[quote style=”boxed”]Just sit down and start. It sounds stupid but I think it is the most important part. Lacking all the necessary skills is totally secondary. With the Internet and all the incredible tools available, any skill is learnable and all knowledge is discoverable with enough dedication.[/quote]
Larry Istrail is a medical student with an entrepreneurial spirit and a penchant for tackling provocative and controversial health-related issues. As a graduate student at Boston University, he saw first hand how poor the current state of dietary research technology is compared to its counterparts in other fields of medical research. We have machines that can literally look through your skin and view your bones. We can tell who your parents are simply from a drop of your spit. Yet when it comes to studying obesity and diet related disease, arguably the most threatening maladies to our public health, we use technology undeveloped since the mid 1900s. Essentially unchanged in the last 60 years, researchers are forced to rely on self-reported dietary intake data inscribed upon a lined sheet of paper, as their sole measure of the behaviors, miscalculations, and potential bias each study subject may unknowingly contribute to the waning internal validity of the research. Each returned food record is an estimate of the food consumed by each individual, offering the investigators but a pencil sketch of what the subject may have actually eaten.
In 2009 he teamed up with 3 others to create his first company, PhotoCalorie, to try to solve this problem. PhotoCalorie is a web-based photographic food journal and iPhone app that lets users visually track their food intake, while allowing the researchers and/or their health professional to literally see what they are eating in real-time. PhotoCalorie is currently being implemented into dietary research at multiple universities, offering the investigators a never-before-seen window into the actual eating behaviors of their study subjects.
In January of 2012, he went solo and founded his second company, the Ancestral Weight Loss Registry, to collect and analyze data concerning the worldwide conundrum of successful weight loss. Those who consume a carbohydrate-restricted or paleo diet are asked to fill out a questionnaire and tell their personal stories in a global, crowd-sourced effort to improve the understanding of carbohydrates, obesity, and overall health. After seven months, nearly 3,000 people have registered from all 50 U.S. states and over 52 countries around the world. The registry also offers a comprehensive dietary research library and marketplace of hand-picked doctors and dietitians that specialize in low carb or paleo nutrition and compete with each other to offer telemedicine-like services related to nutrition, health, and weight loss.
What are you working on right now?
I’m working on expanding and growing the Ancestral Weight Loss Registry, a crowd-sourced, global study of paleo and low carbohydrate nutrition. Browsing through the data from 3,000 people, looking for trends and commonalities.
Where did the idea for Ancestral Weight Loss Registry come from?
The idea came from seeing what the National Weight Control Registry was doing. The NWCR is he largest prospective investigation of long-term successful weight loss maintenance, started by two PhDs in 1994. After nearly 20 years, they have about 10,000 people who have registered and shared their stories. However people can only be a part of the registry if they have lost over 30 pounds and kept it off for a year or more. To me, this is like Yelp.com only allowing you to review a restaurant if you are going to give it 5-stars. Those people who are most successful at losing weight and qualify for the NWCR may be systematically different in ways uncaptured by the registry questionnaire, further confounding the already weak data these questionnaires can provide. I also felt that paleo and low carbohydrate nutrition was not adequately represented in their data. Since the data collected in the NWCR is self-selected, as in AWLR, the trends you will discover are entirely a function of who registers. Therefore the marketing and promotion can essentially determine outcomes supportive of a particular diet. This is why I decided to focus specifically on the underrepresented niche of paleo and low carbohydrate nutrition.
How do you make money?
Each health professional chosen to be a part of the marketplace is allowed to offer their own services, charge their own prices, and work their own hours. Becoming one of our experts is free for any doctor or dietitian, however a percentage of their sales go toward the company’s revenue.
Ultimately I hope to work with researchers to use this crowd-sourced data as a hypothesis generation tool. This crowd-sourced model would eliminate or dramatically reduce the inherent bias researchers may have for a particular idea and elevates hypothesis generation to a more objective, data-driven model as opposed to intuition-driven, which is so often wrong in medicine.
What does your typical day look like?
Being in medical school, my day is very busy and centered around studying. Each day we have four hours of lectures covering about 200 slides of material, and an exam every 2-3 weeks, so the information quickly adds up. Handling this workload while working on AWLR and PhotoCalorie has been a challenge, forcing me to discover new ways of becoming as efficient as possible.
In a typical day, I wake up around 6:30am and indulge in a nice hot cup of coffee. From around 7am-noon I study for my board exam approaching in June, and listen to the first two lectures from that day. I take notes with Anki, a digital flashcard program. All our lectures are recorded and posted online, giving us the chance to attend lecture from home. Depending on the professor’s rate of speech, many of the lectures can be sped up, getting through a 50-minute lecture in 30-40 minutes.
After eating lunch, I try to reserve from about 1pm-5pm for non-school related things, such as going to the gym and working on AWLR. After dinner I go through the second two lectures for that day.
How do you bring ideas to life?
Just sit down and start. It sounds stupid but I think it is the most important part. Lacking all the necessary skills is totally secondary. With the Internet and all the incredible tools available, any skill is learnable and all knowledge is discoverable with enough dedication.
What’s one trend that really excites you?
The Quantified Self Movement: Making it cool, easy and interesting to track yourself will have an incredible impact on research and clinical care as soon as it transfers into mainstream medicine.
What was the worst job you ever had and what did you learn from it?
In high school I was a bus boy at a classy restaurant. I was 15 years old, and not prepared to work double shifts, from about 10am to 1am the following morning. Luckily that wasn’t every day. I learned that being 15 and looking 13 gives your 30-year-old co-workers the impetus to try to boss you around and treat you like dirt. I also learned that even at 15, when you tell your boss what those 30 year olds say to you in front of the customers, they suddenly become friendly and kind.
