Daniel Ek: Life After Spotify, Broken Healthcare Incentives, Catching Disease Early & AI's Potential

(0:00) Daniel Ek joins the Besties! (1:14) Starting Spotify: Beating piracy and betting his own money on the record labels (6:10) Neko Health: The Spotify playbook for healthcare, the $499 body scan, and why US healthcare waits until you're sick (36:04) AI: Tech's failure to sell the upside, open vs. closed models, and regulating compute (44:24) Back to Spotify: Podcasting's open standards and the Stardoll origin story Thanks to our partners for making this possible! As wealth grows, complexity compounds. Between investments, tax strategy and estate planning, coordinating it all can feel like a full-time job. Creative Planning can help with the heavy lifting. https://ad.doubleclick.net/ddm/trackclk/N2598215.3565131ALLIN/B36182939.452362736;dc_trk_aid=646454825;dc_trk_cid=260464105;dc_lat=;dc_rdid=;tag_for_child_directed_treatment=;tfua=;ltd=;dc_tdv=1 Starting a business? Northwest Registered Agent gives you everything you need to build a complete Business Identity including free tools and built-in privacy. Get more at https://www.northwestregisteredagent.com/ALLINFREE Follow the besties: https://x.com/chamath https://x.com/Jason https://x.com/DavidSacks https://x.com/friedberg Follow on X: https://x.com/theallinpod Follow on Instagram: https://www.instagram.com/theallinpod Follow on TikTok: https://www.tiktok.com/@allin Follow on LinkedIn: https://www.linkedin.com/company/allinpod Intro Music Credit: https://rb.gy/tppkzl https://x.com/yung_spielburg Intro Video Credit: https://x.com/TheZachEffect #allin #tech #news

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Jason Calacanis?

  All right, everybody, welcome back to the All In Interview Show where we, the All In Podcast, dedicate an hour to just some of the great thinkers, creators of our time. And today will be no different. Daniel Ek is with us. You know him, the co-founder of Spotify, which he started 20 years ago, and he ran it for those two decades to an extraordinary state of affairs today, well over 700 million active users, over 300 million premium subscribers. But on January 1st this year, he shifted and became the executive chairman with me and David Freiber today. Daniel Ek,

• 0:45Jason Calacanis?

  how are you, sir? Welcome to the program.

• 0:47Speaker 01

  Well, thank you so much for having me. It's good to be on.

• 0:50Jason Calacanis?

  Yeah, it's good to see you. We've known each other for 20 years. I remember the first Shaq, your partner, leaned into me at an internet summit or something and said, hey, check this out. And he showed me Spotify. But this was at a time when nobody had a subscription service. So we're going to talk today about your new startup, which is incredible in the healthcare space. But take us back to the launch of Spotify and how that crazy idea got started, and then how hard it was to break through with the music industry, which are also known as the hardest partners in the world.

• 1:33Jason Calacanis?

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• 2:00Speaker 01

  Yeah, well, I usually start off by sort of saying, whenever anyone asks me about the story, it's like, well, I had hair when I began this, and by the end of this, I obviously ended up being bald. So you can see that it wasn't an easy journey. All jokes aside, I mean, just to kind of set the scene, I mean, I started Spotify in 2006. I was 23 at the time. And the world looked a little bit different. So this is pre iPhone, pre, I mean, Facebook existed, but it was college only. YouTube didn't exist. So just like, that kind of dates me. But this is before all the things we now take for granted. And, and the world at that time,

• 2:42Speaker 01

  and the music industry at that time was in freefall, because music piracy was kind of rampant. So we had Napster, we had Kazaa, we had all these things. And there was an organization called the RIA that went around and actually sued individual consumers in the US for illegally downloading music. And so I was sitting in Sweden, and I was thinking to myself, you know, this is, this is wild, and this is crazy. There's no way to put the genie back in the bottle. And me, my co-founder Martin, we were kind of sitting and spitballing startup ideas at the time. And, and, you know, Martin asked me like, well, you know, if you could do anything you'd like to do, what would you do? And I said, well, you know, my real passion is music,

• 3:25Speaker 01

  but that seems like a really stupid idea. And he's like, well, why is that a stupid idea? And I kind of told him about, you know, it's really hard, because you have to do all these deals with the record companies, you have to then figure out how to do licensing and copyright, and you have to do all of these different things. And he said, well, what if you did this? And then he kept asking these what-if questions. And eventually, I ran out of reasons to say it's, I said, well, I guess you could do something. And if you did something, it would feel like you had all the world's music at your fingertips. And he's like, well, that sounds pretty good. And I said, well, okay, well, let's give it a try. We started trying to license music. Originally, the idea was to try to go global

• 4:09Speaker 01

  from day one. And everyone was just laughing at us when we were originally saying that. But I sort of lucked out, because it turned out that one of the worst music markets in the world was my home country, Sweden. And part of the reason why it was one of the world's music markets was because we had super fast broadband already from the early 2000s. So we were kind of living in the future, where people had such quick bandwidth connections that they could download pretty much whatever they wanted. So they were doing it. And iTunes actually wasn't even available in the marketplace. So there was literally no legal options. So I think the music industry had lost like 80% or something of its revenues. And so it was

• 4:52Speaker 01

  like, it was kind of this crazy of, you know, coincidence and kind of all of these things, the conflicts of events, where we figured out, you know, that me and my partner, we basically took all of our own money that we had made from prior startups. And we said to the record labels, what if we would guarantee you that basically, you'd keep your bonus for the next year, and you'll make your budget for next year, you know, if this really is as bad as you think it is, then you just shut it down after a year, but you still made the bonus. And if this actually works, you win as well. So you win no matter what. And they're like, okay, well, this seems kind of like an interesting idea. And they eventually,

• 5:35Speaker 01

  after a few years of negotiation, agreed to it. So we launched in late 2008. And it instantly became a huge hit. We then took it to the UK and made a huge hit there. And then in 2011, 15 years ago now, we launched in the US. And yeah, I mean, and the rest is sort of history.

