Sep 5, 2025 · 44m · no-priors
No Priors Ep. 130 | With OpenEvidence Founder Daniel Nadler
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gold bands on the timeline = statements, start to end. Hover to read, click to jump. CC turns on captions
OpenEvidence founder Daniel Nadler joins hosts Sarah Guo and Elad Gil to discuss how his platform became the leading clinical AI knowledge engine for American physicians, navigating complex semantic search, bottom-up healthcare distribution, and the exponential growth of medical literature.
How this conversation actually went
Every chapter scored 0–10 on four independent dynamics. Hover any point for the reasoning behind the score. The hosts hold 13.6% of the talking time here. How this is scored →
The hosts as informed peer 4.3 Guest teaching 4.4 Guest disagreement 1.8 The hosts pushing back 1.0
speaking balance: gold is the hosts, purple is the guest (3 minute bins)
Sharpest disagreement ▶ 37:45 Rejection of Cartesian rationalism in entrepreneurship
Nadler dismisses conventional startup narratives and MBA pedagogy, arguing that success comes from compulsive drive and Nietzschean will to power rather than neat circumstantial origin stories.
Hardest push from the hosts ▶ 21:28 Gil challenges autopilot analogy with AI chatbot adoptionWhen Nadler argues humans will never accept pilotless planes or doctorless medicine due to personified trust, Gil pushes back by pointing to millions forming intimate relationships with conversational chatbots.
Biggest teaching moment ▶ 22:39 Exponential acceleration of biomedical publication volumeNadler gives a detailed statistical breakdown of how the doubling rate of peer-reviewed medical citations shifted from every 50 years in 1950 to every 73 days today, demonstrating why med school training models are obsolete.
The host holds their own ▶ 15:53 Gil contextualizes patient data paternalism from personal founder experienceGil brings his own operational background as a digital genomics founder to challenge the paternalistic information gatekeeping practiced by conventional medical establishments.
the scores for every segment, with the reasoning behind each
| Chapter | Topic | The hosts as informed peer | Guest teaching | Guest disagreement | The hosts pushing back | Why |
|---|---|---|---|---|---|---|
| OpenEvidence and the High-Stakes Clinical AI Frontier | 4 | 6 | 1 | 0 | Nadler thoroughly explains the exact clinical use cases of OpenEvidence, using an in-depth medical scenario involving psoriasis, MS, and IL inhibitors to show how semantic search operates in high-stakes medicine. Gil asks an informed question about translating information to recommendations, while Guo opens warmly. | |
| Building a Bloomberg Terminal for Doctors with First-Class Citations | 5 | 4 | 1 | 2 | Gil probes into how the platform handles conflicting clinical evidence, and Guo follows up on user verification behaviors. Nadler details the product design as an auditable routing tool rather than an opaque answer engine, comparing it to a Bloomberg Terminal for physicians. | |
| Treating Physicians as Consumers to Bypass Healthcare Bureaucracy | 4 | 5 | 2 | 0 | Guo asks about the strategic choice between targeting physicians and consumers. Nadler reframes the distinction, explaining that treating physicians as consumers with smartphones bypassed rigid healthcare institutional bureaucracy. | |
| Navigating Patient Information Access and Statistical Literacy | 6 | 4 | 1 | 2 | Gil draws directly on his past experience founding a digital genetics company to ask about the medical establishment's tendency to gatekeep information from patients. Nadler agrees and discusses the nuance of statistical literacy versus patient advocacy. | |
| The Autopilot Analogy and Keeping Doctors in the Loop | 5 | 3 | 2 | 3 | Gil asks about medicine evolving over 10-20 years and raises chatbots when Nadler brings up airplanes landing themselves. Nadler pushes back slightly by emphasizing human tribal psychology and the necessity of keeping human pilots/doctors personifying trust in high-stakes roles. | |
| The Exponential Doubling of Medical Knowledge and Education | 4 | 6 | 1 | 0 | Guo asks about the shortening half-life of medical knowledge. Nadler educates with quantitative citation data, walking through aggressive versus conservative estimates to prove that traditional medical school models must invert toward continuous learning. | |
| Decentralized Hive Minds and Bridging Rural Healthcare Deserts | 5 | 4 | 0 | 1 | Gil asks detailed questions about modern residency training and curbside consults. Nadler highlights how AI tools serve as distributed hive minds and expert consults for sole practitioners in rural healthcare deserts. | |
| Lifestyle Determinants of Health and Longevity Lessons from Japan | 5 | 3 | 2 | 1 | Guo asks about preventative consumer health, leading Nadler into an analysis of Japanese lifestyle, step counts, and diet. Gil adds pushback regarding American political culture discouraging doctors from speaking candidly about obesity and lifestyle risks. | |
| The Will to Power Versus Cartesian Rationalism in Startups | 3 | 5 | 5 | 1 | Guo questions the startup skepticism around 'if you build it they will come.' Nadler forcefully rejects standard startup advice and Cartesian rationalism taught at YC or business schools, arguing instead that compulsive drive, raw aggression, and Nietzschean will to power drive elite success. | |
| Preserving the Psychological Engine and Recruiting Driven Talent | 2 | 4 | 3 | 0 | Guo asks how Nadler applies his motivation framework to hiring. Nadler explains why he avoids psychoanalyzing trauma or propulsion systems and prioritizes hiring people on their own self-driven warpaths where traditional management is redundant. |
Statements from this episode (23)
Nadler: OpenEvidence is probably the only AI company in high-stakes clinical decisions
“We're probably the only company working at the tip of that spear. Most people have self-selected themselves out of the problem of high stakes, clinical decision-making certainly through an AI lens because they view it as ambitious.”
