Does AI know you better than your doctor? w/ Ōura CEO Tom Hale

0:00Hi, everyone. It's Rana. The future of AI is not built in isolation. It is shaped in rooms where ambitious people challenge each other. Masters of Scale Summit is back October 20th through 22nd in San Francisco, bringing together founders and innovators pushing the edge of what is possible. If you're building what comes next, you should be in this room. Apply now at mastersofscale.com slash pioneers. That's mastersofscale.com slash pioneers.

0:36The business world is moving faster than ever. And when change hits, we need to learn in real time. On Rapid Response, you'll hear candid conversations with CEOs and leaders making tough calls about AI, human talent, responsibility, and the bottom line, how they navigate uncertainty, pressure, and high-stakes moments. I'm Bob Safian, former editor-in-chief of Fast Company, and I'll be your host as each episode breaks down what you need to know right now. You can find Rapid Response wherever you get your podcasts.

1:25if we have a large physiological model that makes predictions about you and those predictions aren't just like hey you're getting sick and in three days you're going to be on the couch it's more like hey in 10 years if you don't change your course you're going to have a heart attack that's so powerful it's powerful from so many different dimensions.

1:46We're going to see more of that healthcare sort of trickling to the digital edge of the experience that you're having on your device with your wearables. And there'll be automated, you know, there'll be an AI doctor in your pocket or in the cloud who is looking over you using your large physiological model to understand where you're headed. And that is a transformation in medicine. I think it's going to be incredible. That's Tom Hale, the CEO of Aura. The ring that tracks and measures all kinds of health data. You'll find Aura rings on the fingers of everyone, from elite athletes to patients managing chronic illness.

2:23Since Tom joined in 2022, Aura has grown to a reported$11 billion valuation. Their ring has become super popular, and it's helping people take greater agency over their health. In this episode, Tom and I talk about how wearables like the Oura Ring give your body a voice so you get the data before your doctor does. We also talk about how the trifecta of sensors, data, and machine learning unlock true personalized and preventative health care. I'm Rana El-Khalyubi, and this is Pioneers of AI, a podcast taking you behind the scenes of the AI revolution.

3:05Hi, Tom. Thanks for joining us on Pioneers of AI. Hi, Ron. Thanks for having me on the show. Appreciate it. I want to kind of start with a full disclosure that I wear a whoop just because my son, when he was 13— Oh, sorry. Wrong podcast. Sorry. We're on the wrong podcast. No, I'm kidding. You know what? I'm glad you're wearing a wearable. That's really important. Yeah, well, it's important for you to have some knowledge of your body and your sleep and all that stuff. It's powerful. So I got started on wearables because my son five years ago, he's an athlete and he started kind of tracking his sleep and his physical fitness and whatnot.

3:42And now we're obsessed. And I've learned a ton from tracking my sleep, including this key insight that if I eat within two hours of going to bed, my sleep's messed up. And you're right on it because, you know, actually not as many people know the trick of not eating too close to bedtime. And so like, it's actually weird. You actually, you know, you're sort of almost your body incentivizes you to eat closer to bed if you stay past your bedtime. So tricks for me. I mean, I don't know if you know the story, but. I don't. I'd love to hear it. Well, you know, for me, it was the fall of 2021. You know, COVID was still in effect and the kids were struggling and I was struggling.

4:28It was a tough time. There was a lot of stress. How old were the kids at the time? Yeah, teenagers, like sort of, you know, making the transition into being teens. And so, and as you can imagine, it's just like, it's tough anyway. Throwing a dose of COVID, it's extra tough. But the point is, is that I'm a championship sleeper. What does that say more about that? You know, I can fall asleep at a moment's notice. I stay asleep for a long time. I'm just like, I can really, I'm good at sleeping. But this moment in my life, I actually, I lost sleep. And for the first time in my life, I was waking up in the middle of the night.

