D.A. Wallach
The Frontiers of Health
Video Transcript
The Frontiers of Health
Main Stage Session
Main Street Summit 2025
D.A. Wallach & Brent Beshore
D.A.: I'm so glad to have you. What do I need to know about you?
Brent: Thanks, man. Let's see. How am I showing up? I'm showing up tired, a little bit. I'm showing up encouraged. I'm excited about what's going on.
D.A.: You look ripped, man.
Brent: Under both of those shirts, yeah. That's the vibe.
D.A.: I'm picking up what you're putting down.
From Rock Star to Biotech Investor
Brent: Well, you know, actually we met weirdly enough, I think 10 years ago now. You were the guy I introduced as a musician. You were at the time like a rock star, like a literal rock star.
D.A.: That's a little bit of an overstatement.
Brent: I don't know. Tell us about that. How did you go from music to being in biotech and investing?
D.A.: Unexpectedly. I ended up a professional musician because I started a rock band in college when I was sort of dismayed freshman year to learn that most of my peers were headed towards management consulting or investment banking. And I thought, screw that.
[Laughter]
Brent: Screw those people.
D.A.: Well, I mean, it's good if you want to do transactions, but I'm not here for transactions. I'm here for friendship.
Brent: Yeah. There we go.
D.A.: So I thought, look, what's the best job? It's being a rock musician. And I loved music. And so I was incredibly lucky to end up doing that for a living for many years. And then I think the pattern in my career—which has had no plan—has just been to follow my curiosity wherever it takes me. And so my first foray into business was Spotify, which, serendipitously, was the first investment I did, and it was a really lucky place to start.
Brent: I heard that's done okay.
D.A.: It's done okay. And that brought me out of the world of music into the world of investing. As I started to learn about capital markets and venture capital and how to diligence companies, I started doing more and more of that and spent a few years kind of wandering around doing generalist tech investing. And then I had my first exposure to the healthcare industry and was just blown away by how screwed up it was. I felt that if I'm going to be doing venture capital, I might as well do it somewhere where, one, there's a lot of work that needs to be done, and two, where you get better the longer you do it. Healthcare and biotech—which I now do—are two areas where the intrinsic complexity of those spaces is such that the longer you do it, the better you get, almost certainly. So it's been an interesting turn.
The Frontiers of Health
Brent: Well, let's talk about the frontiers, because you get to see a lot of really interesting things that most of us will find out about in maybe five or ten years. What are the things that you've seen coming down the pipe that you knew were going to be a big deal, and that now are coming to fruition? And what are the things that are that next frontier?
D.A.: I'd say over the past few years, one of the most exciting developments has been to see a number of cancers truly find cures. Part of that comes from the fact that cancer is an extremely heterogeneous disease. It's not one thing. It's not defined by the organ, which is what we talk about it in those terms—you have liver cancer, you have brain cancer. It's an incredibly fragmented pathology. And so the revolution of the past decade, in many ways, has been to taxonomize cancer much more narrowly and to develop therapies that can address the molecular driver of a particular cancer. And in certain cases, that has been curative. So that's been very exciting.
D.A.: If you zoom out to a broad historical frame of reference, the way I think about where we are is that medicine is in this multi-century transformation that began as something that was complete BS. It's fascinating, actually, that medicine now is somewhat scientific, because it began as full-on witchcraft. The first people who said they were doctors in antiquity truly, demonstrably knew nothing. So it was a sophistry kind of profession. And then throughout history, it slowly started to become a real science.
D.A.: What people, I think, often fail to recognize—because it's dressed up in a lot of professionalism and credibility and formalism—is that we're still somewhere in the middle of this journey from witchcraft to becoming a real science. Medicine today is still kind of 50% BS and 50% amazing science.
Brent: How do you, as a consumer of healthcare—which we all are—sort the 50% BS from the real science? How do we know what to pay attention to?
D.A.: The same way I think that intelligent investors try to find the truth, or anyone intellectual tries to find the truth: you have to triangulate across different points of view, across different sources of information, and you shouldn't just receive anything as a matter of settled authority. I don't trust—I mean, if something really bad happened to me, I would as a start want multiple opinions. Anyone here who gets cancer or heart disease or something—do yourself a favor and see multiple physicians and hear multiple points of view.
The U.S. Healthcare System
Brent: Maybe talk about the healthcare system more broadly and the insurance system. Why does it seem like we spend tremendously more and the outcomes aren't fantastic? What is a solution that you can bring to really change the way we do medicine?
D.A.: I know there are a lot of value investing fans here and Buffett fans here. The easiest thing in investing is to bet on things not changing, because most of the world doesn't change that rapidly. We all get excited about the pockets where change is rapid, but most things are stasis. And so the first thing I'll say is I'm not actually that optimistic about the United States healthcare system changing, because there's not a lot of incentive for the people involved in it to change it.
