innovators in America, right? And those are all sorts of different sorts of folks.

Tim Ferriss: Yeah. Let’s dig into that just for a second. For instance, with this podcast, let’s say I was like, “Well, I’ve got good news and I’ve got bad news. The bad news is, I can’t put this out to my whole audience. The good news is you get to tell me which thousand people I send it to, and that gets hand-delivered to a thousand people.” And I mean, a similar way to look at it would be like, “All right, you’re giving a TED Talk, but it never gets shared online. It is only for the thousand people in that room, but you get to handpick them. Who are those people?” And it could be categories of person, but how would you think about that?

Jacob Becraft: I think there are people, policy leaders not just in the United States, but across the globe that need to think critically around how we are going to both handle, enable, and empower the future of medicine because things, incentives, things are going to look quite differently 10 years from now than they do today, in terms of the scope and the style in which we can build medicines.

Tim Ferriss: And the policy leaders are important. Sorry to hop in, but because ultimately, they’re going to determine the rules by which healthcare is played. Is that one way to put it?

Jacob Becraft: Yeah. Healthcare is very similar to the space industry and that policy leaders essentially have two major pieces, is that they are both the arbiters of what is allowed to be done. And they are a major payer, not the only payer, but they are a major payer of the purchasing of that. And so as the fundamentals of medical development change. Now, I’m not making a drug that I hope to give to two million people worldwide. I’m making 100,000 variants of a drug that I’m hoping to give to 10,000 people worldwide, or 10,000 variants of a drug that I hope to give to 100,000 people worldwide. And I get to more people, but there’s more variants. Both the regulatory and the payment systems, I think need to adapt themselves to allow for that.

It’s on us, the medical innovators and the engineers and the entrepreneurs, to build systems that are still good products. You have to think about where you’re going, and then build a system that can still be a good product. If it costs 10,000 times as much, it’s not going to work, right? It just won’t work at scale and you won’t access these patients. But if you can see a path forward and think creatively — I’m not a politics guy, but I am fascinated by policy and how incentives shape the future of highly regulated industries like biomedicine, like space, like all these things, and that is regulation, plus payment. I think that there’s incredible work to be done.

And the last big time of, I think productive collaboration between worldwide policymakers and the United States as a leader, but the last big collaboration of that came in the ’80s when biotech started to take off. In the ’90s when it really ripped, right? When we started to harness the power of recombinant proteins, the Genzyme book, you plugged it earlier, that’s phenomenal.

Tim Ferriss: Oh, the Genentech. Yeah.

Jacob Becraft: Genzyme is the Genentech of Boston. I get the two of them were like — the Genentech book really, studying the history of Genzyme, Genzyme actually had the leader, Henri Termeer, who was the actual quarterback, I’d say, of the policy innovation, worked with government officials to figure out what will this new class of medicines look like that aren’t just small molecules that you can take home. Right? Now, we have antibodies. We have all of these drugs that are amazing because of it. We have the Orphan and Rare Disease Act [Orphan Drug Act], which led to people building these rare disease drugs. I’d say we need to have more productive, collaborative conversations around what the future will look like because things are going to change very fast.

I read the AI report from the White House, for instance, and how the state of AI is. And I looked at, I read through it and I was like, “They actually need one of these for biotechnology as well, because things are changing as rapidly and it’s going to be further accelerated by AI.” And if we don’t have some productive conversations, we’re going to be stuck in one of two places. One is where only the ultra rich can get the really disruptive drugs because they’re the ones who can pay for it, because we don’t have a system set up to have these new radical changes commercial quick enough or dispersed quick enough. Or the second is the inability to pay, the inability to find ways that support an ecosystem makes an uninvestable thesis for investors. And so all of these great innovations that we have coming out of the lab right now —

Tim Ferriss: Just die on the vine.

Jacob Becraft: — get cut off at their knees because, just like space, space industry, it’s a long time cycle to read these things out and you need capital to get there.

Tim Ferriss: So a lot of what I try to do in my own meandering way is kind of answer the thousand people in a room question, right? And then to figure out, it’s like, okay, let’s just say you’re spending time in DC. You sit down, their staffer convinced them to sit down for 30 minutes, right? What do you lead with? And then that can inform potentially the website or appearances on podcasts and stuff. So just in case it’s helpful, I can obviously share this afterwards too, but it’s like, a couple of things come to mind, right? And I think in terms of like, okay, once you identify the people in the room, then it’s like, what does the TED Talk look like if you got 20 minutes on stage? And you’re good at this stuff, but sometimes you’re so close to it that it’s helpful to have a muggle who’s coming at it.

Jacob Becraft: No. I want to hear this, Tim, by the way. This is a free communication lesson from someone much more versed in the area.

Tim Ferriss: Well, yeah, thank God because I can’t do science. So the allocate responsibility as well, I don’t want me in charge of developing immunotherapy. So the Christmas story and the photos, right? So if you started with that, I’m just like, walking through my made up TED Talk, right?

Jacob Becraft: Yeah.

Tim Ferriss: And then you talked about, let’s just say you went from there like, “Okay, let me take a sidebar for a minute.” And you talked about SpaceX and the reusable rockets, right? And the analogy also of like, once you have this engineering platform developed from first principles, now you have something that is payload agnostic, right?

Once you’ve made it economically feasible and you have this platform, whether you’re launching superconductors into space as an alternative to propellants for a satellite reorientation — you should check out this company called Zenno. I might have to redact this, but they’re in New Zealand, Z-E-N-N-O. They’re pretty fucking amazing. But whether it’s that, whether it’s something else, is entirely up to you in terms of deliverables because you’ve done the hard work of developing this engineering platform, right?

Then talking about like, “Okay, well, what does that actually mean for biotech?” And you’ve got the holy grail, right? How do you IV administer genetic medicine? And then you could segue and tell people. Because there’s a good drug and there are lots of good drugs that die. Why do they die? Because they’re never going to actually make it into production, so to speak, at scale in healthcare.

And I’ve seen a lot of analogies with this, and I won’t digress too far, but with psychedelic medicine.

Jacob Becraft: Yeah.

Tim Ferriss: And it’s just like, okay, you need, like, an overnight nurse. This is going to be an eight-hour experience or six-hour experience. And sure, you could argue that you might have the rich people pay $10,000 out of pocket and that subsidizes the — it’s sort of like Uber Black subsidizing UberX. There is an application there, but if it’s fundamentally incompatible with current healthcare, you’re trying to win a race with your ankles tied together, right? It’s probably not going to happen.

And then you have people looking at like, 5-MeO-DMT instead of psilocybin and stuff, and I have my own thoughts on that. But sure, it’s like you look at the failure just real quick, of like, MDMA-assisted psychotherapy when it got in front of the FDA advisory committee, a lot of reasons for that. But then you have people coming out of the gate and they’re like, “Oh, we tried to couple…” They tried to couple psychotherapy with it. The FDA does not regulate psychotherapy.

It became a huge quagmire of just confusion and therefore, these other people are like, “Well, let’s do methylone and has a much shorter half life, you can actually fit it into like an hour hypothetically.” Right? You can decouple the therapy or just looking at drug effects and lo and behold, it’s making a ton more progress, right? But the point of saying all that is that you’ve got the SpaceX, you segue to the holy grail, and then like, what if you could reprogram cells in the body? What happens? So I do love the fired up, like hand wavy delivery thing, right? Because you’re like, what they’ve missed is — and again, I’m ad libbing here, so it might be questions like, “They’re right and they’re wrong. They’re wrong because of reasons X, Y, and Z.”

Right? And this is a lot of hand-wavy stuff and we’re still at a point where we’re defining triple negative breast cancer by what it isn’t.

It’s like, if you have trouble with your shoulder and you’re like, “Well, good news, it’s not like elephantiasis and it’s not Parkinson’s disease.” And you’re like, “How does that help me?” It doesn’t really, right?

But then you say, they are right about delivery, in the sense that if you cannot plug this into healthcare and deliver it to end patients, game over. It doesn’t matter how effective it is in an N-of-1 or an N-of-5, or whatever your small clinical is, right? So in the idea, these are not necessarily in the order, but talking about like even though it’s not the end goal, what if we could turn cancer into a chronic disease that can be managed, right? And it’s like back in fill-in-the-blank, 1980x, right? HIV was a death sentence and no longer the case. Now, you look on television and it’s like, you see ad after ad related to some preventative, but also like maintenance drugs that allow people to live with the chronic condition.

So anyway, those are a few things that kind of hop to mind.

I would be curious, for policymakers, what are the things that most catch their attention, whether from experience or hypothetically, right? What is it that actually gets their attention?

Jacob Becraft: I was in DC yesterday, and my overarching message is sort of like, there are two things we need to do better. We have to build regulations that I think are common sense that still allow us to more cheaply test drugs right now for a lot of reasons. We have sort of vestigial over many years, reasons as to why it takes us a lot of money and a lot of time to just get to a simple answer on a medicine, right? And that is creating a world in which the biotechnology industry is incentivized to do very small steps forward because the cost of failure is so high that you’re trying to reduce your risk in a way that is, let’s make a drug that’s 10 percent better, right? Because taking a truly innovative risk would be very difficult, would be very difficult to underwrite for certain investors.

I’d say at the other side, the thing that catches folks’ attention is to talk about how medicine is fundamentally changing. And we all can see that AI is changing how business is done, how people build things, how people read things, how people parse through information. It’s making highly motivated people 10X better, if not more. And it’s not just AI and biomedicine, it’s sort of multiple threads coming together of novel technologies of how we build medicines, genetic medicines, and their sort of advancements, things like what we’re bringing forward. Our ability to diagnose diseases and subcategorize diseases and change the way in which we interpret how this disease is, the sequencing technologies which allow us to do that and other sorts of computation and AI that plugs into those pieces, all of that’s going to fundamentally change medicine, right?

Tim Ferriss: Yeah.

Jacob Becraft: Because if I can’t just make a decision around the drug that every breast cancer patient gets, and then I agree on the cost that that drug is, and I pay for it a number of years, and then the drug goes to generic and someone brings the next drug forward that’s 25 percent better and blah, blah, blah, and we just continue along that, that’s the non-innovative way in which we’ve been developing medicines for the past number of years. And every once in a while, we have a breakthrough. I’d say, policymakers tend to like that because it comes down to like, numbers, right? And medicine is a very interesting piece in policy.

Tim Ferriss: What do they like? Could you just say that again? They like the idea of breakthrough versus incremental.

Jacob Becraft: They like trying to learn about it. When you start to talk about medicine, it’s very interesting, because medicine, like, you think about paying for medicine, like the government or health insurer, but the government, paying for medicine is a near term cost center that should long-term reduce a larger cost center, right? Brand name medicines are eight percent of US healthcare spending, but hospitals are 26 percent, something like that, in the high 20s, I believe. And so you imagine that for eight percent of your dollar in healthcare spending, you are pulling down the amount of people that are now hospitalized. You are increasing people’s life. You’re keeping people in the workforce, you’re keeping people in their homes. You’re keeping people out of a system that both no one wants to go to the hospital and the government that pays for a lot of people’s hospitalization in the form of Medicare and Medicaid, doesn’t want to pay for people to go to the hospital.

And so you begin to talk about that system and you say, preventative healthcare, but all medicine to a certain extent, it can be thought of as preventative if it’s able to stave off hospitalization. It’s at least, at the very least hopefully, preventing you from being in the hospital. And so policymakers like those conversations.

Tim Ferriss: I’m going to try to keep this from sounding too conspiracy theory, but what I’d love to know is what’s in it for policymakers to help you? And that might sound strange, right? Because I’m not saying these are bad people and we could talk about the kind of industrial regulatory exchange programs another time, but like, that’s a thing, right? So I guess what I’m wondering is, how do you align incentives with policymakers so that they feel compelled and interested in being helpful? That’s the big question that comes to mind.

So let’s just say there are a thousand policy makers listening right now or if you’re in the room, but like what is your ask? If they’re like, “Hey, look.” Again, good news, bad news. “Bad news is I can’t meet again. I’m just too busy. Good news is, if you have a reasonable ask, I can greenlight it right now,” right?

Jacob Becraft: Yeah.

Tim Ferriss: But you need to do it. What is the ask?

Jacob Becraft: My first ask right now is we need to streamline how we test new medicines in humans, in clinical trials. In fact, maybe if this ever sees the light of day, hopefully the op-ed that I wrote on accelerating first-in-human trials and becoming a more innovative powerhouse as a country comes.

Tim Ferriss: Oh, where’s that?

Jacob Becraft: I just wrote it a couple of weeks ago and submitted it to a handful of places in the last couple of days. I think that it’s the single greatest advancement in biomedicine that we’re going to be able to make. And then of course, it opens a lot of doors for us at Strand, because we have way more ideas than we have the resources, time, and money to take forward at $50 million a try. But if you start to make it more simple, and a lot of these things are common sense regulations, we’re spending way too much time and way too much money doing things that I think are quite antiquated and vestigial in our regulatory process. And so if you can reduce that time and reduce the amount of money, then you can change the economics and the incentives around building new drugs. And you can begin to generate more diverse data that allows you to train things like AI models on what actually makes a difference in a drug and a human.

We just don’t have enough data and we don’t have enough diversity of data to be able to train them nearly to the level that we want right now. And a lot of it, just at the end of the day, it comes down to like, does this do something in a human? You could do all you want in the lab, you can do all you want in mice, you can do all you want in primate studies. Whatever it is that you do, it just doesn’t matter to nearly the same level until you do it with a human. And when Genentech and Genzyme were coming up in the ’80s and ’90s, it was a comically fraction of the cost and time that it takes to bring new medicines forward today. This isn’t an impossible thing. We’ve just created a lot of weird barriers and we need to get back to a first principles way of thinking within government as well.

I’m not the only person preaching that, and I’m certainly not the only one in policy that thinks about it. I’d say in America, we want to be the headquarters of innovation, but a lot of other countries want to be innovative too, right? In Asia and in the Middle East, there are countries that are like, “We can do this. We have the technology. We can make investments into the space. We can make investments into companies earlier that we think have a high leverage point in the future health and we want to go in those directions.” The United States is able to do it too, but that’s it, right?

Tim Ferriss: If you did an 80/20 analysis on the impediments and someone is like, “Okay, we want to streamline, but if there are 10 items on your wishlist, let’s pick two or three,” what are those two or three?

Jacob Becraft: One, I think is that we should remove the FDA from a direct permission-based oversight organization on the beginning of first-in-human trials. So let me just explain this for a different sort of audience, right? Right now, in order to do a clinical trial of what we call a first-in-human, the first time you give a drug to a human, a new drug, so a phase one, in order to do that in the United States right now, you need to write an IND, which is called an initial new drug application to the FDA. It’s very long. I think ours for our first trial was 22,000 pages long. You have to have professional writers, professionalized system, all sorts of very expensive things. Just to write it, it’s millions of dollars.

Tim Ferriss: Wow.

Jacob Becraft: The studies that need to go into it are millions of dollars. The manufacturing of your drug and the associated analytics of your drug in order to be correct in the document costs millions of dollars. And this tax up and up and up and up and up. And all of a sudden this application costs you $25 million and it takes 18 months to put together. Now, in China and in Australia, two of the countries that do much faster first-in-human trials than the United States, they have a system where you go to something the hospitals called the IRB, the Investigational Review Board. In Australia, they have a lot of professional centralized IRBs that manage multiple hospitals and they work in a for-profit system to help companies get their procedures like figure out whether or not they’re going to be a fit for the hospital.

You still have to do that in the United States. After you get the IND approved by the FDA, you then have to go to the IRBs. Right now, since it costs so much money and takes so much time to get an IND from the FDA, if you have decided to do that instead of go to Australia and go directly to the IRBs in Australia or go to China, your board wants you to essentially go to the top hospitals, “Hey, if we’re spending 25 million on an IND, I want you to go to MD Anderson. I want you to go to Sloan Kettering. I don’t want you to go to pick a great but random hospital in the Midwest.” So now we have a lot of hospitals in the United States not running first-in-human clinical trials, which means we have a lot of Americans who exhaust their standard of care and can’t get the access to drugs maybe before they are fully approved and they’re just out of options unless they want to fly to Houston or New York or Philly or something like that.

And a lot of people don’t if they’re facing the end of life, or for all sorts of reasons, people don’t want to do that. So you have Americans not having access to drugs. You have companies shoved into clinical trial sites that are already overburdened. You have IRBs at those hospitals which are difficult to deal with and also overburdened in trying to process all the people who are trying to come through their site’s doors. And all of this is taking place after you’ve spent way too much money and way too much time submitting a safety document to the FDA in order for them to approve it when the FDA actually has a lot better things to do as well. So all of that reeks of an inefficient system.

Tim Ferriss: So if they said, “Got it, problem sounds terrible. You can author the solution.” What is the alternative?

Jacob Becraft: The alternative is to allow the hospitals and their IRBs to make the — they already make the decision on whether or not to run a trial and they’re assessing the data that you have on your safety, as well as your efficacy and the patients you want to go after. The IRB is going to assess that and make a call after you get the IND done. I think the transition system to transition to, Australia calls it a CTN. It’s a clinical trial notification system. You notify the regulators, “Hey, we’re going to run a trial.” It’s not a path system. There are exceptions, certain types of drugs still need to go through them for formal approval, but for the most part, you can notify them, go to the IRB, the IRB can say, “Yeah, we think this is safe enough.”

And the reason that is still a very safe option because patient safety, from a drug company perspective, from everyone’s perspective, is number one. There is nothing that will kill your company faster. There is nothing that will make me never be able to sleep again. It would be harming patients, especially harming patients because you are being sloppy. And the group that obviously cares just as much if not more than everyone else, is the hospital’s review board because the hospital does not want patients harmed or dying, God forbid, in their trials, right? The FDA isn’t magical in their oversight of safety, but you distribute this workload across the IRBs that exist throughout the United States and they get certified with the FDA to be able to approve this. You can centralize the IRB so that individual hospitals don’t have to have their own IRB.

You can have all of these systems. All of a sudden you have hospitals that have the ability to attract biotechnology companies for drug trials. It takes infrastructure to run clinical trials. So the free market sort of picks up there and builds a system that I think can accelerate clinical trial management. And you free the FDA to focus on the things that matter, which is approving drugs based on efficacy and safety, that’s how drugs get approved.

Tim Ferriss: I know you’ve got to run in a bit.

Jacob Becraft: We can try to get through. This is fun. We don’t talk about it.

Tim Ferriss: Yeah, this is a juicy piece, so I want to chew on it a little bit more. I’ve funded a bunch of science in mostly New Zealand, but also in a few other countries, simply because the speed of putting through red tape and the sheer amount of red tape is much less. So that’s why I would choose New Zealand and some of these very credible universities over doing research, no offense to Jamaica, but there’s psychedelic stuff going on in Jamaica, but nobody in the US gives a shit, right? They’re not going to listen. It’s not going to hold anyone’s attention.

I guess what I’m wondering is, simultaneously, I can look at New Zealand and say, “Okay, it’s mostly sheep. Yeah, you have some people, but it’s a lot easier to run New Zealand than it is to run the United States.” So I can’t just say this works in New Zealand, copy and paste into the United States. Australia is substantially larger, right? So I guess two questions. The first is, zero to 10 confidence, what is your confidence level that if policymakers got behind it, that something could be done along those lines? Not necessarily even at the federal level, maybe at a state level.

There’s all sorts of complexity there, but what’s your confidence level that something like that could be implemented in the US within the, I don’t know what the timeframe would be, the next five years, let’s just say, five to 10 years, if policymakers got behind it? And then the corollary to that is, is there any competition for scientific innovation that is attractive to a company like Strand, much like companies are moving from, say, California to Texas, right, because there are certain incentives.

Is there a competition for talent globally through which, if the UAE wants to greenlight something incredibly quickly and fund it, that Strand would be interested or is it live or die, ride or die in the United States for any host of different reasons? I know some companies who have tried to tackle the FDA first because they’re like, “Hey, once we have this data, we can copy and paste a lot of it into the EMA in Europe,” which is the sort of equivalent. I know that’s a lot that I just threw out there, but what are your thoughts?

Jacob Becraft: To answer the first question, there is a global competition for running clinical trials like this and actually, what we are in the midst of right now is the United States massively losing to China. China has built an industrialized version of clinical trial infrastructure for first-in-human trials that is so efficient and massively quick that they’re just able to go faster and cheaper into the thing that matters most, which is first-in-human trials. So the United States is actually in the process of very rapidly, as a country, falling behind China because what started as a place for American companies to come run clinical trials to get data and then take it to the FDA and then do larger trials in the United States has now created a flywheel structure within China where now just Chinese companies run their clinical trials faster than the American companies and then bring their Chinese-discovered drugs to the United States.

And what happens is the risk capital then says, “Oh, these companies are more efficient, I will fund these sorts of aspects.”

There’s always state by state like, “We want to have biotechnology here.” Every state’s always tried to have it. The best technologies remain in Boston and San Francisco, just similar to like — tech companies might have left for Miami and Texas, but where’s OpenAI in San Francisco? All due respect to Austin and Miami, I love those cities, but San Francisco, it’s hard to replicate those pieces. And biotechnology, Boston’s really dominated a lot of it for the past 30 years, though in this new age of medicine, I’d say San Francisco is really rivaling Boston because the risk capital and the openness to radical new ideas is much higher.

I think that also attracts a healthy amount of hype-no-substance companies and hype-no-substance founders and technologies. But I think that’s a low price to pay to take some big swings at what could be transformational technologies. Even though I run a company in Boston, I love Massachusetts, I personally identify with that ethos a little bit more of like, “If some bullshit hype filters into this, it’s worth it in order to take the correct swings at the truly big ideas, because one out of 10 transformations is better than seven out of 10 logical steps forward.”

Tim Ferriss: So CTN in the US, some version of that, as you described in Australia, if you were a betting man, if you were like, “Okay, I’m going to go on Polymarket and I’m going to put half my net worth on a bet,” I guess I’m asking you, how possible or impossible is the task of retrofitting the FDA and approval processes?

Jacob Becraft: This is not a comment on politics and this is also not a comment on a lot of different things that are happening at the FDA right now, but I would say in terms of the last 10 years of the FDA, the time to which they would be open to such a radical transformation, and radical in government bureaucracy’s terms, the thing about government bureaucracies is they very rarely seed their oversight. They will take new things to be oversight of, but in general, regulatory anything takes us… This is the problem with nuclear energy in America for the past 30 years.

We just tack on one more thing and one more thing and one more thing and one more thing and these cottage industries emerge to support the giant regulatory machinery. And we don’t take a step back to be like, “Why are we doing this? ” At the same time, I’d say to look at the FDA right now. This is probably the most open I’ve seen people to the idea of like, “We want the FDA to be an exceptional regulatory body. We want them to build regulatory sciences to give us ultimate confidence in the drugs that we build, but there are new technologies that we’ve been slow to implement.”

There have been markets that haven’t been able to be fully created with technology for things like clinical trial analysis because no one was sure if the FDA would embrace them. And there are things such as early-stage safety, which are already handled by hospitals themselves where it will take some time to make. But if I was a betting man, I’d give it a 50 percent likelihood that in the next two years we can get to this. And I wouldn’t be spending my time talking to policymakers about an idea. This isn’t about me just trying to have something to complain about to a senator. I believe that this is possible. I believe that we can do this.

I believe if we don’t do this, it is actually existential, we will lose a lot of our ability to develop drugs in America over the next few years to China if we don’t do it because capital has no allegiance, right? I also believe that like there’s other countries, and especially the UAE, for example, are ones that are watching it carefully and going, “Hey, we have great technology. We have a great landing place for a lot of Western values and Western companies. We have great quality of life here. We could attract folks to come do innovative work here.”

So when I hear various different leaders of countries in the Middle East talk about it, I certainly think it’s possible because they are countries at least over the last 10 years where you’ve seen be able to make aggressive bets in certain directions in order to attract innovation. So if they were able to do that, then yeah, these sorts of things could radically transform how people think about developing medicines. And at the end of the day, if we are able to develop better medicines quicker, faster, cheaper, more ambitiously, everyone wins.

Tim Ferriss: Yeah. I’ve been so impressed with the speed at which the Department of Health in, say, Abu Dhabi or the UAE, even more broadly speaking, but it’s incredible how ambitious they are, but in addition to that, how willing they are to take big swings and accelerate things unbelievably.

