Shafaat Choyon.
Thought leadership · essays on this site
Essays.
Original, in-depth pieces on AI, public health, health-tech and growth, dual-market field notes from the US and Bangladesh. New essays published regularly.
Bangladesh's e-health hackathon names the real bottlenecks
Bangladesh's health ministry has launched a national e-health hackathon aimed at diagnosis backlogs, unverifiable prescriptions and lost referrals, alongside a health database for nearly 200 million people. Those are rail problems, not app problems. Build the rails first.
Jan 16, 2027
AI scribes save 16 minutes a day, not an hour
The biggest study yet found AI scribes cut documentation by 16 minutes a day, and a 238-physician trial found one scribe worked and another did not move the needle. The gains sit with the minority who use them in most visits. Adoption is a change-management job.
Jan 15, 2027
Bangladesh's health budget crossed 1% of GDP. Spend it below the hospital
Bangladesh's FY2026-27 budget puts Tk 69,409 crore into health, 1.01% of GDP and the first time above 1%. Families still pay 79.3% of health costs themselves. The money will do the most good in community clinics, medicines and follow-up, not in new buildings.
Jan 14, 2027
Verification is the product, and now the FDA says so
The FDA wants generative and agentic AI devices tested the way we test doctors: benchmarked before launch, confirmed in the clinic, and monitored after. Bangladesh ran that kind of test on AI chest X-ray readers years ago.
Jan 13, 2027
Tariffs reach the shelf in a year: price like you mean it
New York Fed research finds about 90% of tariffs land on import prices almost at once, but in its scenario a 10% tariff lifts consumer goods prices only about 2.6% after a year. That lag is a pricing window. Bangladesh's brands show how to use it.
Jan 12, 2027
Medicare now pays for outcomes, not apps
Since 5 July 2026, Medicare's ACCESS model has paid tech-enabled care teams $360 a year for an early cardio-kidney-metabolic patient, in full only if at least half their patients hit clinical targets. The winners will be the teams that keep patients, and Bangladesh's blood pressure program shows why.
Jan 11, 2027
300 million people a week ask ChatGPT about their health
OpenAI says more than 300 million people a week ask ChatGPT health questions, and US users can now connect their medical records. Consent turned out to be a design problem. The next contest is over whose plain-language page the answer quotes.
Jan 10, 2027
Shoppers let AI compare, not buy
AI traffic to US retail sites rose 693% last holiday season, but only 14% of Americans are comfortable letting AI place the order. Bangladesh, where 86.8% of online shoppers still pay cash on delivery, shows how to design for that gap.
Jan 9, 2027
The people closest to health care believe more health myths
A 2026 Edelman and Yale analysis found that frequent users of the health system were over 1.5 times as likely to hold three or more divisive health beliefs. The doctor is still the most trusted voice. The clinic just is not built to be a messaging channel yet.
Jan 8, 2027
Epic turned the EHR into an agent factory
Epic's no-code Agent Factory lets health systems build their own AI agents on top of 120 ready-made AI features, with wide release in 2027. When the record becomes the factory, point solutions get squeezed, and integration becomes the strategy.
Jan 7, 2027
Bird flu reached Washington's dairies. Warn the task, not the town
H5N1 was confirmed on two Yakima County dairies on 8 October and in an exposed dairy worker a week later. The public risk is low and the worker risk is real, so one loud message fails both audiences.
Jan 6, 2027
Your next customer reads an AI answer first
Google now shows an AI Overview on 83% of branded US desktop searches, and most searches end without a click. The first sales conversation now happens in an answer you did not write. Here is how to earn your place in it.
Jan 5, 2027
Pre-eclampsia kills 42,000 mothers a year, and we know how to stop it
WHO's new roadmap says high blood pressure in pregnancy causes about 16% of maternal deaths. The tools are cheap and proven. Mothers die in the gaps between visits, wards and hospitals, so the handoff is the intervention.
Jan 4, 2027
Who is accountable when the agent decides?
In three months, two vendors in Medicare's AI prior authorization pilot denied 5,944 requests. The same government is spending $62.7 million on heart failure agents with accountability built in. The difference is an owner and an audit trail.
