A longtime tech exec shows what happens when big minds take on big problems.
On a recent episode of Recode Decode, hosted by Kara Swisher, Vic Gundotra — a longtime high-level executive at Microsoft and Google — talked about his current startup, an easy-to-use home heart monitor that has gotten FDA approval.
That link will take you to the highlights of that discussion, or you can listen in the audio player above. Below, we’ve got a lightly edited transcript of the whole conversation.
If you like this, be sure to subscribe to Recode Decode on iTunes, Google Play Music, TuneIn and Stitcher.
Transcript by Celia Fogel.
Kara Swisher: Today in the red chair is Vic Gundotra, the CEO of mobile heart monitor maker AliveCor. Vic is a longtime techie, spending 15 years at Microsoft and seven years at Google, where he’s best known as the person who led Google’s social networking effort, GooglePlus. In November 2015 he joined AliveCor, which helps consumers monitor their heart health from their smartphones. Vic, welcome to Recode Decode.
Vic Gundotra: Thank you very much, Kara.
You’ve had quite a history. Let’s talk a little bit about you, because where you came from is super interesting. Talk how you got to tech in general and then to AliveCor in the end.
Well you know, when I was a kid I was a hardcore nerd. At a time when that wasn’t necessarily cool.
Where did you grow up?
Right outside of Washington, D.C., in Maryland. And I loved programming at a very, very early age, about 11 years old, and it was far easier to program than talk to girls, so that’s what I did. My teenage years, I coded nonstop.
And why? What got you into it?
You know, there were some bad things that were happening in my life, in my personal life, that I had no control over. But when I sat down as a 12- or 13-year-old in front of a computer, I had control. I learned programming, it allowed me to build beautiful things, I could compile them, fix the bugs, and they were mine. And I was hooked.
What got you into it, though?
When I was 10 years old at my school, there was a principal who had the insight to pull about 10 kids out and said, “I’d like to teach you computer programming, machine language, AdaIC work. And I somehow was selected, I did the class, I found it exceptionally boring.
Until one spring I ran across an article in Byte Magazine and they showed you a trick. On the Apple computer you could hit control break and you would drop into the memory buffer and you could look around and see what was going on. In fact, the trick was you could redirect the graphics buffer to a printer. And it just dawned on me that I could interupt my video games and take what was in the graphics buffer, redirect it to the printer, and now my school books, my covers for my books, had Lode Runner — it was a popular video game — screens on them.
I went to school, for the first time I was cool. Everyone looked over and said, “How did you do that?” And then I remembered everything I learned in the machine language programming class, I understood how to read the memory buffer, and I was hooked.
Right. And then you did it on your own? In college?
I did it on my own, I studied every book I could get. I couldn’t understand Byte Magazine when I was 11, and one day when I was about 18 I realized I understood every article from programming to databases. I did it all.
So it was a refuge.
It was a refuge.
And a control. A way to control.
Exactly, and then when I went to college I decided ...
Where did you go?
I was at George Washington University and then decided instead to go join Bill Gates at Microsoft. My mom was livid. I’m Indian.
You left school.
Yeah, I left school.
Were you a freshman?
Yeah. And my mom was like, “What is this Meecrosoft, I’ve never heard of it.” [KS laughs] I said, “Mom, I think it’s going to be okay.” When they offered me a position they said, “Let’s talk about your options.”
And I assumed that meant they were going to give me two or three different jobs to choose from. I didn’t even understand that meant stock options.
Oh I see. So how did Microsoft find you? Were you working in the computer lab? Because Washington, D.C., is not exactly ...
What happened was, they were just starting up their federal group.
Is this in the ’80s? ’90s?
This is 1991; the group was really starting to grow. But what happened was, it was concurrent with when IBM was breaking up with Microsoft and the headlines in the press were very negative on Microsoft and I think they lowered the hiring bar. They were desperate to find people and I think I got in at a time period during those couple of months where they would take any engineer. And I had the right background.
And this was before the trials and everything.
Oh, this is a decade before that. This was when Microsoft was very small. I don’t think I would have been hired at Microsoft later. But I got in and I met the greatest people. I learned so much from Bill and Steve.
I had the most amazing 15-year career there. I ran their developer relations group, which I later applied in driving Android adoption, but learned about what it took to have a developer ecosystem. Remember, Windows was the underdog. OS2 was going to win, and so the first challenge I got from the leadership team at Microsoft was how do you get developers to write for Windows when they’re all writing for OS2. We were the underdog and we helped turn that around and got everyone to write for Windows.
Did you move to Washington State?
I did. I moved to Seattle.
Right away.
It was about nine months into my job.
What were you working on in D.C.?
Initially, I was working on a VA contract that Microsoft was trying to win. [laughs] I was the engineer on the project doing the RFP. I remember the head of the Veteran’s Affairs, after I did my demo and tried to convince him that this was the right platform, he put his hands on my shoulders and he said, “Young man, you did a really great demo but we are never buying $3,000 color typewriters.” [KS laughs]
Because remember, at the time a GUI and a graphics card, it wasn’t a foregone conclusion that graphical user interfaces were going to win. And at the time it seemed like a crazy expense. But we did win that contract. And the world started to change pretty quickly.
So you moved to Seattle.
Moved to Redmond. Actually lived in Bellevue. Actually, wait, wait, that’s not true. When I was a kid I actually lived in Redmond and then later moved to Bellevue, it’s right across the street.
Right, and then you started moving up at Microsoft.
