The following story was woven together from Chapters 18 and 19 of The Cure Trap, my forthcoming book, about why the most funded word in medicine keeps failing patients.
Part 1: The Question
I first met Brian Pepin over Zoom while he was sitting in an airport on his way home to Portland. I opened with a deliberately provocative question: “What is suffering?”
He gave me a thoughtful answer. He talked about his mission in life, and how it had carried him from electrical engineering to Google to building his own company. I was moved, because it aligned with what I had come to believe myself: that we are here, in the grand sense, to alleviate as much suffering as we can. I told him what that meant for people with Parkinson’s: how it’s like being slowly tortured to death, only the torturer prolongs the sentence for decades.
That was about it. He had a flight to catch. But the conversation planted something: why and how he should involve patients in what he was building. That notion became the Patient Advisory Board at Rune Labs.
It also became a friendship. Years later, when I woke up robbed in a hotel room in Cartagena, Brian was one of the first people I called, and without hesitation he booked me a flight out of there.
Part 2: The Dinner
Rune Labs’ first onsite meeting. The company had rented out the Monterey Bay Aquarium for the evening, there we all sat in front of a giant aquarium, eating fish, getting to know each other. I was with some of Rune’s engineers, and I was quietly getting annoyed. The company was around sixty people at the time. I kept doing the math in my head: what must this evening have cost, and how much good could that money have done elsewhere?
Then Brian came over and I popped. I lectured him, in his own company and at his own dinner, on the sheer waste, and on how much more suffering that money could have alleviated had it been spent elsewhere.
To his credit, he took it calmly. He didn’t push back, didn’t pull rank, didn’t perform being wounded. He just listened.
Later he explained it to me. Evenings like that one do something for a team that no team meeting can: they make people feel they belong to something, and they give them a story to tell. And in the Bay Area, where software engineers are in very high demand, stories like that are recruitment tools. The aquarium isn’t just a perk. It’s how you get the best people to choose your problem over someone else’s.
I have thought about that dinner a lot since. My instinct that night was this book’s instinct: follow the money, count the waste, ask what it could have bought instead. Sometimes that instinct is right. But that night it missed something. If you want the best people working on your problem, then at times you need to treat them like the best.
It is the same rule I argue for patients in this chapter, applied to engineers instead. Treat people like what they are, and pay them as such, whether they are engineers you need to woo or patients you need to hear.
Coming in 2027…
