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Daniel Ek:离开 Spotify 后的生活、失灵的医疗激励、及早发现疾病与 AI 的潜力

Daniel Ek

生物医药AI与软件企业经营技术
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TL;DR
  • 在 Spotify 运营20年、将活跃用户做到了超过7亿、付费订阅用户超过3亿后,Daniel Ek 于1月1日转任执行董事长,并重新投入创业。 Spotify 于2006年成立,2008年末在瑞典上线,2011年进入美国;Neko Health 同样花了5年研发,2023年在瑞典上线,随后进入英国,如今进入美国。“也许只是我的疼痛耐受度比较高。”

  • Neko 的切入口是一项垂直整合、定价499美元且单位经济效益为正的预防性医疗服务。 一次约1小时的检查会测量53项血液指标,采集超过6,000张高分辨率身体图像,评估心血管及其他已有循证依据的指标,并由临床医生解读结果。Ek 称这是“你能为健康投入的最有价值的1小时”。Neko 联合创始人 Hjalmar Nilsonne 是这一构想的核心提出者,负责大部分工作;Ek 并不担任公司的日常 CEO。

  • 超过100,000次扫描已经释放出一个早期健康信号:约1%的会员被发现患有此前未确诊的严重疾病。 Ek 表示,初始健康状况最差的会员改善幅度最大,但明确不把这一结果说成已经证明了人群层面的结论。Neko 建议每年检查一次,但他认为,现在判断大范围普及将如何影响医疗预算还为时过早。

  • 皮肤科说明了为什么 Neko 把多模态、纵向数据视为产品本身,而不是一次性体检。 Neko 用户平均有约950颗痣;Neko 会把它们全部编目,用 AI 标记风险,再叠加临床医生和专科医生的复核,随后比较每次检查中每个病灶的变化。即便是极其优秀的医生,也“不可能记住”一个人几百颗痣在1年前的样子。

  • Ek 对美国医疗体系失灵的初步判断,是激励机制与回报周期错配。 雇主绑定的保险可能只会覆盖同一名会员2年或3年,而预防性投入可能需要10–20年才能收回成本;因此,体系仍然围绕急性症状运转。他的应对方案并不宏大:降低诊断成本,并积累足够的结果数据,让长期投资回报变得可见。

  • 这套数据策略不止覆盖 Neko 自有传感器,还延伸到可穿戴设备、科研以及持续升级的诊断能力。 Neko 已经支持导入 Apple Health 数据,完成了4项临床试验,另有2项正在进行、4项计划开展;Ek 预计 Gen 2 会持续扩展,而不会在10年间停留在静态产品状态。他认为,如果医疗数据的可用规模增加10x或100x,就可能得出今天规模相对有限的数据集无法支持的结论。

  • 谈到 AI,Ek 同时看好开放模型和闭源模型,不愿对发展节奏采取强硬立场,并提出算力是静态模型分类之外的另一项风险变量。 Spotify 会根据任务不同使用前沿模型和微调模型,因为成本、效率与控制能力各不相同;与此同时,一个使用100,000块 GPU 的系统,可能远强于一台家用电脑上运行的开放模型。他更大的不满是,行业没有充分传达 AI “疯狂积极的一面”:从个性化音乐到更早发现疾病,AI 的应用潜力远未被讲清楚。

摘要 · 为研究而整理的核心内容

1. Spotify靠为在位者的下行风险兜底赢得市场

  • 访谈从 Spotify 的规模讲起:在 Ek 运营公司20年后,活跃用户已超过7亿,付费订阅用户超过3亿;1月1日,他转任执行董事长。Ek 23岁时创办 Spotify,那时 iPhone 和 YouTube 尚未出现,Facebook 仍只面向大学生。面对猖獗的盗版和针对个人消费者的诉讼,他得出的结论很直接:“不可能把精灵重新塞回瓶子里”(There’s no way to put the genie back in the bottle)。因此,产品必须让用户感觉自己拥有“触手可及的全世界音乐”(all the world’s music at your fingertips)。

  • 瑞典陷入困境的音乐市场提供了切入口。高速宽带让盗版变得毫不费力,iTunes 又尚未进入,当地音乐行业的收入据 Ek 回忆缩水了约80%;这让瑞典既成为全球最糟糕的音乐市场之一,也成为对合法替代方案异常开放的试验场。

  • Ek 和联合创始人 Martin 把上一家创业公司的收益全部投入,用来保证唱片公司能够获得足够收入,以守住下一年的预算和奖金。Spotify 如果失败,高管仍然能拿到报酬;如果成功,他们则共同分享上行空间。经过多年谈判,Spotify 于2008年末上线,随后扩张至英国,并于2011年进入美国。

  • Stardoll 是 Ek 的运营预演。该网站的平均页面加载时间约为4分钟;他重新设计架构、组建新的技术团队,把加载时间压到1秒以内,随后流量“爆炸式增长”。他原本答应帮忙6–12个月,部分原因是希望 Danny Rimer 能为 Spotify 提供资金——这并没有发生——但他最终还是离开,自己把 Spotify 做了起来。

2. 离开 Spotify 后,Ek 要的是再次做产品,而非只做投资

  • 在 Spotify 上市前后、约2018年之前,Ek 几乎没有多少可投资财富,因为此前12–13年几乎全部精力都放在公司上。开始投资后,他很快确认了自己的偏好:“相比投资,我更喜欢做产品。”在没有实际运营权的情况下给创始人提供建议,不如亲自解决一个问题让他满足。

