What's the difference in revenue distribution for artists between iTunes and Spotify?

On iTunes, 30% goes to Apple, 70% to the record label, with a small percentage of that 70% going to the music publisher and artists (after recouping label expenses). On Spotify, 30% goes to Spotify, and the remaining 70% is split pro rata based on listen time among rights holders, with similar splits to publishers and artists.

Why has healthcare been slow to be disrupted by technology compared to other industries?

Healthcare is heavily labor-paid, with money largely going to doctors and personnel. Hospitals and payers have low margins due to regulations. New technology's impact on human health is not always clear, and the biggest advances have historically come from pharmaceutical innovation, not necessarily system-wide digital disruption.

What does D.A. Wallach envision for the future of medicine?

He foresees a 'biomedicine singularity' where complex biology can be digitally represented and simulated at zero marginal cost, enabling rapid understanding and intervention. This would lead to a shift towards more technology in medicine, a greater role for highly skilled nurses, fewer traditional physicians, and new types of preventative and precision medicines.

How has the Human Genome Project's impact been perceived?

Initially, optimistic predictions were short-term overestimated, as comprehensive understanding didn't follow immediately. However, its long-term impact on sequencing technology, now used to read various biological data, has been underestimated and is integral to cutting-edge medicine.

What are new approaches to liquid biopsy for early cancer detection?

Grail focuses on deeply sequencing peripheral blood to detect subtle tumor DNA. Glympse, a company D.A. is investing in, engineers nanoparticles that break apart upon encountering cancer-related enzymes in the body, creating a larger signal detectable in urine. FreeNome aims to detect the body's systemic response to cancer rather than direct tumor DNA.

What is the "needle of hay in a haystack" problem in early cancer detection from blood?

Detecting early cancer DNA in blood is like finding a 'needle of hay in a haystack' because the tumor DNA (the 'needle of hay') is self-DNA, not foreign, and is present in extremely low concentrations (sub half percent) compared to an abundance of healthy DNA (the 'haystack'). This requires highly precise and deep sequencing.

What is the biggest concern with widespread liquid biopsy screening for cancer?

The primary concern is the risk of over-calling cancer, meaning false positives. If the tests detect very early-stage or pre-clinical tumors that the immune system might naturally clear, it leads to a dilemma about when and how to treat, potentially causing unnecessary anxiety and invasive follow-ups.

How do sensitivity and specificity relate to breast cancer screening with mammograms?

If breast cancer incidence is 1 in 700, and a mammogram has 73% sensitivity, a positive test still means less than a 1% chance of having breast cancer in the general population. Bayesian statistics can update this probability based on individual risk factors (e.g., BRCA mutation). Ideally, a screen should have 100% negative predictive value (no false negatives) to avoid missing actual cancers.

What role could layered diagnostics and family history play in future healthcare?

Combining genomic data, family history, and multiple low-cost screening tools (like mammograms, DWI MRI, and liquid biopsies) could create a 'Swiss cheese' approach to diagnostics. This personalized risk assessment would determine the utility of various tests for each individual, moving towards a more precise and stratified surveillance strategy.

What are some modern advancements in treating allergies?

Research, particularly at Stanford with Dr. Nadeau's work, is making significant progress in desensitization for severe allergies. This immunotherapy involves gradual exposure to allergens, successfully allowing individuals who once had anaphylactic reactions to peanuts to consume them again, showing promise for making these treatments widely accessible.

Key Moments

#06 – D.A. Wallach: music, medicine, longevity, and disruptive technologies

Peter Attia MD

People & Blogs3 min read141 min video

Dec 17, 2019|1,600 views|28|1

liquid biopsies healthspan future of medicine future of healthcare healthcare Chester French

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Key Moments

TL;DR

Musician D.A. Wallach discusses music industry shifts, medical breakthroughs like liquid biopsies, and the future of healthcare.

Key Insights

The music industry has transformed due to the internet, shifting from traditional A&R to online discovery platforms like MySpace.