Jan 3, 2027
The $149 pill: GLP-1s become a subscription business
Weight-loss pills now start at $149 a month cash, and the price climbs as the dose does. That makes GLP-1s a subscription, and most subscribers cancel. Bangladesh, where the drug got cheap years ago, shows that price was never the whole problem.
Jan 2, 2027
AI took the first rung of the career ladder
New Census research finds graduates of the most AI-exposed majors are 5 points less likely to have a job soon after graduating, and earn 13% less when they do. Cutting the junior hire looks like a saving. It is a loan against your future leadership bench.
Jan 1, 2027
$11.1B and no IPOs: digital health is now an execution business
US digital health startups raised $11.1B in the first nine months of 2026, in fewer and bigger deals, and nobody has listed on a stock market since August 2025. Bangladesh's health operators never had an exit to count on. Their playbook is now everyone's.
Dec 31, 2026
Flat budget, new AI line: the CMO's third squeeze
Marketing budgets sit at 7.8% of revenue, and CMOs now put 15.3% of that into AI. Only 30% say they are ready to scale it. The AI line is not new money, so the question is which old line pays for it.
Dec 30, 2026
Half a COO: why fractional leadership is a growth model
One major search firm reports client demand for interim leaders up 310% since 2020, and 83% of independent executives say most of their clients have revenue of $1 billion or less. Only 22% name lower cost as a benefit. Companies buy part-time leaders for speed and skill, which makes fractional a growth model, not a budget trick.
Dec 29, 2026
Overdose deaths fell 12%. The safety net under that drop is being cut
US overdose deaths are down to about 67,800 a year, the third straight year of decline. The drop rests on Medicaid-funded treatment and harm reduction, and both are shrinking just as the drug supply shifts toward stimulants. Bangladesh shows what that next wave looks like.
Dec 28, 2026
LinkedIn reach fell by half. Here is what still travels
Third-party analyses say LinkedIn posts reach about half as many people as they did. LinkedIn's own numbers say time on content is up 10%. Both are true, and the gap between them is the new playbook.
Dec 27, 2026
The insular buyer: trust now ties with quality and price
In Edelman's 2026 brand study, 88% of consumers call trust an important or critical reason to buy, level with quality and value, and more than two-thirds want a brand headquartered in their own country. Bangladesh shows that "local" is earned, not registered.
Dec 25, 2026
Mixed messages, real costs: America now has two vaccine schedules
Ten months after CDC advisers ended the universal hepatitis B birth dose, parents get one answer from Washington and another from their pediatrician. The bill for a split schedule arrives as confusion first and infections later, and the clinic is now the message.
Dec 23, 2026
The contact center is the first AI P&L
Gartner puts a self-service contact at $1.84 and an assisted one at $13.50, and AI agents now sell from $0.99 an outcome. The contact center is where AI first shows up as a line on the books, and in health the bigger line is revenue.
Dec 22, 2026
Dhaka topped the world's dirty-air list, and winter hasn't started
On 6 October, Dhaka's air was the worst of any major city in the world, before the winter smog season. A new study puts the toll at 242 deaths a day across six cities and about $23 billion a year. The biggest single cause is heart disease, which tells us who should own the problem.
Dec 21, 2026
The ACA cliff turned patients into cash buyers
Marketplace deductibles jumped 37% to $3,786 and 2027 premiums are set to rise again. Millions of insured Americans now pay cash for most of their care, and Bangladesh shows what that market rewards.
Dec 20, 2026
Colorado rewrote its AI law: four duties every AI product will meet anyway
From 1 January 2027, Colorado will require four things of any AI that shapes a decision about your job, loan, insurance or care. They are narrower than the old law, and they are what a good product does anyway. Build them once, for the strictest market.
Dec 19, 2026
Medicaid work rules are a paperwork test, not a work test
From 1 January 2027, adults on Medicaid expansion in 43 states must prove 80 hours a month of work or study. Most already qualify. The ones who lose coverage will mostly lose it to paperwork, and outreach is the intervention.