5:07I was having trouble falling asleep. I was having trouble staying asleep. I started researching, you know, kind of solutions and I bumped into aura. So I got an aura ring and I'd been a wearables person for quite some time. I've always had a wearable or two. And this one was really different. What happened is I changed a couple of my behaviors. The obvious ones, stop drinking coffee late in the day. Stop drinking alcohol to kind of take the edge off the coffee. Started trying to go to sleep without staring at the phone before you go to bed. Yeah, I'm guilty of that. Don't watch Netflix. Netflix and sleep compete for your attention.

5:45And I started sleeping in a cold room and I started like kind of really getting into the sort of how do you really optimize around sleep? And let me tell you something. When I recovered sleep, it was as if I was walking out of a black and white television screen of my life experience into a full color 4K technicolor movie. It was amazing. I literally was like asking people like, do you feel like this all the time? Is this how people feel? It was amazing. And so it was such a transformation for me. From an energy boost or mental clarity? Like, what was it? So it was mood. It was energy. It was mental clarity.

6:22It was modulation of like, you know, kind of happier energy during the day. And so it was a really profound transformation for me. And I was like, wow, this product is really affecting people's lives. It affected mine. I need to be a part of this company. I have to say it's incredible to align something you're deeply passionate about with like your everyday work. Yeah. Was that intentional? Well, yeah. I mean, it's always been my intention. I mean, I'm sorry. I'm sure there are people who are very, very good at their jobs, but don't, you know, love what they're working on. I'm not one of those people.

6:58That's awesome. I have to find something that I love. And because if I'm going to put my heart and soul into it, it's got to be, you know, something I'm passionate about. And so for everything that I've worked on, that's been true. And so this is a fascinating domain. You know, it's like physics and physiology and human behavior and health. And, you know, there's so many things that are just fascinating about it. But maybe most importantly, the company itself is a mission-driven company with an idea that it can, you know, have a role in rethinking the transformation of health care from a sick care system to a proactive preventative medicine.

7:32An ounce of prevention, you know, is worth a pound of cure. If you can get people to change their behaviors and you can get people to understand the kinds of behaviors that will mitigate in favor of long-term health. You know, some people call it longevity. Some people call it health span or they say we're shortening the time of sick span towards the end of someone's life. There's obviously the benefits to all the people. If you can really, you know, get people doing healthy things, they will be healthier and I think ultimately happier. If you can do that, you'll also bend the curve on the cost of health care.

8:04And in our society, you know, in our country, you know, one out of five dollars is spent on health care. And I don't know about you, but your health care experience isn't great. It's all oriented towards the end of the life. It's all about this last 10 years. And boy, wouldn't it be great if we could do a better job? So I think that sense of mission for me, honestly, I was very attracted to that. I want to double click on that because one of my investment theses is that to fish at the intersection of profit and purpose. And I truly believe we invest in early stage AI companies that unlock human potential.

8:39And I really think, you know, it's not easy to find the intersection of that Venn diagram. But when you do, it's really powerful. So you hit a billion dollars in revenue and you raised$900 million at an$11 billion valuation. Congratulations. Thank you. What's behind the jump in interest and sales from your perspective? Like what changed? Well, I think it's a couple of things. You know, it's never one thing. Part of it is just the flywheel of customers. You know, we have quite a few customers and they're out there telling, you know, their friends or their parents or their kids or their husband or their partner or whatever, coworker, that this is a good thing and they should do it.

9:20And many times it's a gift of care. I want you to take care of yourself. And so I'm giving you this tool. Maybe to address this up front, I think a lot of people think of wearables as fitness. I mean, you know, you should know how fast you were going and what your heart rate was and all that stuff. And Aura does that as well. But maybe uniquely, Aura orients more around health and maybe more importantly, not health just in the moment. You know, what's my heart rate right now as I'm, you know, finishing my running exercise? But what's my trend over time? And am I improving? Am I not improving? What's going on?

10:01And in some sense, it's providing you this sort of sense of your physiology over time in a way that you might not perceive because it's actually hard for humans to perceive things over a long period of time. Computers are very good at that. Humans are not. AI is particularly good at it. And it's also sometimes things that you just can't sense. We don't know what our blood sugar is. We can't because it's just not something that we can sense. So if you have a glucose biosensor, then you can have a number that tells you what your blood glucose levels are. So this idea of being a wearable that's around health, that's the first thing that I think has been maybe central to our success.