Yeah, I had the most amazing time. I think Steve liked the fact that I was a developer that enjoyed talking to other developers. And truthfully, I was probably better at driving adoption of developers than writing code.
What was the culture like there? It was a very aggressive culture at the time.
You know, people say it was very aggressive and I think that’s largely ...
But you have that reputation.
I do have that reputation in the sense that people at Microsoft — and I think I share the same trait — really are very clear in terms of a vision of what we’re trying to pursue and are very vocal about it.
And that is different in some companies where the culture is much more consensus oriented. And at the time, competing against IBM, there was no time for consensus. Bill said, “This is what we’re going to build,” and we executed. And we were much more of a startup, a very aggressive culture, and Bill, his personality, really was reflected in the rest of the culture.
Absolutely.
And I’m sure I learned a lot from that. In fact, I probably had some deprogramming I had to go through when I went to Google. I’m not sure that one culture is better than the other. They both have their strengths.
Well, it got them into trouble though, I mean immediately. You were there during the trial.
I was there during the trial.
So what was that like?
It was kind of shocking. I mean, imagine waking up every morning and you hear the United States of America versus Microsoft. That’s how the court opened up every morning. And when you spend 10 years building something, you can’t believe ... You go through different stages. The first stage you go through is, “Look, they just don’t understand.”
Yeah, that’s usually the tech point of view, right? [laughs]
Right. “If you just tell them that there’s competition, they’re going to see the Mac and Unix and then they’ll come to believe.” And then you go into anger, which is, “No, people are out to get us. And we’re going to fight them and prove to them that they’re wrong.”
Which is Microsoft’s go-to emotion.
Exactly. By the way, I tried helping people at Google that we had gone through this trajectory so that when Google faced regulatory pressure we could avoid that. In fact, I wrote a famous email that was widely circulated about how not to do what Microsoft did. In many ways, this Trump thing that just happened has many similarities. You know, people just didn’t see it coming. Certainly at Microsoft, it caught us off guard.
Right. It shouldn’t have. It really shouldn’t have. The aggression was so ... we’ll talk about this later, but it’s the idea that you’re not powerful and you’re so powerful. The concept. Again, sort of like this election and all this white rage, they’ve had all this privilege and equality feels like oppression.
And it’s also the incorrect belief that everything is a zero-sum game. That if I win, you have to lose. And we live in a world of abundance.
Right, except that was a mentality at Microsoft, for sure.
It was, it was, it was a mistake.
Yeah, you know, they had to kill people or ...
Clearly a mistake, clearly a mistake.
It was interesting, and it does come right from the founders, I think, and it does iterate down to the people that work there.
It is funny, by the way, if you ever meet Satya [Nadella], how different ...
Different.
I mean he exudes cooperation and “everyone can win.” I spent a lot of years with Satya when I was at Microsoft and I’m not sure that Bill and the board could have picked anyone better. The right personality at the right time. And that’s nothing to take away from Steve, I have a great fondness for Steve, he’s a big bear of a man.
Yeah, can you talk a little bit about your departure there? How much of that was reported correctly about the chair and whatever went on?
So the chair, I never believed actually happened. In fact, I think the chair came from a story from Mark Lucovsky, which even Mark says Steve never threw the chair. I’ve spent so many hours with Steve Ballmer and he is an incredibly passionate man. The most violent thing I’ve ever seen him do is slap his hands together, that’s it.
Yeah, it’s a pretty good slap.
It’s a pretty good slap but he’s a passionate guy! And I just can’t even fathom that Steve would throw a chair, so I don’t believe that story.
Well, not at you, at least.
I’ve never seen him do it, never seen him do it.
What was the reaction when you want to go ... Because Google, talk about a reaction against a company.
It wasn’t a great reaction, it wasn’t a great reaction. It was a very sad reaction. In fact, the truth is I interviewed at Google for a year and then called up Google and said, “I’m not going,” because I was offered a really great vice president position on the MSN team and I was going to stay at Microsoft. I made my decision, I called Google and said, “I’m not going, I’m going to stay at Microsoft.”
And I went on vacation and I was walking along the beach in Hawaii and my wife said, “You look really sad for someone who got a dream, started off as an assistant engineer, is now a vice president at Microsoft, you look sad.” And I said, “Why do you think I look sad?” She goes, “You just look like you’re afraid, you’re not the Vic I know. You look like you took the safe bet.” I said, “I did take the safe bet.” And so she made me reconsider.
And I called Google back up, Alan Eustace actually. I called up Alan, I said, “Alan, I know I said no, but can you give me a few more hours to think about this?” And he laughed, he said, “Vic, take your time, we know how difficult this is.” And I decided to go to Google, and I was nervous and scared.
And why did you want to make that shift? I understand the safe part, but what was your dream of what was happening at Google?
I’m a platform guy, and I really believe in investing my personal efforts into what is the successful platform or will be the successful platform. And Windows’ day had passed. The internet really was the new platform and Google had a deep understanding of the type of architecture software that was built for the cloud, for the internet, would be based on. And that’s where I felt I needed to be.
And so you immediately started working on a range of things.
I did. The first thing they asked me to do was run all of their developer relations efforts; at the time, they really didn’t have any developer relations group. There was no Google IO, there was nothing like that. They didn’t even really have a platform.
And then about six weeks into my job, they asked me to run all of mobile. And so I ran all of the mobile applications. Andy ran the Android team, but I was responsible for mobile applications across iPhone, Android, BlackBerry, Windows Mobile, Nokia devices, Gmail, Google Maps, search, everything. And that was quite an amazing role.