Jacob Becraft: That’s the country we’ve spoken to the least in the Middle East. It’s connections and it’s spending the time trying to decide what people want to do. I’m a believer in allied countries coming together. We run our trials in the United States and Australia. I think countries that share very similar values on the future of the world need to come together to build innovative solutions to the massive problems facing us as a human species. TBD, it’s not every country though.

Tim Ferriss: No, it’s not every country.

Anything you want to talk about just in the last however many minutes we have?

Jacob Becraft: I’ve actually taken a lot away of, I don’t know, responding to how you’re responding to different pieces of the story, right? I view it as important to tell the world about this innovation and whether that means finding the large sovereign wealths of the world that are going to help us. Right now, as a company, everything is working within our technology stack. We sit here and look at these problems. To use a bad analogy, it feels like Sophie’s Choice sometimes around how we’re going to prioritize what we’re going to work on. We can’t work on everything.

The other overused analogy is robbing Peter to pay Paul, right? I wish this wasn’t zero-sum, but if we look at what our technology can do today, I look across and I’m like, “Okay, we want to work on cancer. We want to work on autoimmune disease.” But also kidney is really interesting and oh my God, we could do so much good if we applied this in the CRISPR space and all of these things. What I’ve been trying to spend the last six months of my time thinking about is like, “What is the correct model for us to make sure we are doing our diligence of advancing medicine at the fastest rate we possibly can?”

There are so many different things that we, Strand, can work on. We need to find various different partners. Sometimes that’s pharma partners that are like, “We’re interested in this disease area.” And it’s very simple because the biotech and pharma companies work together all the time on partnerships. But I’d say what’s really interesting is this global opportunity and this broader opportunity to say like, “We could do all of these different diseases. We’re fighting a resource constraint at all times. So how do we find other people who want to participate with us both intellectually and capitally with capital that can help us build various different solutions, whether that’s for diabetes, whether that’s for polycystic kidney disease, whether that’s for all sorts of other indications throughout the world.”

It’ll take novel scientific models because what we are doing is scientifically novel. So we’ll need different sorts of business models to think about this.

You said something earlier about my frustration with biotech’s ambitions sometimes. God, the Genentech and Genzyme people used to do insane things. Genzyme used to drive around Boston collecting placentas from the hospitals. They had a van called the Placentamobile. They would pick up placentas and then use them to purify a protein that they were turning into a drug for a rare disease. It was the ultimate founder mode of like, “How do we stop this disease?”

And somehow we’re now like, “Well, I don’t know. What would that look like from a TPP? And if the FDA won’t think about a proven mechanism…” It is just fucking exhausting. We’ve got to just get our entrepreneurial pants back on and try to fix disease. I’ve just taken the few minutes you gave me and diatribed in six different directions. There is so much cool stuff to do. There’s so many more interesting conversations for us to have on and off a recording. Tim, I love talking to you. You’re just fun, man.

Tim Ferriss: We’ll do more work. We didn’t even really get into the platform aspect of things. I used the SpaceX analogy of the first principles engineering payload agnostic platform, right? We didn’t even really get into the platform. Are you leaning away or leaning into the kind of programming, reprogrammable language around Strand?

Jacob Becraft: I’m leaning away from the words programmable or programming within there because they get people confused about what a platform is. In my new deck, it ends actually with this piece of what Strand is. Strand is a flywheel of various technologies, just AI models, manufacturing expertise, like talent that we have, trade secrets, all of these pieces that create a flywheel of how we build platforms for areas of the body that we want to access. That’s the platforms, right? So tumor delivery is a platform. T-cell delivery is a platform. We want to build more of those platforms over time.

We build them as drugs, like the STX-003 that’s coming to the clinic this year, six months ahead of schedule, that is a drug, but it is a platform for tumors. It’s not a platform for everything you want to do throughout the body, and that’s where people got lost. I think that’s where Moderna got lost. They thought, “Your tumor platform also worked for your liver, worked for the kidney, we could do everything with one platform.” It’s just not true. So what I’ve been trying to do is help people understand. And the SpaceX analogy kind of works well within this because SpaceX, over time, built different platforms for different use cases that were more and more complex and took more and more time and knowledge and they used the learning.

Falcon 1 was able to get single satellites up. It took them a while to figure it out, but they were able to perfect the landing and the recovery and the reusability of a rocket that was useful, but it wasn’t super useful. Then they had Falcon Heavy, right? They were like, “Now we can take multiple things up or we can take large payloads up, we can take astronauts up to the space station, we could do all of these things.” Then they have Starship, right? You can’t start with Starship. Even Elon, 20 years ago, being one of the greatest fundraisers and visionaries, couldn’t go, “We’re going to build Starship. That’s our first product.”

You’ve got to build the Tesla Roadster to get to the Model 3. You’ve got to find the first minimal viable product that does matter and helps you get your feet under yourself. And that’s what our first drug was. And now we’re building more and more ambitious things. I don’t mind talking about a platform because I can scientifically prove we have a tumor platform. I can show you the data, right? We have a T cell platform. I can show you the data of how we can swap things in for the T cell. Whatever you want to put in a T cell, we’ll put into a T cell. It doesn’t matter, but it’s for a T cell, right? And we want to build more platforms over time. That’s where I think we need the most help of finding novel business models, partners throughout the globe who are interested. I don’t mind it. I don’t mind it anymore because we can defend it.

Tim Ferriss: Yeah, totally. Getting satellites into orbit is different from getting to the moon, which is different from getting to Mars, right?

Jacob Becraft: Yeah. And injecting things into tumors is different than getting things to deliver to tumors autonomously through the bloodstream, which is different than getting to T cells, which is different than getting to your kidney, which is different than getting to your brain. Those are all different things and they will be bigger and bigger opportunities for us.

[END OF ROUND 1 CONVERSATION]

Tim Ferriss: And now we get to part two. This is the second conversation with Jake. This is roughly two months later and a lot happened between the first and second recordings. Jake’s op ed ran, we did a ton of split testing and behind the scenes work; the conversation around clinical trials in U.S. competitiveness reached new levels of traction, got in front of new audiences, and ultimately made its way—let’s just call it metaphorically—to the Oval Office, and we will get into all of it. So this next section is a follow up. What happened after the first conversation, what Jake learned from the response, and how he was thinking about the bigger story of Strand and the future of medicine. We get into a lot of fun stuff in this section. Please enjoy…

…So Jake, We first recorded brainstorming and you had a lot of well-formed different approaches to messaging, and then we stopped recording, but at that point you had a pending or hopefully pending op-ed. Could you just walk us through what transpired after that?

Jacob Becraft: Yeah. So we’re working on the message, of course, and how to frame this so that people could digest what needs to happen and sort of both what needs to happen fundamentally, but also the urgency of it. So after that, The Washington Post actually placed it in their op-ed column, and it really, I think, went viral, at least through a lot of biotech and medical policy communities. I sort of saw it spread its way across as a number of people thought either, “I never heard this idea, it’s a fantastic idea to start,” or, “I never heard that there was this sort of pressing risk to our biomedical industrial base going overseas to China, and the US is sort of contributing to it by getting in our own way.”

After that, you and I really sat down and thought about what’s working with the piece. The piece was pretty fully baked, and when you put something in The Washington Post, you don’t have all the control over the full message. There are many other professional publicists and folks involved in that endeavor, which is totally fine. I’m just a lowly scientist, but at the end of the day, you and I started sitting and talking about like, “Okay, but what grabs people’s attention? How do we drive people into the bulk of the message? How do we make people care so that they’ll pick up the message?” And that was really helpful because about a day after the op-ed ran, a member of a congressional staff had reached out and said, “We’re putting together a hearing on the Hill around the risk to the biomedical industrial supply chain and biomedical industry in the United States in relation to what’s going overseas to China and how competition is shaping up and sort of degrading our ability to develop medicines here in the United States.”

And so as we sort of talked through that idea, it really helped because we saw what was working with the piece, we saw what was confusing about the piece and we saw maybe what was maybe not bad, but what was helpful or better or caused more engagement or ABC testing and all of a sudden A is 90 percent of the click-through options. And so once we sort of saw that, and I think one of the things that surprised me the most about it was that the opportunity — maybe it shouldn’t be surprising, but the opportunistic tone of like, “This is the problem, but we can fix it.” Maybe it should be obvious, but that’s the one that sort of got us going. And so when I went down to the Hill about a week and a half after the piece ran, that’s how we reframed the whole story, which is a much more productive way to get politicians to care about something.

If you come to them and you say, “Everything’s bad and it’s burning and we’re done,” I mean, honestly, what is anyone going to do? But coming with reframing it and being upfront about bad things are happening, but we can fix them. It’s in your power, let’s go, was taken up very well. And so between the testimony and a number of meetings after that, that day around D.C., we really started to form a sort of fervor. And fast-forward to about two weeks ago, the President put out his policy objectives, his legislative objectives, and in those legislative objectives — in fact, sort of the President recommends what he thinks the budget should look like, and then Congress takes it up and then actually bakes it into it just for policy sequencing, but in the President’s recommendations, there is this exact idea of removing barriers to getting early stage experimental medicines to American patients in America through FDA reform. And that’s an incredibly quick turnaround for Washington D.C., which I think should inspire all of us to get more involved.

Tim Ferriss: All right, so let me add to the recap. Thank you for that. So we got on the phone, I was in Utah at the time, I remember a very different background. Had our first recording talking about the message, spitballing stuff around. Then you published the op-ed in The Washington Post afterwards, came out, and the piece, I pulled it up, very well baked, edited piece. The headline was “The US Can’t Afford to Offshore Clinical Trials to China: A Burdensome Regulatory Environment is Pushing Clinical Trials Overseas.” And when I saw that, I was like, “Okay, this may be the best of all possible options, but let’s test that.” And to your point, right, there are a lot of stakeholders, a lot of people involved, and also people are busy. So if they’ve got 50 stories to put out, once they’ve done the work on one, they don’t necessarily want to go back and have to fiddle and fuss with every headline that they’ve put out.

But internally grabbed it and had someone on my team go to a site called PickFu. We’re not going to get into the branding of PickFu, but pickfu.com, which is sort of human plus AI helping you to split test. It could be an image, it could be the cover of a board game in my case, or a card game, it could also be a headline. And the purpose for doing that, since people listening might think, “Well, if there’s so many stakeholders, you know they’re not going to change it. Why even bother?” It’s because we got five different options and you and I were texting. I was like, “What do you think of these six options?” And you’re like, “These are the two of the things that internally would come up with that you liked.” It’s like, okay, well let’s only split test those because otherwise what’s the point?

Because the intention behind it is not to change the headline, but to then take messaging and emphasis that you can use in-person or otherwise or on stage in terms of framing. So the fact that you had everything lined up to then have the refined story for congressional testimony and then to ultimately get to the big office, it’s pretty fun. It’s a really fun compression of things.

And I should also, I suppose, just as a recap for folks, highlight that what we ended up talking about a lot towards the end of the conversation was just not simplifying the message for people, but how do you simplify it and make it appealing for policymakers specifically, and that’s how the text conversation unfolded around — and this is also for those people who are writing nonfiction books, whenever there’s a book that’s like, why kids are all depressed and it’s only getting worse, you’re kind of like, “Do I really want to spend 200 pages reading about that problem?” But if it’s like why kids are all depressed and it’s not the only way, then you’re like, “Oh, okay.” There’s actually potentially not a pot of gold at the end of the rainbow, but some type of prescription or recommendation for fixing the situation, then the response rate tends to be a lot higher.

So where do things stand now? How do you feel about the messaging? And you know me, I’m like the person who likes to think of himself as smart, but nonetheless ends up asking dumb questions over and over and over again. But in terms of messaging, like how happy are you with the messaging? And we can obviously bat things around. And then are the policymakers still the sort of primary target for your personal external comms because the regulatory hurdles and the molasses on the ground when you’re trying to push things through is so slow still compared to China or Australia, let’s say?

Jacob Becraft: Yeah. So the idea itself. I mean, from our first conversation that was only, I don’t know, two months ago, not even.

Tim Ferriss: Yeah, not even.

Jacob Becraft: We sort of had this conversation, this is important. Fast-forward two months, the President puts out legislative priorities to Congress that has the message inside of it. I’d say I’m pretty happy with that sort of timeline of movement. And I think that what we successfully did with the story was the bad part of it that is like, “This is happening, this is bad,” and driving urgency of this isn’t a “Let’s have 12 more hearings,” this is a, “We either fix this today or we get comfortable with only getting all of our medicines developed in China or discovered in China, and then the United States will just pay the bill.” So two months is an incredibly quick time for really any amount of legislative progress. I mean, it’s still not done, it’s still not baked, it still needs — these things need to be codified. The FDA needs to actually adapt them, but I’d say that’s a lot of positive forward progress.

And shaping the story around “Here is the solution up front,” I think, helped us really tie folks in. One of the things I learned in trips to D.C. Over the past year is a lot of people go down and are complaining. And it’s very hard. People will hear you out because that’s what you do to a constituent if you’re in public office, you’re like, “This is okay, I’m sorry that that happened.” But it’s really more like being a policy shoulder to cry on than getting anything done. And so going with, this is a problem, this is the urgency, it needs your attention, and here is a solution or part of the solution was really — and moving our narrative — between hacking it out with you, moving the narrative to bring the solution up front, I think helps people not tune out immediately from — to understand what someone’s bringing you a story with.

We’ve talked about this in stories, which is how do you bring your focus and your hook upfront. To me, as a scientist, I like to drill down to the whole piece and explain all the details to people and all the reasons why something is maybe fucked, and instead, I think it’s better to just start with like, “Hey, things aren’t going great, but there is a solution. And then if you want, now that you care a little bit and you see a light at the end of the tunnel, now we can go through the whole process. You can understand the nuance of both what’s happening, what we can do, and how we get to the other side.” It’s almost like when I talk to technologists who are building other companies like mine and try to help scientists understand how to pitch even to other technical investors, the thing I always come back to is no one will learn until they care. So your first goal is to make someone care about what you’re doing, then they’ll learn.

Scientists are very spoiled because when you sit around with a bunch of scientists and talk science, they all care. It’s a science thing. Scientists just, they’re implicitly like, “Oh, wow. You study black holes and the gravity at the center of them? That’s so interesting.” You don’t have to motivate it and there doesn’t have to be a reason, there’s just the reason is, wow, cool. And at MIT when I was there for six years, it was very spoiled environment because I’d be like, “Well, I’m working on the future of RNA medicine and how RNAs are programmable,” and they’d go, “Wow. Tell me more.”

And then you go out to an investor, have dinner with Tim Ferriss and you’ve got to wheel it back and be like, “Why does this even matter besides being a footnote on genetics?” And I think that’s always a good learning, and it’s something I’ve gotten used to with talking about my company and talking about what we’re doing, but then coming back to policy, it just helped drive it back to me that this is a fundamental truth of storytelling. If you’re trying to get something done, make someone care, explain the problem, illustrate a solution, and then help them. Then they can go a level deeper, we could talk about the specifics and the pathway there.

Tim Ferriss: Yeah, for sure. And the storytelling word, and this is important because if you’re proselytizing, if you’re persuading, in almost every instance, it’s going to be some form of storytelling. So after the op-ed came out, after you were giving your congressional testimony, et cetera, et cetera, you also sent me a few different docs. There was the investor update doc, which we may not get into great detail on depending on how much needs to be redacted, but we can, we can always bleep it out or cut it. The second was sort of a primer on mRNA and programmable medicine, if that’s fair to describe it.

And one of the edit notes, which is a suggestion, I mean, I’m not right about everything, but I was like, “You know what? In the second piece, there’s this story of AlphaFold,” and I was like, “That’s a great place to start because sometimes if you begin with high concept or you begin with things that are a little abstract, it’s easy for people to get lost, even if they understand it, for it to cause them to drift.” And so it’s like, okay, maybe start with story, point, story, or sure you could start with a shocking stat and then lead into like, “Here’s the problem, here’s the solution.” There are a lot of ways to do it, but the storytelling piece, it’s easy for people to forget that selling, pitching, board meeting, you name it, a lot of it is going to revolve around your ability to tell compelling stories.

So where would you like to go next? I mean, I grabbed, of course, a whole bunch of things and before this call sent you my kind of edit notes as images that I scanned, but also as a Loom where I kind of walked through my thinking behind some of those edit notes. I wanted to actually, before we move to that, make a quick note for people mentioning PickFu. I don’t have any equity in PickFu, I just like saying it actually, which is like I could make fun of the name, but it’s like the fact of the matter is I just think it’s hilarious to say.

So the other application or value of the split testing is not just having maybe a better idea of one-liners or framing that you could use in person because even though the headline of the op-ed couldn’t be changed, when I then shared that article, I was able to use the same link, sure, but I was able to use a different headline based on the split testing and it was unambiguous. It was like one or two of the headlines tested were by far and away the winners, statistically speaking. And so it’s like, all right, just grab that because ultimately top of the funnel, you need click-through rate before people are ever going to read the piece, so let’s optimize for that. But coming back to, I guess, where to go next, you tell me, man. This is in service of whatever you think might be worthwhile to go over. So what are your thoughts?

Jacob Becraft: So when we move back to the longer piece that I’ve been just trying to organize some of my thoughts around where I think at least a piece of the future of medicine is heading.

Tim Ferriss: The working headline is “RNA Medicine and the Rise of Platform Therapeutics.” Okay.

Jacob Becraft: Yes.

Tim Ferriss: Go ahead. Just wanted to give people something to hang their hat on.

Jacob Becraft: So “RNA Medicine and the Rise of Platform Therapeutics,” and thinking about even introducing to the world what a platform therapy or a therapeutic platform could be, why it changes medicine, why it changes how we think about developing medicines, deploying medicines in the near term, the medium term and the long term. Where are we going? What could be in the clinic next year because of this technology? What could be possible with medicine in five years? And then where are we on a 10 to 15 year time curve in terms of what will be possible? And I’ve been trying to organize some thoughts around this, the way that I see the future. The policy piece of this story over the top is an important aspect of it because biotechnology and space, rocket companies, I think are actually two of the most similar industries out there. You have an incredibly long time horizon in on investment, you have an incredibly high upfront investment cost and you have essentially binary outcomes. The drug works or it doesn’t, you get to orbit or you don’t, you blow up on takeoff or you fail some early stage safety readout.

Those are all very similar. What I think the rocket industry got out in front of them and Elon as sort of the flag bearer of commercial space industry going back to the early 2000s, got out in front of this message with was how to engage policymakers to enable innovation to feedback on itself in a rapid context. And so in the 2000s, it actually was just like it is today with medicine, it was very hard to rapidly launch rockets. It was very hard to fail multiple times — fail or not completely succeed or just be given the privilege to take shots. Now, I want to say, putting a medicine into a human is not the same as launching a rocket that is available to blow up over the Gulf of Mexico, and we can salvage that.

We don’t want to put people’s lives in danger, but we do need common sense regulatory reform to enable this future of medicine, and as I sort of got to the end of that story with you and got that in front of Congress and got it into the President’s legislative priorities, it turned back to this piece of where do I see medicine going? Where do I see platform therapeutics? And your feedback on what I had put together is actually helpful because one of the questions I saw in your loom was, what do you mean by platform? What do you mean by infrastructure? Are these the same things or are these different? And so maybe it’s more helpful to talk about what a platform therapeutic is to start, right?

Tim Ferriss: Yeah.

Jacob Becraft: So a therapeutic platform, people have been claiming medicines are platforms for 20 years in the biotech industry and they’ve almost always been wrong.

Tim Ferriss: It sounds good.

Jacob Becraft: Well, the reason people like it is that theoretically, if you have a platform that can be multiple drugs, then someone will give you a premium over the — it’s like when Sweet Green went public and they were like, “We’re a tech company, not a salad company. We deserve a markup in our market cap,” and you’re like, “Okay. Well, I mean, prove it, maybe. I don’t know. Domino’s is a tech company and an infrastructure company.” So it is possible.

Tim Ferriss: This is like a caffeine ketone-induced interjection, but people should go back and check out the stock charts on Domino’s Pizza compared to all the fancy tech companies and everything. It’ll blow your mind. So just put that aside.

Jacob Becraft: So I think that this doesn’t happen in biotechnology enough for the record, but I try to be a student of business and innovation broadly and study how Elon has built SpaceX, how Domino’s has built Domino’s, and that also shapes my global worldview on, hey, biotechnology is having a rare earth metals moment, a rare earth minerals moment with China right now that was 10, 15 years ago for the electric vehicle industry. On the Domino’s side, you look at that and you go, “Wow, this is an incredible infrastructure tech story of pizza that’s like fine. It’s fine.” I’m from Illinois near Chicago, so their pizza is fine to me. That’s the official talking point. But to wheel it back, what is a platform in business, but I guess what is a platform therapeutic? So in medicine, going back 50 years to the beginning of biotechnology, you started with let’s design this drug and it’s a molecule, it needs to be put together in a certain way.

We do that in the lab and then we take it forward, we put it in a patient, we see how it works and we move it through clinical trials. If it’s successful, then it gets approved and then we can sell it in the marketplace and then the company finally makes some amount of money. And the problem with that, just in terms of IRR or verticalization story is that the company itself gets value because it learns how to do the process, but the technology doesn’t build on itself. So you build one drug and you get that drug approved.

The next time you start back at square one for either a different medicine or a different type. Maybe you take some learnings that you have about that medicine, but everyone has the learnings because we do science in the open. Everyone sees a lot of your FDA documents, they see your medicine that you’re bringing forward. You have to publish your clinical trial results in certain forums. So you’re not gaining any sort of peace by developing it, though as a business, you’re flexing that muscle, which is helpful, and it’s helpful to have that experience as an organization, but you’re not decreasing the risk of future medicines.

So a platform therapeutic seeks to build a common technological infrastructure that you can build multiple different medicines off of. So an example of a platform would actually be Moderna’s RNA vaccine platform. So people like to say this thing about the COVID vaccine, about how Moderna built a COVID vaccine in 62 days and got it into clinical trials, and that’s not exact — sure, that’s true. 62 days from the identification of the COVID antigen, the COVID sequence that they wanted to use, and then 62 days to create a vaccine for testing. But they spent 12 years before that developing this sort of technology, baseline technology, particles, RNA sequences, all these pieces to build a lot of other types of vaccines and therapeutics.

And so when COVID came around, they had flu vaccine and all of these different types of other vaccines that they knew how they worked and they were able to kind of plug and play in a COVID sequence where a flu sequence used to be and use that in that setting. And that’s very powerful in terms of speed. Sort of mRNA vaccines aside and what everyone’s piece on them is, I just think that’s — the story of speed and the story of rollout is really important.

Tim Ferriss: Just for folks who, like me, are like, oh, God, I’m getting maybe not lost, but I’m like, oof, this is biotech, I don’t know very much about. To come back to the Domino’s, or let’s say Uber, or SpaceX, but it’s like if Uber has built the infrastructure and everything necessary with Uber Eats to deliver hamburgers and then it’s like, can you deliver these vaccines? It’s not the best example because you’re not going to be shipping these to people’s homes necessarily. And they’re like, sure. And then the story is, in 60 days, Uber developed an entire system for delivering vaccines. It’s like, well, kind of, but they had everything else already built that enabled them to do that, which then for each additional “launch,” not to mix the SpaceX, but they are de-risking the entire endeavor and speeding it up by effectively skipping all of those steps that are already established, right?

Jacob Becraft: I would say biotechnology is like, I think, incredibly antiquated when it comes to involvement of advanced technologies that are not biological. So when I think about what we need to realize the future of medicine, there’s two different buckets. One of them are new drug technologies. So these are programmable medicines. These are different sorts of ways to think about the drug that gets injected into the person. How is that going to be more advanced, safer, more controllable, more adaptable, more personalizable?

The second piece is physical deployment infrastructure. How do we build small scale manufacturing and clinical supply chains that can deploy nationally and globally to make sure that in your neighborhood, you’re able to get this advanced medicine? And those are two different and important pieces to what I see the future of medicine becoming.

And so on the therapeutic platform side, these are new technologies. This is what we’re developing at Strand. We’re developing various different, to use a SpaceX analogy, various different types of rockets.

And so the way we’re thinking about this is, you have payloads similar to satellites that SpaceX is trying to get more and more fancy payloads, satellites, astronauts, eventually entire data centers or entire moon-based cruise into orbit in an efficient manner that’s scalable for medicine. And in the same way, what we’re trying to solve is doing that with build the technological solutions to get these different proteins into the different areas of the body, and the reason that is such a pressing problem is that right now we have a lot of low-hanging fruit that is diseases we know how to treat, proteins that we know could do something about it, but the inability to sort of get the protein to where it needs to go.

