#433: Skin+Me Founder, James Mishreki on consumer healthtech & how to get to £37M revenue

0:00Welcome to the Health Tech Podcast. Here we talk about everything healthcare and technology. and I'm your host James Someru. So James Meshraki, welcome to Health Tech Podcast, founder of Skin and Me. How are you doing sir? Yeah great thanks, thanks for having me James. You're very welcome. Looking forward to getting into this man. I think the scale that Skin and Me has managed to achieve in healthcare is it's not only admirable, but it's something that I think the whole healthcare industry should look to. I think aspiring entrepreneurs, I would love it if people looked to the scale and success that you've had with Skin and Me and thought, how can we do things similar?

0:46And so what I'm really looking forward to in this chat that we're having is to go into how you did it, a bit of the origin story and thinking about how you build companies how you take ideas to reality and interestingly how you then hand them off to a team how you hire a team in order to do that and thinking about what is quite a gap in the market an interesting business model and so yeah really looking forward to going into all of that stuff with you on first of all how are you where are you speaking to us from yeah well I'm in Dublin for a few days um not not that much warmer than the UK but it's yeah it's been a good start to the year I'm gearing up to launch a new brand which is super exciting interesting so you can maybe share a bit more about that later on but yeah Skin and Me and the other brands we launched have been performing super well and we're planning out a pretty big year for that company.

1:41It's really exciting man so well the first question I tend to ask on this is tell us your story so where does this all begin for you? I mean, you mentioned to me just now that your brother's a doctor, your dad's a doctor. And so healthcare must have been talked about around the dinner table. So what was your childhood like? Were you always a born entrepreneur? Were you starting companies as a child and selling things to schoolmates and things? Or was entrepreneurship something you came to a bit later? Yeah, I think for me, it's either in your blood or it isn't. So I always knew, I used to say when I was very young, say when I grow up, I'm going to be a businessman.

2:16Once I got over the fact that i wanted to be a pop star but i couldn't see how's your voice were you watching the x factor and thinking that's going to be me she didn't realize my age this is way before the x factor anyway i i was always starting businesses in in school from even age 13 you know i'd um use my pocket money to to um buy like uh blank cds and i got a cd ron burner for my birthday so that was like you know the capex came from my birthday present and then um i was able to sell uh any cds in school and that was my little business and i had also i was always tinkering with something and i always kind of knew i wouldn't go down a traditional path and so what happened to bring you towards your first proper company then so how did that emerge what was the what was the driving force and the idea and how did you turn your first proper company into reality yeah well the first thing is that i did go to university because i wasn't sure what else to do at that point and i do regret that you know i lost three years there regrets quite a strong word yeah well if i could do it again i wouldn't go because i never used the degree and i just set up my own companies and the stuff that i learned on the business degree wasn't helpful for starting a business obviously had fun great memories, great friends.

3:41But after university, I started playing poker professionally. I'd always been quite obsessed with it. And interestingly, there is quite a lot of parallels that take you from poker into being an entrepreneur. You're basically making decisions with imperfect information. They're like all day, every day. It's exactly the same as running a company. And so after the poker days, I then started a business with like two of the co-founders in online like data collection we built this b2b software that would track thousands of websites and we'd aggregate information on like retail pricing and retail products track when companies dropped prices and added new products and other retailers would pay us for that data because at the time they were tracking it themselves like people in their teams were literally clicking if they worked at house of phraser they'd be clicking through john lewis's website to see have they changed this like um KitchenAid artisan mixer price and so it's just bonkers so we help them automate things like that and that basically took you know a lot of time like six to seven years of building that company as a bootstrap business before even thinking about getting into the consumer world with skin and meat can we talk about the poker for just a little bit so you mentioned that the the parallels or wouldn't like to be in a negotiation with you as someone with clearly a poker face but um what what was your route into that and what made you stop and and i guess do something arguably more concrete but depends how good you were i guess yeah well not good enough which is actually something i'm quite glad about i you know i've thought about this recently because i i didn't know until like a year ago I mean, I've always had friends and girlfriends tell me I've got ADHD, but I thought, well, just out of interest, I'll do a test.

5:37And yeah, I very much have the inattentive form of ADHD. And you know what I think? I think that my sort of baseline stimulation of like normal is like pretty low. So for me, taking certain risks, it's not that scary. whereas I think it might be scary for people that don't have that type of ADHD. And so for me, when I was young, I just always loved playing poker. I loved the tense moments of bluffing someone and putting your money on the line and not knowing if it was going to work out. And so I think that made it, for me, a pretty easy sort of career, if you'd call it, to take up for a bit of time.

