Consumerization in Medtech: Understanding Patient Behavior to Drive Real Value | LSI Europe '24

Imran Hamid 00:06
Good morning, everyone. Welcome to day three at LSI in sunny Portugal. It's a pleasure to have you all here, and thank you very much to the LSI team for asking myself and my co-investors here to head up a panel on the consumerization of med tech and health tech today. We're going to understand a little bit more about that connection with patient behavior to drive real value. It's also an honor to follow Alan Cohen from DCBC, who talks very eloquently about the tech med movement, and certainly there are some parallels to what we heard this morning that I think we'll pick on in today's conversation. I'll introduce myself and then ask the panelists to give a little bit about their background as well. My name is Imran Hamid. I'm a senior investor at LifeArc Ventures. We're a UK-based medical sciences charity with quite a substantive endowment whereby we invest in early-stage companies across the full spectrum of biotech, health tech, and med tech. I am a former trauma and orthopedic surgeon by background and have spent a number of years in different roles across the new venture and corporate development space. I'll hand over to Katie. Great.

Katie Elias 01:09
Thanks so much for having us. I'm Katie Elias. I'm one of the managing directors at the T1D Fund, which stands for Type One Diabetes Fund, and we are the venture arm of a philanthropy focused on the care and building out the community for type one patients and their families. The charity has been in business for over 50 years. We are about 100 years since the discovery of insulin, and clearly, there's a lot of unmet need in the diabetes community. Our fund was created about eight years ago. It's about a $200 million AUM fund. We invest in both public and private companies, mostly on the biotech side, looking ideally for cures for type one diabetes, but we also invest in metabolic control solutions as well as devices and diagnostics in that space. My background before that is in venture investing on the med tech side, more specifically, with Sofinnova Partners and then Endeavor Vision, and then I moved back to the US for this role about six and a half years ago. Nice to be here.

Owen Willis 02:09
Thank you. My name is Owen Willis. I'm the founder and general partner of Opal Ventures. Opal Ventures is an early-stage health tech-focused fund. We're backing the next generation of healthcare infrastructure. A big part of what we look at and what we back is how do we increase access to care for underserved populations, especially in the US? So much of that has to do with infrastructure, right? And, you know, location of patients, location of services, even all the way down to access to data on kind of how patients are living, what they are doing in their everyday lives, to be able to live the healthiest life possible. My background is actually on more of the operator side. So I was COO of Osmosis, which was a medical education startup. We initially were selling direct to consumer. We eventually pivoted and started selling B2B. I can talk a little bit at some point about that shift of how a consumer-focused business can enable or unlock bigger B2B or enterprise opportunities down the road. We eventually were acquired by Elsevier, the publishing company, and I went on to start a community for ideation and pre-seed stage health tech founders, really focused on getting to market faster, getting them access to experts that help them understand that incentive stack between patients, providers, and the person who is ultimately paying for whatever they're receiving, and use that to find shortcuts to market.

Imran Hamid 03:44
Thank you.

Sahir Ali 03:46
Good morning. Thanks for having me. I'm Sahir Ali. I'm the founder and general partner at Modi Ventures. My background takes a page out of the new bar. I'm a parallel entrepreneur. So I did a few things at the same time. I was a quant on Wall Street for a bit, but then I also shifted my focus to being quantitative with oncology. My PhD was in oncology and AI, and at the same time, I had a consumer company that did fairly well. So these days, I'm investing in what I call the bio stack, where we invest from human health all the way down to the DNA level, from therapeutics to tech, bio to med tech. I look forward to chatting.

