Rob Wachen was 16 when doctors told him that the bump on his back was stage 4 bone cancer, and that his odds of surviving were under 30%.
Surgery meant he would probably live but might never walk again; radiation meant he would keep walking but might not survive.
His parents told him the decision was his alone, and he chose surgery.
The necrosis analysis came back below the threshold, which meant he needed radiation anyway.
One of the only machines in the world that could deliver it was in Boston, so his parents moved there with him while he went through months of treatment in a wheelchair.
He spent two years in chemotherapy, surgery, and learning to walk again. Before the diagnosis, he had been running a six-figure business, competing in Taekwondo, and playing semi-professional saxophone.
He has said that surviving something like that requires hoping for something, and that he always knew if he got through it, he wanted to do something that mattered.
Gavin Uberti's story is stranger in a different way. At 12, he was leading teams in Minecraft to build analog chips, sending precise architecture specs for hundreds of thousands of blocks to group chats.
At 17, he got his first job writing high-performance code, and because a 17-year-old cannot sign a legally binding contract, the company skipped the NDA, sat him down, and said, "Gavin, don't share this information."
That company sold to Apple for $200 million. The next one he worked at sold to Nvidia.
In high school robotics, Gavin and his friend Sanford left their 20-person school team to compete as a two-person unit, on the theory that everyone else split their attention between documentation, outreach, and the robot, and they would only build the robot.
At one point they held the world record for the highest score in the competition.
The two met at Harvard, where Rob ran Prod, a nonprofit accelerator whose alumni companies, Cursor and Mercor among them, are now worth more than $100 billion combined.
When GPT-4 launched with image uploads, Rob dug up a photo of his back from before his diagnosis and asked the model what the bump could be.
It answered immediately that it could be a tumor and that he should get an MRI. His doctors had taken six months to reach the same conclusion. While he sat there absorbing that, a notification appeared on his screen telling him he was out of image credits for the day.
The models were about to change everything, and the infrastructure to serve them did not exist.
Every GPU and TPU running these models had been designed before ChatGPT.
Gavin, who had spent a year optimizing AI models to run on GPUs, believed a system built specifically for inference could be radically better.
In 2023, they dropped out to build it. They were 21.
GPUs can't use all their advertised computing power because they overheat and slow themselves down.
Etched developed what they call low voltage inference, running chips at under half the voltage of any other AI chip, borrowing an insight from Bitcoin miners that everyone in the industry insisted couldn't apply to AI.
And where Nvidia's chips take 4,000 nanoseconds to send data to each other, Etched built a custom interconnect that cuts that by more than 5x, letting an entire cluster share its memory as a single pool.
Mark Ross was the former CTO of Cypress Semiconductor, which sold for $9 billion. When they met him, they were a couple of guys in a dorm room telling a prestigious chip veteran they could be much faster than Nvidia, and he told them what everyone else had: "no, you can't, it will not work."
But if they wanted to convince him, they should write a white paper, build a functional simulation, and show him. After a lot of very long nights, they came back with the simulation, and he looked at it and said, "huh, this works."
Mark is Etched's full-time CTO.
At the end of 2023, they had $15 million in the bank and needed at least $100 million more to finish the chip and build the rack.
They wrote a 30-page memo and asked for it, double the largest semiconductor Series A ever raised, and every major investor in the Valley passed immediately.
The market was uncertain, they were told, and two 22-year-olds could not build this type of company.
Gavin started looking into how hard it would be to go back to Harvard.
They called everyone they knew and survived on small checks, a million here, two million there, enough not to run out of money that month, then a five million check, then ten.
At a board meeting, they looked at a spreadsheet of soft commits totaling $103 million.
When a critical vendor in Bangalore fell a year behind, they shipped a dozen engineers to India for six months, and Gavin lived there for four and a half, running 24-hour development cycles with 12-hour handoffs between continents.
When the chips came back and a clock-domain bug threatened to corrupt every result, people quit and called the problem unsolvable. The fix required aligning two clock signals to within 50 trillionths of a second, on every chip, two billion times a second.
Gavin solved it in two weeks.
They taped out a working chip on their first attempt, the first hardware company founded after ChatGPT to do it, and when silicon came back they had it running inference in a rack in 40 days.
A well-known AI chip company took 10 months to do the same.
Today Etched has more than 400 people, drawn from Nvidia, Google's TPU team, and Broadcom, and half of them live within five minutes of the office.
The company has over $1 billion in customer orders and just raised $800 million.
As Rob says, "We're in a new era of intelligence, where the cost of producing intelligence is so dramatically much cheaper than the value of the intelligence, that we are in a many-year, probably many-decade, supply shortage of these tokens."
Whoever produces the most tokens, he believes, will be the most valuable company in the world.
Posting on 𝕏 helped me quit a corporate PE life, go independent and launch my M&A advisory firm in Poland connecting international investors with local investment opportunities.
