#431 Neko: The Future of Healthcare? With Hjalmar Nilsonne, CEO

27:11We combine that with a 3D camera to capture the shape of your body. And we combine that with thermal cameras to capture the temperature profile of your body. So from the kind of engineering point of view, it's like, okay, now we have an objective representation of core things that tells a lot about human health in general, like very similar to what you would get if you were looking at somebody, if you were touching them, trying to feel if things were swollen, if they're warm, these kinds of things. And we've done all of this, as I said, in six seconds at essentially zero cost because it's all different imaging modalities.

27:46Now, the question is, okay, how do we translate this into something that someone cares about? So then our hero use case there is like, hey, we can now image every single mole on your body. and we can give them every each and every one of them a unique number and whatever happens to you in the future you can now go back and see objectively what was this mole like a year ago two years ago five years ago so by removing the like the data storage is no longer in the head of the doctor it's now objective and you know saved somewhere which also makes like objective comparisons possible. We have this problem.

28:23So my daughter has a rare autoimmune condition. So we need to go to the hospital a few times a year. What we need to do is to check her joints for inflammation. And so the way they do that is you have a very, very good doctor who's kind of warming up her hands. Then she's taking a knee and she's kind of doing this. You know, you're looking at like her every expression, like, is something wrong? And then she said, I think it's OK. you know and as an engineer this would always drive me crazy because like what is this whole business we're trying to do an assessment of circumference we're trying to make an assessment of heat like all of these things can be measured objectively but even worse she had to move to italy so they call us and they say the only person who actually knows the knee is gone so now we're in a bit of a bind because we need to find a new doctor and they need to train up a new recollection of this specific knee.

29:18So we're still in this kind of 18th century mode of medicine where you have these incredibly experienced, amazing doctors, but everything is stored in their head and nothing is captured objectively or easily trackable over time. So the goal of this system was really to do this like comprehensive objective mapping of the outside of your body that would allow us in any future case to go have a rich history to talk about changes, et cetera. And we knew that moles is something that consumers really care about. One thing, it's very visible. It's like you see your moles, so people think about them. It's very obvious that if you have a history, the diagnosis will be better.

30:00And when you go to a doctor, they say, hey, has it changed? And if you're like me, we count them. I have like 848 moles. I don't keep track of all my moles. It's virtually impossible. So it's very clear that, okay, this objective mapping will really guide you to have a better outcome here. And this has also led us to like skin cancer is one of our most common, like we find a lot of malignant melanomas, maybe we'll get into the data from anywhere, people age 30 to 80. So it's also one of the most common cancer types and one of the most easy cancer types to deal with from the kind of true positive, false positive, like the worst thing that can happen is you remove a small piece of skin, which for most people is a very low risk procedure.

30:46And it can be life-saving. So that kind of the standing up part of the scan. So as I said, in like six, seven seconds, we do like thousands and thousands of images. Then we all, we stitched them together. And it turns out again, the unbelievable naivete we had going into this, because it turns out like human bodies come in all kinds of shapes and colors. When you have an iPhone camera, you kind of do this. We can't do that with a physical system. So like figuring out exactly the right amount of lights and focus and all these things turned out to be super complicated. But it doesn't really matter.

31:19At the end of the day, we take all of this data and then we kind of do a lot of data crunching to put it together into kind of one representation of you. Then the second part of the scan is you go and you lay down on this bed. and the main focus or the primary focus on the bed is really cardiovascular disease. So, you know, cardiovascular disease, biggest killer in the world, most expensive disease in the world, but most importantly, half of all cardiovascular disease is undiagnosed, meaning that our emergency rooms are filled with people who have heart attacks and strokes and all these things.

31:54When the doctors get to see them, they realize that this person has been walking around with untreated cardiovascular disease for decade to decades and had they been given the appropriate treatment they wouldn't have ended up like that and this is actually so we've been working with a great cardiologist for the last couple of years working the system from his frustration of seeing every day in his hospital people come in with things that could have been prevented but there wasn't and he's just been on this mission like we have to change this like these people if we could just basically apply guidelines around cardiovascular disease we could save so many and improve so many lives so anyways we have the system where we do the full sort of ECG which is you know traditional ECG where we look at the electrical activity of the heart where we record your heart sound in multiple places and again we record it we don't store it in the head of a clinician we we have it on file so that for anything that's changing in the future and then we have our own system for understanding the heart's pumping function and pulse-wave velocity.

32:55So how the pulse is moving from the heart through your arteries and indications of cardiovascular disease there. We also do the blood pressure on both arms and both legs. And this gets to a little bit of this funny combination because you said it's really, it's a scan, but it's a combination of things. So, you know, we really combine pretty cutting-edge cool stuff with like the super basics. So like, again, when you read the book, it's like, you should always do blood pressure in both arms. Yes. Like most people have never had it done because there's no time. Okay, so we just built a system like, hey, if we're gonna do blood pressure, let's just do both arm, both legs all in like one minute and you know, we're done.