But we are accelerating our knowledge with AI. You have DeepMind and AlphaFold creating the ability to design almost any protein you can imagine to do anything. You have new AI research tools that are helping us understand disease at a higher level of complexity. We’re very soon going to reach a massive bottleneck of all of these different solutions that we know exist, like what to do, and we can’t get them where they need to go. We’re going to have a backlog of satellites and no ability to get them to orbit in a scalable manner. And so it’s great to have AI tools. It’s great to build all this new technology, but we’ve now taken the bottleneck that used to be discovery and we’re shifting it over into deployment and testing.

Tim Ferriss: What I’d love to just come back to in case it has changed, what are the blockers in the way of your most important responsibilities as CEO? Because it’s like I want to make sure that what we’re talking about is kind of in service of that.

Jacob Becraft: I think that’s a fantastic question actually, because I guess what I’m saying about what medicine needs to have a SpaceX moment, for instance, I don’t think at least that it’s a non-obvious thing to realize. The problem is how do you actually execute it? And the reality of medicine development in the United States and how biotech companies work in the United States and the capital formation ecosystem that exists to create medicine in the United States is incredibly swung to the incentivization of making minor steps forward and of doing single things at a time. And so biotechnology actually in the US is not set up from a venture capital standpoint in a lot of ways like technology is. And in tech, you have people constantly being like, “I’m going to build a generational company.”

In biotechnology, 90-plus percent of companies go, “Here’s an idea, I’m going to take it from point A to point B, which is not — point B is not commercial. It is, point A is this is the idea and I think it could work and point B is here’s some evidence that it works and at point B, I’m going to sell the asset.” It’s very similar to how people think about like real estate development, for instance. And so it’s attracted almost like a private equity asset development sort of mindset —

Tim Ferriss: Sorry to interrupt, but I try to be the muggle who’s like, “Ooh, that’s interesting, that’s very memorable,” but just current state of biotech comparable to real estate development for these following reasons, but what would it look like for us to have our SpaceX moment and why is that even relevant? That contrast is super interesting. It’s the first time I’ve heard you say that and immediately I’m like, “Oh, yeah. Okay, got it.” Yeah.

Jacob Becraft: Well, I really think it’s a capital markets problem. Let’s go back to SpaceX again because I just love talking about SpaceX. No one would debate in 2004 maybe that if you radically decreased the cost to orbit per kilogram, that would not be an incredible business. I think that’s very obvious. The question was both technologically and how could we possibly get there, and luckily we had someone who was both already extremely wealthy, he wasn’t a billionaire yet at that point, I don’t think.

Tim Ferriss: Which is fucking crazy to think about.

Jacob Becraft: Yeah, Elon being a lowly 130 millionaire in the 2000s and who then just put it all on black and was like, “Spin the wheel, Johnny. Let’s go,” and then just shot rocket, shot rocket, shot rocket, I’m going to go bankrupt, whatever. He’s like, “I’ll just go back and make another Zip2 and I’ll do another PayPal if this doesn’t work out.” By the way, I was a huge space nerd at the time and in high school following this story and listening to all of the establishment voices being like, “This guy is an idiot. He doesn’t know what he’s doing.” But he had both his own capital. But the other thing about Elon that I think everyone should be able to tell at this point is he’s an incredible capital formation genius. He’s an incredible storyteller, which was one of the core keys of capital formation.

Tim Ferriss: For people listening, are we talking about fundraising? Is that what that means?

Jacob Becraft: Oh, yes. Fundraising. Yeah, it’s about getting money around the idea. The ability to pull tons of dollars together around a core, insane long-term mission is an incredible skillset that deep technology, which is sort of the umbrella that has space and quantum computing and biotechnology, anything that is a long R&D time horizon, requires. And so the capital pools, the fundraising environment that is traditional biotech, really deeply struggles with the idea of long-term bold idea investment. We have very few shots that are even allowed to be taken on goal. And so when I think about, back to your original question, what is my goal as CEO who wants to not just build a better biotech widget? I don’t want to build a better mousetrap to catch more mice for this one person and exit out of the company. We want to fundamentally change how we’re able to build medicines.

That is a long and expensive road. And even as you unlock — if we get drugs approved and we are able to get revenues, by the time we’re there, ideally our research engine is humming so much that even those drug revenues don’t pay for all of our — it’s a constant feed forward until you break through to the other side and all of a sudden you’re staring at a trillion dollar IPO. And so you have to kind of catch that. As CEO, I think about how do we find globally the people who are aligned with that idea, and that’s collaborators, it’s financial support, it’s people who want to think about — if you’re trying to get the best IRR on your dollar between here and next year, I might not be your best bet. I’m sorry, we might not be your best bet. We hope to be. We always hope to drive that original piece, but we want to be the 10, 20, 30 year time horizon massive return that people are going to see while we push medicine forward.

And so those capital partners, they exist, they exist in the United States, they exist outside the United States. We want to be able to reach those folks and tell them these stories. When I think about my role as CEO, as we try to actually build the future, I think about how do I get our story in a way that is digestible because the people who think about these things — everyone wants to cure cancer. I don’t need a story behind curing cancer. I just need a story about like how we’re going to get there and how curing cancer is actually going to be one step on the road to solving disease writ large.

Tim Ferriss: I’m just kind of looking through some of the summaries of the last stuff that we talked about. These are the things that really stick out to me, and then it’s like, okay, when I think of aerospace and I’m not educated, I was not tracking it in t he way that you were, or Steve Jurvetson, who’s been just fascinated by this stuff since day zero. But when I think of, say, NASA, and again, not to — I don’t know what I’m talking about. But I think about NASA and the government is incredibly slow moving and resistant to change because there are going to be a million different reasons. So it’s like, okay, how did not to designate Elon Musk as the paragon of all great things and archangel with capitalism, but he’s done some pretty amazing stuff. Flaws and warts aside right for now.

Jacob Becraft: He’s the greatest currently living American industrialist. I don’t know how anyone could possibly disagree with at least that piece.

Tim Ferriss: Yeah. Yeah, with that piece. So with you and unlocking capital markets, capital formation to support this long-term vision, there are people who have seemingly done this kind of stuff, meaning patient capital, long-term capital, vast quantities of money who have done this before. SpaceX I don’t think would be the only example, at least in terms of training Wall Street to be like, “It’s fine. Jeff is going to figure it out. He told us what he’s going to do.” Amazon is also a pretty fascinating example of sort of disciplining Wall Street to be like, “Oh, we’re the only company that analysts are going to give a pass on not being profitable for a hundred years.” And by the way, if you break even exactly every year, that’s not an accident, but pretty amazing financial planning.

So what do you feel like you most need to do? Is it getting on the road and delivering a concise message to sovereign wealth funds? In your mind, are you like, “Within three years, five years, we outgrow the vast majority of venture capital firms, and okay, maybe we step up and we get some PE firms”? I mean, you already have some patient capital on the cap table. So what do you view as the main dominoes that you need to tip over or at least conditions you need to set so that you can execute on what you’re describing?

Jacob Becraft: Let’s wheel it back to one of the other great capitalists and industrialists of the 20th and 21st century, Jeff Bezos, because he actually did things very differently than how Elon approached SpaceX in terms of building a company that is incredibly complex, incredibly long-term-minded, but he did it in the public market. And you could argue that Tesla has done that as well, and I think that there’s an argument to be had there, but looking at what Amazon did, the thing I think every entrepreneur in the world should read is the correlated first public year to last year of Bezos’ reign over Amazon investor letters.

There’s a Google Doc link online that someone just put them all into 178 page PDF and I think everyone should sit down and spend an afternoon drinking coffee and reading them, knowing what happens with Amazon, reading 1998 through the dotcom bubble burst, through the e-commerce generation, through social media, through everyone coming online in our online world today and watching how Jeff puts forward his vision of the future is that it both gives you a lot of respect, of course, the things he saw coming, but the thing that I respect about it as being a public company or going about building capital in that sort of a way is you need to say what you’re doing in a way that makes sense for your investors. And I think for Amazon, they were incredibly undervalued until they weren’t. For a very long time, Amazon was trading at a pretty low PD ratio and then all of a sudden people were like, “What is AWS, by the way?” And it was an explosion.

Tim Ferriss: It’s our side hustle, little side hustle.

Jacob Becraft: It’s 2017 or 2018, I feel like they went from $120 a share to over $1,500 a share in what seemed no amount of time as all of a sudden people were like, “Hold on. Wait. Maybe owning all levels of the infrastructure and deployment ecosystem plus the brand, plus then building your brands on top, plus also kind of owning the internet in a way, because what is AWS, by the way?” It’s a $25 billion behemoth stuck inside this company and they rocketed from like a — I don’t remember what their market cap was before that, but then to one of the largest companies in the world and that is like everything that’s great, an overnight success 20 years in the making. But if you read the letters and you see it over time, you see them making bets. Not every bet paid off because not every bet should, but I believe it’s very important —

I’m saying this, Tim, because you asked, what do I think I need to do? I think we need to say what we’re doing and we need to say it publicly. We need to say it because it will attract partners. We need to say it because it will remind people who are on this mission with us about what we are building to. I think that obviously if you invested in Amazon’s IPO, you would’ve been very happy in 2014 with the performance of your investment from then to then. But then if you invested in Amazon in 2014, you’d be very happy with the last 12 years of performance of that stock as well because they continued to make those investments. But you have to have people understanding your message and you need to say it. You say it every day. You say it like a mantra, “We are changing the pace of medicine,” because what happens is the exit ramp comes.

If you’re doing things great, the exit ramp will always come. You need to ask yourself if you should get off the highway. And understanding and reminding yourself about what you’re building every single day helps you understand whether or not you need to get off the highway. And I’m not saying every single person should keep their head down and try to build a generational company when someone comes out and offers you an outsized amount of return on your dollar. You have stakeholders, you have shareholders, you have people you have promised a piece to, and you need to be a diligent steward of their capital and be able to create value in that way, but I do think that it helps frame what is our current value that is different than our market cap, whether we’re private or public.

There’s a story about Amazon, I think, during the dotcom boom, I think this is about Bezos, where he wrote something like, “We are not our market cap across every board,” every chalkboard or whiteboard in the Amazon headquarters during the dotcom bubble burst, because obviously the tide went out on everyone who operated through the internet because no one could discern the difference between a zero revenue, let’s get the most people on our website company, and an Amazon who is actually building something real. And so it’s very important to understand your value in order to understand what would be an outsized near term value if an acquirer comes along or just how we’re going to build things because it’s not about near term perception, it’s about long term goal.

And I like to think about this investment philosophy. When I look at someone like Josh Kushner and how he’s made just like this incredible run at Thrive Capital. I think when I look at some of those great investors who have made these high conviction bets, it seems like they’re able to identify this moment in time for companies that is post-conviction, pre-consensus. The ones who know, know we’re post-conviction. We’re no longer saying, “Can we do this?” We’re like, “Oh my God, this is going to work.” But it’s pre-consensus because not everyone has caught on yet or not everyone is convinced. There’s a data set that insiders and technologists or whoever sit there and they go, “Oh my God, I think we’re there.” There’s a moment, if you go back and look at OpenAI or Anthropic, or any of these companies, there’s a moment probably in the late 2010s when OpenAI was running where folks internally telling the story, if you listen to them are like, “Oh my God, this is accelerating.”

Before we got DALL-E, before we got ChatGPT, before we had these tools, there was an internal post-conviction moment. And then of course there’s the, “Oh, wow. I think this beats the Turing test. We’re post-consensus. No one is, I think, going to be able to debate that AI is going to just completely upend the way that everyone lives their life going forward.” And that’s the consensus moment. That’s the 500 billion-plus market cap moment for all of these companies. And so we need to understand where our post-conviction moment is, and then we need to build to bring folks around to the post-consensus moment.

Tim Ferriss: One question popped into my head earlier that I wanted to ensure I didn’t forget, which is — and I don’t have a strong feeling one way or the other, but the Moderna story is so apt in so many ways and yet there’s a fly in the ointment, which is broadly speaking, but even more specifically, COVID vaccine has become so politicized that despite what any one individual might think, they may just need to fall in line with kind of party templates or whatever you might talk about, depending on who you’re talking to, and I’m wondering if that has presented any problem or if it is behind closed doors and closed session, it doesn’t really matter.

Jacob Becraft: Thinking about that analogy, there’s probably better, or maybe not better, but different sorts of analogies you could use there that are just less politically-charged because there’s no reason to wade into politically charged waters to explain these sorts of things.

Another great example could just be the original biotech story around people using technology to make insulin. We used to use pig pancreases, harvest them, grind them up, isolate the insulin, put it out, and the birth of biotechnology was around people taking the insulin gene, putting it into bacteria and getting the bacteria to actually make the insulin protein and then isolating the protein from there. But that actually became a platform because then what did people do? They created Herceptin and other sorts of medicines by taking other proteins and dropping it in.

Tim Ferriss: Growth hormone.

Jacob Becraft: Growth hormone, exactly. Right. And that’s the basis of the genesis of biotechnology. That’s a Genentech story. That is also what Genzyme did when — the sort of bicoastal war between San Francisco and Boston that’s always existed in biotechnology, which I absolutely love. I think it makes things a lot more interesting and just sort of gives a good view on the cultures that set 50 years before any of us were here. That I think is actually maybe even a more powerful story, and we built those platforms and those companies built incredible value and then we got away from it. Then we got more to like, “Okay, now biotechnology is a tool. Let’s get back to drug development.” And capital markets skated — in the ’90s when pharma companies began verticalizing and consolidating, they began pulling in even the big guys themselves, Bristol Myers Squibb, BMS, that’s a big pharma company.

Why does it have that name? Because it used to be three companies. You talk to people who worked in the ’80s and the ’90s, they’re like, “Well, I used to work for Bristol. I used to work for Myers. I worked for Myers Squibb.” They started pulling in and then once they pulled in, they realized they were so large that they couldn’t do research anymore. So they started buying small companies. And so what did our capital markets do? They started building for that acquisition.

The problem that becomes on a timeline like that though, is the whole industry begins to skate where the capital at the other end of the market is pulling. And if that capital is M&A, mergers and acquisitions, buy ups from big pharma, then everyone in the innovation industry is focusing on what pharma wants to buy.

Tim Ferriss: What kind of shoes pharma wants to wear, right?

Jacob Becraft: Yeah. Well, what’s pharma doing today? What’s the M&A situation look like today? To the point where this is an actual saying in biotechnology investing circles, it’s called “short the launch.” It means that when a biotech company like mine has gotten a drug approved and is going to launch it themselves, like actually take it commercial themselves, investors in the public market on the whole will short that because they think a biotech company will mess it up because the muscle doesn’t exist anymore because so few companies do it that they’re like, “Short it. No, they’re going to mess it up. They’re going to miss their projection and their stock’s going to dip and we’re going to win.” And that’s just the market reacting to reality. I don’t know, it’s not nefarious necessarily, but that sort of gives you a picture of how biotechnology has basically succumbed itself to be a little brother to the pharmaceutical industry, a pool of drugs that they can buy, which that’s wonderful.

Google buying your startup in the tech industry is a great exit for everyone involved. However, if the entire tech industry was reliant on Meta, Google, Netflix, whoever buying your company, then you would see a lot weirder and less ambitious dynamics at the entrepreneurial side because you’d just be trying to figure out what is Sundar going to do a year from now. You can’t build for a select group of people’s tastes, and that’s the risk I think biotechnology has found itself in.

Tim Ferriss: Yeah. Are there any more examples — they don’t have to be biotech, but outside of SpaceX, outside of Amazon, not going as far back as Genzyme and Genentech, although it is fun to look back at that, particularly when you read some of these books on the birth of, say, Genentech and you realize it’s like, yeah, it’s top of mind, so I’ll mention it, but it was kind of like Apple. This ragtag group of renegades in a garage really flying by the seat of their pants and doing some wild shit, and as you said, decades later, when everyone is contorting themselves into their probably inaccurate prediction of what the heads of corp dev or the CEO of big companies one, two, and three are thinking, the dynamic is just completely different. The incentives are very different. The timelines are very different.

How you think about building on success, I mean, to get back to the platform. It’s like if every drug has to individually go from A to Z, you don’t have a platform. It’s like if you’re kind of skipping A to M and you’re starting at M, okay, maybe you have a platform. I’m wondering if there are any other sort of entrepreneurs or companies that stand out to you as having parallels to what you’re trying to do.

Jacob Becraft: Before I get to that, just because you just compared Genentech and Apple, and I want to point something out to you, I don’t know if you know this. I don’t know if anyone knows this. So Art Levinson, who was the CEO of Genentech from 1995 to 2000-something, was also on the Apple board of directors and became the chairman replacing Steve Jobs in, I don’t know, 2011 or something.

Tim Ferriss: I did not know that.

Jacob Becraft: I don’t know, there’s a wonderful story about the read through and Art Levinson and his partnership and friendship with Steve Jobs, but between the two of them, they are highly, highly related companies. And I think that is actually why I spend time studying technology and why you see an increased interest, especially in the last five to 10 years among traditional tech and deep tech Silicon Valley investors like Andreessen Horowitz or Playground Global, one of my investors, moving into biotechnology, seeing a resurgence of this both technological and cultural outlook towards building big ideas around what we can do with technology applied to biology and human health. And that I think is really exciting.

I mean, there’s all sorts of examples of companies that have built things like this. I think that Tesla’s a great example. Well, maybe we should move away from an Elon analogy. I don’t mean to ride on Elon. I have spent a lot of time studying him.

But Apple is a great example of a company that sort of built a core platform that solved a delivery problem. Not looking at the early Steve Jobs first tenure at the company, but when he re-came back to the company, cut 80 — I don’t remember what year that was, ’98 maybe or something. He came back to the company, cut 80 percent of their product offerings, refined it, and then moved them, created the smartphone era, upended Blackberry in a way that was so — I mean, they were hated on. But he created the — that’s a delivery system. That’s what a smartphone is. Apple and the iPhone and the iPad, they’re delivery systems of all of the technology workplace that can work within them.

And by creating that delivery system, your iPhone and you are going to work within our ecosystem and attacking that market by partnering with Jony Ive and creating a culture around it, but also creating an ease of operability, created an ability for other companies to deliver their products to consumers, So many companies don’t build smartphones, but they build on smartphones. That’s a delivery platform that also is constantly getting better. The iPhone 1 — I actually just saw an iPhone 1 recently at a friend’s house. He still has his original iPhone 1. I was like, “God, your dad must have been rich.”

Tim Ferriss: No copy-paste.

Jacob Becraft: Yeah, no copy-paste. This thick, man. It’s this thick. It’s this thick, but it’s also the screen is so — I thought it was so big. It’s so small. But each successive one increased its capabilities, increased its form factor, increased what it could do, became a better delivery system, eventually supplanted. Over time you stopped using the earlier versions, but each one, of course, had a ton of value and Apple delivered things to you. They had the iTunes store, they sold you music, they used it to deliver their own products. They were also a platform for other people to deliver their products and that created one of the most valuable companies in the entire world, and that is — you think about what creates the most value and what changes the way that we interact with the world around us, it is delivery solutions. It is being able to launch enough satellites to put internet anywhere in the world and do that on an economical basis.

It is a place where you could design any sort of software and get it into the hands of almost every single person on this planet or at least every single person in the developed world. And I think for medicine, it is being able to reach any cell in the body and get the exact type of protein that we want there. And in the near term, it’ll be more traditional medicines. It’ll be, we need to design them and then we need to create them and then we need to test them and we need to get them to patients and you need to develop for larger patient populations, but if you want to see what that sort of technology enables on a 10 to 20 year timeline, it’s personalization, because once you have a good view or a great understanding of how these delivery solutions work, and you have the infrastructure, manufacturing, clinical, deployment, getting to patients both across the country, across the world, then you can start to be like, “Well, why aren’t we just building bespoke therapies?”

Right now, the economics don’t work, but the economics of Spotify didn’t work in 2001. If Spotify’s entire market was through your desktop computer, you could have never built Spotify, but you can when they’re smartphones, you can when people always have it in their car. And so in 2011, that’s a much better time for Spotify to exist as a company and really take off. Now, that is, I think, where the future of medicine sort of goes towards, a hyper-personalization and an ability to directly — we’re starting to see people trying to build personalized medicine right now.

There’s a story, Baby KJ, that came out last year in the New York Times. Jennifer Doudna was involved, a number of hospitals, they corrected a baby, but the reality of that baby’s genetic problem was that the change needed to be made in the liver, and that’s great for that baby.

And there’s other diseases that we could do that for in the liver, but we’re going to run out. Kidney disease is not going to be solved in the liver, neurodegeneration is not going to be solved in the liver. And so we have to find the other solutions and then build infrastructure that creates an economically viable path forward to where bespoke medicines are possible.

Tim Ferriss: Yeah. We’ll put in a link to Baby KJ and —

Jacob Becraft: Sorry, I just threw in —

Tim Ferriss: No, it was great. Which I hadn’t actually —

Jacob Becraft: Threw in a whole new idea. My larger piece of where I think the future of medicine is going.

Tim Ferriss: Yeah, which I guess we’re not going to get into today, but you and I have texted on why has CRISPR not delivered on the expectations that had everybody euphoric in X years in the past, right? But in this particular case, yeah, KJ became the first patient to receive a personalized systemic CRISPR-based editing therapy, saving him from a fatal liver condition so people can read more about that.

Well, this was super fun. Nice to see you, man.

Jacob Becraft: Good to see you.

Tim Ferriss: Happy to try to be helpful anytime. You know how to find me.

Jacob Becraft: It’s always fun to talk to you, Tim. All right, man. Take care, all right? We’ll talk soon.

Tim Ferriss: Yeah, take care, buddy.

Jacob: Later, man. Bye.

Tim Ferriss: Bye.

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Tim’s Founder Kitchen — From Brainstorm to the President’s Office in Two Months (Featuring Jake Becraft, Strand Therapeutics) (#868)

2026-06-03 05:11:26

“What I want the world to understand is that we are standing right now on the precipice of a revolution in genetic medicine.” — Jake Becraft

Jake Becraft is the CEO and co-founder of Strand Therapeutics, a company building one of the most advanced programmable genetic medicine platforms in biotechnology. Under his leadership, Strand is redefining what RNA medicines can do by enabling cell-selective targeting and therapeutic payload delivery inside the body, unlocking a new class of precision genetic therapies. He has guided the company from its founding vision through platform development and into clinical translation, positioning Strand at the forefront of next generation RNA therapeutics.

Beyond his role at Strand, Dr. Becraft is an influential voice in the national biotechnology landscape. He engages and advises policymakers, defense leaders, and industry stakeholders on biosecurity, innovation strategy, and strengthening American competitiveness in advanced biotechnology. Trained as a synthetic biologist at MIT, he operates at the intersection of science, entrepreneurship, and policy, focused on building both the companies and the institutional frameworks required to secure the future of programmable medicine.

He received his Ph.D. in Biological Engineering and Synthetic Biology from MIT. He serves on the board of the Biotechnology Innovation Organization (BIO) and the Massachusetts Biotechnology Council (MassBio).

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Books, people, tools, and resources mentioned in the interview

Tim’s Founder Kitchen — From Brainstorm to the President’s Office in Two Months (Featuring Jake Becraft, Strand Therapeutics)

Additional podcast platforms

Listen to this episode on Apple Podcasts, Spotify, Overcast, Podcast Addict, Pocket Casts, Castbox, YouTube Music, Amazon Music, Audible, or on your favorite podcast platform.

