A Look Inside Mold-Related Illness | Ariana Thacker, Moldco

28:42I need to go back and see the wire dates. But it was around there. Yeah, I've just pretty much nonstop rejection during that time. I think the best or one of the best signals is when like a VC is investing in a startup and then they go on to just like quit investing and then go join the startup. I think with this, it's like, you know, you're investing and then you decide to stop doing that to go start an actual company in the mold space. One of our investors, who's now a co-founder, actually did that too. So he invested in the fund, he invested in the company, and then he joined the company and now he's a co-founder.

29:19So that's Julian LeFle. Amazing. Yeah. So going through that process in your own mind, at what point did it kind of make sense to you to just focus on this? It was an iterative process. Um, like just based off of what I just described, you can tell a lot of, um, love went into getting conscience off the ground. So I, I really didn't want to let go of that. Like, I felt like that was so part of my ego and identity like to, I couldn't imagine a world without this thing. Yeah. I couldn't imagine a world without conscience. So it took me a lot of time. So what I ended up doing, and I was looking back at my LinkedIn posts at the time, which were so ridiculous because I was like, where is this founder?

30:00I want to find the founder of Moldco. So I was interviewing all these people, several dozen people. Like trying to find someone else to build it? Yeah. Trying to find the CEO and founder. And I was like, I'll help you incubate it. I already did all this work. I'm working on getting Dr. Shoemaker in. We can license in all this IP. Like hindsight, it was just kind of a ridiculous quest. So I tried that for several months while building the company in tandem, running the fund, also getting better. I was still sick during this time too. And there was a lot of personal chaos trying to find like a clean home.

30:33So a lot was going on during this time. But after several months of interviewing founders, there was a point of almost no return. I'm like, okay, I have so much context on how this business works. You're trying to like outsource it so someone else can work on it. Yeah. And then at that point I was so obsessed too. And it was all I can really think about. So, um, and then other investors in my network were like, what are you doing? Like, are you starting this company? What's going on with the fund? We'll back you if you start the company. And I'm like, okay, I think maybe it's time to start the company.

31:04Interesting. Yeah. Yeah. So going from like actually starting the company, you've already put in, you know, months or like a year plus of research into figuring out the problem space. Um, how did you kind of go about deciding, you know, to target that first 90 % and I think this is like years in the making now. So. Yeah. Um, when I describe the solution, it's going to sound obvious, but, um, at the time it was like very non-obvious because the, the information was so complex. Like, so to go through all the information and synthesize the obvious solution took so much time. So status quo, uh, the Shoemaker protocol is, is 12 steps and going through those 12 steps is not the same 12 steps for everyone.

31:49And do you want to just go through what those steps are? It's going to be really complicated for the podcast. At a high level, getting out of the environment, addressing something called Marcon's, which is this bacterial colonization that happens in the nasal passages. So you have to treat that. You have to correct all the hormonal dysregulations. You could introduce something called Lizartan to lower TGF beta 1 levels. That's an FDA approved medication here off label. We don't do that step to be clear. And then we do the VIP peptide spray. So you have to go through a sequence of these different steps, which are varied for each patient.

32:29There are several patient subtypes included. So to simplify all of that into something that can be delivered in a virtual clinic, in a programmatic way, and also in a simple way that patients can understand. Like to identify a solution that met all those constraints was fairly challenging. And to understand if it was true to also address a large portion of the population. So what we ended up doing was cutting off the long tail of very complex patient types to simplify that triangle. So now we just have a three-step approach through MoldCo, which we believe will address the 90 % of the population.

33:10And what is that three-step? Yeah, so that's our detox clear repair, just to put that in simple terms. So the detox step is using a prescription binder. That's the term used in this space to remove the mold and biotoxins from the body. So that's called colacevolam. sometimes known as Wellcol, but we used Cholicevlam. That's the generic version of that. It's an FDA approved medication actually for cholesterol, here used off-label for mold detox. The second step is addressing that Marcon's colonization and biofilm in the nasal passages. So that's an EDTA and xylitol based nasal spray. And the third step is this patented VIP peptide.

33:57So basal intestinal polypeptide is the last step. And that's the repair step. Was it easier to kind of start this because you'd already gone through the process yourself? Yeah, I think this would have been a very challenging task to even see through the matrix and connect all these dots having not been a patient because there's so many questions and nuance and even aspects of treatment and lab testing that are so non-obvious. You wouldn't even know the questions to ask unless you go through it as a patient. And then I just kept experiencing just multiple points of friction almost. Like I had so many odd things happen where I just had to ask so many more questions and get in touch with so many more providers too.