6:22you know ultimately poker you know went to quite a quite a curve of adoption and a lot in america the you know we call them the fish like you basically you need players that aren't very good in the game otherwise there's no margins for for winning and making a career out of it but you know there'd been the glory days then i took up poker and america was basically you know cramping down regulatory wise in a lot of um states so you couldn't really um you know the player pool was just on average much better than it was in the glory days and on top of that people were using poker training websites and so on and so forth the rakes were going up so it was just a harder game to beat and even a good friend of mine that had been making just crazy money for someone fresh out of university um he was already planning to hang his boots up and so i'm very glad that i didn't have i mean i was 21 at the time if i'd won a big tournament for like a million or something like that i probably never would have stopped playing because i would have thought okay this is me set prizes so yeah i'm really glad that nothing like that happened and ultimately i realized you know from a social uh perspective just the idea of sat playing a game online as much as i love the game yeah it doesn't really expose you to the joys of life in a lot of ways and i you know i love working with people and solving problems with that's interesting it's a very isolated game were you better playing online or in person i've always preferred in person but is that because is that your ability to read people or yeah it's just more exciting trying to bluff someone and having to hide that you're bluffing in person it's much easier to do that online the benefit of playing a line is the rate of hands per hour you can get is you know exponentially more than live of course um god the vcs don't if you play james i played a little bit i played a little bit of uni but it's it's interesting actually when you say that um your your attitude to the risk and the stress is that anyone half decent at poker would know immediately if i had a good hand because physiologically i'm i'm like forget like a flush on the table and my face is incredibly flushed like i'm my heart rate's gone up and i i can't suppress it so just physiologically i'm i'm definitely not built for that kind of high stress and actually i just don't have the relationship with those moments to turn it into enjoyment because i'm more thinking what's what's the risk on me I might lose the hand it might put me in a position where now I'm just on the way out and then I get to lose the get like I'm I'm far more and I'm like this with sports as well like I care far more about avoiding loss than I do about going after a win and it's quite it's just a a really strange I guess quirk of my um just the way my mind works I've heard like people like Roy Keane say the same thing that he cared more about avoiding a loss than going towards a win but seemingly success can be driven by either thing right you can fear loss or you can love the win I think I'm far more the fearing the loss which is quite interesting but um yeah it's it's it's funny the the parallels between business then obviously you're adapting to those moments in business and changing one for the other is there anything else that comes to mind in terms of playing poker and doing business?

10:00Well, I think ultimately in both poker and business, you just have to do your best and detach from the outcome because you don't actually control it. You can do your best, but you know, like running a startup, it can be, you know, it's brutal. And sometimes you'll see your friend that started 18 months ago and they just got acquired for nine figures and it might drive you crazy and like you you aren't fully in control of that and so the market will will decide and as long as you just keep learning from your mistakes that's the best you can do but eventually variants will um will will go in your favor nice um so after the first company you got an exit from the first company is that right and then that and then you you went on to skin and me yeah so what at the at the point of exiting that company then obviously um well actually told me through the first exit how did you feel at that exit were you thinking this is this life changing money is this life what shall i do like people talk about exit in different ways they talk about a lack of purpose sometimes um they talk about being able to then turn their focus towards something more meaningful how did you feel at exit and plot the path between that and moving into health care for me yeah it definitely didn't set me up like long term for life it gave me a really strong foundation of cash which meant that when i was looking for my next business i knew that a i had time on my side and b i could sell funds the new company so that was very liberating but no it was like nowhere near enough for me to not be hungry anymore so yeah i mean if if anything i think i i would have preferred to have um exit that company like a year or two earlier even for less money but i feel like um you know i refer to it as a quote-unquote zombie business because it started to perform well, but it was never going to be a breakout because the market got so competitive and it was really hard to have like an unfair advantage in that space.

12:01And the market just got a bit too saturated. So yeah, look, it served its purpose. And when I then, I basically moved to London right after that. And I was all in like a full-time job, just focused on looking for like a network of people that had sold companies invested in startups and so on so i knew for my next venture i wanted to go down a different route i wanted to raise money which means giving up some control but i knew i wanted the opportunity to move much faster and build for scale from the get-go and so why health care then because of of all the uh of all the easy places to build companies you wouldn't have health care as one of them so was that more calling and purpose or did you actually spot the did you spot the gap in the market and go from there yeah well in the category that we started in which was skin I'd had a lot of experience myself having had really severe acne through school and every teen boy that has bad acne there's always a bit of bullying goes on.

13:05It's quite debilitating. And it came back for me in my early to mid-20s as well. So I'd had that personal experience of how much it can affect you. Me and my co-founder at the time were spending a lot of time experimenting in the skincare category. You know, fascinating industry, you know, very high gross margins, low return rates, and a growing market. And so those factors mean that there's a lot of scope to just build something exciting if you can get product market fit. But what we realized were, well, there's this massive market of people that are largely dissatisfied, you know, nearly 200 billion dollar market.

