 Good afternoon. I'm Harry Lewis. I'm the interim dean of the Harvard School of Engineering and Applied Sciences. And it's my privilege to welcome you this afternoon to the Experiment Assembly, a wonderful celebration of entrepreneurship, which we are proud to have hosted here at Harvard by our friends from the Experiment Fund, which I will say a word about in a moment. It is an extraordinary transformation that has happened at Harvard over a relatively short period of time, where undergraduate and graduate student and faculty entrepreneurship moved from being something that was done in secret and in hiding into something that the university sponsored, supported, and celebrated. I actually have a small piece of claim to lay to this transformation, but it's a reminder of how much the world has changed. Until the year 2000 in Harvard College, it was unlawful to start a business in your Harvard dormitory room. That was actually one of the things I did as dean of the college was to move the faculty to repeal the rule, which no one could remember why it was on the books anyway, except for a general anti- entrepreneurial sentiment and had been on the books for hundreds of years. Anyway, we have a wonderful combination of ingredients here at Harvard with the School of Engineering and Applied Sciences embedded in the world's greatest liberal arts college, I may modestly say, surrounded by these fabulous scientific and social science and humanities departments and then with all of the great professional schools that we can connect to. So it's a great transformation that's happened at Harvard over the years. And I do want to thank our friends at the Experiment Fund, the X Fund, and give them some credit also for what they contribute to the education development of students' understanding and progress in their capacity to understand how to translate ideas into inventions and businesses. It's been a great partnership that we've had since the X Fund was created. I also want to acknowledge the Women in Science and Engineering program, the group which had a very nice reception just before this event where my colleague, Professor Margo Seltzer, and our honored guest today, Elizabeth Holmes, talked to that group. So thank you, the women who put that event together. It was a great success. And so without further ado, I'm going to introduce the X Fund co-founders. There is incredible amounts of crimson blood flowing through the veins of the X Fund. I'll start with Hugo von Wuren, who was a graduate in the class of 2007, I believe, who I first met as a freshman. Because at that point, he was the glue of the South African community at Harvard. And one of my kids who was here had a South African roommate. And that's why I met him very early. He developed into the glue of all of Harvard College and has gone on to get another degree, in addition to his college degree, from the Graduate School of Design. He's done several startups that were funded through Y Combinator. He's a founding director of the Arts Science Labs in Cambridge, been a fellow of the Berkman Center, many, many Harvard connections and connections into the entrepreneurial community. Wonderful, wonderful person. And then finally, I also want to introduce Patrick Chung, who has three Harvard degrees, college, law school, business school. It is slightly, his blood is slightly tainted, because there is a little drop of Oxford blood in him as well, because he got a master's degree at Oxford. He's director of 23andMe and a whole bunch of other companies. And he's affiliated in various ways with many companies over the past decades, since he's been at Harvard. He was at NEA before he and Hugo broke off to found the X fund. And he continues to serve Harvard as an elected director of the Harvard Alumni Association. So it's always wonderful to see them. I'm so pleased to be here today. Jay-Z is a bit of a hurdle to have to achieve that level of fame and humor, but I will do my best. Today we are awarding the X fund medal, or the X fund prize as I call it. I urge you not to confuse it with the X prize, which is $20 million, but you have to land a rover on the moon. So I just wanted to assure our guest, Elizabeth, that you don't have to do anything more to collect your medal. And no matter how the interview goes, you still get the medal. So it's going to be very comfortable. And without further ado, let me introduce Elizabeth Holmes. Come on up. So pleased to see you. So we're so eager to hear how Theranos got to where it is, but we want sort of the superhero origin story first. So I thought it might make sense to start a little modestly to paint a day in the life of Elizabeth Holmes in ninth grade. You can pick your day, weekday, weekend, or something. What would a typical day look like in ninth grade? So we're not landing a rover on the moon. That would be a very good day in ninth grade, if you had. Now it can be shown. Yeah, you know, I was a young girl who loved science and math and engineering. I had a family that brought me up in such a way in which, when my brother was getting LEGO sets and construction sets and my friends were getting Barbies, I was getting LEGO sets and construction sets. And I think that was a really wonderful and special thing. And I was very normal working to pursue something that I loved. And on a weekend, what would spare time be? Would it be kind of, let's add this chemical to this chemical and see if it blows up? Would it be? Well, I started a company when I was in high school. That was distributing universities and studied Mandarin and had ended up going to school. That was the most signal-to-noise ratio sentence I think I've ever heard. It's not clear everybody heard it because the mic was going back and forth on the lapel. OK, we'll try it. So if you're adjusted or get you a handheld, it may be. I'll try again. I would love to hear that sentence again. That was an amazing sentence. So I spent my weekends working on developing a company that I'd started when I was in high school, which was built around distributing C++ compilers to universities in Asia. Yeah, I'd been learning Mandarin and wanted to start a business because I was very interested in the concept of building a company as a vehicle, ultimately, for making a difference. And so that was sort of training wheels. As you were saying, typical high school student studying Mandarin went to China. Was this accompanied by the folks? Or it was just like, I'll be back next Saturday. Have some leftovers for me. It was not accompanied by the folks. All right, so you went alone to China, brushed up on Mandarin, and were like, the one thing this place needs is C++. We need to increment RC in this place. I had been programming and recognized that the universities didn't have access to. You're