I have not recovered, I took the opposite path to you - when "standard care" wasn't an option - I gave up. But your post has motivated me, and shown me a roadmap of what is possible. Eternally grateful.
p.s. "I'll talk to anyone, I'll go anywhere, and I can be there anytime" - for me, unfortunately $ is the problem for going anywhere, anytime. Perhaps you can help? I've sent you an email - I'm motivated. ;-)
Yes, it felt like the universe provided in this case. I invest in my batch mate. We end up becoming best friends, our wifes become best friends. Biotech VCs are afraid click chemistry isn't hot enough. I lead multiple rounds and become the biggest investor and it becomes my biggest investment. The year I get cancer click-chemistry wins a Nobel prize. And I become a patient. Unbelievable.
I have worked as an architect in HCLS technology for 10 years with Google and AWS.
Listening to you stitch all the technology and innovation together, moving from the information world to the physical world, as a patient, almost brought me to tears.
You said this will be the standard of care in 30-years, but the capability is here today. Listening to your recording is a profound moment in my life.
Really appreciate it. I agree the capability is here today. I'm trying to get it to more people so that the learning effects and economies of scale can bring the costs down.
Your cancel journey is incredibly inspirational and I will share it on.
But actually, I'm writing to tell you that many of the OTHER things you have done have had a huge positive impact. Gitlab foundation, for example, has been extraordinarily impactful on our organization and many others.
Sid, Thank you for funding Arden Bio. Rheumatology patients and their clinicians are often left to throwing darts from afar, in series and often with significant & permanent function loss with each dart. Moreover, proper care of refractory rare diseases is not something that insurance funds: my otherwise excellent coverage expressly denies "investigatory" treatments, for example. As a small fiber neuropathic vasculitus patient with secondary Sjögren's I really look forward to progress in this field, it cannot happen soon enough. Best of luck in your own care and profile. - Clark
Such an inspiring read. As a bioinformatics researcher I'm awed by the depth of the deck. How do feel about the process of learning cancer biology and bioinformatics?
Ps. I work for BillionToOne oncology and we build some of the most sensitive liquid biopsy tests (https://www.northstaronc.com/). Feel free to reach out if it pique your interest!
It wasn’t easy to learn it while dealing with the side effects of chemo. But AI helped a lot, also see the OpenAI forum talked linked on the page. Love BillionToOne, also see https://osteosarc.com/timeline/ MRD Northstar for my results with it.
how do you handle GitLab + Kilo + all this personal work? what system have you figured out? sorry if you've written about this somewhere, i think there's a meta lesson you have that we all can use.
All of these companies (including the Even One Ventures and Open Core Ventures ones) have CEOs who run them day to day. I try to help with positioning and setting ambitious goals. Y Combinator really opened my eyes to how helpful setting clear and hard to reach goals is.
thanks Sid! i think a lot of people incl myself aspire to be where you are - I have effectively 3 businesses and have only hired one GM (on track to be CEO), but the other 2 I am effectively CEOing. yet I have this maybe misguided asian/protestant theory that I haven't "earned the right" to multicompany yet, and if i take my hands off the wheel the whole thing might be at risk. With GitLab obviously you were driving for many years and it feels like only with your cancer diagnosis you started letting go.
no question in there, just a comment, love your openness and giving back to the community, wish you full success and recovery.
I wish you the best, my brother-in-law (also a close friend) lost his fight against cancer in 2019, it changed my perception of life forever. What we live is a bit like how we die, I had some of the best moments with him while he was more aware than myself about how we are all going to die, he changed my perception of caring much more about the uniqueness and the present moment. One of my favorite quotes is from Buckminster Fuller, "You belong to the Universe. Your significance will remain forever obscure to you ... (see full quote on Wikipedia)". Thank you so much for all the creation you have done in this world Sid, just for Gitlab it's plenty. I am a long time & very satisfied Gitlab customer, I switched a long time ago for its superior CI/CD integration and its super inspiring handbook. Another favorite quote is actually from you ... "My reasoning was I got to tell everyone what I do, and I want it to be a really good story." Lately I fundamentally changed my perception, the most important computer of all is the planet Earth, you seem to be aligned with this vision as well, correct me if my perception is wrong. I hope you keep going on with all those beautiful stories, we are lucky to have you with us.
> You do not have the right to eliminate yourself, you do not belong to you. You belong to the universe. The significance of you will forever remain obscure to you, but you may assume that you are fulfilling your significance if you apply yourself to converting all your experience to highest advantage of others. You and all men are here for the sake of other men.
How do you deal with setbacks both in work and life, and show resilience and belief you can find a solution? Is this innate or something you worked on? Also, are there things you think are impossible for you to do?
I have a stoic mindset, I try to not care about things that are outside my sphere of influence. While the cancer was unfortunate it was out of my control. Having my YCW15 batchmate step up for me during my initial set of treatments to get me Shasqi opened my eyes that I could help create and take new medicines. It was within my sphere of influence. When I reached the end of standard of care I stepped down from the CEO role of GitLab and pushed to do this for me. While it was hard it was easier than I expected and I created companies to help other patients in the same way (maximum diagnostics and single patient IND pathway).