13:47But most people, more than 50 % of people are not happy with what they buy. So just keep out, keep going out to try other products that don't really work for them. And so I guess when we discovered that stat, it was, you know, it set off a bit of a trail of experimentation for me and my co-founder at the time. And, you know, we were looking at some of these companies that were doing online, quote unquote, personalization, but it didn't really mean much. It was basically just a quiz on a website that would push you to certain products. And, you know, we started, you know, brainstorming on our whiteboard a lot of different business models.

14:26And I was always going back to like my experience with acne where, you know, I mean, in the UK, if you have acne, you basically either go to the high street and you buy a brand like Clearasil, which has limited efficacy, or you have to go to see a GP and GPs normally get, you know, a couple of weeks training in dermatology, or if they refer you, you can be waiting six months because there's only a few hundred dermatologists in the UK. yes not like the us and you know 70 million people so you might be waiting many many months and even when you do see a dermatologist you'll be prescribed a generic treatment that wasn't made just for you it was made in mass production and been sitting on a shelf and it's not like you can message the dermatologist every other you know if you have a reaction or you're concerned after a few days you can't whatsapp them or phone them and ask questions and share pictures you're kind are left to it sure if there's an emergency you can go and see them but it felt like there was just a breakdown in you know all these skincare companies trying to do personalization but everyone's unhappy um and you've got people with skin superficial skin conditions like acne that you know have an ineffective high street um or a frankly slow and non-ideal in terms of like customer experience and a huge drive to solve the problem from those individuals as well huge Yeah, absolutely.

15:48I mean, you know, everyone sees your face every time you go out. So everyone wants to have as clearer and healthier skin as possible. So that was kind of the genesis, really. And then me and my co-founder spent a lot of time trying to figure out, OK, is there a potential business model here? So we set up some tests online. We threw money at it. We were shipping boxes out to people. We were testing different ways of personalizing the skincare journey. but um ultimately concluded that the way for this type of business model to work you know the way for it to deliver the best possible results to consumers is to use medical grade ingredients yeah and then you're getting the benefits of what you get through going to see your doctor but you're getting them in a personalized way but true personalization not like the website quizzes um and you're getting better performance like dramatically better performance which is clinically proven in comparison to the high street brands like clearasil and so that was what we then set out to to engineer you know how could we combine that personalization with prescription grade ingredients in a way that's just been you know dramatically leveled up compared to people's current expectations i've got so so so many questions on this this is this is fascinating about how you set that up um the first thing i just want to say at this point though is i i can remember when I was on my GP placement right and um I was an F2 so second year doctor and I had a call through on my phone from reception saying there's some there's someone extremely angry um they're you're you're the only one free they've just come through they're gonna barge through the door any second and as she said that like that they came through the door and I'm I'm a junior doctor at this point and and just sort of put the phone out just just how can I how can I help is everything okay and this it was it was the I sympathize greatly it's the father of a of a of a girl his daughter um had come in previously the pharmacist had called her in pharmacist at the GP had called her in to basically say that the medication that she was on the specific formulation of it which was uh i think there's two or three different medications in this in this one solution that she was using on her skin which was working was actually too expensive for this gp uh practice is what this gp pharmacist told them and that they were going to have to go to three separate solutions to use but it should be the same effect and this gentleman basically said that at the time said that well we've tried all those before it hasn't worked what are you basically telling me that that you're not going to pay for this even though you know it's going to work for my daughter anyway came off they came off the medication his daughter's skin went absolutely awful and he literally burst through my door begging i'm not like i'm being like genuine begging to please go back onto this because it was ruining his daughter's life and it was a incredibly difficult situation because the pharmacist had spoken to me beforehand and said i'm not putting like we can't put them back on and i'm just stuck with you in a rock and a hard place here where i've where i've got an incredibly upset family someone's life literally being ruined i'm like not being dramatic by saying that um and and a and a system in which the solution is literally there it's available but this person can't access it it's just really difficult um and that was actually what I had in mind when um I asked you to come on this podcast actually because that I just wanted to tell you that story because I think that's the problem that you you were solving and I I just felt connected to like what you guys are doing because of that moment you know yeah yeah well thank you for sharing yeah I mean there's been just countless I mean the the most fulfilling part of building the company has been how many countless messages we get from people telling us what their situation was before they discovered us and how much it's it's improved their life um you know some people and also it you know opens your mind to just how much it affects people i remember how bad it was being bullied as a as a teen like no one wants it you want to get to know girls and all that when you're turning 15 16 and uh and and you know some of these messages we get are people that can't let their husband see them without makeup on and haven't in years and we've given them a new lease of life because they've been able to get through this but yeah I think the the access that we've created through building an online model where you get you know assessed right away you have a team of people there you get the product you know shipped out to you if you're suitable for treatment very quickly um it's something that we really want to do to obsess over because you know the current system that most people have to deal with is uh is not that yeah definitely one thing i want to go on to now actually is that you mentioned all the things that you did to immerse yourself in the startup ecosystem after you sold your company down in london and everything that you did to kind of understand what was going on and how to meet certain people and network and all that kind of thing.

