SEveryone is obsessed with genomics. They think it’s the key to unlocking personalized medicine. I’m here to tell you they’re wrong.
I’ve spent the last decade in the trenches of Silicon Valley, building and investing in companies that are trying to change the world. I’ve seen firsthand what works and what doesn’t. And I can tell you with certainty that the future of personalized medicine isn’t just about sequencing your DNA.
It’s about something much bigger: AI-driven predictive health.
The Genomics Hype Machine
Look, I get it. The idea of a single test that can tell you everything you need to know about your health is seductive. And genomics is a powerful tool. It can help us identify rare diseases, understand our risk for certain conditions, and even develop more targeted therapies.
But it’s only one piece of the puzzle. It’s like having a list of ingredients but no recipe. You might know that you have a genetic predisposition for heart disease, but that doesn’t tell you what to do about it. It doesn’t take into account your lifestyle, your environment, or the thousands of other factors that contribute to your health.
I’ve seen too many founders make the same mistake. They spend millions of dollars and years of their lives building a company around a single genomic marker, only to find that it’s not enough. They have a great piece of technology, but they can’t turn it into a product that doctors will use and patients will pay for.
The Real Revolution: AI-Driven Predictive Health
The real revolution in personalized medicine is coming from a different direction. It’s coming from companies that are using AI to analyze a vast range of data—from your medical records and lab results to your wearable data and even your social media activity—to build a truly comprehensive picture of your health.
These companies are building predictive models that can identify your risk for a wide range of diseases, from diabetes and heart disease to cancer and Alzheimer’s. They’re developing tools that can help you make better decisions about your health, from what to eat and how much to exercise to which treatments are most likely to work for you.
I’ve invested in over 200 companies, including some of the biggest names in AI like Anthropic, OpenAI, and Scale AI. I’ve seen the power of AI to transform entire industries. And I believe that healthcare is the next frontier.
From Theory to Practice: A Story from the Trenches
I remember one of our portfolio companies, a small startup out of Stanford. They had a brilliant idea for a new cancer diagnostic based on a novel set of genomic markers. They had the patents, the PhDs, and the fancy lab equipment. But they were struggling to get traction.
Their test was expensive, and it only provided a small piece of the clinical picture. Doctors were hesitant to order it, and insurance companies were reluctant to pay for it.
We sat down with the founders and had a tough conversation. We told them that their technology was impressive, but it wasn’t a business. We pushed them to think bigger, to think about how they could use their technology to solve a real-world problem.
They went back to the drawing board. They started talking to doctors and patients. They realized that the real need wasn’t for another diagnostic test, but for a tool that could help doctors make better treatment decisions.
They pivoted. They built an AI platform that integrated their genomic data with a patient’s clinical history, imaging data, and even data from their wearable devices. The platform used machine learning to predict which treatments were most likely to be effective for a given patient.
The results were astounding. In a clinical trial, their platform was able to predict treatment response with over 90% accuracy. Doctors loved it. Patients loved it. And the company was acquired by a major pharmaceutical company for a nine-figure sum.
The Uncomfortable Truth About Healthcare AI
Building a successful healthcare AI company is not for the faint of heart. It’s a brutal, regulated world. You need more than just a great model. You need a deep understanding of the clinical workflow. You need to be able to navigate the complex web of regulations and reimbursement. And you need to be able to convince doctors to change the way they practice medicine.
Most founders fail because they don’t understand this. They think that if they build a better mousetrap, the world will beat a path to their door. But in healthcare, that’s not how it works.
You need to be a missionary, not a mercenary. You need to be passionate about solving a real problem. And you need to be willing to do the hard, unglamorous work of building a real business.
The Future is Predictive
The future of personalized medicine isn’t about genomics. It’s about AI-driven predictive health. It’s about using the power of AI to make sense of the vast and complex data that surrounds us, and to use that data to build a healthier future for everyone.
The founders who get this will build the next generation of healthcare giants. The ones who don’t will be left behind, holding their expensive gene sequencers.
Frequently Asked Questions
Do all experts agree with this view?
No, and that's fine. The best ideas in business are often contrarian. I share my perspective based on my experience and data, but I encourage you to seek out opposing viewpoints and form your own conclusions.
What experience informs this perspective?
This perspective comes from over a decade of building companies in Silicon Valley, two successful exits (RemoteTeam to Gusto, MovieLaLa to Gfycat), and investing in 200+ startups including Anthropic, OpenAI, and Scale AI. I write about what I've lived.
What's the most common pushback you get on this?
People often push back by citing exceptions or edge cases. And they're usually right that exceptions exist. But building a strategy around exceptions rather than patterns is a losing game for most founders.