Dec 18, 2026
After graduation, every shipment must prove its origin. Let AI build the file
When Bangladesh leaves the least developed country group, keeping preferential access means proving where a product's materials and processing came from, under different rules for each market. That proof is a data problem. AI can assemble the evidence file; a person still signs it.
Dec 1, 2026
Bangladesh's drug regulator has to go digital before 2029
Today was supposed to be Bangladesh's LDC graduation day. The three extra years are a registration window: generics approved before graduation are the ones the industry expects to keep cheap. The bottleneck is not the factories. It is a regulator still working largely on paper.
Nov 24, 2026
After LDC, growth is an operations job
Bangladesh has three more years before it leaves the UN's least developed country group. The preferences and cash incentives that let firms win on price are the part that ends. What replaces them is capability, and the leader who builds it has to understand operations, not just demand.
Nov 17, 2026
Dengue 2026: 114,000 admissions, and the peak arrived on schedule
Bangladesh has admitted 114,251 dengue patients and lost 352 lives this year, most of them since August. The surge is seasonal and predictable. Florida, with its biggest outbreak in a decade, is learning the same lesson.
Oct 31, 2026
Three more years as an LDC: what Bangladesh should buy with the time
On 29 October the UN General Assembly gave Bangladesh three more years before it leaves the least developed country group, to 24 November 2029. That keeps its trade benefits and cheaper medicines until then. The condition is reform, not rest, and the medicine clock is the one that matters most for health.
Oct 30, 2026
Losing measles elimination is a trust bill coming due
The US could lose its measles-free status in November, and Bangladesh just fought a far deadlier outbreak. One ran out of trust, the other ran out of vaccine. Only one is fast to fix.
Oct 28, 2026
The EU blinked on AI. Use the extra 16 months to build, not wait
The Digital Omnibus pushed the EU AI Act's high-risk rules to December 2027. The bans, the transparency rules and the fines did not move. Here is what changed, what did not, and what to build in the gap.
Oct 27, 2026
The Verification Gap in AI Code
96% of developers don't fully trust AI-generated code, only 48% verify it every time. The risk was never bad code, it's shipping with no verification layer.
Oct 7, 2026
The Shrinking CMO
Marketing budgets are flat at 7.7% of revenue, 95% of CMOs feel ROI pressure, and tenure hit a 10-year low of 4.1 years. What keeps a growth leader standing.
Oct 6, 2026
GLP-1 Spawned a Whole Services Economy: Separate From the Drug Itself
Three $100M+ raises hit GLP-1 services in H1 2026. The opportunity isn't the drug, it's the economy forming around it, from the US to Bangladesh.
Oct 5, 2026
Medical Debt's Racial Gap Is a Margin Question in Disguise
56% of Black adults carry medical debt versus 37% of White adults. Bangladesh's out-of-pocket burden resolves the same question differently, who absorbs the cost.
Oct 4, 2026
Rural America Is Running Out of Places to Give Birth
139 rural US hospitals have cut labor and delivery since 2020, a 13% drop in rural birth capacity. Here's the distribution fix hospitals aren't trying yet.
Oct 3, 2026
Retail Media Hits $203.9B While 76% of Purchases Still Happen In Store
Retail media is projected to hit $203.9B in 2026, up 14%, yet 76% of purchases still happen in stores. Digital-first hype meets where buying happens.
Oct 2, 2026
Loneliness Is Worse in Poor Countries, Not Rich Ones
WHO's Commission on Social Connection found loneliness hits low-income countries hardest, 24% versus 11%. The fix isn't a clinic. It's an accessible channel.
Oct 1, 2026
Building in public with AI: what I learned running my own
I didn't just write about AI this quarter: I ran it. A system built for my own work: 155 sessions, zero fabricated facts, verification built in from the start.
Sep 30, 2026
Aging happens fast now: before the systems are ready
Bangladesh's over-60s nearly double by 2050 with no home-care model; the US market tops $250B. Elder care is the next market almost nobody's building yet.
Sep 29, 2026
AI Now Vets Your Employer Brand Before a Candidate Does
38% of jobseekers under 30 used generative AI to research employers in 2025. A model's summary is now a candidate's first look at you. Employer brand needs GEO now.