As mobile was starting to become important.
At the time ...
It really wasn’t.
Yeah, it wasn’t. When Andy and I were working on that, nobody believed we could succeed.
Search is where it was. Desktop search.
Yeah, absolutely. In fact, the reason we had a mobile team was because the desktop teams just didn’t think mobile was big enough. And it’s amazing now, mobile traffic exceeds desktop in most areas.
Oh yeah, it’s the only thing.
And so those were an amazing, amazing number of years. The Gmail team was four or five people, the Google Maps team was five people. It was very very small teams of people. It’s hard to imagine that a few years later ...
And how were you taken at Google? You’re very different. Again, you have a very aggressive reputation.
Yeah, I got in trouble my first day. My first day, I was in Alan Eustace’s office, Andy Rubin walked by, and Alan interrupted Andy, he said, “Andy, come in, come in and sit down and tell Vic what you’re working on.” And he’s working on this secret project called Android.
Andy didn’t get five minutes into his conversation. I interrupted him and I said, “Andy, why would Google build an operating system?” And I pushed on him really hard. Andy got frustrated and said, “I don’t have time for this,” and walked out. Alan Eustace pulled me aside and said, “Let me offer you some coaching.” He said, “This isn’t Microsoft, you should probably let people finish their thoughts.” And I went home, my wife said, “How’d your first day go?” I go, “I got in trouble on my first day!”
[laughs] You’re an asshole, they think you’re an asshole.
Yeah, I said, “I got in trouble my first day,” and thankfully for people like Alan who were amazing coaches ...
Did you change? You had a pretty aggressive reputation the entire time there, that I can recall.
You know, I don’t know how much people really change, and my personality is my personality.
No, I do think Google is more aggressive than they pretend to be. Like they have a different kind of aggression, it’s more passive aggression.
Look, when I was running the mobile teams for Maps, I was pretty aggressive in offering turn-by-turn directions for free. It was a very aggressive thing to do, but we were trying to shake up the industry.
Right, right.
Google photos, we were hyper aggressive offering unlimited storage. But I think that’s good. I think being aggressive and building products and innovating is a good thing.
Right. So you moved quickly on to Google Plus.
Well, not quickly, because I did mobile until we were at about an $8 billion run rate, and then we decided it was so important we were going to take all the mobile pieces and reintegrate them into the desktop teams. So essentially, at that point, I was out of a job.
Eric said, “Let’s talk about Facebook.” And he brought all the vice presidents together and said, “You have an assignment. Tomorrow you’re all going to present for five minutes on what you’re going to go do.” And so I sent him an email, him and Eric and Larry and Sergey, a note at 1:30 in the morning, and said, “If I was king, here’s the ten things I would do.” And so we presented the next day and about a week later we had a meeting with Mark Pincus — Zynga came in — and in the meeting, Eric turned to Mark Pincus and said, “I want you to work with Vic, Vic’s running our social efforts.”
And then the meeting ended, everyone left, and only Larry was in the room. And I said, “Larry, what was all that about?” And Larry kind of laughed, he goes, “Oh, I forgot I was supposed to tell you, you’re running our social efforts now.” And so that’s how I found out that I was going to be running their social efforts.
Ah. So what was the fear of Facebook inside Google? There was a moment there where they just sort of lost their minds.
There was a period of time when ... I mean, Google’s all about talent. And when you see very talented people leave for something else, that’s cause for concern. And at that time we were losing a number of our people to Facebook. Facebook had tremendous momentum. Frankly, some of us, including me, could see the threat that Facebook [represented].
Oh, a hundred percent.
Right? I mean, if you want to advertise, you’re a wedding photographer, you want to advertise to people within 50 miles of Palo Alto who have just changed their relationship status to “engaged,” Facebook absolutely nails that scenario, where Google at the time couldn’t even tell you if you were a male or a female. And so you could see the threat to the core revenue. So yeah, there was concern.
But why create a social network? Because I have to tell you, Google [people] are the least social, they didn’t use social media, they aren’t on it still, they are not social people. You know, it’s a joke that they’re robotic, but they’re robots.
So Kara, I’m not going to argue with you on that point, I’m not going to argue.
[laughs] But you know what I mean? It was interesting, it was an interesting shift.
Well, one thing that social does is ...
By the way, you were very good trying to make the case that Google could do it. I remember us arguing a lot of the time.
Yeah, you know, social is important because people will give you their personal information — their name, where they live, their relationship status — if you provide value. What is the value that Facebook provides? It allows you to connect and share photos with your friends. It allows you to stay connected. And in exchange for that, you’re willing to trade off some information. And that information’s extremely valuable. So I think at it’s very core level, that’s why we were trying to do that.
And what did you all get wrong? Now that you look back at it.
I think you hit on it. I think you actually hit on it. You can’t build a product that everyone doesn’t use. If you don’t have all the engineers using social, then you’re going to miss some of the nuances. And it turns out building social is very difficult.
Right, you can’t force social.
You can’t force it. There’s subtleties to human behavior and connection that you gotta have social people working on social products. And if you don’t have that, then ...
Yeah. I remember at the time, I think, doing a story showing that no Google executive used any social network.
For the record ...
You did.
I had seven million followers, so I was quite proud of that.
This was on Google Plus?
Google Plus, yeah.
So what do you assess, when you look back? And then we’re going to get into what you’re doing now because it’s a total shift, a complete shift. It’s platform, you’re in a platform.
That’s right, that’s right.
But how do you assess the success or not success of it? Google is nowhere in social that I can tell.