Thom Rasche 04:28
Alright. Thom Rasche, my name is partner at Early Bird. We are a Europe-based venture capital company with both tech investments as well as health investments. Those are separate funds. Though I'm part of the healthcare team, we cover the entirety of healthcare, biotech, med tech, diagnostics, and digital health. The reason for that is that we pride ourselves on being probably the only fund in Europe, if not in the world, that has public healthcare insurances as cornerstone investors. In socialized medicine markets, as it is in Europe, this is pretty much unheard of because mostly they are, I'd say, bureaucratic organizations. They are governmentally funded, and they have, at least historically, not been involved in the innovation process. We have a strong belief that neither patients nor physicians nor insurance companies really care what technology is used to them, as long as it helps them. So whether it's a drug, device, or diagnostics, or a combination thereof, who cares? As a fund, we believe we need to have the same strategy to actually focus on that. My background is commercial. I used to work for 16 years for Johnson & Johnson before I stumbled into the venture world, to say the least, that was more coincidence than anything else.

Imran Hamid 05:49
Right? So thank you for that. In terms of setting the context here, it's quite interesting to see a couple of weeks ago, Apple made quite a big announcement that they were now rolling out a breathing disturbance feature with their smartwatch, the concept being that they believe they now have the ability to detect obstructive sleep apnea and use that as an indication for the use of their watch to go and seek further medical assistance. Now, they made this quite substantive press release, but it is still pending FDA approval, and I think it's indicative of large consumer tech players coming increasingly into a space that's been always dominated, frankly, by med tech players. And you know, that's one of many examples. Google, Fitbit, and others have been doing similar things, and that, combined with perhaps this observation that there are now very innovative digital health service providers who are using a connected ecosystem, be it continuous glucose monitoring, weight measurement, sleep tracking, or a range of other metrics, to engage patients very differently. I shouldn't even use the word patients; I should say engage consumers very differently in their lifestyle and behavioral habits. And, you know, taking another step back, we all recognize that healthcare is breaking. It's an old cliché: aging populations, and this concept that if we truly believe prevention is better than cure, is there more that we should be doing at least at the early part of that patient journey, or consumer journey, to actually change behaviors to improve healthcare and ultimately improve population health? If we accept that as a bit of an emerging thesis, that rule kind of gravitates around, and the fact that maybe last year, $180 billion was spent on vitamins alone, which mostly just gets flushed down the toilet, the question to my esteemed panel is: do you think that patient, again, I use the word patient, consumer behavior is changing? And if it is changing, what do we think that med tech or health tech companies should be doing to capture that change? And what is it that we investors should be doing as well? Maybe I'll start with Sahir.

Sahir Ali 08:06
Well, I think, you know, when you think of consumerization, there's a dissonance between consumer and patient. Because if you're going to consumerize it, the word patient itself indicates you're sick. I think the trend of consumerization, at least the one that I particularly like to be engaged with, is how do you empower consumers who want to consume, who really want good health? So how do you sort of do that? I think what's happened with economies of scale in a fairly regulated space of finance, health, and education is that you have this, you know, in clinical terms, treating to the mean. It's the same thing across the board in other large industries. We just kept building larger and larger things as part of the 20th-century concept. And what's happened is we've built things large enough, and so regulation has sort of just allowed those things to give you the basic needs, but not customized needs. A lot of the products that are developed are developed to satisfy the regulation rather than to do what actually is needed. A trend that has quite picked up in the United States, I was reading a McKinsey report just before coming to the panel, it seems like the wellness space, particularly, is now pretty highly placed—close to a trillion-dollar market. An interesting statistic was that the third most recommended are recommendations from physicians themselves. So it's being recommended. I think these are some interesting trends, and we'll go a little bit deeper into it. The final point here for me is that there's this convergence of technology, good design principles, cloud technologies, and particularly a generational shift where millennials and Gen Zs, who are digital-first, are comfortable being that consumer that we're talking about, that behavior change. So that's kind of my perspective, and I'm starting. I mean, we also invest in some of those, and Imran and I have also co-invested. I'm sure you're going to talk about one of those companies, so...

Imran Hamid 10:12
We'll plug our companies. So...

