How A Passion for Technology is Bringing an Impact to Healthcare (With Sami Shalabi, Outcomes4Me)

Elias Torres: Hola. I'm Elias Torres, co- founder and CTO of Drift. You are listening to the American Dream Podcast. Did you know that Drift is part of just 2% of PC Ppac startups led by Latin American founders? Well, I'm on a mission to change that. On this show, you will hear from leaders who have achieved their own version of the American Dream. We'll talk about what the process looked like to get there, the obstacles they face along the way, and the work we still have to do to build the new face of a diverse corporate America.

Speaker 2: foreign language, to the American Dream Podcast. Today I am excited to welcome a special guest on the show. This is a historic episode for this podcast. Someone I known for a very, very long time before either of us were entrepreneurs. Sami Shalabi is the founder and chief operating officer of Outcomes4Me, an AI- driven patient empowerment platform that helps cancer patients navigate their care and gain access to personalize treatment options. Before Sami started Outcomes4Me, he spent nearly 12 years at Google where he built out the Google News products to over a billion users with teams of over 150 people. Today, Sami and I are going to talk about Sami's career journey has looked like and where he's headed with Outcomes4Me. Sami, welcome to the show. Long time- inaudible

Sami: Thank you for having me. Always great to be with you, my friend.

Speaker 2: To give the context to everybody, we were very young. Sami and I are about the same age and... We're exactly the same age, and we were like young whipper snappers, 21, 22 years old working at IBM and Sami was working with this unreal group of developers and the Lotus Organization here in Cambridge. I remember that was probably 1999, I think it was. I came, I think I went to Westford, you guys had the Cambridge office that was a young IBMer, first time full- time employee and I'd love building things on the Lotus Notes platform. Get to meet the people that created Lotus Notes. And then in the room everybody was like, " This Sami, this guy is amazing." And you were building Lotus Quickr at the time. I remember that day like if it was yesterday, I remember the room. I think you were on the floor discussing something with Ned and Miguel and I'm just trying to butt myself in. I want to hang out with this guys. That was awesome. And look at what has happened since then, let's talk about that. So we were at IBM and you did what? What? Some crazy thing you thought of.

Sami: Before what I did, it's probably I think relevant here, is I'm not a US citizen. I actually grew up in the Middle East, came to Massachusetts, literally two suitcases. My mom put me on a plane and sent me and I went to MIT, did my... I didn't actually come wanting to do computer science. I actually came wanting to do mechanical engineering, because I didn't know what computer science was. I liked computers, but I had no idea what a computer science is. So kind of fell into that and fell in love with the domain. And this was the early days of the internet and there's a lot of funny stories of discovering the internet and email and all that. But after graduating, because I was on an F1 visa, it was very, very important for me to actually find a place that'll sponsor me. I did an internship at Lotus, loved the place that was a premier software organization. In those days it was Lotus versus Microsoft. You're like, okay, I wanted to work at a place where you learn how to build professional software at the highest level, which is why I went to Lotus and I stayed there for seven years, because that's how long it took to get for me to get my green card. Because I knew I wanted to do something entrepreneurial. I think this is an immigrant thing. You grow up and you're like, okay, let's figure out how to make money. Let's figure out how to impact, have a lot of impact and do things when you see problems, you're like, okay, how can I turn that into a thing? And that's kind of the energy I came in with Lotus, with the humbleness of learning from some world class engineers. It was also early days of the internet and the product I was learning, Quickr, which was also called Quick Place, was really how do you take Lotus Notes and bring it to the internet in a simple way? We were doing things for the very first time in those days. Just going a little technical, there were no established software stacks, there were no frameworks. We were kind of inventing things from the ground up. We were still coding the servers in C and C plus plus and kind of making stuff up. And things we talked about as being like, this is how you build world class, web applications weren't a thing. This was the web 1. 0. Before a lot kind of... And one of the big things about being at a place like Lotus IBM, this was a organization that was multi- disciplined. It wasn't just an engineering shop. I never heard of a product manager. I never heard of a UX designer. I never heard of how those discipline, I never heard of the word triage. What's a bug? I mean, this is stuff not you learn in college. And it really kind of exposed... It was a great lesson in how to actually build... Not just like you can have good ideas, you can write good code, but as you start to be part of a large organization, there's all this stuff that happens around it so that it becomes a world class product.

Speaker 2: I love that story, right? Because that's what we call this the American dream, right? Because your story is no different than any other immigrant, the whole two pieces of luggage. It's the same thing. I came with my mother. You came by yourself, straight into school. Wow.

