# I. The Longevity Project

How much longer can people actually live? It’s a very open ended 
question. It may not be very easy to answer at all. But there is a sense 
that biotech may be well positioned to try. Biotech, on the wake of the 
computer revolution, seems quite exciting if we think that a whole 
series of problems—e.g. cancer, aging, dying—is close to being solved.

![16-01.png]

Even without the biotech revolution, life expectancy has been rising 
impressively. The rate has been something like 2.5% decade over decade. 
In the mid to late 19th century, expected lifespans were going up at a 
rate of 2.3 to 2.5 years with each passing decade. If you plot the data 
points corresponding to each country’s single demographic (typically 
women) with the longest life expectancy, you get a very straight line on 
a scattershot basis. This isn’t quite equivalent to Moore’s law, but 
it’s analogous. In 1840, life expectancy was just 45 or 46 years. For 
century and a half now, keeping people alive longer has been an 
exponentially harder problem.

![16-02.png]

To some extent, the U.S. has fallen a bit behind in the effort. Life 
expectancy here is several years below the global max. There are all 
sorts of idiosyncratic explanations for this; Americans eat bad food, 
are too inactive, etc. But a little U.S. lag notwithstanding, there has 
been a relentless trend upwards.

![16-03.png]

Another way to think about it is this: every day you survive, you add 5 
of 6 hours to your life. That is a startling realization. The question 
is what happens next. Is the straight line going to continue? Slow down? 
Accelerate? Before 1840, life expectancy was pretty flat for thousands 
of years. Only recently has it really picked up. Whether this is a short 
burst that will stagnate or just the beginning of a fierce acceleration 
remains to be seen.

![16-04.png]

# II. Luck, Life, and Death

## A. Death as Bad Luck

In a sense, longevity is the opposite of bad luck. At the broadest 
level, you get into trouble when something unlucky happens to you. Think 
of everything that can go wrong. Maybe a piece of your DNA mutates and 
starts a cancer. Maybe you get run over by a car. Or maybe you get hit 
by an asteroid. There are many different unlucky things that could 
happen. So the question of longevity can be rephrased as the question of 
whether and to what extent luck can be overcome.

From the 17th to the mid-19th centuries, the prevailing view was that we 
could overcome all these accidents. Francis Bacon’s New Atlantis was the 
classic vision of an accident-free utopia. It was a new Atlantis 
because, unlike the old one that the Gods destroyed, new Atlanteans had 
complete mastery over nature.

This view has been receding since about 1850. Luck and indeterminacy 
have become increasingly dominant as frameworks for thinking about the 
future. This shift was probably driven by the emergence of actuarial 
science and life insurance. When people started to map out the data, 
they realized that life and death could be reduced to probability 
functions. A 30-year-old has a 1 in 1000 chance of dying in given year. 
But at age 100 that chance is 50%.

If we run with this math for a bit, living forever becomes just a matter 
of solving a simple equation:

![16-05.png]

Unchecked probabilistic thinking can be dangerous. It defeats one’s 
ability to shape the future. No County For Old Men captures this well; 
eventually, your luck runs out and you get shot in a deli in Texas. If 
everything is just a probability distribution, you have to resign to it. 
But that ignores your ability to think and avoid playing games that are 
too dependent on luck.

Random historical footnote: 1700, the claim that people could live 
forever seemed stronger than it would today, simply because there were 
people running around claiming to be 150 years old. Since record-keeping 
wasn’t always great back then, good salespeople could persuade others 
that they were, in fact, radically old. Today, of course, it’s easy to 
identify these longevity salesmen’s movies. If you’re 70 years old in 
early 18th century London, you’re perceived as kind of wretched and you 
get no special treatment. But if you’re 150 years old, that’s really 
something special. You might even get a pension from the King.

## B. Shift to Determinacy?

Can we move biology away from the realm of the statistical/probabilistic 
and toward being something that is determinate and solvable?

It depends.

You can think of death as an accident. There are different kinds of 
accidents. You can lay these out on a spectrum, from microscopic 
accidents (genetic mutations) to macroscopic accidents (car crashes) to 
cosmic accidents (asteroid strikes). To solve the longevity problem 
completely, you have to get rid of all of these kinds of accidents. But 
there’s a sense in which certain macro and cosmic accidents are and will 
continue to be pretty probabilistic things. There is good reason to take 
those on later; if we can just get to the microscopic solution, the best 
estimates have people living to between 600 and 1,000 years.

