Junaid Kalia, MD (00:00.43)

Hey everyone, thank you so much for joining us for Signals and Symptoms podcast. Out of the two besties, we have Edward Marks here, who is again, as usual, amazing. So we were talking about the big ideas and the idea is that it's going to be a of a lecture, but the idea is that we are actually going through this. The great acceleration AI infrastructure, AI consumer operating system, which is really what the things are going to be, AI productivity, and the whole thesis of them, of the AI, which is the central dynamic.

The central dynamo is basically spinning everything, accelerating five major innovations at the same time. And that is the core thing. And that's exactly what I mean. I literally had my whole C-suite meeting 10 minutes ago, and I just told everyone that, hey, this is the new era. We need to actually do this. Five major innovation programs, AI, public blockchain, robotics, energy storage, and multi-omics are becoming increasingly interdependent as performance advances in one platform. Conversion should lead to major increase in demand. And that is so poor.

So let me explain this to you. So we were not using LLM for X amount of reasons, but in general, from the last two years, this cost curve of LLM tokens have so decreased that now company-wide, the option is that either you use AI or you get fired. And the reason is that I am spending $100 to $200 per month subscription of five of them is actually equivalent to one person's salary, actually one fifth of one person's

So the question really is for me as a CEO is, hey, why not? Why the hell are you not using it? And if you're not using it, then you don't know how to use a new tool. And if you're not a new how to use a new tool, you're not a learning person. If you're not a learning person, then is there a really space for you in my company? I know this is a little brutal. And then Ed and Harvey can straighten me out and you can give your opinions. But what are your thoughts? Do you feel the same when you're talking about people?

to people, Harvey, you go first before your flight goes up. And then Ed, you can talk about this when you're in live help. And what do you think when talking to different CEOs, CTOs, members? What's the overall energy and how things are moving?

Harvey Castro, MD (02:13.358)

I'll jump in real quick. So I believe strongly in Martex law. And Martex law, basically, I've mentioned it before, think of it as technology is exponential. You and I are all logarithmic and organizations are logarithmic. The bigger the gap between technology and us, the bigger the disruption. I.e. if, say, in this example, Dr. Junaid is saying, hey, he's not going to hire X person if they're not using AI.

That means they're lower in the curve and as a result, he's trying to stay as close as possible so he is not disrupted. So with that principle, I want to encourage everybody out there to really come to these types of podcasts, learn it, understand it so that you are above the curve of others, so that you get that job, you could be able to be that disruptor. Ed, what do you think?

Edward Marx (03:03.434)

Completely agree. But I think everyone knows I do these networking events every night at all major healthcare conferences called Ed Marks the Spot. it goes pretty late. Thankfully, I don't drink. And so it's no problem in the morning. But then I lead charity runs every morning at this event. And I think that's a recurring theme. If I think about recurring themes from our podcast since the beginning, you have to lead.

Leadership is influence and the only way to get influence in the age of AI is to be an agent of AI. So absolutely agree.

Junaid Kalia, MD (03:40.908)

We are agents and double agents of AI because Harvey actually has a twin to the world is entering an unprecedented technology investment cycle. And that's actually for them, of course, is because they're coming from an investment thesis. That is something that we have talked about before. But people will say that. Right. And that, hey, this is the dot com bubble. This is the 1991 energy.

you cycle. And that's exactly how winners are chose. You invest in multiple diversified and then one of those investments is going to go 300 X in the next 20 years. So what you're talking about is that that innovation cycle is going to contract significantly and investment cycle is going to go more rapid and more disruptive and more volatile in my opinion, as compared to dot com bubble.

Do I, again, please feel free to disagree with me, Ed or Harvey, but I think that we are looking at a new, much faster contracted cycle with much more volatility. Do you agree, disagree, or any thoughts?

Harvey Castro, MD (04:53.39)

just say real quick, Ed, if you think about it and you look at, I'm zooming into this thing and you look at AI data center space and then you look at software, AI software, and if you think about it, did SpaceX just do? They added XAI. And so if you think about it, I mean, that's kind of either coincidental or Elon Musk is looking at something like this and saying, wait, I combined these two, my curve.

Edward Marx (05:17.25)

we think, Junaid, about there's still a good segment of the population that doesn't believe this is happening. So I had this conversation with some super intelligent people and I highly respect that. I tried to be as open as possible, but they're like, this is like blockchain or it's like the cloud, you know, it'll pass by and there'll be some change, but nothing dramatic.

And I'm like, no, no, don't you see all these markers? That's the difference. It's not just hype and it's actually happening. You see it happening. So this is definitely a change. that's why, you know, one of the reasons we do signal and symptoms is like encourage people to lay hold of this and lay hold of it with authority and confidence and move and be part of the solution. Like Harvey was talking about earlier with that curve.