Nadler: Golden age of biotech is the dark ages of physician burnout
“The sort of golden age of biotechnology is sort of the dark ages of physician burnout, because it's just impossible to keep up with all the new drugs and all the new mechanisms of action and so on.”
Nadler: Medical error is the third leading cause of US deaths
“It's well known, and it's been often repeated, that medical error is a third leading cause of death in the United States after heart disease and cancer.”
Nadler: Non-fatal medical errors outnumber fatal errors 10x to 100x
“As many people died from medical error, probably a factor of 10 to a hundred as many people had a comorbidity or condition that became aggravated and got worse and so on.”
Nadler: OpenEvidence is used daily by 40% of US doctors
“We're used by 40% of doctors in the United States daily on average. It's about 20 times as much usage as the next thing that could be described as a clinical decision support platform.”
Nadler: OpenEvidence used AI citations months before ChatGPT
“We were actually providing references and, Citations six months or nine months before ChatGPT started doing that.”
Nadler: OpenEvidence is NEJM's largest traffic referrer after Google
“You know, I think we're one of the largest sources of referral traffic to the England Journal of Medicine after Google. The rankings, I don't know if they're number two or three or four, but we're one of the largest sources of referral traffic to our partner i…”
Nadler: OpenEvidence is a consumer company, not a healthcare company
“Open Evidence is not a healthcare company. I wanted to build a consumer in a company, but I wanted to do something that no one had ever done before, which is treat knowledge workers like consumers.”
Nadler: Top hospital CEOs and chief medical officers use OpenEvidence personally
“So the entire, you know, the, this whole senior leadership of UCSF, of MGH, of Mayo Clinic, of Cleveland Clinic, of New York Presbyterian Mount Sinai, Cedars-Sinai, you know, right up to the chief medical officers, the chief physicians, and the CEOs in many ca…”
Nadler: OpenEvidence frequently generates patient handouts and insurance appeal letters
“Encourage physicians to use open evidence to generate patient handouts, and that's actually a very widely used secondary. It's mainly clinical report, but we have all these secondary use cases like prior authorization letters and insurance appeal letters, and …”
Nadler: Unmediated patient access to clinical trials rarely aids constructive decisions
“A patient simply finding some clinical trial published in the New England Journal of Medicine, because it was mentioned on CNN or Fox News, and then going and trying to read it, especially through the lens of fear or hope, Is not necessarily going to result in…”
Nadler: Humans require personification to trust critical automated systems
“That is a attribute of human psychology that we are anthropologically tribal and we don't abstract trust well. We personify trust and we trust things that we personify and anthropomorphize.”
Nadler: Human Doctors Will Remain in the Loop for Our Lifetimes
“I think they're going to be in the loop for a very, very, very long time, and for the rest of our lifetimes, if not longer.”
Nadler: Medical knowledge doubled every 50 years in 1950, 73 days today
“The rate of doubling of medical knowledge as measured by citations in 1950 was every 50 years. So every 50 years the number of total citations of peer-reviewed medical literature doubled. Today it's every 73 days by an estimate in the British Medical Journal a…”
Nadler: Continuing Education Will Become the Majority of Medical Training
“That is going to more or less invert, where the continuing medical education is going to be the majority of your medical education.”
Nadler: OpenEvidence is used by physicians in every US zip code
“We have physicians using open evidence in, in every state electoral county and zip code in the United States, including rural Alaska and southwestern Georgia.”
Nadler: AI tools will bridge specialist medical care gaps in rural US
“I think increasingly, certainly in rural areas and healthcare deserts at the fringes and edges of healthcare in the United States. That's absolutely how certainly open evidence is being used and how I think broadly is going to be used at least to sort of bridg…”
Gil: Political culture stopped doctors from speaking candidly about obesity risks
“Political culture took over and prevented them from speaking their minds on things that were really clear on evidence. That huge impact for the patient population, yet nobody would stand up and say, actually, it's really bad that we're glorifying the fact that…”
Nadler: Treating enterprise users as consumers accelerates adoption across skeptical industries
“While medicine is obviously very specific, the human psychology is not. And everything that was true and that we've seen through the sort of hyper pace consumer internet growth curve adoption by the most traditionally skeptical knowledge workers shows that in …”
Nadler: Elite founders succeed through will to power, not rationalism
“I don't think if you build it, they will come is true. And nor would I say that, you know, Apple or Steve Jobs is a story if, that if you build it, they will come. To me, you know, Apple or Steve Jobs is a story that if you have extraordinary will to power And…”
Nadler: The idea for OpenEvidence is completely obvious, not uniquely creative
“But you need to find this sort of perfect storm of things, and it has very little to do with ideas. You know, the idea for open evidence is the most obvious idea in the world. It's the same as, it's no more creative than let's go to the moon. Let's do somethin…”