  • 至少从2012年或2013年的一次访谈开始,医疗就一直占据他的注意力。他最初困惑的是:医疗支出为何持续上升,结果却在恶化。Ek 没有找到单一原因,但把重点放在慢性病上,包括心脏健康和皮肤癌,因为在他看来,及早发现可以让这些疾病变得可预防,同时把治疗成本和患者痛苦维持在较低水平。

  • Neko 联合创始人 Hjalmar Nilsonne 是公司的核心构想提出者,也负责大部分工作;Ek 仍然深度参与,但不担任日常 CEO。Neko 的判断是,预防始于“多得多的数据”(a lot more data):每一种测量都要更深入,覆盖更多模态,并且持续纵向采集。Ek 明确把这套飞轮与 Spotify 联系起来:更多听歌数据提升了下一首歌的预测能力;更丰富的健康历史,或许同样能提升对未来疾病的预测能力。

3. Neko把预防性医疗压缩进1小时的全套检测

  • 499美元的 Gen 2 检查在设施、护士、医生、诊断设备和软件之间实现垂直整合。会员提供血液样本,检测53项指标;随后进入一套相机设备,采集超过6,000张高分辨率图像;同时接受心脏、血液循环、握力以及其他有循证依据的测量。

  • 包括血液检测在内的结果会在同一次访问中提供,医生可以连续、不间断地完成解读。完整体验约需1小时,但如果受检者问题较少,30–40分钟也能完成。Ek 希望它最终像每年看一次牙医一样成为常规安排,同时承认“500美元仍然是一大笔钱”。

  • 美国业务将从纽约 300 Lafayette 开始。讨论中还提到迈阿密和华盛顿特区是计划中的地点,未来12–24个月将扩大美国覆盖范围。

  • 主持人追问,Neko 与此前的综合医疗概念究竟有何实质区别。Ek 强调的是公司的运营积累:8年产品开发、超过100,000次扫描,以及近期发布的第3年数据调查,而不是刚刚提出一个预防医疗概念并包装上市。

  • 约1%的会员被发现存在严重且此前未确诊的医疗问题,许多人还会获得关于压力、饮食、睡眠及其他生活方式变量的建议。尽管仍处于早期阶段,最让 Ek 感到鼓舞的是,起始健康状况最差的会员改善幅度最大;他提到,有人正是在看到并讨论自己的健康状况后戒了烟。

4. 纵向皮肤科数据,展示 AI 真正创造价值的地方

  • Neko 用户平均有约950颗痣,有些人甚至有几千颗,远远超出普通门诊能够持续、完整检查的范围。Neko 会将每颗痣、每个病灶、皮疹和发红区域全部编目,而不是只检查患者或医生碰巧注意到的部位。

  • AI 系统会标记潜在风险,临床医生进行复核,仍然令人担忧的部位则交由多名皮肤科专科医生检查。Ek 设计的是一种有意保持混合形态的模式:“它应该在优秀的整体体验中,无缝结合 AI 和出色的临床医生”(It should seamlessly be both AI and amazing clinicians in a great packaged experience),而不是让自主算法取代医学判断。

  • 更大的优势会在下一次检查时显现。由于每个病灶都已经完成编目,系统可以识别一年之间的异常变化;即便是“世界上最好的医生”,也不可能可靠地记住950颗痣之前分别是什么样子。

5. 预防的障碍是回报周期错配,而非缺少意愿

  • 当被问及美国医院就诊和药物为何可能达到其表面投入成本数倍时,Ek 没有顺势把自己塑造成能提出3项宏大改革方案的专家。他给出的狭义判断是:“给我看结果,我就给你看激励”(show me the outcome, I’ll show you the incentive):医疗体系诞生于传染病是主要威胁的时代,至今仍然奖励在明确症状出现后进行干预。

  • 雇主绑定的保险让这种错配更加严重。一个人可能只在同一雇主及其保险公司处停留2年或3年,但预防性投入可能需要10年、15年或20年才能收回成本。Ek 设想的切入口,是把一次假设需要100万美元的干预降到数万美元,从而提高有人愿意为其买单的可能性。

  • Neko 表示,499美元的定价已经能够实现正向单位经济效益,部分现有诊所也已实现盈利。但 Ek 不愿据此推导出全国性节省:普遍开展年度筛查究竟会如何影响医疗预算,“我认为现在还无法判断”。

  • 更好的测量最终可能厘清这笔投资的回报。按科技行业标准看,Ek 认为医疗数据集小得出人意料;如果能让可用数据增加10x或100x,就可能得出有用结论。Neko 已完成4项临床试验,2项正在进行,另有4项计划开展,并且每年发布汇总结果。

6. Ek希望用应用、开放程度和实际算力来评判 AI

  • 对前沿 AI 的发展节奏,Ek 没有表达明确支持或反对。更广泛的争论是由主持人提出的,他举例说,危机发生时会让所有人瞬间变成专家;Ek 则转而强调,技术都会带来极端的正面和负面影响,应当把技术引向希望实现的结果。

  • 他的正面案例很具体。Spotify 最终或许可以“为你生命中的每个时刻配上音乐”(soundtrack every moment of your life),让音乐让用户“感受更多”;Neko 则可以持续监测数百个病灶。Ek 认为,科技行业没有把这些具有广泛益处的应用放在台前,已经“造成了极大的伤害”(a terrible disservice)。