Junaid Kalia, MD (06:08.75)

So right. So disruptive technologies can catalyze growth in multiple ways. And that is an example that we need to know. Automated repacement cycle, increased 8x revenue. And the way that they have structured this is, again, catalyze growth in multiple ways. And that is something that is going to be what he exactly gave you the example. When you have one tangent like SpaceX and they have another tangent like internet, now you're really saying, well, why don't we do space data centers?

And that's exactly what you are looking at. And this is, again, a massive opportunity. And also, I'm just going to be honest with you, the risk profile for investors have increased because you really need to find the right companies to put the money in and the right founders and the right team. Each recipient will generate profound macroeconomic results. And then, again, we're not going to get political over here, but the core pieces of this whole administration is, by the way,

that technology is moving at a breath rate that even if there's inflation going on, the counter deflationary effect of technology will be so much that the inflation will actually be expiring. And that's the whole game. Still, you're saying that, that, you know, again, the food is getting cheaper because of AI causing vertical farming. Again, it doesn't apply everywhere. There's going to be spikes where it's going to be great. Everything is now coming from the AI basis.

as we go along. Interesting technologies like quantum computing are unlikely to disrupt for the next 24 years. And that's actually, to be honest with you, I'm going to tell you that this is ARK's bias. So that's very important to understand. ARK is very, very heavy on Bitcoin. they're the biggest, actually, to be honest with you, all the hype and everything in the volatility aside, the biggest threat to Bitcoin is quantum computing. And then they are downplaying this because they don't want to uplay the

content computing. I don't think so it's 20 years. I think we are one major breakthrough away. But the question really is that are we going to use quantum computing right away? mean, nefariously, yes. Breaking high level encryption for military or Bitcoin and everything. Other than in the real life, the B100s and this Harvey's phantom space is going to push into space data centers.

Junaid Kalia, MD (08:33.933)

We are very close to what we want to achieve in terms of energy consumption and AI compute without even requiring quantum. And there are very few use cases in quantum that is really needed, again, except for honestly, I feel like it's just Nefari's use of this. Root to dominate global market, disruptive technologies could grow to dominate global markets. Now this is, again, I'm not so sure, dominate global markets. What do you mean, Bala? So what does global market means? Global market basically means energy market.

you know, significant amount of trade between countries, which include spices to clothes to everything. Will that? I doubt it. What they are pointing towards is that that is China is going to be basically making AI available for the rest of the world. And they're already doing it. And I don't think so that's going to disrupt on top of everything. I think that's a little hyperbole in my opinion. But I just want to make sure that you guys understand again, this is this is not a they're probably doing much more research than I do. But I just want to make sure that these are my opinion. But here's the main thing.

programmable biology, and we are already seeing this. Unfortunately, unregulated with customized proteomics, customized proteins, all of this going through med spas and everything into the technology, and we're going to see a lot of it coming into this. So we are going to go through this. Again, this is a little later, but the technology is getting so much cheaper. We have the cost curve of what we saw for sequencing is going down, but now biosimilars, biologics are getting much more.

And again, we are all impressed or whatever. It's not impressed by the way we have real life situation. But this is odd, Like I saw that the earnings, first of all, the baseline earnings was pretty good, which is really odd that, you know, they were pushing to trillion dollar companies where the P-E ratios was insane. Then they, of course, did the capex and now the valuations are resetting. So what's going on? I mean,

I know we are not talking about an investment perspective, but I just, what is this disconnect?

Edward Marx (10:40.474)

Yeah, it's a really good question. If we bring it back to healthcare, why are these super smart individuals, right? Healthcare requires quite a bit of education. You we're talking about clinicians and others who are running multi-billion dollar enterprises. So it's not for a lack of, you know, capability to understand complex situations, complex environments. And I think it comes down to change. It's like we don't...

We want to deny it because the implications, we want to deny it for a couple of reasons. One, it's, it is more complex, right? We already are busy. We have a complex life and now you want to throw something at me. That's not going to just require a small change in my thought process and my operations, but you're talking about massive change. And so I think just naturally it's like a defense mechanism, like, no, no, it's not going to happen that way. It's going to, it's going to be much slower. It's not going to be that much impact. And I think it's comforting.

So I look at it from a humanistic point of view. I think it's just comforting to say, no, it's not gonna be that radical. It's not gonna. So I think that's part of it is just our change and change management in our own cultures and our cultures within ourselves. So I know that's probably not a technical, it's definitely not a technical answer, but I think that's really what's going on in people's minds. It's just so overwhelming, they're shutting down.