21:34For the early stage founders listening, I actually just want to bring this up and get you to talk about this a little bit of how did you meet your co-founder? Because one of the questions I get so, so, so often is how do I meet a co-founder and all the rest of it? And my answer always tends to just come down to it will be a serendipitous moment, but you've got to do the work and actually to understand everything about the problem that you want to solve, understand who's going to be the the yin to your yang and to understand what complementary skills they're going to need all of these things is just it's time it's work it's effort is what i tend to say but there will probably be a serendipitous moment or moments that lead to that but i'm interested how you make your co-founder in this yeah well i moved to london and didn't really have much of a network at all yeah like in the in the startup world so i knew that was my biggest disadvantage so i basically like i said i'd been through my exit i allocated a few months to pursuing this network building strategy and i treated it like a startup yeah yeah about um four to six months and so it was like full-time all day every day just and i basically mapped the whole uh the whole ecosystem through using linkedin and all sorts of lists and i would just aggressively hammer every single person that had built a startup, that had an exit, had invested in startups, and, you know, get, I don't know, you know, a moderate response rate, but the actual percentage of people that I was able to meet was pretty low.

23:09But it was so worth it, because A, I met my co-founder through it. B, I met some investors that ended up becoming my first investors in skin and me and it helped me just get to know very smart people i also was part of that actually i i had this idea where i was gonna you know if your calling card is just hey i i'm a i'm a founder and i want to meet other founders you know people get a lot of messages like that i do but i built this group and i called it the jam group and we were going to get together once a month and just jam on different business ideas and so i was reaching out to some people say hey I've got this event coming up at the weekend and I would book at this hotel in Shoreditch and it was a real thing.

23:54And so I would reach out to people to want to come to it and some people would come and there was like fascinating discussion there. And that's actually what led to me finding my co-founder. Oh, really? But then other people were like, oh, I can't come to that, but it sounds cool. Yeah, let's grab a coffee or something. And so I just like went from no network to six months later, like a significant network that enabled me to start a business, raise money, and just had, I guess, more exposure to different business models and ideas and so on. Love it. It's funny how we're coming back round to that in the world now.

24:28Like I think we went through this phase of like meetup.com back in the day, which seemed to be like a really good thing. And I can remember doing some of that stuff. What was that like? Yeah, me too. Maybe like 13, 15, about 15 years ago, meetup.com now, wasn't it? And doing all that wave. And then we went through this quite like individualistic phase of everyone working remotely and locking the doors and having a pandemic and all that sort of stuff it seems that the in real life stuff and finding a way to do that that actually drags people out the house to something now seems to be um yeah real high value stuff now again and sort of nice and cool and people want to do it again which is quite nice um but no thanks for sharing that it is about doing the work is what i wanted to put out there but right skin and me so you discovered that you needed to be adjacent to the actual healthcare space here the prescription element of the some of the things you're going to need to ship out to people in order to meet that personalization for what they actually need now it's quite interesting this because once you have that idea and you start pulling on that thread i imagine having not been in the healthcare system was probably an advantage because you know how you don't know how potentially complicated that might be and so you can kind of look at it with fresh eyes but I'm interested in how that went for you the journey of understanding how you were going to interact with the healthcare system and actually set something up because look in the UK calling a spade a spade we have the NHS and anything that kind of either sits adjacent to the NHS or is paid for in some way it gets messy and difficult and and I don't know people get confused by it and it can be not easy to set up for entrepreneurs in a way that ends up delivering a lot of value which obviously you guys did with the scale that you achieved so I'm just quite interested in how you went about that how you learned about it and how you set it up to work like it did yeah it's a regulated category so it's it is complex and it takes quite a bit of time to pull together the right people um and and spend the time yourself to learn how does the medicines act work how does the system work and when you're fresh to it yeah it has some advantages but there was quite a curve to get up there and so you know the first person that we recruited was a consultant dermatologist and we spent a lot of time with professionals from the healthcare industry and advisors just navigating what we call this complex coordination because we're pulling a few different pieces together, right?

27:09We had to do everything from build a pharmacy, build a factory, figure out what are the right treatment pathways, what are the skills that we need in the business to actually set this up. And then on top of all of that, we also had to build a brand and a team and the ability to get this out there to the whole country as fast as we could. And so, I mean, essentially, the first thing you mentioned there is we hired the right person. It seems like as an entrepreneur, if you're thinking of big scale, you can't think about doing everything yourself. And so, yes, the first person we hired was a consultant dermatologist.

27:50was is is that is that your style is that is that your style to kind of the classic hire people smarter than you and get out of your way is that something that you relate to yeah for sure i think it's the the most important skill that you can learn as a founder i'm still learning it never ends i'm reading a steve jobs book at the moment he was still he said getting better and better at it by the time he passed away right it's it's the highest leverage skill that you need and i think a A lot of founders might rush to, oh, I've got an idea. Let's try to raise some money or this and that. But they haven't, like, because it's brutally hard trying to bring together the right team, especially before you have credibility and track record.