Sami: I mean, truly it was actually... Because I'd never been to America. I mean, I was fortunate I went to British schools in the Middle East, but I understood Middle Eastern culture and British culture. I just didn't understand American culture. I mean, this is also an era. This is, again, I'm dating myself. Nineties, there was no interaction. The way I discovered MIT was, there was a TV program that showed a robotics competition. My father was a mechanical engineer and he said, " You should go there. That's where all the smart people go." And that's actually how I discovered MIT and living through... I was in Kuwait, lived through the Gulf War and went to Jordan and my dad passed away. It became a mission to want to go. Okay, how does one apply to MIT? I don't know. I went to, there's a section of the American Embassy called the inaudible. I went there, there was a library. I'm like, okay, where's the college book? Okay, where's the college book? Okay, let put down the name of the universities. I took that down, wrote a letter, put it in the mail. One month later you get this application. And then you kind of methodically go through it, okay, they need you to take the SAT. Okay, what's an SAT? How do I do that? Okay. There's actually kind of a funny story. There was a part of that application... And when you're in kind of growing up in a place where there isn't a lot of peer support, you're kind of like, okay, you get this application, you're going to follow it. There isn't going to be a box that is not filled out. It's going to be perfect. There was one box that asked for your name, address, et cetera. And then there was one that called, there was email. I didn't know what email was. And I went to the encyclopedia, the encyclopedia I guess were so old, there was no explanation. Answering that question was a bit stressful for me, because I could answer everything else except email. Are they going to accept or deny me, because I didn't know my email address? A inaudible What?

Speaker 2: What a moment, what a moment.

Sami: Yeah.

Speaker 2: I don't have that. You're stuck, because encyclopedia doesn't have it. Nobody else around you has one. And who do you call? You got to go around the streets, " Do you have an email? Do you have an email? Does anybody have an email here? Anybody?-" inaudible

Sami: I don't even know what this is, is it a thing you buy? Can I go buy one? Can I go rent one? I don't know. Anyways, so eventually long story. It's like mail back and forth. And it was actually a really humbling experience because it was not just like, I didn't expect it. But I applied and then it came back with an acceptance and a full scholarship. That was a transformative moment. And this is actually where for international students, there are very, very few universities that offer scholarships. MIT is one of them. I know I think some of the Ivy leagues also do it, which is... I mean, put aside, this is just my opinion now, being an American. This is America's secret weapon. They can get unbelievable talent to come here. And the thing is, when you come here and you build a life, you end up building a life, because you see the opportunities in this country. Anyways, so got my letter and then my mom gave me some bunch of money. I had two suitcases, flew to Logan Airport. Came out there, I had a piece of paper that said 77 Mass Ave, okay, that's the address. I get into a cab, take me to 77 Mass Ave in Cambridge. And then you show up and you're like, okay, let me just follow everyone to where they're going. Okay, there's a bunch of people. All right, they're going to the students here, let me go there here and figure it out. And then I had a much heavier British accent at the time. "Hello, my name is Sami. I just arrived." And then it was a very welcoming experience. They set me up in a dorm and five years later, ended up first year transferring from mechanical engineering to CS, because I discovered that and then ended up at Lotus. While I was a student, I was always a hustler, always had to have a side hustle.

Speaker 2: When did you... By the way, I just love that this was a mission for you, because of the words of your father. That's so special. It is transformative. Just the words. This is why we have to always think about the words that we tell others. The word that simple could just change your life. Out of anything your dad could ever done, that was probably one of the most important things he did. You should go- inaudible

Sami: It was like a comment as part of a watching a TV program.

Speaker 2: Yeah.

Sami: And actually, but that competition is called 270 at MIT. The class is called 270. And I went and I watched it in real life.

Speaker 2: Wow. Wow. No, yeah. That's what we have to think as parents, what we tell our kids. As simple as that. I told my son, my youngest, he took an aptitude test that I had to take for a visa. And he goes, " What are you doing dad?" " I'm taking this test. Come here, sit down, take it." And he takes it. And when he was done taking it, he beat me by a point without any practice. And I said to him, " You're so smart." And say, "You know can do computers." And he goes, " No dad, I don't understand them." I go, " You absolutely can, like what are you talking?" He's taking CS in high school now.

Sami: Great. I'm trying to convince my son to do CS. He took a programming class, but it's not sticking the same way when I was messing with computers. But you want them to have the drive, have the work ethic and also follow a passion.

Speaker 2: And follow a passion. Yeah. And he likes art. So what I discovered in the CS class, I don't know what, thank God, but he's writing this python language to render vector graphics. So he has code here and he's rendering this character from anime. He's like, " Dad, look..." He's like, " I do the shadow, I do this drop shadow, I shift this, I do the opacity." And I'm like... I couldn't draw, right? But he's finding the intersection that he likes and I'm just like, oh. So I may have three CS kids in my life. I told you about the first one a little bit. But you had that right, you did not know your passion and he told you that. And then tell me more a little bit about that entrepreneurial hustle. I had that hustle as a Latino, as an immigrant of finding ways to get the job done or doing something. But there's an entrepreneurial one about building a big business or building a business. Did you have that already or was it separate-

Sami: The hustle has always been apart of me. True story, when I was in high school, I figured out that... I made a bunch of... Part of it is you're trying to solve problems and see... And part of it's like to get a little bit of extra spending money. So I had a little program that I kind of coded/ copied, which would basically, if you answer a few questions about your palm and the lines on your palm, it'll actually give you... I found a thing that says, " This line means this, this line means that." So you answer a bunch of questions. And then my cousin was at the local college and I said, " Hey, why don't we offer computer generated palm reading?" I made a couple of hundred bucks doing that. Which was at the Jordanian mind, that's a lot of money.