![16-06.png]

# III. CS and Biology

## A. Difficulty of the Problem

Like death itself, modern drug discovery is probably too much a matter 
of luck. Scientists start with something like 10,000 different 
compounds. After an extensive screening process, those 10,000 are 
reduced to maybe 5 that might make it to Phase 3 testing. Maybe 1 makes 
it through testing and is approved by the FDA. It is an extremely long 
and fairly random process. This is why starting a biotech company is 
usually a brutal undertaking. Most last 10 to 15 years. There’s little 
to no control along the way. What looks promising may not work. There’s 
no iteration or sense of progress. There is just a binary outcome at end 
of a largely stochastic process. You can work hard for 10 years and 
still not know if you’ve just wasted your time.

In Internet businesses, the basic rule is that the company succeeds if 
every round of financing is an up round. In biotech, it’s very hard to 
do that. Investors get tired. Things don’t work. Some biotech investors 
are so candid as to state that they don’t really care about valuations, 
since everything will get wiped out in their favor once a company has 
the inevitable down round. Why negotiate valuation if luck dominates 
everything?

To be fair, we must acknowledge that all the luck-driven, stats-driven 
processes that have dominated people’s thinking have worked pretty well 
over the last few decades. But that doesn’t necessarily mean that 
indeterminacy is sound practice. Its costs may be rising quickly. 
Perhaps we’ve found everything that is easy to find. If so, it will be 
hard to improve armed with nothing but further random processes. This is 
reflected in escalating development costs. It cost $100 million to 
develop a new drug in 1975. Today it costs $1.3 billion. Probably all 
life sciences investment funds have lost money. Biotech investment has 
been roughly as bad a cleantech.

B. The Future of Biotech

Drug discovery is fundamentally a search problem. The search space is 
extremely big. There are lots of possible compounds. An important 
question is thus whether we can use computer technology to reduce scope 
of luck. Can CS make biotech more determinative? At the most basic 
level, biological processes can be thought of as involving some quantum 
of luck in the face of irreversible degradation. Traditional 
therapeutics largely mirrors those processes. But computational 
processes are reversible. You can dive in and re-program things as 
necessary. So one big question is the extent to which biological 
problems can be reduced to computer problems?

![16-07.png]

The cost of DNA sequencing is falling rapidly. It cost $500 million to 
sequence a genome in 2000. Now that’s down to something like $5,000. 
Within a year or two, it will probably cost $1,000. The question is 
whether we can do as much as people have been assuming we can with all 
the information this will yield.

"[it will] revolutionize the diagnosis, prevention and treatment of 
most, if not all, human diseases."
 -- Bill Clinton, 2000

The Human Genome Project was seen as incredibly revolutionary in late 
1990s. But it hasn’t quite lived up to the hype. Perhaps it was all too 
early or too costly. But the second cut may be that it’s because the 
main problem is not a sequencing problem at all. The biggest problem may 
be that we just don’t know what to do with the data. Exactly how much of 
biology is computational is still an open question.

# IV. Examples

We’ll highlight and then have a discussion with people from 3 companies 
who are doing very interesting things in biotech: Stem CentRx, Counsyl, 
and Emerald Therapeutics.

Of these 3, Stem CentRx is the closest to traditional biotech. But there 
is still a heavy computational piece to it. The basic goal is to cure 
all cancer. Their claim is that cancers have stem cells that are very 
different from core cancer cells. This stem-cell subset drives 
cancer/tumor growth. So they aim to target the stem cells and thereby 
knock out the cancer.

Backing up a step, the problem is that chemotherapy can be really 
ineffective at threating cancer. It is very hard to get chemo dosages 
exactly right. Too low a dosage is ineffective at stopping the cancer. 
Too high a dosage kills the patient along with the cancer. So if you can 
identify the subset of cancerous cells that are driving the growth and 
target those cells precisely, chemotherapy would be much less 
destructive and considerably more effective. So far, Stem CentRx’s 
studies on mice have been very promising. We should find out whether the 
approach works for human cancers over the next year or two.

Counsyl is a bioinformatics company whose goal is to become the default 
for pregnancy genetic screening. They have developed single simple test 
for the 100 or so genes that can be screened for inherited traits. They 
focus just on the Mendelian diseases, since beyond that it is currently 
very hard to know how more complicated genetic combinations work. So 
Counsyl has identified a tractable and well-defined subset of the 
problem. Today, Counsyl is involved in screening about 2% of all births 
in the U.S., and expects that figure to rise quite dramatically in 
coming years.