28:34But yeah, I think that more founders need to put that groundwork in. And, you know, if you can't convince the very best people in the country to believe in you or to join you or invest in you or something like that very early on then you know you there's something probably missing right so yeah for us there was a a couple of like key targets that we had it was like family consultant dermatologist there were some other individuals um from a similar background our very first investor was literally the number one person that we'd set out to target in the whole of the uk because he'd built and sold three subscription businesses before in the UK.

29:16So he knew how to set them up with a vertically integrated operation. He didn't have the pharmacy and the medical experience. So we had to bring that in ourselves, but the combination of those two was, was critical. And so that was, um, yeah, that was a real unlock for us. And it always has been. And to be honest, it's something that I still put a ton of my time into just nurturing like, uh, relationships I've got with potential future hires, future co-founders, future CEOs. it kind of never ends yeah you alluded to this just now actually the that your your role in this at the minute is in part balancing this new brand with its clinical rigor to some extent to a great to well to a great degree that has to be um that certainly has to be discoverable if people dig into it but you've got the choice of whether you lead with it versus the consumer brand that's promising this you know convenience and you know convenience and health care often don't really play in the same thing but it's what you ended up delivering I guess which is very interesting your job early on of balancing the two how did you see that brand originally did you see yourself more as a more as a consumer more of a health care brand and how did that change as the company grew yeah really good question because it it changed even before we launched to the extent that we worked with the branding agency and spent 65 000 pounds of the first quarter of a million that we raised on building a brand called gleam so g-l-e-a-m that was the brand and it was very sort of bright poppy well it was like the name the name alone yeah it was quite aggressive with some of the tone of voice and we used that to raise the money so that was our brand and we were known as gleam but we actually realized through that journey that we we made a mistake and we'd made it too it was too far on the consumer uh end and actually what were the indicators of that sorry to interrupt what were the indicators of that we're just talking to lots more and more brand people once we've created the brands um doing some testing with consumers uh and ultimately just try to have like honest conversations with ourselves the more people we brought into the business the more smart debates would have and we realized we're taking a bit of a risk with the brand as gleam because the product is so differentiated that it doesn't need this like over-the-top differentiation from a brand perspective and to your point we need to balance Yes, it needs to be appealing, right?

31:59But it shouldn't look like the little white paper bags you get from a pharmacy. So it needs to be appealing, but it does have to convey real credibility. This is a medical product and people need to fully trust it. So we went through a rebranding process and part of the decision actually to settle on Skin and Me, which was a highly contested, I was CEO at the time and it was a hard decision to make because it was very much a divisive name at the time. I'm very, very glad we picked it in the end. But the Plus really communicated that it was pharmaceutical. And we started using the Plus in lots of different ways across the brand.

32:37And it just it set a new tone for the company. And, you know, ultimately, we've learned that as a brand, we can tell you lots of important information. But who do you listen to the most? you listen to real people that are telling their experience and their story. And so because the product works so well and the service is really high quality, we get a lot of people unprompted that share their experience. And we only, when we do like direct partnerships, we only do it with people that are real customers about real results that are speaking from the heart and people buy into that. And once we started to have an abundance of that, that's kind of what started to drive the flywheel more so than us just telling people what it does interesting it's such a fascinating space for me the the the space between the consumer and getting what they need in health care that will bypass gp we see a lot of online pharmacy and people can fill in you know questionnaires and get sent stuff and and in various that we see in sexual health we see in a few other different places like these things do exist but I'm interested like to explain to me and our listeners what your business actually is in terms of all of its component parts because I think that people can assume wrongly that businesses like this yeah okay you've you fill in an online questionnaire and there's probably just someone at the other end that puts things in a bag and then it gets sent to you and that's it but as you've explained there's online pharmacy there's all these different things probably cqc and like there's all these different parts of the business so can you just sort of piece that jigsaw together for me in terms of what different component parts actually go into what is in entirety the product of skin and me well the reason that we had to raise eight million pounds right out of the gate is because there was there's a lot to do right in order to set this up for scale from the get-go and meet all of the regulatory requirements and so on So we needed a variety of skill sets.

34:46We needed the digital experience to build the consultation service online. You know, we needed great design skills, great technical skills. Got to be able to handle thousands of people, filling it in at one time. I mean, we were on this morning, the TV show, just a few months after launching. And that led to like, signups were like this. And then it had a huge spike that morning. And so we needed a great tech to cope with that. Then we needed to build out a team of prescribers with custom tech that equips them with the right information for them to make their prescribing decisions and decide whether or not an individual is suitable for treatment or not.