10:40It can affect everybody. Sleep is also a very large tam. Everybody on the planet, we hope, is going to go to sleep tonight. And in fact, they're going to be, depending on how they sleep, they're going to be at peak performance or maybe not tomorrow. So that was maybe a baseline. I think the other things to recognize is that as a product, it has a couple of pretty interesting properties. The first is that measuring from the finger is really important. I was going to ask you about that. Why the ring form factor? Yeah, why the ring form factor? I mean, there's lots of reasons, but let's start with accuracy.

11:12It turns out that your heart pumps and sends a wave of blood going down to your arteries, and it stops right here. This is the first stop on that journey. Whereas if you contrast that at the wrist, it's actually on its way back to the heart. It's capillary action. Your veins actually, they have valves in them. They kind of close so that there's no backwash in your blood. They close as the blood goes through. So you're actually getting both a sort of a weaker signal and maybe less information captured in that signal. And you're also seeing through, you're sensing through things like hair and bone and sinew and all these sort of very confounding factors.

11:51Whereas, of course, here, it's two millimeters of pretty uniform tissue that you're sensing through. For illustration, if you've ever been to the hospital, where do they put the sensor? When they put a, you know, a PPG sensor, they put it on the tip of your finger for all the same reasons. So the second part of it, too, of course, is that at night you're looking for comfort. And so this device, which, you know, weighs all of like, you know, four grams and is very low profile and doesn't have any lights on it. If you're not sleeping, the last thing you want to do is like, you don't want to be looking at your cloud and be like, oh, 3 a.m., you know, that's always rough.

12:24We kind of adopted this kind of calm tech strategy of being quiet and sort of receding into the background. And those are really essential elements of sort of differentiation. And so we learned, we saw this when we started introducing the product, is that people would wake up in the morning and they would look at their phone and they would see a score that sort of said, like, how did you sleep? And then there would be sort of a prediction about how your day is going to go. What's your readiness? And, you know, that score turns out to be a really powerful score because within one second, you're like, hey, maybe I should push it today or maybe I should take it easy.

12:57So you talked about readiness and you also have a resilience score. Can you kind of unpack how is that calculated? Yeah. So readiness is about nighttime recovery. If you look at the components of your readiness score, and I'll pull it up just so that. What's your readiness score today? Yeah. Yeah. Pretty good. Pick a day where it's high. No, I'm kidding. Pretty good. You know, not bad. What we look at for readiness is your resting heart rate, your HRV balance, which is over the past 14 days, and HRV is heart rate variability, your body temperature, your recovery index, which is a ratio of, you know, how much effort you put out the previous day and how well you recovered, your sleep, your sleep balance, which is over 14 days, your sleep regularity, which is how close to the window of what's appropriate and consistent for your sleep you were.

13:50By the way, it turns out that consistency of going to bed and waking up is actually really important because your body is sort of going through this. It's got a clock. It's got a circadian clock. And it's sort of saying like whatever time your chronotype says you should be going to sleep, 9, 930, whatever. If you miss that window, then it's sort of off kilter. It's less efficient sleep because your body has missed that window. Can you talk about the sleep chronotypes? Yeah. I'm very curious about that, the different ones. This is sort of sleep science. But so the chronotypes kind of, it turns out not everybody's the same.

14:20Some people are early birds. Some people are night owls. Some people are larks. Some people are wolves. And they have different sort of chronotypes. And chronotype means like what's your sort of optimal circadian rhythm? I am an early bird. I like to wake up at 5 o 'clock. I like to do things in the morning. And I like to get to sleep by like 9, you know. And that's like, that's my chronotype. And that dictates that sort of cycle. dictates what's optimal for you in terms of eating, in terms of exercising, in terms of cognitive function, all that stuff. And so once you know your chronotype, and what's actually one of the things that aura tells you, tells you what your chronotype is, you can start to sort of see like, are you matching your chronotype?

