Daniel Ek：Spotify 之后的生活、扭曲的医疗激励机制、早期疾病检测与 AI 的潜力

好了，各位。

All right, everybody.

欢迎回到《All-In 访谈》节目，在这里，我们 All-In 播客会花一个小时，专门邀请我们这个时代的一些伟大思想家和创作者。

Welcome back to the All-In Interview show, where we, the All-In podcast, dedicate an hour to just some of the great thinkers, creators of our time.

今天也不例外。

And today will be no different.

今天请到的是 Daniel Ek。

Daniel Ek is with us.

大家应该都认识他，他是 Spotify 的联合创始人，20 年前创办了这家公司，并且在这 20 年里，把它经营到了今天这样非凡的规模。

You know him, the co-founder of Spotify, which he started 20 years ago, and he ran it for those two decades to an extraordinary state of affairs today.

活跃用户超过 7 亿，付费订阅用户超过 3 亿。

Well over 700 million active users, over 300 million premium subscribers.

但今年 1 月 1 日，他转型了，成为了执行董事长。

But on January 1st this year, he shifted and became the executive chairman.

今天和我以及 David Friedberg 一起的，是 Daniel Ek。

With me and David Friedberg today, Daniel Ek.

你好吗，先生？

How are you, sir?

欢迎来到我们的节目。

Welcome to the program.

非常感谢你们的邀请。

Well, thank you so much for having me.

能来参加真是太好了。

It's good to be on.

是的，见到你很高兴。

Yeah, it's good to see you.

我们认识已经有20年了。

We've known each other for 20 years.

我记得第一次，你的合伙人Shaq在一次互联网峰会上凑过来对我说：“嘿，看看这个，”然后给我看了Spotify。

I remember the first, Shaq, your partner, leaned into me at a internet summit or something and said, "Hey, check this out," and he showed me Spotify.

但那时候还没有人做订阅服务。

But this was at a time when nobody had a subscription service.

今天我们聊聊你的新创业公司，这太了不起了，而且是在医疗健康领域。

So we're going to talk today about your new startup, which is incredible and in the healthcare space.

但先带我们回到Spotify刚起步的时候，那个疯狂的想法是怎么开始的，然后跟音乐行业打交道有多难，他们可是出了名的最难搞的合作伙伴。

But take us back to the launch of Spotify and how that crazy idea got started, and then how hard it was to break through with the music industry, which are also known as the hardest partners in the world.

我全力以赴。

I'm going all in.

随着你的财富增长，你有没有注意到投资、税务策略和遗产规划之间的事情变得复杂多了？

As your wealth grows, have you noticed how much more complex things get between investments, tax strategy, and estate planning?

管理这一切就像一份你没想要的全职工作。

Managing it all is a full-time job that you didn't ask for.

Creative Planning可以帮你。

Creative Planning can help.

他们的协调团队包括投资经理、注册会计师和关联的遗产律师，可以帮你承担大部分繁重的工作，你就不用操心了。

Their coordinated team of investment managers, CPAs, and affiliated estate attorneys can do much of the heavy lifting so you don't have to.

Creative Planning，让财富协同运作。

Creative Planning, where wealth works together.

请访问creativeplanning.com/allin。

Go to creativeplanning.com/allin.

我全力以赴。

I'm going all in.

嗯，我通常一开始会说，每当有人问我这个故事时，就像这样：'好吧，我开始的时候还有头发，到结束的时候，显然我变成了秃头。'

Well, I usually start off by sort of saying, whenever anyone asks me about the story, it's like, "Well, I had hair when I began this, and by the end of this, I obviously ended up being bald."

所以，你可以看出这不是一段轻松的旅程。

So, you can see that it wasn't an easy journey.

不开玩笑了，简单介绍一下背景，我在2006年创办了Spotify。

All jokes aside, just to kind of set the scene, I started Spotify in 2006.

那时我23岁，世界看起来有点不一样。

I was 23 at the time, and the world looked a little bit different.

那是在iPhone问世之前。

So this is pre-iPhone.

Facebook已经存在了，但只限于大学使用。

Facebook existed, but it was college only.

那时候还没有YouTube。

YouTube didn't exist.

所以这就能看出我多老了，但这些都是我们现在习以为常的东西之前的事。

So just that kind of dates me, but this is before all the things we now take for granted.

那时候的世界，还有音乐产业，都在急剧下滑，因为音乐盗版非常猖獗。

And the world at that time, and the music industry at that time, was in free fall because music piracy was kind of rampant.

我们有Napster，有Kazaa，还有各种类似的东西，而且有个叫RIAA的组织，到处起诉美国那些非法下载音乐的普通消费者。

So we had Napster, we had Kazaa, we had all these things, and there was an organization called the RIAA that went around and actually sued individual consumers in the US for illegally downloading music.

我当时坐在瑞典，心里想：“这太疯狂了，太离谱了。”

And so I was sitting in Sweden, and I was thinking to myself, "This is wild, and this is crazy.

这就像把精灵放回瓶子里，根本不可能。

There's no way to put the genie back in the bottle."

我和我的联合创始人马丁，当时正坐在一起随便聊一些创业点子，马丁问我：“如果你能做任何你想做的事，你会做什么？”

And me and my co-founder, Martin, we were kind of sitting and spitballing startup ideas at the time, and Martin asked me, "Well, if you could do anything you'd like to do, what would you do?"

我说：“我真正的热情是音乐，但那听起来真是个愚蠢的主意。”

And I said, "Well, my real passion is music, but that seems like a really stupid idea."

他就说：“那为什么是个愚蠢的想法呢？”

And he's like, "Well, why is that a stupid idea?"

我跟他讲了讲，这真的很难，因为你得跟唱片公司谈各种合作。

And I kind of told him about, it's really hard because you have to do all these deals with the record companies.