  • 在模型结构上,Ek 预计开放系统和闭源系统会长期共存。Spotify 同时使用前沿模型和内部微调模型,因为有些任务需要更低成本、更高效率,或者需要前沿模型提供商无法提供的定制能力;主持人则用每100万 tokens 约0.13美元对比30美元的输出成本,说明了其中的差距。

  • Ek 认为,算力可能是另一项值得纳入考量的安全变量:一个使用100,000块 GPU 的系统,可能远强于一台家用电脑上运行的开放模型。主持人进一步将其延伸为基于算力的访问权限和认证机制,但 Ek 仍将其视为一个未完成的想法——“也许是我遗漏了什么”(maybe it’s something I’m missing)——而不是已经成形的监管方案。

完整逐字稿
Speaker 1

Daniel Ek is with us. You know him, the co-founder of Spotify, which he started 20 years ago and ran for those 2 decades to an extraordinary state of affairs today: well over 700 million active users and over 300 million premium subscribers. But on January 1 this year, he shifted and became the executive chairman with me and David Freeberg. Daniel, how are you, sir? Welcome to the program.

Daniel Ek

Thank you so much for having me. It’s good to be on.

Speaker 1

It’s good to see you. We’ve known each other for 20 years. I remember the first time Shaq, your partner, leaned into me at an internet summit or something and said, “Hey, check this out.” He showed me Spotify, but this was at a time when nobody had a subscription service.

1. Starting Spotify: Beating piracy and betting his own money on the record labels

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, how that crazy idea got started, and how hard it was to break through with the music industry, which is also known as the hardest partners in the world.

Daniel Ek

I usually start off by saying that whenever anyone asks me about the story: I had hair when I began this, and by the end of it, I obviously ended up being bald. You can see that it wasn’t an easy journey.

All jokes aside, I started Spotify in 2006. I was 23 at the time, and the world looked a little bit different. This was pre-iPhone. Facebook existed, but it was college-only, and YouTube didn’t exist. This was before all the things we now take for granted.

The music industry at that time was in freefall because music piracy was rampant. We had Napster, Kazaa, and all these other services. There was an organization called the RIAA that went around and actually sued individual consumers in the U.S. for illegally downloading music.

I was sitting in Sweden and thinking to myself, “This is wild and crazy. There’s no way to put the genie back in the bottle.” My co-founder Martin and I were sitting around spitballing startup ideas at the time. Martin asked me, “If you could do anything you’d like to do, what would you do?” I said, “My real passion is music, but that seems like a really stupid idea.”

He asked, “Why is that a stupid idea?” I told him it was really hard because you had to do all these deals with the record companies, figure out licensing and copyright, and do all of these different things. He said, “Well, what if you did this?” Then he kept asking these “what if” questions, and eventually I ran out of reasons to say no.

I said, “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.” He said, “Well, that sounds pretty good.” I said, “Okay, let’s give it a try.”

We started trying to license music. Originally, the idea was to try to go global from day one, and everyone was just laughing at us when we said that. But I lucked out because it turned out that one of the worst music markets in the world was my home country, Sweden.

Part of the reason it was one of the worst music markets was that we already had superfast broadband from the early 2000s. We were living in the future, where people had such fast bandwidth connections that they could download pretty much whatever they wanted. So they were doing it, and iTunes wasn’t even available in the market. There were literally no legal options.

I think the music industry had lost 80% or so of its revenue. It was this crazy coincidence, this confluence of events, where my partner and I basically took all of the money we had made from prior startups and said to the record labels, “What if we guaranteed that you’d keep your bonus for the next year and meet your budget for the next year? If this really is as bad as you think it is, then you can shut it down after a year, but you still made the bonus.”

“If this actually works, you win as well. So you win no matter what.” They said, “Okay, this seems like an interesting idea.” Eventually, after a few years of negotiation, they agreed to it.

We launched in late 2008, and it instantly became a huge hit. We then took it to the U.K. and made it a huge hit there. Then, in 2011, 15 years ago now, we launched in the U.S. The rest is history.

Speaker 1

2. Neko Health: The Spotify playbook for healthcare, the $499 body scan, and why US healthcare waits until you're sick

Isn’t that amazing? Five years in the laboratory just to get to the U.S. market is quite a journey. That’s a lot of pain and suffering.

Daniel Ek

The crazy thing is that I’m on the same journey again.

Neko, as crazy as it is, started the company 8 years ago in 2018, and we started it in Sweden in 2023. It took us 5 years to develop the product, try it out in Sweden, and then, once we had proven it in Sweden, take it to the U.K. and do it there. From there, we’re now launching in the U.S.

It’s the exact Spotify playbook again, but this time in healthcare.

Speaker 1

One of the afflictions of great entrepreneurs is that you’re entrepreneurial. You just can’t stop.

Daniel Ek

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

Speaker 1

Once things got smooth, you had to get back into it. At what point did you start thinking about doing other things? Were you actively angel investing at Spotify over the years as CEO, while the business was building, with hundreds of millions of users, a successful public company, and things growing nicely?

You had a great leadership team—we’ve obviously met a lot of your team over the years. How did you start doing these other projects? I know you’ve got a few others, and now you’re focused on Neko.

