Helmy Eltoukhy is co-founder and CEO of Guardant Health, which provides the leading genomic blood test for advanced cancer. A Bay Area native and the son of an entrepreneur, Helmy says his dad gave him the advice that eventually led to him co-founding Guardant: “When you start something new, focus on impact first. Everything else will follow.”
I really subscribe to the idea of no pain, no gain. The most productive things I can do in a given day are usually the ones that don’t come easily. That’s true of little things, like doing a few more push-ups each morning, but it’s also true of how I approach big, strategic decisions. It can be tempting to follow conventional wisdom or shoot from the hip, but choosing the more difficult path, taking the time to dig deeper and do all the analysis and research, is almost always worth it.
Oftentimes it’s about choosing short-term pain because you know it will pay off in the long term. Early on at Guardant, for example, we put a lot of effort into one version of the product before we realized it wasn’t going to set us up for success in the long run. It wasn’t easy to scrap it and start over, but we decided to do it because we knew in the end, it would be better for the company. When you push yourself to go the extra mile, you almost always end up in a better position.
Entrepreneurship is the art of calculated risk-taking. Before you start something new, I think it’s important to understand the core technical and business risks—and resolve them, if you can. The way I see it, you’re going to spend years of blood, sweat and tears on a venture, and that’s if you’re lucky. A lot of people are going to depend on your success, including your partners, team and customers. So it’s worth taking the time to figure out what your first inflection point will be and what you need to do to get there.
That said, once you do have a plan in place, you have to switch gears a bit from thinking about the risks to moving forward with conviction. If you have a great idea, there will be competitors pursuing it, too, so you need to move as quickly and aggressively as you can.
About six years ago, I cut gluten out of my diet. I’d had a pretty scary six months, with a lot of nonspecific symptoms like mild arthritis, stomach pain and dizziness, and when I got a cold, it would last forever. I went to probably half a dozen specialists. I had CTs scans, colonoscopies, endoscopies and a whole battery of blood tests, and was diagnosed with everything from a rare autoimmune disease to cancer. Eventually, we figured out it might be some kind of allergy to gluten, and as soon as I stopped eating it I felt much better.
That was right before we started Guardant, and my experience as a patient is actually one of the reasons I decided to take the plunge. I saw all of these physicians on the front lines who were doing their best and genuinely wanted to help me, but they desperately needed better tools. I realized health care is completely data-starved. I was working on the genomic side of things at the time, and we’d seen the cost of sequencing plummet from millions of dollars to barely $1,000, but most of those advancements weren’t making their way to clinical settings. I decided I could either keep on being frustrated with the system, or I could try to help fix it.
I’m constantly learning how to be a more effective communicator, particularly in terms of presentations and public speaking. Good communication is crucial for pretty much everything if you want to make a real impact, because it doesn’t matter how good your ideas are if you can’t persuade other people to believe in them.
I try to take lessons from anywhere I can. I read books, I’ve worked with coaches, and I study other people who are great communicators. If they persuade me, then there’s probably something I can learn from them and incorporate into my own style. Watching President Obama speak is like a master class, especially when you see how he progressed from the beginning of his first term to the end of his time in office. The last couple of speeches he gave were particularly spectacular. I’m still quite the novice so there’s a lot to learn from him and many others.
One is Superforecasting, by Dan Gardner and Philip Tetlock. It’s about Tetlock’s research on why some people are incredibly good at predicting outcomes and others aren’t—regardless of whether they have expertise in the subject matter. He found people who had zero domain experience, but they would intuitively break things down into their components and weigh probabilities for each one, and they were able to forecast likely scenarios far more accurately than the experts. As founders, we always wish we could see the next step or two steps ahead, so I think the frameworks he describes can be really helpful in leading a company.
The other book I’m reading is Resonate, by Nancy Duarte, which is this very quick, visual guide to giving better presentations. She explains how it all comes down to the art of storytelling, because a great presentation incorporates the same cues. There’s tension, there are highs and lows, there’s what she calls a “S.T.A.R. moment,” which stands for “something they’ll always remember.” She gives the example of Bill Gates’ famous TED Talk on malaria, when he released mosquitoes into the room. It takes a lot of work to prepare a presentation that tells a complete story and can break through the ADD so many of us have, but you’re usually well-rewarded when you do.
I think in general, we’re all wrong more often than we’re right. You never have perfect information, in part because most things aren’t black and white, and in part because there’s just so much we don’t understand. For example, most of the universe is made of dark matter, for which we have no explanation. What we know is a fraction of what we don’t know.
That’s why intellectual humility is so important, especially when you’re in a difficult space like we are at Guardant. If it were easy to design an early detection test for cancer, it would have been done already. Our collective understanding of the disease is so limited that it feels like no matter how much we learn, we’re still just scratching the surface. But that keeps us grounded and open to new ideas and new approaches.
At the same time, it’s important at some point to pick a direction and go forward, even though you don’t know everything, because procrastination is a decision, too. You pay a tax when you wait, and you have to weigh that against the additional information you could gain. If waiting isn’t likely to yield much, you should pick a direction and then adapt as you learn more.
I think it’s hours and days. A project might take a year or so, but I find that if you’re not making progress on a daily basis, weeks and months can go by without moving forward. That’s why it’s so important to break things up and track your progress toward smaller milestones. If you’re only measuring on a monthly or quarterly basis, it’s too easy to let things slide. And then it’s harder to realize when you need to course correct, so it’s difficult to make tangible progress.
I also lean toward shorter units of time because projects always seem to expand into the period of time you give them—and the last few weeks, days or hours end up being the most important. When that deadline is looming and everyone is focused on it, it’s remarkable how much you can accomplish.
- Know the risks
- Tell a story
- No pain, no gain