going dead again. So what was that company called? Echo Technologies. And your folks were like, Elizabeth, go for it. Given you those Legos, best decision we ever made, C++ in China, Mandarin. And what happened next? I had the opportunity to go to Stanford. And I was really interested in health care at that point. And I became enrolled in chemical and electrical engineering. As a freshman. As a freshman and started going down the path we're on. And are your folks or family science and tech oriented already? No, my parents were both in public service. And my dad was in disaster relief. And was done, tempted to trade our mics or demand of the authorities an additional mic. Do we have such a thing? One moment, please, while I button my shirt. Never thought I'd be saying that. Luckily, the mic was off. I'm going to hand you my mic, and you're going to give me yours. And somehow, that's going to improve the situation. How I don't know, but there's a lesson there in zero sum. I'm just going to hold this as if it were a handheld. And all right, there we go. All right, so you went to Stanford. And this is the part where there is like she starts a company doing something so exciting and compelling that I don't know what. Tell us a little bit of that story as you'd like it. No pressure, yeah. I found what I loved. And I'd always believed that the purpose of building something, building a company, is to make a difference in the world. And I got to the point in which I found what I felt like I was born to do. And that was it. So just take us one layer deeper on that. Because my memory is a thoughtful restaurant for anybody that's anyway. But you knew you had this interest in health care. You had this interest in a particular part of science that has to do with dealing with blood, dealing with blood on a chip. This came about because you apprenticed to a professor who had that interest, or you just came into it knowing about it. So we were talking about my family in disaster relief. I'd spent a lot of time thinking about what does it mean to make a difference. And to me, what I resonated with very, very deeply was the experience of watching someone I loved get diagnosed with cancer and understanding what it meant to find out too late in the disease progression process in a case where if we'd known earlier, there was everything that could have been done. And really believing fundamentally that if there was one thing that I could do with my life that I wanted to pursue, it would be trying to change that. And so I got interested in blood and lab testing because it's a tool for being able to help create a system in which early detection becomes a reality. And starting with that overall mission, Stan Lee kind of feeling to it, how did you brush up on now actually how would we make it? So instead of waiting for Hoffman LaRouche to come up. Let's just roll up our sleeves and do this thing. How did that happen? Was it Stanford classes and professors who got along? Was it outside study? Well, I had had the opportunity at Stanford. I was an undergrad. I had sort of convinced my way into working in one of the PhD programs and had wonderful exposure and training from that in the short time that I was there. But I think we reached a point where, and I reached a point where I knew what it was that I was trying to solve for and decided that I wanted to go spend all of my time on that. And that roughly is an easy early therefore blood test. Yes, and the ability to dramatically reduce the sample volume that's required for doing lab testing traditionally and dramatically reduce the cost. Making phlebotomists into the buggy whip makers of our era. Well, we are employing phlebotomists. We think that's really important. In the context of being able to then apply them in areas that they may not have served historically, namely sticking needles in people's arms is no longer the objective. But then being able to get access to more and more lab information with less and less blood using new techniques, which is what we're doing. Kind of the way buggy whip or buggy whip users, teamsters, teams of horses just became truck drivers and are still called teamsters to this day. So kind of not displacing them but retraining them. Retraining, yes. Got it. All right, so let's just stick for a moment again with sophomore year, because this is a key year. So you've got like a Eureka moment? Is it like, all right, this could fit on a chip? Or is it some other Eureka-ish thing that says the next step is to form a company and raise some money? It was the decision that calling and that mission was what I wanted to do with my life. And I was at a point in which I was spending 24 hours a day on it. And my parents were spending all this money on all these classes that I wasn't going to. And that didn't make any sense. So I decided to go spend all my time on it. And I'd found what I loved. So you left Stanford before having the company up and running. Yes. Wow, so that's a serious leap you're taking. Yeah, yeah. I'm just imagining like the phone call between you and your folks. Was that an easy phone call or a hard one? These are the same ones who let me go to China. Like whatevs? We'll have some leftovers on the hob before you when you come home. They were amazing. I mean, they had saved all their lives for me to be able to go to Stanford and the money that they'd saved would have let them retire. And they let me take that money and put it into starting the company. And what was fundraising like? How much did you feel you had to have in order to actually go on the hustings? What was that experience like? You know, it's a fascinating experience. And finding the right people to invest in you, I think, is everything. Because I talk sometimes, a lot of the people that I met would sit down and the first question that they ask is, what's your exit strategy? And you're sort of thinking about what your entry strategy is. And the mindset of being able to build something great for the long term is not necessarily a mindset that every investor has. Did you end up with a practiced answer to that question? What was your answer by the time you'd been asked it four times? We didn't really engage. We turned down the first money that we were offered because we didn't believe that those investors had the same vision we had. And when you say we by this time, did you have a kind of, were there extra musketeers? Ultimately, yeah. Where did they come from? I hired the person that I was working for at Stanford. And that's a wonderful story, isn't it? Yeah, it was great. That person was like, last time I saw you, you were leaving, and now you're hiring me. And you were like, all right, now let's do this thing for real. Fascinating. All right, so what happened next? You know, we