Transcripts

SELECTED LINKS FROM THE EPISODE

Connect with Jacob Becraft:

Twitter | Strand Therapeutics

Books & Recommended Reading

Genentech: The Beginnings of Biotech by Sally Smith Hughes | Amazon
The US Can’t Afford to Offshore Clinical Trials to China by Jacob Becraft | The Washington Post
Strand Therapeutics Announces Initial First-in-Human Phase 1 Data for STX-001 at the 2025 ASCO Annual Meeting | BioSpace
STX-001 ASCO Poster | Journal of Clinical Oncology
The Nobel Prize: Checkpoint Inhibitors | American Journal of Managed Care
Scientists Create In Vivo CAR-T Therapy That Kills Cancer Cells Without Chemotherapy | Innovative Genomics Institute
mRNA Startup Strand Therapeutics Lands $52M to “Program” New Cancer Therapies | MedCity News
The Abscopal Effect in the Era of Checkpoint Inhibitors | National Library of Medicine
Step 1: Collect Underpants, Step 2: ?, Step 3: Profit | Know Your Meme
Biologics: The Role of Delivery Systems in Improved Therapy | Biologics
How the Late Genzyme CEO Henri Termeer Created the Orphan Drug Industry | BioCentury
The Orphan Drug Act (ODA) | Wikipedia
The Recent Large Reduction in Space Launch Cost | NASA Technical Reports Server
FDA Rejects MDMA, Disappointing Drugmaker Lykos and the Psychedelics Industry | NPR
Methylone: Distinct Pharmacological and Mechanistic Effects Compared with MDMA | Transcend Therapeutics
Curing HIV — How Far Have We Come? | amfAR
How Has US Spending on Healthcare Changed over Time? | Peterson-KFF Health System Tracker
Strand Tx CEO Jake Becraft Weighs in on FDA’s IND Reform, China | Fierce Biotech
Testimony of Dr. Jacob Becraft Before the House Select Committee on the CCP | US House of Representatives
Why More Biotechs Are Starting Trials in Australia | Clinical Leader
SpaceX Vehicles: From Falcon 1 to Starship | SpaceX
Strand’s Flywheel: Platforms for Tumor and T-Cell Delivery | Kinnevik
Domino’s Pizza Turnaround Case Study | Dennis Food Service
Rides for Vaccinations | Uber Impact
AlphaFold: Predicting Protein Structures with AI | Google DeepMind
Elon Musk Went from Having 180 Million to Nearly Losing Everything | Leading Entrepreneurs
All of Jeff Bezos’ Amazon Letters to Shareholders, 1997–2020 | Quartr
AWS: Amazon’s “Side Hustle” That Reshaped the Cloud | About Amazon
How Josh Kushner Built Thrive Capital and Became a Billionaire Startup Investor | Fortune
COVID-19 Isn’t Political; Its Response Shouldn’t Be Politicized | Johns Hopkins Bloomberg School of Public Health
From Insulin to Humulin: The Story of the First Genetically Engineered Drug | Genetics Unzipped
Herceptin (Trastuzumab): The First HER2-Targeted Cancer Therapy | Genentech
This Month in 1989: The Creation of Bristol-Myers Squibb | PMLiVE
“Short the Launch”: Biotech from Bust to Boom | BayBridge Bio
Arthur D. Levinson: From Genentech CEO to Apple Chairman | The Franklin Institute
Apple, Its Control Over the iPhone, and The Internet | Matthew Ball
How Smartphones Changed Music and the Music Industry | Hypebot
This May Be the Most Important Medical Story of the Decade | The New York Times

Movies

Sophie’s Choice | Prime Video

Companies

Institutions & Organizations

Concepts & Therapies

People

Relevant Episodes

Rick Doblin — The Psychedelic Domino That Tips All Others (#440) | The Tim Ferriss Show
Dr. Suresh Muthukumaraswamy — LSD Microdosing, Classical Psychedelics vs. Ketamine, Science and Speed in New Zealand (#619) | The Tim Ferriss Show
Steve Jurvetson — How to Pick the Future, Quantum Computing, SpaceX, Tesla, and More (#714) | The Tim Ferriss Show
Walter Isaacson on CRISPR, Jennifer Doudna, Gene Editing, and the Future of the Human Race (#503) | The Tim Ferriss Show

TIMESTAMPS

[00:00:00] Start.
[00:06:07] What Strand does.
[00:08:19] The Boston dinner.
[00:11:05] The image of a body riddled with cancer.
[00:15:05] What stuck for the muggles in the pitch deck.
[00:17:14] A good drug vs. a good product.
[00:19:40] Tricking cancer into snitching on itself.
[00:27:38] The abscopal effect.
[00:34:04] Potency, specificity, and delivery.
[00:35:46] First principles thinking.
[00:36:38] The precipice of a revolution.
[00:41:14] The thousand people in the room.
[00:48:38] Psychedelic medicine as a cautionary tale.
[00:51:17] What actually catches a policymaker’s attention.
[00:53:42] Breakthrough vs. incremental.
[00:54:55] What’s in it for the policymakers?
[00:58:08] The 80/20 wish list.
[01:01:31] Australia’s CTN system.
[01:03:51] Sheep, psychedelics, and red-tape arbitrage.
[01:05:22] China’s clinical-trial flywheel vs. slow-motion American loss.
[01:06:53] The bicoastal biotech ethos.
[01:08:10] Can the FDA actually pull this off?
[01:12:12] The Sophie’s Choice of pharma development.
[01:14:16] Lost arts of founder mode.
[01:15:23] Rockets for tumors, T-cells, and beyond.
[01:19:16] Viral in policy circles.
[01:23:09] The Washington Post headline and the PickFu split test.
[01:27:56] Solution-first storytelling.
[01:33:54] RNA medicine and platform therapeutics.
[01:39:17] Moderna’s 62 days.
[01:40:33] Uber Eats and the de-risked launch.
[01:44:17] CEO blockers.
[01:45:52] Where’s biotech’s SpaceX moment?
[01:46:53] Elon Musk betting black on the wheel.
[01:51:55] AWS and the post-conviction / pre-consensus window.
[01:58:47] COVID politicization.
[01:59:46] Insulin, growth hormone, and the original platform story.
[02:01:35] Biotech as pharma’s little brother.
[02:03:29] More recent role models, Apple edition.
[02:04:50] Art Levinson, Steve Jobs, and the biotech-tech crossover.
[02:06:25] The iPhone as a delivery platform.
[02:08:25] Spotify’s problem and the future of bespoke medicine.
[02:10:07] Baby KJ and the limits of liver-only solutions.
[02:11:19] Parting thoughts.

JACOB BECRAFT QUOTES FROM THE INTERVIEW

“Our goal at Strand, and our challenge, is building drugs today that impact patients’ lives. We’re not a research institute. Our goal is not to do really cool research on mice and join the ranks of people who have cured mice of cancer. There’s millions of them. There could be a Nobel Prize every five minutes for someone who’s cured a mouse of cancer. Our goal is to cure human beings of human-being cancer. Our goal is to cure human beings of human-being diseases, and do so in a safe, effective, scalable way that impacts a person’s life as little as possible. And that is what we’re building.”

— Jacob Becraft

“What I want the world to understand is that we are standing right now on the precipice of a revolution in genetic medicine.”

— Jacob Becraft

“Everyone wants to cure cancer. I don’t need a story behind curing cancer. I just need a story about how we’re going to get there and how curing cancer is actually going to be one step on the road to solving disease writ large.”

— Jacob Becraft

“What we are in the midst of right now is the United States massively losing to China. China has built an industrialized version of clinical trial infrastructure for first-in-human trials that is so efficient and massively quick that they’re just able to go faster and cheaper into the thing that matters most, which is first-in-human trials. So the United States is actually in the process of very rapidly, as a country, falling behind China because what started as a place for American companies to come run clinical trials to get data and then take it to the FDA and then do larger trials in the United States has now created a flywheel structure within China where now just Chinese companies run their clinical trials faster than the American companies and then bring their Chinese-discovered drugs to the United States.”

— Jacob Becraft

“No one will learn until they care.”

— Jacob Becraft

“The biotechnology industry will be dragged kicking and screaming into the future, or it will be built up in a new way from new players.”

— Jacob Becraft

“If some bullshit hype filters into this, it’s worth it in order to take the correct swings at the truly big ideas, because one out of 10 transformations is better than seven out of 10 logical steps forward.”

— Jacob Becraft

“In low odds games, games where there’s a very low odds of success statistically, if you don’t go 100 percent all in, the odds will be zero.”

— Jacob Becraft

“When I look at some of those great investors who have made these high-conviction bets, it seems like they’re able to identify this moment in time for companies that is post-conviction, pre-consensus. The ones who know we’re post-conviction, we’re no longer saying, ‘Can we do this?’ We’re like, ‘Oh, my God, this is going to work.’ But it’s pre-consensus because not everyone has caught on yet or not everyone is convinced.”

— Jacob Becraft

Want to hear another episode with a physician-founder building a new class of medicine? Listen to my conversation with Dr. Kevin Tracey, president and CEO of the Feinstein Institutes for Medical Research, in which we discussed the birth of bioelectronic medicine, stimulating the vagus nerve to tame inflammation, the inflammatory reflex, treating rheumatoid arthritis and Crohn’s disease, SetPoint Medical’s FDA approval journey, alleviating depression and autoimmune disorders, building devices that replace drugs, and much more.

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The post Tim’s Founder Kitchen — From Brainstorm to the President’s Office in Two Months (Featuring Jake Becraft, Strand Therapeutics) (#868) appeared first on The Blog of Author Tim Ferriss.

On The Importance of Desperate Customers

2026-06-02 01:43:09

I’ve been revisiting my Kindle highlights of Pattern Breakers, co-authored by legendary angel investor and friend Mike Maples Jr.

Mike was the kind soul who taught me the fundamentals of angel investing back in 2007/2008. He deserves a lot of credit for the wild startup adventures that followed. He’s one of my favorite people in Silicon Valley, he’s a co-founding partner at Floodgate, and he has been on the Forbes Midas List eight times in the last decade.

Of course, Mike’s principles apply to founding or investing in early-stage tech companies, but many of them also apply to evaluating public stocks or creating anything for the wider world.

One simple distinction from Pattern Breakers worth revisiting often is this: interested vs. desperate.

Mike writes:

[Some of these startups] embraced all the tenets of disciplined entrepreneurship. But, still, something’s missing. They aren’t getting the traction they expected. Why? Because customers are interested in what they have built, but they are not desperate for it. Suddenly you realize that your idea isn’t big enough. You followed the best practices for good execution, yet you’ve encountered the pitfall mentioned earlier in this chapter: settling for a limited upside, the dreaded local maximum.

…

Ultimately, in a start-up, there is a huge cultural difference between finding any number of desperate customers versus zero desperate customers. Many start-ups have a huge theoretical market opportunity but never find a single customer desperate for what they propose to build.

Seeking desperation—a signal for a potentially valuable problem to solve—starts early. One early testing ground is the “implementation prototype”:

Implementation prototype: A focused deliverable that helps you engage potential early believers to identify: What is the most important benefit? Who are the most desperate customers?

To get to the right product and the right business, you have to ask the right questions. Two examples:

In the case of Chegg, the most important question was “What is the limit of someone’s willingness to pay to rent a textbook?” In the case of Okta, it was “What is the most urgent management problem early-adopter cloud customers are trying to solve right now?”

Don’t ask whether people like what you’re planning to make.

People can love or hate what you’re creating, but you don’t want to land in the mild middle.

This applies to writing books, building companies, making crochet socks on Etsy, and a million other projects and paths.

The real name of the game is this: How quickly and clearly can you find your 1,000 True Fans? Sometimes, starting small is what allows you to go big.

The post On The Importance of Desperate Customers appeared first on The Blog of Author Tim Ferriss.

The Tim Ferriss Show Transcripts: Sami Inkinen of Virta Health — Reversing Type 2 Diabetes, Rowing 2,750 Miles, and Lessons from Fixing Metabolic Health in 100,000+ People (#866)

2026-05-22 01:54:04

Please enjoy this transcript of my interview with Sami Inkinen (@samiinkinen), a Finnish-born, Stanford-trained entrepreneur and the founder and CEO/president of Trulia and Virta Health. Virta is on a mission to reverse metabolic disease in one billion people using technology, AI, and nutrition. He is the founder of Fat Chance Row, which he created to raise awareness of the dangers of sugar and its connection to diabetes, rowing 2,750 miles from California to Hawaii with his wife—completely unsupported—while breaking a world record in the process.

The content of this episode is for informational purposes only. Neither Sami Inkinen nor Tim Ferriss is a medical professional, and nothing discussed here should be taken as medical advice or a substitute for consultation with a qualified healthcare provider.

Sami’s full bio

Legal conditions/copyright information

Sami Inkinen of Virta Health — Reversing Type 2 Diabetes, Rowing 2,750 Miles, and Lessons from Fixing Metabolic Health in 100,000+ People

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Listen to this episode on Apple Podcasts, Spotify, Overcast, Podcast Addict, Pocket Casts, Castbox, YouTube Music, Amazon Music, Audible, or on your favorite podcast platform.

Transcripts may contain a few typos. With many episodes lasting 2+ hours, it can be difficult to catch minor errors. Enjoy!

Tim Ferriss: I will start, I suppose, with something that I can potentially use immediately or some variant thereof. Do you still schedule your week, or at least workouts, each Sunday? And I’m reading here — this is from a blog post. Schedule everything, right? This is “Top Five Tips: Getting and Staying in Shape for People who are Busy.” “I spend 10 to 20 minutes every Sunday scheduling most of my workouts in detail similar to any other appointments in my calendar. Like with most unscheduled tasks and to-dos, they’ll fall between the cracks. On the other hand, with proper scheduling, you’ve managed to get in your workouts with 150+ annual travel days, changing cities, super early wake-ups and delayed flights,” et cetera.

So this is kind of a micro question that edges into the macro just around planning and scheduling, but do you still take time out each Sunday to go through these things?

Sami Inkinen: 100 percent. 100 percent. It’s every Sunday. I just find that structure allows flexibility and spontaneity. If you don’t have structure, nothing gets done, at least in my life. And not that my life is super special, but two pretty young kids, happily married, running a company, growing, that’s thousand employees, and then trying to be a kind of semi-athlete in the process, if I don’t schedule, it’s not going to happen. So I spend about 15 minutes at the end of each week, that Sunday, professionally list the three things that absolutely have to get done, and then I schedule a few things, including workouts, and it works very well.

Tim Ferriss: When do you do that on Sunday?

Sami Inkinen: Well, this could be a long conversation, but it’s either early morning before the kids wake up and Sunday gets going, or if I don’t have it done by Sunday afternoon, then it’s after 7:00 p.m. when everybody else quiets down and I take my own time.

Tim Ferriss: Virta, how many employees do you have right now?

Sami Inkinen: Yeah, Virta Health. So we have about 1,000 employees. And the caveat these days, of course, is don’t brag about employees because the more employees you have, less you’ve leveraged AI. But I guess mentioning 1,000 employees, it’s a real company and obviously growing fast, so it takes fair amount of effort. So about 1,000 people.

Tim Ferriss: Well, the good news is, like so many companies in the news these days, if you did end up over-hiring during COVID or something, you cannot say, “We made a mistake.” You can just say, “We’re using AI to improve efficiency,” when you have layoffs. But we won’t dwell on that. The question I had is, what type of training in your life right now are you currently scheduling each week?

Sami Inkinen: Well, we’re talking about training, so this is sort of physical training.

Tim Ferriss: Physical training. Mm-hmm.

Sami Inkinen: It’s really in two buckets. The primary focus is really endurance sports around cycling. So I do a lot of mountain bike racing as well as road bike racing, so that’s essentially endurance training. So I’d say 90 percent is cycling related, and that’s my core workout that essentially happens in the morning every day. 99 percent of the time, it’s one of the first things. It’s not the very, very first thing in the morning. So that’s one. We can go into morning routines and stuff like that in a second if that’s interesting. But I do a little bit of just core work pretty much first thing after waking up. So I don’t even have to schedule that. That’s sort of a non-negotiable. Before the brain even boots up, I’ve done my core work. But cardiovascular work is the main —

Tim Ferriss: Yeah, let’s not tease. Let’s just hop right into it. So what does the morning look like upon waking up, and what time are you getting up?

Sami Inkinen: Yeah. So, again, let’s separate into traveling and not traveling, traveling for work —

Tim Ferriss: Let’s do non-travel.

Sami Inkinen: Yeah, non-traveling. I wake up 5:00 a.m. latest. This morning, alarm was 4:45, so I wake up pretty early. And I have the amazing privilege and luxury that the second I roll off the bed, I jump into a lake or pond. And it’s not a long time, maybe like a minute, just cold water, a couple of strokes. But essentially it’s a freezing cold shower. And this is a mountain lake, so we are talking like 40-degree weather, pretty much straight off the bed. And after that, maybe just a minute or two of some air squats and jumps and core, literally core work. Nothing too special, so that’s some Supermans and leg raises and stuff like that. And I do it because, again, I race bicycles quite a bit, and I have some lower back issues, and core work, it just never gets done unless it’s the very, very first thing in the morning. And then I’ll throw in a couple of pushups there. So that’s 5 to 10 minutes. Straight off the bed, jump into the lake, dripping wet, little bit core, little bit jumps, a little bit this and that.

And I’m just a huge, not just a believer, but the practical experience I’ve had is mood follows movement and motion. So before I even ruminate or think anything, I’ve already been in a lake and done five or 10 minutes of core work and some jumping and get the heart rate up for a little bit, and that’s pretty much the first five, 10 minutes.

And then the other thing I try to do always right after is do something useful for other people. Do something useful for other people. And what is that in practice when I’m not traveling? It’s preparing coffee for my wife and emptying the dishwasher. And it may sound very simple, but that’s like 15 minutes after I’ve woken up, I haven’t had a second to think about or ruminate, “Oh, my back’s hurting,” or “Oh, my God, so much work,” or whatever that is. It’s like a 15-minute boot-up sequence, and it’s like life’s rocking. And then I’m ready to go and do the other things.

Tim Ferriss: Don’t worry, I won’t have you give the minute by minute for your entire day, but after you have done that, so you’ve made coffee for your wife, you’ve emptied the dishwasher, then what? Are you having your first intake of coffee? What does the next 30 to 60 minutes look like for you?

Sami Inkinen: Man, sounds like you’re mind reader. So I do drink coffee. That’s time for an espresso or a cup of coffee at that point. Everybody else is still sleeping in the house. I sit down, and basically I write down my sleep, how many hours I slept. And I have a little diary. It’s a spreadsheet online, 16 years of data now. And I also write three things I’m grateful for. So this is kind of little gratitude journal, super, super simple things. And I try to focus on the mundane, such as leaves in the aspen trees or warm temperature, just simple things, very, very simple things. So I do that and write down a few things.

And then I usually work for about an hour, so clean email and Slacks, or maybe I have like a 20-minute writing thing, so this is kind of my CEO job. So I try to do about hour of that. And then whenever my wife wakes up, then we have sort of a 15, 20-minute couples moment, drink coffee, and talk about life. It’s a really wonderful moment there. So that’s kind of the very morning.

And then my real workout usually happens between 6:30 and 8:30, the exercise. And then after that, get to office. Exception would be if I have any meetings that are across time zones, then it could be a 6:00 a.m. Zoom or something like that. But before that, I’ve always done my swimming in the lake and a little bit core and maybe a cup of espresso. That’s the routine. And pretty much repeated that for more than a decade. It’s nothing too special. People ask like, “What’s the science behind?” I say, “Listen, if it doesn’t feel good, it’s not right for you. If it feels good, repeat it.”

Tim Ferriss: So I suppose there are different types of fun, right? There’s type one, type 2, maybe type three fun, which is just embracing the suck. God, I can’t remember who sent this to me. It was a friend of mine — maybe you recall who this is because I’m sure I pinged you about it. But they were driving up some windy, incredibly steep road in the mountains, and they were taking a video from their car of some lunatic, who I think they called a lunatic, “Look at this fucking guy. He’s crazy,” on what you could envision, listeners or watchers, as incredibly long rollerblades. They’re basically skis with a single track of wheels on them and poles doing uphill, I suppose, Nordic skating, let’s just call it, going up this unending incline, and they’re like, “God, who is that lunatic?” And of course, who did it end up being? Ended up being Sami. So fun means different things, or feeling good means different things in different contexts.

But the reason, for people who are wondering, why am I digging into all these details? Number one, I like the details, and the details matter, but you have always impressed me with the number of important pillars that you’re able to methodically schedule into your life, and furthermore, within those pillars, how you’re able to operate at a very high level in multiple domains. So that’s why I’m asking about the specifics, because these things, much like workouts, tend not to happen accidentally. If you don’t schedule them, particularly with the number of moving pieces that you have, and frankly the number of moving pieces that any person probably has, things will not manifest magically.

And I’m curious, we talked about the single day, do you have any type of — I know for training you almost certainly do have weekly and monthly architectures, particularly with competitions. But from a work, could be work, could be physical perspective, do you have a consistent weekly architecture of any type where, say, you might batch certain types of tasks or meetings or otherwise on certain days or anything like that? Or is it pretty much Monday to Friday more or less the same daily routine?

Sami Inkinen: I do have a system. Well, a couple of things. First, I think it’s good to remind when myself or anyone’s like, “Oh, here’s the system,” and — the reality is life happens all the time, so let’s just remember that. You’re running a company, you have kids, crap hits the fan all the time, or at least frequently, so obviously you have to be flexible. So what I’m going to share next is the kind of beautiful, clean scenario where you can kind of live with your structure. But the reality is you’re running a company —

Tim Ferriss: The platonic ideal gets smashed a lot.

Sami Inkinen: Exactly. It’s 24/7, and the Sunday afternoon walk with your kids or with your spouse may not happen because you need to address a crisis. But let me start with — you mentioned like, “Oh, I’m kind of impressed how many things you can do.” Honestly, the biggest secret is saying no to 99 percent of the things that many people consider quote, unquote, normal. So what you care gets done. And sometimes people ask me like, “Wow, so many sacrifices. You’re trying to be an athlete and a CEO and a founder and trying to be a parent as well, and you even travel with your kids. You must have so many sacrifices.” I actually find that saying no is incredibly liberating in life. I’m way happier that I’m married to one person versus five. It’s awesome. There’s no way I could be a CEO of many companies. I love the kind of focus.

And so I actually find it personally in life, when you find something that kind of fills your cup and is satisfying and gratifying, just having the one or two things that I focus on and then go all in, rather than a sacrifice, it’s a happy place for me. So anyway, I would say that’s my biggest secret.

Tim Ferriss: I think a lot of people will hear what you’re saying and theoretically agree with it, and yet most people are unable to embrace that in practice, for whatever reason. And it doesn’t mean they’re not capable of doing it, but they don’t do it. Why do you think people have trouble saying no or the default is people are inclined to over-commit or that they do the 99 percent of things that are quote, unquote, normal that you say no to? Why do you think not more people do what you’re describing?

Sami Inkinen: Honestly, if I had a perfect answer, I’d probably write a book about it, but —

Tim Ferriss: With all your spare time. Yeah.

Sami Inkinen: Here’s my guess. I think one might just be a narrative. And I can’t tell you how many times someone has said, “Oh, my, you must be sacrificing so much to be able to do what you do.” And I’m sure you could say the same for an Olympic athlete, like, “Oh, my God, so many sacrifices.” But if you’re an Olympic athlete focused on your sport and your craft, sure, you can’t do 99 percent of things quote, unquote, normal people do, but it’s probably incredibly satisfying to be able to do that one thing for the five or 10 or 15 years of your life. So that’s why I meant maybe it’s a narrative that, oh, if I say no to all these, whatever that is, a movie night every night or some distraction, whatever, staying on social media and watching Netflix four hours a day, then, oh, it’s a sacrifice not to do that. So that’s my guess, one thing, that it’s a narrative in our minds, like, oh, you want to do all these consumption things that maybe take time away from the thing that could move your life or profession forward. So that could be one.

And then the other thing is I think this sort of life structure that if you don’t have a basic — we can go back to your original question, what’s your architecture, what’s your structure? If you’ve never taken the time to take a step back and say, “Hey, how am I allocating my time,” it’s very easy to let the universe or the entropy to take control of your time, whether that’s your inbox or text messages from others or phone calls. It’s actually very, very easy let the world run your life as opposed to you running your life.

Tim Ferriss: Well, let’s talk about the weekly architecture, and then I am going to come back to this particular question that I asked. But let’s take a breather on that, and would love to hear more about the weekly architecture or other architectures outside of the daily.

Sami Inkinen: Yeah. So, again, this is sort of in an optimal world, but I would say professionally I do try to group similar type of tasks into specific days. So just to give you an example, Monday is filled with a lot of group and leadership meetings and stuff like that, so there’s one kind of context switching, that it’s meetings in front of the whole company and in front of leadership team and so forth. So that’s Monday. Tuesday I try to have all my one-on-ones, again, one type of context switching. And as an introvert, that takes a lot of energy, by the way, as important as it is and sometimes very enjoyable, but the kind of one person after another, it’s pretty draining for me personally.

Tim Ferriss: How many direct reports do you have?