• 5:58Jason Calacanis?

  I mean, isn't that amazing? Freiber, five years in the laboratory, just to get to the, to the, to the US market is quite a, quite a journey. That's a lot of pain and suffering.

• 6:10Speaker 01

  Yeah, but, but you know, you know, the crazy thing is, I'm on the same journey now again.

• 6:15Jason Calacanis?

  Yeah, here we are.

• 6:17Speaker 01

  Neco, actually, as crazy as it is, we started the company eight years ago, in 2018. And we started it in Sweden in 2023. So it took us five years to develop the product, tried out in Sweden. And then, once we proven it in Sweden, we took it to the UK and did it there. And then from there on, now we're launching in the US. So it's an exact Spotify playbook again, but this time in healthcare.

• 6:46David Friedberg?

  One of the afflictions of great entrepreneurs is you're entrepreneurial, right? I mean, you just can't stop.

• 6:53Speaker 01

  Or maybe I just have a high pain tolerance. I'm not sure which one.

• 6:57David Friedberg?

  Yeah, once things got smooth, you had to get back into it. But at what point did you start thinking about doing other things, Daniel? Were you like actively angel investing at Spotify over the years as CEO? The business is building, hundreds of millions of users, public, successful. Things are growing nicely. You've got a great leadership team. We've obviously met a lot of your team over the years. How did you start to do these other projects? I know you've got a few others and focus on Neco.

• 7:23Speaker 01

  Yeah, it's kind of crazy. I'd forgotten about it. But, but my team now showed me very recently, like, I apparently did this lunch with the FT interview in, I think, 2012 or 2013 or something, just after the US launch of Spotify, where I was talking about healthcare already back then. So I've been thinking about healthcare specifically for a very, very long time. And it's just been, you know, I think a lot of people just talk about sort of all the stuff that's going bad in the world. But my view is that actually, most things are going pretty well. And it's kind of up and to the right on the technology curve and all the things that we're getting. But I try to focus on the problems that aren't

• 8:08Speaker 01

  going that well. You know, one of those happens to be healthcare. So I've been kind of interested about this, as like, you know, how is it that we're spending more and more money on healthcare, but getting worse and worse outcomes? And what can we do about it? And so that really kind of got me into the space. I think healthcare is kind of unique and kind of special. I honestly didn't have any money until Spotify went public. So I wasn't a prolific angel investor.

• 8:35David Friedberg?

  What year was that?

• 8:37Speaker 01

  That was 2018, we went public.

• 8:38David Friedberg?

  2018, right, yeah.

• 8:39Speaker 01

  Yeah. So I probably started doing a little bit of investing in 2018, but I had no money before then. So, you know, it was literally just kind of all in, focused on Spotify for, I guess, you know, the better part of 12, 13 years before I made any investing in, in anything else. And then, you know, you and I, we were talking about it at this dinner, like a week ago or something. But, you know, I then tried to do a little bit of investing. I'd actually already started Neco at that time. And I kind of just realized that I loved building way more than I loved investing. And, and so right now.

• 9:20Jason Calacanis?

  Freiber came to the same conclusion. It's so painful to watch companies you invest in.

• 9:26David Friedberg?

  Well, this was our whole dinner conversation the other night.

• 9:28Jason Calacanis?

  Yeah, get mismanaged and you can't do anything.

• 9:29David Friedberg?

  Well, you spend time on boards. That's why I don't join boards anymore. You're sitting on a board, you advise a CEO and they don't listen to you and you pull your hair out like, I would have done something different. Why didn't you do this? And, you know, and if they are listening to you and you're effectively instructing them on what to do, it also doesn't work because they're not leading. And so I became pretty committed to this idea. Like you find amazing entrepreneur founder CEOs, give them money and never look at it again and you'll be fine, generally better than not. And then, you know, the flip side is if that's really what you're passionate about and you're, you have the activity or the agency, it's to step in and do it yourself.

• 10:08Jason Calacanis?

  Yeah, the more instruction they need, probably the less chance they're going to succeed.

• 10:12David Friedberg?

  Yeah. So Daniel, maybe you could just give us the overview on Neco, kind of what the

• 10:15Jason Calacanis?

  Yeah, and how you came to that idea, right? Yeah. How did you come to this specific idea?

• 10:20Speaker 01

  I started researching the space a very, very long time ago. And maybe just as a quick primer for the audience, the US is spending 18% of its GDP on healthcare. It's the single largest line item in the budget right now. And if you take heart disease alone, it's in the hundreds of billions of dollars that are being spent on that disease group alone in the US alone. I mean, it's just insane. It's larger than Fortune 10 companies revenues, just one disease group. So it's a gigantic problem, as I mentioned. And so I started looking into everything from like, you know, drugs to, you know,

• 11:04Speaker 01

  can you make more efficient drugs? Is it about cancers? And, and basically started like targeting like, what are the, the real reasons why it looks that way? And I think that the, the real conclusion ended up being there's lots of reasons, not one, you know, we see, but we see a few really big ones.