codenamed our product, the Edison, because we knew we were probably going to have to fail 10,000 times before we got it to work, the 10,000th and first time, and we failed. Probably not 10,000 times, but a lot of times. But there's time, yeah. And it's blood, sweat, and tears, right? You get a group of people who are determined to make something work no matter what, and you figure it out. And the product in question, then, is, I mean, this is now wildly simplified. Is it basically a magic box that could take a little bit of blood as an input and a nice report as an output? It's redeveloping the whole lab infrastructure. So the equipment, the hardware is part of it, and we did a lot of work on that. But it's also all the assays, all the chemistries, that are used for processing these samples and other elements of the ecosystem in the context of serving as a laboratory that can handle and process any combination of tests. And do you view yourself in the role of kind of chief scientist as conductor of an orchestra that you've now managed to assemble? How many musketeers are there now? Almost 1,000. Wow. So what's your role in this group? I'm a musketeer. Just a country lawyer. Yeah, I mean, this is a team of people. And it's as much their mission and their vision as it is mine now. And I have the privilege of being able to be a spokesperson for it. I love being able to spend as much time in the product as I possibly can and on sort of the creative ways in which we're communicating and connecting with people around it because so much of what we do is about engaging people in health. But I have the privilege of working with incredible people. Speaking of engaging people, there is both a Twitter monitor going on. And if you use the hashtag Ask Elizabeth, we have folks mining that hashtag, which may be blended with Queen Elizabeth's Q&A. And we'll just draw from either for interesting questions. So you may get some London area questions. That's good. And we're also going to do some Q&A a little later on in the more traditional variety if the microphones are cooperative with that. But I wanted to give you a quote now, which you explain to the San Francisco Business Times. You said, the company's culture is such that confidentiality is the essence of its existence. Is that still true? If it is, can you tell me that that's true? And can you unpack the statement a little bit? Yeah, I've seen that. And we never talked to them about it. I'm not quite sure what context that was taken in. I think one of the things that, as a culture, is really important to us is I'm executing before we talk about something. And so what that was probably talking about is that for 10 years, we never did a press release. We never had a website. We never talked about anything except to people under an undisclosure because we hadn't done it yet. So this is kind of an anti-vaporware stance. It's a belief that if we're really building something for the long term to realize a change in the system, then we need to complete it in terms of, in that case, technology development. And then once it's done, talk about it. And that's true. It is true today, at least what I just said is true today, in the context of the work we're still doing. I mean, there's a lot of people who have questions about different elements of what we do. And as we've completed different milestones that we have for ourselves, we'll talk about them. But until we've done that, we think we need to keep our heads down and get the work done. So if there were somebody in the audience who's like, I'm a professor of the thing that your machine does, as you can tell, I'm keeping my options open here on defining the field. And I would just love to give some blood through the pathway that is the Theranos pathway and give some other blood the normal way, which is called the what, questway or the Brigham women's way, I don't know. The normal way that involves really get stuck, the full bottomists are like, yes. And then compare them to see if the person with two watches knows what time it is or not. With that kind of bake off, is it premature to do that? No, not at all. And we do that all the time. I mean, that's data, right? And data, the beautiful thing about data is that data speaks for itself. So we've had the privilege of working with thousands of physicians in Arizona, which is where we've created our model. First thing we do when we start working with them is say collect blood the traditional way, do it through us, get experience with us before you begin using us. And I think that's really, really important. And that's something we do a lot of. Because the reason I asked was, as best I could tell in reading the press around it was as if that weren't happening. There are entities who collect blood the traditional way, who are very vocal about their opinions about us, which We call them vampires or psilons. Which say a lot of things. But we think, fundamentally, the reason we're doing this is to try to help realize a shift toward early detection. So the quality and the integrity of that data, we hold paramount. And it's part of why we became the first lab and only lab to voluntarily submit all of our tests to FDA, as well as advocate for FDA regulation of lab tests. And I guess your allusion to entities in the world that might not be thrilled to cheer on Theranos. Does that explain a little like when you're forming a board, it's like, who do I want on my board? And your board appears to be kind of like, I assume everybody said yes whom you asked. It's hard to imagine any of these folks are like second choice, like Henry Kissinger. Like the only person missing from your board is the Pope. I was like, where is Pope Francis on your board? We should talk about that. I agree with that. But like you've got a former Defense Secretary. You've got the man who won a Nobel Prize for signing accords to end the war in Vietnam. You've got two former senators. Is that right? Covering both parties? And a doctor. Tell us about like the brainstorming that goes on behind that's the board. Is that the board that says to those interests out there, try us. Henry Kissinger is not someone you want to be the enemy of. No, that's a group of people who I've had the privilege of learning from and who are incredibly wise. And I reached a point in our company in which the people I wanted on our board were people who really understood strategy and who really understood public policy in the context of the fact that our goal is to realize a shift in the health care system here and globally. And who really understood leadership. I mean, one of the amazing things about having the privilege of learning from these people is you learn what it means to lead and build an organization where you're building people from