Sami Inkinen: Well, I should say this has changed all the time. There’s been 15, there’s been 10, and I had eight for a long time. But for the last couple of months, I’ve had two, only two, which is a very small number. And again, that could be another one-hour conversation. But when you’re building a grow company, you always have to ask yourself, “What’s most important for this year?” And there’s not really kind of a school book-perfect kind of approach. But anyways, it is two right now. So Tuesday is that. Wednesday I actually try to reserve for thinking and writing, thinking and writing. So the default is no meetings. And one example of writing that I do, I write a team letter for the whole company from the CEO. So I’ve now written 553 of them.

Tim Ferriss: Wow. So you do that every week.

Sami Inkinen: Every week, and there’s a one topic, and again, another topic we could dive into. But what I find is that it’s as the company has scaled, there are a few things that are very scalable, like whether my email hits five inboxes or thousand obviously doesn’t take any time away from me, but I can give context, explain what’s happening, what’s important, what’s happening in outside world, what’s happening inside the company, and then every employee feels hopefully some level of connection. So that’s one example.

There’s a couple of things that I’ve kind of repeated ever since day one, and now at thousand-employee scale is still very scalable. But that’s just one example. I could be preparing for board meeting or thinking about strategy, which sounds very high-flying, but I would say one thing that’s very, very easy as a CEO of a grow company is to fool yourself that you’re productive and useful by being busy. But if you miss a decision, something around a corner, no amount of knocking tasks off the to-do list is going to compensate that. It’s almost like managing your own brain and feelings. It’s hard not to have a tightly scheduled calendar, but in fact, having that time open for like, you can go for a walk and think about the problem.

So anyway, so that’s kind of my Wednesday. And then Thursday and Friday is a lot of internal client work and those kinds of things, but I usually — that’s not too structured. But that’s a little bit of a typical week.

Tim Ferriss: On Wednesday, when you’re doing the writing and thinking, what are some of the ways that you structure your thinking? There’s unstructured thinking, right? You go for a walk and kind of ponder and allow the void to invite hopefully some type of insight. But then there’s structured thinking. And I guess to the extent that I know you at all, I would say I’m inclined to think you probably have some prompts or structure or an approach to doing thinking. What does that look like, or how would you speak to that?

Sami Inkinen: Yeah, actually typically the way my brain works is the actual thinking and problem-solving happens 24/7, and I’ll give you a specific example. My workouts every morning, which is about an hour, hour and a half, unless it’s a very, very, very high intensity, that’s one of the best times where my thinking happens, and problem-solving and new ideas and creativity happens there. And then for the Wednesday, I actually just block an hour and say — it’s almost like the time to get the words and the thoughts and whatever that might be off my brain to a paper, or obviously in a cloud. So unless I have to do a very kind of left-brain, mathematical, deterministic problem-solving thing, literally like, “Okay, let’s look at how do we improve cross margin,” or something like that, the creative work does not happen at the desk for me.

And one thing that I noticed, this was especially during COVID, when COVID hit, I was listening a lot of podcasts and music and audiobooks on 100 percent of my workouts. It was maybe like a year. And I realized that the problem-solving and the creativity almost stopped. So now I have a rule that maximum of half of my workout I can listen to Tim Ferriss. Sorry. So if your download numbers are going down or listening numbers —

Tim Ferriss: Damn it, Sami. I need all the help I can get.

Sami Inkinen: So if the brain is in a consumption mode, you’re kind of just filling in the cup, and I’ve noticed the creative thoughts and the problem-solving that’s happening or background processing, it’s not happening. So anyways, this is tactical thing that I’ve noticed that too much audiobook or podcasts filling the brain, and it stops creating stuff. It’s very interesting. That’s at least my personal experience. So I’m very conscious of, on those moments when I’m exercising or walking or driving somewhere, that there’s kind of a cutoff point. No more listening. Just let your brain do its thing.

And then the Wednesday comes in, it’s more like, okay, now I kind of have the framework in my head, take an hour and a half to, I don’t know, write about next year’s priorities or the new product we’re going to launch. Or even these team letters that I write, I actually write them in my brain when I’m away from the desk, and then when I sit down, it just — it comes out.

Tim Ferriss: So that actually leads into my follow-up question — I can’t imagine I’m the only person wondering this — which is, when you’re doing these workouts, let’s just say it’s an hour and a half to two hours, the real workouts, in the morning, I would imagine quite a lot percolates and comes up, and if you’re doing that Monday, Tuesday, maybe also Saturday, Sunday, et cetera, by the time you get to Wednesday, if I have not taken some step to maybe verbally record some of that or make short notes in a notebook for cues for later, I would be doubtful that I would be able to recall the good ideas that I had earlier in the week. Do you just have a preternatural sort of inclination to be able to remember all that stuff, or do you take some type of shorthand after the workouts so that you can use those then on Wednesday as prompts? How does that work?

Sami Inkinen: Essentially I write emails to myself or store notes. It’s the same thing. So there’s tidbits along the week, and then I have it for Wednesday. And then half may be in the brain, and half is written somewhere so I don’t forget it all, but yeah.

Tim Ferriss: And you just send yourself an email after the workout with some type of note?

Sami Inkinen: Yeah. Yeah. Yeah.

Tim Ferriss: Mm-hmm. What is an example of what you might cover in a team/company email on a Wednesday, and how long is that? Because that is, like you mentioned earlier, one of the things you’ve repeated since day one. What would be an example that you can share? I mean, it could be hypothetical, but just what might you put into that, and how long is it?

Sami Inkinen: Half is standard structure. So there’s a quote from — again, we can go into details, but we’re in a business of reversing metabolic disease and helping people get healthy with nutrition. So we treat patients like real humans, hundreds of thousands. So half of it is this existing structure. There’s a quote from a patient, so we always kind of lead with, this is why we’re here, and here’s a positive feedback from a patient. Then there’s some business metrics, like how much we’ve grown, and what are the priorities, and just a reminder of this year’s key objectives. So half is like that.

And then the most important other half is topic of the week. So topic of the week is essentially my, as a CEO/founder, essay, and I think that’s what you were asking. I would say they’re roughly in two or three categories. One is what has happened in our external world, what’s the context there, and how does that affect us? One example, this is a real-world example that I’ve written quite a bit about, since we use nutrition as the core tool, but obviously our providers use all the tools in the toolkit, one of the things that has really changed in addressing obesity and metabolic disease over the last couple of years is the GLP-1 drugs, so these are the Ozempics of the world. And so I’ve had a number of letters discussing, how do these drugs potentially affect how we take care of our patients, and what’s the impact on our business? So that would be ity, and how is that affecting our strategy? So that’s one example.

The other category is career and personal advice to our team members, like how to make most out of your experience working at Virta and around that kind of stuff that we discussed now, like personal productivity and how do we make most out of — so that, I would say, is the second category. And then third is just internal, this is what happened, this is what it means for us. So honestly, I kind of like it. It’s my personal outlet, and sometimes I’ve said, “Hey, 530 plus essays, there’s a book in a making. All we need to do is upload it to ChatGPT and we have a book ready to be published.”

Tim Ferriss: I promised I would come back to a thread, which I realize is probably a misworded question. The question I asked was why people have trouble doing what you do, which is saying no to 99 percent of the things that normals do, or feel compelled to do, to your point about the narrative. And I realize that’s perhaps not the right question. The right question might be, what advice would you give to someone who is having trouble saying no, or focusing on just a few things? But I can make it much more specific, because I think the more we can imagine it, perhaps the easier it is to dig into this.

So, let’s say that you had a relatively new hire, who is on the younger side but a 10X engineer, or some equivalent of that. Someone who is clearly a superstar, but who has not established the type of architecture and routine that you have in your life. Let’s just say you sense that they are on the path to burnout, which is going to be bad for them, it’s going to be bad for the company, it’s going to be bad for the patients you serve, and you want to stage an intervention to help them correct course. I imagine you may have even had these conversations. What might that conversation or coaching look like?

Sami Inkinen: Yeah. Well, funny enough, this has been one of the topics of my team letters, one of the 530. So, I would separate it into two things, my advice. One would be this sort of planning. Literally, it would be very simple. Sit down for five minutes on a Sunday evening before the week starts, and write down what absolutely completely needs to get done next week, super-duper simple, professionally and personally, and schedule it into your calendar, literally. And if you have the flexibility, then block two hours in the mornings to get those two or three things done. And then when life happens, or work happens, everything else kind of comes after that. So, that to me would be the number one thing.

And then I would couple that, when Monday comes or Tuesday comes, it’s whether you work in an office or in a remote setting, do not let the universe control your time. So this means absolutely no notifications. Maybe if you have to get text messages for, I don’t know, family emergency or something, but take everything else out and you kind of create that sacred space where you can do that work, whether that’s writing, or coding, or cold calling 15 prospects or whatever that is. It’s super-duper simple, but it’s so easy to then sort of, again, Monday comes, Tuesday comes, and then the world takes over, and you’re like, “Oh, my God, it’s 4:00 p.m. I haven’t done the thing.” So I’d say that would be the one category.

And then the second part —

Tim Ferriss: Can I pause for one second?

Sami Inkinen: Yeah, sure.

Tim Ferriss: Okay. So before we get to the second, for some people listening, if they sit down for 10 minutes on Sunday to write down the things that must get done professionally and personally, they might have a list of 20 things in each category. So, are we talking about one thing, three things in each category? I know this seems like very persnickety, but this seems like a possible failure point for people, right?

Sami Inkinen: Yeah.

Tim Ferriss: So, what is your suggestion there?

Sami Inkinen: Yeah. So, it’s probably one or two things, but this, again, we could launch into another part, which is obviously you need an architecture of annual thinking, planning, like what does business need, for example. In fact, I just have a text file, ASCII file on my computer. I was like, “Here’s the four things to remember as a CEO now and 20 years from now. Here’s the three things for this year. And here’s the three things for this week.” I literally have a text file and I just update it every Sunday.

And a whole another topic, which I’m sure some people think I’m crazy, is I have a 15-year plan for myself, which I accidentally stumbled that it actually could be useful and I update it every year. And again, we can take that offline or take a bookmark how that came about. It’s been incredibly helpful. And again, I want to highlight, structure allows spontaneity and flexibility, but if you don’t have that architecture, then obviously on a Sunday evening it’s like, “Oh, should I write a book, or get a new job, or just do this project that my boss was asking?” So, if you don’t have that North Star, you could be kind of spinning like a compass.

Tim Ferriss: I did take you off track, because you were saying block these things out in the calendar like Sunday, five to 10 minutes, block those things out in your calendar if you can, two hours first thing in the morning. Do not let the universe dictate how you use your time, block out notifications. And then you said the second thing, and then that’s when I interrupted you.

Sami Inkinen: Yes. Second bucket, this is probably the most important as this relates to a burnout and you’re falling apart. And I’m going to knock here on my wood, my table, not too hard to create any noise, but I founded my first software company in April 2000. So now we’re here in 2026, so that’s 26 years, running, building, fast-growth companies. And I haven’t cracked yet. And again, caveat is it could happen tonight. But there’s a few things I’ve learned, and I think these are applicable to, especially any knowledge worker, where everything’s just coming to your brain, and it’s very easy to get stressed, and anxious, and crack. And I’ve written about this as well. Here’s my formula that has worked for me very well.

One, you have to take care of your sort of foundational metabolic health. What is it? It’s sleep, nutrition, exercises. That’s kind of one. If you are metabolically very, very unhealthy, it’s very, very likely that you’re going to crack under pressure. So that’s one. Second one is, it’s very helpful to have, especially for founder CEO types, but for anyone, have at least two or three identities, or outlets. For me, it’s parent/husband, one, CEO, two, and then want to be athlete. And so if one’s failing, hopefully at least two are the areas, outlets in my life where it’s like, “Oh, it’s going okay.” And by the way, it’s never that I’m rocking and winning and ringing the bell in all three at the same time. And it’s very helpful. It’s almost like a mental trick, like, “Oh, my God, work sucks, but at least my kids love me today.”

So having that outlet, and particularly founder types, younger ones, it’s often the opposite. They’re sort of proud of the fact that I only have one thing and I’m ready and willing to die for my company. Well, that’s all well and good when everything’s going well, but you have the first speed bump and then everything falls apart. So that’s the second thing, I would say.

Third one is have peers outside of your company that you can let your hair down and relax. For me, it’s a group of CEOs. Other CEOs was, “Oh, my God, can you believe? Can you believe these employees are bitching again?” But obviously you can’t say that in front of the company. Personally for me, it’s been YPO, the Young President’s Organization since, I guess, 2008. So now for me it’s not anymore the why the young, it’s just PO, because I’m old enough. So, I have that.

And then I think the fourth one I would say is everyone has their own tools, but just understanding how your mind work. It could be meditation, could be some other tools, but that’s been a process for myself, to just realize that if you are just attached to your thoughts, eventually they’re going to get you, and you can’t really think yourself out of the hole that you’ve thought yourself into. So unless you can take a step back and observe like, “Oh, my God, my brain’s having a life of its own.”

So that’s kind of the tool that I would not to crack. So foundational health, have different outlets, identities, have peers you can talk to, could be friends as well, and then some sort of understanding and way of taming your mind, if you will, or being able to see that the mind has the life of its own. That’s been helpful for me. And I will say, again, could happen tonight, but I haven’t touched any prescription drug for anything sort of mind related, and that toolkit has kept me head above the water so far for 25, 26 years.

Tim Ferriss: I have a very left turn question for you. Hopefully, it won’t be incredibly offensive. But I was just thinking, when you were like, “I would knock on wood, but I don’t want to make any noise,” and then you’re like, “I can let my hair down, no offense, sorry.” And you’re very polite, and I’ve only been to Finland once. And I was walking around. And of course, went to the obligatory saunas and so on, which I actually can tie into my story, but I was walking around and in the maybe two days that I was in Helsinki, I thought to myself, because I lived in Japan, I speak Japanese, I’m still close to my host family who I stayed with when I was 15 and I thought, “Finish people feel like white Japanese people.” That was my feeling there.

And the reason it ties into the sauna, different context, but if you go to Japan, it’s everything is very restrained, very polite. People don’t stare you in the eye when you’re walking down the street. And in Japan though, if the boss says, “We need to go out and drink, when you drink, okay. And if the boss says you have to drink, you have to drink. But you go out and you can get really loud, and you can get really boisterous. And you’re allowed to say things when you’ve had some alcohol that basically everyone agrees they’re going to forget the next day like it never happened.

Now, I can’t take it that far with Finland, but when I went to the saunas, one thing that I was very surprised by is that they sell huge stein glasses of beer that people bring into the saunas. And I was like, “Oh, this is where they let their hair down. Okay.” Am I totally off base? I don’t know if you’ve spent time in Japan, but culturally I felt like in my 48 or 72 hours of exposure, I was like, “Wow, this is actually, even Finish itself has some of the phonemes, some of the sounds of Japanese. I mean, it sounds like I’m really overreaching now, but — am I just an insane person, or do you feel like there’s something possibly there?

Sami Inkinen: I think there’s similarities. And you’re definitely the connoisseur of a Japanese culture versus me, having just been to Tokyo and a few other places a couple of times. But that kind of space and distance, and politeness that people — well, actually, there’s no distance in Tokyo obviously, but sort of emotionally there is a kind of distance in Finland and in Japan versus when I came to America 2003, moved to California, it’s like everyone’s on your face and everything’s freaking awesome. And it took a couple of years to, I was like, “Wait, wait, wait, wait, come on, give me space,” and everything’s not awesome.

And so yeah, maybe there are similarities. And then, yeah, alcohol I’m sure has been a mental health tool, not very effective at that in Finland for many, many decades. But sauna, I have to — well, first of all, there’s five and a half million people in Finland, and there are more than three million saunas. More than three million saunas.

Tim Ferriss: It’s a crazy number.

Sami Inkinen: So on average, you have one to two people per sauna in Finland. Babies used to be delivered in sauna in Finland, because it’s the clean, bacteria die in the heat.

Tim Ferriss: Sterilized.

Sami Inkinen: There’s warm water. I think my mom was delivered in sauna. I was in the hospital, just to be clear. So, sauna is beyond being part of the culture. It’s part of the DNA. And it’s culturally, it’s an amazing place, actually, not just kind of let loosen your head down, but you don’t have your uniform, you don’t have your titles, you don’t have your whatever, socioeconomics, singles, symbols, fancy watches, and kind of everyone comes together, whether that’s family, or your friends, or your community. And yes, sauna is definitely a place where a lot of things happen in Finland. And yeah, we could talk about saunas and it’s its role in a culture, but it’s —

Tim Ferriss: Well, let’s talk about it.

Sami Inkinen: — way beyond cold ponds and sauna.

Tim Ferriss: Yeah. Why is that? Why is it so prevalent in Finland? Because it seems like, and I’m sure you’ve seen this, but there’s certain studies in the world of psychedelics where it’s like they did brain imaging and one study that they’ve been slicing over and over again and torturing the data again and again to just produce more and more papers on this one study that was done so long ago. It seems like the same group of 140 fins has been dissected five million times in various announcements around saunas, but why is it so prevalent there versus other places? I don’t know the origin story.

Sami Inkinen: Yeah. And hopefully, there’s a historian who will check me on this, but it definitely goes back hundreds, let’s say, many hundreds of years, where it was sort of necessary. Finland, four seasons incredibly cold winters. So sauna was a place to basically heat and warm up in the winter. It was also a place where you could dehydrate food. So that’s kind of how it goes way back when. And obviously now, it’s not necessary to stay warm and it’s not necessary to dry your food, but I think that’s where it started.

And then in saunas where you duck into a side of a mountain, and then you burn wood on top of rocks, and then you extinguish the fire, and then you make sure that the smokes goes away, and the rocks stay hot for a long time and you go in. That was the original, it’s called, people still have that kind of saunas today, it’s called smoke sauna. So essentially you don’t have a way to get the smoke out other than open the door. So there’s no fireplace where the smoke just goes through a chimney. So that’s called smoke sauna.

It’s a special sauna experience. And obviously, it takes much more time to heat it and make it safe, because you don’t want to go there, where there’s smoke. But I think that’s kind of the history. And then somehow I’m missing the link how it became sort of like a culture, but now, nobody will build a house without a sauna. Literally, first is where it’s a sauna, and then let’s figure out if there’s space for a bathroom. That’s kind of the order in Finland.

Tim Ferriss: I went to this public sauna, it’s pretty fancy, and there’s a word, you could probably tell me what it is, it’s like löyly or something like that.

Sami Inkinen: Oh, löyly.

Tim Ferriss: There we go. So this is, what? The act of throwing water on the stones? Is that what that refers to? Or the sound that it makes? I don’t know what the name of the actual location means, but you can tell me in a second, but the reason I bring it up is I have never experienced so many varieties of sauna, and they had a smoke sauna room. And in my mind, looking at the menu of options before going in, I’m like, “Okay, I get it. It’s a hot room. How different could it be?” But the experiences, and the feeling in the body, and the way it penetrates your being is very different. I was shocked, because I’ve spent so much time in dry saunas in the US, and I’ve also done steam rooms and so on, but I did not expect there to be such a broad palette of experience in saunas.

Sami Inkinen: Yeah.

Tim Ferriss: So that place was amazing.

Sami Inkinen: Yeah. So, I guess Eskimos have a dozen or so words for snow, because they know every nuance and detail. And Finns have dozens of words for different things around sauna that you can’t even translate. Löyly is probably the most important. You judge the sauna and it’s quality based on löyly. And löyly is essentially it’s after you throw water into the rocks, the fireplace, the rocks, and then the steam comes up. It’s not the steam, it’s not the heat, it’s the, I guess you could say the spirit of the steam, but how it feels, how it lands. And let me tell you, there’s a million different variations how it happened. Is it too hot? Is it too sharp? Is it soft? Does it sort of linger around and how does it feel on your body? That is löyly. And you judge the quality of the sauna based on the löyly.

And there’s a whole science to it, kind of like how big is the space. To get the löyly right in a barrel sauna, which by the way I have at my house, is very, very hard, because it’s too small, the fireplace, you can’t get high enough, and you should be sitting kind of above the fireplace. So yeah, löyly is — if you know one word, löyly, and you want to impress Finns, you go to a salon and I say, “What a fantastic löyly.”

Tim Ferriss: I feel like I need to reach out to the Finnish Tourism Board to sponsor this episode, get people headed over to Finland. I really enjoyed it. It was a very short trip, but hopefully I’ll have a chance to get back.

Let’s talk about metabolic health, because certainly Virta, we can talk about Virta. And part of the impetus for this conversation was tons and tons of text messages back and forth, and some of them I’m sure we can’t talk about publicly necessarily because it’s internal data or whatever, but I would have say a conversation with Dominic D’Agostino, who some long-term listeners will know synthesizes novel exogenous, meaning supplemental ketones and so on.

I was, for instance, I give one example, facing a bit of an enigma in my own experience, which was, I’ve gone into ketosis, and I know that’s a very sloppy way of putting it, but let’s just say getting into ketosis, so eating a predominantly fat-based diet, or even doing it through fasting, getting to a point where I feel like my brain has switched over to ketones. And I was lamenting to Dominic that my devices were telling me I was not in ketosis. And I found this implausible, because after so many years of experimenting with it, I feel like I have a very good bead on when my cognition clicks over, and is actually operating at a much faster CPU capacity.

But my finger pricks with, say, a Precision Xtra device, or the Keto-Mojo, were telling me I was basically not ketosis. And very confusingly, even with a breath-based, I think it’s KetoAir or something like that, pretty primitive device, but even with that I was being given a negative. And you sent me a text showing your bar graph over the last 10 years or something of measurable ketone levels going down over time, even though presumably you’re increasingly and increasingly fat adapted. And I was like, “Of course Sami has this data.”

And then you have some fascinating, fascinating data I have certainly never seen anywhere else looking at different cohorts with various combinations of things, with or without, say, dietary ketosis. So that is part of the reason I wanted to have you on. You’re such a meticulous thinker around these things and data cruncher. But let’s maybe just define some terms before we get into things. What is metabolic health? And maybe you could tell your personal story, because my understanding is at some point you were sub 10 percent body fat, but your report card in terms of biomarkers and so on came back and you were pre-diabetic, is my recollection, but perhaps you could take that TED Talk I just gave and use it as a leaping off point for discussing, defining metabolic health and then talking about your own personal journey maybe as a starting point.

Sami Inkinen: And first the caveat, which is that I do have two master’s degrees, but I’m not a medical doctor and I don’t play one on the internet. And I’m sure in this conversation we’ll go into that area, so I just want to be clear: I’m not giving medical advice to anyone, and I’m not a medical doctor. But obviously, I have a lot of experience with the topic that you just asked.

But in terms of, I guess the personal story, so just rewind, not quite all the way back to Finland, but again, my background is not in medical field. I’m a physicist by training, and in fact, started my career in a nuclear power plant way back when in Finland when it was still fashionable. And I guess nuclear power plants coming back to fashion now, again. Which is just to show that like my background is in science and technology, not in healthcare. However, I’ve been essentially an athlete all my life, cross country skier, bi athlete, came to America, started doing triathlons.

Tim Ferriss: Well, you had to ski to school at one point, right?

Sami Inkinen: Yeah, sounds very idyllic. Maybe that was a punishment by my parents. So Nordic skiing to school in the first grade through sixth, so —

Tim Ferriss: Sounds terrible, actually.

Sami Inkinen: And biathlon came handy, so carrying a rifle so I could shoot the bears when they were attacking along the way, which may or may not be true. But yeah, I was an athlete and have been athlete all those years. And then after coming to America, started doing triathlons, and pretty high level athlete. Again, we’re not talking about the Olympic gold medals, but as an amateur, and did many, many Hawaii IRONMANs, I think seven of those world championship races. And even won the world championships in my age group as a triathlete 2012, I believe.

And I give that all as a background context, because my view on metabolic health and sort of chronic disease, type 2 diabetes and obesity, was, this is very embarrassing to admit, was the following, which is, it’s ridiculous, it’s very simple: people know exactly what to do, most people, most Americans, they just don’t do it.

And as a result, we have just obese people everywhere. Everyone has prediabetes or type 2 diabetes. And by the way, it’s more than 50 percent of American adults. Now the data is, I think, 93 percent, this is the published period of number, 93 percent of Americans are metabolically unhealthy in one way or another American adults. And it’s either you have a high blood pressure, or your lipids off, or you’re obese, or you have type 2 diabetes, or prediabetes. And my view, as judgmental as I was, was always, “Listen, ridiculous. You know what to do, but you’re not doing it. You’re eating too much, you’re just eating too much and you’re not exercising. You loser.” And that’s why I pay too many taxes, because healthcare is five trillion a year, of which almost all of it is metabolic health related. So that was my view.