Daniel Ek

It’s kind of crazy. I had forgotten about it, but my team recently showed me that I apparently did an interview with the FT in 2012 or 2013, just after the U.S. launch of Spotify, where I was already talking about healthcare. So I’ve been thinking about healthcare specifically for a very, very long time.

A lot of people talk about all the stuff that’s going badly in the world, but my view is that most things are actually going pretty well. It’s kind of up and to the right on the technology curve, with all the things that we’re getting. I try to focus on the problems that aren’t going that well.

One of those happens to be healthcare. I’ve been interested in the question of how we’re spending more and more money on healthcare but getting worse and worse outcomes, and what we can do about it. That really got me into the space.

I think healthcare is unique and special. I honestly didn’t have any money until Spotify went public, so I wasn’t a prolific angel investor.

Speaker 1

What year was that?

Daniel Ek

That was 2018. We went public then, right?

I probably started doing a little bit of investing in 2018, but I had no money before then. It was literally all-in focus on Spotify for the better part of 12 or 13 years before I made any investments in anything else.

You and I were talking about it at this dinner a week ago or so. I had already started Neko at that time, and I realized that I loved building much more than I loved investing.

Speaker 1

I came to the same conclusion. It’s so painful to watch companies you invest in get mismanaged, and you can’t do it. This was our whole dinner conversation the other day: you spend time on boards, advise a CEO, and they don’t listen to you. You pull your hair out thinking, “I would have done something different. Why didn’t you do this?”

If they are listening to you and you’re effectively instructing them on what to do, that also doesn’t work because they’re not leading. I became pretty committed to the idea that you find amazing entrepreneurs and founder-CEOs, give them money, and never look at it again. You’ll generally be better off than not.

The flip side is that if that’s really what you’re passionate about and you have the activity or agency to step in and do it yourself, you should do that.

Daniel Ek

The more instruction they need, the less likely they are to succeed.

Speaker 1

So, Daniel, maybe you could just give us an overview of Neko.

Daniel Ek

Yeah.

Speaker 1

And how did you come to that idea? How did you come to this specific idea?

Daniel Ek

I started researching the space a very, very long time ago. Maybe, as a quick primer for the audience, the U.S. is spending 18% of its GDP on healthcare. It's the single largest line item in the budget right now.

If you take heart disease alone, it's hundreds of billions of dollars being spent on that disease group in the U.S. alone. It's just insane. It's larger than the revenues of Fortune 10 companies—just one disease group.

So it's a gigantic problem. I started looking into everything, from drugs to whether you can make drugs more efficient, to cancer, and basically started targeting what the real reasons are why it looks that way. I think the real conclusion ended up being that there are lots of reasons, not just one.

We see a few really big ones. Cardiology, or heart health, is a major one. We see skin cancer, melanomas, as another big one. There are a few major groups of illnesses that are overrepresented, but the major one is really chronic disease overall.

The crazy thing about chronic disease, when you read about it, is that if you discover these things early, they're totally preventable. The cost of dealing with them is very small, and the suffering for the person having them, and for their family and community, is very small too.

The key thing is that if you discover things early, you're actually in good shape. So then the question is: Why don't we discover things early? It happens to be that we don't have enough data.

Everyone in the entire healthcare industry agrees that we have to take healthcare from reactive to preventative health. But that's where all the disagreement starts: How do you do that?

My co-founder, Hjalmar Nilsonne, and I believe it all starts with having better data. If you have better data, you're going to be able to discover things much more easily. That, in itself, gives you a chance of discovering those things much earlier, which then creates this virtuous flywheel that can change healthcare.

Speaker 1

So, predictive data that allows you to predict future adverse health outcomes and course-correct ahead of time?

Daniel Ek

Yeah, that's the holy grail—to get to that point. 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 from and across multiple modalities. You need it longitudinally, so you need it over time.

If you had a lot more data and you had it over time, you'd have a much higher likelihood of doing those kinds of predictive analyses. Then we said, “Okay, how do we do that?”

It so happened that if you think about what's really happened in the last 20 years, one of the biggest innovations, of course, is smartphones. We've had more and more sensors packed into those smartphones, so there are more and more cheap sensors and cheap electronics available to us.

Our view was, “Okay, we should be able to utilize this to build a lot more sensors than have been built before.” The other thing is that we started before the LLMs and everything like that. It was then called machine learning, but today we talk about it as AI. We should have a lot better intelligence.

If we have all of these massive datasets, we should be able to make really good predictions. Similar to what we learned with Spotify, the more data we're able to gather, the better predictions we're able to give you about what song to play next.

This is exactly the same thing that you now need to do in healthcare, but obviously it's across multiple modalities and across longitudinal datasets as well.

Speaker 1

Is there evidence today that some of this early observational data can affect ultimate health outcomes? I can see this working for metabolic conditions—things related to exercise depletion rates, blood sugar, and sleep—but ultimately, the correction there is typically diet and exercise.

What are some other examples of major diseases that we can identify ahead of the curve and course-correct? And maybe just explain what Neko is for people who don't know.

Daniel Ek

Yeah. Maybe I'll start there, and then we can get into it.

In a very simple way, the experience of Neko today, and in Gen 2, is $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, to doing everything on our own on the software side.

It's really 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 we have, and that's what we come to work to do every day.