你还得搞定授权和版权的问题，还有各种乱七八糟的事情。

You have to then figure out how to do licensing and copyright, and you have to do all of these different things.

他说：“那如果你这样做呢？”

And he said, "Well, what if you did this?"

然后他不停地问各种“如果”的问题，最后我实在找不出理由来反驳了。

And then he kept asking these what if questions, and eventually I ran out of reasons to say it.

于是我说：“好吧，也许你可以做点什么，如果你做了，感觉就像全世界所有的音乐都在你指尖。”

So I said, "Well, I guess you could do something, and if you did something, it would feel like you had all the world's music at your fingertips."

他说：“那听起来挺不错的。”

And he's like, "Well, that sounds pretty good."

我说：“那好吧。”

And I said, "Well, okay.

那好，咱们试试看吧。

Well, let's give it a try."

我们开始尝试获取音乐授权。

We started trying to license music.

最初的想法是从第一天起就走向全球，当时我们这么说的时候，大家都在笑话我们。

Originally, the idea was to try to go global from day one, and everyone was just laughing at us when we were originally saying that.

但我算是运气好，因为结果发现世界上音乐市场最糟糕的地方之一就是我的祖国瑞典。

But I sort of lucked out because it turned out that one of the worst music markets in the world was my home country, Sweden.

而瑞典之所以成为这样的音乐市场，部分原因是我们从2000年代初就有了超高速宽带。

And part of the reason why it was one of the world's music markets was because we had super-fast broadband already from the early 2000s.

所以我们算是生活在未来，人们有这么快带宽的连接，几乎可以下载任何他们想要的东西。

So we were kind of living in the future where people had such quick bandwidth connections that they could download pretty much whatever they wanted.

所以他们就这么做了，而且当时iTunes甚至还没在市场上推出，所以基本上没有任何合法的选择。

So they were doing it, and iTunes actually wasn't even available in the marketplace, so there was literally no legal options.

所以我觉得音乐产业大概损失了80%左右的收入。

So I think the music industry had lost like 80% or something of its revenues.

所以这真是一个疯狂的巧合，加上所有这些复杂的因素，我和我的搭档基本上把我们之前创业赚的所有钱都拿了出来，然后我们对唱片公司说：“如果我们保证你们明年还能拿到奖金，并且能完成明年的预算，怎么样？”

And so it was kind of this crazy coincidence and kind of all of these things, the complex events where we figured out that, me and my partner, we basically took all of our own money that we had made from prior startups, and we said to the record labels, "What if we would guarantee you that basically you'd keep your bonus for the next year, and you'll make your budget for next year?

如果情况真的像你们想的那么糟，你们一年后关掉它就行了，但奖金还是拿到了。

If this really is as bad as you think it is, then you just shut it down after a year, but you still made the bonus.

如果这真的有效，你们也赢了，所以无论如何你们都是赢家。”

And if this actually works, you win as well, so you win no matter what."

他们就说：“好吧，这听起来是个挺有意思的想法。”

And they're like, "Okay, well, this seems kind of like an interesting idea."

经过几年的谈判，他们最终同意了。

And they eventually, after a few years of negotiation, agreed to it.

所以我们在2008年底推出了，结果一下子就大获成功。

So we launched in late 2008, and it instantly became a huge hit.

然后我们把它带到了英国，在那里也取得了巨大的成功。

We then took it to the UK, and made it a huge hit there.

然后在2011年，也就是15年前，我们在美国推出了。

And then in 2011, 15 years ago now, we launched in the US.

接下来的事情就顺理成章了。

And the rest is sort of history.

弗里德伯格，这难道不令人惊叹吗？

Isn't that amazing, Friedberg?

在实验室里花了五年时间才进入美国市场，这真是一段漫长的旅程。

Five years in the laboratory just to get to the US market is quite a- Quite a journey.

这真是经历了太多的艰辛和磨难。

That's a lot of pain and suffering.

但你知道吗，疯狂的是，我现在又踏上了同样的旅程。

But you know the crazy thing is, I'm on the same journey now again.

我们就在这里。

Here we are.

说起来你可能不信，Neko，我们是在2018年，也就是八年前创办这家公司的。

Neko actually, as crazy as it is, we started the company eight years ago in 2018.

我们是在瑞典起步的，那是2023年。

And we started it in Sweden, in 2023.

所以我们花了五年时间开发产品，在瑞典试用，然后在瑞典验证成功后，又把它带到了英国，在那里也做了一遍。

So it took us five years to develop the product, try it out in Sweden, and then once we'd proven it in Sweden, we took it to the UK and did it there.

然后从那里开始，现在我们正在美国推出。

And then from there on, now we're launching in the US.

所以这完全是Spotify的套路，但这次是在医疗领域。

So it's the exact Spotify playbook again, but this time in healthcare.

伟大企业家的一个特点就是你有创业精神，对吧？

One of the afflictions of great entrepreneurs is you're entrepreneurial, right?

你就是停不下来。

You just can't stop.

或者也许我只是对痛苦的忍耐力比较高。

Or maybe I just have a high pain tolerance.

我也不确定是哪一个。

I'm not sure which one it is.

一旦事情顺利了，你就得重新投入进去。

Once things got smooth, you had to get back into it.

但是丹尼尔，你是什么时候开始考虑做其他事情的呢？

But at what point did you start thinking about doing other things, Daniel?

你在Spotify担任CEO期间，有没有积极地进行天使投资？

Were you actively angel investing at Spotify over the years as CEO?

公司已经拥有数亿用户，上市了，也很成功。

The business is building hundreds of millions of users, public, successful.

一切都在稳步增长。

Things are growing nicely.

你有一个很棒的领导团队。

You've got a great leadership team.