Sep 28, 2026
The US Could Be Short 86,000 Doctors by 2036
AAMC projects the US could be 86,000 physicians short by 2036, but the real gap, at full care parity, is 202,800. Here's what that means.
Sep 27, 2026
Saves, Not Likes: What 300,000 LinkedIn Posts Actually Show
A 2026 report on 300,000 LinkedIn posts: saves outweigh likes, polls rank very low for follower growth, and hashtags haven't worked in years.
Sep 26, 2026
Voice-first AI for the next billion
The last billion online won't type: they'll talk. Voice skips the two barriers keeping AI from those who need it most: literacy and the keyboard.
Sep 25, 2026
The slow pandemic: antimicrobial resistance
Antimicrobial resistance may kill 39 million by 2050: three a minute, South Asia hardest hit. A behavior and communication problem, and so it's neglected.
Sep 24, 2026
AI can translate words, not localize culture
AI dubbing cuts localization cost 70-90%; translation is nearly free. But translating words isn't localizing culture: and that gap is where judgment wins.
Sep 23, 2026
The pharmacy is the front door of care
In Bangladesh care begins at the pharmacist; in the US ~50M live in a pharmacy desert. Same underused node: the pharmacy as health's real front door.
Sep 22, 2026
Commerce runs on chat, not storefronts
Bangladesh has 300,000+ Facebook and Instagram business pages, most run by sellers working from a chat thread. People buy from a person, not a store.
Sep 21, 2026
Heat Kills on Moderate Days, Not Extreme Ones
NYC data: 80% of heat deaths happen on moderately hot days, not extreme ones. The highest-impact public health message is rarely the dramatic headline.
Sep 20, 2026
AI's Real Bottleneck Isn't the Model, It's the Grid
Data center electricity demand grows 26% in 2026 to 565 TWh, with AI servers drawing 31% of it. Power, not model quality, is now deciding who wins the AI race.
Sep 19, 2026
The dual-market operator's edge
Most operators compete in one market. I read two: the US and Bangladesh: daily. Seventeen years taught me that bridge is a position no one else can occupy.
Sep 18, 2026
The nutrition transition: the environment is the disease
Bangladesh now carries undernutrition and diabetes at once; the US drowns in the same processed calories. The food environment, not willpower, is the disease.
Sep 17, 2026
The model's blind spot is your opportunity
AI models learn from a lopsided web. Every language and market it underrepresents is where models are weak: and where you can win. The gap is the opening.
Sep 16, 2026
Femtech: health's clearest open market
Women's health is worth tens of billions, yet barely 4% of biopharma R&D addressed it. The under-served half of the population is health's clearest open market.
Sep 15, 2026
Create the category, don't compete in one
Positioning wins a slot someone else defined. The stronger move: design the category itself: name the problem, set the terms, become the default answer.
Sep 14, 2026
LinkedIn's Algorithm Reads Your Bio Before It Reads Your Post
LinkedIn's 2026 algorithm reportedly reads your headline and About for topical authority before deciding a post's reach. Credibility is set before you hit publish.
Sep 13, 2026
FemTech's £1.5M Government Check Is an Anchor, Not Just Funding
The UK launched a £1.5M FemTech fund under its Women's Health Strategy, public money now formally backing a category private demand alone couldn't scale.
Sep 12, 2026
The remittance-to-health pipeline
Bangladesh took in a record $35.56B in remittances while ~70M face health hardship. Connect them: the country's biggest untapped health-financing rail.
Sep 11, 2026
The mosquito economy: dengue is a climate problem now
Bangladesh logged 102,000+ dengue cases last year; 2026 is climbing. It's no longer only ours: local dengue is turning up in the US. Climate rewrote the map.
Sep 10, 2026
The call-center cliff and AI voice agents
AI voice agents are coming for the call-center economy: Bangladesh built ~$850M and 85,000 jobs on it. Can we move people up the value chain fast enough?
Sep 9, 2026
Trust in the pill: the counterfeit-medicine problem
One in ten medicines in poorer countries is substandard or fake: a trust collapse you engineer out of the supply. Rich-world shortages open the same door.