33:38So that's, again, like thousand year old medicine that we're just applying in a way to be just do what everyone should be doing, but just building in a way where it's super convenient. So that's the goal there really to do a very comprehensive mapping of your cardiovascular health. Then we have the green light on your arm thing. Yeah, tell me about that. So it's a microcirculatory assessment. So, you know, you have, you can have a perfectly functioning heart, arteries, these kinds of things. But you, so basically a healthy macrovasculatory system. Yes. But have, you know, dysregulation in the microvasculatory system.

34:14So the typical example there would be like diabetes, where you get very warm feet because the macrovascular is pumping down blood to your feet because you have nerves and cells that are dying because the microvascular is not working. We have been using for peripheral arterial disease. It's another common dysregulation. So it's essentially an Apple watch on steroids. So we use light projected in very specific wavelengths, in a very specific pattern, to distinguish different layers in the skin and how the regulation of the smallest blood vessels are working there. Many chronic diseases have a stronger relationship to microvasculatory function than what is really well understood today.

34:59So it's also data type that we believe will show to be even more powerful in the future to predict different kinds of disease progression. Then you mentioned we do a few other things. We do the grip strength, as you know, who you probably know better than I do, you know, one of the best predictors for long-term health. So basically, if you're below average on grip strength when you're 38, which I am, I mean, not just 38, I'm below average, when you're 60 or 70, the probability that you're below average on health in general is high, which is why grip strength is a good indicator. We do eye pressure.

35:35So eye pressure, why do we do that? Well, symptoms when you have problems with eye pressure is vision loss. Once you've lost it, it's gone forever. If you catch it early, you can easily fix it. So it's just another one of those health areas where it's like, of course, we should check before you start going blind, not after. We combine this with taking a blood draw, as you saw. The thing that we do that's on the blood draw that's unique is we have at each of our locations, we have our own lab. Which means that we can process the blood in 10 minutes. which means that once you've done all of this data collection, you get dressed, you talk to our doctor, you're not waiting for anything.

36:11You're not waiting for blood results. You don't get an email three weeks after saying like, hey, the bloods were fine. So we want all of your results to be ready when you sit down with our doctor so that when you leave Neko, you should have all your questions out. It was an incredible process. And I think, I know some of the criticisms which we are going to go into to get your thoughts on them. What I will say is that very shortly after having that, my NECO scan, I went to the hospital. I've got a salivary gland stone, incredibly benign, just one of those things that they just need to look at every now and again.

36:44It's fine. It's a hospital even that I've worked in. And when I went, there was no car parking spaces. I then had to go to three different car parks. I when I got into the hospital I actually couldn't find outpatients properly in fact I went to the wrong desk I then I then couldn't find the room I then like had the appointment which was fine and then I got lost on the way out as well and nothing about my experience I think it was because it was so close to having the Neko scan and of course when you're dealing with you know what people think oh you know relatively fit and well people you don't have to design a whole whole hospital whole secondary care unit around them you can build purpose built for the for the human experience the patient's experience it just felt so wildly removed that like you said when you were thinking about how to design Neco Health about what if none of this existed how would we start what would we do if we started again I'm noticing even that conversation turning up as people talk about building hospitals in the Middle East, this idea of leapfrogging, leapfrogging entirely whatever system we've got going now and just thinking, how do we literally just build this entire thing?

37:58And in part, it's disheartening because I am a clinician. I'm from that system. And I know, and I can feel that we are removed from the expectations of a consumer, someone that was actually putting their hand in their pocket and paying would this be good enough or probably not it is a public health care system though and we have to give concessions for that and so it is very it is very confronting a lot of this but it shows the gap i think or it showed for me anyway the gap directly between the two and this idea that by building a health care system a preventative healthcare system from the ground up with the resources that you have the level of things that we can learn about how best that is done which brings me I guess in part to what have you learned because you guys have been doing this for a while you've mentioned some anecdotes of of people that have been through this and thank you for sharing about your daughter by the way I just want to ask you this when you designed Neco Health and you're asking your brother those questions and you've applied an engineer's first principle thinking to, well, you've actually just described observing and you've described some of your internal algorithms of how you observe skin colour, how you observe what's around the bed, all these things that we are taught in medicine and turning those into data types.

39:31I think we are you are very much in the business of doing that right now do you think that's a trend that will keep going and the reason I ask the question is because I think as a particularly I used to work in intensive care and I did a lot in A &E and things like that you would have an you would have an intuition and I can remember there was someone that the everybody wanted to discharge and for whatever reason I just wanted to hold on to them for as long as physically possible and then just before they breached A &E of course massive haematemesis ended up in recess and I was like I cannot I cannot tell you I cannot tell you why I thought that and again I've done that many times and it not been that so you know that's not a perfect system my intuition but clearly you know there's something and all doctors have got these types of stories so this idea of turning what isn't data into data.

40:29Is that in part what you're in the business of doing? I had a very powerful childhood memory where I broke my leg ice skating and my dad ended up in the hospital and my dad came over. And as I was in the hospital with my dad, there would just be people coming in all the time asking him to help out with their patients. Like, oh, we have this and this. What do you think we should do? Can you come and look? And he actually left the room multiple times. Okay, please come over here. So what's going on there? Well, my dad was an extremely dedicated person who had probably seen more examples than anybody else in the hospital.