Emerald Therapeutics is the most computational of these companies. The 
basic goal is to cure all viral infections by reprogramming cells, i.e. 
turning cells into code-based machines. The idea is to build a molecular 
machine that tags cells that contain viruses, and then to release a 
sequence that causes those cells to self-destruct. Emerald is in stealth 
mode, so we can’t say too much. But the high degree of paranoia for 
companies doing programmable anti-viral therapies is understandable. 
These are big secrets that play out over long time horizons, not web 
apps that have a 6-week window to take over the world.

So with that, we’ll have a discussion with Brian Slingerland of Stem 
CentRx, Balaji Srinivasan of Counsyl, and Brian Frezza of Emerald 
Therapeutics.

# V. Perspectives

Peter Thiel: Marc Andreessen visited this class a few weeks ago. His 
claim about the Internet in the late ‘90s was that many of the ideas 
were right, but were just too early. Even if one agrees that next phase 
in biotech is about to start—things are going to get much more 
computational—how do you know that now is the right time? How do you 
know you’re not paddling too early?

Balaji Srinivasan: The sequencing of the genome is like the first 
packets being sent over ARPANET. It’s a proof of concept. This 
technology is happening, but it isn’t yet compelling. So there is a huge 
market if one can make something compelling enough for people to 
actually go and get a genome sequenced. It’s like e-mail or word 
processing. Initially these things were uncomfortable. But when they 
become demonstrably useful, people leave their comfort zones and adopt 
them. Pregnancy testing is a major on ramp. People find it important to 
make sure their children are as healthy as possible. And then there is 
likely to be tons of positive things that can be done with the data 
beyond that.

Peter Thiel: So the question is how you can overcome pervasive fear of 
getting genome sequencing? And the answer is: “Do it for the kids?”

Balaji Srinivasan: Yes. No one spends $1000 to get computer so they can 
use Twitter. But once you have computer, there is zero marginal cost to 
use Twitter. So solving the install problem is the first step. 
Empirically, we’re starting to see very strong adoption. So we are 
confident that we can solve the install problem.

Peter Thiel: Tackling the cancer problem is exciting but also worrisome 
at the same time. It’s an old problem. Nixon said in 1970 that we’d win 
the War on Cancer by ’76. People have been working on it for 40 years. 
So while we’re 40 years closer to a solution, it also seems farther away 
than ever. Doesn’t the fact that it’s taken so long mean that it’s an 
incredibly hard problem that won’t be solved soon?

Brian Slingerland: People have largely followed the same path over the 
past 40 years. The usual approach to cancer is to carpet bomb it with 
chemotherapy or the like. The approaches that have been attempted are 
remarkably similar. So we decided to take really different path. 40 
years of failures have taught us something important. The endpoint that 
everyone focuses on is therapeutic efficacy measured by tumor shrinkage. 
But this isn’t the best metric; tumors can shrink and then come back. 
Focusing on shrinkage may lead to attacking the wrong cells. Embracing 
bioinformatics helps us illuminate better approaches. So we disagree 
that the problem won’t be solved soon; we strongly believe that we have 
a very good chance of doing just that.

Brian Frezza: Half of the timing question is taken care of for us; we’re 
certainly not too late, since viruses still exist. So are we too early? 
I don’t think so. People’s perspective on healthcare development is 
quite different from reality. Industry players tend to be very paranoid 
and secretive until they have a product to release. People discount that 
quite a bit, since they just pay attention to what is brought to market 
and when. What most people see at any given point was started decades 
before they even thought about it.

Biotech got quite a burst in late 70s early 80s, with new recombinant 
DNA and molecular biology techniques. Genentech led the way from the 
late 70s to the early 80s. Nine of the 10 biggest American biotech 
companies were founded during this really short time. Their technology 
came out some 7-8 years later. And that was the window; not very many 
integrated biotech companies have emerged since then. There was a 
certain amount of stuff to find. People found it. And before Genentech, 
the paradigm was pharma, not biotech. That window (becoming an 
integrated pharmaceutical company) had been closed for about 30 years 
before Genentech.

So the bet is that while the traditional biotech window may be closed, 
the comp bio window is just opening. Whoever gets in during that window 
gets installed. There are enormous monopoly barriers to getting to 
market. Here, first mover advantage often becomes last mover advantage. 
Imagine if IE or Chrome had to go through clinical trials just to get to 
market. It would be much harder to get in the game. So whoever manages 
to develop great technology and get it out first is in good shape.