Speaker 2: inaudible. That was some real hustling right there. Indeed.

Sami: Taking, okay, it's modern, it's this. The concept of hustling is I think... My dad also had his own business. I learned from him that things don't just happen. You have to go get them. You have to go... And I used to actually do a lot of... One of the things he figured out, this is again, this is now in the eighties, he figured out if you actually... He did a lot of contracting. If you present your reports or your RFPs using computers, not hand drawn images, people think you're more advanced. So this is the connection of, hey, technology can unlock things. I used to do all these drawings for him using some CAD program that I had on my inaudible PC. And then he would get those projects. I mean, I'm talking about it, it's subconsciously you realize, hey, technology can give you an edge if you know what you're doing. And it can also create a tremendous amount of efficiency. I mean even at the time, word processing, people used to actually type with a typewriter. Not with a... The thing is, if they had feedback on the RFP, we'd just go edit it and it'll be done. You don't have to type a whole thing. If you needed to change something in the architectural drawing, it was a small edit, not redraw the whole hand drawn thing. You realized this thing, technology can actually drive tremendous efficiency. And I got experience with my dad, got experience... And then when I went to MIT, I discovered the internet webpages. The thing at the time was all these classes realized they needed to actually have websites to actually describe the curriculum. And that was an insight I had at MIT. I used to go to professors and ask them, " Hey, do you want a website for your thing?" And this was at the time, there were no tools, there's nothing like any of the tools today, you're like coding- inaudible

Speaker 2: HDML on the classes were TILDA CS 50, let's say. Drop files.

Sami: I used to go around and ask the inaudible, "Do you want a webpage?" And the way MIT works is they actually will cover the cost on the behalf, like the school will pay for it. I had this whole thing where I was running around at school trying to get... And then I ended up hitting capacity. So then I taught some other students that I knew how to do it. And I had this many consulting operation going at MIT. And that kind of mindset has just been with me and everywhere I have been. Even at Lotus, you're like, okay, what's there interesting to do? But the difference is, I would say, I think that was the transformation when you were asking, okay, from trying to solve problems to thinking at another scale. This is actually the thing I would say that was part of the MIT experience and I would say part of the Lotus experience. And then later in my career in the startup, especially at Google, the scale of thinking and the scale of opportunity is actually something you learn. As an individual, as you're growing and building skills, you don't really realize your potential and the potential one can have the impact. And it's definitely been amplified through technology. As a technologist, really... I mean, it's one of the most shocking things. A small number of people can build software that can transform the world, it's kind of nuts. Some of which I've been partially, and I've been part of. A lot of great companies, and I'm sure it was the case of Drift. It started with the small nucleus and look at you now.

Speaker 2: That's powerful. And I think that that's an interesting inflection connection between two things. One is that little hustle attitude that you and I share as immigrants and growing in places with scarce resources where you have to hustle. I don't know, my stereotype would be that the Middle East is way more hustlers than Latin America. I think we're more social and we enjoy... But that notion of more business, more business, selling and stuff, I think there's more experience at that I feel like, than it is in Latin America.

Sami: I mean, I'm not... One of the things, this is a true story, when I came to America, it was the first time I met Latin American people. It was the first of meeting all sorts of people. And actually, what is interesting a lot of my best friends in college were, because there was such overlap in the cultures.

Speaker 2: There is, absolutely. I'm underselling myself, I feel like that not as many businesses, but the hustler of when you are a scarce resource that you have to get something done and you have to find a way. That's the seed, that raw talent that we have. And I love what you said about the scale, it has to be learned. And what I'm trying to say is I feel like an American entrepreneur that has been born here, they might have more access to learning about the scale first. They're trying to build things, because they know the scale potential, the mechanics and deliverers. We have to go stumble our way one step at a time with that hustle and learn the scale until you know what you can achieve, what's possible.

Sami: But I think also that was when we came to America, that was actually very, very true. I mean, I never heard the word entrepreneurship. I didn't know what is. Now, I call myself an entrepreneur. But I didn't know that was a thing. There were no entrepreneurship classes. The whole concept of... Everything was so foreign now. With the internet, with the access to information, our children are getting more and more exposed to this. And I would argue there are now more framework for actually taking an idea and breaking it down and seeing it. I mean, early days I'm like, I didn't know what a tam was or even to think about it. The way you think about creating businesses is it's all about cashflow. As opposed to what the oppor... It's just a very different way of thinking. And that's learned and it's definitely getting better. But that's I think the opportunity, especially with folks who are new to this, it's a learned skill to think at scale. And I would argue of my time around this, the scalable thinking, got a few orders of magnitude larger at Google.