Katie Elias 10:14
Is it too early for us to start arguing, or should we wait? Listen, I think that's a really interesting perspective. And, you know, this idea of top-down versus bottom-up, I think, is a natural tension in this space. Representing a patient community, again, we don't call people with diabetes patients; we call them people with diabetes, not patients. So I very much understand that perspective. At the same time, I think we need to look at these populations and understand what the unmet needs are, what the gaps are. From this audience of health entrepreneurs, I think that's where we've always fundamentally needed to start, which is: what is the unmet need and the problem you're trying to solve? Try to pick the most dire problems first and then work your way back. I do think there's a natural tension between wellness-oriented solutions, which I think may be easier to start getting traction and generate some commercial revenues, which potentially, although I think there are some fallacies there, could be easier for investors to make returns versus the actual unmet needs of these patients. Taking a look at whose care is not well managed in the diabetes community, you know, and I loved Alan's talk, we have patients—people with diabetes—kicking off an immense amount of data that can be captured and better harnessed. I absolutely agree with the comment that if we can make people's lives better and their health outcomes better, we shouldn't care whether it's a therapeutic drug, a device, or a digital solution. I say that a lot in my team. That doesn't mean that's where we invest; we mostly invest on the biotech cure side. But I do think there's this natural tension between these things, getting people who are managing their condition on a daily, hourly basis to be more proactive, but also to have options that allow them to look more holistically at what their individual unmet needs are is something that I think is very tricky. I have to say, I come more from the side of we have to work through regulated products that have evidence generation in order to prove that they actually are providing patient benefit. They're not just making you happier that you used an app. I tend to be more of a skeptic on that side. Again, lots of great data is coming out of CGM and other tools that can improve patient care and improve health outcomes. But for me, as an investor, I still start fundamentally with this idea that ultimately, the user interface needs to be something that people want to use and will use, because if they don't use it, you don't get the outcomes. So they have to be designed with that group of people in mind. However, for me, it starts with patient outcomes and regulation to make sure we're doing that in a safe way.

Imran Hamid 12:58
So, Katie, just picking up on that, I'm curious, Owen, whether you have a similar or different view, particularly in this concept around do we need to create evidence? Is it necessary, if we're in this space where we're engaging consumers, people around improving their health behaviors? How much evidence do we need to create? And do you think that other things may be more important in the way we actually tailor products to meet their expectations?

Owen Willis 13:24
Yeah. I mean, I think having evidence is important, right? You need to know that the things that you are doing, if you are asking patients to spend their time doing something, that it is efficacious.

Imran Hamid 13:36
But again, is it asking, or is it a question that you want to do this, right?

Owen Willis 13:39
Well, so I think one of the things that I want to touch on is, you know, there have been changes in behavior among patients as it relates to health and wellness and data and understanding the different things that either go into their body or the different actions that they do and how that impacts their health. That is something that is true. I would also say that it is not evenly distributed across the entire population, right? A lot of what we think about as wellness, a lot of what we think about as these healthy decision-making, in some ways, it's a luxury for people, right? These are things that take time. These are decisions that require research. These are devices that cost money, right? What I've been seeing in health tech is there's this natural tendency for investors to back companies and back ideas that line up with what they or their community will use or do, right? There ends up being this weird bifurcation where health and healthy living is almost like a luxury product that has started to emerge. But the ways in which I think that is starting to shift and change is the actionability. Think of a lot of these devices and data sets where patients are maybe getting one metric right, one thing to focus on. I think step counters are a really interesting version of that where, you know, there are many, many things you can do to be healthy, to be fit; walking 10,000 steps is the bare minimum, right? But it is something that everyone understands. What that is, everyone can work towards it, and it is the starting point to having a healthier lifestyle. But it is not the end-all, be-all.

Imran Hamid 15:33
And, Thom, what's your view about this concept of, at the moment, it's a bit of a luxury, and we may be looking at it from very singular or sided perspectives? This concept that we now all understand we need to take 10,000 steps a day as a minimum. Do you think there is an evolution here? And do you think we can be doing more as investors and innovators in this space to really grasp that opportunity?