34:47So just like I call it kind of dissecting the elephant. So like you have a big elephant, right? It's just such a big puzzle to try to understand. But going through as a patient was really the golden ticket to get to the kingdom. And I remember documenting a lot of these epiphanies along the way in this very long Google document. So anytime I would have an epiphany, there's so many throughout this process trying to get to truth. I would just put it on this Google document. And by the time I formed the entities, that document was or the entity, that document was over 80 pages. So a lot of insights along the way.

35:28Recently, there's been a number of people who basically kind of announced that they had mold related illnesses. And, you know, Chris Williams and Jordan Peterson. How has that kind of impacted the public perception of just knowing that this is a thing now? I think there's a lot of positive ripple effects from their bravery in announcing that. One, just more awareness. We're seeing the Google search trends increasing for this space too. Mold toxicity has been an exponential climb. For example, we just saw that spike in mold remediation as well. So I think their awareness gave people permission to even ask the question, do I have a mold related health issue?

36:11and to start better understanding what that is. So I think the ripple effects that we'll see longer term are more inspections happening in the home, more interest in labs, and just general open-mindedness from patients, the medical community, and scientists around the Mold Health Connection just from that announcement. Yeah. And is there something where if you have hundreds of thousands of dollars to put towards this, you can do that you can't do if you don't have that kind of money to spend? Right now, the status quo, what patients are paying and how long it takes is they have to first wait several months to get off a wait list to see a qualified provider.

36:51Often they're going through the referral ping pong. And are they still in the environments that are causing these problems while they're going through this process? Every patient kind of has their own unique journey, but yeah, several of these patients often don't relocate right away, or they're waiting for a better financial position to then do the remediation, or they're still trying to figure out how do I work with my landlord to fix my home. So there's just a wide variety of where they're at situationally and why that is the case. But they end up paying tens of thousands of dollars, sometimes hundreds of thousands of dollars.

37:30The most I've heard someone, a single individual pay is$500 ,000 and then$2 million for the family unit. That individual is actually one of our investors because our approach was the only thing that worked for him after a lot of guesswork through alternative medicine and through standard medical practice. Hypothetically, if someone was watching this and they are in an environment where there is mold exposure, what should they do? Yeah, that's a great question. One, if you don't know you have exposure yet, I would start with a dust test. And also we have a free guide that has a checklist too, that you can go through and see some of the obvious and non-obvious signs.

38:09Some of those signs include peeling paint, cracking walls, any warpness, that earthy, musty odor in the home, visual mold. Obviously, any history of water damage in the unit. These are some of the obvious signs. If you have a crawl space, that's notorious for mold growth, too. A flat roof usually tends to be problematic as well. So some home designs, yeah, if you have a pitched roof, you're just able to have the water when there's rainfall just slide off the roof versus a flat roof, then you could have pooling. So there's some of these more obvious structural designs that lend itself to microbial growth, as well as some of the using your senses for the smells and visual cues that there could be mold growth.

38:57So I would start there. If you're looking for the point source of potential mold in the home, we talked about the dust in the HVAC system too, being mold food. That's one bucket. The other bucket is if you're a renter, what you can do if you've identified the sources, work with your landlord. I'm not a lawyer, work with your lawyer if you're going to send cure notices or seven day break lease notices, but that's also an option. The other option too is just relocating if the landlord's not able to fix the issues. Ultimately, if you're a homeowner, you have less options. You ultimately have to remediate and fix the home.

39:33So working with a qualified remediator and try to find someone who's certified like IICRC, NORMI, ACAC, do your diligence. Find someone who's really qualified to help handle your mold situation and probably get a few different opinions where the inspector is different from the remediator, right? So you don't have conflict of interest. So it really just depends on where you are, what if you're renting or buying, and how severe the issue is too. So with us, we are constantly like traveling and staying in lots of, you know, Airbnbs and hotels and all these different places. And I've noticed, I didn't really put two and two together that this could be a possibility, but I definitely notice that in some places we travel to, I'm just like tired or like lethargic or more lethargic.

40:20Is that one of the things that's like a big issue is like if you're traveling and you go to a random Airbnb, you know, if 50 % of houses have this issue, then you can just suddenly not be energetic. Yeah. I mean, that's a great, I mean, I'm traveling for this like eight week stretch. I'm kind of in the eye of the storm being back in Boston right now. I actually have a pretty detailed checklist that I can send you of what I look for when I'm traveling. What is that checklist? Yeah, so, and I work with my team to also help source great places too for when all of us are traveling. So no carpet, one of the newer builds or newly renovated, looking online across multiple different sources if there's been any historic water damage or weird smells or visible mold, calling the front desk to see if they accommodate for hypersensitive patients.