It all started by deep diving on the topic of succession in Poland inspired by the "silver tsunami" theme in the US I read about on 𝕏.
I started writing threads (when they were still a thing) on various case studies from the Polish market. Where it became clear that without external capital many of these companies with succession issues will just close down - so we need to raise awareness of exit options for the business owners.
Then I came across @PrivatEquityGuy's post on a serial acquirers event in Stockholm, reached out and booked my trip to Sweden with like a 2-day notice.
I sat next to the legends of the Swedish compounder space including Roko, Lifco, having no clue who those people are and what they really do back then...
This in turn led me to join a series of other events across the globe London, Singapore and most recently New York (𝕏 RE Gala by @realEstateTrent)... where I met my first clients: PE funds/independent sponsors/FOs/strategics with no exposure to Poland keen to explore what's out there in the 6th largest economy in the EU.
Now here I am with a growing portfolio of clients keen for me to search for target opportunities in Poland and explore a new territory with someone who can speak both the language of the investment world and is also relatable to the Polish business owners and can serve as a bridge between the two worlds.
I've decided against posting on the "platform for professionals" as I find interactions with people here on 𝕏 more genuine and valuable - and starting to post under a nickname has given me more liberty to speak up without wondering if it is suitable for the other platform.
The calibre of people sliding into my DMs has been humbling - their achievements are astonishing and it's so great to compare notes with the great investors from around the world.
@nic_amadio Wait I read it again - he spends $2.5k/month and consider it luxury ? Guess they live in the middle of nowhere and the luxury is buying games on Steam? And no dependants in a family ? This is literally a store clerk salary, I guess we’re all elite in Poland 😅
@FrankRincoawh7@sapitonmix $2M, so 6-8 mln PLN. But I see prices got better, at least these are really large penthouses, few years back a lot of 1000sqft places costed this. https://t.co/ABLjwVAU7e
Besides full body ultrasound CT, just wait until solid-state nanopore sequencing reaches industrial maturity and we get cheap, abundant at-home DNA/RNA testing. You'll know exactly what's causing your cold, what kind of mold that is, which antiobiotic to take, what's wrong with your micriobiome... The future is gonna be great.
What we don’t talk about when we talk about AI in medicine:
Standard of care isn’t standard care. New modalities of care (AI-assisted or otherwise) are always measured against a platonic “standard of care” that doesn’t exist in the real clinic. Medicine is as much art as science. Providers are overworked, tired, rushed, and routinely veer from textbook SOC.
Novel care modalities get killed in the cradle because they can’t measure up to the imaginary provider with infinite time and infinite knowledge. But that’s not what most patients get today. Less-than-perfect care that scales to many more patients is an obvious moral good, but our current bar makes it almost impossible.
Every provider understands that real SOC deviates. Not everything is black and white. Physiology doesn’t fit into clean textbook pathways. The gray areas are where great clinicians shine. We would never allow AI systems to operate in those same gray zones, even if that’s where most real care actually happens.
We also never talk about the patients we don’t see. Clinicians’ judgments about “how healthcare works” come from the patients in front of them. They don’t see the patients who never make it in the door, or the ones who are dead or much sicker because of something that happened upstream: bad access, no access, or bad care.
We struggle to reason about the enormous population that exists completely outside the current healthcare system — invisible due to lack of trust, lack of access, geography, scheduling, childcare, work, etc. AI-assisted, consumer-first care may be one of the only ways to reach many of these patients where they actually are.
Everyone is terrified of AI “hallucinations” and mistakes. But providers hallucinate too. Medical errors are estimated as a leading cause of death in the US. The difference is that when a human clinician makes a mistake, we have malpractice law, liability frameworks, and trillions of dollars of insurance wrapped around that reality.
As AI systems get better and account for a larger share of real decision-making, we’ll have to answer basic questions: do we license and insure models the way we do clinicians, or do providers simply inherit the risk of using them?
Healthcare also isn’t “lindy.” Private health insurance in its modern form took off in the 1950s. Medicare and Medicaid launched in the 1960s. Most of the system we treat as sacred is younger than many of the executives running it. There’s no reason to believe it should exist in its current form for the next century.
Consumer choice is the canary. Our crisis of cost and access is driven by a narrow set of rent-seeking actors who have no real incentive to improve anything. AI-assisted, consumer-first healthcare will eventually show that cheaper, better care is actually possible — and in doing so, expose a lot of the existing system as a scam.
It’s time to (re)build trust. Right now, many providers act like the second-worst thing that can roll into their department is a VC or a tech exec. That distrust is earned. Tech has overpromised and underdelivered in healthcare for decades. But staying in that posture forever won’t fix anything.
The only way out of this crisis is to take seriously the idea that this time might actually be different — and then hold people to it. Venture-backed implosions make for good schadenfreude. But we should feel no pride in delivering bad care, at high cost, to too few people, because we refused to take new tools seriously.