41:11So when you were not sure what to do, you want to go to the person who has seen the most examples. And even if they can't tell you why, they have built up this intuition. And this is why medicine historically is an apprentice work. work. You go with an expert, they show you how to do things, eventually you become the expert and then you show the next generation. So you have these very esteemed older people who have seen a lot and sometimes we've joked about this because I come from tech where it's a bit the opposite. If you're the expert on PHP, nobody's interested anymore because nobody cares about PHP.

41:49So you see who gets funding in tech, it's like 20 year olds, 30 year olds right it's like you have some areas where getting older really means you you have a lot of knowledge and it's usually these kinds of things um but of course that like there's nothing spooky you have examples um and you have certain people who have like combined examples diligence intelligence and they end up becoming very very good at discerning what you should look more carefully at it and what you shouldn't i'll tell you a funny story about this so like we met with one of the a very well-known dermatologist and he said i think this is wonderful this will enable all these things in dermatology and he invited us to meet his dermatology group and we spent an hour talking about a b c d e which is the method for like is should i be worried about this so a is area b is border c is color and he was explaining like this is how dermatologists think and as we And I go, oh, this is all very good.

42:47We can apply, we can try to build kind of algorithms to do A, B, C, D. And as we were kind of wrapping up, he said, but by the way, this isn't really how we do it. And I said, well, what do you mean? And he said, well, you know, I've seen millions of moles. So when I see one that looks funny, I just know that one looks unusual. And as an engineer, I mean, what you're describing is basically machine learning. You have millions of examples that you've accumulated. You have a feedback loop of good, not good. And so when you get to see the million plus one example, if that looks different from the normal ones, you're going to say, let's have a look at that one.

43:24The challenge is historically, like we haven't had a way to capture this information outside of, you know, the heads of these experienced doctors. So I think that's a huge part of, you know, the kind of things that become possible when you do this objective mapping. And we are not an either or kind of thing. I don't know if you had any reason to interact with this, but we do our own follow-ups. So, you know, we have our own dermatologist. We have our own cardiologist. So it's not that we say, you know, hey, either, you know, you use AI or use a dermatologist or anything like that. It's like, hey, let's objectively capture the data.

44:02Is there an indication of risk? Let's bump it up one level to the most capable human person who can make sense giving this like broad Experience and say this looks fine This does not look fine and then over time get better and better at distinguishing what should get bumped up to the specialist I had to have so my cholesterol was high so I had to Go for the extra scan where they break it all down and look at all the different bits and bobs But again at no extra cost to me, which was interesting reminds me back of the model we talked about where you only pay the doctor when you're healthy. So yeah, I've paid my this is how much it is.

44:37You guys are incentivized to make sure that I don't need that next time. And actually, you guys are incentivized to keep me. It's interesting to me. It's interesting to me as a model. Before I move on to the business model, actually, I just want to ask you about something that you've covered a lot here that I just think needs calling out specifically in the value of longitude and all data. here, you're recording things that are only previously heard and compared to, you mentioned the story of your daughter, you know, feeling a knee and understanding the knee and that information being locked down there.

45:07You're surfacing a lot of this data, you're capturing it, you're scanning moles, you're capturing it for comparison down the line. How do repeat scans and longitudinal data fit into how NecoHealth is building value in its company? Going back to Hippocrates, it's like the book of prognostics. We always talk about these are all the findings we have in our scans, we have the life-saving, but we always say, look, the most important group for us is the healthy group, because that's the group where we can still make a difference. So the people who are not yet sick, chronic disease, have these problems, that's how we turn public health around.

45:52And how do we do that? It's by having the data, then showing them the prognosis of where their health is going. Then we don't preach. If you say, hey, I don't care that I have a bunch of risk factors, great, that's your life. You're free to make your own choices, but now you're informed. And this is also why, with an ECHO So way of doing things, you spend more time having a conversation with the doctor than you do in a scan room collecting data. Why? Because the most important part is not having the data. It's communicating well with somebody what they need to understand. Just to interrupt you, sorry.

46:31Yes. I didn't actually think this at the time, but I remember telling my wife afterwards about the scan. and I, it was a conversation. It was actually just a chat and actually, I don't want this to sound like I'm trying to advertise for you guys because we will come on to some critiques but I genuinely, I didn't feel judged, I just felt listened to and actually it became like, give me the context on this. What's your diet like? What do you actually do? Do you think this is a problem for you? Do you want it to come down? Like that was the conversation. And by the way, like I'm not saying that doesn't happen everywhere else, particularly in a public health system like the NHS, you know, time with the GP, continuity of care, et cetera.

47:16That's definitely what we want to be aiming for. I did notice that. And I don't know if that's NECO specific, but I know that that might be clinician specific to those people that you've hired. And I definitely appreciated that. Look, a typical GP, you need to see 30, 40, up to 50 people a day. Yeah. When you work at NECO, you see maybe nine people a day. Yeah. So the amount of time and depth you can go into is just very different. Then you combine that with you don't just have the time, you also have the information. So you have the person in the room, you have the bloods and the ECGs and whatever you want of the foundations of talking about your health, it's all there.

