Bill Ackman: The Biggest Fight of His Life

The Knowledge Project

Bill Ackman discusses his daughter Lucy's life-threatening brain hemorrhage and the subsequent creation of the Ackman-OXman Institute (AOI)

Key takeaways

• Ackman's daughter Lucy is recovering from an arterial venous malformation that caused a severe brain hemorrhage.
• The Ackman-Oxman Institute (AOI) will focus on brain rehabilitation, recovery, and longevity through advanced technology and nutrition.

Main topics

• Brain rehabilitation and longevity
• AI-driven business disruption

Notable quotes

What AI has done is massively increase the risk of disruptions.

Conclusion

A profound exploration of how personal crisis can drive institutional

Transcript preview

Speaker 2 (0:00) So the thing that you need to think through is the risk of disruption. What AI has done is massively increase the risk of disruptions. Speaker 1 (0:12) You've had a challenging year this year with Lucy. What happened? Speaker 2 (0:16) You know, otherwise healthy child, what happened was she had, unbeknownst to us, what's called an arterial venous malformation, which is a kind of structure in the brain where the way the doctors describe it is the arteries. You know, typically blood flows into the arteries and then to the capillaries and then to the veins. And when you go from arteries where there's a huge amount of blood flow to capillaries, the blood flow slows down. and then to the veins so that in her case she had what like a bridge that went from the artery directly to the vein so over time there was too much pressure going into the this these veins in her brain and one of those veins burst and then a large amount of blood you know filled her brain which is a confined volume and so it's you know it's a bit like a balloon blowing up inside your brain and that put pressure on the surrounding brain and the skull, and obviously the skull doesn't move, so the pressure goes downward. It puts pressure on the midbrain. The midbrain is, you know, what keeps you breathing, keeps your heart beating. And the really unfortunate thing, we believe this happened around nine in the morning, based on her aura. She lived, you know, young woman, lives alone in Williamsburg. And I texted her at four o'clock that day. I had called her another time that day. Other family members had done the same. but only when she hadn't picked up her luggage. She was leaving for Abu Dhabi for a wedding. A friend of hers was getting married the following day, and she was picking up her luggage from her mom's house. And she didn't show a couple, when she was two hours late, and no one could reach her that week. I was sleeping at the time, but my oldest daughter went to find her, and they found her lying, she found her lying on the floor of her apartment, barely breathing, you know, face down on the right side. So, and she thought she was dead. Called 911. She could hear her breathing in a very labored way. And then, I don't sleep next to my cell phone. My daughter doesn't know the landline number for my house. So she was able to call someone in the building. Guy in the building knocked on the door. You know, pounded on the door. And handed me the phone with my daughter on it. And then hopped in a cab. The EMT didn't know which hospital to take her because they didn't know what had happened to her. One of the big problems. Sometimes, you know, the EMT thinks someone's just drunk, and that's why they fell. And the way you treat a drunk person is you just let time go by, right? Time going by for a person with a brain hemorrhage is very, you know, the more time the brain is under pressure, the more damage that can take place. Got to the hospital at 12.05, and she was just, you know, sitting on a gurney there while they were trying to figure out what she had. Eventually, they gave her a CT. They figured out she had a hemorrhage. They called the surgeon. And what you need to do is you need to release the pressure on the brain as quickly as possible. And the way you do that is you remove about 40 % of the skull to allow the brain to expand beyond the skull. And we moved her from Elmhurst Hospital, by the way, very pleased with how they cared for her there, City Hospital in Queens. We moved her to Mount Sinai where, you know, Neri and I spent some time helping Mount Sinai. So we knew the team there. And they also have very good neurosurgeons and a neuroscience brain practice. And, you know, she was on a breathing tube. You know, she was wearing some, she had bandage, of course, on her head, and it said, no bone, right, to make sure the nurse is nude, not to be careful. And that's how we started. And so, you know, I basically gave the doctors the, what I call the dare to be great speech. I said, you know, let's... Let's see what can be achieved by, you know, whatever you need from us, unlimited resources. You know, let's look at latest and greatest technologies. I mean, they basically told us, you know, look, Bill, we don't know what kind of deficit she's going to have. You know, 19 hours of pressure on the brain. You know, I didn't learn actually until weeks later they don't normally do the surgery to save someone when it's been more than five hours because the assumption is brain death, basically. So 19 hours, she's close to