Sep 8, 2026
Measure the number you're avoiding
Every team measures something. The winning ones measure the number they'd rather not look at: and decide what to count before they start, not after.
Sep 7, 2026
Where Did the Graduate Jobs Go
UK graduate job ads fell 33% in a year, and 17,000 vacancies drew 1.2M applications. What the squeeze means for employer brand, from the UK to Bangladesh.
Sep 6, 2026
507 Million Children by 2040: A Capacity Problem, Not a Willpower One
World Obesity Atlas 2026: 507 million children overweight or obese by 2040. China, India, and South Asia lead the scale. Health systems need a 15-year plan now.
Sep 5, 2026
The quiet epidemic: tobacco and the new nicotine
Tobacco kills ~158,000 a year in Bangladesh: one in five deaths; the US fight moved to youth vaping. Same economy, opposite framing: shaming never wins it.
Sep 4, 2026
Roads are a health crisis we refuse to own
Bangladesh had its deadliest road year in 2025: 9,000+ lives: while the US cut its toll. Same machine, opposite paths: one treats road death as designable.
Sep 3, 2026
When the buyer is an AI, not a person
Google's agentic checkout and shopping inside ChatGPT mean the next shopper is an agent, not a person. Agentic commerce could reach $3 to 5T: few brands are built for it.
Sep 2, 2026
The cold chain is the product, not the pill
US drug shortages hit 223 in early 2026, lasting five-plus years. For medicines, logistics is the health outcome: and whoever owns the last cold inch wins.
Sep 1, 2026
Pricing is positioning, not a spreadsheet
Your price is the loudest thing your brand says. In cash markets where every taka is felt, pricing is your sharpest positioning decision: not a spreadsheet.
Aug 31, 2026
The Gen Z Pay Cut for Ethics
89% of Gen Z say purpose at work matters to their job satisfaction, and two-thirds of young UK workers would take less pay for an ethical employer. Why employer brand is now a P&L lever.
Aug 30, 2026
Verification Is the Real Product of Running AI in Production
The gap between an AI demo and a production system is verification architecture. Inside the source-checking and refusal design that keeps 155 sessions fact-clean.
Aug 29, 2026
The $200M question: where to spend it on health
The World Bank put $200M into Bangladesh's primary care. Given real money, where does a health dollar actually change an outcome? My answer isn't a shiny app.
Aug 28, 2026
Clean hands, still: the cheapest health tech we underuse
Bangladesh hit 98% water access, yet arsenic poisons ~50M; the US is still pulling 9M lead pipes. Water and hygiene: the highest-return health tech, underused.
Aug 27, 2026
CSAT Over Revenue
55% of CMOs now name customer satisfaction, not revenue growth, as their primary success metric, up from 42% in 2023. What that quiet shift actually means.
Aug 26, 2026
The lab is the wedge: diagnostics-led care
In cash-pay markets the cheapest way into care isn't a doctor: it's a test. I built care that led with the lab, the model richer markets rediscover at home.
Aug 25, 2026
Losing One Nurse Costs a Hospital $60,090
US hospitals lose $60,090 every time an RN leaves, $5.19M a year on average. Why retention is a P&L problem, not an HR one.
Aug 24, 2026
The Creator Economy's Math Problem
207 million people call themselves creators in a $248.95B market, but only 4% earn over $100K a year. The gap between reach and revenue, and why it matters.
Aug 23, 2026
AI Is Now Beating Human Drug Discovery on Its Own Numbers
200+ AI-designed drugs are in clinical development with 80-90% Phase I success versus 40-65% traditionally. AI isn't just faster at discovery, it's more accurate.
Aug 22, 2026
AI Closes the Diagnosis Gap Bangladesh Can't Wait For
Bangladesh has 170M people and a specialist shortage no pipeline closes fast enough. AI triage isn't a supplement there, it's the first clinician many meet.
Aug 21, 2026
Air quality is a health emergency nobody owns
Dhaka's air ranks among the world's worst: PM2.5 ~13x the WHO limit: and US wildfire smoke made the threat American. High-leverage, and no one owns it.
