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hack your body

hack your body
By Open Water Weekly • Issue #5 • View online
My name is David and I’m a partner at Open Water Accelerator. We just launched our fall cohort, so we will now return to publishing weekly issues. We missed you! 
This week’s newsletter features an exclusive interview with Josh Clemente, founder of Levels, and Shak Lakhani, founder of Avro Life Science (YC W18). As always, we’ve included job opportunities in tech and finance as well as a seed stage deal.

building Levels with Josh Clemente 🔨
This week we sat down with Josh Clemente, founder of Levels. Levels is a device that tracks your blood glucose in real time so you can maximize your diet and exercise. Prior to founding Levels, Clemente was the Lead Life Support Systems Engineer at SpaceX.
What’s your ultimate vision with Levels? 
The long term vision for the company is to make a meaningful difference in metabolic outcomes in the world. We intend to do that by having the most robust and actionable model of metabolic health possible. 
We’re going to provide an elegant, obvious interface with information that defines metabolic health as close to the point of decision making as possible. This will make it easy for people to know how to make a better choice and to see the results of their choices stacking up. It will truly be the metabolic health coach in your pocket. 
What do you know now that you wish you knew when you started your company? 
The biggest lesson for me has been to embrace transparency. If simply knowing about your idea is enough for someone to replicate it, then it’s not a very good idea in my opinion. There should be significant execution risk. There should be a challenge that has to be overcome. 
In the past, my approach has been, “I need to keep this thing hidden. I need to be wary of sharing information about this so no one else goes out and does it.” It was really when I partnered with my cofounder, Sam, that I started to understand the flaws of that mindset. He framed it best for me, saying that at this company we share information promiscuously because it’s the best way for potential advocates to see inside your organization, see inside your mind, and understand how you think about and tackle problems. I really wish I had known that and embraced that earlier in the life cycle. 
I found it very interesting that you weren’t just marketing towards current and aspiring professional athletes, but instead are modeling the lifestyle brand for regular people to help them make better decisions.
The question that I frame is: you’re sitting down for lunch, what are you going to eat and why? And that’s a very simple question, but most people feel ill equipped to answer that with any quantitative output. They answer, “Well, I’m going to eat something that tastes good,” or, “I think I’ll eat something that I’ve heard is healthy,” but they don’t have any concrete objective data that’s driving that choice.
The people that do know are the ones that have PhDs in physiology or metabolism, and that needs to change. We need to take the disconnect of research versus action and bring these two things together and mesh them into a framework for making better choices. It has to be based on the individual. It can’t be based on population sets or general advice. 
When your personal body tells you something, you listen, and that’s the light bulb concept behind what we’re doing. After using Levels, you will never look at food the same way again, and this is a good thing. You start to feel confident in the choices you’re making and your choices are supported by data.
What’s the biggest risk you’ve taken? 
The biggest risk for me was leaving my leadership role at SpaceX. I was working on the life support systems team that just flew Bob and Doug to the international space station. It was bittersweet to leave.
I moved cross country to start an entrepreneurial adventure that was in a totally different field, totally different industry. And honestly, the industry did not exist. It was thinking, “Oh, I’ll start a new one,” which was kind of insane. 
A year and a half later when I had zero traction, it felt like a devastatingly bad choice. I was getting nowhere on my own and the insecurity was kind of creeping in, “This is crazy. What did you do? Why’d you do this? SpaceX wouldn’t take you back if you tried now.” I think everyone deals with this type of insecurity when they jump off a ledge, so to speak. I certainly felt like I was in freefall for some time. 
Ultimately things turned around by just continuing to have confidence in the underlying concept and its potential. I had already changed my own life as a result of using continuous glucose monitoring information; that was the thread of objective knowledge that there is something here that kept me pushing ahead. Having that confidence, having that bit of personal skin in the game, helped me to pull through that crazy decision to leave a leadership role at a company that is doing unparalleled things.
How do you get unstuck in that situation where you’re a year and a half in and you don’t have traction? What’s going through your head? How do you keep going and get to where you are now?