death. hours, minutes, I don't know exactly. And so we didn't know what would become of her, but I'm a very optimistic person. And she's regained over time her cognition. She's the same Lucy we knew. She's got the same sense of humor. She's really kind of remarkable. She woke up not being able to walk, to speak, and unfortunately to see. Her walking is coming back. I think she's going to regain her ability to walk. Her speech very slowly is coming back. There's something like 17 vowels beyond the vowels that we were taught. And she can do about 15 of the 17 now. Each day she's almost learning a new consonant. She can say a few words, certainly know she's quite good at. And then vision, she's even shown some progress there. But I've spent a lot of time working with the doctors and... My pitch to them was, let's see what we can do for her and everything we learned for her, we can help others. And Neri and I are going to make this available to everyone. Speaker 2 (5:33) And three months after, I guess, I was coming back from my birthday party, and I got a call from a friend. We were talking to Mount Sinai, actually, about doing a redevelopment of their Fifth Avenue campus to build a brain institute, some kind of brain center. And we had very aligned with their idea. The problem with that is it's probably a 10-year project and super complicated, obviously, taking down an existing hospital, moving people, bringing people back. And a vacant biotechnology building became available on 65th and 11th Avenue, 10 blocks from the office. And 60 days later, we closed the building. We signed a contract to buy the rest of the site. It's a 3.4-acre site. And our goal is to build the world's greatest brain institute. You know, everything from a focus on the patient. How do we get treatments to patients? And there's a ton of interesting things going on in technology. Obviously, everyone knows Neuralink. but there are probably a dozen other companies working on brain-computer interfaces and other ways to get data from the brain, and of course, AI. So not only are we able to get more and more data from the brain, we're able to interpret that data better than ever before. So I'm hoping Lucy can speak normally and on her own, just working at it. I'm hoping her vision returns. But if she has deficits in those areas, there will be solutions in the relative short to intermediate term. Envision a world in where you wear a pair of glasses that basically have a camera, and the camera takes in the vision and kind of ports it to your visual cortex, and that's how you see. I mean, that will be how Elon says he's going to have a rudimentary way for people to see within a relatively short amount of time, and within five years, actually. I've reached out to pretty much everyone for help on this. And he told me, he said, five years, people will have better vision than, well, bionic vision, in effect. The way Dr. Kellner describes it to me is that, it's been Lucy's lead on this whole thing, a lot of neurologists and even neurosurgeons are nihilists. They don't believe that the patients can make really material recoveries, and they can. And we've heard a lot of interesting stories of recovery, which are great to share with Lucy. But we're going to be able to do a lot more. And New York's actually probably one of the best places to do this. And there isn't anything like it. Speaker 1 (7:59) So we're excited about it. What you guys have done in response is just incredible. Speaker 2 (8:04) Yeah. So what's interesting is that all of the skills, experiences, relationships, resources that I've developed over my career work set me up to be incredibly well positioned to help my daughter and to help other people that have this problem. I'm like a real estate investor. So I was able to buy the building at a fraction of... of what it cost and architecture, design. I'm also married to a very talented architect who's gonna play a pretty important role here. So I think we're gonna do something really interesting. And we've had an incredible outpouring of people who wanna be part of this, who in many cases, we love people who write to us, who've dealt with this on a very personal level, have a brother, a sister, a mother, a parent who've suffered and they've seen kind of the nature of the treatment that's available today and they want to change that it's interesting and actually you know people say bill how do you deal with something like this well the first thing i had to do is figure out how to help my child and as i made progress with that this other thing is an amazing you know makes me feel like something good is coming out of you know i have this view that you every bad thing something good comes from it you know this is among the good that's coming from what she's going through And that makes me feel good. Did you always have that view or was that learned? I figured that out over time. When? Was there a moment when not? Well, you know, I've had a few near-death experiences in business. And in each one of those cases, I was materially better off after that. So those are kind of, you know, good lessons. What does not kill you makes you stronger thing is definitely true. And by the way, for my child, for Lucy, I think this is gonna be good for her. Say more about that. Look, she's