Aug 20, 2026
Zero Digital Health IPOs in Six Months: the Exit Bar Just Changed
Zero digital health IPOs landed in H1 2026. Hinge Health's stock doubled anyway, because it cleared the Rule of 40. Here's what changed.
Aug 19, 2026
Financing the uninsured: the missing rail in health
In Bangladesh, out-of-pocket costs are ~68.5% of health spending; ~70M face hardship. The fix isn't a clinic: it's a payment rail I built at national scale.
Aug 18, 2026
The authenticity dividend - your last real moat
In a feed drowning in AI sameness, the scarce thing is proof a person made it. Notes on trust: from Dhaka's markets to the backlash against AI slop.
Aug 17, 2026
The First Fully AI-Designed Drug Could Get FDA Approval Within the Year
Insilico's rentosertib is the first fully AI-designed drug in Phase IIb, with a 60% shot at approval by 2027. Why verification, not design, is the real bottleneck.
Aug 16, 2026
Companion Bots Just Got Regulated Like a Health Product
California's SB 243 and a parallel New York law now require AI companion apps to disclose, detect self-harm risk, and protect minors, after 72% of teens used one.
Aug 15, 2026
86 New AI Medical Devices in One Quarter Is a Maturity Story
Q2 2026: 86 new FDA-cleared AI/ML medical devices, spreading beyond radiology into cardiology, dental, and pathology. This is regulatory maturity, not hype.
Aug 14, 2026
The first 1,000 days: the highest-ROI window in health
Bangladesh cut maternal deaths 79%; the US is the only developed country where they rise. Conception to age two is where a health dollar does the most work.
Aug 13, 2026
Frugal innovation as a design philosophy
The West calls it "frugal innovation." In Bangladesh we called it getting it done. The design principles of 2026 are what scarcity taught us years ago.
Aug 12, 2026
The last mile - health tech's untapped value
Most health tech serves the first mile: the hospital. The untapped value is the last mile: the person far from care, reached where they are.
Aug 11, 2026
Clarity is an intervention, not polish
We treat clarity as polish. It isn't. Confusing health guidance has a body count and a price tag: clarity is itself a health intervention.
Aug 10, 2026
The personal-brand playbook for the markets everyone ignores
The most underrated growth asset in 2026 isn't a company brand: it's a person's. And the biggest opening to build one is where Western creators aren't looking.
Aug 9, 2026
The trust cold-start in two-sided health platforms
Every platform faces the same first problem: nobody comes because nobody's there. In health it's worse: the currency isn't supply and demand, it's trust.
Aug 8, 2026
The DRC's Ebola Outbreak Is a Trust Problem, Not a Virology One
1,406 Ebola cases in the DRC, and WHO cites community mistrust and violence as the active blocker, not the virus. Outbreak response is a trust problem first.
Aug 7, 2026
The workforce crisis and the community-health-worker answer
America's health system is short of people, not technology. The answer is a model Bangladesh has run for decades: move tasks to those closest to the community.
Aug 7, 2026
The consent problem - health AI's real bottleneck
Every debate about health AI fixates on accuracy. What actually stalls it is trust by design: consent, privacy, and provenance: the layer nobody demos.
Aug 6, 2026
Everyone says "AI-powered" - position on the job
When every booth claims the same edge, the phrase means nothing. Positioning must move where copycats can't follow: the job the customer is hiring you to do.
Aug 5, 2026
Telehealth's Fourth Extension Shows Regulatory Uncertainty Is a Distribution Problem
DEA and HHS extended telemedicine prescribing through 2026, a fourth temporary fix, still no permanent rule. Uncertainty is itself a distribution problem.
Aug 4, 2026
Prevention-first: the design window that closes
The US didn't choose sick-care: it backed into what the money rewarded. A market still building its system has an option the US lost: put prevention first.
Aug 4, 2026
How mental health became the premium category
Investors once treated mental health as charity. In 2026 a mental-health app sold for $835M. The demand was always there: someone designed around the barrier.