• 11:23Speaker 01

  Cardiology or heart health is a major one. We see skin cancer, melanomas being another big one. So there's a few sort of major groups of illnesses that is over representative. But the major one is really chronic disease overall. And the crazy thing about chronic disease, when you read about it, is that if you discover these things early, they're totally preventable. And the cost of dealing with them is very small and the suffering for the person, you know, that are having it and their family and community is very small too. So the key thing is if you discover things early, you're actually good.

• 12:07Speaker 01

  And so then the question is, well, why don't we discover things early? And it, it happens to be that we don't have enough data. So everyone in the entire healthcare industry is in agreement that we have to take healthcare from reactive to preventative health. And, but then, you know, there now all the disagreement starts, which is how do you do that? And, and our view, my co-founder Yalmar and I, our view is, is really that it all starts with having better data. If you have better data, you're going to be able to discover things much more easily. And that in itself then leads you to have a chance of discovering those things much

• 12:50Speaker 01

  earlier, which then creates this virtuous flywheel of them changing healthcare.

• 12:55David Friedberg?

  So predictive data that allows you to be predictive about future adverse health outcomes and course correct ahead of time.

• 13:04Speaker 01

  Yeah, that's, that's the holy grail is to get to that point. And, and, and essentially our view is that the way you get there is that you need a lot more data than you have today, both from each modality that you gather data, but also across multiple modalities and you need it longitudinally. So you need it over time. So if you, if you had a lot more data and you had it over time, you'd be able to have a lot higher likelihood of doing those kind of predictive analysis. And then what we then said was, well, well, okay, how do we do that? And it so happened to be that if you think about really what's happened in the last 20 years, one of the biggest innovations, of course, is the smartphones.

• 13:47Speaker 01

  And we've had more and more sensors packed into those smartphones. So there's more and more sheep sensors and sheep electronics that's available to us. So our view was like, okay, well, we should be able to utilize this to build a lot more sensors than what's been able to be built before. And then the other thing, you know, we started free the LLMs and everything like that, but it was then called machine learning, but today we talk about it as AI. We should have a lot better intelligence. So if we have all of these massive data sets, we should be able to make really good predictions about it. And obviously, again, similar to that, this is exactly what we learned with Spotify too. The more data we are able to gather, the better predictions we're able to give you about what song to play next.

• 14:30Speaker 01

  And so this is exactly the, the same thing that you now need to do in healthcare, but obviously it's across multiple modalities and now across longitudinal data sets as well.

• 14:42David Friedberg?

  Is there evidence today that some of this early observational data can affect ultimate health outcomes? I mean, I can see this working for metabolic conditions, things related like exercise depletion rates and blood sugar and sleep, but ultimately the correction there is typically diet, exercise. What are some other examples of major diseases that we can kind of identify ahead of the curve, course correct?

• 15:09Jason Calacanis?

  And maybe just explaining what NICO is for people who don't know.

• 15:13Speaker 01

  Yeah, yeah, maybe I'll start there and then we can get into it. So in a very simple way, the experience of Neco today and in Gen 2 is it's $499. It is a reinvented healthcare experience from the ground up, vertically integrated. We do everything from building our own facilities to having our own nurses and doctors on staff, to building our own diagnostic equipment and doing everything on our own on the software side. So it's, it's, it's really kind of an end to end solution that we've designed from the ground up. And we designed it with the goal of creating the most valuable hour you can invest in your health. That's the mission that we have and that's where we're coming to work to do, you know,

• 15:58Speaker 01

  every day of the, the, every day really at work. The experience is really you come in, the first thing you typically tend to do is that you draw blood from us. So we then measure 53 blood markers. You then go through our skin rig where we have a camera system that takes over 6,000 super high res images across your body, where we index every mole and lesion and all of the possible rashes and rednesses you may have as well. That gets indexed. We then look into your heart and blood circulation. We look at grip strength, all those sort of traditional markers that we have very

• 16:43Speaker 01

  good scientific evidence are valuable indicator as you think about sort of health. Then at the end of this visit that lasts for about an hour, you get uninterrupted time with a clinician and you go through all of the results, including the blood works during that hour. So you have a complete set where you can go through your values within that hour with your doctor and the doctor will answer any questions you may have, but you will also with that clinician, sit down and go through results, you know, about things you may even want to improve as well when it comes to your health. So that's the, that's the experience that we're launching with today in New York, in the US.

• 17:26Speaker 01

  And obviously we'll, we'll launch in many more places across the United States over the next coming months.

• 17:33David Friedberg?

  And just the identification of things ahead of the curve? Cause I, I've heard of other, there was a one medical, there was Forward. I mean, there were a few other kind of attempts at making these integrated centers where you go in and get preventative checkups with their own instrumentation. And, and I think I've heard the thesis a little bit before. What have you identified that may be novel, Daniel, that we, that we haven't seen in the past?

• 17:54Speaker 01

  I think first and foremost, the important thing to mention is, as I mentioned, we started this in 2018. So this company's been around for eight years. We've done more than 100,000 scans already. So we actually publish data every year. So we've just published our third year data survey where we go through the health outcomes that we have across our members. And around 1% of our members have a serious underlying medical situation that is undiagnosed.