41:13So there's this long checklist that we go through as well as looking at the images online to see if we see any of those representative visual cues. Ultimately, I also try to source a backup as well because sometimes when I go there, I'm like, okay, this place missed all of those different criteria. We weren't able to detect that there was mold. And then in that case, I just moved somewhere else but usually within the first handful of minutes of being um somewhere i can start to feel the symptoms and what does that actually uh manifest within your in yourself similar to you i get tired i have brain fog i i just i'm just not on the ball like i can just tell my processing speed is more like uh molasses versus water so it's just it shows up in that way i'm thinking like going down the list and i'm like all right so we had you know months of water damage carpets uh i was staying in the room where there was water damage for like years afterwards yeah that's probably not ideal not ideal uh yeah okay huh and i i travel with binders like that's i have binders in my purse right now like i travel with that and take prophylactic doses because i know i'm gonna have exposure that's in several of the airports um some of which ones almost every airport has mold has mold yeah and and so some are definitely worse than others you can there's visible mold in some of these airports the fuck is going on like this is a nuts huh i feel i feel like this is probably like the most um impactful interview for me personally because it's just like i'd imagine that this has like a massive uh impact on just quality of life in general and how people go about their day.

42:59If you are in an environment or if you are susceptible and you're traveling a lot, if you get to a place and like you said, you notice in a few minutes, what do you do in those circumstances? For me personally, if I'm only going to be there for a night and I'm not somewhere like high stakes, like an important fundraising meeting or meeting a candidate, for example, then I'll probably just grin and bear it and try to suffer through it. Detox later. Yeah. Honestly, I'll probably do that. But if it's bad enough or high stakes enough, I go with the backup plan. Like I end up just having to cancel the accommodation and try to find somewhere else to stay.

43:41And how often are you doing that? That initial checklist is actually pretty good. It's only happened a few times where I had to find a plan B. Is this something where you would want to kind of, I'd imagine that this would also be a very interesting company to build is you basically or a product to build is just making a checklist that automatically checks spots for people before they you know book accommodations that'd be great yeah that would be amazing i'm trying to seed like more mold companies out there when i speak to founders i'm like hey there's opportunity in the mold space to do this like would love to see that company getting built so what what other companies you know you're going to be creating this like uh you know online um thing that helps remediate mold exposure um what other companies should be getting built that aren't getting built right now um i think there's a fintech opportunity to help cover the costs of inspection and remediation and care for these families the remediation tends to be by far the most expensive um i think there's opportunity to help address the more hypersensitive patient types maybe in collaboration with us.

44:51We amassed the largest data set in the world for what we're doing. Thousands of biospecimens, close to 10 ,000 patient history forms. We have a very large data set. So anyone who's open to helping collaborate to find the next generation of treatment and testing, we have an enormous data set to enable that. I think also continuous monitoring of homes, real-time monitoring. If there's mold, as well as some of these other species, the particulate matter, the VOCs, the mycotoxins, the endotoxins, the actinobacteria. I think next generation dust testing or DIY testing in the home. The list goes on and on.

45:29There's so many different opportunities. I think also better quantifying, better design as well, novel materials, quantifying what historically has worked to minimize microbial growth and then optimizing for builds. that doubled down on that. Some of the new materials coming out include this compressed sandstone. It's called Rammed Earth or Sirewall is the brand name for it. So finding more innovations like that that are more affordable because ultimately the solution will end up being we have to address the current microbial growth across the buildings today if we really want to address this.

46:12If this is really at the root cause of so many different chronic illnesses, and 76 % of U.S. adults have one chronic illness or more, that number jumps to the 90s if you're over age 64. We have to find a way to address the building some way, somehow. So effective and affordable techniques to do that at scale. So there's just so many different opportunities in this space. And I think several of those have real commercial value too. I imagine that one of the most difficult things is if you see the spaces wide open and there's all these different avenues to go down that would all be worthwhile and productive to go after.

46:50How are you deciding to go after this and stay focused when you could be doing other things? So the vision for the company, and this is why the entity name is The ImmuneCo, there's a compounding advantage as a business to focus on the health piece because there's applicability not just for mold-related illness, but also other biotoxin illnesses too. And our thesis is that this data set can compound and address some of these other biotoxin illnesses with a lot of the same information and insights that we've gathered. So MoldCo is the first step in this journey. Next up is LymeCo, and after that is LongCo for LongCOVID.