within. It does make for a daunting board meeting, I'd imagine. Like Henry Kissinger's like, no, that's not going to fly. All right, I'll try again. But just on behalf of those who are thinking of starting their own company some days, maybe they get their seed run to funding, they're about to figure out their board. Like, just hum a few bars of how did that happen? Was it like, I'm just going to write to Henry Kissinger? Was it one of the funders? It's like, I know, I'll reach out. I don't mean Henry in particular. But these kind of caliber of people who are in the public eye that are probably not so easy to ring up. I think in the context of people building a company, you need to ask the question, what is useful in the context of the board? And I certainly have felt that at different stages in our lifecycle, different types of expertise was very useful. In our case, those were people who I had the privilege of getting to know and, in many cases, working with for, in some cases, a couple of years before we asked them to join the board. And that was really important to us. Got it. Now, you just came from here, a panel on women in science and such. I'd love to invite you to frame the question you'd like to be asked about women in science, and then answer it. I don't know if I've ever done that before. It was really inspiring to be with the people in that room. They're some of the people that I most respect. And I think it's so important to see women like that keep doing what they're doing, because it's how we redefine what is normal in the context of women in science. And it's these people who are going to do that. I'm also tempted to ask a little bit about academia, because it sounds like, at once, you're both a perfect exemplar of academia at its finest and working best. Like, you got to Stanford and were able to release yourself on your own recognizance, because the institution had nothing more it needed to teach you, because it had already conveyed so much. That's one kind of story. Or is it the Peter Thiel-esque story of, let's just get out there and get to work, at least for those people who have a strong vision, know what they want to do, are so moved to do it that they're going to be avoiding their classes. Academia is almost just not a fit. How would you steer between those polls? I think there's nothing more important than education. And I think that depending on what you're calling is, what it is that you love, you need different types and amounts of it. And in my case, I happened to think that I had what I needed. But in some cases, that means you must have graduate school. In some cases, it means you must have medical school. In some cases, it doesn't. If you were given the impossible, which is a time out, the entire world will just go on hold for a year. And you can now build your junior year at Stanford. Where would you start looking in the course catalog? It's a great question. Yeah, I'm probably in math, because it's at the heart of everything. And that's for the joy of it? Or because you might unlock the secret to something that then does something practical or both? I just, I mean, every area that I've had exposure to, even we were talking earlier, whether it's in art or engineering, it's at the heart of being able to create great things. People keep saying how math is so derivative. And I disagree. I'm with you. I think it's integral to, sorry. I figured if I can't make that joke here, where can I make it? And the answer probably is you can't make it anywhere. And here was wrong, too. I think it worked. It did? Oh, very good. This might be a good moment, actually, to see if there are questions from other people, for which I can take a glimpse to see if, by way of Twitter, San Francisco, and then by Cupertino, a question from this room has arrived on my phone. Here's a question from Stephanie. Hey, what are some books you would give as a gift? So the book that I read over and over again is Meditations by Marcus Aurelius, which is a phenomenal book that talks about a purposeful life. And every time I read it, it means something else. And when did you first read it? When I went to Stanford, when I was going to Stanford. Credit that to Stanford, at least. That's amazing. To my dad, yeah. Wow. English or Latin? English. Very good. Very good. Should we see if there are other questions? And if there are, I can even scoot out to somebody, given what is probably, at this point, a microphone shortage. And feel free to say who you are. And oh, you have a microphone. All right, so we have a microphone. Feel free to indicate that you are moved to ask a question. And we will. Yes. Hi, that was a very inspiring story. It's really amazing to see, and hear firsthand your account of how you saw your company. So I had a question about your perspective on how, so when most people start their own medical companies or startups, they publish scientific literature, and then they use peer reviewed literature as a basis for starting their company. Whereas in your case, it seems to be more patents and in-house. So have you faced any opposition or skepticism on going in a non-traditional way, and do you see this as being standard going forward? When you have startups, especially in the health care medical science industry. Did you hear the question, OK? I did. I think it's a great question. It's very interesting, because for what we do, we're in the lab business. And so the way you measure the integrity of a lab test is that you compare it to some other reference method. And you do, for example, prospective clinical studies in which you measure an analyte in a large group of people and look at the data. Well, the highest bar for that is FDA regulation. Because in addition to doing the analytical validity of a lab test, you have to do the clinical validity of the lab test. And you also have to prove its intended use in the context of how that lab test is interpreted. As a company that believes deeply in the role of the individual in health care, we believe just as deeply that you cannot compromise on the quality of the test. So what we decided to do was run all of those prospective studies for every single one of our tests and submit that data to FDA. In the context of the peer-reviewed literature, what exists with peer-reviewed literature in the lab space is people arguing, for example, that they've invented a new method and that this method is better than that method, for example, for a certain type of test. What matters for us is the integrity of our data, the integrity of our test. So that is what is regulated by FDA. And in fact, the FDA website will tell you that peer-reviewed literature is not even sufficient for demonstrating the integrity of a test. You have to run these very controlled studies. And so