ACHIEVE PODCAST

When I was about ten, a family friend who had migrated left behind an ancient Tandy TRS-80 in Trinidad, and I taught myself BASIC on that machine because I was convinced a computer could help me practice medicine better. [D&D; VITAE 1989]

I did my MD/PhD at Penn over ten years, then took a position at CHOP under Hakon Hakonarson, where we built NeuroFix Therapeutics for ADHD. The genomic engine powering our discoveries barely touched the Black community around the hospital in West Philly, and that finding lit a flame that has never gone out. [D&D; Nat Genet 2011]

I went to Stanford for pathology residency, lasted one year, and quit when Atul Butte said "come work with me." Together we won $38 million in NIH grants building on the UC data lake he'd unified across five medical centers. I published Alzheimer's deep learning in Radiology in 2018, though I wish I'd known in time for my own mother, who now lives with me. I will likely get it too, which is why I need to institutionalize my memory so that my legacy outlives my mind. That is what CANONIC is. [D&D; Radiology 2018]

mammochat.ai · caribchat.ai · gorunner.pro — mortgage to mammogram, same governance.

UCF recruited me in 2019 as the founding Chief of AI, and I built MammoChat across 51 AdventHealth hospitals. But where California had Atul's unified data lake, Florida was fractured and siloed, with no culture of cross-institutional collaboration. When the legislature passed the Stop WOKE Act, post-tenure review, and SB 266, the University of Florida lost 1,800 faculty in a single year, and New College (my alma mater, where my senior thesis was an expert system for diabetes insulin dosing) lost a third of its professors. No lawyer would let any collaboration pass, because frozen is worse than hostile. [VITAE: UCF 2019-2025; thesis]

So I separated. UCF still runs the clinical trial, because that is what they can do. We build the learning community around it, and because we move at the speed of innovation outside academia, we won the $2M Casey DeSantis Cancer Innovation Award. I-Corps at UCF taught us customer discovery (over 70 interviews), and that foundation carried straight into the grant. The governance structure satisfies Tallahassee's reporting requirements by virtue of its design, not because a committee approved it. [VITAE]

Today I'm a founder of one, with BedaSoftware out of Sydney as my engineering partner (they built New Zealand's national electronic health records). Patients use MammoChat and CaribChat, providers use OmicsChat for ABOPM certification, and vendors use GoRunner for real estate ops. All governed, all federated, all FRAND, with the community tier free forever. I build from a garage office in Orlando with six kids in the house, and that constraint is what produced the architecture.

As a pathology resident at Stanford in 2012, I rotated on the molecular pathology service and signed out cases every day where we sequenced a patient's tumor and found variants of unknown significance — mutations nobody had characterized yet. If I discovered that a VUS was clinically significant, that knowledge might stay at Stanford. Maybe it reaches ClinVar after a publication cycle. But it would never reach the community oncologist in Trinidad or the rural hospital in Florida where my mother gets her care. The intelligence exists. It just can't travel. I quit residency after one year. Atul Butte said "come work with me," and I didn't hesitate.

We spent six years together — Stanford then UCSF — and won $38 million in NIH grants building on the UC data lake he'd unified across five medical centers. I moved to UCF in 2019 as founding Chief of AI in Pathology. Then Atul died in June 2025 from MPNST, and his wife Gini asked me to preserve his words. That December, I was writing about Henrietta Lacks when I created a file called CANON.md and realized what I'd written wasn't documentation but a grammar: governance IS compilation. I called it CANNON with two N's — a typo at midnight on New Year's Eve — and the name drifted to one N the way a neutral mutation fixes in a genome, which is Kimura's theory from my PhD applied to language. I compiled Atul's 48 YouTube transcripts using that architecture. The book is live at atulisms.com.

We filed the architecture as six patent families with ninety claims. The examiner ran 252 prior art searches and found nothing blocking, because nobody had patented AI that governs itself — not AI that gets governed by committees, but AI that compiles its own governance contracts the way blockchain compiles financial ones. The patents aren't about AI. They're about AI governance.