47:52So we're setting, I think, both the member and the doctor up to really have a meaningful conversation. And the sort of one-on-one of communication is like, it's not about what you say, it's about what other people hear. you know and i think it's kind of funny so like why do you go and see a doctor well you go there because you need some answers and then it's like how much of time of the doctor's visit was uh sort of given to the answer part where you learn what you need to learn and usually it's a final like 30 seconds so it's like you did all the stuff the phone is ringing and then it's like okay you here's the deal you need to go to we think it's this probably not that you need to go to the pharmacy you need to pick up this thing you need to take it on wednesday but not every other wednesday because then you take like two pills and like off you go and if you're me anyway you're sitting there like first i'm like yeah i totally got it and then i'm out of the door and i'm calling my wife and i start to explain to her and i realized like i didn't get it at all i can't even remember half the thing that was being said to me and so like what is the point of doing all the work if i didn't understand the things i need to understand so we wanted to kind of flip this i mean there are two big things that we're doing to flip it.

49:00One is the time. So like, let's make sure that every person who leaves Neko has had the time to ask their questions, to really learn what they need to know. And the other is just the environment, you know? So I grew up in doctor's offices and usually there's one or two desks, there's like papers everywhere. Like the phone is ringing all the time and you walk in and you're kind of disturbing someone. They're like, okay, I was in the middle of something okay but okay come in who are you you know that's kind of the feeling and again if you're like me you have this kind of rehearsed story in your head like what you're going to say to not feel like an idiot of wasting their time like okay would you have to understand this you know and you get into it um so in our version of the doctor's office as you know there's no desk there's no phone there's no paper there's just like okay actually the doctor's waiting for you you're not disturbing anybody um and it's really to flip you flip the mindset like let's make sure you are empowered to understand your health.

49:53And let's be honest, the problem with public health, you can put in an ad saying don't smoke. It doesn't help. So the problem with public health is we want to have ice cream and Necroni and these are the choices we want to make in the moment. But if we zoom out and say, hey, when you're 60, do you want to be able to have a good life in retirement? We also say yes. So there's a tension there. and most people do not think like, oh, I want to spend like£299 to think about not having a Negroni or whatever. So making that whole experience pleasant enough that they not only come once, but they say, actually, I'm going to come back and I'm going to make this a habit of checking in on my health.

50:33And that to us gives us the chance to make a difference. That bit that you said at the end there is interesting to me because when you said that, so nine people a day, there's obviously going to be a tension here. You know, your CEO, you'll have a CFO that's, you know, reasonably, could that be 10? Could that be 11? Could that be 12? Could that be 18? Surely we could get more throughput here. Do you really need that long in the consultation at the end? Surely that becomes a pressure. And when you're running a business for profit, these exist as pressures. as pressures, but holding firm on this is the number we want to see because we want to make sure we have the highest possible quality of product.

51:18It's interesting because I guess it's a sliding scale of overall impact, right? If every necoclinic saw twice the amount of people, you could argue it makes twice the amount of impact. But I guess the question is, or would it? because is adherence, is the time spent at the end focused on adherence actually the most important time? And so how did you arrive at that? How did you arrive at your model? Do you go P &L first and figure that out? Do you have a margin that you're aiming for there? Necco is the business. Talk to me about Necco as the business. For us to be here to care for your health for the long term, the company has to be here for the long term.

51:56Absolutely. And if we're losing money on everything that we're doing, we're not going to be around. Because who would want to finance an operation that's just losing money? So on the one hand, we need to figure out a way to do this sort of preventive and proactive health service where it's financially sustainable. But on the other hand, we need to make sure that the quality is there so that we're doing something we're proud of and it's positive. And the very honest answer is the time that we had was what we could afford. So we can afford about 20 minutes with the doctor. So that's what we have.

52:30Yeah. Anything more than that, it becomes quite challenging because now basically you're using up two slots and then the price, it doesn't need to go from like 299 to like 349. It needs to go from like 299 to like 500 or something. I understand. So this is like, okay, here is something where it's financially sustainable. We think the experience is there. Yeah. So like the vast majority of people will have a great experience. some people have could spend hours in there so they will be a little bit disappointed but i would say for most people it's who where the alternative is getting five minutes you know in some other context or with a telemedicine thing or whatever that like this feels still very uh sort of unmet i'm proving the model at that point at that price point at that time with clinicians at that level of impact of what patients go on to improve.

53:25Proving that model, I'm interested in the future of that and whether there's an integration with a public healthcare system that you can do when you, when you, what you're essentially doing is proving ROI because for every pound spent on prevention, it delivers more in lack of morbidity and all the rest of it and the amount of tax they Pay Pay and all the rest of it. So at kind of a national level, you can scale up the data that you've got to go, well, this is now purchasable as a service by an entire national public health system. Is that something that you guys think about? We didn't start this company because we thought the world just has too few, like, lecture clinics or something like this.

54:06You know, that is the big burning need we have in the world. Like, the big burning need we have in the world, as I said, is like 80 % of what we're doing in our health care system is associated with chronic disease. and still we're running a basically reactive sick care system, then something more preventive. So that's 100 % where we want to go. Now, the incentives, as I said, are not there yet. So this is one of the reasons why we put on our website all of our outcomes, like because people have concerns, maybe we'll get into it, false positives this, false positives that. So all of the data is on the website and people can draw their own conclusions.