Liquid biopsies hold significant promise for early cancer detection, potentially revolutionizing cancer screening and treatment.

Technology is poised to disrupt healthcare by automating cognitive tasks and enhancing diagnostic capabilities, though widespread implementation faces challenges.

The concept of 'singularity' in biomedicine refers to the digital representation of complex biology, enabling rapid research and intervention.

Learning to think critically and embrace curiosity is vital, not just in science but in all fields, and parents play a key role in nurturing these traits in children.

The future of healthcare may involve highly skilled nurses and AI playing larger roles, while physicians focus on complex cases and personal guidance.

FROM MUSICIAN TO INNOVATOR: A CROSS-DISCIPLINARY JOURNEY

D.A. Wallach, a multifaceted artist, investor, and thinker, shares his unique journey from a successful recording artist with the band Chester French to an engaged observer and participant in technological and medical innovation. His path highlights a deep intellectual curiosity that transcends traditional boundaries, leading him to explore diverse fields from the intricacies of the music industry to the cutting edge of biomedical science.

THE EVOLVING MUSIC INDUSTRY AND DIGITAL DISRUPTION

Wallach recounts the seismic shifts in the music industry driven by the internet, particularly the rise of platforms like MySpace, which fostered viral growth and fan engagement unlike earlier models. He contrasts this with the current landscape, emphasizing how online discovery and distribution have fundamentally altered how artists connect with audiences and build careers, moving away from the gatekeepers of the past.

LIQUID BIOPSIES: A NEW FRONTIER IN HEALTHCARE SCREENING

A central theme is the transformative potential of liquid biopsies for cancer detection. Wallach explains how these blood tests, by detecting minute traces of tumor DNA or other cellular byproducts, could revolutionize early diagnosis. This approach offers a significant advantage over traditional imaging methods, which often detect cancer at later, less treatable stages, promising a future of proactive and personalized cancer prevention.

THE PROMISE AND CHALLENGES OF MEDICAL TECHNOLOGY

The conversation delves into the broader applicability of technology in healthcare, acknowledging that while some industries have been radically disrupted, healthcare's transformation has been slower. Wallach discusses how advancements like AI and computational systems could replace some of the cognitive work of physicians, leading to more efficient diagnostics and personalized treatment plans. However, he also notes the complex interplay of stakeholders and the inherent difficulties in scaling new technologies across the healthcare system.

TOWARDS A 'SINGULARITY' IN BIOMEDICINE

Wallach articulates his vision of a 'singularity' in biomedicine, where complex biological systems can be digitally modeled and simulated. This advancement would allow for rapid, cost-effective experimentation and intervention, accelerating the pace of discovery. He likens this to understanding biological systems at a mechanistic level, moving beyond current limitations of human understanding and slow, costly clinical trials.

INVESTING IN THE FUTURE OF HEALTH AND LONGEVITY

His focus as an investor has shifted towards revolutionary medical interventions, particularly in biotechnology. While acknowledging the importance of longevity research, Wallach emphasizes his passion for reducing existing suffering by tackling diseases early and effectively. He believes the most significant breakthroughs will come from understanding and interfering with the fundamental mechanisms of disease, offering hope for extended healthspan and a reduction in human suffering.

THE SCIENCE OF SCREENING: NAVIGATING COMPLEX DIAGNOSTICS

The discussion explores the statistical nuances of diagnostic screening, including sensitivity, specificity, and predictive values. Wallach uses the 'Swiss cheese' metaphor to illustrate how layering multiple, imperfect tests can improve diagnostic accuracy. He highlights the importance of Bayesian statistics in personalizing risk assessment, acknowledging that the utility of any test depends on an individual's pre-existing risk factors and evolving data.

THE FUTURE OF HEALTHCARE DELIVERY AND ACCESSIBILITY

Looking ahead, Wallach foresees a healthcare system with increased technological integration, potentially featuring a larger role for highly skilled nurses and AI. He stresses the critical need to make advanced treatments and diagnostics, like those emerging from research into immunotherapy and personalized medicine, accessible to everyone, not just the privileged. Bridging the gap from scientific discovery to standard of care remains a significant, albeit solvable, challenge.