Philosphical treatments have got a bad rap because it is so easy for conmen to convert them into fake hope, but when properly applied they are still amazingly effective. It's just that "properly applied" is very often not profitable because all the applicable texts and practices have been quite literally known for thousands of years and are available through well known texts in the public domain.
And Sytse if you read this: beterschap en als dat niet helpt: sterkte. Cancer sucks.
Sorry if this is too specific/personal, but I've been wondering, why does the treatment timeline include antibiotics (dalbavancin)? Does dalbavancin have any suspected antitumor effects, or was it simply to treat complications of surgery / catheter infections?
(edit: actually now that I checked the treatment timeline again it seems to be gone now. It was there 2 weeks ago!)
in light of everything you've learned about the pharmaceutical industry and biotech venture, is there anything in particular about oncology that makes it well suited to venture?
like why is it people with cancer? why isn't it people with muscular diseases?
My pleasure! How does someone support someone going through cancer? I would especially like to know how to best support someone upon initial diagnosis. It seems like you have an amazing support system and I would like to be that for someone.
This is very impressive, top labs doing research often don't have experimental designs that are this elaborate. Was the TCR and BCR-seq you conducted helpful to design cell therapies, neoantigen vaccines, and monitor progress?
Given that you carry the HLA-B*27:05 allele, you might have been blessed by being predisposed to a better response. But probably you want to keep an eye on future autoimmunity issues. Talking from experience...
Thanks for the warning, I hope that it wasn't a personal experience for you.
Thanks for the compliment about the elaborate design. I think that when you make something for one or a few patients it is easier to be more elaborate, even with the same knowledge and equipment.
Maybe the TCR and BCR-seq was most helpful for mRNA design and effectiveness monitoring, but hopefully someone else on my team will answer that better.
The TCR sequencing has been helpful for downselecting TCRs for a TCR based cell therapy, and for monitoring response to various immune therapies (including the vaccines)
Love how you approached and presented this. The data vis on https://osteosarc.com/ is outstanding; such good explorability (is this some open source framework?)
I do have concerns regarding the proposals for scaling personalized medicine. They mostly boil down to "how do you scale the skill set required to operate in high-noise-low-signal domains". In my experience, these are places where poor data/incentives/critical-thinking can easily overshadow the signal; e.g., compelling stories outnumber correct stories.
There seems to be a trade-off: you can walk a bit further than others by keeping the probability distributions for low-quality results in your head, but go too far and everything starts getting overwhelmed by noise. It seems like the FDA's heavy gatekeeping is one way to solve this problem. If you forgo that gatekeeping, then you probably need to deal with the cascading quality issues that result.
Personalized treatments will probably be much harder to evaluate. At least a black-box algorithm that maps `situation → suggested treatment` can have statistics applied to it. But how do you evaluate "individuals made their own decision; here's the list of `situation × outcome`"? Or is the idea that there's currently a wealth of good-solutions, and that we should be relaxing regulations for a while?
Or perhaps we just want to push the regulator burden from "before small trials" to "before medium trials"? Then, these will be treated as case studies: good for experts to pull ideas from, but not high quality evidence for proving anything the third parties? I notice that your diagnostics were numerous, but the treatments were sparse and more sequential than parallel. If that's the norm, then maybe fairly usable data will emerge.
Or do people just have a moral right to seek out their own treatment, regardless of footguns that may be lying in wait? For myself and my loved ones battling cancer, I deeply agree with these:
> Maximize survival instead of the current practice of minimizing liability to the practitioner
> Parallel treatments wherever reasonable, we don't need to know what cured you
But I'm also glad that daily medical decisions are highly standardized and quality-controlled. It makes it easier to trust my doctor (or my loved ones' doctors) without independently investigating each recommendation.
Thank you for sharing—very inspiring. I'm interested in the operations of starting and managing these companies in parallel. How did you go about finding people to run the companies? How much involvement do you have in their day-to-day operations? Are they "your" companies, or do you consider yourself just Customer #1?
Glad to hear! After losing my wife to cancer (highly aggressive brain tumor, she only had six weeks), I'm happy that you had the time, resources, strength, will to take cancer by the lurven
Not my thread, but I just wanted to express my condolences for losing your wife. That must be so tough. My wife is my best friend and I cannot imagine how painful it would be for me to lose her or vice versa.
I’m praying for you both and hoping that you’ve found peace and comfort since she passed. And I hope that you are doing well. I know she would be proud of you for keeping on!
I am so sorry that you had to go through this tragic event, Here's a hug my friend, that must've been incredibly tough on you, I am not religious but I know that She is in Heaven and watching you from above and she will always be within your heart and all the cherished memories you had together.
So sorry to hear that. I'm providing caretaking for my mother, who has GBM now, and we've been lucky to get to month 15 now. It's such a difficult disease to grapple with.
Fantastic. Wishing you all the very best. A very close family member just with Stage 4 just got the pass for the next 3 months. We're 3 years in now. For them, the immunotherapy seems to be working, the radiotherapy has actually left the area affected worse (althogh we'd have never known the outcome if it wasn't tried, so it was a price worth taking).