• 18:25Speaker 01

  That we discovered. Um, so, you know, again, the, the good news is many of our members are healthy and we're just talking about improving their current health status. And as you correctly pointed out, a lot of that ends up coming around stress, around diet, around sleep and those things. But the most encouraging thing we're finding now, as we've done these studies for three years in a row, is that the people with the worst health status are the ones that are improving the most. So it turns out that this ability of, of having a clear visual understanding of where you are in your health journey currently today and having a clinician that sits down

• 19:06Speaker 01

  with you explaining the, the, the situation and possible remedies to that is a huge benefactor for getting people to start improving things around lifestyle. So we've seen members that have gone from a year where they've been smoking to not smoking as part of then having to do this Neco and prioritizing their health. We've obviously seen people with severe medical underlying illnesses that have gone from discovering those and then treating them and having much better overall health as a result. So it's really kind of all across the base, but I'll give you a very concrete example. So take dermatology as a great example.

• 19:47Speaker 01

  The average person at Neco today has 950 moles.

• 19:54David Friedberg?

  The average person has 950 moles?

• 19:58Speaker 01

  Yes.

• 19:58David Friedberg?

  That's insane.

• 19:59Jason Calacanis?

  Some percentage you can't tell, I guess, is the punchline here. They're like not detectable by the human eye.

• 20:04Speaker 01

  For sure. Well, if you really went through your skin, you'd, you'd be surprised how many you'd find. I mean, it's a big dispersion. Some have, you know, many, many thousands and some of them have 500.

• 20:15David Friedberg?

  Seems like a perfect AI application for AI, obviously.

• 20:18Speaker 01

  Exactly. So if you think about it across a normal doctor's visit, how likely is it that that doctor will check out all the 950 moles that you may have? It's not gonna happen. So normally what happens in a normal doctor visit would be you may say, look, I have a mole or the doctor sees, hey, let's take a look at that mole. It looks a little bit funky. And then they bring out their, their tool where they inspect it. They usually these days have a software that checks against whether this mole, they take a camera across many different frequencies to then discover both the, the size of this mole, but also the texture of the mole and so on and so forth. We literally do that.

• 21:03Speaker 01

  And we first have an AI system that flag possible risk factors. And then we have a human clinician that then goes through and reviews those as well. And should we even at that point find something? We then have expert dermatologists on staff, multiple of them, that then also reviews that result. So that's just one indicator of like what happens in one visit. But let's now presume the scenario that we'd have multiple visits and maybe one year it's actually, we don't discover anything, but because we've catalogued and indexed every single one, we can actually now in a longitudinal base, look at them from one year to the next year. So it may be growing abnormally.

• 21:44Speaker 01

  These are things that if you think about it, even the best doctors in the world can't possibly remember how your mole may have looked like from one year to another. So again, back to your point, this is a perfect application of AI, right? But we look at this as like, this is a perfect application of how healthcare should look like. It should seamlessly be both AI and amazing clinicians in a great package experience. So that's essentially what we're trying to do with, with Neco.

• 22:13David Friedberg?

  That's great. And are you actively running it as CEO, Daniel? Or are you operating part-time?

• 22:19Speaker 01

  No. So similar to Spotify these days where I have two great CEOs, I have an amazing co-founder and partner, Yalmer, who's really the brainchild of Neco and he's the one who's doing most of the work, even though I'm sitting here and taking most of the credits at this point. But yeah, he is the real brain.

• 22:37David Friedberg?

  Great.

• 22:38Jason Calacanis?

  You know what I'm struck by? The cost of this is so cheap, $499. You also have Function Health and Superpower, two other great services, about $350, $400. They just do blood work. But if we look at the spending, right? And it's right now, it's healthcare number two, social security number one, and fast, your favorite coming up is the interest payments. Very, very good. Will overtake our healthcare spend. You could actually have folks come to this every year or every other year for four or, oh, every American, four or eight percent of the cost of the total we spend on healthcare. And I'm, I'm curious, is this something you expect people to do yearly or something every other year?

• 23:18Jason Calacanis?

  And what impact do you think an investment of every American getting this done every year or every other year, or maybe every three years even, which would be down to 2% of our budget? What impact would that have on the forward-looking budget and, and the forward-looking spend? If you, and have you done those kinds of calculations?

• 23:36Speaker 01

  Yeah, I mean, look, we, we obviously have a view, but I think it's too early to say. So I don't, I don't want to sit here and say that we know conclusively what will happen. But I think that the, what we do recommend our members is to try to do this on an annual basis. And the way I kind of make this analogy is most of us today are, are trying to go to a dentist on a yearly basis. For some reason, we don't do an annual health checkup, most of us, on an annual basis. So for me, this, this should be as, as regular as going to the dentist or doing anything else like, and it should be an amazing experience. This should be, you know, again, as I said, what we're really doing is a mission here

• 24:19Speaker 01

  is, is trying to create the most valuable hour you can invest in your health. And, and, you know, we know a lot of people are busy, so we want to be brutally efficient with people's time. So you can actually, if you don't have any questions and you're just interested in really doing the test results, you can probably get by in 30, 40 minutes and, and do it. So we're not talking about a lot of time to do that. And obviously, $500 is still a lot of money for people, but I do think it's a great investment if you can afford it to do.