这些年来，我们显然也见过你们团队里的很多人。

We've obviously met a lot of your team over the years.

你是怎么开始做这些其他项目的？

How did you start to do these other projects?

我知道你还有其他几个项目，而且专注于Neko。

I know you've got a few others, and focus on Neko.

这挺疯狂的。

It's kind of crazy.

我都忘了这事儿了，但我的团队最近给我看了一个东西，我好像是在2012年或者2013年左右，也就是Spotify在美国上线之后不久，跟《金融时报》做过一次午餐访谈，那时候我就已经在聊医疗保健了。

I'd forgotten about it, but my team now showed me very recently, I apparently did this lunch with the FT interview in, I think, 2012 or 2013 or something, just after the US launch of Spotify, where I was talking about healthcare, already back then.

所以，我其实对医疗保健这个领域已经思考了很长时间。

So, I've been thinking about healthcare specifically for a very long time.

我觉得很多人都在谈论世界上那些不好的事情，但我的看法是，其实大部分事情都在往好的方向发展，技术曲线也在不断上升，我们得到的东西越来越多。

And it's just been, I think a lot of people just talk about sort of all the stuff that's going bad in the world, but my view is that actually most things are going pretty well and it's kind of up into the right on the technology curve and all the things that we're getting.

但我更关注那些进展不太顺利的问题。

But I try to focus on the problems that aren't going that well.

医疗保健就是其中之一。

One of those happens to be healthcare.

所以我一直对这个话题很感兴趣，比如，为什么我们在医疗保健上花的钱越来越多，但结果却越来越差？

So I've been kind of interested about this as like, how is it that we're spending more and more money on healthcare, but getting worse and worse outcomes?

我们能做些什么呢？

And what can we do about it?

所以这真的让我进入了这个领域。

And so that really kind of got me into the space.

我觉得医疗保健很独特，也很特别。

I think healthcare is kind of unique and kind of special.

说实话，在Spotify上市之前我没什么钱，所以我并不是一个活跃的天使投资人。

I honestly didn't have any money until Spotify went public, so I wasn't a prolific angel investor.

那是哪一年？

What year was that?

我们是2018年上市的。

That was 2018 we went public.

18年，对。

'18, right.

是的。

Yep.

所以我大概是从2018年开始做一点投资的，但是——

So, I probably started doing a little bit of investing in 2018, but-

……

...

在那之前我一点钱都没有。

I had no money before then.

所以，在投资其他任何东西之前，我基本上把所有精力都集中在Spotify上，大概有十二三年吧。

So, it was literally just kind of all-in focus on Spotify for, I guess, the better part of 12, 13 years before I made any investing in anything else.

然后，你和我，我们大概一周前在晚餐时聊过这个。

And then, you and I, we were talking about it at this dinner a week ago or something.

但后来我试着做了一点投资。

But, I then tried to do a little bit of investing.

其实那时候我已经开始做Neko了，我发现自己更喜欢创业，而不是投资。

I'd actually already started Neko at that time, and I kind of just realized that I loved building way more than I loved investing.

所以现在——

And so right now-

弗里德伯格也得出了同样的结论。

Friedberg came to the same conclusion.

看着你投资的公司，真是让人心疼。

It's so painful to watch companies you invest in.

这就是我们前几天晚餐时聊的全部内容。

This was our whole dinner conversation the other night.

对，看着公司被管理得一塌糊涂，你却无能为力。

Yeah, get mismanaged and you can't do anything.

嗯，你会花时间在董事会上。

Well, you spend time on boards.

这就是为什么我不再参加董事会了。

That's why I don't join boards anymore.

你坐在董事会上，给CEO提建议，但他们不听你的，你急得抓耳挠腮，心想：“我会做不同的事情。

You're sitting on a board, you advise a CEO, and they don't listen to you, and you pull your hair out like, "I would've done something different.

你为什么不做这个？”

Why didn't you do this?"

如果他们听你的，你实际上在指导他们该怎么做，那也不行，因为他们没有在领导。

And if they are listening to you and you're effectively instructing them on what to do, it also doesn't work because they're not leading.

所以我后来就特别坚定这个想法，就是找到特别厉害的创业者当CEO，把钱给他们，然后就不用再管了，肯定没问题。

And so I became pretty committed to this idea, like you find amazing entrepreneur founder CEOs, give them money and never look at it again, and you'll be fine.

一般来说，这样比不这样要好。

Generally better than not.

反过来，如果你真的对这件事特别有热情，而且你有能力或者有办法，那就自己下场去做。

And then the flip side is, if that's really what you're passionate about and you have the activity or the agency, it's to step in and do it yourself.

他们越需要指导——

The more instruction they need-

……可能成功的几率就越小。

... probably the less chance they're going to succeed.

所以Daniel，你能不能大概介绍一下Neko，就是它主要是做什么的——

So Daniel, maybe you could just give us the overview on Neko, kind of what the-

对，还有你是怎么——

Yeah, and how you came-

……做这个生意的——

... the business-

还有你是怎么想到这个点子的，对吧？

And how you came to that idea, right?

你是怎么想到这个具体点子的？

How did you come to this specific idea?

我很早以前就开始研究这个领域了。

I started researching the space a very long time ago.

先给听众简单介绍一下背景，美国在医疗保健上的支出占GDP的18%。

And maybe just as a quick primer for the audience, the US is spending 18% of its GDP on healthcare.

这是目前预算中最大的一项开支。

It's the single largest line item in the budgets right now.

光说心脏病，光在美国，花在这个疾病上的钱就有数千亿美元。

And if you take heart disease alone, it's in the hundreds of billions of dollars that are being spent on that disease group alone in the US alone.

这简直太疯狂了。

It's just insane.