54:42But the facts are kind of the facts. Now we think we want to live in a future where access to preventive healthcare is not dependent on what kind of work you have or how much money you have. The only reason we are 299 is that we are in the unsubsidized part of the healthcare system. I don't know if this is true, but someone made a post kind of comparing us to what they were doing in their GP practice and they said that they get about 160 pounds per visit in their GP practice. And I thought that was interesting because that means we're about a 2x higher. And then when you look at kind of what we can do in one of our visits compared to like just a visit of chatting with someone for a few minutes, it's a big difference.

55:25I don't think we're like miles off to begin with. And then I think, you know, we launched here about a year ago. So I think we're still pretty early in our journey. What I think is wonderful with technology is if you think about like something like a smartphone, you know, in the 1980s, like the Wall Street guys to have these big, like, what's the movie called? The Michael Douglas thing. You know, they're all running around with these big phones. And everyone is kind of, that was kind of a silly thing. But then you fast forward like 20, 30 years later. And basically every single person on the planet, even in the poorest part of Africa, they have now a phone in their pocket.

56:04And what's even more interesting, I think, like, if you are, you know, Barack Obama, you don't have a better phone than I do. probably you actually have a worse phone because you probably have security concerns. So the difference, and actually like if you live in Ethiopia, my phone probably isn't that much better than your phone. You probably have a cheaper Android phone. I probably have like a better camera. But it's not like you can watch YouTube. You can do pretty much the same stuff. So when you apply technology to a problem and you're able to reinvest over a significant period of time, suddenly it's not crazy to imagine a world where actually a lot of the underlying tech around prevention and primary care could be quite similar in Ethiopia, Washington, D.C., and London, because ultimately it's driven by the capabilities of the tech.

56:56And then rich people always find ways to spend their money. So they buy phones in gold and they put diamonds on it and stuff like this. So I'm sure even in that future, there's going to be some super fancy services. But what's going to be different is not the tech or the information, it's going to be the surface level stuff. So Yalmar, humor me then. Do you honestly believe in this future of abundance where we all would have access to a similar excellent level of preventative health where everyone would have what Neko could do now, for example? I mean, my question to you would be like, can you tell me constraints that makes it impossible?

57:38So I don't know. So again, it's not obvious to me that it's impossible. Now, is it certain? No. So I mean, this is why we and many other folks like us will have to do a lot of hard work over the coming decades to usher in something new. Yeah. But again, I haven't seen anything that would lead me to believe that you couldn't do it. Well, I would say it depends who pays and how much, ultimately. Because we've talked about this gap between the rich will always experiment. They always have the resource to experiment. And now, you know, your class concierge medicine, people spending 100 grand a year on private GP and every referral going and all the rest of it, you know, you put that in that category now and longevity drugs and all the stuff that whatever weird and wonderful stuff they are doing.

58:35and then you have sort of public screening programs and NECO almost sitting above that as certainly not near that concierge stuff but it's certainly an out of pocket for people that can afford it and so I guess one of the critiques obviously is that is this widening health inequality do we then have a two-tier system where there's people that can afford 299 a year that can do this and there's the people who can't and are we widening equality that way if that is the case at the moment then what is being done to make that not the case and accessibility for everybody yeah so as i said like our vision is very clear that we want to create something that eventually i mean if we go again if we just go back to the basics it's like I think my belief is that a country like the UK would be way better off if everybody had the ability to get a free scan like NECO every year.

59:33Yeah. And that's like just on like health economics. If you just look at like the cost benefit, I believe that already to be the case. But obviously there's a journey that we have to make to convince the rest of the world that this is the case. And it's a journey that we have to do on one side with facts, with showing our data, which we're doing. But on the other side, with the consumer, of taking them along for the journey. And one of the things that I learned, like working on climate change for 10 years, is like a lot of these things, we think it's up to politicians to do things. And we think it's up to like big corporations to do things.

1:00:07But actually, what ends up driving a lot of the big changes in the world is the consumer. And kind of the heart of mind is the consumer. As consumers, we're always voting for what kind of future do we want. We vote with our wallets. We vote with our time. So a big part of what we're trying to do with NECO is to inspire people to say, hey, the future could be very different. You could have a healthcare future where you looked forward to going there. The experience was brutally efficient with your time. All the results were done when you were there. And of course, it's preventive in nature. That future is possible.

1:00:45How do I know that? Because it already exists. Now, it doesn't exist everywhere for everybody. So then the question is, okay, we know it can exist. So what is the journey from existing in a few places to existing in many places? And as you say, that's one part of that is a tech question, because for the last two years, we've been working like absolute maniacs just to build more centers, because we have a wait list that's growing and growing and growing with consumers voting, saying, hey, I'm into this. Like a lot of them, they don't quite know what it is, but whatever it is, this is something like it's resonating with something that I've been looking for.

1:01:23And then the other part, as you say, it's a reimbursement question of like, how long will it take to convince parts of the systems to say like, actually, we would save a lot of money if we offer it. And I think we'll start with certain groups like men who check box X, Y, and Z on risk or whatever. Let's start with them. And if NECU can help them have a better trajectory. I think very interestingly, a couple of months ago, now we posted our first data on what happens between scan one and scan two. Yes, I saw this. So our first two data stories were what you can see easily in the first year, which is what did we find?