• 24:50Jason Calacanis?

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• 25:33Jason Calacanis?

  And then like there's some profit that comes from maybe the upsells? Take us with the economic model here and then how that will work with the insurance industrial complex as, just functional as it is here in America?

• 25:47Speaker 01

  Yeah. Well, so the benefit of, of being vertically integrated is that we've been able to build, you know, everything ourselves, which means we can also cut costs in a pretty dramatic way. So within that $500 a year, we are, the unit economics are positive. And we have clinics today that are profitable, that we're operating already today. So, so we think this is a good price point to enter in because it's a great value for people. But because we do all the things ourselves, we're able to still make this, you know, economically viable for us to, to create a great business and to be able to grow and

• 26:30Speaker 01

  invest in that business so that we can spread it to more places as well.

• 26:33David Friedberg?

  So Daniel, are you focused exclusively on this project? You have other stuff you're working on?

• 26:37Speaker 01

  I'm not exclusively focused on it, but it's obviously one of the things that are taking a lot of my time and rightfully so. It's one of the biggest problems in the world. But I'm still spending time with Spotify and exec share there. So that's still, you know, my baby, even though I'm not involved in it on an everyday basis. And we have a few other companies with Prima Materia, which is a company I, I created together with Shaq that you mentioned earlier, where we're trying to really do, you know, what I mentioned before, which is like, how do we, how do we pay it forward and kind of almost be like the greatest co-founder you could possibly find? That's, that's what the ambition of Prima Materia.

• 27:22David Friedberg?

  The healthcare thing really perplexes me. I kind of look at the, the biggest issues for affordability for people in the US right now. It's, you know, buying a home. Dealing with your educational costs and then healthcare costs is one of the top three. I feel like we can solve education costs and we can solve home costs with certain market incentives that have been distorted. But healthcare is much more complex. As you look at the US system, beyond just kind of preventative care, the cost for servicing patients in a hospital, like, why is it $15,000 to get stitches at an ER? You know,

• 28:03David Friedberg?

  why is it $20,000 to get a drug that costs 30 bucks to make? You know, why, when the doctor is making 200 grand a year, does the doctor seeing me for eight minutes cost my insurance company $6,000? I mean, what is going on, from your view, that extends beyond, like, get in front of all of the catch-up problems and so on? But what's structurally going on with the healthcare system in the US? And if you were emperor of the US for a day, and you got to say you could do anything you wanted, what are the top kind of three things that we're missing that maybe Neco doesn't necessarily address today, but are kind of things that you would recommend we fix?

• 28:42Speaker 01

  Well, I mean, again, I'm definitely not an expert on the US healthcare system. But for me, it is like the, show me the outcome, I'll show you the incentive. It's one of those classical problems. And if you really, really think about it at the moment, the entire system is predicated on, and the healthcare system was built around a time when we were dealing with infectious disease. That was how the healthcare system was built and dealt with. So all the incentives are really around that, which means we're fixing you acutely when there's massive amounts of symptoms. So where we have to go is we have to go to the healthcare system being preventative. That means it has to be way

• 29:23Speaker 01

  more long-term today. So I'll just mention, one of the problems that exists is because normally your healthcare is tied to your employment in one shape or form, and because the average tenure of your employment is not that very long, it means that you may have only two, three years at one employer, and then you switch. And when you switch, you switch insurers, too. So one of the questions, then, if you're that insurer, should you invest in something where the payback time may be 10, or 15, or 20 years to do that? Those are just some of those sort of incentive things, like, how do we, how do we look at the ROI of some investments that may be 10, 15, 20 years into the future? And who takes

• 30:06Speaker 01

  those investments? These are not easy things to answer, and I don't claim to have all the answers to them. But one of the things we're trying to do with that, because we're just trying to bring the cost down, so that the ROI doesn't have to be that we, we have to invest, or the insurance industry have to invest, or employers have to invest millions of dollars speculatively, hoping to get it back in 20 years' time with very little data. So our view is, like, if we lower it, so it may not be a million dollars, it may be, you know, make it up, tens of thousands of dollars, even if that payback time was 10 or 20 years, I think that there will be a higher propensity and likelihood for a pickup on that. And then the second thing we're trying to do, obviously, is we're trying

• 30:51Speaker 01

  to add more data to the system. And if we had more data, then it's much more likely, with these multimodal longitudinal data sets, to be able to kind of actually see, well, what's the efficacy of these things over time? This is also part of the reason, by the way, why we are investing in, in releasing our data every year of what we're finding, so that people can see, okay, well, what happens both on an aggregate Neco population, which is also super cool, because normally in healthcare systems, you, they're very country-specific, right? Like, and, and so this is one of the few healthcare companies

• 31:30Speaker 01

  that are, it's not global, but at least multi-country systems straight away. So that's also super interesting. Like, what are we finding in the UK that may or may be similar or dissimilar to the US? That's gonna be super fascinating.

• 31:46Jason Calacanis?

  Well, what did you find between Stockholm and the UK? I mean, I can take some guesses, but I'm guessing people in Sweden were much more fit in the UK. You probably had more cardiovascular disease and diabetes. Yeah, and those are the two, I believe, you tell me if I'm right, Friedberg, aren't those like the two biggest spends in terms of healthcare spending? I think diabetes is number one, I could be wrong, but cardiovascular diabetes seems to be the big two. So what did you learn between the two populations?