The experience is that you come in, and the first thing you typically do is have blood drawn. We then measure 53 blood markers. You go through our skin rig, where we have a camera system that takes more than 6,000 super-high-resolution images across your body. We index every mole and lesion, as well as all of the possible rashes and redness you may have.

We then look at your heart and blood circulation, and we look at grip strength—all the traditional markers for which we have very good scientific evidence that they're valuable indicators of health.

At the end of this visit, which lasts about an hour, you get uninterrupted time with the clinician. You go through all of the results, including the blood work, during that hour. You have a complete set of results that you can go through with your doctor, and the doctor will answer any questions you may have.

You also sit down with that clinician and go through results about things you may want to improve when it comes to your health. That's the experience we're launching with today in New York in the U.S., and obviously we'll launch in many more places across the United States over the coming months.

Speaker 1

And just the identification of things ahead of the curve—because I've heard of other attempts. There was One Medical, there was Forward. There were a few other attempts at making these integrated centers where you go in and get preventative checkups with their own instrumentation. I think I've heard the thesis a little bit before.

What have you identified that might be novel, Daniel, that we haven't seen in the past?

Daniel Ek

I think, first and foremost, the important thing to mention is that, as I mentioned, we started this in 2018. This company has been around for 8 years. We've done more than 100,000 scans already.

We publish data every year. We've just published our third-year data survey, where we go through the health outcomes we have across our members, and around 1% of our members have a serious underlying medical situation that is undiagnosed when we discover it.

The good news is that many of our members are healthy, and we're just talking about improving their current health status. As you correctly pointed out, a lot of that ends up coming down to stress, diet, sleep, and those things.

But the most encouraging thing we're finding now, as we've done these studies for 3 years in a row, is that the people with the worst health status are the ones improving the most. It turns out that having a clear visual understanding of where you are in your health journey today, and having a clinician sit down with you and explain the situation and possible remedies, is a huge factor in getting people to start improving their lifestyle.

We've seen members go from years of smoking to not smoking as part of doing Neko and prioritizing their health. We've obviously seen people with severe underlying medical illnesses discover and treat them, resulting in much better overall health.

So it's really all across the board, but I'll give you a very concrete example. Take dermatology as a great example. The average person at Neko today has 950 moles. It's pretty crazy.

Speaker 1

The average person has 950 moles?

Daniel Ek

Yes.

Speaker 1

That's insane. Some percentage, you can't tell, I guess, is the punch line here. They're not detectable by the—

Daniel Ek

Well, if you really went through your skin, you'd be surprised how many you'd find. It's a big dispersion. Some have many, many thousands. Some of them have—

Speaker 1

Seems like a perfect AI application, obviously.

Daniel Ek

Exactly. So if you think about it, across a normal doctor's visit, how likely is it that that doctor will check out all 950 moles that you may have? It's not going to happen.

Normally, what happens in a normal doctor's visit is that you may say, “Look, I have a mole,” or the doctor sees one and says, “Hey, let's take a look at that mole. It looks a little bit funky.” Then they bring out their tool and inspect it.

Usually these days, they have software that checks it. They take a camera across many different frequencies to discover both the size of the mole and its texture, and so on and so forth.

We literally do that. We first have an AI system that flags possible risk factors, and then we have a human clinician who goes through and reviews those as well. Should we, even at that point, find something, we then have expert dermatologists on staff—multiple of them—who also review that result.

That’s just one indicator of what happens in one visit. But let’s now presume the scenario that we’d have multiple visits and maybe, one year, we don’t discover anything. Because we’ve cataloged and indexed every single one, we can now look at them longitudinally from one year to the next. So it may be growing abnormally. 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 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 a perfect application of how health care should look. It should seamlessly be both AI and amazing clinicians in a great packaged experience. So that’s essentially what we’re trying to do with Neko.

Speaker 1

That’s great. Are you actively running it as CEO, Daniel, or are you operating part-time?

Daniel Ek

Yeah, no. Similar to Spotify these days, where I have 2 great CEOs, I have an amazing co-founder and partner, Hjalmar, who’s really the brainchild of Neko. He’s the one who’s doing most of the work, even though I’m sitting here and taking most of the credit at this point. But he’s the real brain.

Speaker 1

Great. You know what I’m struck by? The cost of this is so cheap: $499. You also have Function Health and Superpower, 2 other great services, at about $350 or $400. They just do blood work.

But if we look at the spending, right now health care is number 2, Social Security is number 1, and in fact, your favorite coming up is the interest payments. Friedberg will overtake our health care spend. You could actually have folks come to this every year or every other year for 4% or 8% of the total cost we spend on health care.

I’m curious: Is this something you expect people to do yearly or every other year? What impact do you think an investment of every American getting this done every year, every other year, or maybe every 3 years—even, which would be down to 2% of our budget—would have on the forward-looking budget and spend? Have you done those kinds of calculations?

Daniel Ek

Yeah. We obviously have a view, but I think it’s too early to say, so I don’t want to sit here and say that we know conclusively what will happen. But what we do recommend to our members is that they try to do this on an annual basis.

The way I make this analogy is that most of us today are trying to go to a dentist on a yearly basis. For some reason, most of us don’t do an annual health checkup. So for me, this should be as regular as going to the dentist or doing anything else, and it should be an amazing experience.