Thom Rasche 15:54
So I think there are a couple of points to be made. First of all, we are managing other people's money. So if we are managing other people's money, they want it back, best with a return. If we have the conviction that we would be investing in a sector which, in a time frame of five to ten years, would get you a high return on that investment, then we would do it, whether that is in the prevention space or not. So far, we don't have that conviction, to be quite honest. I think you need to segregate really clearly two markets: one is the wellness prevention market and then the disease market, i.e., the first healthcare market. You can argue whether that borderline is blurring and moving to one side or the other; that probably is the case. But my argument is, and maybe I'm too old for this, is that those people who wear an iWatch or iPhone don't really need it; the other ones need it, and they don't wear them. The problem is that all things we do in prevention and/or trying to move people to the Withings of the world or all that—those people who buy that and actually spend money on that have an awareness. They do sports, they move, they watch their weight, they do blood pressure monitoring, they do even sleep apnea monitoring. Those who really need it do not do it.

Imran Hamid 17:24
Katie, what's your view on the future when the next Apple iWatch has a non-invasive continuous glucose monitor? How is that going to change the world? And how's that going to change our perception of the way we interact with our metabolic state, our diet, and nutrition, etc.?

Katie Elias 17:42
First of all, I wish that it were that easy, and so I love the future state. Having looked at a ton of these fully non-invasive glucose monitoring technologies, I would say we still have a long way to go. There are some really smart people working on that for many years. Our group's litmus test is, you know, can you have accuracy enough to dose insulin off of this? If you can't, then, you know, come back to us when you can. So we're getting closer to that, but I would just say I think we're a little ways away.

Imran Hamid 18:14
Is that the right entry? Okay to be well again, I...

Katie Elias 18:17
I think, you know, when we look at how can we improve health outcomes for the community, which is from a disease-focused mindset, where I come from and kind of where I grew up again, coming from working in hospitals and then working on the medical device side as an operator and then moving into venture. I mean, I got into this whole business because I'm trying to improve human health, including people who we've identified their condition, and we have great treatments available if we could just get them to the right people and make sure that they're easy enough to use that they want to use them. So, you know, I think when we look at the impact of CGM, as you mentioned, on health outcomes, there was a great study presented at the EASD meeting in Madrid. We can go around real-world outcomes in type one and type two. Patients on CGM, we see there is absolutely a definite health benefit for patients using it. You can reduce your HbA1c levels, you can reduce hospitalizations, and ultimately, you can improve care and outcomes for these patients. You know, I think that is sort of the benchmark of how can we get more people to utilize these therapies, and that's coming. I mean, the type one community has been a leader in that space because they kind of don't have any other choice. I think in the type two community, we have to kind of turn things around. We look at device companies and the traditional model of like, I built this thing, and here's what it's good for. What else can I use it for? What we need to do in this environment is to say, okay, we have some technology, but then we have different patient populations for whom that technology was not originally envisioned. i.e., a non-insulin-dependent type two community is the classical CGM that was designed for a type one population. Can you just shove it over there? Or do you need to rethink things? One of the companies we've invested in earlier this week, Biolink, is a sensor-based company—not non-invasive, but I'd say quite minimally invasive—doing some really interesting work using data to try to think about expanding that technology to a broader patient population and giving people things like visual cues of where their glycemia is right now, as opposed to making it too complicated for them. Again, if you're to Tom's point, dealing with a population who isn't going to risk—they're not already on insulin, necessarily; they're not going to have a coma overnight if they go low—getting them to be motivated and engaging with them is just going to require a different mindset and a different product than what we've been doing for a fully insulin-dependent population from age two to 15. So I think we need to rethink tailoring products to these different populations. Again, that starts to maybe cross over closer to wellness, closer to prevention, but again, I'm still more focused on disease state.

Imran Hamid 21:10
And with that being said, I mean, Sahir, I'm curious, do you think there's a shift in what still feels like a little bit of traditional, slightly paternalistic medical practice, where the institutions and the professionals control how patients interact with them and their expectations of the care they receive? Do you think that could change over time? What are you seeing?