Well, Google Photos is pretty impressive.
Yes, absolutely. But it’s so in their area.
And they have some great assets like Android.
Right, but I don’t interact with my photos, I just store them there.
Yeah, that’s a very good point.
Just storage, I don’t do other things with them.
Look, I use Facebook today as my primary way to communicate with my friends.
And Twitter perhaps.
And Twitter, a little bit of Twitter, but mostly Facebook. And my kids are on Snapchat incessantly, and Instagram.
So what does Google do? Is it just like, “Nah, let’s just give it up and focus on cloud”?
First of all, Sundar is … We were talking about Satya being a big change, Sundar’s a tremendous …
Another lovely guy.
Another lovely guy, tremendous product visionary guy. I mean, think about what he led with Chrome. How is Google going to produce a browser that beat a browser that shipped in the operating system? Yet he was able to accomplish that.
I worked with Sundar for many many years. He is brilliant at bringing people together without the confrontation. In fact, I think he’s much better at leading without confrontation than probably anyone I know.
So he has got a big challenge now. How does he keep Google continuing to move? You know, he inherited a ship that was already on fire. He had to keep it going. And he’s done that. At least Satya had a ship that had kind of stalled and he had to get it going. In many respects, Sundar’s job was even harder, expectations to keep Google going. And I think his shift to really focusing on the next big platform …
Which is cloud.
Which is artificial intelligence.
Artificial intelligence, I’m sorry.
Yeah, and he has done that brilliantly, and he’s really pivoted the company, got everyone to rally towards a common cause, a common architectural framework. And he’s made it available for even my small company. We’re building on TensorFlow. So that’s fantastic. If you win developers, you win the platform, you’re going to be protected in the future, and Sundar deeply gets it.
And has moved to the areas they’re strong in.
Yeah, he’s also a very technical guy. So like Satya, these are technical CEOs that really understand what they’re doing. And so I couldn’t be happier for both of them.
So you left. Why did you leave?
I left because it was approaching eight years and I had teenage children and for me it had been 24 years of 60- to 80-hour work weeks. And I didn’t want to miss my kids growing up. And I thought I had accomplished everything I wanted to accomplish. I wanted to shift the focus of my life and it was time for me to move. And I did that. I left; honestly, I thought I was going to be retired, in the sense of the word of not working professionally for a living forever.
And you’d thought about doing a fundraising ... you do the typical thing, you all go around and decide what to do.
That was widely reported and I never ever considered it.
I know I called you about it, I don’t think I reported it.
I never did it, no. I travelled the world with my kids and I took photographs. It turns out it took me more than a year to recover from Google. I didn’t realize how burned-out I was. And it turns out building Google Plus, in particular, was extremely stressful. Getting a year to be with my kids and taking that opportunity was a wonderful thing.
And then you happened upon this.
Well, my friends told me, they said, “Vic, you’re going to be bored. You can’t just take photographs and travel, you’re going to want to do something.” And I was convinced they were wrong, I didn’t realize I was burned-out. I didn’t realize it took about a year until those feelings of leading software teams, building software, really came back.
They came back in a big way and I thought about — what do I want to build? And as I was thinking about that, Vinod Khosla — who’s relentless, never give him your phone number [KS laughs], never give it, oh my god I can’t even tell you how many times he called. He called over the course of the year so many times that the phone would ring, my wife would see it, Friday night 7 pm is when he’d call, when we were at dinner, and she’d say, “Don’t pick it up, it’s Vinod.” And I did pick it up to tell Vinod, “Please stop calling.” And he said, “I’ll stop calling if you tell me what it would take to get you to go lead a company.” And I said, “I’ll call you later, next weekend, and I’ll tell you.” And I told him three things. And he said, “I got a company that has those three things and you need to go visit this company.”
What were they?
The three things I told him was wearables. I believe computing, since my earliest days, has gone from PCs to tablets to phones to ... and I think wearables, in the future we will have computing on our bodies.
Number two, machine learning. When I started the machine learning efforts to do voice recognition on the phone in 2007, people laughed. They said, “No one’s going to speak to their phone." And yet we trained Mandarin, we had voice recognition working in Mandarin in six weeks, because we took Chinese newscasts that had closed captioning and we fed that into our systems. And then the work we did with Google Photos with machine learning, I had a deep understanding of the impact it could have.
So wearables, machine learning and … ?
And number three, I wanted to do something that I got up on Monday morning and jumped out of bed to go do.
Right, not a photo service.
I don’t want to go optimize YouTube watch time for 70 percent more this quarter.
Why not, it’s so meaningful? [laughter] All right, so you got to this company.
I got to this company.
All right, when we get back we’re going to talk about this company which is a … How do you describe it?
It’s a digital health company based on machine learning.
It’s called AliveCor.
AliveCor.
All right, when we get back we’ll talk more about that with Vic Gundotra.
[ad read]
We’re here with Vic Gundotra who is a former Microsoft and Google executive, a very high-ranking Google executive. He was in charge of Google Plus and mobile there for many years, and now he’s doing something else which is a digital health company, which is a big shift, even though ... it isn’t, but it is.
You were doing these things at Microsoft and Google, versions of these things which are platforms, machine learning, AI. But you’ve moved into devices and health, so can you explain? You wanted to get up in the morning and do something meaningful, presumably.
Yeah, you know, heart disease is a really big deal. You know, more people die of heart disease ...
Do you have family members?
I do. My father had two heart attacks in front of me, it’s one of the reasons why I’m doing this.