47:31So addressing the full scope of mold and biotoxin-related illnesses, where we're seeing the same pattern of microbial insults, fungal, bacterial, viral, leading to innate immune system dysregulation, leading to chronic inflammation. And the overarching illness is something called chronic inflammatory response syndrome. So as a company, what can we do? We can start with MoldCo using something that's near Silver Bullet, following the Shoemaker protocol, better subtype these patients, later on additional medications and testing to then be able to spin out LimeCo and LongCo. It is very tempting to continue to build in the mold economy.

48:13I think it's very fragmented. I think there's tremendous opportunity and makes sense from a channel standpoint. But ultimately, I think all these different partners in the space, the whole cast of characters from inspectors and remediators, air purification, et cetera, are all more marketing channel partners than us looking to displace that, maintaining this concept that everyone's an ally and together we can help these patients achieve aspirational health together. And another idea too is that the environmental aspect is a very big problem. Every building is a unique organism. There isn't really a great solution I've seen that's so copy-paste yet.

48:55It's going to require technical innovation versus what we're seeing in Moldco. We already have something that's been validated across 30 years of research. So the solution is there. Do I think it's the modern iPhone today? No, I think it's more like the iPhone 4. And that's where the R &D piece comes in. So we can continue to innovate on that and get better and then address 100 % getting 100 % versus the 90 % getting somewhere between 70 to 90%. So for all those reasons, the strategy is designed the way it is focused on healthcare as primary. Unlike long COVID, does this also have, is there like a correlation between mold exposure and long covid um so dr shoemaker's take on that and our this is also consistent with our clinical team's take two is that uh covid was a priming event for worse outcomes so it's just this like uh what is it i think charlie munger has this lalapalooza idea where you know a one plus one plus one equals like seven instead of three yeah um and so like having you know mold in your home and then being exposed to covet or other diseases can kind of like compound on each other.

50:00Yeah. And there's also other, exactly, there's other takes to around microbial burden. You start accumulating these different microbes and then it leads to worse outcomes too. COVID seemed to be a more intense priming event. So that's our current take. Right now we need more research to really validate that, but that's what we're, yeah, that's the take of our team. How are you going to kind of go from like the first patient to scaling up to like maybe millions of patients? Yeah, great question. So we've built a programmable patient journey through our virtual clinic. We've spent a lot of time developing our guidelines, developing our approach so that it is that programmatic logic so patients can go through treatment and get the lab testing for scale.

50:48Like we built this with scale in mind. So now it's just amplifying what we've already built. And also to get there, we need to bring in more de novo providers into our platform. So providers that aren't from this field, right? We're recruiting new providers, training them under Dr. Shoemaker, Dr. Scott McMahon, who's our medical director, and through our training program to then be able to effectively treat patients in this ecosystem. system. So we're able to demonstrate all of that and build that. So the foundation there is set, and we're already starting our 50-state expansion. I anticipate we'll be there by March of next year.

51:28What does that actually look like? What that looks like is that patients across the U.S. can come to our site. They can order lab testing. We have the blood draw. We have the genetic susceptibility. We have the dust test and go through care. So they'd be able to have a visit with one of our providers after they have the intake to make sure that they are qualified for care. They have access to a concierge care portal where they can message their care team at any time and get their questions answered. We're also building out an LLM to be able to handle communications at scale. This is a very complex illness and several of these patients understandably had to be their own doctor.

52:12They're very educated. They sometimes know as much as the doctors do. So to meet patients where they are, like being able to handle the complexity of those communications, we want a tech enabled approach and then guiding them through the treatment steps that are delivered to their door. Has this been one of those things where like doctors are not like testing for it? And so they're trying to, they're trying to treat every other illness that's related to it, but they're not actually getting to the fundamental route. And so you go into the doctor's office and they're like giving you a pill, whereas this is actually the thing that's causing the thing that needs the pill.

52:45That's one common patient journey. Often what does end up getting treated is the most acute symptom being presented, which could be anxiety. Another thing that happens is misdiagnosis or misdiagnosis. There's also gaslighting that happens. Sometimes your doctor may say you need to go to a psychiatrist because these symptoms aren't real. They're psychosomatic. So we've seen all of that. But there's no environmental health screening questions at the annual visit. I actually wrote a policy memo to shift that. There's no insurance code for mold-related illness. There's an insurance code for being bit by a turtle, but not for mold-related illness.