Aug 3, 2026
After the scribe: where health AI goes next
The AI scribe was the easy win. The real 2026 question is what AI does after the note: in the back office where the money and the misery live.
Aug 2, 2026
The EU AI Act's Enforcement Deadline Is a Redesign Brief
The EU AI Act high-risk rules now start 2 December 2027, with fines up to €35M or 7% of global turnover. Compliance is a redesign problem, not a legal one.
Aug 1, 2026
Stop throwing away what you publish
The most wasteful thing in content isn't a bad idea: it's a good one you published once and dropped. Atomize a few durable assets instead of churning posts.
Aug 1, 2026
Telehealth's second act: care that comes to you
Telehealth's first act was pandemic video for the waiting room. The second act is less a video call and more care delivered to your home, on your schedule.
Jul 31, 2026
Shame is a design flaw: not a personal failing
Shame feels like clarity but works like a wall. In health comms, stigma is a barrier you design around: channel, framing, segmentation: not lecture away.
Jul 30, 2026
Provenance over volume - AI's next health win
The AI health rush chases the wrong verb. Everyone races to generate more; the scarce thing was never volume: it's proving what's true and where it came from.
Jul 29, 2026
Retention is the real growth engine
Acquisition costs rose ~60% in five years. Winners obsess over the leaky bucket: cash markets taught me retention, not reach, is the growth engine.
Jul 28, 2026
When patients pay cash, everything about the product changes
In the US, health products are built for a payer. In most of the world the patient pays: and that fact is a design discipline the US is drifting toward.
Jul 27, 2026
A hotline on a bar of soap: the object is the channel
Praava's doctor hotline on Lifebuoy soap took about 3,000 calls a day. The lesson: borrow an object people already hold, then staff the line behind it.
Jul 26, 2026
AI for the two-person Dhaka business
Everyone tells the enterprise AI story. The one that matters: a two-person Dhaka shop running like a twenty-person one: an SME's first affordable team.
Jul 25, 2026
When nobody trusts anybody, trust is the growth strategy
In low-trust categories, trust isn't a brand value: it's the growth engine. From moving 10 million onto digital payments where trust was the entire barrier.
Jul 24, 2026
The middle is disappearing: digital health's $4B quarter
Digital health raised $4B last quarter and 12 companies took 59%. What that concentration and "AI as table stakes" mean for everyone who isn't a megadeal.
Jul 23, 2026
GLP-1s: the drug was never the hard part
Only ~12% of Americans take a GLP-1, and most who start quit. Pharma solved the biology; behavior and adherence decide the outcome: the layer I've built on.
Jul 22, 2026
The agentic solo operator: a team of one
Agentic AI removed the ceiling on what one operator can ship. Field notes from running a full growth engine solo: where judgment, not labor, is the limit.
Jul 21, 2026
The pendulum swings back to brand
Performance marketers report diminishing returns, ad spend passed $1T, and AI floods every channel with sameness. The scarce asset: a brand people trust.
Jul 20, 2026
Where health AI actually lands by 2027: a builder's bet
Adoption is done. Three bets on where health AI actually lands by 2027: people over models, judgment, and plumbing: each grounded in work I've shipped.
Jul 19, 2026
I rebuilt my website to be read by AI, not just Google
80% of searches now end without a click. Field notes on optimizing for answer engines: structured data, llms.txt, and becoming the source AI actually cites.
Jul 18, 2026
The healthtech leapfrog Bangladesh already made
Bangladesh jumped from cash straight to mobile money. In health tech the same leapfrog is the opening: build access-first, not a copy of the US. I've run it.
Jul 17, 2026
Measles is back: a trust problem, not a supply problem
The US passed 2,200 measles cases in 2026: a trust problem, not supply. Why messengers beat facts, from a soap-packet hotline in Dhaka to a US campus campaign.
Jul 16, 2026
Bangla-first AI: the market the giants keep skipping
Bengali is a top-seven world language and barely a fraction of the web. A builder's dual-market case for the opportunity the giants overlook.
Jul 15, 2026
Health communication that changes behavior
Field notes on segmentation, friction, framing and measurement: the principles behind campaigns that move behavior, not just awareness.
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