Mentioned in This Episode

●Products

●Software & Apps

●Companies

●Organizations

●Books

●Concepts

●People Referenced

Common Questions

D.A. initially had an interest in investing but didn't know which direction to go. He met Ashton Kutcher, who provided a template for an artist entering venture capital. Spotify's emergence as a successful company provided the pivot for D.A. to become a professional investor.

Topics

Health & Longevity Technology & Innovation Precision Medicine Digital Platforms Cancer Screening Music Industry Disruption Healthcare Innovation Liquid Biopsies Biotechnology Investing

Mentioned in this video

Media

Chester French

D.A. Wallach's band, which released three full-length albums and toured with notable artists.

Weezer

Band that Chester French toured with.

Blink-182

Band that Chester French toured with, noted as Peter Attia's favorite.

La La Land

Film directed by Damien Chazelle in which D.A. Wallach had a small cameo.

Time Machine

D.A. Wallach's solo album released in 2016.

Whiplash

A high-octane movie about a drummer, partly autobiographical for Damien Chazelle, and one of Peter Attia's top five films.

Concepts

Ripple

One of the start-up companies D.A. Wallach has advised, and an early investment for him.

BMI

One of the two most prominent Performing Rights Societies in the US, managing public performance rights for artists.

People

Damien Chazelle

D.A. Wallach's friend and former bandmate who later became a filmmaker, directing Whiplash and La La Land.

Curtis Mayfield

One of D.A. Wallach's major musical influences, embodying linear storytelling in music.

John Coltrane

Saxophonist who Elvin Jones played a lot with.

Toni Braxton

Used hypothetically to illustrate how recording artists own the recording of a song, separate from the songwriting rights.

Shawn Fanning

Co-founder of Napster with Shawn Parker.

Craig Venter

His genome being sequenced was an initial milestone of the Human Genome Project.

Mark Zuckerberg

Described as a genius business person and technologist, but not particularly interested in culture for Facebook.

Keith Moon

Mentioned as a great rock drummer.

Lady Gaga

Artist that Chester French toured with.

Daniel Chester French

Sculptor of the Lincoln Memorial and the John Harvard statue, after whom D.A. Wallach's band Chester French was named.

Bob Marley

One of D.A. Wallach's major musical influences.

Clyde Stubblefield

Drummer for James Brown and one of D.A. Wallach's favorite drummers.

Pandora

A popular streaming service at the time Spotify emerged, focused on algorithmic radio rather than on-demand music.

Sangeeta Bhatia

An extraordinary researcher at MIT and founder of Glympse, whose work on endoproteases and nanoparticles is key to early cancer detection.

Pharrell Williams

Discovered D.A. Wallach while he was an undergrad at Harvard and signed him to a deal.

Jimmy Iovine

Ran Interscope Records and worked with D.A. Wallach and Pharrell Williams on a record deal.

Bernard Purdie

A jazz drummer, claimed to be one of the most recorded drummers of all time, and admired by D.A. Wallach.

John Bonham

An influential rock drummer, known for playing 'behind the beat' and his incredible opening riff on Led Zeppelin's 'Good Times Bad Times.'

Steve Jobs

Pioneered the legal paid download model with iTunes, gaining control over music distribution.

Shawn Parker

Involved with Napster and Spotify, and interested in immunotherapy for allergies.

Atul Gawande

Mentioned as someone who rightly reminds the medical community to focus on implementing simple changes for enormous impact.

D.A. Wallach

Guest on the podcast, described as a Renaissance man, recording artist, songwriter, investor, and essayist.

Gary Taubes

Someone Peter Attia and D.A. Wallach met through, who influenced Wallach's interest in obesity and nutrition research.

Kanye West

Provided Chester French with their big break, flying them to Los Angeles and offering a record deal.

Elvin Jones

Jazz drummer, D.A. Wallach's favorite, known for playing with John Coltrane and his expressive range.