One evening, after I left Google, my brother came up to visit from Southern California with his wife and his kids. My dad came over. We’re all having a wonderful evening and my dad had two glasses of red wine, he’s about to go home, and I say, “Dad, don’t go home, you’ve had two glasses of wine, it’s 11 o’clock, stay here.” And he says, “Where am I going to stay? The house is filled with guests.” I say, “Stay upstairs in the den.” No one’s slept up there before, but he says, “All right, all right, I’ll stay.”
And a few hours later, about 4 in the morning, he bangs on my door, which happens to be right next door to the den. And he’s grabbing his chest and he says, “You need to rush me to the emergency room, something’s really wrong.” He was actually having an episode of supraventricular tachycardia, minutes away from death. I rushed him to Good Samaritan in Los Gatos where they saved his life, and the doctors told me that if I had been a minute or two minutes late, I would have lost my dad.
Wow.
When you see someone you love having a heart issue, it’s worse than a horror movie. I mean, you’re looking at them, and you’re thinking, "Is this the last comment I’m ever going to hear from my dad?" It’s horrifying. And then you find out that it’s the No. 1 killer of women. One out of four women will die of heart disease. One out of thirty is breast cancer. Last year 8.6 million women died of heart disease. That’s more than 25,000 ...
Which is also about our eating habits and our stress levels and things.
Yeah it is, but imagine if 25,000 airlines crashed this year, all filled with women. We would be in crisis! And yet heart disease is happening. This company, AliveCor, has a product that allows you to detect a critical arrhythmia at home.
So stalker Vinod Khosla stalked you until [laughter] …
He was relentless. He made me look at this company, and I met the people, I met the co-founder, Dr. Dave Albert, who’s a charming doctor. Once you meet Dave, you’ll fall in love. And they just needed some leadership.
Right. Now explain to people what it is. Right now, it’s a little device, you hold it on both sides and it goes to your phone.
Yeah, it’s the size of a stick of gum and it’s got electrodes on both sides. You just hold it in front of your iPhone or your Android device, we’ll do an electrocardiogram, an EKG, of your heart. Most people can’t read those squiggly lines, so our software will interpret it and tell you whether you’re in normal sinus rhythm or you have possible atrial fibrillation.
And then it does your voice too, correct?
It records your voice, it’ll record activity. If you have an Omron blood pressure cuff, it’ll record hypertension. There’s lots of ways you can use it, but at its basic, simplest level, it was originally a device that did your electrocardiogram.
So the point is to do this every day, because — why? Because this is not something people do. And listen, I’ve had a lot of EKGs, I had a stroke as you know. It’s expensive, it’s a pain, it’s something you don’t do a lot.
It’s also invasive. I mean, if you’re a woman you have to go in, take off your shirt and put all these electrodes on you. It takes almost half an hour, you might get one or two done a year, and here’s a device you can do every morning. You can just hold it for 30 seconds and do a check on your heart. Do you know, on average, it takes 1.7 years before they diagnose you as having atrial fibrillation? And by the way, in many cases the first time you’re diagnosed …
Is when you have a heart attack.
That’s exactly right. So women feel shortness of breath, it’s the No. 1 symptom of heart disease. And instead of checking their heart or feeling palpitations, they say, “Honey, I need to sit down and have a cup of tea.” And they’re not even aware that you can have a device in your purse that can check your heart.
And by the way, if you have A-fib, doctors know how to treat it. They can put you on an anticoagulant that could save you from a stroke. So it’s largely an awareness problem. People don’t know they can carry a stick in their purse that can save their lives.
So eventually, these sticks are going to be on watches and all kinds of things.
Yeah. In fact, we just launched a band like the Apple Watch in Europe. We do not have regulatory clearance by the FDA to use it here.
You’re wearing it right now.
Yeah, we can’t sell it in this country but we’re working very closely with the FDA. The moment they give us regulatory approval, we’ll make it available for sale in the U.S. But this is on my Apple Watch, I just touch it.
With one finger.
With one finger. How discreet this is! I can do it right now while we’re talking. And I can do an EKG.
So the software’s on the Apple Watch.
Yeah, it’s on the Apple Watch, it’ll do an EKG. But the same software, we sell today in the form of that stick.
Right, and so then the software communicates to who? Because this is like ... you won’t want to do this in a vacuum.
So it communicates to you, the user. Iit will give you a diagnosis, whether your heart’s in normal sinus rhythm or possible atrial fibrillation on the phone.
In addition, we provide two options on the phone. One option is to have a physician that you pay for do an overread of the rhythm strip. You can pay $19 and have a doctor review this immediately.
Another option is for you to email that, your rhythm strip, to your physician. We’ve seen many patients do that. I get emails every day from people who have been affected by this device. I got one last night.
Right, that they had A-fib and didn’t know it.
I got an email, I could read it to you. The email from last night says that a 69-year-old man from a small coastal town in California says he bought the device because his wife’s cardiologist told him to get it. It helped her, she went into A-fib and was in the hospital for two days.
But two days ago, he was feeling sick. He thought it was indigestion. He pulls out the AliveCor device, it says his heart rhythm is not normal. He calls 911, they rush him to the hospital where he has a massive heart attack. 90 percent blockage. And he writes us a note that says, “Thank you for saving my wife’s life and my life.” We get mail like that every day.