就这一个疾病的花费，比财富10强公司的收入还多。

It's larger than Fortune 10 companies' revenues, just one disease group.

所以，正如我提到的，这是一个巨大的问题。

So it's a gigantic problem, as I mentioned.

于是我开始研究各种方向，从药物到能否制造更高效的药物。

And so I started looking into everything from drugs to can you make more efficient drugs?

是不是跟癌症有关？

Is it about cancers?

基本上我开始针对那些真正导致这种情况的原因去探究。

And basically started targeting what are the real reasons why it looks that way.

我觉得最终的结论是，原因有很多，而不是单一一个。

And I think the real conclusion ended up being there's lots of reasons, not one.

但我们看到了几个非常主要的原因。

But we see a few really big ones.

心脏病学或者说心脏健康是一个主要方面。

Cardiology or heart health is a major one.

我们还看到皮肤癌，黑色素瘤是另一个大问题。

We see skin cancer, melanomas being another big one.

所以有几大类疾病是特别常见的。

So there's a few sort of major groups of illnesses that is over-representative.

但最主要的还是慢性病，整体来看。

But the major one is really chronic disease, overall.

关于慢性病，最让人惊讶的是，如果你早点发现这些问题，它们完全可以预防，处理起来成本很低，对患者本人、他们的家庭和社区来说，痛苦也很小。

And the crazy thing about chronic disease when you read about it is that if you discover these things early, they're totally preventable, and the cost of dealing with them is very small, and the suffering for the person that are having it in their family and community is very small, too.

所以关键就是，如果你早点发现，就没事了。

So the key thing is if you discover things early, you're actually good.

那问题就来了，为什么我们不早点发现呢？

And so then the question is, well, why don't we discover things early?

原因是我们没有足够的数据。

And it happens to be that We don't have enough data.

整个医疗行业都一致认为，我们必须把医疗从被动治疗转向主动预防。

So everyone in the entire healthcare industry is in agreement that we have to take healthcare from reactive to preventative health.

但接下来，所有的分歧就开始了，那就是怎么做到这一点？

But then, now all the disagreement starts, which is how do you do that?

我和我的联合创始人Hjalmar都认为，这一切都始于拥有更好的数据。

And our view, my co-founder Hjalmar and I, our view is really that it all starts with having better data.

如果你有更好的数据，你就能更容易地发现问题，这本身就能让你有机会更早地发现这些问题，从而形成一个良性循环，最终改变医疗保健。

If you have better data, you're going to be able to discover things much more easily, and that in itself then leads you to have a chance of discovering those things much earlier, which then creates this virtuous flywheel of then changing healthcare.

所以，预测性数据能让你预测未来的不良健康结果，并提前纠正方向。

So predictive data that allows you to be predictive about future adverse health outcomes, and course-correct ahead of time.

这就是终极目标，要达到那个境界。

That's the Holy Grail, is to get to that point.

基本上，我们认为要达到那个目标，你需要比现在多得多的数据，无论是从每种数据收集方式，还是跨多种方式，而且你需要纵向数据，也就是要随时间推移的数据。

And essentially, our view is that the way you get there is that you need a lot more data than you have today, both from each modality that you gather data, but also across multiple modalities, and you need it longitudinally, so you need it over time.

所以，如果你有更多的数据，并且有随时间推移的数据，你就能有更高的可能性进行那种预测性分析。

So if you had a lot more data and you had it over time, you'd be able to have a lot higher likelihood of doing those kind of predictive analysis.

然后我们就会说："好吧，那我们怎么做呢？"

And then what we then said was, "Well, okay, how do we do that?"

而且，如果你想想过去20年真正发生了什么，最大的创新之一当然是智能手机。

And it so happened to be that if you think about really what's happened in the last 20 years, one of the biggest innovations, of course, is the smartphones.

而且这些智能手机里集成的传感器越来越多。

And we've had more and more sensors packed into those smartphones.

所以我们现在能用到越来越多便宜的传感器和电子元件。

So there's more and more cheap sensors and cheap electronics that's available to us.

所以我们觉得，应该可以利用这些技术，制造出比以前多得多的传感器。

So our view was like, okay, well, we should be able to utilize this to build a lot more sensors than what's been able to be built before.

另外，我们开始做这件事的时候，还没有大语言模型这些东西，那时候叫机器学习，现在大家都叫人工智能了。

And then the other thing, we started pre the LLMs and everything like that, but it was then called machine learning, but today we talk about it as AI.

我们应该有更强的智能。

We should have a lot better intelligence.

所以如果我们有这些海量的数据集，就应该能做出非常准确的预测。

So if we have all these massive data sets, we should be able to make really good predictions about it.

而且很明显，这跟我们在Spotify学到的经验是一样的。

And obviously, again, similar to that, this is exactly what we learned with Spotify, too.

我们收集的数据越多，就越能准确预测你接下来想听哪首歌。

The more data we're able to gather, the better predictions we're able to give you about what song to play next.

所以这正是现在在医疗领域需要做的事情，但显然它跨越了多种模式，现在也涉及纵向数据集。

And so this is exactly the same thing that you now need to do in healthcare, but obviously it's across multiple modalities and now across longitudinal data sets as well.

今天是否有证据表明，一些早期的观察数据能影响最终的医疗结果？

Is there evidence today that some of this early observational data can affect ultimate health outcomes?

我能看到这在代谢疾病方面起作用，比如运动消耗率、血糖和睡眠，但最终的纠正通常是饮食和运动。

I can see this working for metabolic conditions, things related like exercise depletion rates and blood sugar and sleep, but ultimately the correction there is typically diet, exercise.

还有哪些其他重大疾病的例子，我们可以提前识别并纠正方向？

What are some other examples of major diseases that we can kind of identify ahead of the curve, course correct?

