Aug 8, 2022 · 32m · american-optimist
How Psychedelic Medicine Could Transform Healthcare | Why Medical School Is Broken · Joe Lonsdale
0:00 / 0:00
▶ Watch on YouTube →
gold bands on the timeline = statements, start to end. Hover to read, click to jump. CC turns on captions
In this episode of American Optimist, host Joe Lonsdale interviews 8VC partner Sebastian Caliri about reforming broken healthcare incentives through value-based care, overcoming institutional flaws in medical education, and expanding access to breakthrough psychedelic medicines.
How this conversation actually went
Every chapter scored 0–10 on four independent dynamics. Hover any point for the reasoning behind the score. Joe holds 30.8% of the talking time here. How this is scored →
Joe as informed peer 5.4 Guest teaching 2.5 Guest disagreement 0.8 Joe pushing back 0.1
speaking balance: gold is Joe, purple is the guest (3 minute bins)
Sharpest disagreement ▶ 22:55 Caliri gently hedges Lonsdale's geopolitical framing
When Joe asserts Chinese state-owned enterprises are intentionally poisoning Americans as revenge for the Opium Wars, Sebastian moderates the claim, arguing it is difficult to determine whether it is ignorance or malice.
Hardest push from Joe ▶ 22:55 Lonsdale presses on Chinese state intentionalityJoe directly interrupts Sebastian's general commentary to insist that Chinese state-owned enterprises are shipping fentanyl precursors on purpose.
Biggest teaching moment ▶ 20:32 Caliri defines and explains PACE program mechanicsSebastian educates Joe on the PACE program acronym and business model, explaining how Medicaid/Medicare funding can be diverted from nursing homes to adult daycares.
Joe holds their own ▶ 8:34 Lonsdale details regulatory hurdles for AI diagnosticsJoe cites the exact commercial and regulatory lobbying struggle faced by portfolio company Digital Diagnostics to obtain a reimbursement code for autonomous retinopathy screens.
the scores for every segment, with the reasoning behind each
| Chapter | Topic | Joe as informed peer | Guest teaching | Guest disagreement | Joe pushing back | Why |
|---|---|---|---|---|---|---|
| Preview: Transforming Behavioral Health with Psychedelic Medicine | 4 | 3 | 1 | 0 | Joe introduces Sebastian and asks about his background transitioning from Stanford Med School to technology. Sebastian explains the traditional credentialist mindset in biotech vs the entrepreneurial agency of Thiel Fellows. The exchange is completely collaborative and conversational. | |
| Key Learnings at Palantir: Business as a Tool for Impact | 6 | 2 | 1 | 0 | The two discuss how business can be a tool for systemic impact and diagnose the decline of multifactor productivity in healthcare. Joe interjects with clear definitions of economic productivity and system-level misalignment, building on Sebastian's points smoothly. | |
| Fee-for-Service Billing Codes and Innovation Bottlenecks | 7 | 3 | 1 | 0 | Joe cites specific examples from their portfolio, such as lobbying for AI diagnostic reimbursement codes for diabetic retinopathy. Sebastian elaborates on how fee-for-service coding structures disincentivize preventative, holistic care. | |
| Portfolio Spotlight: CityBlock Health and Underserved Medicaid Care | 6 | 2 | 0 | 0 | Joe highlights portfolio investments like Cityblock Health and discusses high-spend dual-eligible populations. Sebastian details how value-based capitated care allows scalable business models to serve Medicaid and rural elderly patients. | |
| Optimism in Behavioral Health: The Psychedelic Medicine Frontier | 5 | 3 | 1 | 0 | Sebastian outlines the clinical trial pipeline for psychedelic medicines including MDMA and psilocybin, while Joe references their investment in Mindbloom and notes societal resistance. Both agree on the economic and therapeutic value propositions. | |
| Personal Experience with Ketamine Therapy Transformation | 2 | 4 | 0 | 0 | Joe listens as Sebastian recounts a personal story of accompanying a friend through IV ketamine therapy for severe depression. The dynamic is purely narrative and supportive. | |
| Treating Veteran PTSD with MDMA and Overcoming Legacy Stigma | 5 | 3 | 1 | 0 | Joe connects psychedelic therapy to veteran PTSD and Palantir's special forces connections. Sebastian introduces PACE programs as an alternative to skilled nursing facilities for aging seniors, which Joe immediately connects back to value-based care. | |
| The Neglected Crisis: The Opioid and Fentanyl Epidemic | 5 | 2 | 2 | 1 | The conversation covers the fentanyl crisis and rising obesity rates. When Joe suggests the Chinese state may be intentionally targeting the West, Sebastian mildly qualifies the claim, noting it is hard to separate ignorance from malice. | |
| Onshoring Manufacturing, Robotics, and Clean Energy Needs | 7 | 2 | 0 | 0 | Joe brings in insights from investor David Einhorn regarding real-world manufacturing deficits versus pure SaaS software. Sebastian builds on this by identifying energy and kilowatt-hour costs as the governing constraints for automated American manufacturing. | |
| Career Advice for Students: Substance vs. Status Games | 6 | 1 | 1 | 0 | Joe delivers extended reflections on avoiding credentialist status games, comparing building Palantir to climbing military ranks. Sebastian reinforces the message while noting specific technical exceptions like fusion or clinical medicine. | |
| Overcoming Institutional Conformity in Medical Training | 6 | 2 | 1 | 0 | Joe critiques institutional conformity and medical training culture as risk-averse. Sebastian agrees, recounting how med school discourages questioning protocols, while praising rare physician-entrepreneurs like Toyin Ajayi. |
Statements from this episode (21)
Caliri: Much of medical school is irrelevant hazing rather than training
“I think that really a lot of it isn't terribly relevant to the clinical practice of medicine. Sometimes it felt more like a hazing ritual than anything really important related to training you to be a doctor.”