Right, right. A lot of the stuff in wearables has not really hit very big. There’s a lot of them, most people find them useless for the most part. And the Apple Watch has been somewhat of a disappointment for a lot of people. Why do you think that is, and where does it go? Because it seems like finding your steps or calling an Uber is kind of pointless. It doesn’t even work, the Uber part. Where does this go with these wearables? Because wearables are an important part of your business.
In terms of wearables, we’re at the early days. We’re largely where smartphones were before the iPhone. Smartphones were out there, but only represented 1 or 2 percent of the usage until the iPhone happened.
It wasn’t that smartphones had the form factor wrong, it’s just that the software experience wasn’t right. And to a large extent, that’s where we are with wearables. The form factor is right, but we haven’t hit the software experience that makes it something you have to have.
Fitness products are nice. We’re not a fitness product. We’re an FDA-cleared, clinical-grade product. That’s very different than a Fitbit. I think the issue with some of these fitness products is that once you use them and you know what 10,000 steps are, you know what that feels like, it’s over.
Right, it also doesn’t tell you anything. It doesn’t say, “Ah, you ate this donut this morning, this is why your blood sugar is [high], and by the way, you need to get up and do this.” It should be more prescriptive, I guess.
Absolutely. And we are absolutely going to get there. Let me just ask you a question: What do you think is going to be more accurate: Getting an EKG at your doctor’s office once or twice a year or having an electrocardiogram of your heart every day?
The second, obviously.
Yeah, and imagine what machine learning can do. But machine learning has millions ... we now have over 10 million EKGs.
So you signed a deal with the Mayo Clinic. Explain that. And they’re giving you money, which you’re not going to tell me how much it is, right?
Yeah, they’ve invested in our company in a pretty significant way, and that deal is incredible. I mean, the story of what’s going on there. So let me tell you the story.
People’s electrical current can be interrupted, including in their heart, if their potassium levels get out of whack, either too high or too low. They call that hyper- or hypokalemia. It’s a life-threatening condition. And today people who are on dialysis often will have this happen to them, or renal heart failure patients, lots of conditions can cause this. The only way to check your potassium levels today is to get a blood test. It’s not an expensive blood test, a hundred bucks, and they do a blood test …
It’s expensive for some people.
For some people it is, but if it’s a life threatening condition, you do it. Imagine you don’t have to take a blood test. And what researchers at the Mayo Clinic discovered — and by the way, it was well known before, they knew that your EKG, the morphology of your t-wave, is indicative of potassium levels.
But what Mayo Clinic did is they started running studies and were able to [pin]point with a high degree of accuracy what your potassium level was. They compared it with people who were taking simultaneous blood tests, and it was shocking to see the correlation. They used our device in those studies. So we were naturally the right partner for them. And we have a much bigger machine learning team.
So the concept is, you take all these EKGs and then blood tests, because now you have a blood pressure cuff, and find other things.
Absolutely, absolutely. I know I’m convinced we’ve already seen early indications that hidden in your EKG are other vital markers. Maybe for potassium, but there’s likely other things there that humans cannot see.
If you’re taking it every day.
Even if they’re not taking them every day, once we have a signature of what you are, then based on million of other samples, the machines are likely to be able to see things that humans can’t. No human doctor can look at an EKG and tell you with a high degree of accuracy what your potassium level is, but the machines might be able to do so.
Right, right. Well, there’s two things that come off from this. One is, do we really need doctors? Will machines be our doctors? I just had a talk with Anne Wojcicki about the lack of need for radiologists going forward.
I probably have a radically different view. I think we’re always going to need doctors because people want another human to tell them what’s going on. And I think in the future, and Vinod Khosla has said this many times, bedside manner, a degree in the arts, is really going to ...
Couldn’t you get a robot, eventually, that does that?
You know, maybe some far distance into the future, beyond my lifetime, that may happen. But I think today, you would never drive a car without airbags and antilock brakes. You just wouldn’t buy one. I think in the next half decade, no physician will practice without deep learning, machine learning systems by his side, or her side, to help.
Is there a resistance to it? Because I have gone through a major illness, they didn’t know anything. And to get them to say that was ... I’d always be like, “You don’t know, do you?” And they’re like, “Yes, we do.” I’m like, “No, you actually don’t, and just tell me and that’s fine.” I noticed it was a lack of data. It felt like they were guessing and they didn’t need to because there was so much data.
So Kara, this is an entirely new field. It’s been only half a decade since machines have gotten so good that we’ve had the software that with enough data they can pull out things that we can’t see. The field of medicine moves very slowly. Half a decade is a very short period of time.
So yes, you’re right, there’s some resistance on the part of physicians that machines will be able to do diagnosis. But frankly, I’ve also seen incredible enthusiasm. I can think of Dr. [Ronald] Karlsberg, Dr. Takata, I can think of many doctors at the Mayo Clinic, at Cleveland Clinic, Cedar Sinai, that are actually at the forefront of understanding how to use these tools. So I think it will happen.
Because health care has been the one area. You know, Google tried to move into it, they keep trying to do it. It’s been a real wall that people can’t get over.
You know, I thought sometimes the enterprise moves slow, and it does. Health care is the slowest of all enterprises.
I could tell you, in fact, without using the name — if I told you the name, you’d say “this is the No. 1 or No. 2 heart hospital in the world.” We went through a tour of how they did cardiology. I’m not going to give you the details, but it was shocking to see how old the software was. I mean, some of the software used to do billing and management was written in MUMPS [Massachusetts General Hospital Utility Multi-Programming System]. Some of your listeners will remember MUMPS.
I don’t even know what that is.
It’s a programming language used 30 years ago! And yet this is software that they’re deploying today. And so part of that is the abundance of caution. You know, hospitals ...