35:26and then we had to build our facility and the facility has um everything in it from the actual production of the creams that get prescribed um to the machinery that we've had to build in-house in order to fill the daily doser which is this custom bottle that we developed to uh to make sure every time you dispense you're getting a fixed dermatologist design dose of treatment which is something people don't get from a tube of cream, all the way through to like putting the box together with, you know, if you've seen one of our boxes, it has your name on it and all of your custom information and getting that shipped out.

36:03So it's a, you know, a massive operation requires a broad set of skills. And we had to pull a lot of that together before we even launched. So unlike a lot of startups, like we didn't have the option to just test this out for 10 grand. it's not that type of business and so it required a lot of risk in that regard but it it you know we had such high conviction as did our investors that this was such a clear gap in the market that you know we we took the risk we raised a lot of money we built everything for scale from the get-go in this way and fortunately it did all click into place pretty pretty quickly yeah so So when you think about going end to end through that customer journey, and even you could include the knowledge of you doing all of that stuff, if that does find its way into the consumer journey somewhere, what are the areas of that journey that you think build the most trust?

37:04And the reason I ask that is because I think early on, late on and you build brand and you've got case study and track record and all the rest of it my friends use it my family use it it's great and blah blah like I get it that that it's easy to trust the brand once it gets to that level early on and yes having a this morning slot will do that the authority the credibility of being able to be selected and go on there that will definitely do you wonders but what do you think builds the trust for people to you know engage in this online consultation and get what they need and and what are the elements of your brand that deliver that trust with trust being so important in healthcare yeah well i think back to my uh answer on the branding you know the reason that we shifted from gleam to being skin and me is because we realized the importance of um conveying the clinical nature of the business And so combining that, you know, brand pillar of clinical authority with a growing team of medical professionals that we brought in, it wasn't just Ben, the first consultant dermatologist.

38:14We brought in Malvina, another dermatologist, Jason, another dermatologist, and just built out that team and made sure that they were very much surfaced when it came to our website and all of our comms. We started putting content out there on our social media and in all sorts of places. um you know we encourage people to leave a trust pilot review if they were one of our early customers and so um because people are having such a great experience we could point to that these are real people grading it five stars and i think that combination um gave people confidence i also think you know our marketing was appealing we would also run some offers in the early days of the online service where people could try it out for just a few pounds instead of paying like a full month's price and that lowered the barrier to entry for people and so in the early days that combination helped us build up a bit of momentum and then once the snowball was was moving it was um yeah it it grew faster and faster interesting for you and your investors thinking about the relationship between your customer acquisition costs and your clinical quality or even just your view you know your running costs and the clinical quality the more clinicians clinicians are very expensive beasts and what that can do to unit economics and things people find it difficult to find these types of business models in health care how easy was it for you to find that business model especially by the way when you're adding this word personalization you know you mentioned true personalization so you know maybe not standardization or smart standard ideas and you talk about personalizations all these things chip away don't they at margin and unit economics so how did you think about the business model and setting that up to scale yeah well first of all you know we could only get money from our investors if we had a very compelling five-year plan that showed that we deeply understood what the costs of bringing these individuals in what the cost per customer was going to be and how that would model over time but one of the advantages that we had to build into the business of who we that we knew would give us competitive advantage and give us more wiggle room on uh unit economics is building a vertically integrated operation so most startups don't have that um that that um optionality right because they don't have the right skills in house yeah so for us we recruited a a number of people that had been at a company called graze beforehand which is a um was basically one of the pioneers of subscription and so they they built um like the snack the little you'd get in the post yeah and they built a highly efficient factory operation and so we recruited some people like that that knew how to build very efficient factories combined that with the um the farmer experience that we recruited into the business and because of that combination it meant that we were building in-house we weren't paying a third party so the margin that we have on the product is is higher than it would be if we were outsourcing it.

41:19And that gave us more flex. And I'd say that efficiency operationally is an absolute strength of our team and our business. And that just means that we can make the model work and it makes it harder for someone else to try to come in and out-compete us. And I want to talk about personalization. So personalization in healthcare is, for the last few years 10 years maybe it's been this word that has been thrown around as it's it's what we want what we want is personalization and especially with advances in genomics and things like that and people talking about um you know mapping genomes and assessing how much of a certain medication you can have and this is being this type of personalization being what we're considering as like a goal or whatever it is how do you view personalization in in healthcare in terms of where we are now and what you wanted to achieve and and is is that what we want is is true personalization per patient is it what we want is it what's achievable and is that somewhat in your thesis for what you want to do long term yeah i think it's incredibly important i think what why would you choose to have a generic way of getting treatment and information if you could have it tailored to to you and i think cost at scale is the answer isn't it it's like when you've got a health system it sort of has to in order to especially a public health care system it sort of has to i think that's probably where that's probably the answer yeah yeah yeah i mean we've had the luxury of yeah i'm not like criticize the nhs in that regard because we've had the luxury of starting from a blank canvas and going after very specific verticals and so we can like deliver a dramatically better and more personalized customer experience but i think the more innovation that happens doing this and the more access to data through all sorts of whether we wearables or testing um you know all the biomarker testing that's happening um i absolutely think there's going to be convergence between that and more and more treatments.