Sahir Ali 21:36
I mean, I think that was the term that was introduced by the previous speaker: tech, med tech, bio. I think there is a shift. If we step back, I mean, we're talking about consumerization, but let's also talk about the consumerization of the physicians and clinicians themselves. We talked about yesterday pathology; for 400 years, we've been using the same staining, using microscopes, and digital pathology has been rare to go and especially was not getting adopted by clinicians themselves. I'm not sure why, but it's better to look at things on a monitor and zoom in than just a single eye into a microscope. COVID accelerated that. If you look at the drug discovery space, I mean, these are traditional setups. We're not saying we're there yet, but there is this right convergence of things. I think we are starting to, as I mentioned previously, these large economies of scale that happened over 100 years in finance, education, and healthcare. I think there's a right convergence of consumerization, which requires the right technology and design principles. I think design principles are the number one thing here. If they've been designed keeping in mind what the consumer wants, what ultimately a consumer wants in this space is health.

Imran Hamid 22:52
How much of that comes through the physician?

Sahir Ali 22:55
Yes, and then, if you think about it, there's a new breed of physicians who are digitally native. If you look at even one of the companies we backed, it thinks about auscultation in a completely different paradigm. We should have digital biomarkers that are not just subjective. How many physicians actually even know how to detect murmurs after a while? It's gone. It's a straight fee-for-service model. If I heard something and I'm not sure what I'm hearing, well, it's a cardiology referral. I'm talking about the United States here. That's what I mean. There's an entire system that is just designed towards this sort of—what I heard the term is called a vending machine model in healthcare. The last thing I'll say is that what this allows us to do is look at this vending machine model. You get sick, you go to the doctor. I'm talking about United States behavior now, and in that 15 minutes, you have a consultation. But I think there is everything else around it. Of course, you're sick, you need that sort of approach of how to manage a disease, how to treat that. But can we think about prevention and a continuous sort of consumerization of health, where maybe devices do have a play? You know, the Aura Ring, for example, I use it, and it gamifies enough that somehow there's this correlation to you just keeping that in mind and making the right choices. I think that's what I mean. There's this bigger trend. I absolutely agree with your point that there is this divide between folks who are hyper-aware of that, and I think that's a newer generation, and then there are folks who just are not aware, and they need a different approach.

Thom Rasche 24:30
I think your hope is that this population, which is a little bit more aware, is growing. I doubt it, to be honest, but yeah, that's another story. So there is a generation that is more digital. I think I completely agree on this. You said an interesting term: the times are over where the physician controls the patient. I think that's actually a fairly wrong terminology. How about guiding? Because actually, I believe patients want to be guided. I don't think patients want to take ownership. Everything I've learned in healthcare is that those who are diseased want guidance and want help. I think this is more a system problem. By the way, whether that's Europe or the US, it's actually the same. Right now, if a physician would give, let's say, an obese patient an Apple Watch and say, "Listen, why don't you wear this? It gives me the ability to adjust your medications a little bit more thoroughly and guide you through your day," I am fairly convinced that compliance would increase and people would actually do it. Today, the systems don't allow it, so it's not necessarily a tech question in my view; it's more a system question on how you drive that. Again, wellness and consumers, for me, is a really different story in that sense. I think there are things happening. We know that, for instance, glucose is a good example, which is the best indicator for metabolic action. You can actually have people nutritional consultancy with glucose and all kinds of things. But that's all, to me, on the wellness side. I'm staying with, like Katie, there's more on the disease side. How do we help and enable those patients better to get fewer physician visits, fewer hospitalizations, fewer emergency room visits? All of that tech is there. I actually believe the technology is easy. It's ready and can be utilized. It isn't.

Imran Hamid 26:21
So, Owen, as someone who's literally sitting in the middle of us, can you think of any interesting examples where they've got the balance right? Any companies out there that have seemed to align some of these push and pull factors, be it the consumer wanting to be healthier, the healthcare system waiting for them to become unwell so they can do something? Are there things you've seen in the middle that resonate as an investor or an operator?