Isaac Newton

His work in physics made a chaotic universe seem simple, analogous to future breakthroughs in biology.

Olivia Attia

Peter Attia's daughter who plays the drums and was encouraged by D.A. and Adam during a jam session.

Stevie Wonder

Mentioned as a musical icon, falling under the Motown influence.

Ashton Kutcher

Became a good friend of D.A. Wallach's, providing a template for an artist transitioning into technology investment.

Bill Clinton

Held a press conference with Craig Venter about the Human Genome Project, inspiring future scientists.

James Brown

Regarded by D.A. Wallach as important for his performance and 'groove,' defining a style of music centered on the drummer.

Judea Pearl

Professor at UCLA and author of 'The Book of Why,' an expert in causal inference.

Ray Kurzweil

Coined the term 'singularity' as the moment human minds merge with machines.

Chuck Berry

Mentioned as an 'awesome' and 'unhinged' live performer whose early rock would have been incredibly shocking.

Nina Simone

Identified as one of the greatest virtuosic live performers based on a documentary.

Companies

MySpace

An important platform for Chester French to build their audience online, allowing spam, 'Top 8' lists, and user customization.

Doctor On Demand

One of the start-up companies D.A. Wallach has advised.

Snapchat

Cited as a platform that, like MySpace, embraces expressive and culturally contextualized user interaction.

Motown

A musical style and record label that influenced D.A. Wallach, noted for its songwriters.

SpaceX

One of the start-up companies D.A. Wallach has advised.

Emulate

One of the start-up companies D.A. Wallach has advised.

McKinsey & Company

Consulting firm whose consultants are predicted to implement IT operating efficiencies in healthcare organizations.

Spotify

D.A. Wallach was an artist-in-residence at Spotify, and he discusses its origins and impact on the music industry.

Facebook

Compared to MySpace; described as less culturally expressive and more focused on accurate real-world relationships.

Illumina

A behemoth genome sequencing business and the spin-out company Grail.

Napster

An early file-sharing site that allowed free music trading, contributing to the music industry's decline.

Glympse

A Boston-based company founded by Sangeeta Bhatia that engineers nanoparticles to detect early cancer by sensing enzymatic remodeling in tissues.

FreeNome

A company taking a different approach to liquid biopsy, focusing on the body's systemic response to cancer rather than tumor DNA.

Software & Apps

Lincoln Memorial

Sculpted by Daniel Chester French, the namesake of Chester French band.

John Harvard Statue

Sculpture by Daniel Chester French in Harvard's main quad, inspiring the band name Chester French.

iTunes Store

Apple's platform for MP3 downloads, which pioneered a paid download model.

Organizations

The Beatles

One of D.A. Wallach's major musical influences.

ASCAP

One of the two most prominent Performing Rights Societies in the US, managing public performance rights for artists.

Stanford University

Location of a major center for allergy desensitization research funded by Shawn Parker.

Santa Fe Institute

An organization D.A. Wallach is involved with, known for studying complex adaptive systems.

Harvard University

D.A. Wallach's alma mater, where he was discovered as an undergrad and where many classmates pursued investment banking and management consulting.

UCLA

University where Judea Pearl is a professor.

FDA

Regulated OncoBlot, approving it for specific use in patients with metastatic cancer of unknown primary.

Mount Sinai

Institution in New York that is taking forward allergy desensitization research.

Children's Hospital of Philadelphia

Institution in Philly that is taking forward allergy desensitization research.

MIT

The institution where Sangeeta Bhatia is an extraordinary researcher.

Products

OncoBlot

A protein assay for cancer detection that showed high accuracy for metastatic cancer of unknown primary but over-estimated cancer prevalence in healthy populations.

Grail

A spin-out of Illumina that uses deep sequencing of peripheral blood to detect early cancers by identifying tumor DNA.

Books

The Book of Why

A phenomenal book by Judea Pearl on causal inference, which explains the math behind diagnostics like sensitivity and specificity.