53:22So that was also in the policy memo. And there's also no lab testing currently for any of the biomarkers that we're testing for, except for ones that are unrelated but proxy to mold, like antigliad and antibodies, because we often see a gluten sensitivity, ferritin, which is often dysregulated. But some of these other markers like VEGF, TGF beta 1, MMP9, MSH, C4A, these are not tested for even through immunologists or allergists. We just don't see those lab tests getting done. Because this has such a massive impact on so many other things, I know there's this kind of like, or at least for a few years, there's this exponential curve on not only antidepressants, but also like Adderall and a bunch of other like focus drugs.

54:10Is this kind of one of those root cause issues for all those other things? And there's just like massive pill farms being built on top of trying to eliminate or correct for this? I think a subset of that market, yes. Just because some of the common symptoms that present are anxiety, depression, even something called mold rage. What is that? But mold rage, you have angry outbursts that are this unregulated emotional response, usually due to the neuroinflammation that occurs and some of the hormonal changes that occur as a result of this. So there's that. And then there's also the cognitive impacts where you have the brain fog and poor knowledge assimilation and you're just not able to learn or retain information.

54:52So you have the memory impacts, too. So that's a component of it. I think it'd be too bold to say that's the entire market. I don't think that's the case. I think it's a subset of the market. And similarly, it's our thesis too, just given the women's health impacts, which also need a lot more research. Only 12 % of funds go towards women's health research. But what we see is the multiple miscarriages and misperiods and infertility. So it makes me wonder how much of IVF can just be solved by getting out of the mold environment and going through treatment. On the R &D side, what are you guys spending the most time for research and going from iPhone 4 to iPhone 17?

55:37Yeah, that's the vision. To get there, we want to find what are the most effective and safe treatments available today for patients. So we're not opting for an FDA pathway drug. We're not looking for new chemical entities. We're looking for medications and peptides that are already in existence that can be prescribed off-label to patients today. It's like expanding scope on what those things are kind of impacting and curing. Yes, exactly. So repurposing existing medications for this use case, like one, that tends to be a lot more affordable for patients and two, it's available near term. And you can run shorter duration, lower cost studies and trials to demonstrate that.

56:21So that's what we're optimizing for as well as novel biomarkers to help with better testing and better subtyping of patients. Perhaps it'd be a specific patient A gets medication A, patient B gets medication B. So right now, after we've amassed what we think is the world's largest data set in the space, I'm pretty sure it is just from meeting so many people and being deep in it, which is thousands of biospecimens and the 10 ,000 patient history forms, which includes the environmental data, MRI data, RNA-seq data, past medical history, genetic data, etc. We have all that in our repository. Right now, we're just making sense of that.

56:59We've started sequencing the biobank via RNA sequencing. The next step from there is just making sense of that to then find the next generation of treatments and lab testing. You guys have really started to market this and try to spread awareness of mold-related issues. What's been the most surprising thing for you so far? That's a great question. I was surprised by how many people have made the mold health connection. Going in, I was almost skeptical that we would be able to move fast with that quadrant of patients. I was expecting a lot more education and awareness to be needed to be able to reach these patients, but a lot of them are coming in very familiar with Dr.

57:44Shoemaker, having read several of the Reddit forums, participating in the Facebook groups. I I was surprised by how big that patient population already is. So that was surprising. And I was also surprised by the scope of treatments out there that have potential. So much right now outside of the Shoemaker protocol is anecdotal and guesswork, but I think there's merit. I would love to just better understand the efficacy and safety of those approaches. So I'm excited by the whole scope of potential treatments for the next generation of this too, just based off of what I've been crowdsourcing from patients already.

58:27You briefly mentioned that there can be a noticeable IQ drop with constant chronic mold exposure. How big of an impact does that have or can that have? Yeah, I do recall at least one published study on this looking at the IQ drop due to water damage building or maybe it was specific mold exposure. I think that's something that needs a lot more research. But what gets me curious is, is it contributing to social disparities if mold is more prevalent in some of these lower income homes or areas or older buildings? is that then impacting school performance and cognitive abilities. Like social mobility, I assume.

59:09Correct. Because here in the States, you're, and I'm sure this will change with AI and new forms of education coming out, but one of the biggest contributors to social mobility is just having more education, right? And maybe you're given an unfair advantage if you're not able to be performant at school beyond a potential IQ drop. It's just the fatigue and the whole host of other symptoms that you could be experiencing as well as the emotional dysregulation. So I almost wonder if it's putting some kids at an unfair advantage right out the gate and limiting that mobility. Yeah. I'd also imagine that if that does have a very negative impact on a whole bunch of other things, it's not only that.