Owen Willis 26:47
Yeah, there are definitely things, especially as we think about the elder care space, aging in place, aging at home. There's starting to be an alignment of incentives where there is a need to collect data, there is a need for RPM, and I think technology is now in a place where it can be miniaturized in a way that it's actually usable. One of the things that I have a lot of interest in is kind of the passive monitoring versus the active monitoring, right? I think anytime you're doing active monitoring, as you said, the people who you want to do it are not actually doing it, right? They're not filling in the log. I think we've all kind of tried it at some point, and for 99% of people, it falls off. But, you know, having a device, let's say a piece of radar technology, installed above the bed of an elderly parent, being able to see, you know, kind of how is their heart doing? How is their breathing? What is their likelihood of a fall? That is not only incredibly valuable; it's information that doesn't rely on an individual person to input anything, and it's something that there is a willingness to pay for on the part of both the providers and the payer side. I think that's an area where things kind of line up from an incentive perspective. The one thing I would say to your point, I have a wonderful doctor who is constantly encouraging me to get an Aura Ring or do sleep studies or things like that. I would say that's not really the norm, right? I think there's still a little bit of that firewall of that kind of personal health data that's being collected and what is being looked at by a doctor. Part of it is just, I think doctors just don't know what to do with it, right? The efficacy might be off; it can lead you down a number of different paths. It could be expensive for the patient. You end up in a place where the patients are consuming a tremendous amount of data on their end, plus they have full access to the internet and every Reddit thread on every disease that's ever happened. Then you have the doctors that are just like, "What do I do with all of this information?" How do I, as you said, guide the patient towards the right thing? I think we're still trying to figure out what that looks like.

Imran Hamid 29:15
It's funny you mention that example. I saw a company recently called, I think it's called Metabolic Health. We're not investors; it's all out of scope for us in terms of what we do. But they're based in the United Arab Emirates, so a very innovative space with a lot of capital. In some regards, it's a bit of a blank canvas in terms of the healthcare system. They've set up what feels like a very high-end healthcare wellness concierge service. So on day one, you get a Withings weighing scale, you get an Aura Ring, you see a nutritionist face to face. I think they have an app where you can take photos of every single meal, and using AI, they're then effectively analyzing more, suggesting what your calorific and macro intake is. The consumers of this are paying what looks like a pretty high-end gym membership fee on a monthly basis to get continuous feedback from psychologists, health coaches, nutritionists, and personal trainers. I was quite blown away that people are doing that here and now. I wonder how much we are suffering from the fact that we sit in what you could call developed or mature healthcare systems, where the architecture, infrastructure, and regulatory framework are so, I guess, established. We're just unable to think past that. Is that a fair statement? I don't know, Katie, what's your view on that?

Katie Elias 30:36
I mean, I think to Tom's point, the people who are going to take advantage of those situations, maybe in the mature markets, are the people who are going to wear the Apple Watch in the first place. Again, I just don't know that we're going to solve that from the bottom up that way. I like the example you came on around passive monitoring, and I think that is something that I absolutely agree has been steadily increasing, although fairly slowly increasing over the time I've spent in my career working on this. One of the first projects I worked on at Medtronic was an implantable hemodynamic monitor, which never got integrated into their products. My research was around essentially heart failure management just through stepping on the scale, right? We know there's some basic stuff you can do to try to predict decompensation events in heart failure patients. Your weight and water retention are, I mean, it's like as big a signal as you get, and people don't do it, right? Now there's a company that I've heard of that essentially has a little camera under your bed, and it measures your water weight and your ankles every time you get out of bed in the morning. I think moving from the acute care setting in the hospital to home-based care and using less and less staff to do that, all of that is going in the right direction. Again, taking this very fundamental predictor of heart failure compensation and making it so easy to do that the person doesn't have to do anything. The other piece, though, is exactly what you said, which is when I started in that project in heart failure, you know, 20 years ago, the doctors were terrified of getting all these alerts. I mean, that was one of the major barriers; they didn't want to know when these things were happening because then they have to do something about it. I'm legally liable. How do we use data and decision support and work with regulators to get that equation right so that they are getting more and more comfortable and the data is being packaged in a more usable way that they actually want that information because it's actionable and not a liability risk? I think we're still just, you know, the wave hasn't crested yet. I think we're working it out as we go, but I think it has to go in that direction. The data is critical, but if nobody wants to see the data because it's too much or other risk factors, then we're not going to achieve what we're trying to achieve.