14:56Are you out of sync with your chronotype? Of course, what is jet lag? Jet lag is when you are out of sync with your chronotype because your body is saying, I should be asleep right now, but I'm not. I'm in this meeting in London. And you know, I'm barely able to keep my eyes open. So we were just talking about readiness, how much activity have you had in the previous day. So you look at all these things and sort of they're pulled together and you can decompose them, but it gives you kind of a single score between zero and 100. And the thing is, it's not just a score, it's also a set of insights.

15:25And the insights sort of surface there to help you nudge your behavior. You know, maybe it'll say, hey, it looks like you ate too close to dinner last night. Your heart rate was elevated in the early part of your sleep. And as a result, you didn't get great deep sleep. So there's this sort of education that comes along with it. as you're learning about yourself, you're sort of seeing these scores and just figuring out what's normal for you. Then you're also being educated about it. But here's the magic. We measure you at night, primarily. We measure you during the day as well, but we measure you at night.

15:54And measuring at night allows us to set a baseline for you, which is like what's normal for you. And then as you deviate from that baseline, that's a signal to the system to help understand what's going on for you, right? So like if you deviate in terms of sleep or temperature or your resting heart rate is elevated, then we can kind of say, oh, looks like something's going on. Let's explore that. Let's explain that. So this idea of baseline is really important. The other thing that's really powerful about measuring your body at night is that you more or less go through the same process every night.

16:25You fall asleep. You go into deep sleep. Your temperature drops. Melatonin is released by your brain. You go into, you know, kind of some sleep architecture. The second part of your night is usually more REM sleep than deep sleep. And then when you wake up, your temperature rises a little bit. There's a little spike of cortisol. All these things happen, but they happen kind of consistently. Whereas during the day, what happens during the day is very varied, right? You know, you might have a restful day. You might have a tough day. You might have a hard work day. You might have a recovery day. So the day is really important as well, but the signal is not as clear during the day and it's less confounded during the day than is at night.

17:01So those are part of the, like the secret elements of aura, which again, the power of aura is when we get it right, you're like, whoa, how did it know I'm getting sick? It makes a prediction three days in advance. It says, you look like you might be getting sick. You're like, I feel fine. I'm good. And then three days later on the couch, you know, surrounded by Kleenex, watching Netflix and drinking tea. And you're like, how did it know? Coming up after a short break, more on what Aura is looking for when it's predicting what's ahead for your health. Stay with us.

17:44Whether you rent or own, your housing payment is probably your biggest bill of the month. So here's something worth noting. Built is the membership that actually rewards you for it. Every housing payment earns you points that you can redeem toward travel with partners like United, along with stays at Hyatt Hotels, Lyft Rides, Amazon.com purchases, and more. And the neighborhood concierge feature can make restaurant reservations, book fitness classes, and find you local spots, all while racking up rewards at 45 ,000-plus merchant partners. So whether you're paying rent or paying a mortgage, Built works for both.

18:20Join the membership for where you live at joinbuilt.com slash pioneers of AI. That's J-O-I-N-B-I-L-T dot com slash pioneers of AI. On Pioneers of AI, we often talk about what it really takes to transform an organization in the age of AI. If that's something you're thinking about, there's a new podcast worth checking out. It's called Winning with AI from Bain & Company, hosted by AI pioneer and investor Andrew Eng, who, by the way, I'm a huge fan of. In each episode, Andrew sits down with leading CEOs across industries to explore what it takes to drive enterprise-wide AI transformation. Not just adopting tools, but rethinking how organizations operate.

19:08Find Winning with AI on Spotify, Apple Podcasts, and wherever you listen. On Masters of Scale, iconic leaders reveal how they've beaten the odds. Asking really strong questions is a superpower. You want to show up with something radically different and how they've grown companies to incredible heights. The greatest rewards always come from the greatest risks. That's hit the gas. Airbnb, Zillow, Microsoft, Liquid Death and more. Hear from the founders who've changed the game. It's anything but business as usual. Find Masters of Scale on Apple Podcasts, Spotify, YouTube or wherever else you get podcasts.