• 32:12Speaker 01

  Well, I mean, it's really early, and it's still on relatively small base. It's 100,000 scans, as I mentioned before. But I, so I don't know that I think we're ready to speak about sort of population-level health outcomes. But as we grow in Neco, I think we will. And, and that's gonna be super cool. And then, you know, we're, we're already today doing lots of clinical trials. We've done four already. We have two underway. We have another four we're going. So we're partnering with the research community as well, deeply around these data sets that we already have today, and that we will gather more on tomorrow, too. And I think my, my point with all of this is really just to say, look, we actually,

• 32:56Speaker 01

  it's, for, for, for people in tech, the amount of data that exists in the healthcare system is actually not as, the data sets are not that large. That's the crazy part. And so, you know, I, I think it's a pretty safe set, that if we can 10x or 100x the amount of data that comes available, we're gonna be able to draw super interesting conclusions about that. Not just Neco, but the whole healthcare system. That's really the bet we're making.

• 33:24Jason Calacanis?

  Put it, put in the wearables in there. It's gonna be really interesting with the Ouras, the Whoops, the Fitbits. You start with Apple Watches, you start correlating that data with the blood work. I noticed Whoop offering labs now through Quest, and I don't think, maybe you can sync, you know, your Ora Whoop with some of those. But we don't, I've never seen any data, you know, we have sleep, we have recovery, we have heart rate, you know, but I don't think anybody's put the blood work together with that. And then your system, I mean, this could really change everything in terms of healthcare if we can correlate that. Maybe you could speak to the impact you think wearables are gonna have. And do you think you partner with them, or you just have a, a, a Neco

• 34:08Jason Calacanis?

  wearable, you eventually just make part of this subscription at $9.95? Because it does seem like there's, these are commodified for the basic 80% of it, I'm sure. So what are your thoughts there?

• 34:18Speaker 01

  Well, already today, we, we do allow you to import your Apple Health data. So if you do have wearable data, we will take that. So anyone who, and a lot of the big Ora Whoop, etc., do allow you to write a lot of that to Apple Health as well. That's just one, one sort of example of that. So, yeah, we would, we would love to have, of course, more data, because that enables us to, again, when the clinician sits down with you, to be able to give you a much more 360 perspective about your current health status. So that's one of the things that we encourage. But I do want to say also that I think that this is just like, the, the service that we're launching today, it is

• 35:03Speaker 01

  very rare in itself that, you know, when you create a diagnostic product, the normal way of doing that in this space is you created that, you spend X amount of years doing R and D for that thing, then you literally spend the next 10 years selling exactly that thing. And with Neco, within this three-year, when we launched, and now launching in the US, we're on Gen 2. So we've already upgraded our diagnostic infrastructure. And so I think what you should expect with Neco is that we're launching with one thing today, but we're gonna keep adding more and more and more value, and we'll keep adding more

• 35:40Speaker 01

  and more, you know, valuable diagnostics that we can find and we can put in at the price point, you know. So, so that's kind of the goal. So this is just the beginning. And, and the goal is obviously to make this even more valuable, so that we can deliver against our mission of having the most valuable hour you can spend on your health.

• 36:03David Friedberg?

  Daniel, do you want to take a step back and talk about what's going on broadly in the tech industry right now and AI? You know, what's your view on pacing the frontier?

• 36:11Jason Calacanis?

  I want to hear these questions. Yes.

• 36:13David Friedberg?

  Yeah. Do we, do we need to pace the frontier?

• 36:16Speaker 01

  I'm struck by the fact that if, if we kind of look at the, the, the world, and certainly over the last few years, I kind of always, always say, you know, we're walking into COVID, and every one of us became virologists. We were all of a sudden supply chain experts after the first, you know, oil tanker in the Hormuz trade got stuck somewhere, you know. And then with Ukraine war broken out, we were all military experts and military strategies.

• 36:49David Friedberg?

  Are you talking about the online podcast right now?

• 36:50Speaker 01

  Ah, you know, I'm just talking.

• 36:53Jason Calacanis?

  It's actually the, we renamed it the All In Laboratory Pod. It's the All In Lab because we are just, we're just a lab. We need to be regulated because our opinions are so dangerous. You know, that maybe Spotify's podcasting could regulate us.

• 37:12Speaker 01

  Yeah, my, my point is just like, everyone expresses these things with such extreme confidence. And it turns out that most of the time, we ended up being completely wrong, even the biggest experts. So I'm not sure I have much value to add, except to say that I believe that we're still in the innings where we can alter the impact for how to use these technologies. And, you know, my view is that the, every great technology has extreme positives and extreme negatives. And it's really up to us now to steer this towards the outcome that we want.

• 37:50Speaker 01

  And I think it's great that the debates are being had, but honestly, I have no sort of strong opinion one way or the other, if we should pace it or if we should not. I, I, I just know that if I look at healthcare and I look at what we're doing at Spotify, like, it is truly amazing. I mean, the, the perfect music product is one that, you know, I, I've described this many times, and I think we're getting closer to it now, which is, which is awesome is, right now, you know, you can put together a better playlist yourself than what the system could do. But I think in the future, downrightly, we can soundtrack every moment of your life in an amazing way, where you just feel more.