Peter Thiel: Talk about your corporate strategy. Even if your technology 
works, how do you distribute it?

Balaji Srinivasan: If you think of drugs, biotech, and now genomics as 
qualitatively different entities, you’ll see that genomics companies can 
do things quite differently. Genomics is much more computational than 
pharma or traditional biotech. With molecular diagnostics—but unlike 
traditional therapeutics—once you’ve assayed a sample, you’re on info 
superhighway. Internet rules apply. You can go from conception to 
product and sales within 15-18 months. It’s not quite as fast as 
Internet businesses. But it’s considerably faster than the 7-8 years it 
takes in biotech. In the early ‘90s there was an opening for web 1.0. In 
the late ‘90s there was the web 2.0 window. Now it’s genomics. We think 
that bio should just be sensors and gathering data. Everything else 
should be done at the command line.

Brian Slingerland: Stem CentRx has more of a traditional biotech 
process. We spent 3 years on the proof of concept phase. Now that we’ve 
finished all the efficacy studies in cancers in mice, we are in 
full-blown drug development mode. This process can be accelerated by 
adopting best practices from tech culture. It’s like SpaceX; if the 
competition is so screwed up, you can radically improve things by 
cutting bureaucracy and taking on a Silicon Valley culture.

Brian Frezza: We are creating a platform, not an isolated product. We 
create infrastructure for all sorts of future antiviral technologies. So 
being able to handle the science in a routine and scalable way is key. 
The culture is an important part too. Even though we have PhD organic 
chemists and molecular biologists, we shoot for a hardcore tech startup 
culture. We automate processes in the lab using advanced robotics. We 
use git to track our lab notebooks. We write a ton of software. We are 
the first movers in our space, and we’re trying to move very quickly, 
but we’re also building a platform that’s designed to scale 
exponentially.

Peter Thiel: How do you know that there isn’t someone else secretly 
pursuing the same strategy? And if you’re confident as to what other 
people are or aren’t doing, how do you know that they don’t know about 
you and that your secrecy is working?

Balaji Srinivasan: It’s like the Rumsfeld quip: there are known 
unknowns. Ultimately we think most people miss the key secrets in health 
industry because they are so caught up in the status quo that they 
actually can’t think their way to good solutions. Contrast the 
healthcare industry with the fitness industry. Ultimately, your fitness 
is your responsibility. You can join good gyms or get personal trainers. 
All that’s great. But the buck stops with you—you have to take the 
initiative. But consider how that initiative plays out in healthcare. If 
you come to a doctor’s appointment wanting to talk about something 
you’ve researched, doctors get pissed. You are either undermining their 
authority or you’re an idiot. But that’s odd; you are with your body for 
a lifetime, whereas the doctor is with you for 20 minutes each year. The 
one area of medicine that works—fitness—operates orthogonally to the 
rest of medicine in practice.

When these systems get build up, it’s very hard to clear away the 
overhang. People have thought themselves out of thinking about non 
status quo solutions. Stuff that actually works is perceived as crazy.

Brian Frezza: One bad vestige of the biotech boom is what happened to 
patents. In pharma, traditionally compounds got patents. But in biotech, 
general techniques became patentable. Genentech, for example, managed to 
patent recombinant antibodies as a general concept . So biotech is 
littered with really broad patents. Some biotech companies literally 
generate millions in revenue just from patent licensing; they produce no 
drugs at all. So it’s best not to generate a large amount of public 
interest in new techniques you’re developing if you don’t want to 
encourage stray IP to accumulate.

Ultimately, you can’t prove a negative. It is distinctly possible that 
there is a Ruby Therapeutics out there that is doing the same thing we 
are. But we very much doubt it, given how unique what we’re doing is. 
Even knowing that they may be out there, it still makes sense for both 
companies to stay quiet until you’re ready for revenue.

Brian Slingerland: There’s really no rush to spill the secret plans. 
This space is very much unlike fast-moving consumer Internet startups. 
Here, if you have something unique, you should nurse it. One good rule 
of thumb is to issue no press releases until you push a drug. That said, 
it’s a balancing act. Since our approach has been proven out and we’ll 
be moving to human trials, we are becoming a more public-facing company. 
No one wants to take a drug made by a stealth company with no info on 
its website. You just want to make sure that you don’t divulge too much 
too early.