Speaker 2: Yeah. I mean, that is- inaudible

Sami: 12 years at Google. You walk in and you're thinking about products and you're thinking about millions. And then one of the moments for me at Google was when I was working on my very first product there, it was actually a great environment, Dave. There was a lot of flexibility. But we got to a million users very, very quickly. And the reaction from folks around me... I'm like, if you are a startup million, pop the champagne we're IPOing tomorrow, let's go. And then at Google, all the response is like, "No, no, no, no. That's nothing. You need moly. So how do you think at that scale? And it just starts to change the way you think and the level of ambition. And because it has implications, it's the order of magnitude of thinking because it starts to change how you triage things and where you spend your energy. That's actually one of the things I spend a lot of time with my team at the Outcomes4Me, is how do we think about scalable thinking? I don't want to add a hundred users or a million users or a thousand users. How do we own the market? And that requires a very different set of tactic than growing 10%, 5%, whatever those percentages, smaller numbers. How do you add a zero? How do you add multiple zero to the problem? Which is, I think... And you realize that's also a learned skill.

Speaker 2: It's learned. And I think that that's what we want to share with others, is that to not be intimidated or be scared or think that you were not born with it. Because that one is just a matter of learning. I don't know what a good analogy is, but it's kind of like you're doing some little digging in your backyard with the shovel or with the little hand thing. And somebody that manages a large equipment can dig up way more. But it's just because they just learn how to pull two levers, they got trained to. It's not that they were more powerful, they were exposed to it. You've been exposed to Google and it's one of the largest companies in the world. And wow, that's going to be... It just pushes the boundary, because of the distribution they have, because of the size, because of the magnitude. And most people that just do smaller startups never get to experience and learn those lessons. I remember the day when I asked around, and I didn't see you anymore at Google. And they were like, " Yeah, Sami left. He went to start a startup." And now that I think about it, that was probably... What year was that?

Sami: I left 2005-2006, something like that. It was awhile ago. I was out for seven years. inaudible It was around seven years. I had gotten my green card. And that day I got my green card. I was like, I'm out. I'm going. I'm doing my thing. Because it was very important as an immigrant, getting your status under control is a very high priority. And once that threat restriction was removed, it's just, okay, now there's an opportunity. And I connected actually with one of my coworkers at Lotus. And this was kind of the beginnings of Web 2.0. And there was an insight there. This was the beginning of cell phones and the beginning of text messaging. And you just saw this explosion of text messaging as a new medium of communication. It's like people stopped calling each other, they're just texting each other constantly. The realization is the amount of communication that's happening here, there's opportunity to remove friction and how can computing completely change that experience? Such that it becomes more efficient. We started this company called Cinko with the intent of how can text messaging communication drive more efficiency? And we kind of invented what looks like Twitter. What was interesting about that, we even had the 140 character limit, not because we did any market, inaudible because it was the SMS limit. That's where that number came from. And people would text in the stuff and we'd store it and you'd shared it with your friends and then you'd post your updates. You can go back and if you're following someone, you see their stuff. I mean, it's very, very similar in the overall dynamics. We even had the equivalent of invites, invite friends to whatever, and it'll send the text messages and it'll send you a report. So it was just kind of using text messaging as a medium communication and a medium of managing your life. And that was kind of the thesis of the company. We did very well, initially. We raised the million dollars at the time, which was a bunch of money. For me, it was like, these numbers were just like, what do you mean a million dollars? Am I a millionaire now? I don't know. But it was just kind of the first exposure to the whole VC world, raising money. I didn't know. I mean, I heard of-

Speaker 2: Who invested?

Sami: At the time. It was Flagship Ventures or it was a dabbling in consumer. This was Web 2.0 at the time. So we raised a bunch of money. I mean, we're still operating very lean, very nimble. I mean, we were four or five people max at the time. And this is again, the power of technology. You can build a lot of stuff with a small number of people. And we were slowly rolling it out on campuses, et cetera, to kind of tune the product. And this is actually also where you learn distribution is super hard. I think we talked about this. First time founders think about products, second time founders think about distribution, because you realize it's one of the hardest things. So we're kind of getting some traction and then in the middle of like, okay, we're about to go raise our second round, Google knocked on our door and said, " Hey, we're interested in what you're doing. You guys seem to think about mobile very differently from anyone else we've seen. You guys look like you're building a platform as opposed to just a solution." And back and forth, back and forth, back and forth. It ended up resulting in Google acquiring the company. We were a small... A few of us just went to Google. It was like two people, because they just wanted the core entity. They didn't want anything else. We were very, very, very lean. That's kind of how that transition. But it took a lot of work. And this is also an era where the nature of M and A or acquisitions was very different from the way it is today. Because I've been fortunate to have acquired companies for Google and the process we went through is very different from the process I went through. It was, we're a small little company, a small number of people, but I have never seen due diligences like this. It was a multi- month... We had agreed to terms and it was months and months and months of due diligence. It's definitely- inaudible

Speaker 2: How much easier?

Sami: Oh, it's much, much, much easier. The financial system has definitely innovated to accelerate these acquisitions. The last acquisition I did at Google took a month from start. Those are on the smaller side, not the huge ones. And then our acquisition took eight months, which is an eternity in internet.

Speaker 2: Oh, my God. Yeah. Eight months, I would've died.

Sami: I didn't sleep for eight months, because you're pretty much waiting for the next email, for the next due diligence request. I mean, there's a funny story. They don't do this anymore. At some point they asked... Because we had a domain, they're like, " Okay, we need to see the terms of service for the domain." I remember going to, what's it called?