59:50It's also, I'd imagine that that correlates with weight gain and eating habits and sleeping habits and not all compounds. Yeah, we do see weight gain. We see leptin resistance in patients. Dr. Shoemaker and Dr. Scott thinks it's one of the biggest or one of the bigger contributors to obesity here as well as a host of metabolic conditions. There's something called molecular hypometabolism that happens beyond leptin resistance too. for these patients where the mitochondria are impacted. We're noticing that mold and it ends up being a ribotoxin in the body. So that's like a whole other thread that we're exploring more through our data set.

1:00:32But yeah, I think there's social penalties with that. The mood changes, just not being able to be your best self, right? And it could impact forming relationships and friendships. yeah and like i'd imagine long-term thinking and you know planning and all this stuff is there a way to build something similar to like a smoke detector that you can just plug into the wall and then you're constantly measuring the mold exposure in your house or that that's on my wish list like that would be a dream come true for me like just to have that what's not like what's stopping that from being the case it's a technological breakthrough that's needed there's a few companies that are trying to solve that.

1:01:13I'm on their wait list and I've met the founders. I'm really eagerly waiting for that solution. There's one, I think the company that comes close is an SF-based company and they have, it's not a continuous monitor for the mold. They have a little cassette where you need to ship that into the lab, but they were able to remove the specialized talent in the loop for that. And with AI trained on 50 ,000 images per fungal strain, be able to identify what's on that little cassette. So that's really interesting. I think that comes close. That's like the 80-20 to get there, but I am waiting for some sort of breakthrough for a continuous monitor in the home.

1:01:52That'd be incredible. For the team building and kind of trying to create the right culture inside of the company, have you just kind of like optimized hiring for people that have experienced this sort of thing in the past and kind of come to this on their own? Or how are you deciding to do that? It just kind of happened that way. It wasn't really my top one, two, even 10 things that I was looking for. But the two, recently we announced Julian and Kevin as co-founders in the company, which I'm really excited about. They definitely earned it. They are incredible to work with. So they're our patients.

1:02:33Quite a few people on the team have experienced that or have a family member that has experienced that. So it was pretty accidental in that way. And then for culture building, what we end up doing in the company is having these eras, right? Like, I don't know if culture should be stagnant. I think there's a time and place to show up in different ways. So we had the era of excellence. So how do we have an excellent experience and how do we show up with excellence for our patients? Before that, it was the era of delight. How do we delight our patients until we can really ramp up the product and processes to really get to the era of excellence?

1:03:12Now it's the era of value. We're just now entering that next week. It's just how do you as an individual in the company have autonomy and empowerment to drive value for the business, building on the systems that were done? That's the tuning fork for culture. Like we meet weekly to reinforce these different eras in the company. And the shift of that really just depends on the business needs. For the first step, were you based in like, I imagine that this is not very many patients, but you're basically having a super high touch relationship with each one of them to like show that you really care and you're like trying to solve all their stuff manually.

1:03:48Yeah. How did you kind of start out with that and then go through these other two evolutions? We're nonstop listening to the patient. I read every single support message that comes through. We're just obsessive with understanding what this patient needs. We're meeting with them on calls. We're reading through all the Reddit forums. We read all the reviews. We're reading all the comments. We're just really obsessed with listening to our patients and building for the patient. So it just became focused on that obsession. And then we prioritize the product around that. Like, how do we drive value for patients?

1:04:27Normally, my final question is, what's the hardest thing you've overcome? But the problem is, I think I already know. Is that a good question? What's the hardest thing? What is the hardest thing you've overcome? I think it's like internal demons, right? Like, I don't even think it's an external thing. Like I, you know, like the whole host of internal fear and anxiety that shows up when you're building, like constantly overcoming that and expanding what's possible and having courage. Like I am more anxious and more fear prone. So having to do everything I'm doing with that internal state has been the continuously hardest thing to overcome all the time.

1:05:09Max Macchione from Superpower described that there's like one of the most important things is kind of like being low fear. but I'm not sure if low fear is, it's not like a constant. Sometimes you're very low fear and sometimes you're much less willing to take actions. I think high courage is the ideal to optimize for because you can't really, like you can control the fear to an extent. I try not to put energy there, but I rather put energy into what I can control and I can control how I show up and I can continue to choose actions and have behaviors and thought processes that reinforce courage, despite how I'm feeling.