If you were to start again, what would you do differently?
I would have started getting involved in the start up world earlier, learning the rules of the game in college or before.
As an entrepreneur, what is the one thing you do over and over and recommend everyone else do?
Contact famous and influential people. Steve Jobs described how he called up Bill Hewlett when he was 12 years old and asked for extra parts to build a frequency counter. His number was still in the phone book, and he gave Steve what he wanted, and a summer job working on frequency counters.
So far in my experience, people are more than willing to help if you are bold enough to ask. I went to a conference a couple years ago, and one of the keynote speakers was Jeff Taylor, the founder of Monster.com. After his talk I stood in a 20-minute line for the chance to speak with him. When I finally got my turn, I handed him my business card and told him I’m a young entrepreneur in the Boston area and would love any advice or help he could offer. He gave me his card, and after a few emails back and forth one of my other co-founders and I were treated to dinner by Mr. Taylor at one of the nicer restaurants in Boston, telling us about how he came up with the idea for
Monster.com (it came to him while he was sleeping, and he jotted it down while half asleep. When he awoke, he realized he had a “Monster” idea), and how their super bowl commercial wasn’t as successful as he had hoped. He also set us up with a meeting with one of his angel investor friends. An experience I will never forget.
I’ve become friends with many the biggest names in the paleo and low carb world simply by emailing them and describing how passionate I am about the work they are doing. Just ask.
What is one failure you had as an entrepreneur, and how did you overcome it?
I wish there was only one! Speaking about my experience with PhotoCalorie, the major “failures” that come to mind are just being turned down over and over. It is such a difficult task to get a large company or hospital to meet with a few dudes that designed a technology they boldly (or naively) claim can revolutionize the way dietary research is done. The status quo is so easy and comfortable. Adopting something new and experimental requires a lot of work on their part, and not many people are willing to take that on.
I try to overcome these setbacks by just blindly and wholeheartedly believing in our product, and myself. And to understand that, assuming you don’t have a crappy product, each rejection is just one step closer to the first deal.
What is one business idea that you’re willing to give away to our readers?
“The DD,” a bar that will drive you home for free if you buy enough drinks.
If you could change one thing in the world, what would it be and how would you go about it?
Remove insurance from healthcare, except for to finance rare, unexpected, and costly events. A crazy idea in the world of healthcare, yet known in every other insurance industry as: the whole point of insurance.
Tell us something about you that very few people know?
I took a year off between high school and college to play basketball at the Lawrenceville school in southern New Jersey, in the hopes of playing in college. I was one of two post-graduates on the team, filling the void of now Chicago Bulls forward Joakim Noah the year after he left to play at Florida University.
What are your three favorite online tools or resources and what do you love about them?
Rescuetime – This one service has boosted my productivity 10-fold. It is a sleek and simple program that you download onto your computer. It tracks everything you do and creates reports, telling you what day and what time you are most productive, which websites you spend the most time on, and more. It also has a feature called “Get Focused” that blocks you out of all distracting websites on the internet for a specified amount of time. This has been an absolute lifesaver in medical school.
Anki – Free digital flashcard program that enables you to learn new material as quickly and efficiently as possible. After you make cards and review them, Anki will show you review cards each day based on how you ranked the card. Cards you rated as difficult will be shown the next day, while those you rank as easy won’t be shown again for a few days.
Gremln – a great service to automate your twitter and facebook accounts, and get analytics on all your tweets.
What is the one book that you recommend our community should read and why?
Good Calories, Bad Calories – a gripping page-turner offering an insightful account of nutrition and health research over the past 200 years. The political influence, researcher bias, and how a few people can influence a global belief that a particular diet is healthy or dangerous.
Three people we should follow on Twitter and why?
Tim Ferriss – Interesting and unique posts and ideas related to acquiring new skills and increasing productivity.
Peter Attia – The founder of the Nutrition Science initiative, looking to bring the rigor of medical science research into the field of nutrition.
Daniel Kraft – Tweets about the future of medicine.
When was the last time you laughed out loud? What caused it?
Last night. Watching the Daily show.
Who is your hero?
My parents. They immigrated to the U.S. in 1983, escaping from communist Romania with literally the clothing on their backs, and a $20 bill hidden in the lining of my dad’s leather jacket. I was born three years later. My Mom worked her way up and became a senior software engineer, working on top-secret government projects. My Dad became the senior director of bioinformatics under Craig Venter at Celera Genomics, during the private vs. public race to sequence the human genome. He is now a chair professor at Brown. Their “American dream” story is an inspiration to me, and definitely pushes them to the top of my hero list, tied for first place.
What is it like being a medical student and running a weight loss registry?
It’s interesting, busy, and exciting. I feel like I live a double life for the most part: med student by day, wanna-be entrepreneur by night. I’d say the majority of my classmates have no idea I started AWLR last January, while we were elbow deep in gross anatomy (literally). It has forced me to self-experiment and find the most efficient and effective ways to cram massive amounts of information into my brain, while leaving enough free time to have fun and work on the company.
What type of doctor are you going to be?
No idea. We don’t do hospital rotations until next year, so I have another year or so to decide. If I had to pick today I’d say internal medicine, maybe cardiology or endocrinology. In a dream world, I’d like to try to reinvent the private practice, which is a dying breed right now. Some mixture of consumer driven healthcare, big data analytics, paleolithic nutrition, and mobile health technology.
Ancestral Weight Loss Registry: www.awlr.org
On Twitter: @AncestralWLR
Larry Istrail on LinkedIn: http://www.linkedin.com/in/larryistrail/
On tumblr: http://medstud86.tumblr.com/