Sid — I’m at FDA and would like to talk to you about your proposals to make industry more patient friendly. Will reach out to this address unless there’s a better one.
Having lost several members of our family to cancer over the last several decades, including my mother, I sometimes question where all the money going into cancer research has gone. Maybe what has been lacking are motivated patients with both the means and the intellectual capacity to drive for solutions. Again, I hope you find a path.
Saw your post, read the first sentence and was curious to see what sources you would provide.
YouTube is hardly an acceptable source as videos do not let people discern information well. It’s basically only a hit better than telling ppl to google for themselves..
> Fasting (1 to n weeks) is said to provide potential benefits for certain types of cancer treatments. Pre-cancer, it is said to potentially prevent cancer onset. This is potentially powerful for those of us with a family history with cancer.
It makes sense. Cells need nutrients for the cell cycle, similar to the way computers need RAM to execute programs.
Fasting not only deprives cancer cells of nutrients, but also triggers a homeostatic response in the entire body. This response includes putting its garbage collection system (autophagy) into overdrive mode so that it can reclaim the limited resources it has left to survive. Fasting is a reductive treatment, like purging oxygen from a server room on fire. It might help slow it down, but it can take healthy inhabitants along with it.
Additive treatments offer more options. If you catch the fire early and it’s contained (non-metastatic), you can target it with a fire blanket (surgery, stem cell transplantation) or a fire extinguisher (small molecules, biologics, peptides, gene therapy, etc.) to put it out. The sprinklers are a last ditch effort for larger fires (chemotherapy, radiation), which could save the building, but result in significant collateral damage.
If we were serious as a society about fighting this disease we would engineer an approach that guarantees early detection on as many people as possible. My guess, not having looked at numbers at all, is that the societal cost of late detection must be staggering. In other words, I am thinking --and I could be wrong-- that even if we provided annual checkups for free with a suitable technology, it might be cheaper than the devastation caused by cancer.
While not all cancers are the same, we cannot ignore the fact that there's a metabolic link to cancer onset and development. Our industrialized food system simply isn't healthy. I don't know how we do it, but there has to be a way to alter behavioral patterns (nutrition, exercise, visceral fat control, substance abuse, etc.) to actually protect people from both bad inputs and, frankly, themselves.
I don't say "themselves" in the sense of suggesting an overlord scenario. The reality is that most people are ill-informed and our industrialized food system is designed to be supremely addictive. Anyone who has battled with processed food understands just how difficult it can be not to consume it, both from a widespread availability perspective and what it does to your brain.
Despite the fact that treatment options and efficacy have improved, without fixing these factors it will be impossible to win this battle at scale.
This post is about a man's struggle with a deadly cancer.
I cant understand how you could possibly think this question is not "tone deaf" unless you are genuinely autistic - not using it as an insult, genuinely curious - since such a question would be simply beyond the pale in polite society, given the context.
Sure, but this isn't really an AMA thread [despite the offer to "answer any questions"]. This is about Sid's journey with (extremely advanced) cancer. Airing grievances about Gitlab is just out of place here, you gotta read the room.
Paying different amounts for different regions is not being an asshole. Virtually every company on the planet does regional CoL adjustments.
And get a grip - you are free to bring value to the world in your way if you're not happy to be an employee. Attacking others that have done nothing to harm you is entirely uncalled for, especially on a discussion about their own cancer. Please act like an adult.
In case you're considering moving to GitLab we currently have no plans that I'm aware of to pay from bringing your own runners. Happy to answer any questions.
I'd be more interested in understanding why OAI would think exporting PII to a 3rd party platform was acceptable. As for whether they follow the same standard with other providers, all bets are now off
At Kilo (VScode plugin, BYOK so works with Claude Pro) we just rolled out autocomplete to 10% of our user base on Friday and we're happy with what we're seeing. The autocomplete is based a Mistal model (Codestral) that is fast and accurate https://mistral.ai/news/codestral We copied a lot of code from Continue.dev (best open source autocomplete in our view). We plan to roll it out to 100% of our users no later than Tuesday. The autocomplete is consumption priced (no markup) but the cost per month should be low single digit dollars.
Kilo’s been on my list of tools to try anyway. Good to hear you’ve got a strategy for useful autocomplete. Any idea how it compares with Supermaven both in terms of speed and quality? Supermaven really had found a sweet spot for both. I found LLM autocomplete was generally more annoying than it was worth prior to Supermaven.
The cost improvements are great. If you miss the automation that AWS does for database servers consider using something like https://www.ubicloud.com/ that is great for PostgreSQL servers. On bare metal these typically also support 5x the number of IOPS without paying through the nose.
So the core idea is to use an LLM to draft reasoning as a structured, JSON domain-specific language (DSL), then deterministically translate that into first-order logic and verify it with a theorem prover (Z3).
Interesting that the final answer is provably entailed (or you get a counterexample), instead of being merely persuasive chain-of-thought.
reply