Imran Hamid 32:49
And Sahir, coming back to...

Thom Rasche 32:51
...swallowing a pill, sorry, takes a nanosecond. Using an app takes minutes. We know that patients are not compliant swallowing a pill.

Imran Hamid 33:02
So are we saying that they're more compliant with apps than they are with pills?

Thom Rasche 33:07
No, I actually believe that they will be less compliant with apps than they are with a pill because swallowing a pill is a really nanosecond activity, whereas actually with an app, you really need to get engaged and actually work with us. Again, when we talk about those patients who are not compliant, that's a bigger hurdle in a fully... with Europe, it's like it needs to be totally passive. We cannot expect patients to comply and work with us.

Imran Hamid 33:36
So, Tom, full disclosure, you completely triggered me with that statement. I think you're looking at the wrong companies.

Thom Rasche 33:50
Yeah, absolutely.

Imran Hamid 33:50
In fact, I'm on the board of Clinical Affect Therapeutics. It's one of the leading substance use disorder companies in the US, and they have exceptional data, as many of their other companies in that space do. By using thoughtful app design, UX, UI, and really thoughtful engagement with psychiatrists, group therapy, individual therapy, all done virtually, they got somewhere in the region of 80 to 90% retention after three months, which is indicative of, in my opinion, sort of tier 1-3. That is much better than most consumer apps can achieve, and the point being is, for that particular clinical category, that's much better than inpatient care. So if you compare digital to inpatient care, you can actually drive much, much better engagement because the indication is like that. People don't want to go to a bricks-and-mortar clinic and be seen as getting addiction therapy care. They'd much rather do it from the comfort of their own home. So I think, again, my personal view is it depends on the type of patient, the disease you're dealing with, and some of the accessibility issues.

Unknown Speaker 35:05
Yeah. And to your point, where's the bar? And it's going to be different in different diseases.

Imran Hamid 35:14
Exactly. So I think the point that I'm perhaps suggesting is very much on a case-by-case basis, depending on the disease, depending on the category. A final question to hear before I ask for some summarizing thoughts: as the person in the room who's coming from, I think, one of the newer funds who has less legacy and tradition to worry about, what is it that excites you? Do you think it's as clear as there's a divide between healthcare and consumer, and thou shalt not mix? Or do you think there's an opportunity in the middle to actually drive innovation? If there is an opportunity, what attracts you to writing a check in that space?

Sahir Ali 35:47
Well, I think, like every tech, even medicine without tech, the biotech revolution happened because you had recombinant DNA. Without a microscope, we would never sell their pathology. So I guess we keep saying there's tech or there's health. It's not. It's actually that modern medicine is tech. Now I think we step back and say, okay, well, it's about the patient. But I am challenging why we use the word patient now. Points were made; I agree with you. But why get to a position where you have to go see a doctor? If you do see a doctor, the doctor is not available to you. Now, I'll give you an example. What happened with the banks and the FinTech? Yes, it has its own regulations, right? It's not a life-or-death matter. But how many of us check our statements on a daily basis? There are pop-ups that happen. It's passive. If I have a certain transaction, I get an email. When was the last time you checked your—you sat there like we used to do 15 years ago? That's a generational shift. It is happening. I was looking at consumer data from the McKinsey Report: 70 to 80% in Asia, I mean, China particularly, in the US have engaged with consumer products in just the last five years. I think it's happening. There's a generational shift now. From a new investment perspective, that's the bet I'm willing to make. You know, one of the companies that Imran and I have invested in looks at sleep in a very different way. You can take drugs or you have these opportunities to look at sleep in a very different way. Design products that are so tuned with what a consumer wants. It's shipped in well-designed for the ears. It's passive. I didn't know this until I looked at this company, that there is a good segment of the world population that actually goes to sleep listening to something. I did not know that. Even Elon tweeted that two months ago that he listens to audiobooks, but a doctor doesn't, may not know these behaviors, and that's what tech allows you to do. The type of data that Aura has captured from PPG, I don't think many have that, right? So there's an opportunity to blend them, but be careful and be very systematic about what that is. I think there's an opportunity to inform each other as well. I think it's not just disease versus wellness. I agree there's a border being blended there, and that's what excites me.