Of course, people should assume there are 10 companies coming after 
them. It’s always safe to assume that you have to work better and faster 
to come out ahead.

Peter Thiel: If you thought that a Ruby Therapeutics—or 10 different 
versions of them—was actually out there, wouldn’t it make sense to be 
more open and collaborate? And how do you recruit people if you’re so 
secretive?

Balaji Srinivasan: In ecology, when you want to know how many species 
are in a jungle, you take a sample and project out. Sizing up the 
competition is a similar task. If you take a hard look at your 
network—search through the Silicon Valley part of the forest—and see no 
capital being deployed and no one working on the same problems, you can 
be reasonably confident that you’re alone. People would really have to 
come out of nowhere.

Personal referrals are very important for recruiting. We try and get 
each engineer to refer 2 people. 2^n scales very well. You get great 
people, but also get to stay under the radar.

Peter Thiel: That recruiting strategy has worked well in every company 
that I’ve been involved with. You have to keep a clear head about it. If 
you ask MBAs to refer talented people who are good to work with, you’ll 
get far too many recruits. But if you put the same question to 
engineers—and maybe it’s their friends who you really want to 
recruit—you may get a shocking silence because they are too shy. So you 
have to find a way to get them comfortable with referring people.

Brian Frezza: One strategy that works for that is to sit down with your 
engineers and go through their Facebook friends with them, one by one, 
and ask them who is good and who they’d like to work with.

Peter Thiel: The bias for Silicon Valley entrepreneurs is to go work on 
a web or mobile app. Why should more people think about doing 
biotech/computational stuff instead?

Balaji Srinivasan: The thing to remember is that the next big thing 
won’t look like the last big thing. Search didn’t look like the desktop. 
Social didn’t look like search.

The human genome will never become obsolete. Mobile/local/social? It’s 
hard to say. Mobile seems to have a lot of growth ahead of it. So that’s 
at least a reasonable bet. Local? There’s not really a defensible 
advantage anymore. And social has been colonized. Flags have been 
planted.

Ultimately you simply have to care about what you’re doing. Another 
dating app really doesn’t matter. It’s hard to bleed/sweat/cry for. 
Meaningfulness is a big part of why people should think differently. And 
we think genomics is really meaningful.

Brian Frezza: Elon Musk is a master recruiter. The narrative is stark 
and simple:
 “We don’t pay as well as Google. But this is the most exiting project 
you can work on in your life.” You want to attract the people who find 
that narrative attractive. People can always try to find a lottery 
ticket of a startup. But the satisfaction of creating a tech revolution 
is much bigger than what comes from just chasing dollars.

Brian Slingerland: One reason that CS people may be ignoring biotech is 
that they think that they’ll be relegated to supporting roles. But 
that’s far from true at many biotech companies. CS people are at the 
very core of what we do at Stem CentRx. So if CS people have an interest 
in curing cancer or things like that, it’s certainly something they 
should think about. Have I mentioned that we’re hiring?

Peter Thiel: We usually say that advertising works best if it is hidden. 
But sometimes it actually works if it’s completely transparent. 
[laughter]

Being opaque can be so tiring. The standard wisdom in the VC world is: 
“If you want money, ask for advice. If you want advice, ask for money.” 
That game is exhausting. Sometimes it can be refreshing to hear someone 
say, “I really just want money.”

Question from the audience: [unintelligible]

Peter Thiel: I think this is basically just the regulatory question. So 
talk about regulatory risks and whatnot.

Brian Slingerland: The regulatory system is a necessary evil at this 
point. There is very little upside for the FDA to approve drugs faster. 
And they get in lots of trouble if they approve things too quickly and a 
trial goes wrong. There is a lot of talk about doing trials in China or 
India right now. These expedited processes are certainly interesting. 
Perhaps people should think about them more. And how the FDA responds 
will be interesting as well.

Peter Thiel: It is very odd that the FDA has a bottleneck on global drug 
development. There has to be some tipping point beyond which the U.S. no 
longer gets to dictate what drugs are developed in the entire world. 
Past that inflection point, the U.S. may have to compete with China on 
how quickly drugs can be developed. That could be a huge paradigm shift. 
So while things look pretty bad now, the future may be quite promising. 
SpaceX was very heavily regulated at first, but persevered and got 
through it. And the aero regulations have eased up in the last decade. 
So the sheer unfriendliness of the baseline could be a great 
opportunity.

