🦄 vol. 8
karl and matt chat about the shifts in power and catching cancer
corporate fangs 🧛🏽♂️
This morning, along with 1 billion others, my iPhone's alarm woke me up after a late night on my Kindle. Also, fortunately, Facebook reminded me and 2.85 billion other users to wish my colleague a happy birthday. You get it, no need to speak about my emails on Microsoft and Google.
What I'm saying is: it's not even 8am and I've already interacted with 5 of the largest companies in the world - FAAMG (technically, in the S&P 500 but if we exclude Saudi Aramco that statement holds true). These corporations have their fangs in all of us - even from the comfort of our homes.
Has it always been this way? 🧐
largest companies 1990 - 2020 (market cap) *ex saudi aramco
If we look back a few decades:
1990s: Japan will take over the world
32 of the world's top 50 companies were Japanese. Until the Japanese recession hit in 1991, from an asset bubble collapse, known as the “The Lost Decades”.
In the states, the internet had just become available for unrestricted use. Microsoft was growing explosively, with Bill Gates becoming the world’s richest man and Apple releasing their iMac.
Google, Amazon and Ebay were founded.
The Dot.com Bubble burst.
Market crashes of 2002 and 2007.
Facebook was born and so was the iPhone.
2010s: the come up
The BLM movement, Brexit and Trump's Presidency & impeachment (the Facebook-Cambridge Analytica scandal), the #MeToo movement.
These events were all made possible by tech and it's unraveling power, or more likely our ignorance to it's capability.
2020s: the blow up
What we're experiencing is unique: the top 5 largest companies in the world are all from the same sector and country.
Is the fact that we interact with these companies so frequently and in our most intimate confines of life the cause for their market domination? Or just a product of their design?
Staying power 🏆
If we look at the most innovative companies, they are all tech focused with Tesla replacing Facebook (positioned 13th) in the top 5. Innovation is not just research and development (R&D), rather R&D is one technique of obtaining innovation. If it were equivalent to R&D, Amazon would be leading the pack with $43 billion spent on R&D compared to Apple's $20 billion and Google’s $28 billion. These figures represent 11%, 7% and 15% of their annual revenue respectively compared to industry averages of 11%.
Of course, there are no guarantees that higher R&D expenditure will directly lead to higher growth and profits, but there is definitely a correlation.
How long will they last?⏳
Another trip down memory lane takes us to the mid 1800s when John D. Rockefeller established the Standard Oil Company. It controlled 90% of the U.S. oil market by 1880 but was broken up by The Sherman Antitrust Act in 1911. This resulted in 34 new companies, the largest of which became ExxonMobil. The company's share of the industry declined from 33% to 13%.
For a society that relied on oil to power their lives, Americans were at the mercy of these giants.
A century later - could history be repeating itself? Consumers of these tech giants benefit from free access to their platforms, but at what cost? Non-existent anti-trust enforcement and exceptionally weak patent rights have been the ingredients supporting the FAAMG's market dominance. Will the FAAMGs face the same fate in the decade unfolding, if not what do we expect to see?
catching cancer 🏃♂️🩸
It's been a weird few weeks with regard to all things blood-related. Tony Hawk dropped a line of skateboards coloured with paint infused with vials of his own blood. And, if you've been keenly following our recommendations, you'll be well-acquainted with the story of Elizabeth Holmes, founder of Theranos, who now faces criminal charges and up to 20 years in prison. But the world of bio-tech does have incredible promise - here's a cooler blood-related piece for you.
The current landscape 📝
Cancer is largely a disease of senescence; which means as human longevity increases, so too does our risk of cancer. And, if you weren't already aware, we're going to live a whole lot longer than we used to. Simple arithmetic means cancer's incidence will only continue to grow.
Luckily, cancer follows a relatively predictable path: local disease that seeds distant metastasis. The difficulty (and importance) lies in early detection that allows for timeous intervention.
For all the progress that’s been made in healthcare, we’re only 5% more likely to survive metastatic disease today as we were in 1980 (and that’s pretty scary). And while many believe treatments for late-stage disease will improve, it's unlikely they’ll be (completely) curative. No wonder we’re placing greater emphasis on spotting it earlier.
At present, we screen for cancer in myriad ways with different tests employed for different pathologies; serum biomarkers, invasive tissue biopsies and/or imaging modalities all have their limitations, meaning we're still picking it up too late.
So what's your angle? 📐
Now here's where it gets exciting. Start-ups like Grail, Precidine and CancerSEEK are leveraging liquid biopsies to aid earlier detection. These minimally-invasive procedures screen the blood for the presence of circulating tumour cells (CTCs) or circulating cell-free DNA (ctDNA), both of which are products of malignancy that are shed into the bloodstream.
Disclaimer: It’s actually far more complex than a blood test, but next-generation sequencing and DNA methylation analysis by machine learning are far too heavy for a Monday morning.
Why am I only hearing about it now? 🔉
Weirdly enough, screening the blood for cancer biomarkers is not a novel concept but the convergence of genomic processing and machine learning are driving down costs and increasing accessibility, allowing for widespread deployment. Wright's Law, where cost declines as a function of production, projects costs to fall from ~$3500 to ~$800 by 2023.
So what's the good news? 🗞📰
Modelling suggests the use of liquid biopsies could decrease cancer deaths in the US by more than 10%. And I think the implications for Africa would be even more significant:
🧬🩸Screening requires a multi-modal approach (multiple blood tests, imaging and/or tissue biopsy), which is more costly than a one-off liquid biopsy.
💉🩺Treatment requires greater expertise and costs more as disease advances. In Africa, not all health systems have the personnel nor the finances to treat advanced disease; liquid biopsies may aid that.
🔎 Recurrence monitoring becomes mores sensitive and cost-efficient, when compared to current methods.
This is all occurring in the backdrop of a shift in disease burden. For much of the last century, Africa has been plagued by infectious diseases, but now diseases of lifestyle, one of which is cancer, are coming to dominate our health systems. Liquid biopsies may prove to be a valuable tool for health systems that are ill-equipped and already overburdened.
for those looking for a new book, matt’s reading shoe dog by nike founder phil knight
sash loved the fact that drake’s certified lover boy shattered streaming records
karl watched the ceo of nvidia talking, only to realise that it was completely cgi