Andy and I have been working on our thesis at USV around self-directed healthcare. We published it yesterday on the USV blog. The gist is that people are fed up with the existing healthcare system, and a movement has formed at the edges of the market. It consists of individuals who want to take their health in their own hands and a variety of products and services that empower them to do so.

USV has made several investments in self-directed healthcare, and Steve and I have angel-invested in several companies that fit this thesis over the past years. I grew up in a household with two doctors. I spent a good chunk of last year researching how to prevent heart disease. I have been going on a years-long personal health journey. This is a space I care about a lot.

One of the things I've noticed is that many entrepreneurs envision the same end-state. They want to be the AI advocate and doctor that is always on and personalized to everyone who uses the service. The way they plan to get there is by accumulating large datasets on customers through a variety of different mechanisms: biomarkers through bloodwork, diagnostics and scans, self-reported information, wearable and sensor data, etc. It's a very unique moment in time where a lot of founders share a similar vision but have very different approaches to get there.

I think it's important that whichever approach a founder takes, they must build a good business along the way. Not everyone is going to get to the holy grail, but a lot of people can build great companies while they try. There are likely many different viable paths, some direct to consumer, some through practitioners in the existing system, and others I can't even imagine. Each will have their own pros and cons. I don't think this is a winner takes all market. It is so large. But value will absolutely accrue to the players that accumulate the most data the fastest, successfully use that data to create experiences that drive positive and measurable results, and build trusted brands.

There are some open questions I have and some we have discussed as a group at USV about unknown dynamics:

• Will direct-to-consumer companies need to partner with known celebrities and medical influencers to achieve scale? We have seen how credible influencers with their own distribution channel and following can help get a business off the ground rapidly: Peter Attia and Early, Sam Harris and Waking Up, Dr. Becky and Good Inside, Andrew Huberman and Athletic Greens, Tim Ferris and Momentous, Mark Hyman and Function Health, countless celebrity endorsements of wearable companies, and many more. I do not think this is a pre-requisite for success, but it certainly has proven to help jumpstart the early stages.

• Are many solutions marketing wrappers for someone else's product? If a company is selling someone else's product or service to accumulate data on customers, what does that mean for barriers to entry? Does the wedge need to be proprietary, or can it piggyback on something else? How does one think about exclusivity and/or other dynamics with these partners?

• If barriers are low and the movement continues to pick up steam (as I suspect it will), will D2C customer acquisition channels quickly become a race to the bottom? We saw unsustainable margin compression in most D2C companies over the past decade. Digital acquisition channels quickly get arbitraged and unit economics go upside down. Will similar dynamics be at play and if so when?

These open questions are not deterrents by any means, but they should be proactively addressed by entrepreneurs along with a convincing view of what makes their approach genuinely unique.

I am excited to see how this space unfolds and think we will see a shift in consumer behavior and participation in self-directed healthcare much more quickly than we thought possible. Most of all, I love using these products and trying new services and am eager to continue to partner with great entrepreneurs building them. The tailwinds are strong and society is embracing change. A generation of iconic companies that empower consumers to live healthier lives are getting started right now.

Yesterday Nick published a post about USV's thesis-driven approach to investing. We also updated our About page. There is a section called How We Operate that I love. I have had a lot of conversations lately about why I joined USV and why I think it's such a unique place. I wrote about my relationship with the firm over time, but that was only part of the story behind my decision. The rest is encapsulated by this tweet that Andy wrote:

Andy Weissman

@aweissman

If I was asked to describe 3 things that in combination make USV a unique venture firm:

1/ small funds for 15+ yrs (last core fund $275M)
2/ "vehemently" generalist - everyone invests in every area of thesis
3/ completely collaborative investment decisions, made as a collective

341

7:19 PM • Oct 20, 2022

For the last several weeks I’ve tried to use Perplexity as my default search engine on mobile. I’ve enjoyed the experience more than Google and ChatGPT and I’m going to stick with it for now. I don’t know if my usage will last for a long time, mainly because I think other search applications will quickly innovate on user experience and that for the first time in decades this will be a hot and competitive market.

One of the new behaviors I noticed for myself was that I now like to use voice as an input to search. I’ve always been a typer, especially on mobile. But new AI powered search results actually improve as my queries become much more specific and detailed, and voice is a more seamless and natural way to make this happen. Instead of a quick text blurb, a conversational approach to search now yields superior results.

Voice as a part of UX has been around for a long time (eg Siri), but I think we are about to see it explode in usage. A key part of that is the movement to natural language as the fuel by which we make software do things for us. I no longer think of voice as just an input, I think of conversation as the new UX. This leaves many open questions, like will people be speaking out loud to their personal devices all day long? Is that preferable to being hunched over our phones tapping away? Will we be comfortable expressing our private interactions with software out loud?