Question from the audience: When you disclose your secret to prospective 
hires, do they try to use that knowledge as leverage to hold you up and 
negotiate more?

Brian Frezza: It hasn’t been a problem at all. VCs don’t sign NDAs, but 
job candidates will. And it would take years for anyone we talk with to 
replicate our technology on their own.

Question from the audience: What role does HIPPA play in tech 
innovation?

Balaji Srinivasan: HIPAA could be seen as tech problem. How can we 
follow such and such standards, etc.

But it’s also an interesting genomics problem. A person’s genome 
provides a great deal of information about their relatives. On one hand, 
this data is private medical data. On the other hand, it’s inherently 
statistical and requires aggregation to do anything very useful with it. 
So the trick is to figure out how to do private aggregations. To get 
value out of your genome, you simply must allow some computation on it. 
The challenge is catalyzing this very important social shift toward 
becoming okay with that while preserving strong privacy controls.

Question from the audience: Unlike the web, where you can get feedback 
in minutes, how do you know if you’re on the right track in 
computational biotech?

Brian Frezza: We use physical models and actual validation experiments. 
We don’t just use statistical approaches. But our processes are 
internal. We don’t go outside and seek external validation. Just like 
Instagram doesn’t get outside people to come in and appraise its code 
base. You develop a plan and execute it internally. Sometimes you have a 
multi-year cycle to get data back. You just work as efficiently as 
possible to shorten cycle times.

Balaji Srinivasan: Slow iteration is not law of nature. Pharma and 
biotech usually move very slowly, but both have moved pretty fast at 
times. From 1920-1923 Insulin moved at the speed of software. Today, 
platforms like Heroku have greatly reduced iteration times. The question 
is whether we can do that for biotech. Nowhere is it written in stone 
that you can’t go from conception to market in 18 months.

Brian Frezza: That depends very much on what you’re doing. Genentech was 
founded the same year as Apple was, in 1976. Building a platform and 
building infrastructure take time. There can be lots of overhead. 
Ancillary things can take longer than a single product lifecycle to 
accumulate.

Question from the audience: How does biotech VC compare to regular VC?

Brian Slingerland: We never did the classic venture capital route 
because VC is broken with respect biotech. Biotech VCs have all lost 
money. They usually have time horizons that are far too short. VCs that 
say they want biotech tend to really want products brought to market 
extremely quickly.

Brian Frezza: “Integrated drug platform” is an ominous phrase for VCs. 
More biotech VCs are focused on globalization than on real technical 
innovation. VCs typically found a company around a single compound and 
then pour a bunch of money into it to push it through the 
capital-intensive trial process. Most VCs not interested in 
multi-compound companies doing serious pre-clinical research.

Question from the audience: How useful are end-stage trials in trying to 
figure out how to cure cancer? Don’t you get inaccurate or just 
different genome data from terminal patients?

Brian Slingerland: Not being able to trial on earlier stage people is 
always a challenge. But our technology it is designed to apply to 
patients at all stages. All I can say is that our approach is stage 
agnostic for a variety of technical reasons. But generally speaking 
yours is a valid concern. That’s why traditional drugs that show initial 
progress often fizzle out in extended trials.

Question from the audience: What were some of your early struggles or 
challenges?

Brian Frezza: The amount of time it took to set up a lab was shockingly 
large. 100% of our time went into acquiring equipment, negotiating 
price, dealing with initialization failures, etc. We greatly 
underestimated the time required to get up and running because we were 
coming out of existing, well-supplied labs. It basically takes a whole 
year to get up and running. There’s just a huge difference from the 
computer/Internet tech world.

Peter Thiel: With Internet businesses, you can be up and running without 
doing hardly anything. At PayPal, the biggest interface with reality was 
that, on Max’s orders, people had to assemble their own desks. But Luke 
Nosek thought even that was too much. So he found a company called 
Delegate Everything, who dispatched this elderly woman handyperson out 
to assemble the desk for him so that he could do more work on the 
computer.

Balaji Srinivasan: Startups are always hard at the start. There are 
futons and ironing boards in the office. You have to rush to clean up 
for meetings. But maybe the hardest thing is just to get your foundation 
right and make sure you plan to build something valuable. You don’t have 
to do a science fair project at the start. You just have to do your 
analytical homework and make sure what you’re doing is valid. You have 
to give yourself the best chance of success as things unfold in the 
future.