And I’m very, very embarrassed to say that’s how I was thinking. Sort of judging people like, “You’re unhealthy for reasons that are 100 percent in your control.” And then I got the moment where I had to eat a lot of humble pie, and I discovered that despite being, I don’t know, 10 percent body fat or whatever, and exercising 15 hours a week, and performing well as a triathlete, I was pre-diabetic. All the numbers are often essentially on my way to type 2 diabetes, and I was like, “Shit, wait, I’m not one of those people with no willpower, I’m not one of those lazy people, I’m not one of those ‘middle of America,’ 300 pounds seatbelt extender. That’s not me. Seriously, what’s going on here?” And this was 2012, around the time my previous company Trulia went public, and I was like, well, first I have to figure this out for myself, because if I can’t avoid being metabolically unhealthy, nobody can. Well, guess what? Nobody can. That is the status quo in America today with so many people metabolically unhealthy.

And that got me very interested in this whole topic of, what is actually driving poor metabolic health? fortunately met with amazing scientists who helped me understand that, fundamentally, obesity, type 2 diabetes and the other conditions that result from poor metabolic health, it’s not a personal choice. People don’t wake up on a Monday morning and say, “I want to gain 200 pounds and develop type 2 diabetes. That sounds awesome. And sticking an insulin needle to my body for the next 10 years every day, awesome. Sign me up.” No, it is not lack of willpower. However, nutrition and food is the number one driver of poor metabolic health.

And if you know how to use nutrition, if you know how to use nutrition to actually improve and reverse your metabolic health, you can take an average, let’s just call it 300-pound middle of America truck driver or average person that we, people on the coast often look at like, “Oh, it’s your fault.” And systematically, reverse the condition nutritionally. And essentially, that’s what we’ve done at Virta Health now, with more than quarter million patients and scaling fast. But let me just pause there.

That’s kind of the how did the Nordic skier physicist from Sigma get interesting in metabolic health, and then we can take this down to different paths.

Tim Ferriss: Yeah, let’s hop in. I want to start with, well, as you might expect, question about diet. I want to know what, looking back, what the problem was with your diet, and also, this is of course a leading question, so feel free to discard it if it’s not a good question, but how large a role does high fructose corn syrup play broadly in the US in metabolic dysfunction, right? If that just were removed from the market, what impact would that have? But let’s begin with just your personal retrospective. Hindsight 2020, what was wrong with your diet? When you were actually 15 hours a week, roughly 10 percent body fat, performing well in competition. What was wrong with your diet?

Sami Inkinen: Number one question I get like, “Oh, was it your genetics? Because you were exercising so much.” Obviously genes play a part in everything, but I just want to remind that, given about 60 percent of American adults, six-zero, either have type 2 diabetes or prediabetes today. Clearly it’s not like our gene pool has changed. So it can’t really be genes. Or if 93 percent are American also metabolically unhealthy, it’s not like our genes have changed. So no, it’s not that same was the N equals one thing with very, very bad genes. This is happening to a lot of people. I would say one thing. The first one is there.

The second thing is that it is possible to be skinny and lean and metabolically unhealthy. Some kind of people of certain background, especially in Asia, it’s more common that you don’t gain 100 pounds, but you’re very metabolically unhealthy. Also, you can out exercise the calories and burn and not gain massive amount of fat, but you can still be elevated blood sugar, elevated insulin and be insulin resistant. And that’s basically what I was doing. It’s very, very hard. I can tell you that I was hungry for 15 years as an athlete. It’s like, “I’m always more hungry than I could. And if I eat to my appetite, I’m going to gain fat. I can’t do that as an athlete.”

So now I’m going to answer your question. So my N equals one, I’m absolutely convinced because I was able to fix and improve it is I was eating six meals a day of essentially incredibly high carbohydrate and incredibly high glycemic index foods and practically no fat for 10 plus years.

Tim Ferriss: So you weren’t eating Twinkies.

Sami Inkinen: No.

Tim Ferriss: We’re talking about things like white rice or what are we talking about?

Sami Inkinen: Rice, bread, apples, granola bars. I don’t know, ketchup, pasta. But anything that has a glucose molecule turns into blood sugar. Sure. If it’s an apple or if it’s lots of fiber, it comes very, very slowly. But if you’re eating 4,000 calories a day, of which 3,000 is carbs, do the math, 750 grams of carbs a day or more. And so you’re basically drip-feeding sugar into your veins constantly. Jamba Juice in the afternoon, once I get tired. I just remember it was my diet all the time. When you’re in your 20s and you can overdose. People say, “Dose makes the poison.” That’s true. You can tolerate for a long time, but once you get to your 30s, it gets very hard. So very convinced that that was it.

Tim Ferriss: What are some of the more surprising things that you have seen within Virta Health now that you have more than N equals one? And what do the interventions look like?

Sami Inkinen: Yeah. Well, let’s start from the front end of your question.

What’s the most surprising? The most surprising is that we’ve been able to be successful with literally anyone, anyone. I’ll give you one example. And why is that surprising?

Even overcoming my own concept of, “It’s all about willpower.” I had this like, but it’s like people aren’t maybe not as educated as I am. Maybe they’re kind of busy lives. Maybe they don’t have my willpower or the willpower of willpower Olympians.” So that’s been one of the most surprising.

We work with Native American tribes, 800 or so large employers. There’s truck drivers. We’ve analyzed outcomes based on what’s called ADI, Area Deprivation Index. So you take all zip codes in America, and you rank them by average income, exactly the same outcomes. Exactly the same outcomes. We looked at race, ethnicities, exactly the same outcomes. And these are large scale, tens of thousands, hundreds of thousands of patients.

So that’s one that’s been very surprising, which is to say, “If you fix the biology, you fix the outcomes.” This isn’t, “Oh, you didn’t even go to high school and you have a very busy life, so we need some sort of extra willpower training.”

No, you fix the biology, you fix the body and the outcome. So that’s number one.

Number two is the magnitude of improvements. So to give you a couple of examples, someone may have had type 2 diabetes for 15 years. They are on 100 units of insulin a day, sticking the insulin needle three times a day for 10 years. And we can reverse that state of type 2 diabetes in six to nine months, and then sustain it for long term.

13 percent average body weight loss, and this is like on an intent-to-treat basis, not thousands start and then you calculate results based on five successful ones. No, you calculate the average drugs from all the thousand. So 13 percent.

In our clinical trial that was about 30 pounds or so, average weight loss at one year and sustained, and mostly fat because we did DEXA scans as well.

I would say the third one is the broad-spectrum effects, and some of these are peer-reviewed. So we’ve been able to show not just blood sugar down and reversing type 2 diabetes, not just weight loss, but up to 75 percent reduction in liver disease. It used to be called fatty liver disease, but scientists changed it to liver disease. So it’s called MASH and MASLD. By the way, it costs $100 billion a year in America today.

There’s one FDA-approved drug today, one FDA approved drug today for MASH. It’s one type of liver disease. It costs 45,000 a year. No kidding. And it came out to market last year, first time, 2025, billion dollars in sales. We deliver similar results nutritionally.

Tim Ferriss: I think this is public. This is in our texts, but the paper just accepted through peer review treating Stage 4. There is no Stage 5, if I’m remembering correctly.

Metastatic pancreatic cancer. This is bad news. This is super, super bad news. I mean, if my memory serves, this is kind of like a Steve Jobs-type situation with — okay, but this is treating Stage 4 metastatic pancreatic cancer with three chemo drugs, that’s one arm, versus same drugs and on Virta, trying to get patients into ketosis remotely. Well, do you want to describe the results of that?

Sami Inkinen: Yeah. So this was a very well-controlled, it’s a randomized control trial for Stage 4 metastatic pancreatic cancer. We ran the trial with a number of academic oncology centers. So this wasn’t just us, a very well-controlled randomized controlled trial.

And before I talk about the results, just a reminder: pancreatic cancer is number two or number three killer, depending on the year of cancers in America. So it’s very deadly. It’s usually diagnosed too late, at Stage 4 metastatic stage. And the life expectancy is usually 12 to 18 months or 12 months. It’s very, very deadly cancer.

And so we had a trial where we had one arm where we randomized people. It was chemo, three drugs, and then another arm, as you mentioned. Same drugs, exactly the same therapy, plus the Virta nutrition therapy. And we were able to show just about 35 percent life extension on average in that arm, chemo plus Virta.

Again, it’s a very deadly disease. 35 percent is stunning, but of course we’re still counting months. It’s not that you go from 12 months to 12 years on average.

But I guess going back to your earlier question, that shows the power of metabolic health and poor metabolic health and what might be possible. What is absolutely possible is reversing type 2 diabetes, losing weight, preventing liver disease.

We didn’t even talk about kidney disease and other things. But the fact that we can drive outcomes even with some cancers, and I will say, “some cancers.” I can’t say, “Oh, nutrition can cure cancer.” Not quite.

But poor metabolic health and in our case, we didn’t really define the poor metabolic health in the beginning, but essentially it’s high glucose levels, high fasting insulin levels and what you then might call insulin resistance. Your body’s primarily burning sugar and you’re constantly hungry, you’re constantly craving. So even if you’re 100 pounds overweight, you’re hungry and you want to eat more of that stuff. That’s the typical state of poor metabolic health.

And then it manifests itself with type 2 diabetes, cardiovascular disease, fatty liver disease often, eventually chronic kidney disease and many other things.

And seems like many cancers thrive in that kind of environment, in that kind of poor metabolic health.

Tim Ferriss: Yeah. I don’t think that’s controversial. I mean, maybe look, says the non-doctor to the non-doctor, but I mean, certain cancers, not all, are very glycolytic, right?

Sami Inkinen: Mm-hmm.

Tim Ferriss: I mean, they’re really dependent on a steady fuel of sugar to simplify it. Dom, I think for people who want to hear more on that, also Dominic D’Agostino has spoken about it quite a bit in a couple of my conversations with him.

So what I want to ask you about, because we’ve teased it a little bit, the Virta nutrition therapy. I’m looking at the Virta quick guide right now. If you don’t mind, I’ll just kind of lay out some of it, right?

Sami Inkinen: Sure.

Tim Ferriss: Because for me, this is where probably the magic is embedded. And I want to learn more about how you guys get the compliance, the adherence that you do. Because that to me has always been this very elusive, I don’t want to say missing link, but challenging link with anything approaching what we might consider a ketogenic diet.

And I want you to also dispel if I’m making a false equivalence with the ketogenic diet, but you have curb your carbohydrates, aim to begin with around 30 grams per day just as needed.

And you have some very important stuff in here, right? Measure total carbs, not net carbs. This is where people try sometimes outsmart themselves, and then you give examples of what that can look like. And then building your plate, what does an actual meal plate look like? Non-starchy vegetables, moderate protein, added fat, salt and extras, et cetera.

So I’d love for you to describe what you have found to work when you are getting people started, and just what you’ve picked up over time in terms of the most helpful components. I was going to say ingredients, but not food ingredients. Ingredients for getting people to adhere to these diets, right?

Because my assumption, which may be incorrect is, “Okay, I, Tim Ferriss, I can go to Whole Foods and buy salmon and vegetables and this and that.” But a lot of people in economically depressed circumstances or areas or fill in the blank buy a lot of their what some people would consider unhealthy food because it’s very inexpensive and it’s readily available.

And having spent time around a number of Native American reservations, it’s like, “Man, there are food deserts in the United States.”

What have you found, what have you learned over the course? Because your data set is so incredible. I mean, it’s just like such a rich and amazing data set. What have you learned about helping with adherence and compliance, or modifying the diet itself?

Sami Inkinen: Yeah. Well, I will bracket, you said we have big dataset. We absolutely have the largest dataset of metabolic disease reversal in the world, millions of patient years of data and data points from each patient every single day. Not just qualitative information, but blood biomarkers.

Yeah, let me try to peel the onion to answer your question, because a lot goes into it. I guess just to take a step back, yes, we use nutrition, individualized nutrition as the core therapy to treat our patients. It is our own protocol.

I say “our own protocol” because any kind of generic label that you put into it, people go to Google and they Google and they can go wrong in 1,000 different ways. So anyway, so we use our own protocol.

But yes, to address and reverse insulin resistance, you do have to reduce your total carbohydrate intake. And we have dose response curves to know that the more and the better you do it, the better outcomes you typically see.

But that’s sort of number one thing I will say that yes, we use nutrition as a therapy to reverse metabolic disease. And I will say that as a physicist, using nutrition as a drug or as a therapy is harder than nuclear physics.

Why? For all the reasons you mentioned. Because every person makes a medical decision three to four times a day, that’s when you eat. It’s different today versus tomorrow, and then it’s different between individuals. So it is a very, very hard puzzle to solve. Fortunately, computers and software is very helpful about that. So that’s one, individualized nutrition.

Number two, what does it take, and how do we approach? Key piece, even if you know exactly what somebody should eat, is you need the support system. And I guess that’s my tech background with Trulia and other things that comes to play that everything we do, we do virtually.

So what we can do is we can monitor your biomarkers remotely. We give you tools to do that. We can track blood ketones, blood glucose, your weight, and other things. And then we have actual real medical doctors, not me, who are full-time employees who monitor you, and coaches who can then make adjustments.

Tim Ferriss: Is that collected through continuous —

Sami Inkinen: Collected devices —

Tim Ferriss: — monitors? Is it also blood draws, or is it mostly some type of continuous monitoring?

Sami Inkinen: It’s all of the above. Some patients get a CGM and some it’s a finger prick. But not everybody gets a CGM, depends on the situation. We do lab draws one to two times a year, so that obviously can’t happen daily.

Tim Ferriss: Yeah, I got it.

Sami Inkinen: Yeah, yeah.

Tim Ferriss: With the finger prick, that’s some type of Bluetooth-enabled thing that —

Sami Inkinen: Automatically.

Tim Ferriss: — automatically syncs the data.

Sami Inkinen: Exactly.

Tim Ferriss: So they’re not manually having to enter any values.

Sami Inkinen: No, exactly. It goes to the cloud and gets to us.

And I say that because if you say, “Oh, here’s how to eat. Here’s a brochure or a book or something,” it’s kind of like telling a car driver, “Just hold onto the steering wheel straight. It’s going to be awesome. Here’s brake and gas pedal.”

And you know what’s going to happen. The car is going to beautifully stay on the road until the first corner. It’s like, “Ooh, forgot to mention that we may need to adjust, turn left, turn right.”

And so it’s the same thing with nutrition, that unless you have this kind of a platform, there’s constant adjustments and constant adjustment. It’s kind of like a self-driving car. But then if you have the cameras, white line and yellow line align, and you kind of try to keep it in between.

So with the remote monitoring, we can try to keep you between the yellow and the white line. So that’s the second thing.

The third piece for adherence, we start talking about nutrition. The most important thing early is to understand the constraints that a person has. I’ll give you silly examples.

If we tell a vegan to have bacon and eggs for breakfast, you know what happens? They’re going to say, “F-U-C-K, I’m out.” Right?

Tim Ferriss: Yeah.

Sami Inkinen: There’s no way to convince a vegan to have bacon and eggs for breakfast, and vice versa. There’s other things, obviously if you are, we work with US Foods, large kind of actual food delivery, food service, is truck drivers. Their concept of a lunch is McDonald’s.

We can’t tell them, “Oh, here’s the list, go shop Whole Foods or Erewhon, and then go home and cook at home.” It’s like, “Okay, McDonald’s it is. We’re going to reverse your diabetes on McDonald’s diet.” And by the way, we do that.

Tim Ferriss: I don’t want that to get buried.

Sami Inkinen: Yeah.

Tim Ferriss: But what are some sample meals that people might get at a McDonald’s or something like that?

Sami Inkinen: Perfect. Yeah. So that’s the next step with food, and maybe I’ll give an example. It’s like, “Okay, now that we know you are a truck driver and you will never become a vegan, you can never become a vegan.” Obviously I’m tongue in cheek here, but most of them don’t.

Tim Ferriss: Yeah, I’m not a vegan either.

Sami Inkinen: Yeah, yeah, yeah.

Tim Ferriss: And I’m not sure if you’re probably not either, right?

Sami Inkinen: Yeah. And by the way, we have many, many successful vegan patients.

Tim Ferriss: Yeah, yeah, yeah.

Sami Inkinen: So I know, sorry if I started a diet war here, but — okay, example, you truck drive. Okay, so McDonald’s it is, it may not be the pinnacle of health. But we can reverse your metabolic disease with that. And let’s forget the organics, we’ll do that later if you can. Here’s what you do.

You go there, say, “All right, well, you want your burger, maybe you even add extra cheese. But please ask them to drop the bun and just have a lettuce wrap, get that.

“Then you go to the condiments. Yeah, mayo might be fine, but don’t take the ketchup because we can educate you and tell you that ketchup is colored sugar. You can’t have that.

“Yeah, you want your soda. You really want your soda, water is not enough? Okay, so go for the Diet Coke. Don’t take the soda with the sugar.”

Again, somebody’s listening like, “Oh, Diet Coke’s bad for you.” I totally agree. I’d rather drink water. But again, let’s not let perfection be the enemy of progress.

So that would be a McDonald’s kind of a session, and off you go.

Tim Ferriss: Yeah.

Sami Inkinen: So that’s the second step with food. And then the third one is really empowering the patients with — we talk about AI, like AI-based tools.

You go to a restaurant, or you’re trying to cook something. You can take a picture and we instantaneously say like, “Hey, what kind of adjustments should you make?” and tie that to your actual situation. So how do you change that?

And this happens every day, two, three, four times a day. And that’s the self-driving car analogy, that the car that goes straight is fantastic until you have a corner. And that’s 100 percent of the diets in America today. You can’t do one size fits all.

And then before you ask a follow-up question, this is mind-blowing for people, and ties to your earlier question as well.

The adherence of Virta patients, again, which are real Americans, not Samis, real Americans, is twice as high at one year as taking a GLP-1 drug.

We have 83 percent adherence retention of patients at one year, and look at any of the publicly available data. People stick to GLP-1s like 40 percent, maybe 50 percent, 30 to 50 percent. Why is that?

Number one reason is the user-perceived benefits. It’s like, “I can’t believe I feel this good. I can’t believe I’ve lost 35 pounds. I can’t believe I don’t need to stick the insulin needle to my body.”

And the stories that we hear from people is like, “I’m 65, I thought I don’t see my grandkids grow. Now I see, and I have so much energy that I’m gardening the first time in 20 years,” or whatever that is.

And you know this. When you’re feeling really, really bad, you’re sick and everything’s hurting, and then that suddenly goes away, that’s like life is freaking awesome.

Tim Ferriss: It is.

Sami Inkinen: And so I think the number one reason is the benefits are so strong versus a calorie-restricted diet where you’re like, “This sucks, but I’m going to look good on a beach at least for a week.”

Tim Ferriss: How do the experience of benefits l differ from GLP-1s? Just because we’re segueing directly from that, and certainly a lot of people listening will either directly themselves have experienced or know someone who has lost 35 pounds and feels more energy because the GLP-1s do make you slightly more ketotic.

For the people who are wondering why they might feel sharper, that’s actually one very plausible piece of the puzzle.

But how do the perceived benefits differ in a way? And maybe there’s more to explain it, I’m sure there is, the two times GLP-1 adherence at one year. I guess that’s what you said, right?

Sami Inkinen: Mm-hmm. Mm-hmm.

Tim Ferriss: So I’m just trying to identify where those two interventions diverge.

Sami Inkinen: Yeah, absolutely. First, I will say our Virta providers prescribe both oral and injectable GLP-1s when appropriate and/or necessary. And when our client, the plan sponsors like an employer, health plan have them in a plan design.

So I just wanted to mention that so that nobody thinks, “Oh, this is some sort of nutrition dogma.” No, there’s effective pharmaceuticals and especially GLP-1s in obesity and metabolic disease context are way better than the 1980s and ’90s diet pills. So it’s a real, real innovation.

Tim Ferriss: You guys don’t prescribe Fen-Phen to your patients?

Sami Inkinen: We don’t. We don’t. By the way, there are companies that do that to lower cost of GLP-1s, but absolutely we don’t do that.

Tim Ferriss: Yeah.

Sami Inkinen: I’ll start from very basics. The GLP-1s 100 percent affect your appetite. They change how much you eat, so you eat less, but they alone don’t change what you eat. So that’s a starting point.

Tim Ferriss: Sure.

Sami Inkinen: And if you don’t change what you eat, you’re not going to be perfectly or even optimally metabolically healthy. And so one example is you lower appetite, you eat less.

But the second you come off these drugs, all the data shows that your weight skyrockets. And more likely than not, you gain fat and you’ve lost pounds of muscle.

By the way, we’ve shown the patients who come to us on GLP-1s, and once they discontinue the drug for whatever reason, by personal choice or side effects, we’ve been able to sustain that weight loss. This is published in peer-reviewed data, 18 months out. And soon we will have even longer-term data. But 18 months, no weight regain. Why? Because we start changing what you eat while you’re on the drug, and if you do that.

But to sharpen the point to your question, obviously we know the side effects of healthy nutrition: none. Every drug has side effects. So that’s one thing. And these GLP-1s are tolerated much better than many, many other drugs. But there’s a lot of things, nausea and stomach issues.

And it’s interesting, we’ve surveyed the patients who are on GLP-1s in our care. 80 percent of them say, “I either want to severely reduce the dependence on these drugs, or get completely off of them.”

So this idea which is prevalent, at least in the press, “Americans just want to take a pill, and keep taking the pill for the rest of their lives.” Most people, if given the choice, if given the choice to be healthy without, they don’t want to be taking drugs.

So I guess hopefully that answers the question of what are the user-perceived benefits? Well, there’s no user side effects when you’re eating healthy food. But with the drug, you usually have that.

I’m not the expert to talk to how energy levels or excitement or mood and things like that change. I think lots of data will come out when millions of people on these GLP-1s for years, but yeah, eager to see what happens.

But there’s definitely a lot of things to be fully aware, like lean body mass in elderly populations, 65 and plus people who lose a lot of weight on GLP-1s, very alarming reports coming out.

Tim Ferriss: I want to get granular again with just a hypothetical example of a vegan, because you mentioned this. This word has come up a couple of times.

And in a way, in my mind, I’ve always envisioned that as a tougher nut to crack than McDonald’s, just because so many — how should I put this?

This is true across the board if you just walk through any grocery store, including Whole Foods. There are a lot of junk foods masquerading as health foods, which are full of ingredients that are terrible for you. Incredibly high glycemic, meaning they’re going to spike your blood sugar.

Maybe we could talk about glycemic index versus glycemic load. But suffice to say if you eat it and you check your blood sugar within 90 minutes, it’s going to be a lot higher. And this seems to be true of a lot of vegetarian or vegan food also.

So what would be an example of how a diet plan, or let’s just say a meal or a day of meals for a vegan, let’s just say, on the Virta program?

Sami Inkinen: Yeah. Yeah. Again, I will say everything has to be individualized. But to use average figures, we rarely have to massively change protein intake for our patients.

Maybe surprisingly to some people, the standard of American diet has a, give or take, maybe it’s a little bit on a low side, but more or less the right amount of protein. And by the way, that’s the most expensive macronutrient.

So sometimes people are like, “Oh, when you start treating your patients, it must be so much more expensive.” Well, actually protein is the most expensive. We rarely changed that a lot.

In vegan context, that’s probably the hardest thing to get right, to get sufficient amount of protein. And you really have to get at least 1.2 grams per kilo, kilo. One kilo is 2.2 pounds of protein proline or normal body weight mass. So if you’re 80-kilo person, which is 176 pounds, that would be a kind of lean person, 100 grams of protein a day is minimum you have to.

So that’s probably the hardest, and vegans know this very well. You have to look at nuts and tofu and may need to rely on soy, and are you willing to eat eggs? But that would be one.

So we figure out again with the patient like, “Okay, what are you willing to eat? Are you able to have dairy?” Some people are okay, some not. But that’s probably the hardest usually to make sure that people get adequate protein.

And protein is really essentially it’s the only macronutrient that doesn’t really store itself. So you have to get it couple of times, two to three times a day to maintain your body mass.

Then after that, it’s actually interesting. To get the sufficient calories if there’s a lot of crap vegan food, meaning sugar or cornflakes or whatever, then we start replacing those with healthy fats.

And this is also misconstrued like, “Oh, it must be so expensive because corn is subsidized, or corn syrup is subsidized. Hence, you can have unlimited amount of corn calories, cost nothing.”