This should be, again, as I said, what we’re really doing as a mission here: trying to create the most valuable hour you can invest in your health. We know a lot of people are busy, so we want to be brutally efficient with people’s time. If you don’t have any questions and you’re just interested in getting the test results, you could probably get by in 30 or 40 minutes and do it. We’re not talking about a lot of time.

Obviously, $500 is still a lot of money for people, but I do think it’s a great investment if you can afford it.

Speaker 1

That $500—do you lose money on every visit or break even, and then there’s some profit that comes from maybe the upsells? Take us through the economic model here and then how that will work with the insurance industrial complex, as dysfunctional as it is here in America.

Daniel Ek

Yeah. The benefit of being vertically integrated is that we’ve been able to build everything ourselves, which means we can also cut costs in a pretty dramatic way. Within that $500 a year, our unit economics are positive, and we have clinics today that are profitable and that we’re already operating.

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 economically viable for us—to create a great business and to be able to grow and invest in that business so that we can spread it to more places as well.

Speaker 1

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

Daniel Ek

I’m not exclusively focused on it, but it’s obviously one of the things that’s 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. I’m executive chair there, so that’s still my baby, even though I’m not involved in it on an everyday basis.

We have a few other companies with Prima Materia, which is a company I created together with Shak, who I mentioned earlier. We’re trying to really do what I mentioned before: How do we pay it forward and almost be like the greatest co-founder you could possibly find? That’s the ambition of Prima Materia.

Speaker 1

The health care thing really perplexes me. I look at the biggest issues for affordability for people in the US right now: buying a home, dealing with educational costs, and health care costs are the top 3. I feel like we can solve education costs and home costs with certain market incentives that have been distorted. But health care is much more complex.

As you look at the US system beyond just preventative care, the cost of servicing patients in a hospital—why is it $15,000 to get stitches at an ER? Why is it $20,000 to get a drug that costs $30 to make? Why, when the doctor is making $200,000 a year, does the doctor seeing me for 8 minutes cost my insurance company $6,000?

What is going on, from your view, that extends beyond getting in front of all of the catch-up problems and so on? What’s structurally going on with the health care system in the US?

And if you were emperor of the US for a day and got to say you could do anything you wanted, what are the top 3 things we’re missing that maybe Neko doesn’t necessarily address today, but that you would recommend we fix?

Daniel Ek

I’m definitely not an expert on the US health care system, but for me, it’s, “Show me the outcome, I’ll show you the incentive.” It’s one of those classical problems.

If you really think about it, at the moment, the entire system is predicated on—and the health care system was built around—a time when we were dealing with infectious disease. That was how the health care system was built and dealt with. So all the incentives are really around that, which means we’re fixing you acutely when there are massive amounts of symptoms.

Where we have to go is toward a health care system that is preventative. That means it has to be much more long-term today. I’ll just mention one of the problems that exists: Normally, your health care is tied to your employment in one shape or form. Because the average tenure of your employment isn’t very long, it means that you may have only 2 or 3 years at one employer, and then you switch. When you switch, you switch insurers, too.

One of the questions then, if you’re that insurer, is whether you should invest in something where the payback time may be 10, 15, or 20 years. Those are just some of those incentive issues. How do we look at the ROI of some investments that may be 10, 15, or 20 years into the future, and who takes those investments?

These aren’t easy things to answer, and I don’t claim to have all the answers. But one of the things we’re trying to do is bring the cost down so that the ROI doesn’t have to be an investment of millions of dollars by the insurance industry or employers, speculatively hoping to get it back in 20 years with very little data.

Our view is that if we lower it so it may not be a million dollars—it may be, I’m making it up, tens of thousands of dollars—even if that payback time were 10 or 20 years, I think there would be a higher propensity and likelihood for a pickup on that.

The second thing we’re trying to do, obviously, is add more data to the system. If we had more data, then with these multimodal, longitudinal data sets, it’s much more likely that we could actually see the efficacy of these things over time.

This is also part of the reason why we’re investing in releasing our data every year—what we’re finding—so that people can see what happens both on an aggregate Neko population, which is also super cool, because normally health care systems are very country-specific.

This is one of the few health care companies that isn’t global but is at least a multi-country system straightaway.

Speaker 1

So that's also super interesting. What are we finding in the UK that may or may not be similar or dissimilar to the US? What did you find between Stockholm and the UK? 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.

Those are the two, I believe. You tell me if I'm right. Aren't those the 2 biggest spends in terms of health care spending? I think diabetes is number 1. I could be wrong, but cardiovascular disease and diabetes seem to be the big 2. So what did you learn between the 2 populations?

Daniel Ek

Well, I mean, it's really early, and it's still on a relatively small base. It's 100,000 scans, as I mentioned before. But I don't think we're ready to speak about population-level health outcomes, but as we grow in Neko, I think we will. And that's going to be super cool.

We're already doing lots of clinical trials. We've done 4 already; we have 2 underway, and we have another 4 we're going to do. 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 of tomorrow, too.

I think my point with all of this is really just to say, look, for people in tech, the amount of data that exists in the health care system is actually not—the data sets are not that large. That's the crazy part. If we can 10x or 100x the amount of data that becomes available, we're going to be able to draw super interesting conclusions about that. Not just Neko, but the whole health care system.

Speaker 1

That's really the bet we're making. Putting the wearables in there is going to be really interesting with the Oura, the Whoop, and the Fitbit. You start with Apple Watches, and 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 your Oura or Whoop with some of those, but I've never seen any data.

