What to do when the tide is going out

There’s a famous quote by Warren Buffett that’s something along the lines of, “It’s only when the tide goes out that you find out who’s been swimming naked.”

I’ve been thinking about this quote recently. Now, when the Prophet of Omaha said this, he was referring to businesses whose bad financials are revealed once there’s an economic downturn, which, coincidentally, happens to actually be very relevant right now. But, that’s not the way I’ve been thinking about it. 

I think there’s a real psychological truth embedded in this as well. Psychologically, when intellectual tides are raising all swimmers in a certain field, it’s easy to happily paddle away with no swimtrunks on. Raising money is easy. Getting interest and validation from your friends is easy. Every tweet about your progress gets 50 likes and 5 comments, easy.

Now maybe, despite all the validation, you still feel like you’re naked. You have a sense of imposter syndrome, or you have internal doubts about whether being able to paddle in a rising tide can eventually turn into you being a champion open-water swimmer, despite your tweets to the contrary. But everyone else is cheering you on, and you know of at least a couple people who are even more naked than you are, and so being naked seems like not such a big deal, at least not right now. You keep just paddling and waving, enjoying the rising tide.

Meet The Swimming Pigs of The Bahamas
If you’re unlucky, tourists will come up to you and try to pet you.

But then the tide goes out. There are fewer people cheering. Whatever limited boats were offering assistance to swimmers (possibly lending out swimsuits) seem much fewer and farther between. The water is getting colder, and cold water plus nakedness is a bad mix, especially if people can see you. Just paddling is harder, and you realize that if you actually try to become an open-water swimmer, there’s no way you can avoid showing your bare ass to the world.

So what do you do? Ideally, when the tide was rising, you would have knit yourself a swimsuit, so it’d be a little less cold now. It also would have been smart to have already had a plan to go from a rising-tide paddler to an open-water swimmer while the tide was going up, instead of wasting your time doing underwater frontflips. 

It’s too late for any of that now, though. Now the reality of the situation is that you are naked, the tide is going out, and you’re actually a little tired from your paddling and underwater front flips. Maybe you should grit your teeth and force yourself to swim regardless. That’s what someone who really believed in the importance of this pool would do. But, it’s probably pretty tempting to wait for a moment where you don’t think anyone is looking, scurry along the beach like a pale, flabby crab, and find another rising tide to paddle around in.

One interesting thing about Twitter, now that I’ve started to use it more, is that I’ve been able to watch this happen in real time, more or less. I’ve noticed quite a few people who were happy paddlers when the tide was rising in one pool suddenly pop up in a different pool, their projects (some of which they received significant amounts of money for) suddenly languishing, their team’s LinkedIns quietly updated to a new job: “VP at NewCo: April 2022-July 2022”, “PM at Microsoft: August 2022 – Present”.

When I see people pop up in a different pool, I don’t think they never cared about the old pool. A lot of the people I’m describing seemed to genuinely care about the issues in the old pool. Their Twitter threads and long posts were thoughtful and interesting, chock full of interesting facts and statistics. They weren’t in the old pool because they wanted to make a quick buck; they were in the old pool because they cared about the old pool.

But, I also think it was fun to care a lot about the old pool when the tide was rising. I think for a certain variety of person, writing big posts on Substack about an issue and then making a Tweet thread about it that gets lots of likes is super fun. I mean, hell, that describes me!

It’s also really fun to raise a lot of money, and then find people who you like, and then give them money to work on the thing you care about. You get to have conversations with them about what they’re doing, and probably you both can complain about the problem together. You can all agree that the legacy approaches to these issues suffer from some serious problems, and that it’s really a shame that the pool has been taken over by bureaucrats. As the new paddlers, you will make sure that there’s a new backstroke in town.

But what I know isn’t fun is the hard, grinding work of actually putting together an organization. This is especially true if you’re looking to put together something that can survive and tackle the problems in a unique way even in a falling tide. 

Organization building and careful step-by-step maneuvering is way more boring than raising money or paying people who care about the same issues you are. In a rising tide, it seems like it’s moving too slow. In a falling tide, it seems like too small of strokes for this giant ocean that suddenly looms in front of you. Either way, it’s easier to paddle and wave to the people on shore.

I don’t blame anyone for jumping into the water naked. That’s what I did with my pharma startup. But, if I may toot my own horn, I have been working very hard for the past couple years to train my open-water swimming and knit my swimsuit.

 I have: 

1. Written (and rewritten, and rewritten, and rewritten) patents. 

2. Very slowly found people to work with who I can trust through intensive networking with literally everyone

2 and searching on the 12th page of Google.

3. Struggled through 15 step FDA flowcharts to figure out how to make an electronic submission. 

4. Personally shipped drugs across international lines and gone through the customs steps necessary to do so. 

5. Made substantial contributions in hour long meetings in which 6 people argue about a paragraph of a 60 page protocol. 

6. Talked to a bunch of very uniformed VCs to try to raise money and still gotten ghosted. Then, after getting ghosted, put on a 7 day free trial of one of their Substacks which then asked me for $25/month to keep subscribing (ok that was just one VC but it was still absurd)

I have done these things in a rising tide and a falling tide

3, and will continue to do these things. Right now, the tide is falling, but I am less naked than I was a year ago because I have done all of this. As I’m writing this on January 3, the second half of our pilot trial starts tomorrow. I’m expecting to see proposals from manufacturers by the end of this week, and I should be getting a response from the FDA about our registration soon. 

A year ago, I wasn’t close to any of those things. I had just gotten my ACX grant, which I had planned to use to knit a pattern that, in retrospect, would not have survived the swim

4. I hadn’t yet pivoted to cats, raised any money, or been close to any sort of actual trial. I could have very easily spent the past year paddling and waving to bystanders, but I didn’t. I knew I wanted to actually swim.

Real work on hard problems is rarely fun. It’s mostly grinding, and occasionally, when there’s a breakthrough, exhilarating. It can be fun talking about it, or writing about it, but it’s important not to mistake the fun parts for the real parts. And, if you are having fun, take some of that energy to actually work on the hard parts.

It is always tempting to just jump in another pool. But, that’s not the way things get fixed.


For those of you with large twitter followings, for whom 50 likes would be unimpressive, please feel free to multiply these numbers by 10 or 100 as necessary.


And believe me, these weren’t fun conversations bitching about problems in the pharma world, of which there are many. My fun conversations are usually not particularly productive. These are boring, trust-building conversations with serious people where I convince them that I am a serious person working on a serious problem and need help. Then they connect me with people who can help me.


Although, to be honest, the tide hasn’t been rising in drug repurposing for like 20 years.


Pharmacokinetic physiologically-based modeling, which I thought I could use as a virtual phase 1. As it turns out, the technology was too immature and couldn’t be extended to my use the way I thought it could.