The paradox of bike helmet laws: the fact that wearing a helmet, without question, reduces an individual rider’s risk of injury (recent work estimates an 88 percent reduction in brain injuries and an 85 percent decrease in head injuries) but appears oddly neutral, or worse, for riders at large. Add in the fact that legislation does increase helmet usage among riders, and it would seem to follow that these laws should produce a net public safety benefit. Public education and infrastructure upgrades, as the aforementioned works shows, protect riders considerably even before helmets come into play. Both efforts increase the overall amount of cycling, which provides safety in numbers. Mandatory helmet laws, meanwhile, may discourage riding to the point where public safety as a whole suffers from the relative decrease in physical exercise.

In places where riding is already safe, helmet laws are likely to have a “large unintended negative health impact.” In places where it’s unsafe, the laws may make riding a little safer, but are also likely to distract attention from initiatives, such as infrastructure upgrades, that would be even more effective.


If you think about what happens when you go see a doctor in their office, it’s a stressful, rushed conversation. Research says that you get about 12 seconds of talking before your doctor interrupts you and starts hammering you with questions. You have to think on your feet because the conversation is forced and you know your doctor doesn’t have all the time in the world. 

One of the ways we’re mitigating this problem with Sherpaa is via good old-fashioned online communication. When you have a problem, you simply log in to Sherpaa and choose from:

  • I am sick
  • I am hurt
  • I have a mental health concern
  • I need a referral
  • I need a refill
  • I have an insurance question

After that you get a big free text box to write as much as you want with the time to think about what you want to write, free of interruptions from a harried doctor. 

The quality of the information we get as Sherpaa doctors is far more detailed and thought-out than your traditional office visit. When one of our clients creates a case, we typically get a few paragraphs of information, then we send back more detailed questions we need answered and then you again get unlimited amounts of time to think about how best to answer those questions.

It’s a highly efficient means of obtaining super high quality information. Given that a diagnosis is about 90% asking the right questions and 10% tests or imaging, I think we can be better doctors…online.

Because forced, stressful, synchronous communication is one of the worst means of communication known to humans.

I trained as a pediatrician at St. Vincents Hospital in the West Village. I think Vinnies was the reason why I stayed sane during residency. If I had to do my residency somewhere in Pennsyltucky, I don’t know if I could have made it. I needed the diversity, the beauty, the history, and the community. I needed the most beautiful neighborhood in the best city in the world.

And the West Village sure had the diversity. All you had to do was hang out in the ER on a Friday night and you’d see almost anything you could imagine. We had the celebrities right next to the well-known neighborhood drunks who made an appearance every weekend. We also treated the Brooklyn poor who were savvy enough to know that Vinnies was just a block away from the Manhattan-bound L train and was far superior than any hospital in Brooklyn. 

The one thing about being a doctor I just couldn’t handle is you are the point person for all the horrible things that happen in society. An NYU student jumps from the 10th floor of the library, you see it. In fact, I saw three of those one year. A kid in the projects a few blocks away tries to scale down from the roof of the building to enter his burned down apartment to get his video games, only to have his rope break from the 12th story, you see that too. You see the kid who was riding his skateboard on the sidewalk as his neighbor is mowing the yard who inadvertently runs over a baseball sending it into the child’s head at 300mph, yep, you see that too. Or the one month old who was riding in the back of an SUV on a treelined highway on a windy day that sent a tree falling into her parents in the front seat, killing them instantly. You see it.

The one thing I could never get used to was simply how often babies are born in toilets and left to be found by someone else only to be rushed to the ER and transported to our Neonatal Intensive Care Unit. Their first breath in this beautiful world is toilet water. This happens more than any of you could possibly think and I would care to remember. 

I no longer practice medicine. One of the reasons is because I’m a fairly optimistic “the world is a beautiful place” kind of guy and quite susceptible to my environment and the people around me. As a pediatrician, your world view is skewed toward the horrific. Hell, as any kind of doctor, you’re surrounded by sick people and death. This just wasn’t for me nor was it something I considered upon making my decision to enter medical school. If the vast majority of pre-med students knew exactly what they were getting into when they decided to become a doctor, we’d probably have very few doctors. Naiveté is necessary. But once I found myself in that world surrounded by babies born in toilets and random fatal accidents, I knew I had to do something else. I knew I had to be in a situation that wasn’t so bad for my emotional and mental health. I figured Preventive Medicine made sense— work with healthy people and keep them well. But who pays a doctor to keep you well? Nobody really. It’s estimated that 2% of our healthcare system’s dollars come from preventive measures. 

I’m extremely happy with my life and the decisions I made to do both a pediatric and preventive medicine residency. I don’t have to be on the front lines. Not everyone is cut out for that. And I can build systems that help doctors be better doctors and patients be better patients. I can build a platform that makes doctors more accessible, because accessibility is the best prevention. I’m honestly the luckiest man having stumbled into my newfound profession. I’d like to say this was all part of some grand masterplan, but my plan was to create my life by always being on the lookout for opportunities to build things that make healthcare better.

And I can look in awe at those amazing healthcare professionals who are on the front lines sawing babies out of sewer pipes in China. Hug one of them if you know one tonight and just say thank you. They sacrificed a blissfully ignorant worldview that most of us are lucky enough to have, to witness firsthand the shit of the world so they can save others. They are a special breed.

I got into The National back in 2005 and saw them at the 9:30 Club in DC on their Alligator tour. And ever since then, they’ve consistently created a body of work that gets better with each album. However, upon the first listen of each new record, it takes me about 2 weeks to realize that the newest record is better than the last one. 