Speaker 2: GoDaddy?

Sami: It was GoDaddy, but the terms of service were so long. I didn't have a laser printer. So I went to Kinko's, printed it out, put it in a FedEx box and shipped it to them. That was how funny it was back in those days.

Speaker 2: It was you I think to me, you leaving IBM and another one, Kevin Gibbs going to Google. But you I think were probably one of the first ones that I knew personally that left to do a startup. It was like, he's gone. Where did he go?

Sami: Yeah, it was an unusual thing at the time. I mean, it was very rare, because a lot of tech people, you end up at the big tech companies and you're like, you never left.

Speaker 2: Go to Google. They would go to Google, Microsoft, they would go switch.

Sami: They switched from one big tech company to another. And I think part of it is age, overall kind of family status. And I think I would argue part of it is also some naivety. I didn't know what I was getting into. I called it the naivety of youth. You don't know what you're signing up for. I mean, you just do the back of the envelope and I'm generally an optimist about life in general. And you're just like, okay, this is going to work. We're going to make it happen. Let's go figure it out. Oh, holy moly. I'm earning half what I used to. Now, what? Okay, so can I make that work? I just got married. And you're like, okay. And then, oh, I didn't really have that conversation with my wife properly. And you're like, oh, then we need to adjust it. " What do you mean then?" So there was a lot of discomfort, but I also buried myself in the work to put that behind us. And you just put your heart and soul into it and as a result, it helps you focus on moving forward. And I would say I learned a lot at Lotus in those two years I did the startup. And I don't know if you had a similar, I probably learned 10 times more. It was the first time I attend a board meeting. Holy moly, you have to have an opinion when you show up to those things, you have to think about it before you show up. You can't wing those things. There's a lot of that. And just being around seasoned folks, you realize there's a lot of growth beyond just writing great code and great products. There's a lot more to the problem of building teams, organizations, and even great products and all these things were new skills.

Speaker 2: But it's something to keep encouraging people and inspiring others that having a company with two or three people, that could be a very magical place. Where everything, all dreams can come true in one way or another. Might not be a straight path, but you had that. And look where you end up, 12 years of Google, extremely successful, built great products. There's a lot of products that get sunsetted at Google, but you built one of the ones that is still to this day going really strong. That's a testament to you, I would assume, to what you did at that level at scale. But I was going to give you a hard time and say, yeah, Sami, just stay there. Like IBM, right? You did IBM seven and then 12 there. Two big companies. And I'm kind of happy that I did 10 years at IBM and I've done 15 in the entrepreneurial world, and I don't think I'm ever going back. I like this world of building and creating and I'm so impressed by you that you had that short stint with Cinco and now you're back at it again. So tell mem that must have been a huge decision.

Sami: So there's several sides. The entrepreneurial hustle, those two years at Google actually was what made me, I think very successful there. Because I just thought very differently from, it was just the hustle of that. And what it does is, it makes you much more well- rounded and just building on one of the things you said from two years of doing your own thing will make you a better person wherever you are. Big company, small company, next startup, new startup, whatever it is. Because you learn so much from those, because the problems you will see and solve are much more real. And the difference is there's very little like, " Hey, boss, fix it, make it go away." You're the boss. So you end up having to really solve some problems you normally you wouldn't have to... Everything from business. At Google, one of the things you learn scale, you learn that you can actually build products that can fundamentally impact the world. In the case I did was leading the re- imagination of Google News around which was triggered by what was happening in the United States around the presidential election between Hillary and Trump and the news industry's relationship with Google got really sour. It's like we're proliferating for reinforcing filter bubbles, destroying our business model. What are we going to do about that? Which actually triggered the formation of a group that I ultimately ended up taking over, which was like re- imagining what news is like. And the ambition there was like, we are going to actually solve a much larger problem, a societal problem. We're helping people get involved. And you learn the discipline of what does that mean? What does news mean for people? And after doing that, you see the success. When I took over Google News, it was a big problem. And then in the one year after it's launched, we more than doubled, added another billion users, which is kind of crazy. And that just didn't happen organically. This is actually where I learned a lot about the problems of the way you... A brand will get you a certain number. You actually have to think about this in order to reach that scale. And there was all sorts of work we did about partnering with folks, viral flows in the product, because it just doesn't happen. This whole organic thing, yes, it does happen, but it's so hard and it's so rare. You have to be very, very- inaudible

Speaker 2: Part of it has to be designed and I think you're right. I mean, the entry bar for Google might be higher than most every other company. And you get that for free. But anything else after that, you have to earn it. You have to design, you have to iterate on it and think and innovate. If not, it's not going to be for free. Which is why a lot of Google products fail. People think just because they're Google doesn't mean you have guarantees.