that's where we've focused. I think it's different depending on the field. And as a growing company, you can only put so many resources in so many places at one time. We think that the importance of peer-reviewed literature is invaluable. For us, for what we do, meeting the FDA quality bar is the thing that matters most, because the question that we have to answer is when we say the value of a glucose test is X, is it X? And that sort of is more applicable to the FDA framework, which is why we approached it that way. So it sounds a little bit like this is further explaining what I had asked before of the Eureka moment. The Eureka moment was less. I have a new methodology for something. If you add the acid to the water, things work out much better. It's not that kind of methodological insight, but rather I'm going to set a goal. And if we can achieve this goal by hook, by crook as an engineering almost hacking matter and then make it replicable, we win. So let's just get down to business, get some musketeers, and get to work. And tell me if I'm translating this right. It was both. I mean, we've had to completely redevelop the assays and also the hardware that is used in a traditional laboratory. And there were very big Eureka moments associated with that. We didn't know when we started exactly how we were going to do it. And it took us years and hundreds of millions of dollars to figure it out. But we did. But in parallel with that, we said the purpose of these technologies is to provide an incredibly high integrity lab service. And so therefore, we must subject ourselves to the highest level of regulation because what we have to prove to ourselves and to the world is that ultimately what comes out of all of those technologies, which required Eureka moments, is of value. And that value has to be accurate every single time. So now I have this kind of cartoonish vision of a neatly wrapped package being deposited at the footstep, at the doorstep of the FDA. Like FDA, go to it. Have they come back with anything yet? Have they been like by gum? We've run the tests. And believe for you, or have they been like come back Saturday? Well, we're working with them. And this is a very new and controversial space. The lab industry has argued that FDA regulation is not necessary because we're all already regulated by what's called CLIA, which is a law that effectively describes the way in which labs should be regulated. So their argument is, well, we're already regulated by them. Why do we need to also be regulated by FDA? None of that law labs have different statuses or a gold star or not a gold star. They have certifications and they get audited. And for example, every week we do what's called proficiency testing, which is where you have blinded samples that are sent to you. And you have to get the right answer on the samples in order to maintain your license fundamentally. And so we looked at this. We went through the CLIA certification process. We've done all the audits. We do all the blinded sample analysis. But the bar, going back to the question that was asked, to realize clearance or approval from FDA is higher. And the way that I always think about this, we have an extremely long-term mindset in what we do is if my mom is getting her testing done through us, which she does, I want to know every single time that the integrity of that test is perfect. And if it's not, then we shouldn't be offering the test. And if to know that, we need to go through all this extra work and spend all this extra money and all this extra time, then that's the right thing to do. And therefore, we have basically said, we didn't have to do this, we're going to submit all the tests to FDA. And we're creating a framework to show that it's possible to do this. Has the FDA indicated that they will at some point then weigh in with how they view this stuff? I think they view this as the fact that laboratory-developed tests should be regulated by FDA, and they actually just issued a guidance document that describes their proposed framework for starting to do this. Got it. Other questions? Yes, over in that zone. Feel free to say who you are or not. Hi, my name's Eva Shang. I'm a student at Harvard College. So my question is, given the profit-driven nature of running a company and the public health nature of the work that you're trying to do, what kinds of moral concerns and dilemmas come up for you and have come up for you in the course of your work? So I've always believed that you can do well by doing good. And in the context of, for example, our business, one of the things that we've done and that we spent the last 12 years on doing was really reducing the cost of testing and reducing it to a point which we can, for example, bill Medicare or bill Medicaid, started at 50% off of what they were willing to pay, going to 90% off of what they're willing to pay. Because we fundamentally believe that if you're running a business where, effectively, your business model is to wait until you get someone who's uninsured and then you find this person who's in need and you're going to go charge them $10,000 for a test, that is not the right thing to do. And so the way we've designed this company is around being able to provide access. So we develop tests which we make available for $2. That's the type of thing that traditionally would be funded by foundations because we think it's the way to build a better business. And we think that in health care, more and more people need to be thinking like technology companies where you're constantly reducing price and you're constantly improving quality, not because you have to, but because you can. And that ends up creating a better product for your end user. Do you have thoughts on an international strategy on places where you could imagine a test as self-contained, at least as the collection piece of it is, and cheap as it appears that it could be, could really transform testing? We think it could be transformative and it's something that is incredibly important to us and we think there's tremendous opportunity there, especially in the context of the fact that in so many environments, there's not a good traditional lab infrastructure and there's great opportunity to, like cell phones did with landlines, leapfrog over the lack of effective traditional technology in a lot of these countries. Other questions? I see a hand in that zone. I assume the mic is already finding its way. Oh, wherever the mic is, is I guess where the question is. Hello, my name is Magnus Larson. I have a startup, also doing early detection, but haven't gotten to the same stage as you have yet. I think it's wonderful what you're doing in this field. I'm curious about, now that you have this whole infrastructure of working with doctors and