It was the realization that I had allowed myself to forget the value of an exceptional team. Going back to SpaceX, the most groundbreaking thing about it is the quality of the people and the action oriented culture that the team operates under. Elon Musk is a great guy and I’ll get to him in a minute, but he is not the reason SpaceX is successful. 
It doesn’t matter how good the quality of your ideas are. It’s whether or not you have the team that can execute. I allowed myself to forget that. I tried to do this venture solo and tried to make significant progress on my own. The inflection point was when I realized that I needed help, I needed support. I needed a framework that was built with multiple perspectives. 
I had known my cofounder Sam, who’s a good friend of mine, for several years and he and I stay in touch about our projects. One of us reached out and we had a deep conversation about what I was working on and the light bulb went off in his mind too. At that moment, there was a 48 hour period basically where we went from conversation to partnership and what I had worked on for a year and a half with very little inertia became a real thing overnight. It was just the force multiplier of having two minds on it. 
Eventually as the team came together, it’s gone in an unbelievable amount of time from an idea to a reality. I think the lesson is to just realize your own limitations. It’s always better to have support, to find people who have similar values and work together. 
Who did you look up to while growing up and who inspires you today? 
I’ve always looked up to my dad and then my grandfather. These two guys have shaped my worldview in ways that are just kind of hard to fully describe. My understanding of independence and equality, the benefits of challenging the status quo and thinking outside the box, hard work, and close relationships are all things that I learned from them specifically. 
My mom is also another hero in my life. She patiently taught me from kindergarten through 12th grade. I was homeschooled. Having those tight relationships with my parents and my grandfather, I am cognizant of those lessons learned and how impactful role models can be. 
Today, I’m inspired by Elon Musk. This is a guy who completely ignores the objective impossibility of his ideas, and he just works to shape the future in his mental image. He’s just says, “This is how it should be. I’m gonna make it happen.” Many say that what he is doing is “crazy” or “impossible” but he does it anyway. 
It is challenging to push past the limitations other people put on you and I continue to be blown away with Musk’s work. I’ve worked with him, everyone’s got their faults, but this guy is someone I think is utterly inspirational for me and for many generations to come. 
How did homeschooling shape you? 
The biggest thing is that it taught me to teach myself. When I got to college, I went to class maybe 40% of the time. I would take the textbook, sit down, and teach myself through reverse engineering problems. I take the answer key in the problem and figure out how the concept works. That was kind of how I learned. I learned by myself basically because I’m from a large family and my mom did a really good job showing us how to string together those concepts. That’s what mattered, not so much reading and trying to memorize the words in the book. 
My parents were both nonconventional in many ways. We were allowed to set our own schedule and I spent a lot of time outside in the woods. I spent a lot of time in the garage building crazy machines that were made out of chainsaws and bicycles. That homeschooling environment of being able to really think independently and freely ended up being what I think got me my job at SpaceX, because I knew how to build stuff. I knew how to solve problems that I had not seen before because I needed to teach myself. I think you can get a lot of this through various means of education. 
I certainly feel that I was lucky to have had that opportunity. And, in retrospect, even though I didn’t like it while I was going through it, I think it was critical to where I am today. 
What do you think the future of software is? 
I’m going to caveat this by saying I’m not an expert. My personal career has been in hardware, but I do have some feelings about this. I think, in general, the future of software is that there will be more of it and it will be more actionable and insightful rather than just this utilitarian toolset. When I hear the word software, I think about Microsoft Excel. I think the software of the future is the integrated external second brain. Obviously we hear that term a lot, but something that is a layer in our lives that helps us make better choices every day. 
Of course, I have a personal reason for believing that. This is what Levels is doing. Look at the future of health software as an example. It will be predictive and much more like financial software than our current medical records, which are totally useless; no one has ever consulted their personal medical record to make a decision in their lives. Today, I can pull out my phone and I can pull out my mobile banking apps and see my retirement projections, 15 to 30 years in the future. I have an opportunity to share that information with an expert, to get their opinions. I can see projections, best and worst case outcomes. 