Sami: Yeah, I learned this, if you have a thing with a Google name you're going to get a million users, then it's hard to get more than that. You have to be intentional, you have to think about distribution. This was our relationship with Google Play, which was basically built on the relationship with Android. Android was exploding, primarily its relationship with the phone manufacturer. Those kind of relationships are the things that drive incredible growth. A lot of highly distributed products kind of did that by doing the very clever partnerships and very clever product flows to get them at that level. But coming back to your original question, which was what happened? So you work on these societal problems, a couple of things happen. A bunch of family members got diagnosed with cancer. And being in Boston, which is kind of the mecca of healthcare, everyone's calling, " Hey, do you know an oncologist?" " Do you know an oncologist?" " Is my doctor, is it right? Is what I'm getting wrong?" Is it this, is it that? And because I'm fortunate, I have a network, et cetera, I'm able to help answer these questions. The thing that blew my mind is the more you dig into this problem, there's a tremendous amount of friction. The information on the internet is so confusing. It is incredibly confusing. I mean, you ask any physician, they hate Dr. Google, because most people's diagnoses are highly nuanced to their actual treatment is the function of their diagnosis and the test result. And it's especially the case in cancer. To take it one step further, I actually didn't know this, cancer treatment in the United States is defined by a whole series of nationally defined clinical guidelines by this organization called the NCCN, the National Comprehensive in Boston. And in the top cancer centers, the top oncologists sit on the committees that define the national guidelines. And if you look at them as a computer scientist, you'll notice they look like a decision tree. You do a whole bunch of tests and then you go, okay, per two positive... " Okay, this is your treatment." " Okay, this is your treatment, plus if this test is..." True and you look at them like, okay, why isn't this an algorithm?

Speaker 2: And it's not that big, I'm assuming it's still... And it's quite not that large of a decision trip.

Sami: No, no. It's a pretty significant. It's actually-

Speaker 2: inaudible

Sami: It's pretty significant. It's hundreds and hundreds of people per cancers- inaudible

Speaker 2: Props to them that they have developed that, right?

Sami: Yes. It's actually, it's very, very impressive work. I think the first part, the second part that I found in particular interesting is... And this shows the actual scope of the problem. The guidelines change every three months. And you may have heard the term precision medicine, and I didn't know what that meant. Okay, precision, it's more precise. But actually the more you dig into it, and it's very, very relevant in oncology. Is in precision medicine, what all the signs and all the focus is essentially they look at your genetics, what you're born with. Genomics, which is basically the biomarkers and characteristics of the tumor. And those become new inputs into deciding what your treatment and almost all the new drugs are pretty much looking at genetics and genomics as a means to decide what treatment you're on. They're moving at a rate of... They're changing every three months, because the science is moving very, very quickly. There's a lot of research in cancer. And then you like, if you take a general oncologist, and this is a study that I quote a lot, is for a general oncologist to be up to date with the latest science, they need to be reading 27 hours of work a day, which is impossible.

Speaker 2: Not going to happen.

Sami: So there's a real problem there in Boston, because you see specialists of specialists, you're almost certainly always getting the latest cancer treatments. The latest treatments, and-

Speaker 2: The latest is still nine months behind or whatever.

Sami: In Boston, in the top hospitals it's usually the case. But when you start to go into community settings outside of the academic centers, a lot of the times you may not be getting the latest treatments. That's the first part. For the other thing that was I think also surprising to me, is for advanced cancers, like state metastatic stage four, really the best... That's a pretty grim diagnosis. The best options are clinical trials. And if you want to see another shit show, there are a few thousand clinical trials. You go to the state of the art, which is this thing called clinical trial, which is a government website, try to decipher anything. And you're like, why isn't technology... I spent my career pretty much trying to match... Google News, we were seeing 64, 000 new articles a minute, and we're able to get them in front of users based on their interests within seconds of us seeing that stuff, this is a solvable CS problem. And if you kind of put that together-

Speaker 2: Which it's solvable, because it's not like you're figuring out the science. You're just leveraging the science of the few of the best and making sure, making it accessible to everybody in real time so they don't have to digest all this papers and the stuff. And you're saying you're going to get the latest information in factors.

Sami: That's exactly. And this is actually the catalyst link, you get all these family members, they're asking you for help. You're trying to untangle this, you're talking to the inaudible, and you realize there's actually a lot of opportunity for technology to completely transform the experience at scale. Again, going back at scale. In the process connected with an MIT classmate of mine who is from the farmer world, the big question is it's like, okay, you've got a problem. Is this something that can... Is this a business or is this just a solution or is this just a feature? And after spending a lot of time, there is a business. Which is about helping people get on clinical trials, getting more awareness around the latest treatments. And if you approach it from a... Let's build a product that solves people's cancer journey, not what's their treatment or their entire holistic journey and you enhance it with sponsored experiences that are about helping improve their journey, you can actually make both sides work. And that was kind of like the catalyst. I started off as an advisor with the company around this problem. And then you see the friction, you see the opportunity and you're like, okay, this is... We can actually do something transformative here that is not about just building an oncology solution. We can actually fundamentally change people's outcomes at scale, primarily by empowering people to have the information. When people ask what do we do at Outcomes4Me, the thing that commonly comes back, you're going to tell me if I go to the Mayo Clinic, what they're going to tell me without me having to travel by just answering a few questions. And the answer is yes, because they're going to tell you what's based on these national in the guidelines. And then when you approach the problem as a technologist who enjoys building consumer experiences, it's not about just features. You need to think about the entire journey. And when you think about it, the journey, now you need to start adding all these other things, because now you're creating an engaged product that people use that actually is providing value, that's providing support. That's actually helping with their emotions, that's dealing with mental health, that's dealing with compliance with... And then suddenly all this stuff comes together and it's like, oh, this is a pretty big idea with a pretty big solution. So that was kind of the transformation where it was initially catalyzed by what was happening in my life. You see a problem, and the latter half is like, well, if that is the problem, is there an opportunity to solve this at scale? This is again the thing I learned. You need to think about that order of magnitude. When you think about it that way, then it becomes a pretty big opportunity that you also feel great about too.