也许可以解释一下Neko是什么，给那些不了解的人。

And maybe just explaining what Neko is for people who don't know.

也许我先从那里开始，然后我们再深入讨论。

Maybe I'll start there and then we can get into it.

简单来说，Neko目前和Gen 2的体验是，价格是499美元。

So, in a very simple way, the experience of Neko today and in Gen 2 is, it's $499.

这是一种从头开始重新设计的医疗体验，垂直整合。

It is a reinvented healthcare experience from the ground up, vertically integrated.

我们从建自己的设施，到配备自己的护士和医生，再到自己研发诊断设备，软件方面也全部自己来做。

We do everything from building our own facilities, to having our own nurses and doctors on staff, to building our own diagnostic equipment and doing everything on our own on the software side.

所以这真的是一个从头到尾设计的一体化解决方案。

So it's really kind of an end-to-end solution that we've designed from the ground up.

我们设计它的目标，就是打造你为健康投入的最有价值的一小时。

And we designed it with the goal of creating the most valuable hour you can invest in your health.

这就是我们的使命，也是我们每天来上班真正要做的事。

That's the mission that we have, and that's what we're coming to work to do every day really at work.

体验是这样的：你来了之后，通常第一件事就是抽血。

The experience is really, you come in, the first thing you typically tend to do is that you draw blood from us.

然后我们会测量53项血液指标。

So we then measure 53 blood markers.

接着你会经过我们的皮肤检测设备，那里有一套摄像系统，会拍下你全身超过6000张超高分辨率图像，我们会记录你身上的每一颗痣、每一个皮损，以及你可能有的所有皮疹和发红的地方。

You then go through our skin rig, where we have a camera system that takes over 6,000 super high-res images across your body, where we index every mole and lesion and all of the possible rashes and rednesses you may have as well.

这些都会被记录下来。

That gets indexed.

然后我们会检查你的心脏和血液循环。

We then look into your heart and blood circulation.

我们会看握力，以及所有那些传统指标，这些指标有很好的科学证据表明，它们是评估健康状况的重要参考。

We look at grip strength, all the sort of traditional markers that we have very good scientific evidence are a valuable indicator as you think about sort of health.

这次检查大约持续一个小时，在结束时，你会和临床医生有一段不受打扰的时间，在这段时间里，你可以查看所有结果，包括血液检查的结果。

Then at the end of this visit that lasts for about an hour, you get uninterrupted time with a clinician, and you go through all of the results, including the blood works, during that hour.

所以你有完整的一套数据，可以在那一小时内和医生一起查看你的各项指标，医生也会回答你可能有的任何问题。

So you have a complete set where you can go through your values within that hour with your doctor, and the doctor will answer any questions you may have.

而且，你还会和那位临床医生坐下来，一起讨论结果，包括你可能想要改善的健康方面。

But you will also, with that clinician, sit down and go through results about things you may even want to improve as well when it comes to your health.

这就是我们今天在纽约推出的体验，在美国，显然在接下来的几个月里，我们会在美国更多地方推出。

So that's the experience that we're launching with today, in New York, in the US, and obviously we'll launch in many more places across the United States over the next coming months.

而且，提前发现问题的能力也很重要。

And just the identification of things ahead of the curve.

因为我听说过其他的——比如One Medical，还有Forward。

Because I've heard of other-- There was One Medical, there was Forward.

之前也有过一些类似的尝试，想打造这种综合中心，让你进去做预防性检查，用他们自己的设备。我之前也听过类似的说法。

There were a few other kind of attempts at making these integrated centers where you go in and get preventative checkups with their own instrumentation, and I think I've heard the thesis a little bit before.

丹尼尔，你觉得有哪些是以前没见过的、比较新颖的地方？

What have you identified that may be novel, Daniel, that we haven't seen in the past?

我觉得首先最重要的是，就像我说的，我们是从2018年开始做这个的。

I think first and foremost, the important thing to mention is, as I mentioned, we started this in 2018.

所以这家公司已经成立八年了。

So this company's been around for eight years.

我们已经做了超过十万次扫描。

We've done more than 100,000 scans already.

我们每年都会发布数据。

So we actually publish data every year.

我们刚刚发布了第三年的数据报告，里面涵盖了会员们的健康结果。

So we've just published our third year data survey, where we go through the health outcomes that we have across our members.

大约有1%的会员存在严重的潜在健康问题，之前没有被诊断出来，是我们发现的。

And around 1% of our members Have a serious underlying medical situation that is undiagnosed that we discover.

再说一次，好消息是，我们很多会员都很健康，我们只是在讨论如何改善他们目前的健康状况。

So again, the good news is many of our members are healthy, and we're just talking about improving their current health status.

而且正如你正确指出的，很多问题最终都归结到压力、饮食和睡眠这些方面。

And as you correctly pointed out, a lot of that ends up becoming around stress, around diet, around sleep, and those things.

但最令人鼓舞的是，在我们连续三年进行这些研究后，我们发现健康状况最差的人改善得最多。

But the most encouraging thing we're finding now as we've done these studies for three years in a row is that the people with the worst health status are the ones that are improving the most.

所以事实证明，能够清晰地了解自己当前的健康状况，并且有临床医生坐下来解释情况和可能的解决方案，这对促使人们开始改善生活方式起到了巨大的作用。

So it turns out that this ability of having a clear visual understanding of where you are in your health journey currently today and having a clinician that sits down with you explaining the situation and possible remedies to that is a huge benefactor for getting people to start improving things around lifestyle.

所以我们看到一些会员，从之前吸烟，到后来戒烟，这都因为他们参与了Neko并重视自己的健康。

So we've seen members that have gone from year where they've been smoking to not smoking as part of them having to do this Neko and prioritizing their health.

