Otto

Digital-health is boring. But all the people are goofy. Let's bring more of that weird, innovative energy to the surface y'all. That's what it's gonna take to get more outsiders excited to build in this space.

@paulg What, they both look pretty Irish.

If you have multiple kids you might be surprised by how different they look.

@hypersoren X the bastion of human prose

going on linkedin and reading the heavy chatgpt writing style gives me nausea that we've allowed this little game of Professional Sounding Updates to become mediator of work feels bearish for the economy agi cannot come soon enough we seriously must get out and just do things

A stranger complemented my squat form at gym this morning. About to have the best goddamn day.

@maxmarchione Come by @photonhealth we can jam

Just arrived in NYC. Who should I meet to chat peptides?

@maxmarchione You ever read about the (S)-thalidomide enantiomer? 10k children with severe birth defects, thousands died. The FDA is there for a good reason, and it's to prevent humanity from pulling ourselves backward.

I didn't have "pharma bro brings sanity to peptides craze" on my 2026 bingo card.

In healthcare, the competition is really the opacity of the status quo

I think the main problem is that the rules are actually still very vague with the whole 503a/b personalization thing – my assumption is the appetite for risk is uneven and the ones with big legal teams or small ones that have nothing to lose both take the bet. Brands are still too complex for patients to access, and compounds have generally been very effective in terms of negative price pressure. All to say, Brands probably need to change how they sell even more for this to look more like a real market.

Photon shared this post today on LinkedIn and it's crazy to see just how ridiculous compounded GLP-1s got for prescribing. They're still going on to the tune of what looks like 20-30%. Take that for what you will and use that in models is my guess. At least for the ones that aren't breaking rules.

@dvasishtha @yrechtman Best compromise here is to offer early exercise.

@yrechtman How do you feel about extending exercise windows? Say 2-3 years?

Since this is back trending on the timeline: 4 year vesting schedules are an anachronistic holdover. Many of my companies have started switching to longer timelines.

@dvasishtha Series A is the best time to join a company - optimal trade off between cash and affordable upside on equity. But tell your friend to pick based on people, mission, and personal growth opportunities. The money follows if these are right.

Helping a friend decide between two offers it's really emphasizing how much riskier later stage equity can be for employees even if the company feels “safer” The two offers are for: - series A co: raised $15M on $70M - series C co: raised $50M on $400M He’s waiting on the 409A but we're assuming common is at a ~67% discount to the last preferred If the series C co gives him 0.5%, he needs to spend ~$660k to fully exercise. If the series A co gives him 0.7%, he may need to spend ~$162k. That's a huge delta not just on exercise costs but also because of the tax advantages at the series A co where he can: - early exercise and start the holding period sooner - preserve QSBS eligibility - actually keep the equity if he leaves At the series C co the exercise window can force the issue since if he leaves, now he has 90 days or whatever the window is to come up with hundreds of thousands of dollars AND pay taxes on any paper appreciation or forfeit the options. So yes the later stage co may be less risky at the company level but the upside can be significantly muted. It's why you should negotiate cash comp harder at series C / growth stage cos. If the strike is expensive, the exercise window is short, and future refreshes are also going to be expensive, a meaningful % of that equity is pseudo-comp and tax disadvantaged at best.

Thanks for the inspiration to write, @WillManidis.

SF says: do not die. NYC says: live like a god. I wrote about why those have become the two dominant secular ideals of American life, and why both miss the point.

@StuartBlitz You mean you don’t live life on the edge like this?

People that let their phone battery go below 50% without a fully-charged power brick are mentally ill

This was the idea behind our April fools joke last year. Could be neat … It’s quite common to augment algae or lettuce to produce proteins, like peptides. That’s regulated as food too… I don’t think customization down to individual or day makes much sense vs the befits of mass production. photonhealth.com/blog/photon-la…

I think everyone will have a machine that makes your personalized peptide of the day in the morning which you inject

rewatching mad men and getting the sudden urge to start chain smoking and day drinking at work

Sometimes I just open Claude, I look at the empty text box, and I just wait.

“No it’s triple tax advantaged!!” I said as my wife pulled out her HSA card for a $9 fee.

You learn a lot about yourself at sea. Last week I spent 90 hours aboard a 44-foot sailboat for a 600 mile race around the Caribbean. Sleep is the hardest part, especially when operating at the edge of physical and mental limits. For me, offshore sailing has always yielded some potent parallels to company building and leadership back on land. Lots of differences too. Startups are iterative games, with lots of flexibility to recover form mistakes. We all have time to sleep and take weekends off. While we can change the crew if things aren't right, team is everything. Winning is ephemeral, yet finishing a race can feel impossible. Quitting and sailing back to the dock is even harder. The only way is forward. The coolest lesson from this race: One boat capsized in the night, and another stopped to pickup the crew. That rescue boat went on to WIN their class. How classy is that?