Speaker 2: Wow. Yeah. No, this is fantastic. Makes a lot of sense. And it is super inspiring to be able to recap that journey from you should go to that school, you should go to that competition. To show up, knowing nothing to doing whatever it takes, not complaining. You went to IBM, you kind of triaged that and you said, okay, I'm going to go work there, because I need my visa, I need my green card. Then you become an entrepreneur, learn to do the work, and then you get exposed to scale. I mean, we had some scale at IBM, but you made an impact, because I mean, we're still dealing with this problem with the news. News is a complete disaster, but you got to play it and try to solve it at the highest levels. And then you're just run into this unfortunate events, that series of events. But your mind is now thinking at scale and now you're like, how do I solve this for the whole world? I mean, if the best person, the best doctor is just going to triage something in a decision tree that is outdated, at least I'm going to do that automatically and make the same decision for you in real time. And you can change the lives. We're solving, we're curing cancer little by little with advances. But this is the dream of AI to be able to say, everybody gets the same treatment. You can be in the jungle in Nicaragua and you can through a phone and through a text message.

Sami: That's exactly right. I mean, one of the saddest things about when a drug gets approved, it takes years for it to actually get disseminated. It starts with the top cancer centers, but it takes a long time for it to get prescribed. And that's actually, I think our big opportunity, is help people get on these new innovations. In the case of clinical trials, get them onto trials earlier, because they're so hard to untangle and figure it out. And that's the kind of stuff that actually changes people's outcomes. And the difference is thinking about at scale, but the solution we're building is helping one life at a time.

Speaker 2: But you can build infinitely, you can do that.

Sami: It's been a great couple of years, because one in four breast cancer patients are on the platform. Which is great impact. We don't measure it, but we know anecdotally that people are actually using our app to get on trials and argue with their doctors. No, the app told me I can get on. The doctor says no. And then they've emailed us, your app actually got me on a clinical trial. That's actually pretty fundamental.

Speaker 2: Because how has the doctor... The doctor has no time to breathe or eat lunch.

Sami: Yes. And then if you actually look at the health, the challenges on the healthcare system, the actual time doctors spend with patients is shrinking. Because the system's trying to make it much more efficient, because their time is expensive and cancer treatment is psychologically... It's a big... It's very, very, very challenging. And most patients want infinite time with their doctor to answer all their questions, let alone the emotions, et cetera. And if technology can help make that time more efficient and more pointed, that's empowerment. And that's kind of

Speaker 2: Just to get to answers. Just to get to at least spread it, go to this clinical trial. They're waiting for people, you can qualify them for them. It's amazing, it solves the problem on both sides.

Sami: Yeah. One of the things actually, we spend a lot of time with patient education, half the time is I don't even know what questions done. Why is that relevant? We've been spending a fair bit of energy just helping with the treatment. The other interesting thing where we're going to spend some time on solving that is after cancer treatment, people's care transitions from the oncologist to the primary care. And typically a lot of the drugs people take to deal with the cancer can have a lot of secondary effects that need to be monitored. Some of the drugs can compromise the heart. That's also where things tend to fall through the cracks, because the primary care isn't equipped. So we spend actually a whole bunch of... And our general approach, and this is again a philosophy of when you're building world class products. First you need engineering, you need product, you need design. But I think one of the critical things is you need domain experts in the space to help guide what you're building. When you combine all these things, that's when the magic happens. We have physicians, nurse practitioners on staff, and we partner with top cancer centers. For example, we're thinking about inaudible, we've been building our survivorship module, which is what happens after cancer treatment with Vanderbilt Cancer Center, with Dr. Deb Friedman, who is on the committee that's writing the national guidelines for survivorship, for cancer, to transform those guidelines into technology. So a lot of good things happen in healthcare. They get into guidelines, but then the transition from guidelines to technology is I think where the opportunity is and where the friction is. And sometimes people don't even realize technology can play a role, because they've been working in a certain way.

Speaker 2: I love the connection, the arc from you editing a CAD design and the basic innovation was really just the editability of this thing and not have to reprint it, not redraw it. Which I experienced the same type in my stuff with my first computer. And you think that would've been gone by now, that ability to that efficiency and here you are effectively saving the time of a human being just going through a decision tree and getting a copy of a decision tree and you're like digitizing it to be able to navigate a complex tree. So it more accurately takes the person to the spot. We have the answer in front of us, but we don't know how to distribute it and how to monitor it and how to coach it and how to scale the delivery of it.

Sami: Yes, scale the delivery... To go back, those decision trees are actually clinician facing. They're not patient facing, because they're just incomprehensible.

