In defence of the naïve founder 

One of my most memorable moments from medical school was during my rotation in a psychiatric hospital. Unlike traditional medicine, you’re unlikely to figure out what is going on by sticking the patient with needles. Instead you learn to listen for inconsistencies that might indicate a delusion or hallucination.

On one occasion, I was taking a medical history from a well-kept man on a psychiatric ward who wouldn’t have looked out of place in a law firm or investment bank. That was until he started to describe, in all seriousness, that “agents” had been tailing him for weeks. Apparently, he had been assigned a top secret mission to penetrate a cult and was on the verge of uncovering a major conspiracy.

While delusions of this kind sound impressive, it wouldn’t be unusual to hear similarly grandiose stories from a startup founder.

Self-confidence to the point of delusional seems to be a common trait amongst successful founders. Later stage founders often admit to having no idea what they were getting themselves into when they first started their company. 

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The Art of Deciding

“To take away a man’s freedom of choice, even his freedom to make the wrong choice, is to manipulate him as though he were a puppet and not a person.”

Madeline L’Engle

The ability to decide is at the heart of what it means to be human. After all, history started with the hasty decision to take a bite of the forbidden fruit. And, like Adam most of us make consequential decisions with little to no thought. 

Decision-making is not taught in schools and rarely discussed in leadership circles. There are countless books on how to be more productive, yet relatively few on how to decide. In fact, it wasn’t until recently that academia moved away from the ludicrous idea that humans are rational beings and decision-making gained the fancy moniker, “behavioral economics”, signifying its elevation as a formal field of science, thanks to the work of prominent academics such as Daniel Kahneman and Richard Thaler.

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The Most Important Thing I Learned During Y Combinator

Tuesday “dinners” were a big part of the YC experience. An opportunity to take a break from the grind, share notes and compare progress with fellow batchmates. 

But the highlight of the evening was always an off-the-record talk by an experienced startup founder who was, more often than not, also YC alumnus. During my batch (Winter 2018), we had the opportunity to hear from no less than Drew Houston (Dropbox), Brian Chesky and Joe Gebbia (Airbnb), and Emmit Shear and Justin Kan (Twitch), to name a few. 

The talk that I’ve thought back to the most was Sam Altman, former President of YC’s, opening address on “How to Succeed”.

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The UK and Creating an Innovative Health-Tech Culture

Imagine a near-infinite improbability drive that takes common, raw materials and transforms them into a conveyor belt of wealth-creating products and services. 

Once you owed such a device, you would do everything you could to preserve and protect it. The improbability drive I refer to is “innovation” and the UK was once good at it for healthcare. 

From penicillin to the smallpox vaccine, the UK has a long history of punching above its weight in the field of healthcare innovation. Unfortunately, we have ceded that lead, in part, due to an increasingly hostile culture towards health-tech entrepreneurs.

Here’s why. Innovation is the result of trial and error by tinkerers, often preceding our scientific understanding. It proliferates in decentralized environments where people are free to think, experiment and speculate. It is almost always bottom-up rather than top-down.

The first challenge is the UK’s centralized approach to healthcare that optimizes for low cost at the expense of innovation and spends 20% less per capita on healthcare than the OECD average.

A lack of willingness to invest in innovative health-tech projects coupled with bureaucratic decision-making has created an environment of limited opportunity for new upstarts. The result has been a brain drain of the best and brightest health-tech entrepreneurs migrating to more innovation-friendly markets.

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