The First Lady of Florida was diagnosed with breast cancer, and the experience led to the Cancer Innovation Fund, which awarded us two million dollars to build MammoChat. That's 20,000 governed patient interactions across 51 hospitals, and any woman in America can use mammochat.ai right now for free. [VITAE: NCT06604078, FL DOH]

CaribChat has been endorsed by the Organisation of Eastern Caribbean States, which represents 15 sovereign nations, and we're launching at the CAOH conference in Trinidad this July with Marisa Nimrod as co-investigator. The EU AI Act goes into full enforcement on August 2, 2026, with penalties of up to 7% of global revenue, and Brussels is still not ready. Small islands beat big continents.

We've published 65 blog posts across 16 eras, including "729 Hallucinations," "IRB Without a Law," and "Stop Prompting, Start Governing." The content isn't marketing; the content is the product demo.

Market timing: We published two papers quantifying the governance gap at over $600 billion annually ($255B US, €344B EU), with 82% of those failures preventable, but most institutions are still in the "we'll deal with it later" phase, which is the posture of every organization that hasn't been sued yet.

Cultural trust: Soursop has documented anticancer properties in the literature, but it also has documented herb-drug interactions with certain chemotherapy regimens. CaribChat acknowledges the tradition, flags the interaction, and tells her to talk to her oncologist. That's a governance constraint in the compiler: if it fails, the build fails. The ungoverned answer does not reach the patient.

Capital: I build from a garage office with six kids and no venture funding, but if you design for the valley of death from day one, your architecture assumes scarcity instead of abundance, and you cross it leaner than anyone who tried to throw money at the gap.

I use Claude as my primary development partner, and we've done over 1,100 governed sessions together. Every session produces a transcript that gets SHA-256 hashed, the patterns promote into our learning system, the learning compiles into context that governs the next session, and the loop closes.

For entrepreneurs: Think about what blockchain did for financial contracts: it created a distributed ledger that enforces agreements without a middleman. Now imagine the same idea applied to institutional trust. Every clinical response cited, every vendor task COIN-minted, every compliance requirement met automatically. Agents that enforce contracts.

Federated: Trinidad's patient data stays in Trinidad, and the architecture delivers HIPAA compliance by construction, not by contract. GDPR by construction. Caribbean data sovereignty by construction. The same pipeline that governs clinical AI also compiled ATULISMS from YouTube transcripts and governs GoRunner's real estate operations.

Caribbean: CaribChat launches at the CAOH conference in Port of Spain this July, with 15 OECS nations endorsing governed clinical AI. We're co-filing patents with St. George's University and there's a JAMA paper in progress: sovereign AI for Small Island Developing States.

Two boards: CAOH governs Caribbean oncology while ABOPM governs US precision medicine; CaribChat serves CAOH's patients and OmicsChat serves ABOPM's providers, with the same governance compiler underneath both sides of the Atlantic.

COIN: Patients use MammoChat and CaribChat for free (always), providers and vendors earn credits for contributing governed evidence, and institutions spend credits for governed intelligence. The value accrues to the people who create it, not to a platform that extracts it. All governed, all federated, all FRAND.

1. Perseverance needs a scorecard. We've published 65 blog posts across 16 eras documenting every phase of building this company. That's not content marketing; that's the scorecard. If I ever stop writing, it means I've stopped learning.

2. Outrun the bureaucracy. When the institution's lawyers get scared, don't fight them; outrun them. GoRunner is live, MammoChat is live, CaribChat launches in July, and none of them waited for committee approval.

3. Submit to your own system. The compiler that audits clinical AI also audits the sessions that built the compiler; the governance architecture scores 255 on itself. If you wouldn't submit to your own product, your product isn't good enough yet. Atul taught me that about data, and Dario Amodei, the CEO of Anthropic, taught me that about AI safety.