Well, guess what? You can buy 9,000 calories, so one liter of high-quality olive oil from Costco for, what does it cost, two bucks? So it’s a misconception. The cheap subsidized sugar calories can actually be replaced at the same cost.

Now if you’re very, very overweight, you don’t want to be replacing those calories because guess what? You want your body to give the fat calories. And then around the kind of healthy vegan food, then we guide the patient towards leafier, less starchy, vegetable options. So you can eat very sumptuous vegan food. I think we even have, because this was a misconception in our very early days, so we’ve been pretty vocal.

We have bunch of patients who are vegan. If somebody Googles “Virta Health on vegan diet” or something, there’s a couple of our patients have openly shared what they eat, but it’s totally manageable. In fact, you just end up throwing out the window the crap vegan food, so I don’t know — sugar-frosted cornflakes would be a perfect example of that. Orange juice or something like that, which I love oranges, but orange juice is essentially soda.

Tim Ferriss: Tell me if I’m hearing this correctly. It sounds like, if you reduce the high glycemic junk that someone is consuming, you’re going to over time improve metabolic health, right? But is it fair to say that, for instance, the truck driver who’s eating the lettuce wrapped cheeseburgers and drinking Diet Coke, man, you do that for, depending on the size of the person and blah, blah, blah, blah, blah, obviously, if it’s a male, I don’t know, maybe in three to five days, that person’s probably clocking in at, who knows, 0.7 plus millimolars. I’m not sure how you say it.

Ketones, right? Beta-hydroxybutyrate, I would imagine, but in the vegan example, maybe you’re simply reducing the glycemic load, but maybe not getting deeply into ketosis, just because the question in my mind was related to the protein, right? How do you consume tofu, tempeh, et cetera, et cetera, et cetera while keeping your total carb count low? It doesn’t immediately seem possible to me, unless they’re willing to eat eggs, but if we take eggs off the table, then it seems like you can significantly improve metabolic health, but it may not be through the vehicle of what would technically be considered ketogenic. Is that fair to say?

Sami Inkinen: Yeah. That’s why We don’t really use the ketogenic —

Tim Ferriss: The K words?

Sami Inkinen: Again, for two main reasons. One, you Google it, and you get your version that you get the love or hate, and likely it’s wrong, and then two is it’s all on a spectrum or kind of a dose response curve, and we never want to let perfection be the enemy of progress. The less you have hunger and cravings and the better you feel, more sustainable and easier everything is, including just life. That’s what we teach to our patients, and you can kind of be anywhere in the dose response curve and be successful.

The further you are, we can pretty much predict not just your health outcomes here out, but even the healthcare cost savings, which is sort of insane, because drug companies do these trials. You take one pill, this is what happens. You take two pills, this, and then you kind of want to optimize where you want to be on a curve. Our therapy is no different, and we show this to people. We actually say, “It’s your choice, and you get here,” but the beauty is that we empower people so they can make their choice. Then, the beauty also is that you don’t have to be perfect, and you can still be very, very successful. Average diet is so bad, honestly, that it’s relatively easy to make your own progress.

Tim Ferriss: Yeah. The Standard American Diet, SAD.

Sami Inkinen: Yes.

Tim Ferriss: I just love that the acronym is SAD. It’s so good. Whoever came up with that, God bless you. What a great acronym. I want to get back to your training, so we’re going to get off of Virta in a moment, but I want to say, just for people who maybe have heard the last few conversations I’ve had with Dominic, I am deeply interested in ketosis, the ketogenic diet, and exogenous ketones, but I have seen, I think Virta is approaching this the right way with a greater degree of flexibility. I would also just point to, for instance, the slow carb diet and The 4-Hour Body. It is not a ketogenic diet, right? You’re consuming legumes, you’re consuming a lot of fiber in the form of beans or lentils, et cetera.

It is not ketogenic in any way, but it does reduce or eliminate processed food. It eliminates most starchy carbohydrates, except for one day a week, and the types of transformations that you can see metabolically are just remarkable. Granted, that is a book, so by nature of its format it is a kind of on size, hopefully, fits most, whereas Virta is much more adaptable and customized for the left right turns that you described, but I wanted to just underscore the fact that I am not a keto purist by any stretch of the imagination, and most of the time I am not in ketosis, although I do spend time in that range.

I want to hop from Virta to a question around training. So, just in brief, and I’m not sure this number even exists, but what is it an average non-athlete VO2 max, and what is your VO2 max?

Sami Inkinen: I’m freaking old by the way, I just turned — Do you know how old I am?

Tim Ferriss: I don’t know how old you are. You’ve got those impeccable Finnish genetics. I have no idea.

Sami Inkinen: Oh, my God. I turned 50 in December.

Tim Ferriss: Oh, nice. Congratulations.

Sami Inkinen: Yeah, so I’m very, very old. This is at least what my —

Tim Ferriss: You’re not that old.

Sami Inkinen: — two kids tell me, who are like 10 or something, but I think at this age in particular, or even like a 30-year-old fit male, VO2 max is measured relative to your body weight, so it’s how much oxygen you can consume, your body can utilize, so it’s milliliters per kilo per minute. I think it’s maybe 40.

Tim Ferriss: Would be on the average side?

Sami Inkinen: 40 maybe or 35 or 40 or 45. Yeah, my measure is more than 80 milliliters. It’s pretty high, very high. The caveat is it was measured a couple of years ago, so it’s probably a little bit lower today, because the VO2 max tends to go a little bit down as you age. You can still kind of increase the percentage of that, that you can produce for five or 10 or 15 or 20 minutes, but it’s kind of very, very high. I think the highest ever method recently, it’s more than 100, but if you’re 90, you’re kind of Olympic. 85 to 90 gets you to kind of Olympic podium in endurance sports, can catch, and again, that’s not the one and only measure. There’s a lot of other things, but if you’re above 90, you should not be doing podcasts. You should be in the Olympics.

Tim Ferriss: Well, good news, bad news. I’m going to stick with the podcasting. I’m definitely not above 90. The reason I’m bringing this up is that, in conversations with my doctors and people I really trust, as well as a number of podcast guests, like Dr. Tommy Wood, who is a neuroscientist and phenomenal athlete also, the topic of endurance training, as it factors in, I hesitate to use some of these labels, but endurance/aerobic training, as it factors in, you’ll see very quickly why I’m struggling with terms, factors into health span and longevity. It’s become a topic du jour in the last handful of years in particular.

The way it’s been presented to me is, and I’m particularly interested in this for its implications for cognitive health and potential volumetric changes in the hippocampus and so on with certain types of training, given that I have Alzheimer’s in my family, but the way I’m taught to think about it is that, let’s just say zone two is the base of the pyramid and then VO2 max is the height of the pyramid, and you’re trying to maximize the total surface area/size of that two-dimensional pyramid, and I will confess, I’m very ashamed to confess, I hate sitting on a stationary bike. I absolutely loathe it. I find it so boring.

I also just see these long term changes in the sort of kyphosis, like the hunchback postures of some long-term cyclists, and I want nothing to do with that. I have enough back issues as it is. So, my question for you is, when you’re trying to get a normy to do more endurance-like training, and I am on the path. I have some spinal issues with the lumbar and sacral kind of segments of the spine, which I won’t bore everybody with right now, but I’m hoping to get to a point where I can actually do sports I enjoy, like jiu-jitsu or other things which, at least for high intensity interval training, mimic something like the Norwegian four by four really well, right?

I could do a round of four minutes, take three minutes off, do another round of four minutes, and maybe it’s four minutes on, four minutes off or three minutes on, three minutes off, but close enough, right? If I’m doing it consistently, but as it stands right now, I can’t really do incline treadmill with, say, a ruck sack or something for zone two because of the hip extension and the issues that causes in the lower back, so despite my best efforts to avoid the stationary bike, I keep on ending up on this damn stationary bike. And road biking just scares me too much with the traffic, say, in a place like Austin. Everyone I know here who has done street, road biking for more than a handful of years has had some type of accident.

What would be your advice for someone who’s trying to get, literally, back in the saddle to do some training? How do you think about this type of training, as it fits into health span and so on? Because I’m not intrinsically someone who enjoys this particular type of training. I remember for The 4-Hour Body, I was in South Africa at the Sports Science Institute of South Africa, and they did a muscle biopsy of my thigh, my quadricep, my vastus lateralis, and they looked at all the enzymes. I can’t imitate a good quality, strong South African accent. It’s pretty good. It’s a great accent, but “years.” I can’t even say “years.” That’s how you ferret out the South Africans, or the North English.

But the point is he came back and he showed me these charts of enzymes like citrate synthase, which seem to be correlated to endurance capacity. Tertius, I think that was his name. He said, “Basically, this flat line is Homer Simpson, and here is your line, which is like infinitely below Homer Simpson,” so I don’t think I’m very well-built for this stuff. This was a long litany of complaints, but how would you suggest I think about this kind of training, right? Because it seems important. I’m not sure how to make it more interesting. I do find the interval stuff a little more compelling, and it keeps my attention more than the zone two, but it seems like you kind of want to do both. What are your thoughts? I’m just turning this into a therapy session.

Sami Inkinen: Sure. Asking the non-coach a coaching question. My favorite topic, pretending to be an expert.

Tim Ferriss: Yeah, but you’ve dealt with coaches.

Sami Inkinen: I will take it. I will take it. Yeah, so my approach, I’ve had a coach, and then, essentially, 95 percent of my life I’ve self coached myself, because I take it as an interesting puzzle to try to learn, and then surprise, surprise, as an entrepreneur I don’t really want to be told what to do, so I ended up self coaching. Based on that experience and with that caveat, first of all, on a high level, my approach, basically, in everything in business, metabolic health training is kind of nailed the basics, less marginal gains and crazy. I know it’s boring and doesn’t sell a lot of supplements and stuff, but it’s like nail the basics, less marginal gains and crazy.

When you do that, that’s when you actually get the 99 percent of the results. For training, specifically, also whatever you want to accomplish, and you’ve done a lot of sports and lifting, the very basics are very simple. It’s progressive overload and specificity. If you don’t have progressive overload, even if it’s just the walking or hiking or running, you aren’t going to get better. Initially, when you’ve done nothing, come off the couch, it’s like very easy progressive overload. It’s like do anything, and you get better, and then the other one is just the sort of specificity. If you want to be a sprinter, you can’t train like a marathon runner and vice versa.

If you want to squat a lot, bench press isn’t going to help a lot, so it’s literally those principles that I use, but to give specific advice to you, what you just said, to get the cardiovascular stimuli, you obviously have to get your muscles burning oxygen, using oxygen and then burning either fat or carbs and your heart rate up, so you need to do something for that. The reason cycling or any kind of a bike thing is so widely used, it doesn’t take space, and if it’s indoors, it’s very safe, and it’s low impact. It’s low impact. One thing I would say for the bike is, and Austin has a lot of good bike stores, shout out to Mellow Johnny’s and others.

Tim Ferriss: I have two indoor bikes upstairs.

Sami Inkinen: Exactly.

Tim Ferriss: One was set up by tech from Mellow Johnny’s, so I’ve got the bike.

Sami Inkinen: There you go. So, one is bike fit, so if there’s someone who’s like a PT and a bike fitter, and say, “Hey, I have these XYZ issues. Fit this bike to specifically work for me as much as I hate it,” so that’s one thing where you could get the handlebar crazy high or something like that, maybe even do a lot of standing. By the way, those are fun workouts to kind of, I don’t know, do a three-minute standing, three-minute seated, three-minute standing, whatever. So, that would be one thing to consider for the bike, that you get a fit that’s specifically for your back issues. It may not be the world’s most aerodynamic, but if it’s stationary bike, who cares? So, that’s one. The other thing, you don’t have a lot of snow around, but I know you occasionally go to places with snow. Nordic skiing and sort of skinning, obviously fantastic. Fantastic.

Tim Ferriss: Yes.

Sami Inkinen: Fantastic.

Tim Ferriss: Skinning, I love. I love skinning. If I’m outside, I’m not going to get hit by a car. If I could do skinning every day, I would, and my back actually loves it. So yes, I’m 100 percent behind skinning.

Sami Inkinen: Then, of course, often people who’ve kind of totally destroyed their knees and hips, it’s swimming, which I hate swimming personally, as a traveler. Well, elements of it are beautiful. You go underwater, and it’s kind of like meditation, but more than 20 minutes, and it’s like, “Please give me a break.”

Tim Ferriss: See, I will take the swimming. I’ll take the swimming over the cycling. I went and did some swimming yesterday, so I’m up for the swimming.

Sami Inkinen: Yeah. Then, if you live in a mountains, it’s very, very easy to get sort of zone one, zone two by just walking, even without actual weight, because you go up, up, and sort of speed walk. Then, maybe the last one I say, if you have the self-confidence to not feel too embarrassed, is Nordic walking. So, Nordic skiers do summertime. You either walk or run with them, but you basically have poles and you go uphill. You’ll probably get an extra 10 heartbeat and kind of higher level exercise.

Tim Ferriss: So, it’s kind of like jogging uphill with poles?

Sami Inkinen: Poles, poles. Yeah.

Tim Ferriss: Yeah.

Sami Inkinen: Obviously, you could just walk and then use them.

Tim Ferriss: Yeah. I could get into that. I use poles. Yeah, I could get into that.

Sami Inkinen: Then, to the sort of VO2 max, so building a better aerobic engine in like zone two does help your VO2 max two, and then of course, if you lower your body fat, body weight, the kind of denominator in the calculation improves, but specifically VO2 max training, you actually get the adaptation pretty quickly. I don’t do it all the time, crazy amount, because it can also burn you out. The two most common ways to really hit VO2 max is either you do sort of 30 seconds on and offs, like you go very hard, and then 30 second easy, but then essentially you kind of keep hitting the VO2 max oxygen consumption or sort of two to four minutes all out. They’re very, very hard, or two to three minutes all out, and then you take three minutes off and you do that whatever, four or five minutes, four or five times. Those are the most effective, I would say, and typical ways to specifically get your VO2 max up, but they can burn you out if you do too many of those.

And so, for me, personally, what I do typically closer to like a specific event or race, it may be like three weeks, where I do two of them a week, so just like six workouts. Then, I drop it to, I don’t know, one every two weeks or something. You can burn out and you can’t keep growing, and the VO2 max isn’t just going to infinitely keep going up. Bad news. And so, maybe that’s how I think about it. Find a sport where you can comfortably and enjoyably do an hour or so of cardio, whatever that is, and then this would be my advice. Think strategically when you do your VO2 block, and that could be just, I don’t know, three weeks or maybe it’s two weeks every quarter or something like that, and then the maintenance dose, again, I’m using dangerous terms here, because who knows what the optimal dose is? But constantly pushing the VO2 max, I think it’s just the injury risk, it burns you out, and it’s not going to do anything, because once you reach your VO2 max ceiling, you kind of are there, so there you go.

Tim Ferriss: Yeah, so a broader question I want to ask you about is what exercise dogma or sacred cows you have stress tested? Because I was looking at, this is a blog post that you wrote, this is a while ago, and I actually don’t have written down here the title, but it’s about hacking your running speed in four weeks. I’m tempted to read this whole thing, but I’ll just read some of it, right? So, my total running time averaged one hour, 50 minutes per week. It’s a four-step protocol for four weeks. So first, and I won’t read all of this, but develop muscle endurance by running 10 to 15 minutes every day, right? That might surprise people, because it’s like, “That’s more achievable than I would have expected.” You contrast that with the conventional approach of doing a long run once a week and increasing the distance each week, so I’m not going to steal the thunder.

We could comment on this as an example, but then broadly speaking, just kind of like unfounded sacred cows, because man, there are so many everywhere, not just an exercise, but everywhere. Number two, build your cardiovascular engine with all out, I think this is 10 by one-minute set, once a week, on a treadmill for regulating effort, right? And so, the total workout is less than 35 minutes, and you give links to scientific evidence. Number three, plyometrics for quick improvements in running efficiency. Even highly trained endurance runners seem to improve their running times in a few weeks of plyometrics, which is not that much, right? Roughly five-minute routine, three times a week, three times 12 explosive box jumps, three times 12 jumps for max height, right? Which is sometimes replaced with skipping into a hill. I don’t know what skipping into a hill is. Maybe you can explain that. This approach took 40 seconds or roughly 10 percent per mile off my best running speed in four weeks, leading up to a competition. Typically, a five percent improvement per year is a huge jump.

I mean, that’s kind of bananas. Then, you also added the note on, simultaneously gained about a pound or two of body weight, so my speed gain wasn’t due to change in body weight. This seems to, and I just confessed that I hate endurance stuff, so I’m really wading into the deep end of my ignorance pool here, but this seems to fly in the face of a lot of conventional recommendations, so I was hoping you can speak to anything that I mentioned, but also just broadly speaking, dogma in exercise because there’s so much crap, and there’s so many things that never really get stress tested in daily living, health, wellness, right? It’s like you hear all this crap all the time, where it’s like, “You only use 10 percent of your brain.” That’s not true. Evolution wouldn’t allow that to be the case, right? Drink to eight glasses of water a day. It’s like, “Well, yeah. It really kind of depends, right?” I mean, there’s so many recommendations you hear over and over again, so what have you uncovered in terms of dogmas?

Sami Inkinen: Well, first of all, that particular like, “Oh, my God. I need to get fast and running,” I wanted to do a triathlon, this is already a couple of years ago, actually, just about 10 years ago, wanted to do a triathlon, and I was training to row across the Pacific Ocean with my wife in a row boat, which is a whole other conversation we can have. I had stopped kind of running, and I was lifting weights, doing a lot of front squats. I was weighing 200 pounds, and like right now, I’m kind of in a cycling team, so my weight’s like 177 pounds. I was 23 pounds heavier.

Tim Ferriss: It’s a lot heavier.

Sami Inkinen: And I was like, “Whoa, how do I go from zero to hero? I want to be the Tim Ferriss of running. How do I hack this?”

Tim Ferriss: You don’t want to be the Tim Ferriss of running, I can tell you. That is my weak, Achilles heel.

Sami Inkinen: So how do I hack this? In that approach, basically, I wanted to slice and dice the running performance or at least the minimum, fancy, Silicon Valley term, first principles, but into contributing parts, like what are the one or two, three things you need to have? One, muscular endurance. You can be cardiovascularly fit, but go and run a downhill for 30 minutes or even 10 minutes. Your legs are noodles. You can’t continue running, so you need minimum dose for muscular endurance so that your legs don’t fall apart, and I think I was running for a triathlon that had a half a marathon, so 13 miles, 13 by one miles to run, so muscular endurance was one.

Then there was the efficiency you mentioned and so forth, but anyways, to go back to the actual, broader question, a couple of things for me. Especially for endurance sports, triathlon and for a marathon running and other things, one is like massive load and volume, and you kind of get more and more tired over like six weeks, eight weeks, maybe twelve weeks.

Then, you taper for two or three weeks, and you hope that after your last crazy week, in two or three weeks, you dig yourself out of the hole, and then you are super-fast on a race day. It’s like, literally, you’re on a knife’s edge all the time, and I completely changed that in the last four or five years I was really competing in triathlon, which is I want to be ready to race almost at the end of every week, meaning progressive overload but stay vibrant, and no matter how hard of a workout I do, say, on a Saturday or Sunday, by Wednesday I have to be ready to hit hard and feel like I can do almost like my best numbers. Personally, I found that more effective, avoided any kind of over-training, and I think when you’re lifting weights at the gym, this concept is much easier to crash.

It’s like, let’s say do your bench press, and for three weeks your reps or weight just keeps going down, everybody would be like, “What the F? Clearly I’m not either eating enough or I’m lifting too often,” but endurance athletes do exactly that. They kind of keep grinding, grinding, grinding. They get more tired. Then, they hope they get out of the hole, so that would be one thing that, basically, training in a way where you progressive overload, you hit your body, but then in sort of three to four days, you are back better, faster, stronger than ever, and then you keep repeating that. Personally, I found that, at least for myself, way safer, way more objective, and I always knew, “Oh. I’m getting stronger,” “oh. I’m getting more tired,” “All right. I’m going to take two days off, or maybe I have a full rest week,” so I would say that’s one thing.

The second thing, again, I’m not a running coach, a running expert per se, but especially if you have a multi-sport approach, it’s way better to train the cardiovascular engine on a low impact machine, so cycling. If you’re doing triathlon, I’ve done more than 10 full distance iron mans, and fastest was eight hours, 24 minutes, which is pretty fast for an amateur, especially before all the aerodynamic gains that people now have on bikes, so maybe I could take 10, 15 minutes off of that, but 824 is pretty fast. I run a 256 marathon off the bike. I think it was 256, two hours, 56 minutes after the swim and the bike. So, reasonably fast, but my longest run, to be able to run a marathon in a triathlon, was usually one hour, 20 minutes, which is like, I don’t know, nine or 10 miles, so just as an example, that would be the second thing.I don’t think you need specificity in that sense.

If you need to build a cardiovascular engine, do it in a way that doesn’t beat your body down, so like cycling versus running. I think that would be one thing, and then let’s leave the nutrition aside, but that’s like a war, like how much should you eat carbs versus this, and should you do carb loading and all that? Needless to say, I’m personally a huge believer that, as long as you sort of fuel the work while you do it, you don’t have to gain, because glycogen stores three grams of water, so if you have 600 grams, let’s just say 600 grams of carbs glycogen in your body, so that’s 2,400 calories, you have another 1,800 grams of water, so it’s 2.4 kilos, so that’s five or six pounds if you’re like fully loaded. I haven’t found, even for very long distance, you don’t need to gain five or six pounds. If you drip feed and fuel the actual work, you get to the same results. Controversial statement, but that’s my experience.

Tim Ferriss: I recommend people read the blog post also, and since you mentioned it and we’re probably not going to go for a six-hour conversation, I can’t not mention the rowing 2,400 plus miles with your wife. I think that was 43 days plus? 43 days, three hours, something like that, which sounds like, I mean, it really sounds like a divorce camp to me, and we could spend another three hours just talking about this insane decision to row for that. It was way more. Yeah, 2,750 miles roughly from California to Hawaii. I mean, the flight itself is pretty long from Hawaii, but my question is around, you Domestic peace or —

Sami Inkinen: Violence, violence.

Tim Ferriss: Yeah, minimizing violence. I was looking at this piece in USA Today, and it says that you had a written and signed formal document that not only described how you would treat each other in the journey, but even how you would respond to specific complaints and gripes. It’s like the only thing more Sami than rowing almost 3,000 miles is having this document. I wanted to hear about this document, and if it was as helpful as you hoped it would be and also anything else that you guys figured out in terms of not killing each other over that period of time being stuck on a boat.

Sami Inkinen: Yeah. Well, for listeners, just the context is, indeed, it’s 2,400 nautical miles from Monterey, California to Hawaii, Waikiki Beach, the shortest distance, but weather wasn’t really our friend. So we ended up doing 2,750 nautical miles. And I think it was 45 days and three hours, but who’s counting? But essentially a month and a half, almost seven weeks of rowing with my wife and completely unsupported.

I just want to be clear, no helicopters, no follow boats. There weren’t submarines around us and helicopters dropping bonbons. So it was just two of us. First of all, there’s so many life lessons and if you, Tim, are fortunate to find a woman of your life, that’s definitely a way to test the relationship’s longevity. And if you survive it both and come out together, and I will say this, we had been married for four years. We had known each other for six years. Having gone through that experience and hopping off the boat on a platform on Waikiki Beach and hugging my wife, that still is the sweetest moment in my life.

Hugging her and knowing there’s only one person on this planet who knows exactly what we went through and it’s my freaking wife. And the fact that we got it through together, no amount of hardship is going to break this, including having kids. But anyways, so it certainly was life transforming experience many ways.

The document, it served two purposes. One, in a kind of preparation phase I maybe mistakenly wanted to make sure that my wife is 100 percent in. So I was like, “This is what it’s going to take. This isn’t show up in two weeks and start rowing. It’s going to be a halftime job for six months to even get physically ready and kind of train and know how to jump into survival suit. It’s a halftime job.” So part of the document was like, “I’m signing into this. I’m not going to give up.” Which sounds like husband is asking wife to do that, but yes, that’s me.

And then the other half was about behaviors on the boat and the most important piece of the document that served us very, very well is the following. Any and every decision once it’s made is water under the bridge because we had to make a lot of decisions around safety and navigation and do we go this and all of that. Lots of decisions every day, like what do we do today? And you would never know if that was the right decision because the weather changes. And it’s one thing to do that at home and then you go to work and you forget it, but you’re basically stuck in a small stinky box for 45 days. There’s unlimited opportunities to get back to it and kind of bicker about it. That was incredibly helpful and served us very well.