We have sleep, recovery, and heart rate, 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 health care if we can correlate that. Maybe you could speak to the impact you think wearables are going to have.

Do you think you partner with them, or do you just have a Neko wearable you eventually make part of the subscription at $9.95? It does seem like these are commodified for the basic 80% of it, I'm sure.

Daniel Ek

Yeah.

Speaker 1

So what are your thoughts there?

Daniel Ek

Already today, we do allow you to import your Apple Health data. So if you do have wearable data, we will take that. Anyone who has a wearable—and a lot of the big ones, Oura, Whoop, et cetera, do allow you to write a lot of that to Apple Health as well. That's just one example of that.

We would love to have more data, because that enables us, again, when the clinician sits down with you, to give you a much more 360-degree perspective about your current health status. So that's one of the things that we encourage.

But I do want to say also that this is just like the service we're launching today. It is very rare in itself that, when you create a diagnostic product, the normal way of doing that in this space is you spend X amount of years doing R&D for that thing, then you literally spend the next 10 years selling exactly that thing.

With Neko, within the 3 years since we launched, and now as we're launching in the US, we're on Gen 2. So we've already upgraded our diagnostic infrastructure. I think what you should expect with Neko is that we're launching with one thing today, but we're going to keep adding more and more value, and we're going to keep adding more and more valuable diagnostics that we can find and put in at the price point.

That's kind of the goal. This is just the beginning, 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.

Speaker 1

3. AI: Tech's failure to sell the upside, open vs. closed models, and regulating compute

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? What's your view on pacing the—

Daniel Ek

I hear these questions. Yes.

Speaker 1

Do we need to pace the frontier? I'm struck by the fact that, if we look at the world, and certainly over the last few years, I always say we're walking into COVID and every one of us became a virologist. We were all of a sudden supply-chain experts after the Ever Given got stuck in the Suez Canal. Then, with the Ukraine war breaking out, we were all military experts. Are—

Daniel Ek

Are you talking about the All-In podcast right now?

Speaker 1

We're just talking in—

It's actually, 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, Daniel, that maybe Spotify's podcasting could regulate us because our opinions are crazy. Yeah. And my point is just that everyone expresses these things with such extreme confidence, and it turns out most of the time we end up being completely wrong, even the biggest experts.

I'm not sure I have much value to add, except to say that I believe we're still in the innings where we can alter the impact of how to use these technologies. My view is that every great technology has extreme positives and extreme negatives, and it's really up to us now to steer this toward the outcome that we want.

I think it's great that the debates are being had, but honestly, I have no strong opinion one way or the other about whether we should pace it or not. I just know that if I look at health care and I look at what we're doing at Spotify, it's truly amazing.

The perfect music product is one that I've described many times, and I think we're getting closer to it now, which is awesome. Right now, you can put together a better playlist yourself than what the system could do. But I think in the future, we can soundtrack every moment of your life in an amazing way, where you just feel more.

The power of great music is that you will feel more. If you're happy, you'll feel happier. If you're wallowing and feeling sad, you'll feel even sadder in that moment. That's thanks to AI.

Then, if I look at the example we talked about with dermatology, 950 moles being able to be tracked over time, keeping you safe—these are positive, amazing examples with AI. Yet we tend to amplify the negative. I want to see more positive examples of AI. I think we, as an industry, have done a terrible disservice by not talking about all the really crazy-positive stuff that we can use AI for that actually greatly benefits everyone.

Speaker 1

In that sense, do you also think about the benefit and the value of open-source AI and open-weight models? You can now look at something like 13 cents per million tokens of output cost versus $30. That's an incredible difference that unleashes this technology across a broad spectrum of businesses and individuals.

There is no concentration of value or wealth among a handful of businesses or individuals if we can really make these open-weight and open-source models proliferate. But obviously, this regulatory conversation may restrict the expansion of open-source and open-weight models. Do you have a view on the importance there?

Daniel Ek

I think technology has always gone between open and closed, right? We had Windows versus Linux in the first iteration, iOS versus Android. We've seen this play out so many times, and where we tend to net out is that we tend to have both.

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 brings a lot of innovation that will be really helpful for the ecosystem as well.

I completely agree with you that, if you look at these now, and certainly what we're seeing at Spotify, we're obviously using a lot of the frontier models, but we have a bunch of fine-tuned models ourselves, too. We tend to do both, and that is actually making us more innovative. It's 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 would want to.

I personally think it's going to be both. But one of the things I heard that is a perspective I haven't heard before, and maybe I would encourage people to consider—not that I'm an expert on all these things—is the amount of compute.

If you think about it, for me, this isn't just about the intelligence itself of a single model, but the amount of compute you're doing can indicate something, right? If I'm using 100,000 GPUs for something, that's probably going to be a lot more powerful than if I'm running an open-source model on my home PC.

It’s probably very unlikely that I’m going to be able to do an enormous cyber thing. Certainly, if the companies have mythos class models to protect themselves, I should be able to do a lot of damage with an open-source model on my home PC. I find it fascinating to think about whether there’s a way of looking at the amount of compute as one factor in that as well.

Speaker 1

Right. Assuming model equivalency, compute is a key metric of defensibility. That’s really where we can start to build guardrails around who can have access to the most compute and how you get certified for compute, as opposed to being certified for software. Wasn’t that the original concept, 2 years ago? One of the original ideas for limiting this was how many teraflops or how many GPUs you had?