Junaid Kalia, MD (12:05.908)

And I have to admit, it was very overwhelming. And it is very hard because human learning is at a very different pace, which is again, you're basically creating AIs at a PhD level. AI agents could facilitate more than eight trillion in online consumption in 2030. Insane numbers that we look at. Again, very small portion of the overall market, just being honest. But this is representing a significant chunk.

And this is going to really adversely impact advertising revenue and who controls it. And again, this is becoming a little bit more scarier from a consumer perspective because it was very different when it was deterministic search, right? Search for a car with four wheels, whatever. Then I want to search this and are there at the back end, the advertisers are going to be basically going to be very honest upfront that this is an ad or is this something, you know.

I paid to get my results better, which is, again, the game we used to play, search engine optimization and everything. But again, it is taking a new form as we go forward. Anything to add over here as a consumer of health care? Maybe this is going to change the way you consume health care because of all of this.

Edward Marx (13:22.178)

Yeah, of course, it's gonna radically change. I even spoke to people, I'm not gonna mention because of their thesis, I'm not gonna mention which organizations these thoughts came from, but let me just say leading academic organizations, the individuals, some of the individuals running them, will tell you it's gonna completely change, right? The primary care will be gone as we know it, those sort of things. They are actively inside of their organizations trying to alert everyone, but.

As one person said, another moment. And I wasn't around, but I can only imagine what the discussion was like at Kodak, right? When everything was changing with film. It's like, well, we're Kodak. Nothing's going to change. We're Kodak. And so there's these large organizations, prestigious, and that's what they're thinking. And it's kind of scary that

people aren't and people in organizations aren't really grabbing on to it, yeah, it's definitely coming.

Junaid Kalia, MD (14:23.182)

We're going to end on this slide today. And this is really what to continue with Ed's team here, that exactly the cost of intelligence is collapsing. There was one thing in which we could say that there are some use cases that were actually dominant, like creating a blog or AS log everywhere with videos and everything. What's really happening, what is truly transformative, is essentially that you are getting a PhD level person

that you do not have to train is going to read all the context and get ready on boarded in two hours as compared to even if I have a human, I have unlimited budget, I have massive humans just to onboard them and to be able to do that context and get ready. That is changing. Edward, any more thoughts before we close for today? Anything new that I should know, our audiences should know?

Edward Marx (15:15.722)

If I talk about the biggest gains so far, so these are from actual providers, some on the payer side, but ambient listening, that's been the biggest thing, right? And again, people, it's been pretty disruptive, but it kind of went slow. So they're sort of used to this kind of slow roll. So the ambient listening, the messaging for in baskets and things like that, the automation, leveraging AI to respond to patient queries and stuff, that's been very good.

And then for research and reporting. some are laying hold of that. And obviously you talked at length about this. Cost reductions, like how can I eliminate costs? And to your point, Junaid, you could just ask chat, like, how do I do this? You could put in your, dump your financials from your health system. Maybe you don't need all these analysts. You know, I'll never forget. I walked in, I don't think people understand how many, how manual everything is. I'll never forget the scene. And I don't want to name.

my organization just because it's not, I don't want any negative shade on my organization because every organization is like this. But it's just, it was just overwhelming because I literally, wanted to visit the finance department, right? I was trying to visit all my colleagues and get an understanding of operations to see how IT could work with them and leverage technology to make them more efficient. And I got, I was given this address and I thought I pulled into like a Costco and I opened the door and in it was like,

2000 people all sitting in cubes in the giant warehouse. And they were manually, of course there was some automation. This wasn't very long ago, but the amount of manual effort. And now today you can leverage AI and that warehouse had, I don't think they've done it yet, but I'm sure it's going to be here. So cost reduction. some people are doing, but ambient listening was, it's kind of like the easy entry point for everyone. And it's good, right? It's very helpful. So.

What are the challenges? And one was staff and patient education. So educating staff and you've been to Junaid, you've been saying, hey, you're telling your own team, either you leverage AI or you're out because this is the future. You don't want to be stuck in the past. Data standards, normalization. Regulations is a big killer, especially in healthcare. You know, it's along with nuclear energy, it's the most regulated industries. And we keep...

Edward Marx (17:40.91)

Regulate over I think we over regulate ourselves and hurts us while other we have to be careful on this right We haven't talked about this much, but if we over regulate which we do We're gonna get We're gonna get completely distant to mediated and then human in the loop, you know Always try to make sure somehow some way there's a human in the loop. That'll be interesting as things evolve

Junaid Kalia, MD (18:02.446)