Yes, around privacy.
Privacy and people’s lives. But part of it is also that it desperately needs to be modernized.
It feels very leeches to me, some of the time, when I go into the hospitals.
On the flip side of that, too, is all the bad press around Theranos and other medical services. It seems to have set back devices quite a bit, or health-care startups in Silicon Valley. It definitely has had a chilling effect.
It’s an unmitigated disaster. It not only affects investment — venture capitalists are going to think twice before they invest, this was a very high-profile blow-up — but frankly it erodes confidence by consumers. If you’re a consumer and there’s a Silicon Valley startup doing something interested in health care, how do you know it’s not another Theranos?
It makes me angry, it makes me frustrated. Yes, working with the FDA is challenging. Yes, it takes an extra nine months to a year to get something done. But those agencies are put in their place to protect consumers, and in health care you’ve got to follow the rules, you gotta do these things. And skipping over these steps is terrible.
Is that a Silicon Valley disease, so to speak? Or is it just fraud?
Boy, that’s a tough question.
[laughs] You don’t have to answer it.
I’m not going to answer it in the Theranos case.
Fraud.
Yeah, well ... But I do think sometimes Silicon Valley has a philosophy to move fast and break things. You can’t do that when it comes to people’s health care. You tell someone their heart rhythm is normal and they die of a heart attack? That’s on you. And so the clinical evidence you have to have to get the FDA to say, “You can tell this person they’ve got normal sinus rhythm,” is appropriately huge. And you’ve got to go through that process.
So what happens to that? What impact has Theranos had? Because I get blood tests all the time. I have a blood issue and I would love something like that, like you just do a pin prick and then you do it from your phone, that would be friggin’ fantastic to have that happen.
I think we’ve talk about the negative impact that it’s had, particularly in the VC community and eroding people’s confidence in some of these new startups. But the flip side is it’s also eliminated some charlatans.
If you were a startup thinking you’re going to do something in the medical space, now even investors know to ask you, “Show me your 510(k). Show me what the FDA has said.” So it’s also had a positive experience in that it’s like a fire that’s eaten up all the brush and the only digital companies that are going to be left standing are the real ones.
So are you getting more investments? You got an investment from the Mayo Clinic. How are Silicon Valley VCs looking at this? You’ve got a record, you’ve got a reputation. Presumably you could raise money easily.
There’s good and bad. There’s people like Khosla and the Mayo Clinic that have invested in us, and frankly there are some very high-profile names that have said no. Because they’ve been scared. And I understand that. Not everyone’s going to say yes.
And when you think about that, is it the money-making or the nervousness? Because where’s the money-making from your products?
I think our money-making, or our real business, is going to be in changing the relationship between the patient and the doctor. Today, you have great software to talk to your friends. You don’t write your own software, you use Facebook or you use Instagram or whatever. Yet today, when a mom talks to her pediatrician, she’s often pointed to a hideous portal that she has to remember a different password for. Your relationship with your doctor has not been changed through software.
Sure, it’s very inefficient.
And we’re about to do that with AliveCor. Our next-generation products are really aimed at the modification of behavior of the physician to the patient. And we think there’s tremendous opportunity there to go build beautiful software that’s loved by physicians and consumers. And I think that’s what you’re going to see from us.
What, you’re talking about the Facebook of that? Because that’s been tried. They’ve come over my desk over the years, this idea of “you talk to your patient, you manage your parent’s health,” there’s been a lot of that.
So the next podcast we do, I’m going to walk you through what we’re doing. I think it’s spectacular. I’m very excited. Most people believe their doubts and doubt their beliefs. And when it comes to health care, you can see why people don’t believe it will ever change. I’m not like that. I think we as a company have a chance to revolutionize the software platform used in medicine, and we’re going to give it our best shot.
Right, but the device then isn’t the thing. Or is it? You have to have the device.
The device will be a component of it, but it’s not ...
Right, because you need the data right?
You need the data, you need the platform, you need to have others be able to participate. And one thing I do know how to do, [where] I’ve had some success in my life, is platforms. Ecosystems.
So what else could you measure?
Oh, there’s activity, there’s weight, there’s blood pressure, there’s voice.
Talk about voice for a second. Because that was interesting when I was talking into it.
Look, when someone you love comes home, you barely have to say a few words, and you can say, “Honey, you’re sick, you had a bad day, you’re coming down with a cold.” We pick up health signals in the voice very naturally with our kids, with our loved ones. Even a doctor today will do that eye test. He’ll look at you, listen to you talk, and that informs his decisions. Why can’t software do that?
Every time we do an EKG we also record your voice. Are there signals in the voice that indicate stress? Are there signals in the voice that represent a change from a baseline? Can software pick that up and alert you? We think it can, and we’re in the process of collecting that data.
All right, lastly on this topic, the fear of all this information. It’s not just like me trading “I hate Trump” things on Facebook, of which there are many. It’s something else. It’s something quite personal, and a lot of personal information could affect insurance companies, your job, everything. How worried should people be about this becoming so machine-learned and so in-AI and everything else?
Well, people are willing to trade off very sensitive information if they get value from it. For example, I have a credit card. They’ve never betrayed my trust, yet if you look at my credit card data, you’ll know everything about my life. You’ll know where I am, what I buy, who I buy it for, where I ship it to.