我们也看到一些有严重潜在疾病的人，从发现疾病到治疗，最终整体健康状况大大改善。

We've obviously seen people with severe medical underlying illnesses that have gone from discovering those and then treating them and having much better overall health as a result.

所以这真的涵盖了各个层面。

So it's really kind of all across the base.

不过我给你举一个非常具体的例子。

But I'll give you a very concrete example.

就拿皮肤科来说吧，这是个很好的例子。

So take dermatology as a great example.

现在Neko的会员平均每人有950颗痣。

The average person at Neko today has 950 moles.

这挺夸张的。

It's pretty crazy.

平均每人有950颗痣？

The average person has 950 moles?

是的。

Yes.

这也太离谱了。

That's insane.

我想这里的关键是，有些痣的比例是你无法用肉眼分辨的。

Some percentage you can't tell, I guess, is the punchline here.

它们是人眼看不见的。

They're not detectable by the human eye.

当然。

For sure.

嗯，如果你真的仔细检查自己的皮肤，你会惊讶地发现有多少颗痣。

Well, if you really went through your skin, you'd be surprised how many you'd find.

分布差异很大。

It's a big dispersion.

有些人有几千颗，有些人只有五百颗。

Some have many thousands, and some of them have 500.

这显然是AI的完美应用场景。

Seems like a perfect application for AI, obviously.

没错。

Exactly.

所以想想看，在普通的医生就诊中，医生有多大可能检查你身上可能有的950颗痣呢？

So if you think about it across a normal doctor's visit, how likely is it that that doctor will check out all the 950 moles that you may have?

那是不可能的。

It's not going to happen.

所以通常在看医生的时候，你可能会说：“你看，我这里有个痣”，或者医生看到后说：“嘿，让我们看看这颗痣。”

So normally what happens in a normal doctor visit would be you may say, "Look, I have a mole," or the doctor sees, "Hey, let's take a look at that mole.

“看起来有点不对劲。”

It looks a little bit funky."

然后他们会拿出工具来检查。

And then they bring out their tool where they inspect it.

现在他们通常会有软件来检查这颗痣——他们会用相机在不同频率下拍摄，从而了解这颗痣的大小、质地等等。

They usually these days have a software that checks against whether this mole-- They take a camera across many different frequencies to then discover both the size of this mole but also the texture of the mole and so on and so forth.

我们就是这么做的，首先用AI系统标记可能的风险因素，然后由人类临床医生进行复核。

We literally do that, and we first have an AI system that flag possible risk factors, and then we have a human clinician that then goes through and reviews those as well.

如果那时我们发现任何问题，我们还有多名皮肤科专家在团队里，他们也会复核结果。

And should we even at that point find something, we then have expert dermatologists on staff, multiple of them, that then also reviews that result.

这只是看一次医生时发生的一个例子。

So that's just one indicator of what happens in one visit.

但让我们假设有多次就诊的情况，也许有一年我们什么都没发现。

But let's now presume the scenario that we'd have multiple visits, and maybe one year, it's actually we don't discover anything.

但因为我们对每一颗都做了记录和索引，现在我们可以纵向比较，看看它们从一年到下一年有什么变化。

But because we've cataloged and indexed every single one, we can actually now in a longitudinal base look at them from one year to the next year.

所以它可能是在异常生长。

So it may be growing abnormally.

这些情况，你想想看，即使是世界上最顶尖的医生，也不可能记得你去年那颗痣长什么样。

These are things that if you think about it, even the best doctors in the world can't possibly remember how your mole may have looked like from one year to another.

所以回到你的观点，这确实是AI的完美应用场景。

So again, back to your point, this is a perfect application of AI.

但我们认为，这也是医疗保健应该有的样子。

But we look at this as like this is a perfect application of how healthcare should look like.

它应该把AI和优秀的临床医生无缝结合起来，提供一种很棒的体验。

It should seamlessly be both AI and amazing clinicians in a great package experience.

这基本上就是我们在Neko想做的事情。

So that's essentially what we're trying to do with Neko.

那太好了。

That's great.

丹尼尔，你现在是作为CEO在积极运营公司，还是你——

And are you actively running it as CEO, Daniel, or are you-

不是。

No

……兼职运营？

... operating part-time?

不是。就像现在的Spotify一样，我有两位很棒的CEO，我有一位出色的联合创始人和合作伙伴，Hjalmar，他才是Neko真正的核心人物，大部分工作都是他在做，虽然我坐在这里，目前拿走了大部分功劳。

No. So similar to Spotify these days, where I have two great CEOs, I have an amazing co-founder and partner, Hjalmar, who's really the brainchild of Neko, and he's the one who's doing most of the work, even though I'm sitting here and taking most of the credits at this point.

但没错，他才是真正的智囊。

But yeah, he's the real brain.

太好了。

Great.

你们知道什么让我印象深刻吗？

You know what I'm struck by?

这个价格太便宜了，才499美元。

The cost of this is so cheap, $499.

你还有Function Health和Superpower，另外两个很棒的服务，大概350到400美元。

You also have Function Health and Superpower, two other great services, about 350, 400.

它们就只做血液检查。

They just do blood work.

但如果我们看支出，目前医疗是第二，社保第一，而且很快，你最喜欢的那个——利息支出，很快就会超过我们的医疗支出。

But if we look at the spending, and right now it's healthcare number two, Social Security number one, and fast, your favorite coming up is the interest payments very, very-- will overtake our healthcare spend.

你其实可以让人们每年或每两年来做一次，每个美国人，花费我们医疗总支出的4%或8%。

You could actually have folks come to this every year or every other year for four or-- every American, 4% or 8% of the cost of the total we spend on healthcare.