hospitals, have you considered expanding beyond using blood as the basis for early detection? Yeah, so ever since we launched our lab infrastructure, which was just over a year ago, we process all matrices, right? So we do urine testing, we do feces testing, we do saliva, we do swabs, smears, and we think that those, in some cases, are just as important, if not more important than blood. I was looking for another quote I had found from you, because this may be on the minds of would-be people who are doing startups, because there's always that line between I'm right and the rest of the world just needs to catch up to me, or maybe the rest of the world is what we call reality and I should tune in more to it. You're quoted, I think, by the same journal article that you were somewhat skeptical of from the earlier quote. Quote, if I needed to, I would restart this company as many times as possible to make this thing happen. This has, I don't know if we'd call it a, what's the right metaphor? Is it the Energizer Bunny? Is it the Terminator? It's a sense of kind of relentlessness and we're just gonna keep going. I just love a meditation on that with knowing that there are people wondering how long to keep on keeping on with that idea they have as they're trying to get the rest of the world to conform to them. I think it's different for every person. I did say that and you know, for me I've always believed that in any field when people find what they love, it is by definition what they have the potential to be incredibly great at and what that meant for me was finding something that I love so much that if I got fired or I had to start the company over, I would keep doing it because it's what I wanna do with my life and I think there is something so profound in that because when you realize that and you understand why you're doing it, you keep going through really, really hard circumstances and that's so essential and ultimately succeeding. On the inspiration front, Shailen Thomas who's texting me some of the questions from the feed asks, do you have need for a prospective MDJD at your company which is what Shailen is about to be doing so can connect you up later but he's now totally mortified. Call me. The other question that he forwarded was from Tiffany Lazo-Sadre, where will Theranos be in 10 years and what do you think could stop Theranos from getting there? I can't tell if that's a question from the entities or if that's just a more casual kind of question. What's your greatest weakness? You know where we wanna be is at a point in which we're making early detection and prevention a reality in our healthcare system and at a point in which people have access to actionable health information in ways that they haven't before. So what that means in our belief system is empowering people and empowering people, in part means working to create great transparency around pricing because one of the great challenges in our healthcare system is that people have not had visibility into what things cost and that has allowed the industry to operate in ways that are very different from other industries, for example, the technology industry. So 10 years from now we wanna see lab testing be incredibly low cost and be incredibly accessible including as painless as possible so that people engage with it and engage with it in a preventative context in time for their physicians to be able to change outcomes. Could you ever imagine once the investors are paid back, paid back even handsomely, open sourcing everything, going from the utter secrecy needed to make the thing happen and flow to complete transparency in order to make sure it gets picked up and distributed as much as possible? Yeah, I mean where we are now versus where we were two years ago in the context of the amount of information that's out there about us is very different and it'll be the same two years from now and the more that we can partner and work with other companies and academic institutions to realize this mission, it's something that we're deeply interested in and already doing some things around. Got it. One more question, wherever the mic is is where it'll be. Hi, my name is Eric Feigolding from the Harvard School of Public Health. I'm not a laboratory person per se, but a lot of our laboratory colleagues have these questions and there are no technologies amazing for capillary blood but capillary blood is arterial blood. It's not venous, different from venipuncture. And so a lot of questions in terms of, there's concerns about contamination from cellular components when you take capillary and you get very different results for lipids and for protein and for calcium, sodium and lots of these other things that, arterial blood from your capillary is very different. So, and again, a lot of your results are not published in the literature. So how would you address these to these traditional laboratory scientists? This is what we call a very big picture question. No, I think it's good. The old arterial versus venous debate of almost religious war. I think it's great. You know, so first of all, we publish clinical correlations on our website. They're on there right now. They've always been on there. And we know other labs don't do that. This is why it's hard, right? So when I talked about having to redevelop all the assays, these are some of the challenges that are presenting and getting an assay to work on a capillary sample, right? So we have clinical correlations for lipids and other analytes published on our website. We've submitted them in the context of all the submissions that we're working on with FDA. And we've passed all of our proficiency testing with CLIA on them for years now. We've been certified as a lab since 2011. To do this, we've had to redevelop the chemistry and really develop the assay to be able to handle the interfering substances, to be able to see a close to perfect clinical correlation with either a venous sample or arterial samples you normally don't do except for a certain subset of tests that require arterial sampling like blood gases and others. And so that is the validation process. And that is why we believe so strongly in the quality standards that are essential around doing the type of testing that we do because it's really hard and you have to be right, right? I hear you saying as this moves into the mainstream, as obviously you'd want it to do, that the proof will just be in the pudding. How soon till there'll be lots of pudding? Like what's your timeline for moving beyond a couple of Walgreens where they're piloting this into really widespread use? Well, we already have pudding in a regulatory context with respect to- Regulatory pudding is my favorite. It's very good. With respect to the certifications that we've