Caliri: Making Money and Having Scaled Impact Are One and the Same
“Making money and having impact at scale are one and the same.”
Caliri: Amazon Was More Helpful to Americans During Pandemic Than Government
“Amazon was far more helpful to many Americans than anything the government did”
Caliri: Healthcare multifactor productivity is declining as the sector expands
“I think that in healthcare, as it has become a bigger and bigger part of our economy multifactor productivity has actually been declining.”
Caliri: Lack of billing codes delayed AI diagnostic deployment for years
“There was no code for AI to perform a diabetic retinopathy screen. And so even though we had the technology for years, we couldn't get paid for it. It was silly. And this is something we could have deployed across the country by now. And, you know, instead we …”
Caliri: Dual-eligible Medicare-Medicaid patients incur $20k to $30k+ annually
“20, 25, 30 plus thousand dollars a year in medical spend for this population.”
Caliri: Value-based care makes rural primary care economically viable
“In fee for service world, you simply can't get paid much for delivering primary care to patients in rural America. And that's partly why they aren't out there. But in a value based model where you get rewarded for keeping people out of the emergency room, out …”
Caliri: Early clinical trial results for psychedelic medicines are strongly positive
“Early clinical trial results for many of these different compounds are really positive, really strong, both for the basic sort of common disease like depression, anxiety, but also for things that are quite a bit more challenging to treat.
Substance use, eatin…”
Caliri: Psychedelic medicine is on the cusp of mainstream cultural acceptance
“I think we're on the cusp of both cultural acceptance, but also a whole trove of data being released about the effectiveness of these drugs and these types of therapies.”
Caliri: Ketamine Sessions Are Far Cheaper Than Years of Talk Therapy
“It's far cheaper to do a couple of ketamine sessions than be using talk therapy, you know, a couple of times a week for years on end.”
Caliri: MDMA is one of the most promising treatments for PTSD
“There's a great phase two trial using MDMA for patients with PTSD. That result was released, I think a couple months ago from a nonprofit called MAPS. And the results are really strong. It's one of the most promising therapeutic modalities out there for PTSD.”
Lonsdale: In-Home Senior Care Under Value-Based Models Is Far More Efficient
“Another version of value based care in a sense for old people who are staying in their homes is way more efficient.”
Caliri: US Opioid Overdose Deaths Growing Over 30% Year-Over-Year
“And in fact, if you look at the most recent data, we're still seeing 30, 30 plus percent year-over-year growth in opioid overdose deaths.”
Caliri: Chinese State-Owned Enterprises Ship Fentanyl Precursors to Mexico
“There are state-owned enterprises in China that are shipping fentanyl and fentanyl precursors to Mexico.”
Lonsdale: Brands get 10x better sales using fit models over obese models
“One of the funny things, which I probably shouldn't say, but I will, is that we have consumer stuff we do sometimes, and a lot of the consumer companies I see around are starting to put, like, very obese people as their models, and I asked our partners who kno…”
Lonsdale: Tech Over-Indexed on SaaS Instead of Real-World Manufacturing
“I think we've done too much in tech the last 10 years where they, if they define tech as the software and optimizing things and having all these smart people getting really good at building software as a service. Whereas we actually need to be building things …”
Caliri: Energy Costs Will Dominate Manufacturing as Automation Increases
“And I think the interesting thing that comes with all this automation is, you know, of course energy will start to dominate the cost equation when it comes to manufacturing.”
Lonsdale: Bari Weiss has more impact via Substack than legacy media
“You think, oh, I want to climb to the top of the New York Times or the Washington Post, but actually, Barry Weiss is having a much bigger impact right now. You're on her own stub stack, right?”
Lonsdale: Founding Palantir had more defense impact than becoming a general
“I could have tried to go be a general in the defense department and taken 20 or 30 years to get there, but actually starting Palance here had a much, much bigger impact on defense than kind of going into the bottom and playing the status game and climbing up.”
Lonsdale: Healthcare is the most 'woke' industry due to uncritical conformity
“I mean, to me, this is why I think healthcare is like the most woke of all the industries is because to be woke, which is like to be part of this like modern religion of what you're supposed to believe, you have to not question things. You have to go along wit…”
Caliri: Medical training and residency condition doctors against critical questioning
“I think to survive In medical training, you can't ask too many questions, right? In medical school, if you start asking, why am I memorizing this list of antibiotics and the bugs they match up to, they'll say, you know, just memorize the list. This isn't the t…”