我很好奇，你期望人们每年做一次，还是每两年做一次？

And I'm curious, is this something you expect people to do yearly or something every other year?

如果每个美国人都每年、每两年，甚至每三年做一次，那成本会降到我们预算的2%，你觉得这对未来的预算和支出会有什么影响？你有没有做过类似的计算？

And what impact do you think an investment of every American getting this done every year or every other year, or maybe every three years even, which would be down to 2% of our budget, what impact would that have on the forward-looking budget and the forward-looking spend, and have you done those kind of calculations?

是的，我们当然有自己的看法，但我觉得现在说还为时过早。

Yeah, look, we obviously have a view, but I think it's too early to say.

所以我不想坐在这里说我们已经确切知道会发生什么。

So I don't want to sit here and say that we know conclusively what will happen.

但我觉得我们给会员的建议是尽量每年做一次。

But I think what we do recommend our members is to try to do this on an annual basis.

我打个比方，现在大多数人每年都会去看牙医。

And the way I kind of make this analogy is most of us today are trying to go to a dentist on a yearly basis.

但不知道为什么，我们大多数人却不会每年做一次体检。

For some reason, we don't do an annual health checkup, most of us, on an annual basis.

所以对我来说，这应该像看牙医或做其他事情一样规律，而且应该是一次很棒的体验。

So for me, this should be as regular as going to the dentist or doing anything else, and it should be an amazing experience.

再说一次，正如我所说，我们在这里的真正使命是努力创造你为健康投入的最有价值的一小时。

Again, as I said, what we're really doing as a mission here is trying to create the most valuable hour you can invest in your health.

我们知道很多人很忙，所以我们要非常高效地利用人们的时间。

And we know a lot of people are busy, so we want to be brutally efficient with people's time.

所以如果你没有问题，只是对查看检测结果感兴趣，你大概可以在30到40分钟内完成。

So you can actually, if you don't have any questions and you're just interested in really doing the test results, you could probably get by in 30, 40 minutes-

哇

Wow

……然后完成它。

... and do it.

所以其实不需要花太多时间。

So we're not talking about a lot of time to do that.

当然，500美元对很多人来说还是一笔不小的开销，但如果你负担得起，我觉得这绝对是一笔很值得的投资。

And obviously, $500 is still a lot of money for people, but I do think it's a great investment if you can afford it, to do.

我决定全力以赴。

I'm going all in.

创业通常意味着要同时应付各种不同的服务，才能看起来像那么回事。

Starting a business usually means juggling a bunch of different services just to look legit.

但现在不用了。

Not anymore.

有了Northwest Registered Agent，你可以在一个地方搞定完整的商业身份。

With Northwest Registered Agent, you get a complete business identity all in one place.

包括商业地址、域名、网站、电话号码等等。

A business address, domain, website, phone number, and more.

从第一天起就内置了隐私保护。

With privacy protection built in from day one.

别花几百或几千美元去买那些在西北注册代理那里免费就能得到的服务。

Don't spend hundreds or thousands on services you can get from Northwest for free.

访问 northwestregisteredagent.com/allinfree，今天就利用免费资源来打造你的业务。

Visit northwestregisteredagent.com/allinfree and start using free resources to build your business today.

我全力投入。

I'm going all in.

那500美元，每次就诊要么亏钱，要么保本，然后可能通过追加销售来赚点利润？

That $500, you lose money on every visit or break even, and then there's some profit that comes from maybe the upsells?

给我们讲讲这个经济模式，以及它如何与美国的保险行业体系——尽管它问题重重——协同运作。

Take us through the economic model here, and then how that will work with the insurance industrial complex, as dysfunctional as it is here in America.

嗯，垂直整合的好处在于，我们能够自己构建一切，这意味着我们也能大幅削减成本。

Well, so the benefit of being vertically integrated is that we've been able to build everything ourselves, which means we can also cut costs in a pretty dramatic way.

所以在每年500美元的范围内，单位经济是正的。

So within that $500 a year, the unit economics are positive.

我们现在已经有诊所开始盈利了，而且已经在运营中。

And we have clinics today that are profitable that we're operating already today.

所以我们觉得这个价格点进入市场是合适的，因为对人们来说性价比很高。

So we think this is a good price point to enter in because it's a great value for people.

但因为我们所有事情都是自己做的，所以我们仍然能让这个业务在经济上可行，既能打造一个优秀的企业，又能持续发展和投资，这样我们也能把它推广到更多地方。

But because we do all the things ourselves, we're able to still make this economically viable for us to create a great business and to be able to grow and invest in that business so that we can spread it to more places as well.

那么丹尼尔，你是只专注于这个项目吗？

So Daniel, are you focused exclusively on this project?

你还有其他在做的事情吗？

You have other stuff you're working on?

我不是只专注在这上面，但这显然是我花很多时间的事情之一，而且这也是应该的。

I'm not exclusively focused on it, but it's obviously one of the things that is taking a lot of my time, and rightfully so.

这是世界上最大的问题之一。

It's one of the biggest problems in the world.

但我仍然在花时间在Spotify上。

But I'm still spending time with Spotify.

我是那里的执行主席。

I'm exec chair there.

所以那仍然是我的心血，虽然我不是每天都在参与。

So that's still my baby, even though I'm not involved in it on an everyday basis.

我们还有几家其他公司，和Prima Materia一起，那是我和沙克一起创办的公司，你们之前提到过，我们真的想做到我之前说的，就是如何回馈社会，几乎成为你能找到的最好的联合创始人。

And we have a few other companies with Prima Materia, which is a company I created together with Shaq, that you guys mentioned earlier, where we're trying to really do what I mentioned before, which is how do we pay it forward and kind of almost be the greatest co-founder you could possibly find?

这就是Prima Materia的雄心。

That's the ambition of Prima Materia.