Speaker 2: Oh yeah, absolutely- inaudible

Sami: Is taking that and trying it into consumer friendly language that they can understand.

Speaker 2: But it is impressive that we have... Sometimes medicine blows us away how simple it is. But it's impressive that they have created such a thing that has highly effective rates or effective rates better than just having a customized doctor just for you. They're not going to figure out on their own. It's putting together everybody's research into one place that is-

Sami: Just amazing.

Speaker 2: ... amazing.Love that. And I love, like I said, that you continue to pursue the dream and you got off your ass at Google, you could have stayed there being busy. And it's an encouragement to people, to think about opportunities and things that they run into their life and face, go after them. Because you could have delegated this problem to somebody else, but you took it on. And that's such powerful and speaks so highly of you, of what you're willing to do. And it's what a pleasure and privilege of knowing you and seeing a little bit of the arc of your life, getting to know a little bit of the earlier part of it and continue to know you and see how you're going to change the world. So we still have TW 10, 20, maybe 40 years left. So you're kicking my ass to do more.

Sami: If you have an idea, you see a friction point in the world. As always, if you've got the time and the drive-

Speaker 2: The help.

Sami: ...there's a lot of problems. I mean, this is actually one of, for me, the most challenging things about the problem in healthcare is, because I don't come from healthcare everywhere you look, there are problems. I wouldn't say problems. It's problems that technology can remove friction. And that's actually one of the biggest challenges when I talk to the team. It's like everywhere you look, it's very, very easy to get lost in all the problems of healthcare. And it's really trying to find that path and the forest to have impact. Again, good scalable thinking. You can tube on the wrong things.

Speaker 2: We are so scared of with our kids and stuff like that, I always think as a parent of removing friction from them, but friction is never going away. I mean, the goal of human beings is to remove friction, because it just creates itself and it creeps upon us. But if you don't learn to deal with friction, how you going to ever be successful, right?

Sami: Yes. And it's not just deal with friction, it's also being able to identify it.

Speaker 2: You feel it. Sometimes people are numb to it, but that immigrant thing is, I think that that's what we're susceptible. Part of the hustle is the ability to detect the friction and be able to say, why am I, it's like this is not working. They say salespeople, they're like water coming down the roof. Water finds the path of least resistant always going down. That's what a household is, right? It's like when you're moving water, because you're like, I want to avoid it.

Sami: Yes. And I think the other half of it is that, especially if you've been in a developing country, the level of friction is just another level. I mean, first thing actually, this was the experience for me. I mean, getting a passport in the United States was for me, an eyeopening experience. Getting a passport in another country has been... It's easier to go to the doctor, get a colonoscopy and come back than sometimes to get your first passport.

Speaker 2: Yeah. When I got married, I was going to Ecuador with my wife, and that was 20 years ago. And they changed the law that I'm from Nicaragua. I didn't need a visa at that time when I checked. But when I got married, they changed it, I need it. So they did not let me get on the plane. I just went driving around Miami and in about less than 24 hours I had gotten my visa, because I'm an immigrant hustler. But I literally went to places. I don't have a network, but yet we found the consulate in some building of Ecuador. And then who was there? It's funny, because this guy came before me and the bell says, " Do not ring the bell more than three times," or something like that. And the guy goes, ding, ding, ding, ding. So the person comes out and says, and he goes, " I need my visa. Stamp it." And the woman goes, " No, we can't do that today. Come back tomorrow." Because the guy violated the rules. When I saw that, when I waited there and then I brought the pictures of my wedding and they knew my wife. I'm in the back of the embassy. That's how you get the stuff done. But it's like I went from no visa and no car, no Uber, no phones. This is 1998. And I was like, find my way to get to the country. And when we were getting out, same thing. Her ID had expired from Ecuador and then we had to leave the airport while we were past customs, go out to some ministry thing and we had to get it done. And I had to do some illegal stuff to get it done and come back to the plane so we make our flight, but it's mind blowing compare it right now. I took a picture at CVS, send it to the post office, and they just mailed me my passport.

Sami: Yes. It was such a transformer. And then you realize, because we've seen the stuff and you've seen the extremes. So whenever you see extreme stuff, you're like, it can be efficient. And then once you learn technology, you're like, oh, we can use tech to remove all these friction flow.

Speaker 2: That's awesome. Awesome. Great stories. I feel like we're going to have to do more stories. Thank you so much for being on the episode, historic episode.

Sami: inaudible always.

Speaker 2: I hope everybody understand... I don't know. I hope they can all get a glimpse of how impressive of an impact you made on the world and that you continue to do. From a kid that didn't even have an email address inaudible.

Sami: Yeah. I didn't know what it was.

Speaker 2: What great stories. Thank you so much, Sami.

Sami: Thank you for having me. Really enjoyed the conversation.

Elias Torres: Thanks for listening to the American Dream Podcast. Make sure to hit subscribe so you never miss when a new episode drops. If you like this episode, please leave a six star review wherever you listen to your podcast. And if you're interested in learning more about My American Dream Mission, subscribe to my newsletter linked in the show notes.