I love this album. This song is one of their finest. Bryan Devendorf has to be the best drummer in rock right now. 

I also went a few weeks ago to see the movie, Mistaken for Strangers,  made by Matt Berninger’s brother who, at age 30, still lived at home with his parents in Cincinnati. Matt, the singer for The National, invited his younger brother along for 9 months to film a movie about The National on their tour supporting their last album. I think everyone, including Matt and his brother thought it was going to be a movie about The National, but in the end, everyone working on the movie discovered that the movie would be far more interesting if it was about brotherhood. The National is a super weird band, because it’s composed of two sets of twins, and then the lead singer, Matt. They’re a very symmetric band. It had parallels to another one of my favorite movies, Junebug. But if you have a brother, like I do, see the movie. It’s surprisingly wonderful and moving. After the movie, Matt, his brother Tom, and Matt’s wife answered questions from the audience. ‘Twas amazing. 

Part of being an entrepreneur is knowing when to shift tactics.

When you’re building something new like Sherpaa, you have no real precedent to see how other companies sold the product/service. You can’t learn from others. So you have to build something, get it out there, see how people react, and experiment with what works best. Once you get a hunch that something is more effective, you build that and run with it.

We created Sherpaa to increase access to healthcare and make healthcare affordable for companies. When we launched with tumblr in February 2012, I made an assumption that companies would pay for access to a doctor for their employees. We were right. We’re now up to about 40 companies. However, when Cheryl joined Sherpaa in May 2012, she brought a whole new level of expertise to the company. I knew the medical side of things. She knew the HR/health insurance side. So we combined our expertise and continued to sell Sherpaa as 24/7 email and phone access to our group of doctors, paid for by companies looking to offer their employees an amazing perk and save money.

Although some companies were willing to pay for perks for their employees, not every company wants to or can. However, every company has a mandated, yearly, big, hairy problem— they have to purchase health insurance. It’s such a pain in the ass and it’s confusing as all hell. I don’t want to bore you, but they essentially have two very old-school and boring options— a health insurance broker (picture a sleazy insurance salesman incentivized to get you to spend as much as possible) or a Professional Employer Organization (a creepy company that “hires” your employees, groups them all together with all the other companies they’ve “hired” and goes to health insurance companies as a large group to secure lower cost health insurance). This means you may work for “super cool internet startup company” but get paid by this creepy thing called Trinet or Ambrose, or ADP. PEOs also offer payroll. But payroll is easy with plenty of super affordable options. However, PEOs charge about $150-$180 an employee per month for all of this stuff they say they can do. So any cost they save by lumping you together for health insurance is offset by their monthly fees. There are a ton of problems with PEOs which is beyond the scope of this post. But for the most part, they’re designed to put out fires when you’re small. But once you grow bigger than 20 employees are so, it’s time to be a big boy company and get off the PEO or you have a financial albatross around your company’s neck.

The other option companies have are brokers. For the most part, you reach out to them once a year, they get your company the most expensive insurance they can get you to buy, and then they go away and say your employees are on their own. They did the job they were hired to do. However, they don’t help individual employees use their health insurance wisely and they are incentivized to maximize your spending.

I think there’s a massive hole in the market between a creepy, bloated, expensive PEO and a once a year conversation with a broker who’s not financially on your side. There needs to be an entity that can procure health insurance for you and also help you and your employees use that health insurance wisely on a daily basis so you don’t waste time or money.

But for the past year we’ve been selling Sherpaa as a perk (24/7 access to doctors!), not part of the mandated equation (purchase health insurance and get this super amazing benefit, 24/7 access to doctors!). So, all of that is changing. We’re focusing equally on procuring insurance for you and giving you access to our group of doctors. We procure the most logical health insurance for your company and then we partner our doctors with you and your employees so you use that health insurance effectively so you don’t waste time or money.

And, year after year, we get better and better. In fact, the companies we’re renewing for year two saw health insurance premiums increase half as much as what they would have increased without Sherpaa. We also discovered that employees covered by Sherpaa spent half as much on healthcare expenses this past year than we expected. Why? Because when you have a doctor available to you within a few minutes to speak with you and create a plan with you, you never waste time or money. We’re doing something wonderful here. Making healthcare accessible and more affordable. It’s my dream come true.

There’s currently a measles outbreak occurring in Williamsburg and Borough Park in Brooklyn. There have been 34 cases, 8 of which were in adults.

Here’a brief history of measles in America. This is what effective vaccines do: 

Measles is coming back because of a quack of a doctor in the UK who admitted to publishing blatantly false data for fame and notoriety. He falsely connected autism with the Measles, Mumps, and Rubella vaccine. He’s since admitted it and has been banned for life from practicing medicine in the UK. Rightly so. The body count is up to 1155. 

Measles is also coming back because of the anti-science movement (hipsters in Williamsburg?). The anti-vacciners are on par with the Christian Scientists believing that prayer will save your diabetes. If you are not vaccinating your children, you are simply rejecting science and one of the most remarkable inventions of humankind. On the same level as rejecting cars, planes, elevators, etc.. 

The issue of vaccinating your kids has very little to do with your kids, and everything to do with protecting the health of your community. Vaccinate your kids, and you’re doing your kid, your family, and your community a social favor. Don’t vaccinate your kids, and you are selfishly anti-social putting your kids, yourself, and your community at unnecessary risk of death.