1:02:00So we could say, okay, we have all these like life-saving interventions that we found, et cetera, et cetera. But then the other question is, okay, does there seem to be any point of doing this scan if we didn't find anything? And I wouldn't say we have conclusive evidence to show that this is exactly like the percentage that we did and somebody else did. But what we can say is as a group, our cohort got healthier between scan one and scan two. And the group actually who benefited the most were those with pre-existing chronic conditions. Those who already had diabetes or cardiovascular disease or metabolic syndromes, they had a three to five times bigger improvement, something like this, than the average member.

1:02:41What's really interesting about that is, and again, I can't prove the exact correlation, but what I think is happening is you have people walking around with a chronic disease. And for the first time in a long time, someone has sat down with them for 20 minutes and really talked them through what this means for them and what they can do about it. and that has really inspired them to make a bigger change than for the average person. So we think that's pointing to the fact that this kind of thing, it helps chronics, it helps healthy people, and it definitely helps people with undiagnosed conditions that we find.

1:03:14I suppose to these people as well, is it that someone is actually party to a mixture of data that's not come at the same clinician at one time before because of all the different tests that you're doing? It's a new collection of data, isn't it? And therefore that clinician, they won't have had that conversation in that way from anyone else simply because they won't have had the same amount of data points. Yeah. So it's potentially that as well. Yeah. Anxiety in the worried well. I saw the reports. Four out of five people didn't actually need any intervention, which is great. that's also a lot of healthy people wanting to get scanned out of their own interest and that side of things what do you say to criticism that you're creating anxiety in the worried well well first of all i would say like if you look at our marketing we almost only talk about health and not disease so the typical like hey we want a lot of word well it's like you probably have cancer come get a test you will basically never see us do this kind of marketing because neko is all about health It's not about disease.

1:04:21To me, the concept of the word, well, doesn't really exist, but we can get into that. But I would say in general, the reason we have an avalanche of consumers wanting to come to Neko is that we've created a completely new way of experience healthcare. It's not because finally you can find a time with a doctor. So if you're very worried, you can always go to Harley Street or wherever. There's no shortage of options for someone with health anxiety to go somewhere and talk to somebody. So I would say the reason we have had this enormous interest is not because there are so many of them. It's because we have this new experience.

1:04:53We estimate that about 70 % of our members have never done any kind of health check before. So it's folks who are not traditionally thinking about this, but they're drawn into what they're seeing and building a new interest in their long-term health. Now, the reason I would slightly disagree with this idea of the word well is I think like if someone wants to put time and energy towards their long-term health, isn't that great? Isn't that what public health should be about? I think that the idea of the word well being kind of a blemish on society is a little bit strange. Like if, I don't know, if you were worried about your finances and you say, oh, I want to act responsibly for future generations of my family.

1:05:34I don't think anyone would say, hey. I see your point. I see your point. I see your point. Interestingly, it's just come to my mind, what do you think about full body MRIs in that case? Because obviously, when you had a blank piece of paper with Daniel, anything was on the table, right? Why this rather than that? Well, look, I think every imaging modality has great uses. So, I mean, it's amazing what these technologies can do. So x-ray has a great use, MRI has a great use. The reality is if you look at like what are people dying from? It's like cardiovascular disease Diabetes metabolic syndromes like can you see that in an MRI?

1:06:13The answer is no interesting like what you can see in an MRI is some like cancers and Cancer is up there now if you look what kind of cancers are up there It's like breast cancer prostate cancer skin cancer So also not all of them are like for skin cancer for example, you can't do in an MRI So I would just say for us that's a little bit of like a niche use case and it's also very expensive So we don't have you know, we don't have a beef with a full-body MRI I think if you want to do that you can go and do it But if you want to look at like what really is driving again 80 % of the problems of the healthcare system Those are not things that you see in an MRI It's not an image that you kind of study like that And I would also say that the MRI when you can see something wrong big thing in your heart that's wrong that by definition is pretty late stage.

1:07:00So like when your heart has a bunch of like plaque and builds up, that is going with years or decades with cardiovascular risks, unmitigated most of the time. So I would also say that for us, the MRI is like a later stage tool once you have a lot of problems. Interesting. And we also just haven't found a way where we could say that like, hey, everybody in Britain, let's give them an MRI scan next year. I just don't know how that could ever be. You could afford that or even practically do it. Yeah. So it's a very, very powerful imaging technology, but it's not obvious that it's suitable for broad prevention or that it could ever be affordable at a larger scale.

1:07:39Makes a lot of sense. I'm not going to get away with not asking you about AI. You're an engineer. You obviously understand it. And AI is probably not the best tool to use, not the best term to use for you, because it means a lot of different things to a lot of different people. It's a catch-all term. And LLMs obviously have clouded that massively because everyone now just uses it to mean LLMs. But for you and your business, so for Neko Health, where's AI genuinely being used right now? And what's in the roadmap? Look, so first of all, there is no clear definition of what's AI, what's not AI. So what we focus on at Neko is like, hey, we want to build the best possible tools for our doctors to get the right information, to draw the right conclusions, and then be able to talk about it with our member.