But I’m not worried about that, because they’ve done a good job of being stewards of that information and they provide me great value: I don’t have to carry cash around. And I think the same is true here. If software is alerting you to a health condition, before it becomes severe and saves your life, it says, “You have possible atrial fibrillation, get to a doctor,” and because of that you avoided a stroke, I think you’re going to say, “I’m willing to do this every day.”
Right, and pay for it, presumably.
And pay for it.
Do you imagine offering that to people? Right now it’s free.
Our device is $99.
Oh, the device itself, right.
The device is $99, you can buy it off Amazon or our website.
But the services.
The services will come. I think people will pay monthly for less than the cost of an office visit to have the machines be your first line of defense.
Yeah, I would love to never go to a doctor again.
All right, we’re here talking with Vic Gundotra, who is the CEO of AliveCor, a digital health company. He is a former Google and Microsoft executive.
[ad read]
We’re here with Vic Gundotra, a former Google and Microsoft executive who is now CEO of AliveCor, and we’ve been talking about digital health, machine learning, AI and where it’s going.
But I want to talk a little bit more broadly, Vic, because you’ve had a big seat to a lot of changes. Where do you see Silicon Valley right now? Because again, health care’s not something they’ve been ... to me, Silicon Valley has been, I always say it’s big minds chasing small ideas. This is a big idea, which is why I want to hear you talk about this. Where do you see Silicon Valley right now, and then maybe in the age of Trump, too? Because things are going to change drastically, I think — or maybe not.
First of all, I have to warn you that I’m an eternal optimist. Very optimistic about the future.
Oh, I can’t stand you types of people.
At least I put my cards on the table. [KS laughs] You know, when I see Silicon Valley, I do see some challenges. Some of the inequality is scary and disturbing. But I also see an incredible force for good.
My father used to tell me, when I was a kid, that he was worried that manufacturing jobs were going to leave this country. If you told me, “Hey Vic, when you’re older and you’ve got teenage kids, the best car company in the world is going to be in some of the most expensive real estate in the middle of Silicon Valley, it’s going to shake things up,” I’m not sure I would have believed you. They’re building Teslas in Silicon Valley. The manufacturing has come right back.
There’s probably 10 other examples I could give you of Silicon Valley companies who are legitimately changing the world, or trying to. I like to think of AliveCor as one of those companies as well, and they’re a much smaller scale. But that sense of optimism, that sense of “we can change the world,” exists in this valley in a way unlike any other.
And the right talent pool lives here. Yeah, Silicon Valley has its problems. Yes, there’s sometimes arrogance, and frankly the Trump election also helped unveil a tremendous bubble of blindness to the problems that many Americans face that people in Silicon Valley literally could not see. But despite these problems, overall there’s no place I’d rather be at this point in human history than in this valley.
Because?
Because the opportunity to make your dreams actually happen, to be surrounded by people who believe the impossible is possible and maybe even probable. It exists here.
All right, but what are those dreams? Because here you have, this week alone, Facebook denying it has an impact on the election when it clearly has an impact on the election, or pretending ... like there’s almost a willful ... they suspend their responsibility into things. I think they do that all the time. “Hey, it’s not us!” You know, it’s sort of “guns don’t kill people, people kill people.” I’m like, well, you know, Twitter was a really big deal in the election, it had a part.
And again, of course, it’s humans operating these things, but at the same time the responsibility for ... look, AI, it’s going to eliminate a lot of jobs, it just is. And they pretend it’s not. And so of course the story they tell, except for Elon Musk, is of a happy shiny future where everyone gets taken along, but they don’t get taken along. You know what I mean? That’s the kind of seriousness that never gets addressed.
I think you’re right, Kara. There is some aspects of some of the work that is going on that the future is unknown.
Okay.
I like to think positive, I like to think that yes, artificial intelligence may remove certain jobs that the machines can do better, but that will free up those people to pursue things that have more value. I believe that’s happened over the last 100 years.
So should Silicon Valley have a part in figuring that out?
I do believe Silicon Valley has a responsibility to think about people beyond the Valley. And I think this election is very very indicative of the pain. For example, I’ve got family members that live in Florida. They don’t have the experience I do.
In the Valley, I throw a barbeque and my neighbors come over, one neighbor is in venture capital, another neighbor works at Microsoft, another one works at Apple, another one works at Tesla. They have experienced eight years of the stock market going up, they work at companies where there’s optimism and hope and they’re changing the future.
For my relatives that don’t live in the Valley, their experience is completely opposite. The stock market has gone up, they really haven’t participated; they either work for companies that are in decline or have shipped jobs overseas. They see the world very differently, and the Trump message resonated with them.
Absolutely.
And I think we in Silicon Valley have to be self-aware that the optimism, hope, enthusiasm and excitement that we have in the Valley every day, with the people that we work with, is not indicative of what most Americans feel.
All right, but what do you do then? Because you are creating things that will make it worse. It was interesting when Trump was talking about manufacturing. I’m like, “Manufacturing?” Most regular jobs are — you know, it’s not just, "You’re never getting those back," but now get to the next level of jobs that can be easily replaced in this new ...
I’ll tell you what I think we should do. The first thing we have to do is be open to other viewpoints. I was shocked during the election how many of my friends would refuse to follow any of the sites that were conservative. Like Drudge Report, one of the most trafficked sites in the world, and yet my liberal friends would not read it. How can you understand the other side? Just like some of my conservative friends wouldn’t read the New York Times. You gotta have an open mind.
Well, there’s a little bit of a difference between the Drudge Report and the New York Times, let’s be clear.
Well, it depends who you ask, right? It depends who you ask.
Well, okay. I like my facts, so, you know.</st