43:35I'm super excited about it. You know, I think we're in the future, in maybe 20, 30 years, a kid will grow up and from being born, they've got all of their information tracked so that if their parents want to, they can have them on perfect diet and all of this stuff to maximize their long-term health. Whereas at the moment, I mean, I was from a medical family, but I was eating, you know, Rice Krispies and Pop Tarts when I was a little kid. And I think that was great for me. But yeah, I think also the ability to spot any potentially threatening conditions at a very early stage will be, and then get appropriate treatments personalized to you will be just the norm.

44:23And I think youngsters will say to us, what? You used to just go to a doctor and get something that everyone else got. it is crazy to think it is crazy to think when you look at the direction of travel I think it is crazy to think that I think I think it is gonna seem very very bizarre that we did certain things so generically especially when you know I've worked obviously as a doctor in health care and you see the way that you know people some patients on the wards have got these really big stacks of notes and you look at their drug chart and it's just what you'd call polypharmacy it's just it's just full of various medications for various things a new symptom pops up a new drug goes on a new symptom pops up a new drug comes on and you can guarantee there's been no study of how all those drugs interact with each other in this exact way with someone with this genetics and that sort of thing that the level of data that we can have the processing power that is available to us the AI conversation goodness knows how we've got three quarters into this without mentioning AI but we have um but all of that side of the world as well and how that's going to influence healthcare it's crazy to to think that we're practicing the way that we do to be honest i think and that's only a good thing i think we should be embarrassed of how we deliver healthcare every six months we probably should look but it's like your website right everyone's website should be embarrassing six months on because you haven't updated it when the company's gone so far like it is just one of those things i think is gonna be a marker of success for us in healthcare to be honest especially with open ai announced today didn't they they've now got chat gpt health or whatever is coming out it's crazy the speed that this is all going um but let me ask you a couple of questions on skin before we move on to um your next exciting project um how would you describe the relationship between between skin and me and the nhs would you say it's a compliment would you say it's a substitute Would you say it's a pressure release valve?

46:18Because the reality is for that person I saw when I was doing GP, they had literally at the time no other alternative because this didn't exist. And so it's clear it solves a problem. I'm just interested in how you view it in terms of its adjacency to the NHS and how you might think about partnerships with other healthcare or retail organizations and that side of things. Where does it sit with the NHS and other partners? well our goal was to always make our service as accessible as possible from a price perspective yeah and i think if you look at the value proposition like what you get you know um in comparison to the alternative if you want to get treated yourself which is going um well if you can afford to going privately to see a dermatologist and paying hundreds just for your consultation yeah uh for a very short consultation most people can't afford that right um and so we've filled a gap in between the two where we've got a price as accessible as possible and i think that's evidenced by the fact that you know a while ago we crossed the million customers mark and the uk is a pretty small country and we're now shipping out millions of boxes per year so it's clear that there's a value proposition that makes sense for people there versus the trade-off of money they maybe can't afford privately or the time it takes to the nhs to get um like to get treatment that is not going to be as personalized and tailored to you nice my final question james is that you mentioned you mentioned the phrase i was ceo at the time um what changed and again reason i ask is because i think uh from people i've spoken to from things i've seen and even my own experience you can be you can be a very good ceo at a certain stage of company um and it's interesting but things need to change i think quite a lot for companies and so i'm interested in what you meant by that and when you were ceo from and until and yeah what was behind the decision to change that yeah i mean i was ceo at skinnami in the early years and i think i've i know what i'm good at i'm good at coming up with an idea validating it and bringing together the right people the best people to put that idea and into the world incentivizing them, assembling them, organizing them, and then going out to raise the capital that's needed to set the business up for success.

48:42And I can be the leader in those early days. Do I think I'm the best like long-term operational leader? No, I think like it's skin of me, we have someone better than me doing that now. And, you know, if you look at Richard Branson with his companies, he's rarely been the long-term CEO. He's the CEO of the group, but he always brings in an individual who he feels is more competent than him to run the day-to-day operations. You know, I think there's just, I still love like the early days in a way. I love setting that early culture. You know, you need brutal honesty. You've got to move forward with like 65 % confidence.

49:23and it's just incredibly exciting and energizing once you've brought that team together. But yeah, the long-term growth of the business, I think I'm better at, you know, it's going to be, I'm still the main shareholder and I've moved into chairman, but I'm now focusing on spinning up another company where I'm going to be chairman, I'm exec chairman, my co-founder is CEO, and that's how I'm trying to focus my energy going forward. I think that's how I can have the most impact. Nice. You said culture, you like setting up that culture. What do you, how would you have described the culture at Skin and Me in the early days?