1:08:25And in doing that, we do a lot of data processing. We do a lot of data analysis and all these things. Like if you wanted to do marketing, you could call some of those things AI. Is it AI or signal processing? Like it doesn't really matter. And if you go to our website, I don't even think we mention AI. So I would say in the near term, what we care about is like, are we building great tools for our doctors to draw the right conclusion? But when you zoom out a bit, then it's pretty obvious like the healthcare system in 10 or 20 years will be heavily, heavily supported by huge data sets and computation that helps you draw the right conclusions from these data sets.

1:09:06And without the doubt, NECA will be one of the companies at the very, very kind of cutting edge of doing that because we do this broad data collection. So it's a huge part of our mission to say, hey, how do we make sure that we draw the right conclusions from that? And again, if you look at what humans are good at, Like, looking at 10 ,000 rows in Excel and drawing the right conclusion is not one of the things we're good at. So humans should probably not be too much in the business of looking at huge, big, complex data sets, cross-referencing that with, you know, tens of thousands of publications.

1:09:41They are pretty good at, like, doing the judgment call. And, I mean, again, like, when my daughter got her diagnosis, like, I didn't need an LLM. like I needed to sit down with a doctor who has sat down with family like ours many times and I needed to ask this doctor like what does this mean for our family yeah like what is our life going to be like and that's not a conversation that I want to have with an LLM okay so I just think there are like scientific conclusions that probably over time will be able to support better and better with big data sets and AI. And then there is the, I think, I cannot imagine a healthcare future.

1:10:21Actually, let me put it differently. I think a healthcare future where it's like, hey, you just get an email with a PDF with all the results and you don't talk to anybody, nobody cares for you. To me, that's a bit of a dystopic vision of the future. Yes. So to me, I can't really imagine a healthcare system that doesn't have compassion, that doesn't have care, that doesn't have interpersonal connection. But I also think that if we're going to do things way better, like we need to use technology to do a lot of the heavy lifting. Thank you for saying that. That is a really big exhale moment for me hearing you say that, because I think you're going to be one of the most important people, arguably in the world, that gets listened to on things like this because you're actually building it and you're building it at a real scale.

1:11:20And you have the ability to define what will be looked at as and held up as the optimal patient experience. like that's in your power and that's a very privileged position to be in incredibly privileged position to be in and i think the care that is required to navigate what ai does and what humans do what ai is incredibly perfect for and good at versus what humans are you know perfect for and and good at and the grey area in between of how we split those roles. There is no global or even national strategy on that from any healthcare system that I have found or seen. Nobody is understanding all of the different interactions, all of the different points at which information is exchanged.

1:12:16We've not listed those out ever and said which is human, which is AI and which is a mix and what percentage is that mix what ratio is that mix and what exactly let's shrink the task let's break that into 10 things and tell me exactly what humans ai do we've never done that and so i think the ultimately the power that you have to to to really lead thought globally on that as to what works is so so so important so i very much appreciate the way that you've communicated that because if we lose human to human information exchange or touch or soft communication to efficiency if we lose that I think we're in real trouble because it's a very slippery slope that when you think that 20 minutes at the end of the consultation and you know you being potentially under pressure to drop that for efficiency in different things and oh this could be done by AI and that could be done by AI I actually you know your your personal experience with your daughter and your family being clinicians all that stuff replays into this and it it make I'm I'm I'm glad that you think about it in the way that you do and and I would encourage you to never lose that and to please keep hold of that of of always thinking like okay where are we best as humans or ultimately what do we actually want of healthcare what is healthcare what is the vision of perfect healthcare because yes it is perfect diagnosis and treatment but it's also patient experience that's part that should be part of the definition and in that case should we ever have an ai in front of us at the point of suffering alone you know it's interesting it's interesting it gets very philosophical it does it does like what is the doctor.

1:14:12Like, what is the role? No, no, I completely agree. I completely agree. And it's very relevant to you, actually. And you sound well-read in that, in that you've read down to Hippocrates and forwards. So it feels like you've taken care with that, right? Like, you seem to notice your power in this. The philosophical nature of thinking about what is medicine, what is it for, and what's the role, like, between the doctor and patient in these things. Now, I think we have a little bit warped. If you look at kind of popular culture and like what they imagine as kind of heroic doctor, I think today you mainly have two flavors.

1:14:49You have sort of the pit, I don't know if you know the show, it's like an emergency room show where it's like every episode I think follows like one day or one shift I should say. Like people are coming in and there's chaos and someone is dying and you know the heroic doctors are like saving lives and it's all like it's like a war zone and they're almost like war heroes. And so like that's one image of like the heroic doctor. Then also you have the other, which is more like the doctor house, which is like you're on a kind of a murder mystery and it's a complete opposite. You have a team of like eight people trying to like, is it lupus?