• 38:35Speaker 01

  Like, the, the power of great music is that you will feel more. If you're happy, you'll feel happier. If you're, you know, wallowing and feeling sad, you know, you'll feel, feel, feeling more wallowing and sad in that moment. And, you know, that, that's thanks to AI. And then if I look at, you know, the example we talked about with dermatology, like, you know, 950 moles, being able to track them over time, keeping you safe, like, these are positive, amazing examples with AI. And yet, we talk about this thing as, as, we, we, we tend to amplify that, but I want to see more positive examples of AI. I, I think we, as an industry, have done a terrible disservice of not talking about

• 39:18Speaker 01

  all the really, really crazy, positive stuff that we can use AI for that actually greatly benefits everyone.

• 39:27David Friedberg?

  And in that sense, do you also think about the benefit and the value of open source AI, open weight models?

• 39:35Speaker 01

  Absolutely.

• 39:35David Friedberg?

  Where I think you can now look at like a 13 cent per million token output cost versus $30. That's an incredible difference that unleashes this technology across a broad spectrum of businesses and individuals, that there is no, you know, concentration of value or wealth amongst a handful of businesses or individuals. And if we can really make these open weights and open source models proliferate. But obviously, this regulatory conversation may restrict the expansion of open source and open weight models. And if you have a view on kind of the importance there.

• 40:13Speaker 01

  I think technology's always gone between open and closed, right? Like, we had Windows versus Linux in the first iteration, you know, iOS versus Android. Like, we, we've seen this play out so many times. And where we tend to net out is that we tend to have both. And, you know, to the extent that I have a view about it, I've very positively advocated for open source models before, and I will keep on doing that because I think that that brings a lot of innovation that will be really helpful for the ecosystem as well. So I completely agree with you, David, that, I think that, you know, if you, if you look

• 40:53Speaker 01

  at these now, and certainly what we're seeing, you know, at, let's take Spotify as an example, we're, we're obviously using a lot of the frontier models, but we, we have a bunch of fine-tuned models ourselves too. And we tend to do both. And that is actually making us more innovative. And that's actually allowing us to do certain things that we couldn't do with the frontier models, either because of cost and efficiency reasons, or sometimes because we just couldn't tune them the way we want it. And so, I, I, I personally think it's like, it's going to be both. But one of the things I heard, that, that is a perspective I haven't heard before, that

• 41:34Speaker 01

  maybe I would encourage people, not that I am sort of an expert on all these things, but I, I'm, I'm surprised that people haven't talked about sort of the amount of compute. So if you think about it, it's, for me, this isn't about just the intelligence itself of a single model, but it's still, you know, of the basis of, you know, the amount of computes you're doing can indicate something, right? Like, so if, if I'm using 100,000 GPUs for something, that's probably gonna be a lot more powerful than if I'm running an open source model on my home PC. It, it, it's probably very unlikely that I'm gonna be able to do an enormous cyber

• 42:16Speaker 01

  thing, certainly if, if, if the companies have mythos class models to, to try to, you know, protect themselves, that I should be able to, with an open source model on my home PC, do a lot of damage. So, you know, I, I, I just find it to be a fascinating thing to just think about if there's a way of, of, of looking at the amount of computes as well, and, and as one sort of factor in that.

• 42:42David Friedberg?

  Right, assuming, assuming model equivalency, compute as a key metric of defensibility, and that's really where we can start to build guardrails around who can have access to the most compute, and how do you get certified for compute as opposed to certified for software?

• 42:59Jason Calacanis?

  Wasn't that the original, like, two years ago, that one of the original concepts of limiting this was how many teraflops or how many GPUs you had?

• 43:08David Friedberg?

  What they did, that, that was how they wrote the regulatory laws around regulating models.

• 43:14Jason Calacanis?

  Right.

• 43:14David Friedberg?

  So they basically set a model that was trained on X number of teraflops. And it was like, this was like a California.

• 43:23Jason Calacanis?

  As if this is static, like, it is nothing's gonna change.

• 43:26David Friedberg?

  Genius Assembly got together and said, we figured it out. We know how to classify, you know, scary models and bad models.

• 43:32Jason Calacanis?

  How many ethernet cables are in your data center as a proxy for how powerful?

• 43:37David Friedberg?

  How many watts of power went into making this model? But I do think your point of compute as a roadblock is probably a good one. This is what it used to be. You, you remember when Cray supercomputers came out? And there was a limited access, and they were considered like a security risk, and you had to get approved in order to get access to a Cray supercomputer? Because you could use them to design nuclear weapons, and you could use them to crack codes and do all the things that people worried about. Yeah, today, a Cray supercomputer, I think, is less power than a washing machine or something, some, some product we probably have in our kitchen.

• 44:08Jason Calacanis?

  Yep.

• 44:08David Friedberg?

  It is a really great point, actually, Daniel, because if you've got strong compute installed as a defense capability, assuming model equivalency, you're gonna be hugely advantaged.

• 44:19Speaker 01

  I haven't seen it in the debate at least, and, and I'm surprised, but maybe it's something I'm missing, so.

• 44:24Jason Calacanis?

  Hey, before we let you go, I guess, two questions for you. Take them whichever order you want. What's the strategy, strategy and how does Spotify look at something we care about deeply, podcasting, which is, you know, built on open standards? And you guys have become a major player in it. Open standards are kind of moving one direction, and Spotify's got a lot of proprietary stuff. I've talked to you about this, and some of your team members, like, hey, can we keep supporting the open source part? And then the second piece, people don't know this, but there was this incredible company, Star Doll, it was one of the first companies in Stockholm, Sweden, to ever get funding from American VCs. You were the CTO, if I remember, or the intern for a couple of years?