Yet the question I would ask myself is, “How do I know I’m going to be there to enjoy that retirement?” I think the future of software will be our health information being available in the moment via software in the same way that we use our financial information now. It will help guide you in real time so you understand the “deposits and transactions” you’re making daily and how the interest on those “assets and liabilities” are going to set you up for good or bad outcomes. I see the future of software as being embedded, useful, and actionable.
future of drug delivery with Shak Lakhani 💊
What have your last six months looked like and what do your next six months look like for growing this company?  
We’re spending a lot of time selecting our internal assets: the drugs of highest interest that we want to take to the clinic ourselves. When it comes to bringing in different drugs to market, we can go one of two different ways:
  1. License in compounds from leading pharmaceutical companies and go to market ourselves. However, this can be pretty costly at an early stage company. 
  2. Explore generic drugs. Generic drugs have smaller margins, but if put in the right dosage form for us to patch could still do really well. 
At the moment we’re opting for the latter, looking at generic drugs where there aren’t any restrictions to working with them from an IP/market landscape point of view. It’s just a matter of if we have the technical chops to make it happen. 
One of the fundamental steps that we’re making is to attempt to get larger molecules through the skin. We’re trying to stretch the boundaries of what we believe to be possible. We’re spending our time talking to dozens and dozens of clinicians and specialists to figure out the science of it. 
So, those are my main initiatives. Figure out what our internal products will be that we’ll spend three to five years taking to market ourselves and finding out if we’re able to get larger and larger molecules through the skin. 
Our next six months are going to be more of the same, but hopefully at a faster pace as COVID eases up where we are in Waterloo and we move into a new lab space. 
The tricky part about biology or science in many cases is it’s not necessarily additive; sometimes it is synergistic. What this means is that if we perform a series of steps in a certain order, it’ll have one outcome, but if we perform them in a different order, it’ll have a drastically different outcome. Sometimes even though a step may lead to a better result in one manifestation, if another variable has been tweaked ahead of time in another manifestation, it might actually take you backwards. The process is about trying to understand which of our parameters are universally helpful or which of our parameters can go in both directions. We will also be exploring this in the next few months.
What do you get about this space that your competitors don’t get? Why were you able to start this company versus some large pharmaceutical companies? 
I think it’s probably a mix of naiveté, enabling technology, and a belief in the ability to realize value in something where traditionally value isn’t described. Pharma companies and the pharma ecosystem as a whole are heavily weighted towards new drugs and new therapeutics. That makes sense because that’s how the industry has been driven for the last hundred plus years; you look for a new drug, try to bring it to market, and hopefully make billions off of it. 
The way I see it is that the rate of drug discoveries is declining and patients still need better solutions and cures. There is value in improving the way drugs are delivered to patients and in some cases a new delivery method might be as valuable as a new drug.
I don’t know if this is necessarily something that pharmaceutical companies haven’t realized, I’m sure that they have in some manifestations, but it’s about making something that seems scientifically ridiculous enough to not be worth pursuing possible. That’s the core thing that we’re going after here. 
A lot of that is based on other branches of my scientific philosophy that I think make sense. We look at the types of technologies that will manifest themselves in other industries, but still work on the same fundamental principles that can be safely ported into our tech. That helps us take a look at how we can use nature and information that already exists to push the boundaries of what we think is possible.
What do you know now that you wish you knew when you started your company? 
If you think that your vision is already big enough, nine out of ten times, you’re wrong. I think that we started Avro Life Sciences with too narrow a scope. 
As a young founder, you can have a lack of perspective. You’re working on something that seems like it’s really tough and can be really impactful, but you don’t realize your scope of the possibilities is already constrained to start with. One of the things I wish I knew was how much more we could potentially do if we opened our minds. 
The other thing I wish I’d known is how many things go wrong along the way. I think it’s easy when you’re a precocious young founder to say, “Yes, I’m smart and I will figure all these problems out that other people have not been able to solve.” It’s a common mistake to underestimate the efforts of people in the past and then find yourself in a situation where you’re in over your head.