a wonderful, amazing person, but if you can recover from something as devastating as this, it's gonna make her into, like, a superhuman person. And she was... she is a wonderful human being. I mean, one of the things that's helping her recover is, you know, one, you know, her mom has been there every day. You know, I moved my office into the hospital. You know, that... within a day of her moving into the hospital, I did two IPOs, the two Pershing IPOs I did from room 1107, room 107 on the 11th floor of 11 West at Mount Sinai Hospital, on the power of Zoom. So I would do a Zoom meeting for 45 minutes, and then I would go spend 15 minutes with my daughter. And then I'd do the next meeting. And so I had my daughter as the inspiration, you know, for these two IPOs. that we were working on, and we only moved her out of the hospital August 8th, and she's been rehabilitating in Bridgehampton. And then she's coming back into the city, you know, for a little procedure, and then she's moving into her own apartment that we've been... We bought an apartment in our building within a few weeks of the incident, and we've been designing it to be, you know, the best rehab, recovery place for her to live. And... Speaker 2 (11:16) You know, socialization, social interaction is absolutely critical for someone recovering from something like this. The emotional support that you get and everything, and her friends have been amazing. Her friends have been with her every day. Every day, one or more of her friends shows up and talks to her, eats with her, engages with her. And, you know, she's like this super giving person, ton of friends. Everyone loves Lucy. And so she's getting an amazing return on that. you know because Speaker 1 (11:47) her Speaker 2 (11:47) friends are are showing up to save her all Speaker 1 (11:49) of this makes me feel that humans can be so amazing yeah Speaker 2 (11:55) i mean you know the uh you can recover from almost anything yeah um Speaker 2 (12:02) And by the way, there's a lot more hope for people who've had strokes, brain injuries, military, TBI-type stuff. And there are a number of people in the field that have been really frustrated with... you know, how far we've not gone, who want to be the Speaker 1 (12:22) ones that fix this. What's been preventing us from going further? Like, why haven't we pushed the limits on this stuff? Speaker 2 (12:28) The answer is some combination of the insurance industry and just economics and hospitals, how they work. I mean, a neurosurgeon wants to do their surgery and then move on to the next one. Neurosurgeons are highly compensated, but they get paid for doing surgeries. They don't get paid for the recovery of the patient over time. You know, rehabilitation, every... hospital has some kind of rehabilitation program, but in many cases it's embarrassingly inadequate. And the insurance company might pay for only six weeks of care. And then they get sent home. And their home is not the ideal place. And it's in a major, takes a village. What if they're the principal breadwinner and they're devastated by this? Maybe the other family member has to go out and work as opposed to care for them. One of the most depressing things I was told. by the head of rehab at Mass General, who we've been talking to. He said, Bill, you know, what Lucy's achieved is remarkable. She's had incredible care. The typical person, one, they wouldn't do the surgery. Two, if they do the surgery, the typical patient ends up in a nursing home when they check out of the hospital because the family can't take care of them, and they die a few months later from pneumonia because just the care that can be achieved in a nursing home. It's like super depressing. And so, you know, this is one of the cases where, you know, I'm financially unconstrained in my ability to help her. And so we can maximize the care. Now, what we're going to try to figure out in the Institute is how we do this in a way that everyone can have the benefit of the care and technology is going to help a lot. A great speech therapist could be $500 an hour. That, you know, insurance will pay for whatever percentage of that, but only for some period of time. But people can keep recovering years and years later. But of course, AI could be an amazing speech therapist. So there are lots of ways that technology are going to enable us to help people recover Speaker 1 (14:20) from these injuries. And by the way, this all, Speaker 2 (14:21) you know, we're calling it, the focus is brain rehab, recovery, and longevity, right? What does a brain rehab recovery institute do? It focuses on brain recovery and your physical recovery. The brain plus your physical recovery is fundamentally longevity. And the other thing that hospitals aren't very good at is nutrition. The food in hospitals is frightening, right? They have someone who has a heart attack, and the next morning they're having like pancakes with orange juice. In Lucy's case, we made food for her for every meal. The Institute's gonna have amazing food. Because nutrition is, you know, critical. So there are a lot of things we can do. Taking advantage of this financial circumstance, I'm gonna use it in a way that will enable us to build something optimal and I think ultimately self-sustaining. Speaker 1 (15:08) You're an incredible father. Like, what an amazing response to terrible circumstances. Speaker 2 (15:14) You know, I would feel if I couldn't do it, I would be one of the most frustrated people in the world. I literally feel like I was designed to help her. Like, everything I knew how to do. You Speaker 1 (15:26) mentioned the Oura Ring, the data on the Oura Ring. What was the data that indicated something was... So Speaker 2 (15:31) I've been in touch with the CEO of Oura. He actually reached out on Twitter. And I think you can, certainly with an Apple Watch and hopefully with an Oura Ring. So what happened was, if you look at her, Spike actually put it on Twitter, at like 9 o'clock or so, there was a... there was a very quick spike in her pulse and then kind of a drop-off that looked kind of unusual. And if you combine that spike and a drop-off with someone falling, like the Apple Watch has an alert when someone falls. Right. Well, if that happens and it happens when there's a huge spike in their pulse, you Speaker 1 (16:08) can Speaker 2 (16:08) say, you know, did they have a heart attack? Did they have a whatever? You know, these are things you can look at. And I think Oura Ring should have the same capability. And I think they're working on it. Speaker 1 (16:18) How do you keep your mind in a healthy place? Like, what do you do to keep your head right? I Speaker 2 (16:23) play tennis almost every morning or do some form of exercise. I think that's probably the most important thing I do because it's the one thing I do over the course of the day where I'm completely focused on the ball that's coming at me as opposed to whatever else is going on. So I think that is a really important form of meditation for me. That's one. I've got a good night's sleep. I spend time with my family, things like that. Do you still meditate? I haven't in a while. I did for this challenging year, and I was in the middle of a divorce. I was kind of on my own, and it really helped. And I probably should find 20 minutes a day to meditate. How do you manage it all? Speaker 1 (17:04) I mean, you have four effective public entities. have this with your daughter, you have a seven-year-old, you want to be a great husband. How do you harmonize all of these things? So Pershing Speaker 2 (17:18) Square has come a long way from when I started it. When I started it, I was sort of the chief bottle washer guy. And I would come up with all the ideas and I have an analyst that would help me prosecute them. And that's how we, and there was activism, I was the guy, et cetera. Over 22 years, we've built an amazing team. We're in an industry where the half-life of someone who works for a... A firm, Speaker 1 (17:38) people Speaker 2 (17:38) are paying, the top people can move from one place to another and get huge $100 million bonuses for showing up, things like this. And the result is a lot of turnover in the industry. We have no turnover at Virgin Square. Is that good or bad? Well, if there's someone that we've had no turnover, obviously we've made some mistakes and we've replaced some people over time. But if you look at the investment team, the investment team has been the same team for now nine years. with a couple of new additions and that's actually a really good thing. You know, if you have a constant revolving door of new people, you don't really know that you can trust people over time. You know, are they really telling you the truth? Are they really telling you all the risks and rewards of a particular situation? When you've built a relationship with people and you work with them for nine years and you have this culture of transparency and candidness, I don't for a second ever question anything that's being told to me by a member of the investment team. They're telling me the flat. you know, candid truth. That's a very comfortable place. So the answer to your question is the Pershing investment process is incredibly well run by a very experienced team that I play an important role in at the ultimate say, but I am no longer the guy that generates the bulk of the ideas. I'm someone that generates a minority of the ideas in the portfolio. So that's helpful. And then the business itself. The way it's structured is, Ben is responsible for running a lot of the business elements of Pershing Square. So that frees me up to think, it frees me up to work on more strategic stuff, and it frees me up to come up with the occasional idea. So Pershing takes care of itself. Well, we have a number of public entities. We have an amazing accounting team. And those public companies all do the same thing. They're really just... There's the management company that earns fees from the entities we're on, that's Pershing Square Inc. PS, ticker. There are two funds that are publicly traded that own effectively the same portfolio. There's certain governance responsibilities we have for those entities, but they're really actually each of them have independent boards of directors. Our role there is as the external investment manager. We have excellent boards at both of those. you know the typical closed-end fund board is a bit of an embarrassment i don't know if you how closely you follow the space but you know you've seen boas weinstein going into proxy comms the typical closed-end fund