D.A.: The insurance industry is a great example of this. I would argue pretty fervently that it adds no value. It's an extractive component of our healthcare system. Insurance functions to pool risk because you don't know at birth who's going to get what diseases and who's going to be expensive to take care of. So we all kind of go in on it together. In America today, we essentially socialize about 50% of our total healthcare costs across Medicare and Medicaid and so forth. And then we deliver or pay for the other 50% through the employer-based health insurance model that most of us are familiar with.
D.A.: Your employer outsources your medical insurance coverage to a private insurance company. That private insurance company is meant to sort of manage how that money is spent. That's really what they're there to do—to ration care at some level. That can either be done by these private insurance companies or by the government, which is how a lot of places do it. But because we outsource it to this highly fragmented insurance ecosystem, we create just a fractal level of complexity around administering payments and figuring out who needs to be paid for what and at what prices. One of the crazy things is that if you go to a hospital for a particular service, depending on what your insurance is, there's going to be a different price for the same service.
Brent: Yeah.
D.A.: So there are all these extra layers in the system that are just there to route payments and figure out who's owed what and how much their negotiated rate was. The best idea I've been able to come up with is something I call Zero Toll Medicine. Forgive me, it uses crypto—
Brent: Disqualified.
[Laughter]
D.A.: I'm interested in this aspect of crypto that I think is historically original, which is that you can basically program how individual dollars can be spent. My best idea is you give every person in America and every physician in America a crypto wallet. You basically have the U.S. government deposit into those wallets healthcare stablecoins when something's going on with you. You get some cancer, the government looks at what, on average, it takes to treat that cancer in terms of dollars, and we deposit that amount in your crypto wallet. And now you, as the patient, have the power to figure out how to most efficiently spend those dollars. You can do comparison shopping, and we can incentivize you to spend as little as possible to achieve the best outcome.
D.A.: I think the patient is the most underutilized component in our system. Think about how much time the average mom or dad in America spends choosing a grill when they need to buy a new one. You see how smart people are—they go all over Reddit, they figure out all this stuff, and they end up buying a Big Green Egg.
Brent: Probably the smart ones. I'd say Traeger, but we can agree to disagree.
D.A.: Fair enough. But we don't do that in medicine. As soon as you get sick—the most significant event maybe in your entire life and the most expensive thing that's ever going to happen to you—and you just go, “Doctor, tell me what to do. You decide.”
Brent: Yeah. It's crazy.
AI and the Future of Healthcare
Brent: Talk about AI and the impact it's going to have on the healthcare system and on health in general. There have been some pretty fantastic claims out there about transforming and basically eradicating disease. What's your take from the inside? You see a lot of this stuff early. Is AI going to transform how we do healthcare? Is it going to transform disease? How do you think about AI?
D.A.: There are two domains that I think about a lot. One is the development of new medicines—biotech—and the other is the delivery of medicine—healthcare. In the biotech domain, there is a lot of—I would say—over-optimism right now around the potential for AI to fundamentally transform molecular biology and drug development. You'll hear Jensen get up and talk at Nvidia things—that's one of the four or five areas they're always trumpeting as about to change everything. Unfortunately, today, the only way we can figure out if drugs are safe and effective is to run human clinical trials. And that sucks because they're very expensive and very time-consuming. So until we can truly simulate whole human physiology in silicon, it's going to be very hard to shortcut that.
D.A.: On the other hand, in the healthcare space, I believe we have already crossed this chasm of having the technology to put essentially the world's best doctor in every person's pocket on earth. I'm a little biased having lived through the transition to streaming music, but I think of it as an analogy—we're entering the era of streaming medicine.
D.A.: Today, we deliver medicine in a highly decentralized manner where we try to find brainiacs at 18 and then put them through 10 years of education, try to impart to them everything we've ever figured out about human biology and pathophysiology. Then they go out there in the world and they imperfectly apply that to patients in a very fragmented manner with a huge amount of variation—which is terrible. The same medical situation that a patient has in Colombia versus New York City versus Nairobi should get exactly the same knowledge deployed against it. It's a very inefficient way for us to deliver medical knowledge.
D.A.: By contrast, streaming medicine would be this idea that we're going to, with AI, basically centralize in the cloud everything that humanity has learned about medicine. And then we're going to enable every person on the planet, for free, to access that medical knowledge wherever they are, whenever they need it. How you actually deploy that in the context of care settings has to be worked out—that's the hard part. But I feel like we've already crossed this historical chasm. It should be the biggest thing that's happened to medicine in 150 to 200 years.
Brent: Yeah. I'll say personally, I had a series of blood tests done recently and was just curious about what it meant. There were some markers that were off, and I asked three separate doctors to give me feedback. One basically said, “No, don't worry about it.” The other gave me one answer that didn't make much sense. And the third one didn't even respond. I put them all into ChatGPT and said, “Hey, you're the best longevity doctor in the history of the world. Drawing on all these things, make those comparisons.” It gave me a 12-page, unbelievably documented report on every single blood marker. So I'm already starting to use it that way, and it feels like the future is here.
Brent: D.A., I'm so glad. Thank you so much for joining us and for being here. Appreciate you, sir.
D.A.: Yeah, my pleasure. Thanks for doing this.