Daniel Ek

No. What they did—that was how they wrote the regulatory laws around regulating models, right? So they basically set a model that was trained on X number of teraflops, and it was like a California—

Speaker 1

This is static, like—

Daniel Ek

The California genius assembly got together and said, “We figured it out. We know how to classify scary models and bad models.”

Speaker 1

How many Ethernet cables are in your data center as a proxy for how powerful—

Daniel Ek

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 remember when Cray supercomputers came out—

Speaker 1

And there was limited access, and they were considered a security risk. You had to get approved in order to get access to a Cray supercomputer because you could use them to design nuclear weapons, crack codes, and do all the things people worried about. Yeah. Today, a Cray supercomputer, I think, is less powerful than a washing machine or some product we probably have in our kitchen. 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 going to be hugely advantaged.

Daniel Ek

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

Speaker 1

4. Back to Spotify: Podcasting's open standards and the Stardoll origin story

Hey, before we let you go, I guess 2 questions for you. Take them in whichever order you want. What’s the strategy, and how does Spotify look at something we care about deeply, podcasting, which is built on open standards? You guys have become a major player in it, and open standards are kind of moving in one direction, while Spotify has a lot of proprietary stuff. I’ve talked to you about this and some of your team members: Can we keep supporting the open-source part?

The second piece people don’t know is that there was this incredible company, Stardoll. 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.

Daniel Ek

Well, I was the intern, CTO, whatever.

Speaker 1

People don’t know this. This was an incredibly innovative company in terms of many variables, like digital goods and subscriptions and all that stuff. So maybe take us through either or both of those questions, because those are 2 personal things that I would love to hear about if we were at dinner.

Daniel Ek

Yeah, I mean, look. Again, as I said, I think the open and closed are going to be 2 things that are going to exist side by side. The interesting thing about Spotify today is that, on the one hand, of course, we’re a huge platform in podcasting, and we have a destination where there are certain things that we’re doing that general podcasting may or may not be doing. 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.

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. There are a bunch of podcasters that are using our tools to distribute to some of the other platforms, too. We’re obviously doing that through open standards. So I don’t think the answer for us is one way or the other. We think both can coexist, but obviously, if you want to innovate within a standard, the key is to have other people agree to that standard, and that can sometimes take longer. So it might be harder to innovate. Spotify’s approach has been, “Let’s support both in tandem.”

Speaker 1

But then there are 2 features I just wanted to make sure I ask you about. There’s one for going live. This is part of the new standard, so having that on our page. When we go live, it actually respects the RSS feed and sends that note out. Then there’s another one called value and donations, where the person who has the podcast—if they happen to be doing donations on whatever platform, or they do them through PayPal—those 2 features are what the podcast OGs in the underground really want Spotify to support. I’m just doing my job in representing as a 17-year podcaster. Please add or support those 2 if you think it’s worthy of doing.

Daniel Ek

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

Speaker 1

Right to the chairman while I’ve got him on the line.

Daniel Ek

Yeah, of course. Of course.

Speaker 1

But tell us about—

Daniel Ek

I’ll definitely bring the feature request to the team.

Speaker 1

Tell us about Stardoll while you wrap up here. What did you learn there when you were 20 years old—21, 22, whatever it was at Stardoll?

Daniel Ek

Yeah. You know, it was a great experience. It brings me back down memory lane. I started at Stardoll just before I started Spotify. There was an entrepreneur called Mattias who was one of the original entrepreneurs in the Swedish ecosystem. He had been around since the dot-com bubble, and it was originally a site called Paperdoll Heaven in Turku, Finland, created by an old lady and her son, of all places.

Index Ventures had invested in it and taken a majority stake to help with it because they had no idea how to scale the site. Index and Mattias came in with the idea of rebranding it and building it into Stardoll. They came to me one day and asked around for people who knew tech and could be technical enough to help build it.

I had already decided I wanted to go build Spotify, but Danny Rimer is very good at convincing people to do things. As a favor to him, and sort of hoping that he would come and fund Spotify—which, by the way, didn’t end up happening—I said, “Okay, fine. I’ll help you for, I think, 6 to 12 months, something like that.”

So I went over to Finland and checked it out. It was kind of wild and crazy because I think the average page-load time at that time was 4 minutes. It took 4 minutes to render a simple page. Basically, the server was completely breaking down, it seemed. I was like, “Holy, this is crazy. I wonder how much more traffic you could do if you actually made this work in a snappy way?”

We basically rearchitected 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. Sequoia invested. I said, “Okay, well, I’ve done my part. Thank you,” and then I went off and built Spotify.

Speaker 1

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

Daniel Ek

We launched the first one at 300 Lafayette. Go sign up on nekohealth.com waitlist, and we’ll try to get to you as soon as possible.

Speaker 1

And this is in New York, 300 Lafayette Street. 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 D.C. We’re going to try to launch all over the U.S. in the coming 12 to 24 months.

Yeah, it’s great. Right on the street. That’s back in the day when Pseudo had their big studios; they were right around the corner from you. Wow, talk about memory lane. All right, continued success. Everybody, go to nekohealth.com and sign up for the waitlist. I’ll see you next time. Bye-bye.

Speaker 1

I’m going all in.