undergone, the state licensures and all the proficiency testing and audits that we've done. And then fundamentally to get to a point where you can do a submission to FDA, you have to have all your data, obviously, right? In so far as expanding the locations, we have decided to take the time to do this right in the context of creating a model that's really scalable and a model that provides the quality and integrity of services that we want to see in terms of people being able to walk out of a location and actually make the statement that, and we hear a lot of this, this was fun or this was wonderful, which people don't talk about in the context of lab testing. You're tripped to the phlebotomist. Yes, exactly. It was fun. So we're at a point now where every single time someone comes to us, we ask them to rate us and over thousands and tens of thousands of visits, we've maintained a 4.8 out of five or higher rating in terms of the experience and understanding how to institutionalize and operationalize and scale that has been our work and now we're beginning to replicate it. Now you opened with what I had called the Stan Lee sort of origin story, the thing that really drove you to wanna do this, which was seeing somebody die who maybe didn't have to, had the diagnosis been earlier. Now with all that has happened since, how close is the goal, not just of a CBC or basics, to be able to use a capillary blood to actually get those elusive markers for cancer or for other things that are almost immediately actionable? Well, we're starting it now and people are able to come in and do those tests today. The access point, it's not just about capillary blood, it's about incredibly low cost, it's about transparent pricing, it's about being able to go somewhere to do a test on a weekend without having to go to an emergency room and we see, for example, in our wellness centers, which are what we call the places that we offer our testing, people coming in with years worth of lab requisitions, meaning these are requisitions that they've been sent to go do tests from physicians and they didn't go and it's often because they can't afford it or it's not convenient or they're scared of needles. That's the fun part, if you could make it actually a pleasant experience, you do it. You can engage them. But when you look at this question of early detection, I mean, the example that blows my mind is that as a country, 20% of our entire US healthcare spend is on type two diabetes, which is reversible through lifestyle and diet and we have 80 million Americans right now who are pre-diabetic, 90% of whom don't know it and all you need is a very simple test and you start to find this out in time to do something about it and at that point, people can choose to do something or not but the fact they don't have this information is what we need to change. So every day, starting with these 40 locations that we've built out in Arizona and Phoenix, we're providing access and we know that's starting to change because we're seeing all these people who wouldn't get tested before who are now starting to get tested. Another question, is the mic found another home? Hi, my name is Mohamed Saleh. I'm a student from the University of Toronto and I'm turning at Dana Farmer and I have a couple of questions so you can pick and choose if you want. One to a customer. Okay, then it would be a question about the potential of over-diagnosing. There's a lot of talk about how, say, for example, mammographies over-diagnosing through that and whether this would be something that's something that's going to be commissioned by a doctor or is it just going to be freely available at your local Walgreens or how's that going to work? It's a great question. Yeah, it's a really important question and we think a lot about this. So our philosophy on it is as follows. First, we fundamentally believe that it's a human right. If people want to spend their own money that they pay taxes on to go purchase a test in the interest of preventative care that you cannot buy law, tell them that that is illegal, right? I mean, the fact that I can go buy a gun, shoot myself and that's fine but ordering an allergy test is illegal, right? That the government is going to prohibit me from that. There's something wrong with that and when you think about the diabetes point and the reality that we've got all these people walking around in our country that are bankrupting the country because they are not diagnosed, right? Fundamentally early enough, we got to change our system. Now, one of the reasons that we believe so strongly in the importance of FDA regulation and the intended use of these tests is that if this data is in the hands of an individual then you need to make sure it's right and you need to make sure that what you're saying about it is right and that's why we've been doing all that work. In addition, we believe that if you can transform the cost of testing, then you can take tests that are confirmatory in nature and make them accessible earlier, right? So for example, in the context of infectious diseases are the cost of a nucleic acid amplification-based assay is so inexpensive on our platform that you don't have to rely on an antibody screen and therefore you don't have the false positive challenge that you would traditionally have and so that's what we're doing is taking these confirmatory tests and making them incredibly inexpensive so that you can improve the integrity of the testing. Finally, in so far as our world is concerned, our mission is early detection, right? That's why I started this company, that's what we believe in, that's what we work 24 hours a day for every single day. So the purpose of this is to get someone to engage with a physician. So all of our technology, all of our tools are about changing the reality that today, 40 to 60% of Americans do not go get a requisition done when they're given this requisition by a physician. Get them to get engaged so that they can see their doctor, right? The only paradigm that we know for this is pregnancy testing, right? Where women, they don't go to their doctor and then go do a pregnancy test. They do a pregnancy test, what's the first thing they do? They go to their doctor, right? So as a technology company, what we're interested in is if someone engages in getting a test done, how do we then link them into the care paradigm so that they can work with their physician to intervene earlier? And that's where we're investing. One more question, is the mic found at home? Thank you. I'm Nidhi, I'm a data scientist. So my question is, one of the side effects of what you're doing is the digitization of all of this data. And have you already started mining it and are you seeing any trends or do you have plans to do that? And if