Andy and I have been working on our thesis at USV around self-directed healthcare. We published it yesterday on the USV blog. The gist is that people are fed up with the existing healthcare system, and a movement has formed at the edges of the market. It consists of individuals who want to take their health in their own hands and a variety of products and services that empower them to do so.

USV has made several investments in self-directed healthcare, and Steve and I have angel-invested in several companies that fit this thesis over the past years. I grew up in a household with two doctors. I spent a good chunk of last year researching how to prevent heart disease. I have been going on a years-long personal health journey. This is a space I care about a lot.

One of the things I've noticed is that many entrepreneurs envision the same end-state. They want to be the AI advocate and doctor that is always on and personalized to everyone who uses the service. The way they plan to get there is by accumulating large datasets on customers through a variety of different mechanisms: biomarkers through bloodwork, diagnostics and scans, self-reported information, wearable and sensor data, etc. It's a very unique moment in time where a lot of founders share a similar vision but have very different approaches to get there.

I think it's important that whichever approach a founder takes, they must build a good business along the way. Not everyone is going to get to the holy grail, but a lot of people can build great companies while they try. There are likely many different viable paths, some direct to consumer, some through practitioners in the existing system, and others I can't even imagine. Each will have their own pros and cons. I don't think this is a winner takes all market. It is so large. But value will absolutely accrue to the players that accumulate the most data the fastest, successfully use that data to create experiences that drive positive and measurable results, and build trusted brands.

There are some open questions I have and some we have discussed as a group at USV about unknown dynamics:

• Will direct-to-consumer companies need to partner with known celebrities and medical influencers to achieve scale? We have seen how credible influencers with their own distribution channel and following can help get a business off the ground rapidly: Peter Attia and Early, Sam Harris and Waking Up, Dr. Becky and Good Inside, Andrew Huberman and Athletic Greens, Tim Ferris and Momentous, Mark Hyman and Function Health, countless celebrity endorsements of wearable companies, and many more. I do not think this is a pre-requisite for success, but it certainly has proven to help jumpstart the early stages.

• Are many solutions marketing wrappers for someone else's product? If a company is selling someone else's product or service to accumulate data on customers, what does that mean for barriers to entry? Does the wedge need to be proprietary, or can it piggyback on something else? How does one think about exclusivity and/or other dynamics with these partners?

• If barriers are low and the movement continues to pick up steam (as I suspect it will), will D2C customer acquisition channels quickly become a race to the bottom? We saw unsustainable margin compression in most D2C companies over the past decade. Digital acquisition channels quickly get arbitraged and unit economics go upside down. Will similar dynamics be at play and if so when?

These open questions are not deterrents by any means, but they should be proactively addressed by entrepreneurs along with a convincing view of what makes their approach genuinely unique.

I am excited to see how this space unfolds and think we will see a shift in consumer behavior and participation in self-directed healthcare much more quickly than we thought possible. Most of all, I love using these products and trying new services and am eager to continue to partner with great entrepreneurs building them. The tailwinds are strong and society is embracing change. A generation of iconic companies that empower consumers to live healthier lives are getting started right now.

Yesterday Nick published a post about USV's thesis-driven approach to investing. We also updated our About page. There is a section called How We Operate that I love. I have had a lot of conversations lately about why I joined USV and why I think it's such a unique place. I wrote about my relationship with the firm over time, but that was only part of the story behind my decision. The rest is encapsulated by this tweet that Andy wrote:

Andy Weissman

@aweissman

If I was asked to describe 3 things that in combination make USV a unique venture firm:

1/ small funds for 15+ yrs (last core fund $275M)
2/ "vehemently" generalist - everyone invests in every area of thesis
3/ completely collaborative investment decisions, made as a collective

341

7:19 PM • Oct 20, 2022

For the last several weeks I’ve tried to use Perplexity as my default search engine on mobile. I’ve enjoyed the experience more than Google and ChatGPT and I’m going to stick with it for now. I don’t know if my usage will last for a long time, mainly because I think other search applications will quickly innovate on user experience and that for the first time in decades this will be a hot and competitive market.

One of the new behaviors I noticed for myself was that I now like to use voice as an input to search. I’ve always been a typer, especially on mobile. But new AI powered search results actually improve as my queries become much more specific and detailed, and voice is a more seamless and natural way to make this happen. Instead of a quick text blurb, a conversational approach to search now yields superior results.

Voice as a part of UX has been around for a long time (eg Siri), but I think we are about to see it explode in usage. A key part of that is the movement to natural language as the fuel by which we make software do things for us. I no longer think of voice as just an input, I think of conversation as the new UX. This leaves many open questions, like will people be speaking out loud to their personal devices all day long? Is that preferable to being hunched over our phones tapping away? Will we be comfortable expressing our private interactions with software out loud?