医疗保健这件事真的让我很困惑。

The healthcare thing really perplexes me.

我看了看现在美国人在负担能力方面面临的最大问题。

I kind of look at the biggest issues for affordability for people in the US right now.

买房、教育费用，还有医疗费用，是前三大问题。

It's buying a home, dealing with your educational costs, and then healthcare cost is the top three.

我觉得我们可以通过纠正某些被扭曲的市场激励来解决教育费用和购房成本。

I feel like we can solve education costs and we can solve home costs with certain market incentives that have been distorted.

但医疗保健要复杂得多。

But healthcare is much more complex.

你看美国的医疗体系，除了预防保健之外，在医院里给病人治病的费用，为什么在急诊室缝个针要一万五千美元？

As you look at the US system, beyond just kind of preventative care, the cost for servicing patients in a hospital, why is it $15,000 to get stitches at an ER?

为什么一种制造成本只要三十美元的药，要卖两万美元？

Why is it $20,000 to get a drug that costs 30 bucks to make?

为什么医生一年挣二十万美元，他给我看八分钟病，我的保险公司就要付六千美元？

Why, when the doctor's making 200 grand a year, does the doctor seeing me for eight minutes cost my insurance company $6,000?

从你的角度看，除了要解决那些积压的问题之外，美国医疗体系在结构上到底出了什么问题？

What is going on, from your view, that extends beyond get in front of all of the catch-up problems and so on, but what's structurally going on with the healthcare system in the US?

如果你当一天美国的皇帝，想做什么就做什么，你觉得我们最缺的三件事是什么？也许Neko现在还没解决，但你会建议我们去修复的。

And if you were emperor of the US for a day, and you got to say you could do anything you wanted, what are the top three things that we're missing that maybe Neko doesn't necessarily address today, but are things that you would recommend we fix?

嗯，再说一次，我绝对不是美国医疗体系的专家，但对我来说，这就像‘你给我看结果，我就给你看激励’。

Well, again, I'm definitely not an expert on the US healthcare system, but for me, it is like the show me the outcome, I'll show you the incentive.

这是经典问题之一，如果你真的认真想想，目前整个体系都是建立在——医疗体系是在我们应对传染病的时候建立的。

It's one of those classical problems, and if you really, really think about it, at the moment, the entire system is predicated on, and the healthcare system was built around a time when we were dealing with infectious disease.

这就是医疗体系当初建立和运作的方式。

That was how the healthcare system was built and dealt with.

所以所有的激励机制都是围绕这个来的，也就是说，当症状大量出现时，我们才进行紧急治疗。

So all the incentives are really around that, which means we're fixing you acutely when there's massive amounts of symptoms.

所以我们要转向预防性的医疗体系。

So where we have to go is we have to go to the healthcare system being preventative.

这意味着它必须更加注重长期。

That means it has to be way more long-term today.

我提一个存在的问题，因为通常你的医疗保健与你的工作以某种形式挂钩，而平均工作任期并不长，这意味着你可能在一个雇主那里只待两三年，然后换工作，换工作时，保险公司也换了。

So I'll just mention one of the problems that exists is because normally your healthcare is tied to your employment in one shape or form, and because the average tenure of your employment is not that very long, it means that you may have only two or three years at one employer, and then you switch, and when you switch, you switch insurers, too.

那么，如果你是那个保险公司，你会投资一个回报期可能长达10年、15年或20年的项目吗？

So one of the questions then, if you're that insurer, should you invest in something where the payback time may be 10 or 15 or 20 years to do that?

这些就是一些激励方面的问题，比如我们如何看待那些可能在未来10年、15年、20年才有回报的投资的ROI？

Those are just some of those sort of incentive things like how do we look at the ROI of some investments that may be 10, 15, 20 years into the future?

谁来承担这些投资？

And who takes those investments?

这些问题都不好回答，我也不敢说我有全部答案。

These are not easy ... things to answer, and I don't claim to have all the answers to them.

但我们正在努力做的一件事，就是尽量降低成本，这样就不需要非得投入巨资，或者保险公司、雇主们冒险投入几百万美元，指望二十年后才能回本，而且数据还很少。

But one of the things we're trying to do in that, because we're just trying to bring the cost down so that the ROI doesn't have to be that we have to invest, or the insurance industry have to invest, or employers have to invest millions of dollars speculatively hoping to get it back in 20 years' time with very little data.

我们的想法是，如果把成本降下来，可能不是几百万，而是几万块，就算回本周期还是十年二十年，我觉得大家接受和采用的意愿会高很多。

So our view is, if we lower it, so it may not be a million dollars, it may be, I make it up tens of thousands of dollars, even if that payback time was 10 or 20 years, I think that there would be a higher propensity and likelihood for a pickup on that.

然后我们做的第二件事，显然就是往系统里加更多数据。

And then the second thing we're trying to do, obviously, is we're trying to add more data to the system.

如果数据更多，有了这些多模态的长期数据，就更容易看到这些干预措施长期的效果到底怎么样。

And if we had more data, then it's much more likely with these multimodal longitudinal data sets to be able to actually see, well, what's the efficacy of these things over time?

顺便说一句，这也是我们每年都会公布我们发现的数据的原因之一。

This is also part of the reason, by the way, why we are investing in releasing our data every year of what we're finding.

这样大家就能看到，在整个人群层面会发生什么，这也很酷，因为通常医疗系统都是按国家来划分的，对吧？

So that people can see, okay, well, what happens, both on an aggregate Neko population, which is also super cool because normally in healthcare systems, they're very country specific, right?

所以我们是少数几家不是全球性、但至少一开始就跨多个国家的医疗公司之一。

And so this is one of the few healthcare companies that are, it's not global, but at least multi-country systems straight away.