19:55I think that is very powerful how aura can detect like the onset of COVID or IBS flares or, you know, if you have a cold or the flu, it's really fascinating. It's tapping into it, I guess, the difference between like a deviation from your baseline sleep architecture or is it like your heart rate variability or your heart rate or all of the above? again it's it it depends because each one of those signals might signal something different if your heart rate lowers late in the night that's probably a good sign that you either had alcohol or exercised or ate too close to bedtime because your heart rate is elevated because it's doing the work that those things you know stimulate it i think the other thing that's really powerful about you know measuring at night is that you're not just measuring you know one metric you're measuring multiple metrics.

20:45And so, for example, if your temperature is just a little bit elevated and your respiration is just a little bit elevated and your heart rate is a little bit elevated and your heart rate variability is just a little bit, that's really interesting. And if they happen more or less in the same timeframe, your body is probably responding to an infection. Like that's a really interesting set of signals that's pretty clear. And the way we found this out was during COVID, we had 65 ,000 people who offered to share their data with Aura as part of a study with UCSF. We do a lot of work with scientific institutions and research institutions.

21:20Love that. They shared their data and they said, we'll also share our diagnoses if we get diagnosed with COVID. And so about 9 ,500 of them got diagnosed with COVID and the UCSF research team went back and looked at that data and looked for the signatures in their biometrics. And lo and behold, two and three quarters days before they had a positive PCR test or a COVID diagnosis, we saw these signals all in the same timeframe. And so now it's actually a feature of the product called Symptom Radar, which is basically a prediction about the onset of a variety of things, including influenza-like illnesses.

21:52It's not predicting what illness you have. It's just saying, hey, your body's biometrics have shifted in a meaningful way. And that's just, it's fascinating because, The feature is one that lots of people have taken to TikTok or Instagram, and they've said they told really fascinating stories about how symptom radar gave them some agency and authority in their health journey. I'll give you a couple of examples. And this is a fascinating one. One is a Paralympian. And he came home to stay with his family. And he's like, I'm not feeling great. I'm not feeling good. And they're like, oh, come on.

22:28You're a Paralympian. Bucket up. You got to train today. And they were giving him kind of, you know, the hard line. And he's like, I'm not feeling great. And he got a symptom radar alert. And then the next day he got another one. It's like, I don't know. Maybe I should listen to this. And then he ultimately went to the emergency room. And they were like, it's a good thing you came because you have appendicitis and your appendix was about to burst. What? That's insane. Ora didn't know that he had appendicitis. But like clearly his body was like, ah, you know, having a moment. And all that stuff showed up in his biometrics.

22:56and it was translated into a symptom radar alert. Same thing with like lymphoma. There's a nurse, a pediatric nurse. This was about a year ago. She was feeling terrible and she wasn't sure why. And she would go to doctors and they're like, I don't know, you know, maybe you should rest more. Like it was not helpful. And she kept getting these symptom radar alerts and sort of just, she kept pushing and advocating for herself and saying, I know something's wrong. Look at this, look at this, look at this. And it turned out she had, you know, early stage lymphoma. Wow. And the thing is, is like part of it is like just her having the agency and knowledge of her own physiology and call it the independent, you know, kind of authority that saying, yeah, something's really going on, gave her that agency.

23:39Objective data to take, yeah. Third party data. And in some sense, your body doesn't lie. It can't lie. You know, whereas doctors know this. Patients are remarkably forgetful or sometimes, you know, they can't translate what they're experiencing into words. And part of their job is to extract that. And it's really great if you have information that's like objective and continuous and high quality and accurate and maybe contain some information that, you know, you might not have access to. For a patient or user with chronic illness, what kind of insights does the Oura Ring give that is like really fundamentally important to their health journey?

24:16Yeah, I mean, so it's probably two or three things are probably the most important and the most common. And, you know, one, of course, is the signs of an oncoming infection, right? So if you're immunocompromised, maybe you're going through chemotherapy, maybe you're, you know, maybe you're ME-CFS, whatever. For you, a cold is a real problem. It's not just an annoyance. It's a real problem. And so having that kind of forward visibility turns out to be very useful. Readiness is the next one because readiness is kind of a proxy for like how, what's the state of your kind of your body's kind of ability to kind of go through the day.