What’s the biggest risk you’ve ever taken?
This does feel like a bit of a cop out answer, but I think the biggest risk I’ve taken is forming a company in this space. All the optics and all the odds are stacked against us. Why are two college drop outs from Waterloo gonna figure something out that big pharma companies haven’t? Just logically speaking, it doesn’t carry through at all. That’s a pretty gnarly risk in itself. 
I think the other risk is tackling a fairly large problem. It would be a lot easier and a lot more feasible to bring a single drug to market. I don’t think that’s impactful enough in most cases. It’s important to strike a good balance between how interesting or how impactful something is and how realistic it is. 
Have you had any big failures so far? If so, how do you recover from setbacks as a team?
We had one major failure. One of the formulations we were working with, that we thought might be the one that took us to market, had major stability issues and didn’t have strong results in our first set of trials. 
It was half a year or a year of research down the drain. We figured out how to take the useful parts of the process that we had learned from that experience and adapt them to our next iterations. 
For us, we accept that untraditional work is tough and we expect to fail sometimes. It’s just a matter of figuring out why something has gone wrong and how we can take that information and make it useful to us in another way so that things go right the next time. 
Do you think you’ll go back to college once you follow the course of this company? 
Once I see it go through (hopefully it ends up doing quite well), I would be interested in going back to school to pursue a PhD or explore a field that would be relevant to my next company. I’m probably too set in a startup mindset now or too addicted to the kind of stuff that I do to enjoy a corporate role. 
What do you think the future of the entire drug industry is going to look like 20 years down the road? 
I think there’s a scene in Family Guys that depicts it kind of well: Quagmire walks out of a building and then gets an STD shot that automatically comes out of his phone. I don’t think it will go quite that far, but I think that it is possible to have a society where we have, at an early age, a set of vaccinations or injections that will selectively activate or fight off infections that you encounter along your lifespan. There will be smart drugs as opposed to drugs that you need to take.
I think that there will also be a number of conditions that will hopefully be reversed or cured through gene therapies and cell therapies. That’ll hopefully allow for the elimination of certain conditions or better treatment, whether that’s for cardiac health or for Alzheimer’s and mental health, or whether that’s for the more specific musculoskeletal or retinal diseases that we see today. 
I think that there’s hope for gene therapies that act as permanent cures as opposed to bandaid solutions, and for appropriate or engineered drugs/bacteria combinations that create a stimuli responsive system in your body that shuts down problems before they occur. 
our take on the future of health tech 📣
Currently health care is reactive. Doctors detect an issue and then they prescribe a treatment to remedy the issue. The future of health tech will be in proactive care. Doctors will have tools to identify health issues before they emerge.
The health devices of the near future will detect critical health issues shortly before they happen. An example of this would be an Apple Watch calling an ambulance because they detected a series of irregular heart beats that indicate the user may have a heart attack shortly.
The next generation of connected devices will also use big data to help users live an healthier lifestyle and prevent long term health issues. Levels is an example of a company working to build a healthier future for its customers. Levels provides a dashboard that can produce a number for how healthy a user is eating and regulating their blood sugar.
Another early mover in the health care field is Whoop. The Whoop Fitness Band measures sleep, fatigue, and strain in athletes. With this data, the band can also predict when a user will catch a cold due to fatigue. As Whoop continues to refine their algorithm, I would not be surprised if they could start predicting a user’s lifespan.
At Open Water we are looking for the next generation of health tech that will keep its. users healthy and detect problems before they emerge. If you are working on a platform similar to this, we would love to hear about it.
leaving shore⛵: Savvy is raising an angel round
Savvy is a cash flow based underwriting platform for housing, insurance, and lending. They leverage their position in the market and data advantage to distribute financial super efficiently to consumers and businesses. 
They are based in Brooklyn and backed by Antler VC, Switch Ventures, New Lab Ventures, and The MBA Fund. 
Savvy is currently raising a small angel round to scale our engineering team to meet the overwhelming customer demand. If you would like to learn more, reply to this email and I’ll make the introduction.
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