The one thing I will say, and then you can ask other questions, we had a lot of time, obviously 45 days, three hours. We slept about six, seven hours a day. So there’s 18 hours a day to talk, listen, be together, can’t escape, can’t go to the bathroom, can’t lock the door, go to the bedroom, you cannot. And so some of it was silent, some of it was we had to fill the airwaves and we had all kinds of questions to each other. And one of the questions my wife had to me was, I think we were running out of questions. She said, “Listen, of all our friends, if it wasn’t me, who would you marry?” And as a diligent engineer, I stepped into that trap and answered it going through friend by friend, landing on the very specific one. But anyways, that is a question no married or unmarried person should ever answer, but I answered.

Tim Ferriss: When you were done with your very thoughtful engineer’s response to that question, how did she respond? And later was she like, “Yeah, I just for whatever reason wanted to throw a Molotov cocktail into the boat and see what would happen.” I mean, what happened afterwards?

Sami Inkinen: I remember it vividly sadly. It was, “I can’t believe that’s the last one I don’t think.” And, yeah, I have to explain myself out of it. But, yeah, it was a life transforming trip during which I made several big life decisions, one of which we made together, which was to start a family, which also is a complicated, obviously big decision to have kids. And entering the boat, we were both convinced that life’s too good to be mess, to be destroyed with children. And we literally changed our minds within the hour at the same time independently, which is quite something.

Tim Ferriss: So you decided to start a family, meaning you made the decision to start a family on the boat, or you actually started trying to have a family on the boat?

Sami Inkinen: Both, actually. So I think we were about seven or 10 days into the trip. It was very, very stormy early. And I had had enough white space ruminate about life and it was like a lightning strike. I still cannot explain this feeling of like, I was in my 30s, what is there to do? I could start five more companies and I don’t know, put my name on the side of a hospital, which I don’t want. What’s the meaning? Essentially it’s an existential crisis. What can a human do? So what’s worthy of the life? And obviously there’s a number of things, but the lightning that hit me was, wow, can you imagine raising a child? That’s incredible. And I turned to my wife and said, “Listen, this is kind of weird because we’ve talked about this and we don’t want, but I just feel we should start a family.” And her immediate response was, “Well, I’ve been thinking about exactly the same for the last 24 hours, exactly the same last 24 hours.” And then and there it was, “This is it. It’s going to happen.”

And my wife happens to be even more decisive than I am. So we had an Iridium satellite phone. This is time way before Starlink, which works, but you can send like a text message barely, and she texted to her girlfriend who obviously wasn’t rowing and said, “Hey, I’m going to give you some data. Can you start tracking my ovulation cycle so you can tell us, text us back when is the exact timing?” And we should have tried on the boat, and I will say that was the least romantic moment for both of us. And the fun part of this story is there’s a little bit of a mystery, but we got off the boat just about 10 years and nine months ago now and my oldest daughter is 10 years old. So there’s a little bit of a mystery what happened and where it happened, but it’s very close.

Tim Ferriss: When you had that lightning strike, and you both very coincidentally or not had that lightning strike at roughly the same time, if you tried to explain it, do you think it was just the incredible isolation of the two of you? Was it your wife saying, “Oh, my God, I love Sami, but I need at least one other person to talk to?” If you had to try to explain it, even if it’s grasping for straws, what do you think led to that lightning strike?

Sami Inkinen: My guess is it was the clarity of thought when there were no distractions, like the clarity of thought. And I think there’s even a theory of the brain or the mind is kind of Bayesian, like you have priors, you have so many priors and you’re always stuck in your rigid thinking and obviously there’s science that you can kind of loosen those priors with psychedelics and other things and then you kind of see things clearly.

I honestly think that there was the ability to think cleanly and clearly and that’s kind of what contributed to it. And what I found in life is ultimately the human experience is 100 percent subjective and if you’re not in touch outside of that, it’s just computers and algorithms, but it’s 100 percent subjective. And when you really tune into the subjective experience, oftentimes the biggest decisions in life are based on that, like who do you marry?

By the way, I had a spreadsheet for that too, but then I realized, met my wife, I threw the spreadsheet out the window and that was it. Same thing about having children, like the truly meaningful decisions, they are ultimately subjective in nature. And when you’re truly in kind of touch, how does it land? How does it feel? The answer kind of comes there. And I feel in the middle of the rowboat, no email, no nothing, no job, no task, no to dos, all to space. It was much easier to be in touch with that kind of experience and feeling. So that’s the story I tell, but may or may not be true.

Tim Ferriss: Makes sense to me, especially after a period of time of being on the boat, right? Once you have the routine aspects more or less on autopilot. Of course you have the decisions about angle and direction and so on. But I want to come back to something you said, which was, sure, I could start five more companies or have your name on side of a hospital. I know as you mentioned, that’s not of interest.

It seems like you did not, this is from Forbes, so who knows, but did not own a car until you were 36, talks about basically how minimalist or some might even say, “Austere you have been for certainly a period of time.” And you’re talking about renting cars from Thrifty. It had the cheapest cars, had not bought a watch in 15 years, exercise clothes are all swag from various endurance competitions, which is funny because I sometimes get shit for wearing all the free swag that I have. Most of what I wear is free stuff that I’ve gotten.

I’ve never been accused of having a great fashion sense. And the rest of his casual wardrobe is 10 copies of the same t-shirts and jeans. Literally this shirt that I have, I basically have crew and v-neck. It’s the same brand. It’s the same shirt. It’s just different colors. So my question is, is that a Sami thing? Is it a Finnish thing? And where have you found the most value in — let me rephrase that. What are some examples of where you have found great value in overcoming that type of frugality, where spending money has actually produced a real improvement in your quality of life?

Sami Inkinen: Yeah, interesting. Feels like a two-part question. Maybe the start is, I think I mentioned earlier that I find people say, “Sacrifice,” or you have to say, “No,” to so many things. I actually find saying, “No,” and focusing on the essential incredibly liberating and it’s kind of my happy place.

And so for some of these crap around and too much choice, what color t-shirt or what kind of clothes do I put on? I just find it very liberal. I love the fact that things are as simple as they are and sure life is way more complicated now than say 15 years ago, but I actually like not to clutter my life with money or anything else. Let’s put it that way and keep things very simple. And I’ll briefly give the example of the car story. So yes, I’ve had my driver license ever since it was possible in Finland.

It was 18, so 18. But actually I didn’t buy my first car. My wife bought it. Maybe I was 36 first because I had been renting Thrifty car from San Francisco Airport for eight years. Why that? It’s a funny story, but it illustrates my point. Well, first of all, I didn’t have any credit in America, and I needed a car after I came out to Stanford. For work reasons I could go to Thrifty and rent it. This was like 19 bucks a day, no credit, I could rent it. And then I realized this is amazing because I travel so much for work. I don’t need to wash the car. I don’t need to change the oils. It got broken into twice in San Francisco. I could just drive the 19 bucks a day car to airport and drive out with a new car.

I was like, “This is so convenient. No worries.” Ford Escape, that was my car of choice. And then one weekend I came home years, years later, and my wife’s like, “This is it. You need to own a car. You’re an adult. You can’t be renting all the time.” And she bought me the same Ford Escape that I had been renting for seven years. So that was it. So that’s kind of where it’s I think mainly coming from that the simplicity and convenience, focus on the things that matter. Sure, I have fancy bicycles to ride fast.

Tim Ferriss: What was the color? I want to know if you threw some flourish in there. Was it white or black or was it like electric blue with a racing stripe?

Sami Inkinen: Unfortunately didn’t have flames on the side, but it was blue, the one that she bought.

Tim Ferriss: Oh, I get that. I got it.

Sami Inkinen: Yeah, yeah, it was —

Tim Ferriss: No spoiler on the back? Yeah.

Sami Inkinen: No spoiler on the back. So there’s that. Yeah, so my approach to money is very, very simple. The less I have to think about the happier I am, and the fact that earlier success have enough for house and food and leftovers is wonderful. But if I have to be thinking about the leftovers at all, something’s wrong. So simplicity is very, very — but yeah, buying time is very helpful. There’s some things that just it’s good to have service and helpers around. I would say that’s a good investment.

And then the one and only thing where I would say, “Yeah, I do like sort of living environment to have a house that you can enjoy, not for the sake of it, but to have the kind of little things and conveniences you have, whether that’s to be able to exercise or roll into a lake…”

Tim Ferriss: Have a [inaudible].

Sami Inkinen: “…roll into a lake from your house.” So I would say that, but yeah, the less I have to think about money, happier I am. It’s just focus on life and the life’s happening, forget the money, life’s happening, go and make it happen.

Tim Ferriss: Do you have any books that you recommend or gift to people more than others?

Sami Inkinen: That is a good question. I’m not a big book gifter other than recommend for my like Virta team and sadly they are professionally, and they are all too kind of well known and common that they would add a lot of value. There’s the —

Tim Ferriss: Well, what are they?

Sami Inkinen: Score [Takes] Care of Itself, High Output Management —

Tim Ferriss: What was the first one?

Sami Inkinen: The Score [Takes] Care of Itself The 49ers coaches, Walsh’s book and High Output Management. Actually the High Growth Handbook by Elad Gil is much, much, much new. And I know you’ve interviewed Elad. So it’s in a professional setting. I do read a lot. If you want to plug for a book that I’ve really, really enjoyed over the last year, very inspiring, shows what’s possible in life and a little bit of leaves this kind of universe, leaves you wondering like what’s really true in a universe and whatnot is Trejo by Danny Trejo. Absolutely mind-blowing book.

Tim Ferriss: Yeah. Machete, he’s appeared in a bunch of Robert Rodriguez films, Robert’s right here —

Sami Inkinen: Oh, my God.

Tim Ferriss: — in Austin.

Sami Inkinen: That story.

Tim Ferriss: How on Earth did you end up picking up that book?

Sami Inkinen: Well, in our family, I read a lot, but there’s one person who reads more, that’s my wife. So I’d say half of my book recommendations come from her because she screens 10 books for everyone that I read so is a good filter. And I cried several times. I laughed several times, and I was incredibly inspired and came out reading that book, belief in humanity and just it was amazing.

Tim Ferriss: If you had given me a million guesses for what you were going to say, I never would have guessed Trejo by Danny Trejo, so T-R-E-J-O, right? If I’m getting that.

Sami Inkinen: Yes, yes.

Tim Ferriss: Right. Yeah. Okay. Wow. Okay. You’re full of surprises, Sami. I like it.

Sami Inkinen: Also, if you are ever contemplating having a family, that book also gives humility as you think about how much can you affect your kids’ life, and I’m not going to give a spoiler alert, but it’s highly recommend.

Tim Ferriss: I’ll get it. I’ll get it on Kindle today. I mean, we have covered a lot. I have a few questions I’d love to ask as we start to wind down, but is there anything else that you would like to cover, make sure that we discuss or anywhere you’d like to point my audience? I mean, I’m going to link to everything in the show notes. Of course, they can find Virta Health, V-I-R-T-A, Virtahealth.com on the website and we’ll include everything where people can find it easily. But is there anything else that you would like us to cover?

Sami Inkinen: I think you covered things very, very well. I would say, “My professional duty is to be an evangelizer,” and say, this very sad metabolic health mess that we find ourselves in America and globally and this savvy, the common sense thing that, oh, the diseases that we talked about, type 2 diabetes, obesity, cardiovascular, is they’re chronic and progressive, and the best we can do is to manage them with an every increasing load of medications is fundamentally not true.

And whether that’s Virta or something else, I just want to be very clear that there’s hope in the horizon and the hope is largely in the form of nutrition, but not in a traditional way that you need to restrict and suffer. So that’s sort of my professional duty to bring hope and say, if you’re living with type 2 diabetes, and by the way, people who are living with type 2 diabetes, usually they’re family members, their relatives, and you’ve seen people lose eyes and limbs and lives because of type 2 diabetes. To me, mostly completely unnecessary for the last three, four decades, that that disease, among with other metabolic health conditions, is fundamentally reversible and you don’t hear that from your doctor today, sadly.

And it’s not doctors’ fault, they’re well-meaning, but you go to medical school, you get literally zero, 0.5 hours of a nutrition training and nobody tells that conditions like type 2 diabetes can be reversed systematically, not miraculously. And so hopefully I can be a messenger of hope that these conditions are reversible, especially after I already disclosed that I used to live thinking it’s your fault, it’s your fault, you are just lazy, you don’t have the willpower, but that’s not true. Nobody gets these things because they’re lazy or they decide. It’s because of our food environment and the food environment kind of slowly but surely poisons us. But if you know a few little tricks and changes, you can actually turn back the clock. So that’s my PSA.

Tim Ferriss: And I want to say to folks, if you’re a large employer, who are the actual customers of Virta Health? Who should actually go check out the website?

Sami Inkinen: Yeah, thank you. That’s so nice. Anyone who pays healthcare costs in America could be and should be a customer. If you pay healthcare costs, you are paying for the party or people staying sick and others profiting from the sickness. So this includes self-insured employers and we work with like 800 of them. So essentially all Fortune 1000 employers, self-insurer and thousands of others. So all self-insured employers, obviously health insurance companies when they take risk on their patients. And this includes the private Medicare Advantage, private Medicaid, managed Medicaid organizations, state employee groups. I think we work with 13 out of 50 states today already. So state employee groups and then some government entities, there’s VA, there’s DOD and others. Any payer who pays healthcare costs could be our customer. And our pitch to them is, guess what? We’ll help you make money. Yes, indeed, we’ll help you make money.

And the side benefit is we also save lives. And I say that because the love language of American capitalism is dollars. And so when you can help someone else to make money, you’re going to be very, very successful, and I love it.

Tim Ferriss: Virta has done something that I wasn’t sure could be done. I mean, you have, as you already mentioned, I mean the world’s largest data set of this type of metabolic health and disease reversal and the way that you’ve been able to refine and engineer and iterate and further polish a program for individualized care and sort of mass scale adherence really makes, it’s mind-boggling to me. It’s really, really incredibly impressive.

And I don’t want to say, “I know how much work goes into it,” but I think I have an idea of just how challenging that is because I think of myself as someone who kind of specializes in behavioral change. And to your point, you can do a lot of really innovative things once you free yourself from the tyranny of the perfect, right? Not letting perfection be the enemy of progress. That is the mistake of a one size fits all approach like you need to be on the ketogenic diet and you need to hit this minimal concentration of blood, blah, blah, blah, blah, blah. It’s just not going to work on a mass scale. It just doesn’t work.

But when you have different ways to help people improve five, 10, 20 percent, 50 percent. The way that moves the needle over time, this is not the right way to put it, but it defies conventional explanation in the way that as you already put it, a lot of doctors have been taught in their minimal exposure to say, “Nutrition.” So the science that you’re doing, and I’ll say it as it’s on me, but really what you’re doing with the controls and with the trials, but also with the cohort analysis and everything else you’re doing internally, like the science you’re doing is incredibly, incredibly valuable. And I don’t just mean that in dollar science, it’s valuable to humanity.

So I really applaud you for building Virta and I just felt like we needed to have this conversation because A, you’re just such a freak of nature, and I wanted to talk to you about all the things we’ve talked about, but also because what you’ve built is something that I wasn’t sure it could be built. And with the many text messages and seeing a lot of stuff that just blew my mind, I wanted to have you on, so I’m glad and grateful that you took the time.

Sami Inkinen: Yeah. Thank you so much. And honestly, I appreciate those kind words. It’s 11 years in the making and never take it for granted, bigger company, bigger problems, but trying hard every day.

Tim Ferriss: Well, I’m going to pick up Trejo, which is not what I expected to be my immediate next step after having this conversation, but for everybody listening, we will link to everything in the show notes. You can find Sami, certainly you can find Virta first and foremost at Virtahealth.com, V-I-R-T-A. You can find Sami Inkiken. Good luck with the spelling, S-A-M-I I-N-K-I-N-E-N on all of the places, samiinkinen.com, on Instagram, X, et cetera. I’m not sure how active you are on those, but check out the blog posts for sure. And we’ll link to everything as I mentioned in the show notes at tim.blog/podcast. Just search for Sami S-A-M-I. I can promise you he’s the only one who’s going to pop up.

And until next time, just be a bit kinder than is necessary to others, but also to yourself and take those 20 minutes on Sunday, plan it out, get those things in the calendar. Otherwise, it’s going to get crowded out by the universe and then woe is you, woe is us. So take care of that. And, Sami, again, thank you so much for the time.

Sami Inkinen: Thank you very much.

Tim Ferriss: All right, folks, until next time. Thanks for tuning in.

DUE TO SOME HEADACHES IN THE PAST, PLEASE NOTE LEGAL CONDITIONS:

The post The Tim Ferriss Show Transcripts: Sami Inkinen of Virta Health — Reversing Type 2 Diabetes, Rowing 2,750 Miles, and Lessons from Fixing Metabolic Health in 100,000+ People (#866) appeared first on The Blog of Author Tim Ferriss.

Sami Inkinen of Virta Health — Reversing Type 2 Diabetes, Rowing 2,750 Miles, and Lessons from Fixing Metabolic Health in 100,000+ People (#866)

2026-05-21 00:48:09

Sami Inkinen (@samiinkinen) is a Finnish-born, Stanford-trained entrepreneur and the founder and CEO/president of Trulia and Virta Health. Virta is on a mission to reverse metabolic disease in one billion people using technology, AI, and nutrition. Previously, Sami held roles at Microsoft, Nokia, and McKinsey & Company, after starting his career at a nuclear power plant in Finland. Sami holds an MS in engineering physics from the Helsinki University of Technology and an MBA from Stanford University.

A world-class endurance athlete, Sami is a triathlon age-group world champion and an 8-hour, 24-minute Ironman finisher, having completed the Hawaii Ironman World Championship seven times.

Sami also founded Fat Chance Row to raise awareness of the dangers of sugar and its connection to diabetes, rowing 2,750 miles from California to Hawaii with his wife—completely unsupported—while breaking a world record in the process.

Please enjoy!

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Books, people, tools, and resources mentioned in the interview

Sami Inkinen of Virta Health — Reversing Type 2 Diabetes, Rowing 2,750 Miles, and Lessons from Fixing Metabolic Health in 100,000+ People

Additional podcast platforms

Listen to this episode on Apple Podcasts, Spotify, Overcast, Podcast Addict, Pocket Casts, Castbox, YouTube Music, Amazon Music, Audible, or on your favorite podcast platform.

Transcripts

SELECTED LINKS FROM THE EPISODE

Connect with Sami Inkinen:

Website | LinkedIn | Instagram | Twitter

People

Concepts, Protocols, and Drugs Referenced

Area Deprivation Index (ADI)
Fen-Phen
GLP-1 Receptor Agonists (Ozempic, etc.)
Löyly
MASH / MASLD
The Norwegian 4×4 Interval Protocol
Rezdiffra (Resmetirom) by Madrigal Pharmaceuticals
Type 2 Diabetes
VO2 Max

Places, Institutions, and Events

Helsinki University of Technology (Now Aalto University)
IRONMAN World Championship (Kona)
McKinsey & Company
Microsoft
Nokia
Sports Science Institute of South Africa
Stanford Graduate School of Business
Wildflower Triathlon

Timestamps

[00:00] Start.
[01:45] How Sami uses 15 minutes every Sunday to outrun the universe.
[03:37] Virta: at a thousand employees and counting.
[04:15] The 5 a.m. boot-up: cold lake, core work, and emptying the dishwasher.
[06:45] Why mood follows movement before the brain even boots up.
[11:54] Saying no to 99% of what “normal people” do.
[19:29] The weekly architecture.
[20:29] Two direct reports: the case for radical subtraction.
[21:09] 553 CEO letters and the case for one scalable habit.
[32:36] The text-file life plan.
[33:32] The 15-year personal plan Sami stumbled into by accident.
[34:30] The four-pillar formula for not cracking in 26 years of founder life.
[38:20] What “white Japanese people” and beer steins in saunas have in common.
[45:55] Smoke saunas, löyly, and the one Finnish word worth knowing.
[48:37] The lean, ten-percent-body-fat triathlete who was quietly going prediabetic.
[53:07] Why 93% of American adults are metabolically unhealthy.
[56:05] Reversing type 2 diabetes the way Virta actually does it.
[1:00:17] Most surprising interventions.
[1:03:32] The pancreatic cancer trial that bought patients 35% more time.
[1:07:02] The McDonald’s protocol: how to reverse diabetes from the drive-thru.
[1:16:00] Why GLP-1 adherence collapses and Virta’s doesn’t.
[1:21:10] Vegans, tofu, and the hardest macronutrient to get right.
[1:25:27] The dose-response curve that lets perfect stop being the enemy of progress.
[1:29:32] VO2 max blocks: how Sami trains an 80+ engine without burning out.
[1:41:56] Hacking 10% off your running speed in four weeks.
[1:46:09] Progressive overload, specificity, and the case against the long ride.
[1:50:07] 45 days, three hours, and a contract to keep a marriage afloat.
[1:55:27] The lightning strike in the middle of the Pacific that started a family.
[2:01:15] The 36-year-old who bought his first car only because his wife made him.
[2:05:40] The book recommendation no one saw coming: Trejo.
[2:07:51] The PSA: chronic, progressive, and irreversible — three words Sami refuses.
[2:11:40] Parting thoughts.

SAMI INKINEN QUOTES FROM THE INTERVIEW

“Structure allows flexibility and spontaneity.”

— Sami Inkinen

“Mood follows movement and motion.”

— Sami Inkinen

“The biggest secret is saying no to 99 percent of the things that many people consider ‘normal’ so what you care [about] gets done.”

— Sami Inkinen

“Truck drivers, their concept of a lunch is McDonald’s. We can’t tell them, ‘Oh, here’s the list. Go shop Whole Foods or Erewhon, and then go home and cook at home.’ It’s like, ‘Okay, McDonald’s it is. We’re going to reverse your diabetes on McDonald’s diet.’ And by the way, we do that.“

— Sami Inkinen

“The adherence of Virta patients, again, which are real Americans, not Samis, real Americans, is twice as high at one year as taking a GLP-1 drug. We have 83 percent adherence retention of patients at one year. And look at any of the publicly available data: people stick to GLP-1s like 40 percent, maybe 50 percent, 30 to 50 percent.”

— Sami Inkinen

“GLP-1s 100 percent affect your appetite. They change how much you eat, so you eat less, but they alone don’t change what you eat. … And if you don’t change what you eat, you’re not going to be perfectly or even optimally metabolically healthy.”

— Sami Inkinen

“Type 2 diabetes can be reversed systematically, not miraculously. And so hopefully I can be a messenger of hope that these conditions are reversible, especially after I already disclosed that I used to live thinking it’s your fault, it’s your fault, you are just lazy, you don’t have the willpower. But that’s not true. Nobody gets these things because they’re lazy or they decide. It’s because of our food environment. And the food environment kind of slowly but surely poisons us. But if you know a few little tricks and changes, you can actually turn back the clock.”

— Sami Inkinen

“The love language of American capitalism is dollars. And so when you can help someone else to make money, you’re going to be very, very successful.”

— Sami Inkinen

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Want to hear another conversation about ketones, metabolic health, and what your devices might be missing? Listen to my conversation with ketogenic-diet researcher Dr. Dominic D’Agostino, in which we discussed the ketone measurement paradox of feeling sharp at low readings, the carburetor analogy for ketone production versus utilization, metabolic memory and becoming more fat-adapted over time, my 18-day keto experiment, intermittent fasting as a keto on-ramp, the glucose-ketone index sweet spot, post-meal walking and GLUT4 activation, one-week-per-month protocols, low-carb Mediterranean as the 80/20 minimum effective dose, and much more.

The post Sami Inkinen of Virta Health — Reversing Type 2 Diabetes, Rowing 2,750 Miles, and Lessons from Fixing Metabolic Health in 100,000+ People (#866) appeared first on The Blog of Author Tim Ferriss.

The Tim Ferriss Show Transcripts: The Most Incredible Transformation I’ve Ever Seen — Jerzy Gregorek on Autism, Cerebral Palsy, Coaching, and the Power of Micro-Progressions (#865)

2026-05-15 13:01:11

Jerzy Gregorek (@TheHappyBody) is a 4x World Weightlifting Champion, co-founder of UCLA’s weightlifting team, and co-creator, with his wife Aniela, of the Happy Body program.

To fill out the form on Cerebral Palsy Research Project, visit tim.blog/cp.

To watch Prisoner No More for free, click here.

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