1:15:21And like, it's all this stuff. And they're all, what they have in common is they're doing all these like inject them with this. They're doing all these like crazy interventions. I mean, these are both great doctors, obviously. Like my dad was like the emergency room style doctor, very macho, very like, you know, if your head is still like on your shoulders, you're fine, you know? So that's a great guy. But when you look at like what's actually driving suffering and so like in our healthcare, like it's, as I said, it's like cardiovascular disease, diabetes, and like, what are these heroic doctor roles that we imagine do to help with that?

1:15:56And the answer is basically nothing. And then you say, okay, what are the risks that lead to that? Well, it's like high blood pressure, it's high lipids, it's high body mass, it's alcohol, it's tobacco. And then it's like, what are those kind of heroic doctor types doing to solve for that? Well, basically nothing. So I just think we have this big void in kind of our general idea about what heroic doctors do around actually driving long-term health. And that is seen as kind of like boring or whatever. And we're trying to make it fun. And I think like this whole thing we're talking about with the role of the doctor with the AI, I think will bring back a lot more thinking about, you know, out of the like the emergency room into the more day to day where we're going to be able to support each and every individual way better.

1:16:47But I think still any time when you really need it, there's a person there, someone who cares for you. And that person is going to be able to do like 10 times a better job when they're equipped, not like the experience you had in the hospital. But again, like my parents have worked like that my entire life. They're working super hard. Everyone in that hospital is trying, but everyone in the hospital ends up going, you know, crossing, you know, all this stuff, getting lost and whatnot. So I think this, like, to me, this future of abundance, I see, I don't think the tensions are that big, but not everybody sees it yet.

1:17:18And not everybody thinks that, you know, the future can be much better than the present, in particular when it comes to health care. Like, I think there's a lot of sort of doom and gloom and every year it gets worse. And every year the costs are spiraling out of control. And, you know, in the U.S., they have to shut down the whole country because they couldn't figure out how to pay for health care. So I get it. Like, the trends are not looking fun. But I think, you know, again, it's within our powers to steer away from that and steer into a different kind of future. But I definitely agree with you.

1:17:48Like, doing that in a very thoughtful way is very important. And, you know, maybe not everybody working in AI right now, they just say, you know, just ask health questions for a thing that has never been validated for health questions. You know, that's pretty, maybe not the most responsible. It's going to be fascinating. I think you guys are at such an amazing point of this. It's an incredible point in time to be doing what you're doing. Building a business model in prevention is hard. You've managed to do it. You've had to build vertically an incredible amount of stuff yourselves. So, yeah, it is difficult.

1:18:24It's capital intensive, but you've managed to do it. It's incredible what you've achieved so far. I'm so interested in seeing how this plays out in the long term. I'm interested in seeing how this longitudinal data feeds into value. I'm interested in seeing how any future ROI of this entire system is determined to the point at which we can see that world of abundance, where we can start to see this reach the masses, so to speak. There's so much to be excited about in prevention. And this really is a movement. It's more than just you guys doing it. As you've said, there's a lot of people that want this to happen and believe it can.

1:19:04It's just that so many of us are, I guess, struggling to see the way that plot the path, as you've said, between now and then. My final question is if you have any takeaways for the health tech community from what you've already been able to achieve. There'll be a lot of founders thinking about business models in prevention or ideas or how to turn their ideas into reality. You've done all of this and more to the point of revenue generation and clinics worldwide. What advice do you have for other people building in the prevention space? Well, I think what most often goes wrong is that you start with an idea of kind of like, what can you get paid for?

1:19:44So let's say, hey, we can help some group improve a little bit on some disease and there's a payment code or something for that. And then they work backwards and then you spend years saying, oh, now we have an FDA approval or we're MDR approved and we're allowed to do it. Rather than saying like, what would be an amazing product? Like what would be an experience where people go like, holy cow, I can't believe you can do diabetes prevention that way or whatever. Because at the end of the day, you can have all the regulatory approvals in the world. You can have all the stats in the world. You can even have the reimbursement.

1:20:21If the product isn't worth talking about, and I don't mean it's bad. I just mean literally, if it's not so good that people say you have to see this, like, I'm sorry, but it's probably not going to go anywhere. And it's very easy in a highly regulated environment to focus on making the regulatory stuff great rather than making the product great. And the reality is you can be 3 ,000 % compliant and not be commercially successful. So at the end of the day, but it's the same as for any business. If you want to succeed as a startup, your product has to be really exceptional and very, very different from what exists because the inertia otherwise is just that people are not going to care.

1:21:03That would be my only advice. It's not much of an advice because it's like build a great product. Well, it solved the problem and then bring joy, isn't it? It's doing both ultimately. Yarmar, it's been an absolute pleasure. Thank you so much for joining me. For people that want to learn more about Necco Health, they want to book in for a scan, where do they go? Yes, if you want to try the scan, you should go to our website. If you want to work with us and experience the product, you should definitely check that out as well. We're hiring across not just London, but other places in the UK as well.

1:21:33So I would say anyone is interested in seeing kind of our take on prevention, I would highly encourage you to get in touch. It's been a pleasure. Thank you. Thank you so much. Hey, everyone. Thanks for listening and making it all the way to the end of this episode. Remember to subscribe, rate us and leave a review. And you can head to the description of this episode to follow me on all of my social media so you don't miss out on any of the latest health tech content.

1:21:59Thank you.