• 45:03Speaker 01

  Uh, well, I was the intern CTO, whatever. It was probably one of those.

• 45:08Jason Calacanis?

  People don't know, this was an incredibly innovative company in terms of, you know, many variables, like digital goods and subscriptions and all that stuff. So maybe, take us through either, both of those questions, because that's just, you know, two personal things that I would love to hear about if we were at dinner.

• 45:23Speaker 01

  Yeah, I mean, I mean, look, again, as I said, I think the, the open and closed are going to be two things that are gonna exist.

• 45:33Speaker 01

  Side by side. So the interesting thing about Spotify today is like, on the one hand, of course, we're a huge platform in podcasting and we have a destination. There are certain things that we're doing that a general podcast may or may not be doing. You know, one of those will be how we're handling comments and so on that are specific to the platform. But we actually do have tools. So what a lot of people don't know is that we also through our platform aggregate and distribute podcasts onto a lot of the other podcasting platforms. So there's a bunch of podcasters that are using our tools to then distribute to some of the other platforms too. And we're obviously doing

• 46:13Speaker 01

  that through open standards. So I don't think the answer for us is like one way or the other. We think both can coexist. But obviously, if you're, if you want to innovate within a standard, then the key is to have other people agree to that standard. And that can sometimes take you longer. So it might be harder to innovate. Innovates. So Spotify's approach has been let's support both in tandem. So that's that.

• 46:40Jason Calacanis?

  Well, then there's two features. I'm just wanted to make sure I ask you about. There's one for going live. So this is part of the new standard. So having that on our page. So when we go live, it actually respects the RSS feed and sends that note out. And then there's another one called value and donations where the person who has like, you know, if they happen to be doing donations on whatever platform or they do them through PayPal, those two, the like podcast OGs in the underground really want Spotify to support. So I'm just doing my job and representing as a 17 year podcaster, please add those two or support those two if you think it's worthy of doing.

• 47:17Speaker 01

  All right. Well, it's no longer my decision alone, I should say, but I will certainly bring.

• 47:22Jason Calacanis?

  I'm going right to the chairman while I got him on the line.

• 47:25Speaker 01

  Yeah, of course. Of course. But yeah, I'll definitely bring the feature request to the team.

• 47:31Jason Calacanis?

  Tell us about Startall. What you, what you wrap up. What'd you learn there when you were 20 years old, 21, 22, whatever it was, Startall?

• 47:37Speaker 01

  Yeah. You know, it was a great experience. It was, it's kind of a, you know, it brings me back to memory lane, you know, I, I did Startall just before I started Spotify. So there was a entrepreneur called Matthias, who was kind of one of the OG entrepreneurs in the Swedish ecosystem. He'd been around since the dot com bubble. And he had, it was originally the site called Paper Doll Heaven in Turco, Finland, out of all places, by this old lady and her son. And Index Ventures had invested in it and taking kind of a majority

• 48:17Speaker 01

  stake to help doing this because they had no idea of scaling this site. And actually, you know, and Index and Matthias kind of came in with the idea of rebranding it and building it into Startall. And so they came to me one day and they, they sort of asked around for people who knew tech and could be technical enough to help build it. And I had already decided I wanted to go build Spotify, but Danny Reimer is very good at convincing people to do things. And so as a favor to him and sort of me hoping that he would come and fund Spotify, which by the way, didn't end up happening. But, you

• 48:59Speaker 01

  know, I, I kind of said, okay, fine, I'll help you for, I think it was six to 12 months, something like that. But so I went over to Finland and I checked it out. It was kind of wild and crazy because I think the average page load time at that time was like four minutes. So it took four minutes to render a simple page. So it was basically the server was completely breaking down by it seems. I was like, holy, this is crazy. I wonder how much more traffic you can do if you actually made this work like in a snappy way. And so we basically re-architected the website. I hired an entirely new technical team and brought it down to under a second of load time. And obviously, the traffic exploded,

• 49:44Speaker 01

  Sequoia invested.

• 49:45Jason Calacanis?

  Yeah.

• 49:46Speaker 01

  You know, and I said, okay, well, I've done my part. Thank you. And then I went off and built Spotify.

• 49:54Jason Calacanis?

  It's amazing, these origin stories, like what happened right before the thing is always interesting to me. Listen, Daniel, continued success. If people want to try Neko, N E K O, where can they go?

• 50:06Speaker 01

  So we launched the first one at 300 Lafayette. So go sign up on nekohealth.com waitlist and we'll try to get to you as soon as possible.

• 50:18Jason Calacanis?

  And this is in New York, 300 Lafayette Street.

• 50:20Speaker 01

  Yes. So only in New York so far, but we're expanding quickly. Both the number of venues we have in New York, we're launching in Florida as well, in Miami, and we're launching in DC. And we're gonna try to launch all over the US in the coming 12 to 24 months.

• 50:38Jason Calacanis?

  Yeah, it's great. Right on Houston Street. Let's say, back in the day when Sudo had their big studios, they were right around the corner from you. A lot of talk about memory lane. All right. Continued success. Everybody go to nekohealth.com and sign up for the waitlist. We'll see you next time. Bye bye.