so, can you talk about some of them? So this is another really important area. We publish on our website that our policy is people own their own data period. We will never advertise on it. We will never sell it. And if they ask us to delete it, we'll delete it 100% of the time. And we think in healthcare that is fundamental. So we haven't already started mining in that context. We think there's tremendous potential. I mean, we were talking about the open source question earlier to where people do want their health information to be used in a research context or in a context in which people could look for patterns and these types of things to be able to engage there. But that's in a situation in which they explicitly say, I wanna be part of something like this. And in the future, I think there's a lot of companies that are doing wonderful work in trying to make an impact in that space. For us right now, what's really important is to create an ecosystem that's highly secure where no one gets access to this data because part of the challenge has been historically, companies have been selling this lab data and people are not gonna go in and get a test for a sexually transmitted infection if their mom or their insurance company or someone who they don't want to see it is seeing it. So we've invested a lot in creating a highly secure ecosystem. Which also suggests that some of the research being done at places like our CS department on differential privacy on other ways of taking big old databases and making them so they are still useful as big data but not useful for microscopic pinpointing could be very interesting techniques to try to apply to. I agree, we'd love to learn more. I'm glad you asked. I think we have somebody who can tell you. Before we introduce you to her, last question. Once again, for those who are in the audience and thinking of starting their own companies and such, I guess you really got this thing started around 2003 or so, which is kind of an eternity ago. We just had the crash of 2001, people were sort of picking themselves off the floor a little bit. Do you have a sense of whether the environment in which your idea and honestly your passion for it was able to be detected, amplified, channeled, refracted, does that environment still obtain there or is it so loaded with, I will dare use the word spam? Right, so many people saying, have I got a great idea? Is it still possible or how does it work? Any advice you'd give for somebody who might say, gee, I'd like to follow in these footsteps for my passion, but it's so hard. I mean, we saw the statistics from Patrick of just how many things come over their transom and then they picked 10. How do you get through that in this environment? I think it's always possible. I mean, one of the most interesting things to me has been reading about what it meant to be an entrepreneur in the early 1900s, right? And at each generation, each cycle, there's a different economy, there's a different environment, but what holds true is what I think is so amazing about this country, which is it's a place where if you have an idea and you don't let it go, you can create something. And I think the merits of the work and the commitment and drive and hard work that the people put into it can win, right? If you really, really commit to it. Well, and that really suggests why you might have named your earlier project Edison and the perspiration and inspiration ratios and your willingness to really pursue that and to take that leap that you described, I figured it would be good to end our conversation with a meditation from Marcus Aurelius. Most of them are about death, so it was, be a bit of a downer, but here's one that seems somewhat fitting. You tell me, the point of life is to follow reason and the divine spirit and to accept whatever nature sends you to live in this way is not to fear death, but to hold it in contempt. Pass on your way then with a smiling face under the smile of him who builds you go. I don't know how well that exactly fits the moment, but certainly having a sense of oneself and where you wanna go and what you wanna do and really the impact you wanna have on the world, I can't think of somebody who's better exemplified that than you have in your choices in your career and in your remarks today. So we owe you a huge thanks for spending some time with us and talking about this, thank you. It's an honor to be here. So now it's a matter of traffic management. I think we are going to turn the proceedings over to my dear colleague and friend, Professor Margo Seltzer, who is going to, I think you have indeed earned it, is going to award you the X-Fund Medal. So I'll turn it over to you. Margo. Thank you. Wasn't that inspiring? It is so rare in today's startup culture to hear about company values and a shared mission and making the world better. And I've had the pleasure of co-teaching with Regina Herzlinger at the business school in innovating in healthcare and she says, do good, do well. And those exact words came out of your mouth and it was wonderful. So I have the distinct honor of getting to give this remarkable, amazing woman a fabulous award. And again, when you hear about entrepreneurship, you think high tech and the next cool app as opposed to fundamentally changing the world. And I think that recognizing Elizabeth for her work is really a fabulous match with exactly what the experiment medal is about. It's awarded for an outstanding visionary check, role model check, liberal arts founders check, and the kind of people that X-Fund wants to identify and support throughout the world. So I can't imagine that they could have found a better recipient this year. And I am just so thrilled. The medal is inscribed, pair experimenta ad weretatum through experiments to the truth. So we have this cute little tradition at Harvard that when you get an honor degree and I think it's good to stand up and we read the inscription which they can all see they can all see up there. And I will read here which says for her belief that every little drop counts in the astounding quest to bring everyone the most essential data about themselves on behalf of the X-Fund. Thank you so much, Elizabeth and Margot. We could not have done this without you. We really appreciate it. Everyone, thank you. That concludes our event today. We look forward to seeing you next year and we look forward to your help to build this fund. Someone joked earlier today that it takes a village to raise a child. We joke that it takes a university to raise a venture fund and we're very lucky to have all of you with us in that quest. So everyone's invited tonight at 9 p.m. at Alden and Harlow for experiment cocktails. Please join us there. And with that, thank you very much. We'll see you next year.