Imran Hamid 38:09
I think so. Coming off the last few minutes of the panel, it would be great to get, I guess, everyone's personal views on: we look forward in the next five to ten years. What are our hopes and dreams of what might change or might look different? And I've thought about is that something that we could do anything about here or now? Thom?

Thom Rasche 38:27
So my dream would be that we actually enable our systems to utilize the data and technologies available to guide patients better through their disease states. If we could achieve that in the next ten years, I think we've achieved a lot. I really have achieved a lot. Because I think, to me, this is not a technology question. It's there; you have it.

Unknown Speaker 38:50
Right. Sahir?

Sahir Ali 38:53
The future I get excited about is that I should be able to open something, and that tells me the current state of my being. That means if I'm wearing a wearable and all the data is at my palm, it tells me what's my level, what's the state of my being. If it's not going in a direction I'd like to, almost like a state machine, I can switch it back, and if that's with the help of a doctor, wellness, whatever that is, but I want to be able to know what my being is.

Owen Willis 39:20
Going back to the title of the panel, I think one of the things I'd want to see is, you know, kind of the lesson of this consumerization going back into med tech and applying to health tech is this understanding that patients will engage if you meet them where they are. If you are, you know, let's say you're building a mental health product for young men, you know that product needs to be able to insert itself into a video game, right? And be kind of happening alongside when they're doing other activities and things that they enjoy. I think we're already starting to see that. We're already starting to see movement there. The last thing I'll say is, I think affordability is an important part of it. We're a backer of a company called Superpower, which does affordable biomarker testing, bringing kind of that top-tier concierge medicine to everyone. In just launching in that way, they have made it so that they now have a waitlist of 30,000 patients waiting to sign up for this platform. I think there is opportunity with that if you are able to make it affordable and meet patients where they are.

Katie Elias 40:30
Yeah, I really like your comments around meeting patients where they are. Again, I would just say there are different views of what we're talking about here. My perspective is like an Aura Ring and a consumer-based CGM is not going to help somebody who has Parkinson's disease. You know what I would like to do? Because there are diseases that aren't necessarily preventable yet, and maybe hopefully someday there will be. Again, we focus more on disease-modifying therapies dealing with root biology and the immune system and other pieces. I think that wave is coming too to solve some of those issues. But if we can apply some of these activities in the more consumer market and learn about behavior, learn about what motivates people, and then apply that to these maybe not as easily preventable yet diseases, I think we're going to be in great shape. What I would love to see is for these guys to be extremely successful in figuring out how to do that so we can then take those insights and apply them to disease states where, you know, knowing how you sleep isn't going to keep you from getting cancer in most cases. So that's my closing thought.

Imran Hamid 41:39
Thank you. For what it's worth, my dream is, let's not think about disease as an inevitability. I'd love to have a world where, actually, you know, we don't assume that patients—or I keep on using the word patients—force of habit from being a physician for a number of years. I would love to be in a world where we don't assume that people have to become patients and they have to become diseased. It would be a lovely thing to be able to take large swaths of the population and just take a completely different route. How we do that? I don't think we know yet, but amongst us, all the investor community and the startups out there, I'd love us to explore that together. And with that final thought, thank you very much to all the panelists. I hope you enjoyed the discussion and debate. Hope you did too. Thank you very much.