50:01What do you think led to the success? Were there certain cultural elements of the way that things were run that you think, I don't know, spotted problems early and corrected them or allowed you to go at certain speed or kept clinical rigor or like what, what are there any cultural elements that maybe founders listening there in the early days can perhaps learn from in the way that they try and set up culture? Yeah, well, everyone that you need to bring in early on just needs to have a real intensity about them and really be maniacally focused on what you're trying to achieve. And they should put it above everything else.

50:34And you bring a team like that together, that's like the hardest box to check, I would say. And, you know, when it comes to laying the groundwork to setting up the business, you've got to make a lot of decisions. And you have to have a lot of debates with this team of obsessive people. And so they can get quite heated for the right reasons. And the most important thing is that the best ideas win and you don't give a damn who they come from. But everyone needs to have the comfort of just brutal honesty and really challenging each other and not being afraid to say it straight. We don't have time to beat around the bush and worry about hurting people's feelings and if your feelings do get hurt because the group don't think your idea is the best one and they give good reasons why then you're probably not in the right environment and yeah we would always try to just start with first principles back to you know the way that we set up skin and me like the reason that you get your daily doser in the post and the reason it's got your name like etched into the metal is because we started with first principles okay well what's the information that we need to convey okay legally it's xyz right how well at the moment you get a written on a little piece of paper which from a pharmacy which isn't very pretty and so we challenge ourselves okay well can we etch it into metal and that was a bit of a crazy thought at the time but turns out there was no law stopping us using metal instead of paper um and so that led to us like coming up with this awesome idea and then figuring out how to take it out into the world we also had because we had such a high quality team we could raise enough capital that meant we could take have the breathing space on some of these decisions to not have to rush them if you have to rush decisions because we're going to be out of money in a month then you're probably going to compromise them interesting and so it all starts with good team right so you you've you've said that's one that one of your strengths you're a good early ceo in part because you're able to to get this early team together we talked when we're talking about poker you know the ability to actually convince the ability to convince someone to leave a very comfortable high paying job with a nice pension to join this super risky but we're going to shoot for the stars type company being you know clearly a strength of yours i'm interested though in hiring specifically so we hear so much about how you know hiring's difficult like it's guessing it's this you've got to hire quickly fire even quicker all that sort of stuff what makes you excuse me what makes you so good at recruitment and hiring is there anything that you can pass on to our listeners any kind of rules that you have around hiring or ways that you conduct your hiring processes to kind of make you one of the best people at this uh well i'd say i'm still like where i want to be at it but uh the reason i've done okay at it is i'd say i've always got an active recruiting posture so if i'm at an event whatever it is if i see something on linkedin i'm always reaching out to people and always trying to line up a conversation because that pipeline of people that you're nurturing just uh a it's very hard to build and B, the stars have to align when you're looking for someone.

53:51And so you kind of want to have them in a warm funnel. And a lot of people won't be available. They might have uprooted their family and moved to New Zealand. And so you just need to be constantly on the lookout. I'd say that I, yeah, I try to understand, I just dig into someone a bit. Like what do they enjoy doing in their spare time? And how obsessive are they as a person? right? Have they just like rode the Atlantic as a one man band and then some of the crazy stuff. And if so, they probably love taking on big challenges and they'll stop at nothing to achieve them. Are they, what type of questions do they ask?

54:32I think that's so important. Like even when you're, when you're interviewing someone, if they ask like very generic questions or do they ask questions that show that if they were in this team, they'd be giving me as the CEO or the leader, the confidence that they're really identifying problems that I haven't thought of. And they're really challenging the status quo. I'm pushing you, yeah, yeah, yeah. Exactly. And they're all great early signals. And of course, intelligence is a non-negotiable. But I think that it's easier to come by intelligence. It's much harder to come by that obsessive, resilience, challenge the status quo mentality.

55:08And if you can combine the two, you've got great potential early stage pedigree. Interesting. because you're going to be doing this exercise soon with your new company set S3 unless you've already done it behind the scenes because I could find nothing about this. So you've done a great job of remaining completely stealth on this. I know that it's consumer health. So again, health interest. I know it's called S3. That's everything that I know. So if you're willing to share anything great, if not, what can you share on the new company or even the thesis, even the problem you're looking to solve or something along those lines?

55:41Yeah, this is, it's going to be interesting. talk about this without saying what it is but it's uh it's something that we all use every day it's um a category that uh it's a health problem that affects one in three people and there's an incumbent at the moment that is owned by a major consumer health group and the product doesn't work for all those one in three people so a lot of people go untreated yet and that's because they're using technology that they acquired 20 years ago and they haven't improved on it. So what we've done back to the team point is we've recruited the two key individuals that were at that company for the last like 10, 15 years.